GÝRÝÞ ve AMAÇ: Levosimendan (LVS) Phosfodiestheraz III’ü inhibe eder ve ATP-duyarlý K+ kanallarýný açar. Anti-oxidan, antiinflammatuar, inotropik ve vasodilatator etkileri ile kardiyoprotektiftir. LVS, kardiyak cerrahi sýrasýnda düþük düþük ejeksiyon fraksiyonlu hastalarda kullanýmý tercihedilir. Böylece nöronlarý indirekt olarak koruduðu bildirilmiþtir. Ancak, nöronlar üzerine direk etkileri bilinmemektedir. Biz, fare kökenli nöroblastoma hücre dizinini kullanarak (NB2a) hücrelerle ilaç etkileþiminin olduðu kültürde LVS’nin direkt nöroprotektif etkilerini araþtýrdýk
YÖNTEM ve GEREÇLER: Bu amaçla, LVS (0,1, 0,3, 1, 3, 10, 30 and 100 μM)’nýn nöroprotektif etkileri, direkt toksik etkileri için appopitozis TUNEL metot ile ve hücre canlýlýðý için MTT ile test edildi. Ayný zamanda LSV’nýn orta ve kronik toksik etkileri için nörit uzamasý ölçüldü.
BULGULAR: LVS hücre çoðalmasýna negatif etki etmedi. Apopitotik hücrelerin sayýsý kontrol hücrelerininkinden farklý deðildi (p>0.05). Buna ek olarak, nörit inhibisyonunun görülmediði NST ile tüm konsantrasyonlarda orta derecede nörotoksik etki yoktu. 1 μM konsantrasyonda LVS, nöroprotektif ve fonksiyonel etkiyi açýkça gösteren nörit uzamasýný anlamlý olarak artýrdý.
TARTIÞMA ve SONUÇ: LVS'nýn kültürde direkt nöroprotektif etkileri klinik kullaným için önemli olabilir. LVS, travma veya iþlemin kendisinin doðasýnda olabilen beyin hasarlarý için riskli hastalarda güvenle kullanýlabilir.

INTRODUCTION: Levosimendan (LVS) inhibits phosphodiestherase III and opens the ATP-sensitive K+ channels (KATP). It is cardioprotective due to its anti-oxidant, anti-inflammatuary, inotropic and vasodilatatory effects. The use of LVS is prefered in patients who have decreased ejection fraction during cardiac surgery. Therefore it has been reported that LVS protects neurons indirectly. Hovewer, its direct effects on neurons have not been known yet. We examined direct neuroprotective effects of LVS using neuroblastoma cell line of mouse origin (NB2a) in culture where drug interaction with cells occurs.
METHODS: To this end, the neuroprotective effects of LVS (0,1, 0,3, 1, 3, 10, 30 and 100 μM) have been tested for its direct toxic effects by TUNEL method for apoptosis and by MTT for cell viability. We also examined moderate and chronic toxic effect of LSV by measure neurite outgrowth.
RESULTS: LVS didn’t effect the cellular proliferation negatively. The number of apoptotic cells didn’t differ from the number of control cells (p>0.05). Additionally, any moderate neurotoxic effects were not seen in all concentrations of NST which did not inhibit neurite outgrowth. Moreover, LVS at 1 μM concentration significantly increased the lengh of neurite showing clearly its neuroprotective and functional effects.
DISCUSSION AND CONCLUSION: These direct neuroprotective effects of LVS in culture might be important for clinical use. LVS can be used securely in patients that have a risk for a brain injury due to the nature of disease, trauma or the procedure itself.

