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Permanent URI for this collectionhttps://hdl.handle.net/20.500.14411/22

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Prognostic Value of the C-Reactive Protein-Albumin-Lymphocyte (CALLY) Index for 1-Year Mortality After Transcatheter Aortic Valve Implantation
(MDPI, 2026) Guney, Murat Can; Suygun, Hakan; Turinay Ertop, Zeynep Seyma; Polat, Melike; Bozkurt, Engin; Ayhan, Huseyin; Keles, Telat
Objectives: Systemic inflammation, malnutrition, and immune dysregulation have emerged as important determinants of long-term outcomes after transcatheter aortic valve implantation (TAVI). The C-reactive protein-albumin-lymphocyte (CALLY) index is a novel immunonutritional biomarker that integrates these pathophysiological domains; however, its prognostic value in TAVI patients has not yet been investigated. This study aimed to evaluate the association between the CALLY index and 1-year mortality after TAVI. Methods: This retrospective observational study included 532 consecutive patients who underwent TAVI at a tertiary-care center between 2014 and 2023. Baseline laboratory parameters were obtained before the procedure, and the CALLY index was calculated as (albumin & times; lymphocyte count)/(C-reactive protein & times; 10). The primary endpoint was 1-year mortality. Receiver operating characteristic (ROC) curve analysis was performed to assess the discriminative ability of the CALLY index and conventional surgical risk scores. Multivariable regression analyses were used to identify independent predictors of mortality. Results: During the 1-year follow-up period, 85 patients (15.9%) died. Patients who died had significantly lower baseline CALLY index values compared to survivors (p < 0.001). The CALLY index demonstrated good discriminative performance for 1-year mortality (AUC: 0.797), outperforming EuroSCORE II (AUC: 0.705) and the Society of Thoracic Surgeons (STS) score (AUC: 0.619). A CALLY cut-off value of 0.45, derived using Youden's index, was associated with a more than threefold increased risk of mortality. In multivariable analysis, the CALLY index remained independently associated with 1-year mortality, along with EuroSCORE II and more than mild mitral regurgitation. Conclusions: The CALLY index is a strong and independent predictor of 1-year mortality after TAVI and provides incremental prognostic value beyond conventional surgical risk scores. Given its simplicity and reliance on routinely available laboratory parameters, the CALLY index may serve as a practical tool for long-term risk stratification in patients undergoing TAVI.
Transcatheter Aortic Valve Implantation in Nonagenarians: A Comparative Analysis of Baseline Characteristics and 1-Year Outcomes
(MDPI, 2025) Guney, Murat Can; Bozkurt, Engin
Background: Transcatheter aortic valve implantation (TAVI) is increasingly used in elderly patients with severe aortic stenosis, yet data on nonagenarians remain limited. This study aimed to compare clinical characteristics and outcomes of patients aged >= 90 years with those aged <90 years undergoing TAVI. Methods: We retrospectively analyzed 620 patients who underwent transfemoral TAVI. Patients were divided into two groups: <90 years (n = 545) and >= 90 years (n = 75). Baseline clinical, procedural, and outcome data were compared. Results: Nonagenarians had lower body mass index (BMI) and a lower prevalence of comorbidities such as diabetes, hyperlipidemia, and prior coronary artery bypass grafting CABG (all p < 0.05). All-cause mortality was higher in nonagenarians at 1 month (8.0% vs. 5.5%, p = 0.425), 6 months (9.3% vs. 7.9%, p = 0.838), and 1 year (21.3% vs. 16.7%, p = 0.405), though these differences were not statistically significant. In-hospital stroke occurred more frequently in patients >= 90 years (6.7% vs. 2.2%, p = 0.044). Conclusions: Despite a higher rate of in-hospital stroke, nonagenarians undergoing TAVI had comparable mortality outcomes to younger patients. These findings support the feasibility of TAVI in selected very elderly patients, while highlighting the need for tailored stroke prevention strategies. Trial Registration: The trial is retrospectively registered, and a clinical trial number is not applicable.
