INTRODUCTION: Internal juguler vein is preferred for central venous catheterization because of lower infection and complication rates and ultrasound guidance increases success rates. We aimed in this study to evaluate the effect of internal juguler vein position in relation to carotid artery depending on the two different head position (neutral position vs. 45 degree rotation) to access time and complication rates.
METHODS: Patients were randomly assigned into two groups as 45° contralateral head rotation and neutral head position group. Access times and complications were recorded.
RESULTS: Position of IJV in relation to carotid artery was significantly different between two groups ( p<0.05). While IJV was laterally positioned in relation to carotid artery in neutral group, 45° head rotation increased the risk of anterior displacement. There was no significant difference between two groups for venous diameter, depth of vein, number of attempts and access time (p>0.05).
DISCUSSION AND CONCLUSION: In IJV catheterization, head rotation may increase the visibility of anatomical landmarks; on the other hand, as a result of increased head rotation IJV replaces anterior of carotid artery and this position increases carotid artery puncture. In our study, it has been shown that anterior placement of the IJV in the neutral position is less but intervention with ultrasound guidence avoides arterial puncture. In neutral position the procedure area is smaller, this may cause difficulties in practice but between two grups the intervention times were not different. Neverthless we think that this will be an advantage in trauma patients whom head rotation cannot be possible.

INTRODUCTION: In this article, we discuss the relationship and intraoperative changes of EEG,SEF, PSI values measured by SedLine® and bilateral cerebral oxymetry(rSO2) values measured by NIRS in heart transplantation
METHODS: 13 adult patients who undergone heart transplantation were included in our study. Demographical, preoperative, intraoperative hemodynamic values; cerebral monitorization and mortality data were collected prospectively. Bilateral SEF values, PSI values and bilateral rSO2 values were collected prior to anaesthesic induction (phase 1), 5 minutes after induction (phase 2), 5 minutes after establishing cardiopulmonary bypass (phase 3),5 minutes after cross-clamping (phase 4), at fifth minute after weaning from cardiopulmonary bypass (phase5), and at the end of the operation(phase 6).
RESULTS: Mean age was 32.7±10.8 years. rSO2 and SEF values did not show any significant difference between right and left hemispheres. Preinduction SEF, PSI and rSO2 values declined significantly after induction and remained significantly lower throughout the operation
DISCUSSION AND CONCLUSION: In this study, cerebral monitoring values decreased significantly after induction and remained low throughout the operation as expected. No neurological adverse events were observed in these cases. Multimodal neuromonitorization can be a lodestar for anaesthetic induction, resternotomies, cannulation, serious arrhythmias, hypotensive periods, embolic events due to intracardiac thrombi and new-onset dysfunction of the donor heart.

INTRODUCTION: Intraoperative transesophageal echocardiography (TEE) has widely used in cardiac surgery, and has become a standard monitoring. Intraoperative TEE should affect surgical decisions and allows early evaluation after cardiopulmonary bypass (CPB).
The purpose of the study investigates clinical benefits of intraoperatif TEE undergoing open heart surgery in 604 patients and reveals the effect of the surgical decision.
METHODS: Between January 2014 – February 2016; preoperative transthoracic echocardiography and intraoperative pre and post-CPB TEE data were retrospective evaluated in 604 patients who were operated due to valvular heart disease, intracardiac mass and aorta surgery in Antalya Training and Research Hospital. Preoperative and postoperative data were compared.
RESULTS: Intraoperative TEE examinations influenced surgical decision making in 8.9%. This related 6.6% in mitral valve, 1.5% in aort valve and 0.8% in tricuspit valve. 5 patients was returned to CPB after evaluated with TEE. 5 patients who was required Extracorporeal membrane oxygenation (ECMO), 12 patients who was canullated to minimal invasive surgery and 21 patients who was required intraaortic baloon pump were controlled with TEE.
DISCUSSION AND CONCLUSION: In the current study, we determined as 8.9% of impact of surgery decision making. This affect was most widely observed in simultaneously CABG and mitral valve surgery.
In conclusion, intraoperative TEE is affect the surgery decision making and is noticed the early complications in post CPB period.

