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Article Citation - WoS: 13Citation - Scopus: 14Evaluation 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, Engin; Ayhan, HuseyinObjective: 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.Article Citation - WoS: 4Citation - 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: 1Citation - Scopus: 1Kardiyovasküler Aldatma-Salgını: Kardiyovasküler Tedavilerde Kandırma ve Yanlış Bilgilendirme Epidemisinin Yaygınlaşması(Baycınar Medical Publishing - Baycınar Tıbbi Yayıncılık, 2024) Demirkılıç, Ufuk; Tosun, BurcuSon zamanlarda, bazı kalp damar cerrahları sıklıkla yanıltıcı terimler kullanarak pazarlama amacıyla sosyal medyayı giderek daha fazla kullanmaktadır. “Kardiyovasküler aldatma- salgını” olarak adlandırdığımız bu eğilim, kardiyovasküler tedaviler için yanıltıcı reklamların salgın benzeri bir şekilde yayılmasını içeren bir durumu yansıtmaktadır. Bu tür yanlış bilgilere maruz kalmanın, profesyonel kaynaklardan gelen bilgiye doğal olarak güvenen hastaları tehlikeye atmakla kalmayıp, aynı zamanda tıbbi etik ve bilimsel doğruluğa olan kamu güvenini de zedelemektedir. Ayrıca, bu durum tedavi reddine ve olumsuz sağlık sonuçlarına da katkıda bulunmaktadır. Bu sorunları değerlendiren kapsamlı küresel düzenlemelerin yetersizliği, acilen daha etkili uygulama önlemlerine gereksinim olduğunu ortaya çıkarmaktadır.Article Surgical Treatment of a Patient With Recurrent Bleb Leak and Glaucoma: Bleb Excision Combined With Gonioscopy-Assisted Transluminal Trabeculotomy(Galenos Publ House, 2022) Boluk, Ceyda Eristi; Aktas, ZeynepHere we present a case of intermittent bleb leakage with increased intraocular pressure (IOP) during recovery periods that was treated with gonioscopy-assisted transluminal trabeculotomy (GATT) combined with avascular bleb excision. A 60-year-old woman exhibiting simultaneous leaking bleb and glaucoma underwent GATT and bleb revision. At her final visit, the bleb leakage had resolved and IOP was under control without any further antiglaucoma medication. GATT may be useful for glaucoma patients exhibiting intermittent bleb leakage after failed trabeculectomy.Article Romatizmal Mitral Kapak Hastalığında Yeni Yolak: Sitokrom P450 ve Glutatyon S Transferaz İzozim Ekspresyonu(Walter de Gruyter Gmbh, 2020) Şimşek, Erdal; Şimşek, Gülçin; Sayol, Mehmet Fazıl Tolga; Kaygın, Pınar; Oğuztüzün, Serpil; Düzgün, Ali Cemal; Kaplan, Sadi; Sarialtin, Sezen; Soyal, Mehmet Fazil TolgaAmaç: Romatizmal mitral kapak hastalığı ve iskemik mitral kapak yetmezlikli hastalarda Sitokrom P450 (CYP)1A1, glutatyon S-transferaz pi (GSTP1) ve omega (GSTO1) izozimleri karşılaştırılarak, romatizmal mitral kapak hastalığı ile oksidatif stres arasındaki ilişki araştırıldı. Gereç ve Yöntem: Kontrol grubunu, iskemik mitral kapak yetmezliği sebebiyle ameliyat edilen (group I, n:14), çalışma grubunu ise romatizmal mitral kapak hastalığı nedeni ile ameliyat edilen (group II, n:29) hastalar oluşturmuştur. Mitral kapak materyalleri hematoksilen ve eozinle boyandı. CYP1A1, GSTP1, ve GSTO1 immünohistokimyasal belirteçler ile çalışıldı. Bulgular: Çalışma grubunda %20.7 GSTP1 isozim protein ekspresyonu gözlendi; fakat kontrol grubunda ekspresyon izlenmedi. Bu bulgu GSTP1 izozim açısından istatistiksel olarak önemli bulundu. Çalışma ve kontrol grupları arasında GSTO1 ve CYP1A1 protein ekspresyonları açısından istatistiksel anlamlı farklılık görülmedi. Sonuç: Bu çalışmada GSTP1 izozimi romatizmal mitral kapak hastalığı ile ilişkili olabileceği görüldü. Romatizmal mitral kapak hastalığı olan hastalarda oksidatif stresi önleyen strateji, hastalığın ilerleyişini engellemek için çok değerli bir seçim olabilir.Article Citation - WoS: 3Citation - Scopus: 1Caval Valve Implantation Procedure in 7 Cases of Torrential Tricuspid Regurgitation and Step-By Description of the Procedure(Kare Publ, 2025) Sarıçam, Ersin; Barcin, Cem; Çelebi, Aksüyek Savaş; Asfour, Mohamed; Bozbas, Huseyin; İlkay, Erdoğan; Cam, Ersin; Celebi, Savas A.Tricuspid regurgitation (TR) is an increasingly