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GÝRÝÞ ve AMAÇ: Sempatektomi, plevral biyopsi, akciðer parankim biyopsisi, plöredezis ve büllektomi gibi minör Video Yardýmlý Torakoskopik Cerrahi (VATS) prosedürlerde, klasik entübasyonla tek akciðer ventilasyon tekniðine alternatif olarak Non-Entübe VATS (NIVATS) tekniði kullanýmý giderek artmaktadýr. Amacýmýz, bilateral ve uniportal sempatektomilerde klasik entübasyon yöntemi ile supraglottik bir hava yolu aracýyla spontan solunum korunarak uygulanan NIVATS tekniðini, uygulanabilirlik ve perioperatif etkiler açýsýndan karþýlaþtýrmaktý.
YÖNTEM ve GEREÇLER: Hastalar, Laringeal Mask Airway (LMA) veya Çift Lümenli Tüp (ÇLT) kullanýmýna göre Grup LMA (n: 20) ve Grup ÇLT (n: 20) olarak iki grupta deðerlendirildi. Her iki grubun demografik verileri, anestezi ve cerrahi süreleri, solunum parametreleri, cerrahi zorluk deðerlendirmesi, anestezi sonrasý bakým ünitesindeki aðrý skoru, analjezik ajan kullanýmý ve kalýþ süresi; postoperatif oral alým ve mobilizasyon baþlangýç süreleri, postoperatif takiplerindeki aðrý skorlarý, hava kaçaðý, pnömotoraks, hava kaçaðý, boðaz aðrýsý, bulantý-kusma komplikasyonlarý ve hastanede kalýþ süreleri karþýlaþtýrýldý.
BULGULAR: : Anestezi indüksiyon süresi LMA grubunda belirgin olarak düþük bulundu (p<0,001). Maksimum solunum sonu karbondioksit (EtCO2), minimum periferal oksijen satürasyonu (SpO2), maksimum solunum sayýsý LMA grubunda anlamlý olarak yüksekti (p<0,001). Ortalama inspire edilen oksijen fraksiyonu (FiO2) ve ortalama tidal volüm ÇLT grubunda anlamlý olarak yüksek bulundu (p<0,05). Cerrahi uygulanabilirlik açýsýndan iki grup arasýnda istatistiksel olarak anlamlý bir fark görülmedi. Postoperatif dönemde oral beslenmeye baþlama ve mobilize olma zamanlarý arasýnda anlamlý fark bulundu (p<0,05). Diðer aðrý skorlarý, postoperatif komplikasyonlar ve hastanede kalýþ süreleri arasýnda istatistiksel olarak anlamlý bir fark görülmedi.
TARTIÞMA ve SONUÇ: VATS Sempatektomi vakalarýnda LMA ile spontan solunum korunarak iyatrojenik açýk pnömotoraks oluþturulduðunda NIVATS anestezi tekniðinin etkili ve güvenli bir þekilde kullanýlabileceði kanýsýndayýz.

INTRODUCTION: The use of Non-Intubated Video Assisted Thoracoscopic Surgery (NIVATS) technique is gradually increasing as an alternative method to classical intubation in minor Video Assisted Thoracoscopic Surgeries (VATS) such as sympathectomy, pleural biopsy, lung parenchymal biopsy, pleurodesis and bullectomy. Our aim was to compare a NIVATS technique with the classical intubation method applied in bilateral and uniportal sympathectomies in terms of feasibility and perioperative effects.
METHODS: According to the use of Laryngeal Mask Airway (LMA) or Double Lumen Tube (DLT), the patients were evaluated in two groups as Group LMA (n: 20) and Group DLT (n: 20). Demographic data, anesthesia and surgery times, respiratory parameters, surgical feasibility assessment, the postoperative oral intake and mobilization starting times, pain scores, sore throat, nausea-vomiting, air leak, pneumothorax at postoperative follow-ups, and length of hospital stay were compared between groups.
RESULTS: Anesthesia induction time was significantly lower in the LMA group (p<0.001). Maximum EtCO2, minimum SpO2, and maximum respiratory rate were significantly higher in the LMA group (p<0.001). Mean FiO2 and mean TV were significantly higher in the DLT group (p<0.05). There was no statistically significant difference between the two groups in terms of surgical feasibility. There was a significant difference between the time of starting oral feeding and mobilizing (p<0.05). There was no statistically significant difference between pain scores, postoperative complications and length of hospital stay.
DISCUSSION AND CONCLUSION: Our data suggest that LMA NIVATS technique by preserving spontaneous ventilation and establishing iatrogenic open pneumothorax is a feasible and safe strategy in bilateral and uniportal VATS sympathectomy.