Predictive Factors of Cardiac Function Recovery and Mortality in Patients With Reduced Ejection Fraction Undergoing Transcatheter Aortic Valve Implantation
(Mdpi, 2025) Guney, Murat Can; Suygun, Hakan; Polat, Melike; Ayhan, Huseyin; Keles, Telat; Ertop, Zeynep Seyma Turinay; Bozkurt, Engin; Turinay Ertop, Zeynep Şeyma
Background and Objectives: Patients with reduced left ventricular ejection fraction (LVEF) are reported to have unfavorable outcomes following transcatheter aortic valve implantation (TAVI). This study aims to evaluate outcomes and identify predictive factors for LVEF recovery following TAVI in patients with reduced LVEF. Materials and Methods: This retrospective study analyzed 114 patients with symptomatic severe aortic stenosis (AS) with LVEF < 40% who underwent TAVI between 2011 and 2023 at two centers. Echocardiographic parameters, including LVEF, ventricular dimensions, and relative wall thickness (RWT), were assessed at baseline and during follow-up. The outcomes and predictors of substantial LVEF improvement and mortality were analyzed using univariate and multivariate logistic regression methods. Results: Anemia (OR = 4.345, 95% CI: 1.208-15.626, p = 0.024), RWT (OR = 1.224, 95% CI: 1.064-1.407, p = 0.005), and early post-procedural changes in left ventricular end-systolic dimension (LVESD) (OR = 1.297, 95% CI: 1.037-1.622, p = 0.023) and left ventricular end-diastolic dimension (LVEDD) (OR = 1.346, 95% CI: 1.034-1.753, p = 0.027) at one-month follow-up were identified as significant factors associated with LVEF recovery at one year. Regarding factors related to mortality, higher baseline AVMG levels were associated with a lower probability of death after one year (OR = 0.926, 95% CI: 0.875-0.979, p = 0.007). Conversely, a more limited increase in LVEF from baseline to the final follow-up was linked to poor prognosis and higher mortality at one year (95% CI: 1.045-1.594, p = 0.018). Conclusions: This study demonstrated that TAVI in patients with AS and reduced LVEF can be performed with high procedural success, low mortality, and significant improvement in cardiac function during follow-up. Additionally, anemia, baseline RWT, and early post-procedural changes in LVESD and LVEDD were identified as factors associated with LVEF recovery. Baseline AVMG and changes in LVEF at the final follow-up were found to be significant predictors of total mortality.
Citation - WoS: 3
Citation - Scopus: 3
Prognostic Implications and Predictors of Mitral Regurgitancy Reduction After Transcatheter Aortic Valve Implantation
(Mdpi, 2024) Guney, Murat Can; Suygun, Hakan; Polat, Melike; Ayhan, Huseyin; Keles, Telat; Ertop, Zeynep Seyma Turinay; Bozkurt, Engin; Turinay Ertop, Zeynep Şeyma
Background: Mitral regurgitation (MR) is a common condition observed in patients undergoing transcatheter aortic valve implantation (TAVI) for the treatment of aortic stenosis (AS). However, the impact of TAVI on MR outcomes and the factors predicting MR improvement remains uncertain. Understanding these predictors can enhance patient management and guide clinical decisions. Methods: This retrospective cohort study included 156 patients with moderate to severe MR undergoing TAVI. MR severity was assessed via echocardiography at baseline, as well as 6 months and 1 year after TAVI. Patients were divided into groups based on MR reduction: no improvement or worsening, one-degree improvement, and at least two-degree improvement. Clinical, echocardiographic, and procedural characteristics were evaluated as predictive factors for MR improvement after TAVI. Results: MR reduction occurred in 68% of patients at 6 months and 81% at 1 year. Factors predicting a reduction of two grades or more in MR severity included lower baseline LVEDD (OR = 1.345, 95% CI: 1.112-1.628, p = 0.002) lower baseline LA (OR = 1.121, 95% CI: 1.015-1.237, p = 0.024), lower baseline LVMI (OR = 1.109, 95% CI: 1.020-1.207, p = 0.024), and higher baseline EF levels (OR = 1.701, 95% CI: 1.007-2.871, p = 0.047). No significant association was found between MR reduction at 6 months and one-year mortality. (p = 0.65). Conclusions: Baseline echocardiographic parameters are valuable in predicting MR improvement post-TAVI, with LVMI emerging as a novel predictor. However, MR reduction did not independently predict survival, underscoring the need for further research to optimize patient selection and management strategies in TAVI candidates.
