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Article Citation - WoS: 3Citation - Scopus: 4Semptomatik Çok Ciddi Aort Darlıklı Hastalarda Transkateter Aort Kapak İmplantasyonun Etkisi(Kare Publ, 2021) Karaduman, Bilge Duran; Ayhan, Hüseyin; Keles, Telat; Bozkurt, EnginAmaç: Aort darlığı (AD) ilerleyici bir hastalıktır ve tek tedavi seçeneği olan kapak replasmanı semptomatik hale geldikten sonra ve geri dönüşümsüz miyokardiyal hasar gelişmeden önce yapılmalıdır. Çok ciddi aort darlığı (ÇCAD) hastalarında cerrahi kapak replasmanı asemptomatik olsa bile önerilmektedir. Ancak ÇCAD hastalarında transkateter aortik kapak implantasyonunun (TAVI) etkisi hakkında ayrıntılı bir çalışma yoktur. Bu çalışmada amacımız, semptomatik ÇCAD hastalarında TAVI’nin uygulanabilirliğini ve güvenilirliğini göstermektir. Yöntemler: Merkezimizde TAVI uygulanan toplam 505 ardışık semptomatik AD hastası retrospektif olarak incelendi. Hastaların ortalama yaşı 77.8±7.6 yıl ve %56.4 kadın idi. Hastalar ÇCAD grubu (n: 134 hasta) ve yüksek gradyentli AD grubu (YGAD, n: 371 hasta) olarak iki gruba ayrıldı. Bulgular: ÇCAD grubunda daha fazla kadın cinsiyet, daha yüksek sol ventrikül ejeksiyon (SV) fraksiyonu, daha fazla küçük SV, hipertrofik SV, daha fazla normal koronerler ve daha az koroner arter hastalığı, bypas cerrahisi, miyokard enfarktüsü ve atriyal fibrilasyon öyküsü vardı. Predilatasyon ve Edwards SAPIEN 3 ÇCAD grubunda olarak daha az kullanıldı. VARC-2 kriterlerine göre majör komplikasyonlar ve hastane içi mortalitede (ÇCAD grubu; 5 hasta, YG AD grubu; 16 hasta, p: 0.769) istatistiksel fark saptanmadı. İki grup arasında Cox regresyon modeli sağ kalım eğrisinde ÇCAD lehine istatistiksel olarak anlamlı fark vardı (p<0.001). Sonuç: Bu çalışmamız ile semptomatik çok ciddi aort darlığında TAVI’nin kabul edilebilir komplikasyon ve daha yüksek sağ kalım oranları ile uygulanabilir ve güvenli olduğu gösterilmiştir. Hâlihazırda cerrahi kapak replasmanı endikasyonu olan asemptomatik ÇCAD hastalarında TAVI uygulanabilmesi için daha fazla randomize büyük çalışma gereklidir.Article Transcatheter Aortic Valve Implantation in Nonagenarians: A Comparative Analysis of Baseline Characteristics and 1-Year Outcomes(MDPI, 2025) Guney, Murat Can; Bozkurt, EnginBackground: 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.Article Citation - WoS: 1Citation - Scopus: 1Karotis 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, HüseyinAmaç: 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.Article Citation - WoS: 13Citation - Scopus: 13Evaluation of procedural and clinical outcomes of transcatheter aortic valve implantation: A single-center experience(Kare Publ, 2020) Karaduman, Bilge Duran; Kayaoğlu, Hüseyin Ayhan; Keleş, Telat; Bozkurt, EnginObjective: Transcatheter aortic valve implantation (TAVI) is an established alternative to surgical aortic valve replacement. Our study aimed to evaluate the implementation of TAVI at our large-volume center, having an all-comer patient population with short and long-term follow-ups. Methods: This retrospective, single-center analysis included 556 consecutive patients with symptomatic severe aortic stenosis (AS) who underwent TAVI between July 2011 and December 2019. Results: The mean age of the entire population was 77.6±7.9 years, and 54.9% were women. The Society of Thoracic Surgeons (STS) mean score of the cohort was 6.0%±3.5%. The balloon-expandable valve (Sapien XT, Sapien 3; Edwards Lifesciences, Irvine, California) was the most frequently used valves in this cohort (94.6%). Transfemoral access was used in 96.3% of patients. Implantation success was achieved in 96.6% of cases. During the TAVI procedure, 7.2% of patients required permanent pacemaker implantation, with 37.5% in the Lotus valve group needing the most permanent pacemakers. The mean length of hospital stay for the entire cohort was 4.5±2.3 days. Overall, 22 (3.9%) in-hospital deaths occurred before hospital discharge. The mean follow-up period