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GÝRÝÞ ve AMAÇ: Perkutan dilatasyon trakeostomi yöntemlerinden Griggs (GWDR) ve Ciaglia Blue Rhino’yu (CBR) avantajlarý ve dezavantajlarý ile deðerlendirip birbirlerine üstünlüklerini saptamak.
YÖNTEM ve GEREÇLER: 2015-2016 yýllarý arasýnda ICU’da percutan dilatasyon trakeostomi yapýlan toplam 84 hasta çalýþmaya dâhil edildi. Hastalarýn 42’sine Ciaglia metodu, 42’sine Griggs metodu ile bronkoskopi klavuzluðunda trakeostomi açýldý. Hastalarýn bütün verileri kayýt edildi.di.
BULGULAR: Çalýþma populasyonun yaþ medianlarý 65.5 (16-88) CBR, 66,5 (17-83) GWDR yýldý (p>0.05). CBR grubunda iþlem süresi medyan 4 dk. (range: 3,5-10), GBWR grubunda 4,5 dk. (3,5-11) idi (p>0.05). CBR grubunda toplam 20 hastada minör komplikasyon görülürken, GDWR grubunda 26 hastada minör komplikasyon görüldü. CBR grubunda toplam 13 hastada major komplikasyon görülürken, GDWR grubunda toplam 10 hastada major komplikasyon görüldü. Major ve minör komplikasyonlar her 2 grupta tek tek karþýlaþtýrýldýðýnda anlamlý bir fark yoktu. Her iki grubun iþlem sonrasý ICU’da kalýþ süreleri karþýlaþtýrýldýðýnda GDWR grubunda anlamlý olarak düþüktü (p=0.03). Obezitenin komplikasyon geliþme riskini 22.89 (%95CI: 5.85-89.55, p=0.01) arttýrdýðý gözlendi.
TARTIÞMA ve SONUÇ: Çalýþmada, hem GDWR yöntemi hem de CBR yöntemi arasýnda küçük farklar dýþýnda önemli bir farka rastlanmadý. Her iki yöntemin etkili ve güvenli olduðu gözlendi.

INTRODUCTION: To evaluate Griggs (GWDR) and Ciaglia Blue Rhino (CBR) percutaneous dilatation
tracheostomy methods with their advantages and disadvantages and to determine their
superiority to each other.
METHODS: A total of 84 patients who underwent percutaneous dilatation tracheostomy between 2015 and 2016 were included in the study. Bronchoscopy-guided tracheostomy was performed in 42 patients with Ciaglia method and 42 patients with Griggs method. All data of the patients were recorded.
RESULTS: The median age of the study population was 65.5 (16-88) years in the CBR group and 66.5 (17-83) years in the GWDR group (p>0.05). The median duration of the procedure was 4 minutes (range, 3.5 to 10 minutes) in the CBR group and 4.5 minutes (range, 3.5 to 11 minutes) in the GBWR group (p>0.05). Minor complications were seen in 20 patients in the CBR group and 26 patients in the GDWR group. Major complications were seen in 13 patients in the CBR group and 10 patients in the GDWR group. The comparison of major and minor complications per se in both groups showed no significant difference. The duration of ICU stays after the procedure was significantly lower in the GDWR group compared to the CBR group (p=0.03). It was observed that obesity increased the risk of complications by 22.89% (95% GA, 5.85-89.55, p=0.01).
DISCUSSION AND CONCLUSION: There were no significant differences between GDWR and CBR methods except for small differences. Both methods were found to be effective and safe.