Citation - WoS: 5
Citation - Scopus: 5
Incidence and Predictors of Permanent Pacemaker Implantation After Transcatheter Aortic Valve Implantation With a Balloon-Expandable Biosprosthesis in Patients With Bicuspid Aortic Valves
(Termedia Publishing House Ltd, 2024) Suygun, Hakan; Kasapkara, Haci Ahmet; Guney, Murat Can; Polat, Melike; Bozkurt, Engin
Introduction: There are few data on permanent pacemaker implantation (PPMI) in patients who have undergone transcatheter aortic valve implantation (TAVI) for bicuspid aortic valve (BAV) stenosis. Aim: The purpose of this study was to evaluate the predictors and incidence of PPMI in bicuspid patients using a balloon-expandable (BE) TAVI device. Material and methods: A total of 62 patients with bicuspid morphology who had undergone successful TAVI using a BE device without previous PPMI were included (retrospectively). Their baseline clinical, electrocardiographic (ECG), echocardiographic, and multislice computed tomography (MSCT) details were collected. Results: The incidence of PPMI after TAVI in this BAV cohort was 12.9%. All eight patients with PPMs were found to have type 1 left-right (LR) fusion morphology. In univariate analysis, the presence of right bundle branch block (RBBB) in preprocedural ECG ( p < 0.0001), short membraneous septum (MS) evaluated in MSCT ( p < 0.0001), and increased annulus-left main coronary artery distance ( p = 0.02) were statistically significant for PPMI. Among these parameters included in the model using multivariate Firth logistic regression analysis, the presence of preprocedural RBBB ( p = 0.001) and shortness of the MS in MSCT ( p = 0.004) were independent risk factors for predicting postprocedural PPMI in patients who underwent TAVI among those with BAV. Conclusions: Preprocedural RBBB on ECG and shorter MS are independent risk factors for PPMI after TAVI in BAV patients and these parameters should be considered before the procedure to guide clinical decision making. Type 1 LR patients may be considered at increased risk of PPMI.
Citation - WoS: 1
Citation - Scopus: 1
Outcomes of Transcatheter Aortic Valve Implantation in Patients With and Without Diabetes Mellitus
(Soc Brasil Cirurgia Cardiovasc, 2024) Ayhan, Huseyin; Guney, Murat Can; Keles, Telat; Bozkurt, Engin
Introduction: Diabetes mellitus (DM) in patients undergoing cardiac transcatheter or surgical interventions usually is correlated with poor outcomes. Transcatheter aortic valve implantation (TAVI) has been developed as a therapy choice for inoperable, high-, or intermediate-risk surgical patients with severe aortic stenosis (AS). Objective: To evaluate the impact of DM and hemoglobin A1c (HbA1c) on outcomes and survival after TAVI. Methods: Five hundred and fifty-two symptomatic severe AS patients who underwent TAVI, of whom 164 (29.7%) had DM, were included in this retrospective study. Follow-up was performed after 30 days, six months, and annually. Results: The device success and risks of procedural-related complications were similar between patients with and without DM, except for acute kidney injury, which was more frequent in the DM group (2.4% vs. 0%, P=0.021). In-hospital and first-year mortality were similar between the groups (4.9% vs. 3.6%, P=0.490 and 15.0% vs. 11.2%, P=0.282, respectively). There was a statistical difference between HbA1c >= 6.5 and HbA1c <= 6.49 groups in total mortality (34.4% vs. 15.8%, P<0.001, respectively). The only independent predictors were Society of Thoracic Surgeons score (hazard ratio [HR] 1.28, 95% confidence interval [CI] 1.09-1.51; P=0.003) and HbA1c level >= 6.5 (HR 10.78, 95% CI 2.58-21.50; P=0.003) in multivariable logistic regression analysis. Conclusion: In this study, we conclude that DM was not correlated with an increased mortality risk or complication rates after TAVI. Also, it was shown that mortality was higher in patients with HbA1c >= 6.5, and it was an independent predictor for long-term mortality.