prevalent and clinically significant health problem.1 Due to the growing understanding of the importance of TR, the tricuspid valve has transitioned from being a forgotten valve to one of significant concern. Tricuspid regurgitation is often functional, and as it progresses to moderate or severe stages, hospital admissions increase and prognosis worsens.1,2 There are no effective pharmacological treatments for TR, and the 5-year survival rate with medical management is reported to be less than 50%.3 Therefore, early diagnosis and timely intervention for TR is crucial. Both surgical and percutaneous treatment options are available for severe TR. The mortality rate for isolated TR surgery is generally high.4 In recent years, transcatheter treatments have become feasible for this patient group, and accumulating evidence shows that transcatheter treatment is superior to medical management.5,6 Transcatheter interventions for TR can be performed in 4 ways, 2 involving repair and 2 involving valve We aimed to present our experience with transcatheter caval valve implantation (CAVI) in 7 patients with torrential TR who were not suitable for surgical intervention or transcatheter edge-to-edge repair (T-TEER) due to severe coaptation defects, review the current literature, and provide a step-by-step description of the procedure.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.Article Citation - WoS: 2Citation - Scopus: 3The Clinical and Demographical Characteristics of Turkish Pediatric Lymphedema Patients: a Multicenter Study(Tubitak Scientific & Technological Research Council Turkey, 2022) Borman, Pinar; Balcan, Aysegul; Eyigor, Sibel; Coskun, Evrim; Ayhan, Figen; Cakit, Burcu Duyur; Dogan, Sevil Ceyhan; Vural, Secil Pervane; Ayvaz, Deniz Nazire Çağdaş; Vural, MeltemBackground/aim: Reducing lymphedema-associated burden and disability in the pediatric setting requires improved awareness and understanding clinical properties of the lymphedema. The aim of this study was to evaluate the clinical and demographic characteristics of patients with pediatric lymphedema presented to different lymphedema centers in Turkey. Materials and methods: The socio-demographic and clinical characteristics of the children including age, gender, presence of genetic syndromes, duration of edema, site and stage of lymphedema and the received therapies were determined. Parental and children education on self-management techniques were recorded. Results: A total of 122 children (female: 66, male: 56) with a mean age of 120.7 +/- 71.2 months were included from 7 centers. Of them; 92% had primary, 8% had secondary lymphedema mostly due to infection and trauma. Lymphedema was part of a syndrome in 18% of the children. The most common site of involvement was the lower extremity, followed by upper extremity and genital involvement. Lymphedema was complicated in 17 % of children, mainly with a clinical picture of cellulitis, infection, and pain. The median duration of lymphedema was 41 (5-216) months. Although most of the children had stage 2 lymphedema, only 40% of them received treatment. The most commonly received treatment was compression therapy. No family or child was educated for self-care management before. Conclusion: In conclusion, pediatric lymphedema has a comparable gender distribution and usually involves the lower extremities. Although most of the children had advanced disease, more than half of the patients did not receive any treatment indicating the unmet need for management of lymphedema. The education of patients and/or children about self-management methods were lacking. We suggest educational activities for both families of children with lymphedema and health care providers, in order to facilitate early reference to lymphedema units and to receive prompt preventive and therapeutic approaches for this suffering condition.Article Citation - WoS: 13Citation - Scopus: 13Association 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, BilgeBackground/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.