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GÝRÝÞ ve AMAÇ: There were no significant differences between GDWR and CBR methods except for small differences. Both methods were found to be effective and safe.
YÖNTEM ve GEREÇLER: Kasým 2013 - Aralýk 2017 tarihleri arasýnda ciddi aort darlýðý nedeniyle kardiyoloji kliniði tarafýndan TAVÝ iþlemi uygulanan hastalarýn arþiv kayýtlarý incelenerek, uygulanan anestezi yaklaþýmlarý, iþleme ait özellikler ve hasta sonuçlarý deðerlendirildi.
BULGULAR: 100 (50 kadýn/50 erkek) TAVÝ olgusunun 15’ine genel anestezi (GA), 49’una lokal anestezi-sedasyon (LS), 36’sýna lokal anestezi-monitörize anestezi bakýmý (LM) uygulanmýþtý. LM grubunda, anestezi ve iþlem süreleri, GA ve LS gruplarýna göre anlamlý þekilde kýsaydý (p<0.05). Vazoaktif ajan, sývý infüzyonu ve yoðun bakým (YBÜ) kalýþ süreleri GA grubunda yüksekti (p<0.05). Otuz günlük mortalite tüm gruplarda %14 iken, GA grubunda mortalite oraný LS ve LM gruplarýndan anlamlý derecede yüksek bulundu (p=0.007).
TARTIÞMA ve SONUÇ: Teknolojik ilerlemeler ve deneyimlerin artýþýyla, TAVÝ için GA gereksinimi azalmýþ ve saðladýðý avantajlar ile keskin bir þekilde LS ve LM uygulamalarýna kaymýþtýr. Ancak, iyi hasta sonuçlarý için anestezi tekniðinden baðýmsýz olarak, intraoperatif dönemde tüm hastalar yakýn takip edilmelidir.

INTRODUCTION: Transcatheter Aortic Valve Implantation (TAVI) procedure is a minimally invasive technique that have been applied in aortic stenosis pathologies which carry high-risk for conventional surgery. Although there is no definitive consensus on anesthesic applications, general, local anesthesic and sedation techniques are being used. In this study, we aimed to evaluate our anesthesia methods used in TAVI procedures, and their effects on results.
METHODS: The archive records of patients who underwent TAVI procedure due to the severe aortic stenosis between 2013 and 2017 were analyzed. Anesthesic approaches, features of the procedure, and patient outcomes were evaluated.
RESULTS: Of the 100 (50 women/50 men) patients who underwent TAVI, 15 had general anesthesia (GA) (15%), and 49 had local anesthesia with sedation (LS) (49%), and 36 had local anesthesia with monitorized anesthesia care (LM) (36%). In the LM group, the anesthesia and procedure times were significantly shorter compared to the GA and LS groups (p<0.05). Vasoactive agenst, and fluid infusions were used more frequently and intensive care (ICU) stay were prolonged in the GA (p<0.05). While the 30-day mortality was 14% in all groups, the mortality rate in the GA was significantly higher than the LS and LM (p=0.007).
DISCUSSION AND CONCLUSION: With an increase in technological advances and experience, the need GA for TAVI has decreased and the anesthesia technique has shifted sharply to applications of LS and LM with the advantages they provided. However, regardless of the anesthesia technique, all patients should be followed up closely in the intraoperative period for good patient outcomes.