Citation - WoS: 13
Citation - Scopus: 13
Association between monocyte to high-density lipoprotein cholesterol ratio and bicuspid\raortic valve degeneration
(Tubitak Scientific & Technological Research Council Turkey, 2020) Karaduman, Bilge Duran; Ayhan, Hüseyin; Keles, Telat; Bozkurt, Engin; Duran Karaduman, Bilge
Background/aim: From a pathophysiological point of view, inflammation is thought to be more dominant in bicuspid aortic valve\r(BAV) stenosis than tricuspid aortic valve (TAV) stenosis. Our study aimed to determine the association between monocyte to highdensity lipoprotein cholesterol (HDL-C) ratio (MHR), a new inflammatory marker, and the speed of progression of stenosis and\rpathophysiology of BAV stenosis.\rMaterials and methods: A total of 210 severe aortic stenosis patients (70 consecutive BAV patients, 140 matched TAV patients) were\rretrospectively enrolled in the study. Clinical and echocardiographic data and laboratory results related to our research were collected\rretrospectively from the patients’ records. MHR was measured as the ratio of the absolute monocyte count to the HDL-C value.\rResults: Seventy BAV (mean age: 72.0 ± 9.1 years, 42.9% female) and 140 TAV patients (mean age: 77.9 ± 8.3 years, 51.4% female)\rwith severe aortic stenosis were enrolled in this study. There was no difference between the two groups in terms of another baseline\rdemographic or clinic findings except age (P < 0.001). Monocyte count, hemoglobin level, mean platelet volume was significantly\rhigher, and HDL-C level was significantly lower in the BAV group, while other lipid and CBC parameters were found to be similar. In\rthe multivariate analysis, MHR (P = 0.005, 95% CI: 0.90–0.98) and, as expected, age (P = 0.001, 95% CI: 1.02–1.11) were found to be\rsignificant as the independent predictor of BAV, after adjusting for other risk factors.\rConclusion: Our study showed a significant correlation between increased MHR and BAV. MHR was determined as a significant\rindependent predictor for the speed of progression and diagnosis of severe BAV stenosis in multivariate analysis.
Citation - WoS: 16
Citation - Scopus: 19
The Triglyceride-Glucose Index Predicts Peripheral Artery Disease Complexity
(Tubitak Scientific & Technological Research Council Turkey, 2020) Karaduman, Bilge Duran; Ayhan, Hüseyin; Keles, Telat; Bozkurt, Engin; Duran Karaduman, Bilge
Background/aim: High levels of triglyceride (TG) and fasting blood glucose (FBG) values increase atherosclerosis risk. This study\revaluates the relationship between peripheral artery disease (PAD) severity and complexity, as assessed by TransAtlantic InterSociety\rConsensus-II (TASC-II) classification and the triglyceride-glucose (TyG) index.\rMaterials and methods: A total of 71 consecutive patients with PAD (males 93%, mean age 63.3 ± 9.7), who underwent percutaneous\rperipheral intervention were included retrospectively. The patients were divided into two groups according to the angiographically\rdetected lesions. Those with TASC A-B lesions were included in Group 1, and those with TASC C-D lesions were included in Group 2.\rTyG index was calculated as formula: ln[fasting TG (mg/dL) × fasting plasma glucose (mg/dL)/2].\rResults: There were 40 patients in Group 1 (90.3% men, with a mean age of 63.6 ± 9.3 years) and 31 patients in Group 2 (96.8% men,\rwith a mean age of 62.0 ± 8.6 years). In the majority of patients in both groups, the target vessels are iliac arteries and femoral arteries.\rIn Group 2, platelet count and TyG index were significantly high, according to Group 1. The TyG index was significantly correlated with\rTASC-II, Rutherford category, HbA1c, and HDL-C.\rConclusion: In this present study, we showed that the TyG index was an independent predictor of peripheral artery disease complexity,\raccording to TASC-II classification, for the first time in the literature.