INTRODUCTION: Optimizing the transfusion strategy and to take the measures in the preoperative period, it is necessary to identify the subgroup of patients at high risk of bleeding. The purpose of this study; The frequency of intraoperative blood product use in patients with cardiac surgery and to investigate the properties of the distribution by type of surgery, to determine the relationship between results and mortality.
METHODS: In 2015, 1023 patients have undergone cardiac surgery, were analyzed retrospectively. Patient's age, sex, BMI, case type, preoperative hemoglobin, hematocrit, INR, aPTT, blood product use quantities, cross,CPB,operation duration and 30-day mortality were recorded. Patients were divided into 3 groups, according to the number of red blood cells (RBC) uses, Group I ever used, 1-2 RBC used Group II,≥3 RBC used in Group III.
RESULTS: 43.01% of all patients in Group I, 43.1% in Group II and 13.8% of Group III respectively. Age, gender, INR values between Groups I and III significantly different; BMI, ASA risk classification, the Hb/Htc values and cross/CPB/operation time was found statistically significant different in all three groups(p<0.001). Maximum use of the RBC according to the type of case(3.1Ü)re-operation, while the minimum rate of use of RBC was surgical adult congenital surgery. The mortality rate of8.1% for all patients,30.3% in Group III, 6.3 % in GroupII and 2.7% in GroupI(p<0.001).
DISCUSSION AND CONCLUSION: Advanced age,female sex,extension of the duration of operation/CPB/Cross, low entrance Hb/Htc values and the type of surgery to increase the use ofRBC. With the increase of use RBC has been found that increased mortality.

INTRODUCTION: Left ventricular assist devices (LVAD) give a chance to patients with end stage heart failure to live until a suitable heart is found for cardiac transplantation. However, transplantation procedure have some compelling conditions in patients with LVAD. In this study, we evaluate our cardiac transplantation patients with LVAD and non LVAD.
METHODS: The medical records of cardiac transplantation patients with and without LVAD who were performed in last 1.5 years by our hospital transplantation team were retrospectively reviewed. Type of LVAD, duration on LVAD, morbidity, mortality and discharge data were collected.
RESULTS: Ten patients underwent transplant as a primary surgery and 12 patients underwent transplant with LVAD. Duration on LVAD were between one day and one year. There were five mortality and one morbidity in LVAD bridged group. All patients with primary transplantation and 7 patients with transplantation after LVAD were discharged without any complications.
DISCUSSION AND CONCLUSION: There was a significant higher mortality in LVAD bridge patients compare with primary transplantation group. Reoperation and hemolysis causes more bleeding in LVAD patients. Infection rate is higher in the bridged patients due to the longer hospital stay, presence of driveline and prior cardiac surgery. Thus, complications regarding infection and bleeding increase morbidity and mortality.

INTRODUCTION: Minimally invasive surgery is used as an alternative method to conventional surgery in patients undergoing cardiac surgery. It provides to reduced surgical trauma, improved quality of life, better cosmesis, less painfull, early recovery, reduced operative mortality.
The aim of current study is to investigate different techniques which are used in minimally invasive mitral valve surgery in our hospital and to evaluate the early results.
METHODS: Between January 2014-February 2016; 24 patients undergoing minimally invasive surgery due to mitral valve pathology (minimally invasive mitral valve surgery via anterolateral thoracotomy (STMIMKC) and transapical off-pump mitral valve repair with Neochord implantation(AKTANI)) in Antalya Training and Research Hospital were evaluated retrospectively.
RESULTS: Mitral valve repair with mitral ring was performed in 12 patients in group STMIMKC. Neochord was implanted in 7 patients in group AKTANI.
Duration of surgery, duration of mechanical ventilation and amount of blood used in postoperatively was statistical lower in group AKTANI (P=0.020, 0.045 ve 0.036). Duration of intensive care and hospital stay was similar in both group. One patient in group STMIMKC was reoperated because of bleeding in postoperative 6th hour. Atelectasis was observed in two patients in group STMIMKC. Inotropic drug used was statitical higher in STMIMKC group (P=0.032).
There was no mortality in both groups in postoperative three months.
DISCUSSION AND CONCLUSION: STMIMKC ve AKTANI techniques are safety and feasible. Both techniques have positive short-term results. AKTANI is shortened the duration of mechanical ventilation and hospitalization and reduced the postoperative blood usage.
Patient selection is the most important criteria to appropriate method selection.

Off-pump coronary artery bypass (OPCAB) was an alternative method to cardiopulmonary bypass (CPB) due to the protection of physiological circulation and lung function in recent times. Stroke is a major complication of bypass surgery and seen more rarely during OPCAB. In the present case, we presented middle cerebral artery (MCA) infarction due to the cerebral embolism during OPCAB.

Angiosarcoma is a rare cardiac tumors and mortality is high. Patients with angiosarcoma generally present with nonspecific symptoms and angiosarcoma tumors are aggressive. Hemodynamic instability can develop due to the blocking of right ventricular load depend on the tumor size. Therefore, anesthetic management is important. In this case, anesthetic management of patient were presented with cardiac tamponade depending on right atrial angiosarcoma.

In patient with pediatric heart failure, when the medical therapy is inadequate, ventricular assist device equipments are an alternative that offers the chance of life to patients. However, patient selection must be good because of the high cost of these devices. It is needed that continuous spontaneous heart beats and normal cerebral function for implanting LVAD. We talk about a pediatric patients admitted to our hospital with acute cardiac failure leading up to heart transplantation with intraoperative neuromonitoring.