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GÝRÝÞ ve AMAÇ: Kardiyovasküler cerrahide postoperatif infeksiyonlarýn önlenebilmesi preoperatif infeksiyonlarýn
tedavisiyle olasýdýr. Ancak, klinik yakýnmasý olmayan, tüm laboratuvar bulgularý normal alt solunum yolu
veya üriner sistem kolonizasyonu olan kültür (+) hastalarda üzerinde düþünce birliðine varýlmýþ rutin klinik
protokol yoktur. Çalýþmamýzda, klinik muayene, laboratuvar bulgularý normal olan hastalardan preoperatuvar
alýnan trakeal/idrar kültürlerinin sonuçlarýný ve üreme saptanan kolonize hastalarda bunun kliniðe
yansýmasýný irdeledik. Böylece major risk gruplarýný tanýmlamayý, olasý klinik sonuçlarý paylaþmayý amaçladýk.
YÖNTEM ve GEREÇLER: Hastanemizde, Ocak 2016-Haziran 2019 arasýndaki muayene bulgularý ve laboratuvar bulgularý normal olan KVC hastalarýndan ameliyattan önce trakeal/idrar kültürü alýndý. Hastalar retrospektif olarak kültürlerinde üreme olmayan (G-I) ve olan (G-II) 2 gruba ayrýlarak demografik bulgular, risk faktörleri, kros klamp-baypas pompa süreleri, yoðun bakým-hastane yatýþ süresi, kan ürünleri tüketimi, majör komplikasyonlar, sistemik infeksiyon ve mortalite açýsýndan karþýlaþtýrýldý.
BULGULAR: Tüm bulgularýn normal olduðu 307 hastanýn 90’ýnda (%61.11) üreme oldu. Trakeada en sýk Pseudomonas (35), idrardaysa E.coli (13) üredi. Kadýn cinsiyette kolonizasyon anlamlý yüksek bulundu. Komorbiditiler arasýndan DM, HT, kreatinin, albumin, EF, PAP deðerleri arasýnda da fark saptanmazken, sigara içenler ve KOAH’lý hastalar G-II grubunda anlamlý olarak daha fazlaydý. Ek olarak G-II hastalarýn YBÜ/hastane kalýþ sürelerinin daha uzun olduðu, daha fazla kan ürünü tüketildiði, postoperatuvar dönemde daha yüksek oranda infeksiyon geliþtiði saptandý. G-I’de majör komplikasyon olarak tam blok, ciddi aritmi, plevral efüzyon, G-II’deyse plevral efüzyon, ciddi aritmi, geçici iskemik atak, ileus olarak not edildi. Mortalite açýsýndan istatistiki fark saptanmadý.
TARTIÞMA ve SONUÇ: Sigara ve KOAH’ýn KVC operasyonlarýnda ciddi risk faktörleri olduðunu, bu hastalarda ameliyat öncesi alýnacak idrar-trakeal kültürlerin postoperatuvar dönemde infeksiyon sorunu yaþayan hastalarda koruyucu ve yol gösterici olduðuna inanmaktayýz.

INTRODUCTION:
Prevention of postoperative infections in cardiovascular surgery is possible with the treatment of preoperative infections. However, there is no routine clinical protocols agreed on patients without clinical complaints with normal laboratory findings but culture positive cultures and lower respiratory or urinary tract colonizations In our study we examined the clinical implication of asymptomatic patients with normal laboratory findings and colonization in their preoperative tracheal/urine cultures. Hence we aimed to identify major risk groups and share possible clinical results.
METHODS: Tracheal / urine cultures were obtained preoperatively from the CVS patients who had normal examination and laboratory findings between January 2016 - and June 2019 in our hospital. The patients were retrospectively divided into two groups as those having non reproductive (GI) and reproductive (G-II) cultures, and were compared in terms of demographic data, risk factors, cross-clamping/bypass times, intensive care/hospital stay, blood product consumption, major complications, systemic infection and mortality.
RESULTS: Bacterial growth was found in 90 of 307 (61.1 %) patients with normal findings. Most frequently in trachea, Pseudomonas spp., and in urine E.coli were grown. Colonization was found significantly higher in female gender. There was no difference between the groups in terms of DM, HT, creatinine,albumin, EF and PAP values while there was significant difference between smokers and COPD patients. Also, it was found that G-II patients had longer ICU/hospital stay, more frequently required blood products and developed a higher rate of postoperative infection. There was no statistical difference between groups in terms of mortality.
DISCUSSION AND CONCLUSION: We believe that smoking and COPD are serious risk factors in CVS operations,and tracheal/ urine culture samples taken during preoperative period may be the guiding reference to high risk cardiovascular patients such as smokers and COPD who may suffer from postoperative infection.