Citation - WoS: 2
Citation - Scopus: 2
Transcatheter valve-in-valve implantation Edwards Sapien XT in a direct flow valve after early degeneration
(Wiley-hindawi, 2020) Duran Karaduman, Bilge; Ayhan, Huseyin; Bulguroglu, Serkan; Keles, Telat; Bozkurt, Engin
In recent years, the use of bioprosthetic valve (BPV) has increased significantly with both surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) due to reasons such as the advantage of not using anticoagulants. Nevertheless, major disadvantage of all BPV is the risk of early structural valve deterioration, leading to valve dysfunction, and requires reoperation, which significantly increases the risk of mortality or major morbidity especially after SAVR. There are a limited number of TAV-in-TAV case reports due to TAVI BPV degeneration. In our knowledge, this is the second report of TAV-in-TAV implantation wherein a previously implanted transfemoral 25-mm nonmetallic Direct Flow SVD valve treated with ViV TAVI via Edwards Sapien XT.
Citation - WoS: 1
Citation - Scopus: 1
Karotis Arter Stentlemesinin Etkinliği ve Güvenliği: Tek Merkez Deneyimi
(Kare Publ, 2020) Karaduman, Bilge Duran; Karaduman, Bilge Duran; Ayhan, Hüseyin; Ayhan, Hüseyin; Keles, Telat; Bozkurt, Engin; Karaduman, Bilge Duran; Ayhan, Hüseyin
Amaç: İnternal karotis arterdeki orta ve şiddetli darlıklar tüm inmelerin %10–15’ine neden olmaktadır. Bu çalışmada, üçüncü basamak bir referans merkezde karotis arter stentlemesinin (KAS) güvenliğini ve kısa dönem etkinliğini değerlendirmeyi amaçladık. Yöntemler: Üçüncü basamak merkezimizde Ocak 2017 ile Mayıs 2018 arasında KAS uygulanan hastalar geriye dönük olarak değerlendirildi. KAS uygulanan 145 hasta çalışmaya dahil edildi. Bulgular: Hastaların ortalama yaşı 70.1±8.6 yıl idi ve tüm grubun %75.2’si erkek olup %37.9’unda hipertansiyon mevcuttu. Hastaların 81’i (%55.9) semptomatik, 64’ü (%44.1) asemptomatik olarak gruplandırıldı. Semptomatik hastalarda koroner girişimler daha çok KAS sonrası (%38.9) yapılırken, asemptomatik grupta ise KAS öncesi (%25.9) ve sonrasında (%25.9) benzer oranlarda yapıldığı görüldü ama gruplar arasında istatistiksel fark yoktu. Semptomatik hastalarda (%59.2), asemptomatik hastalarda (%78.7) olduğu gibi distal emboli koruyucu cihaz (EKC), proksimal EKC’ye göre daha fazla kullanıldı. Ancak proksimal EKC, semptomatik hastalarda asemptomatik hastalara kıyasla anlamlı olarak daha fazla kullanıldı. Hastane içi ölüm görülmedi ve tüm popülasyonda 5 (%3.4) hastada inme veya geçici iskemik atak (GİA) gözlendi. Asemptomatik grupta GİA veya inme gözlenmedi, semptomatik grupta 2 hastada (%2.4) inme ve 3 hastada (%3.7) GİA görüldü. Sonuç: Bu çalışma kabul edilebilir komplikasyon oranları ile KAS’ın güvenirliğini ve uygulanabilirliğini ortaya koymuştur. KAS prosedürü, deneyimli girişimciler tarafından optimal tıbbi tedavi altında, agresif risk modifikasyonu ile EKC kullanılarak, uygun hastalarda en az komplikasyonla gerçekleştirilmelidir.

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