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    Early Results of Combined and Staged Coronary Bypass and Carotid Endarterectomy in Advanced Age Patients in Single Centre
    (Bentham Science Publ Ltd, 2009) Iyem, Hikmet; Buket, Suat
    Aim: In present study, we aimed to compare the staged and combined surgery in patients with severe carotid stenosis and coronary atherosclerosis and detect the factors affecting mortality and morbidity. Material and method: Between 2004 and 2008, 120 patients with predominant ischemic heart disease were enrolled to study. Patients were divided into three groups on basis surgery procedure. Group 1 (n=40) includeed patients had coronary artery disease without carotid disease underwent coronary artery by-pass graft (CABG) operation. Group 2 (n=40): included patients underwent combined surgery procedure including CABG and carotid endarterectomy (CEA). Patients underwent staged CABG and CEA were enrolled to Group 3 (n=40). All patients were in advanced aged and were had the same risk factors atributable atherosclerosis Results: Mean age of the patients in all groups were 68 +/- 6, 69 +/- 3, 71 +/- 2 respectively, and 83% were male. Eight patients died in all groups at follow-up(seven in group 2 and 3, and one in group 1) and the difference between both groups was statistically significant (p<0.001). The follow-up period in the intensive care unit, and hospitalization period were not statistically different between CABG group and combined CEA plus CABG group. Conclusion: We think that the results of staged or combined CABG plus CEA surgery are satisfactory in patients with severe carotid disease and advanced coronary artery disease. However, the mortality and morbidity in both procedures are higher than those of alone.
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    Evaluation of the reliability of the EuroSCORE risk-analysis prediction in high-risk older patients undergoing CABG
    (Clinics Cardive Publ Pty Ltd, 2009) Iyem, Hikmet
    Background: The aim of this prospective study was to evaluate the reliability of EuroSCORE risk-analysis predictions on early mortality in high-risk older patients who underwent heart surgery. Methods: From January 2008 to February 2009, a total of 128 consecutive high-risk older patients who underwent open-heart surgery were included. Patients who required emergency surgery, had pulmonary hypertension, a recent myocardial infarction, underwent combined heart surgery procedures or had renal disease were included. The patients had a mean age of 72 +/- 9 years (range 64-91, 53.1% male) and were evaluated for surgery. Results: Coronary artery bypass graft (CABG) surgery was performed on 112 patients and valve surgery on 16. Eight patients (6.25%) died in hospital. The observed mortality rate was lower than the expected mortality obtained using EuroSCORE (6.25% vs 11.2 +/- 7.2%, respectively, p < 0.021). Conclusion: There was no correlation between the preoperative logarithmic score of expected mortality and the observed mortality rate in these older high-risk patients who underwent open-heart surgery.
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    High levels of high-sensitivity C-reactive protein and impaired autonomic activity in smokers
    (Turkish Soc Cardiology, 2008) Alyan, Omer; Kacmaz, Fehmi; Ozdemir, Ozcan; Karahan, Zulkuf; Taskesen, Tuncay; Iyem, Hikmet; Alan, Sait
    Objectives: We investigated the relationship between high sensitivity C-reactive protein (hs-CRP) activity and autonomic nervous activity using heart rate variability in smokers. Study design: The study consisted of 136 healthy subjects, including 66 smokers (35 women, 31 men; mean age 36 years) and 70 nonsmokers (43 women, 27 men; mean age 34 years). Serum samples were collected from all the subjects. Three-channel, 24-hr Holter monitoring was performed to derive the mean heart rate, standard deviation of normal NN intervals (SDNN), standard deviation of 5-minute mean NN intervals (SDANN), root mean square differences of successive NN intervals (RMSSD), high-(HF) and low-(LF) frequency power components, and the LF/HF ratio. Results: In smokers, the mean duration of smoking was 13.6 +/- 8.2 years (range 3 to 45 years), and the mean number of cigarettes consumed per day was 16.3 +/- 7.1 (range 5 to 40). Smokers exhibited significantly higher mean heart rate, hs-CRP and fibrinogen levels, mean platelet volume, white blood cell count, LF, and LF/HF ratio, with significantly lower SDNN, SDANN, RMSSD, and HF values. In smokers, hs-CRP was correlated with the number of cigarettes consumed per day, duration of smoking, fibrinogen level, mean platelet volume, white blood cell count, LF, and LF/HF ratio, and inversely correlated with HF, SDNN, and SDANN. Even smoking a single cigarette resulted in an acute, 0.07-fold increase in the hs-CRP level (p< 0.0001). In linear regression analysis, both the number of cigarettes consumed per day (beta= 0.52, p= 0.011) and duration of smoking (beta= 0.073, p< 0.0001) had an independent effect on the hs-CRP level. Conclusion: Smoking both impairs the sympathovagal balance and increases the hs-CRP activity in otherwise healthy smokers, the combination of which would probably contribute to a higher rate of cardiovascular events.