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GÝRÝÞ ve AMAÇ: Konjenital kalp hastalýklarýnda kompleks kardiyak cerrahi operasyonlarýnýn artýþýyla birlikte, ekstrakorporeal membran oksijenasyonu(ECMO) gibi mekanik destek cihazlarýnýn uygulamasý artmýþtýr. ECMO teknikleri ve yöntemlerindeki önemli geliþmelere raðmen, prognoz hala kötüdür. Bu çalýþmanýn amacý pediyatrik kalp cerrahisi sonrasý venö-arteriyel(VA) ECMO takýlan hastalarý deðerlendirmek ve bu hastalarda organ disfonksiyonu ile mortalite arasýndaki iliþkiyi göstermektir.
YÖNTEM ve GEREÇLER: Kliniðimizde VA-ECMO takýlan ve 48 saatten daha uzun süre takip edilen 63 hasta retrospektif olarak çalýþmaya alýndý ve iki grup oluþturuldu. Grup 1: 30 gün içinde mortal seyreden hastalar(n: 47), Grup 2: Yaþayan hastalar (n: 16). Hastalarýn demografik verileri ile birlikte, ECMO yerleþtirme zamaný, kreatinin, BUN(kan üre nitrojen), ALT(alanin aminotransferaz), AST(aspartat aminotransferaz), bilirubin, albumin ve platelet düzeyleri kaydedildi.
BULGULAR: Çalýþma grubumuzda 36 hasta (%57,1) ECMO’dan ayrýlýrken, bu hastalardan 16’sý (16/63, %25.4) taburcu oldu. Toplamda 47 hasta (47/63, %74.6) eksitus oldu. Grup 1’de univentriküler tamir yapýlan (26/47, %55.31) hasta sayýsý Grup 2’ye göre daha yüksek 5(%31.25) olmakla birlikte, bu fark anlamlý bulunmadý(p>0.05). Grup 1’de 27 hastaya (%57.44%), Grup 2’de ise 4 hastaya (% 31.25 ) postoperatif ECMO yerleþtirilmiþ olup, bu fark istatistiksel olarak anlamlý bulundu (p<0.02). Mortal seyreden Grup 1 hastalarýnda kreatinin, BUN, ALT, AST yüksek iken, albümin ve platelet deðerleri Grup 2 ‘ye göre düþük bulundu(p<0,05).
TARTIÞMA ve SONUÇ: Organ disfonksiyon parametrelerinin mortaliteyi göstermede etkili olduðu ve ECMO’nun postoperatif olarak yerleþtirildiði hastalarda mortalitenin yüksek bulunduðu tespit edilmiþtir.

INTRODUCTION: The application of mechanical support devices such as extracorporeal membrane oxygenation(ECMO) has increased with the increase of complex cardiac surgery operations in congenital heart diseases. Despite significant advances in ECMO techniques and methods, the prognosis is still poor. The aim of this study is to show the relationship between organ dysfunction and mortality in patients with veno-arterial (VA)ECMO after pediatric cardiac surgery.
METHODS: 63 patients in the pediatric cardiac ICU who had VA-ECMO, were followed up to 48 hours in our clinic, were retrospectively included in the study and two groups were formed. In Group1: Patients with mortality in 30 days(n: 47), Group 2: Living patients (n: 16). Along with the demographic data of the patients, ECMO placement time, creatinine, BUN(blood urea nitrogen), ALT(alanine aminotransferase), AST(aspartate aminotransferase), bilirubin, albumin and platelet levels were recorded.
RESULTS: While 36 patients(57.1%) left ECMO in our study group, 16 of these patients (16/63,25.4%) were discharged. A total of 47 patients (47/63, 74.6%) died. Although the number of patients who underwent univentricular repair (26/47,55.31%) in Group 1 was 5(31.25%) higher than Group2, this difference was not significant(p> 0.05). Postoperative ECMO was placed in 27 patients(57.44%) in Group1 and 4 patients(31.25%) in Group2, and this difference was statistically significant (p <0.02). While creatinine, BUN, ALT, AST were higher in Group1 patients who had higher mortality, albumin and platelet values were lower than Group 2(p <0.05).
DISCUSSION AND CONCLUSION: Especially when ECMO was placed postoperatively, these patients mortality was high and organ dysfunction parameters were found to be effective in showing mortality.