was 15.1±14.9 months for all patients, and a significant improvement was noted in all echocardiographic parameters and functional capacity. Paravalvular leak (PVL) was documented in 18.9% patients, mild in 17.9%, and moderate in 1% at discharge. No cases with severe PVL, necessitating additional procedures. The multiple logistic regression analysis revealed that sex, STS score, baseline SYNTAX score, bicuspid valve morphology, common femoral artery diameter, and post-TAVI PVL were independent predictors of overall mortality. Conclusion: To our knowledge, this study, which is the largest single-center real-world experience of TAVI in Turkey, demonstrated low complication rates with favorable short- and mid-term THV performance in patients undergoing TAVI.Editorial Transcatheter Aortic Valve Implantation in Bicuspid Aortic Valve Patients With Coagulation Factor 7 and 11 Deficiency and Atrial Fibrillation(Kare Publ, 2023) Guney, Murat Can; Karaduman, Bilge Duran; Ayhan, Huseyin; Keles, Telat; Bozkurt, Engin[No Abstract Available]Article Citation - WoS: 2Citation - Scopus: 2Transcatheter 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, EnginIn 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.Article Citation - WoS: 2Citation - Scopus: 2Prognostic 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, EnginBackground: 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.Editorial Citation - WoS: 5Citation - Scopus: 5Transcatheter Treatment Tricuspid Regurgitation by Valve-In Implantation With a Novel Balloon-Expandable Myval® Thv(Polish Cardiac Soc-polskie Towarzystwo Kardiologiczne, 2022) Ayhan, Huseyin; Karaduman, Bilge Duran; Keles, Telat; Bozkurt, Engin[No Abstract Available]Article Citation - WoS: 3Citation - Scopus: 4Incidence 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, EnginIntroduction:
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.Article Association Between Rutherford Classification and Cha2ds2< Chads2 and Ascvd Scores in Peripheral Artery Disease Patients(Bmc, 2020) Karaduman, Bilge Duran; Ayhan, Huseyin; Keles, Telat; Bozkurt, EnginBackground and Aim: The classification system is important in assessing the severity of Peripheral Artery Disease (PAD) and making the treatment decision. However, classification systems may not be sufficient and scoring systems developed to predict cardiovascular and cerebrovascular events can also be useful to assess the severity of PAD. In this study, our aim was to investigate the association of the Rutherford classification and CHADS(2), CHA(2)DS(2)-VASc and ASCVD scores in PAD patients. Method: A total of 65 consecutive patients with PAD (males 92.3%, mean age 63.0 +/- 9.2 years), who underwent percutaneous peripheral intervention were included in our retrospective study. Results: There were 16 patients in Category 2, 31 patients in Category 3, and 10 patients in Category 4 and eight patients in Category 5. The CHADS(2), CHA(2)DS(2)-VASc and ASCVD scores were found to be significantly different among the Rutherford categories and between each other. From Category 1 to 5, CHADS(2), CHA(2)DS(2)-VASc and ASCVD scores were significantly increased. When we grouped the scores as CHADS 2 <2 and <2 and CHA(2)DS(2)-VASc<4 and >= 4, it was determined that as the category increased the score group also increased. There was significantly correlation between CHADS(2), CHA(2)DS(2)-VASc and ASCVD scores with the Rutherford categories in correlation analyses. Conclusion: As far as we know, in this study which is the first study about the association of Rutherford classification and scoring systems, the major finding of the present study is that the CHADS(2), CHA(2)DS(2)-VASc and ASCVD scores was independently correlated with the severity of Rutherford Category in patients with PAD. (C) 2020 Association for Research into Arterial Structure and Physiology. Publishing services by Atlantis Press International B.V.
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