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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 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]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 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.Article Citation - WoS: 4Citation - Scopus: 4Clinical Outcomes After Transcatheter Aortic Valve Implantation in Active Cancer Patients and Cancer Survivors(Baycinar Medical Publ-baycinar Tibbi Yayincilik, 2021) Karaduman, Bilge Duran; Ayhan, Huseyin; Keles, Telat; Bozkurt, EnginBackground: In this study, we aimed to evaluate the clinical characteristics, perioperative, and mid-term outcomes of patients with severe symptomatic aortic stenosis and active cancer disease and cancer survivors undergoing transcatheter aortic valve implantation. Methods: Between December 2011 and March 2019, a total of 550 patients (248 males, 302 females; mean age: 77.6 +/- 7.9 years; range, 46 to 103 years) who underwent transcatheter aortic valve implantation for severe symptomatic aortic stenosis in our center were retrospectively analyzed. Baseline demographic characteristics, cancer type, laboratory data, procedural data, and outcome data of the patients were collected. The primary outcome measure was all-cause mortality at 30 days and every six months up to maximally available follow-up. Follow-up was performed at 30 days, six months, and 12 months after the procedure and annually thereafter. Results: Of the patients, 36 had a cancer diagnosis-active (n=10) or cured (n=26). The most common types of cancer were colorectal (16.6%), prostate (13.8%), leukemia (11.1%), and bladder (11.1%) cancers. Post-procedural complication rates were similar between the two groups. No mortality was observed in the cancer group at one month of follow-up. During follow-up, seven patients died within one year due to non-cardiac reasons. Although mortality at one year was higher in cancer patients, it did not reach statistical significance (23.3% vs. 11.6%, respectively; p=0.061). The estimated cumulative survival rate was 71.0% in the non-cancer group and 58.3% in the cancer group. The multivariate Cox regression analysis revealed that cancer was independently associated with cumulative mortality after adjusting for age, sex, body mass index, and atrial fibrillation (p=0.008). Conclusion: Our study results show that transcatheter aortic valve implantation is safe and feasible in active cancer patients and cancer survivors with similar short-term and mid-term mortality and procedure-related complication rates, compared to non-cancer patients.Article Citation - WoS: 8Citation - Scopus: 9Impact of Coronary Revascularization on Outcomesof Transcatheter Aortic Valve Implantation(Aves, 2021) Karaduman, Bilge Duran; Ayhan, Hüseyin; Keles, Telat; Bozkurt, EnginObjective: Although the effect of coronary revascularization on clinical outcomes before and after transcatheter valve implantation (TAVI) is debatable, there is currently insufficient data to determine the most appropriate revascularization strategy. In this study, we present our single-center experience of percutaneous coronary intervention (PCI) and its effect on clinical outcomes and mortality in patients undergoing TAVI.Methods: We performed a retrospective analysis of 526 consecutive patients at our center, and 127 patients with obstructive coronary artery disease were included in the study. Patients were divided into two groups: the revascularization group (group 1) and the non-revascularization group (group 2). Procedural complications and long-term all-cause mortality rates were compared between the two groups.Results: Of the 526 patients, group 1 comprised 65 patients (12.3%) who underwent PCI, and group 2 comprised 62 patients (11.7%) who did not undergo revascularization. According to Valve Academic Research Consortium 2 criteria, post-procedural complications, including pericardial effusion, stroke, major vascular complications, major bleeding, and emerging arrhythmias, were similar between the groups. A Kaplan–Meier survival curve analysis showed no significant difference between the revascularization and non-revascularization groups (Overall: 40.0±2.8 month; 95% CI 34.4-45.6 month, p=0.959). After adjustment for basal SYNTAX score, chronic kidney disease stage, previous myocardial infarction, and baseline troponin levels, the long-term survival of group 1 was significantly longer when compared with group 2 (p=0.036). In 75.4% of cases, PCI was performed within 11.0±14.7 days before or after TAVI as a staged procedure. In 13.8% of cases, PCI was performed simultaneously with TAVI. While there was no significant difference in in-hospital, 6-month, and 1-year mortality rates between the simultaneous and staged PCI groups, there was a significant difference in 30-day mortality (11.1% vs. 0%, respectively; p=0.016).Conclusion: Peri-procedural and long-term safety outcomes and mortality rates are not significantly different between revascularized and non-revascularized patients, and neither staged nor simultaneous PCI have adverse outcomes in patients undergoing TAVI.Letter Management of Left Ventricular Outflow Tract Obstruction in Transcatheter Mitral Valve Replacement(Aves, 2021) Bozkurt, Engin; Ayhan, Huseyin; Karaduman, Bilge Duran[No Abstract Available]Article Citation - WoS: 16Citation - Scopus: 19The Triglyceride-Glucose Index Predicts Peripheral Artery Disease Complexity(Tubitak Scientific & Technological Research Council Turkey, 2020) Karaduman, Bilge Duran; Ayhan, Hüseyin; Keles, Telat; Bozkurt, EnginBackground/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.