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    Hybrid and staged repair in the treatment of a case with extensive aortic aneurysm
    (Ekin Tibbi Yayincilik Ltd Sti-Ekin Medical Publ, 2009) Iyem, Hikmet; Cirban, Yilmaz; Memis, Ahmet; Buket, Suat
    In this article we present a successful management of a case with extensive aortic aneurysm which was treated by a combination of open surgery and endovascular stent grafting Cardiopulmonary bypass was established via right femoral and right atrial cannulation. Patient was cooled down till 18 degrees and following the cardiac arrest, Bentall procedure was performed by using a composite graft. A 26 mm Talent endovascular stent was placed into the descending aorta through arcus aorta under direct vision. Later on, distal anastomosis was performed for the total hemiarcus replacement. The distal part of the composit graft and the proximal part of the hemiarcus graft was anastomosed during rewarming. After one week, a second endovascular stent graft was placed into the descending aorta under general anesthesia in peripheric angiography laboratory and the treatment was completed.
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    Ruptured Aneursym of Left Paracolic Branch of Superior Mesenteric Artery: Report of an Uncommon Case
    (Ortadogu Ad Pres & Publ Co, 2010) Iyem, Hikmet; Buket, Suat
    A 56-years-old male patient admitted to our emergency room with hypovolemic shock. He had the history of abdominal pain, nausea, vomitting and bloody defecation for eight hours. Multislice computed tomography (MSCT) was performed. MSCT revealed a ruptured aneurysm of 60 x 56 mm of left superior paracolic branch of superior mesenteric artery (SMA). The abdominal cavity was opened by median abdominal incision above and under the level of umbilicus. A giant ruptured aneurysm of left paracolic branch of SMA was seen. The ruptured aneurysmatic sac was resected and remained tissue were sutured primarily. Patient was extubated on the 18(th) hour of postoperative period. He was discaharged uneventfully on the 10(th) day of hospitalization. We aimed to emphasise the importance of early radiological recognition of ruptured aneursym of left paracolic branch of SMA and its early surgical treatment.
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    Should embolectomy be performed in late acute lower extremity arterial occlusions?
    (Dove Medical Press Ltd, 2009) Iyem, Hikmet; Eren, M. Nesimi
    Background: We analyzed the embolectomy results and complications of patients who were operated on after a diagnosis of late acute arterial occlusion of lower extremities. Methods: A total of 122 patients operated on in our clinic between 2004 and 2009 for late acute arterial occlusion were included in the study. Late arterial occlusion was defined as occlusion occuring 72 hours after initial manifestation of the patient complaints related to the affected lower extremity. Results: Average age of the 122 patients (71 male, 51 female) was 54.2 +/- 16.8 years. In this cohort, 64.75% of patients had cardiac pathologies, while 28.68% had extracardiac causes; 1.64% patients had cathetherization, 0.81% patient had malignancy, and 2.46% patients had a history of trauma. In 1.64% of the cases, no reason for thromboembolysis could be found. Thirty-one patients (25.40%) had additional surgical operations, 14 (11.47%) had fasciotomy, and 9 (7.37%) had amputation. Re-embolectomy was performed on 37 patients (30.32%) who had ongoing ischemia after an operation. Additional surgical operations were performed on 31 patients (25.40%) with ongoing ischemia. In 14 of these cases (11.47%), patients were treated with fasciotomy due to development of compartment syndrome. Amputation was performed on a total of 9 patients. Early in the postoperative phase, mortality was observed in 11 patients (9.01%). Conclusion: We believe that late embolectomies of acute late leg ischemia increases blood flow in the extremity and reduces the number of amputations required.