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GÝRÝÞ ve AMAÇ: Bu çalýþmada, vücut kitle indeksinin (VKÝ) kardiyak cerrahi sonrasý mortalite ve morbidite üzerine etkilerini deðerlendirdik.
YÖNTEM ve GEREÇLER: Kliniðimizde açýk kalp cerrahisi geçiren 813 hastanýn kayýtlarý retrospektif olarak incelendi. Kayýtlarý eksiksiz olan 555 hasta çalýþmaya dahil edildi. Kayýtlardan vücut kitle indeksi (VKÝ) ≥ 30 kg/m2 ve VKÝ < 30kg/m2 olan hastalarda postoperatif mortalite ve morbidite geliþimleri karþýlaþtýrýldý.
BULGULAR: Hastalarýn 389’u (%70) VKÝ< 30kg/m2 obez olmayan (Grup N), 166’sý VKÝ ≥ 30 kg/m2 obez (Grup OB) idi. Gruplarýn yaþ ortalamalarý (sýrasýyla 59.2±12.5, 59.6±9.6 yýl p=0.65) benzerdi. Kadýn cinsiyet, diabetes mellitus, hipertansiyon, hiperlipidemi Grup OB’de fazla bulundu (p< 0.05). Ýntraoperatif kardiyopulmoner baypas (101±43, 98±42 p=0.26), aort kros klemp (64±32.7, 61.6±32.5 p=0.21) süreleri benzerdi. Postoperatif pulmoner (%19, %10), renal (%13, %9) komplikasyonlar Grup OB’de anlamlý þekilde fazlayken (p<0.05), tamponad (%3.1, %0.6) ve kanama revizyonu (%5.7, %1.8) Grup N’de daha fazla bulundu (p<0.05). Ameliyat sonrasý 27 (%5) hastada mortalite görüldü. Mortalite oranlarý, yoðun bakým ve hastane kalýþ süreleri arasýnda istatistiksel anlamlý fark tespit edilmedi (p<0.05).
TARTIÞMA ve SONUÇ: Obezite, kalp cerrahisi sonrasý solunum sistemi ve renal komplikasyonlarla, düþük vücut aðýrlýðý ise tamponad ve kanama revizyonu gibi morbiditelerle iliþkilidir.

INTRODUCTION: In this study, we evaluated the effects of body mass index on mortality and morbidity after cardiac surgery.
METHODS: The record of 813 patients who performed open-heart surgery in our clinic were retrospectively analyzed. 505 patients with complete records were included in the study. Postoperative mortality and morbidity developments were compared in patients with a body mass index of (BMI) ≥30 kg/㎡ and BMI ≤30 kg/㎡ from the records.
RESULTS: 389 (%70) of patients were BMI < 30 kg/㎡, non-obese (Group N), 166 of them were BMI ≥30 kg/㎡, obese (Group OB). The mean age of groups (59.2±12.5, 59.6±9.6 years, respectively, p = 0.65) was similar. Female gender, Diabetes Mellitus (DM), hypertension, hyperlipidemia were more common in Group OB (p<0.05). Intraoperative cardiopulmonary bypass (101±43, 98±42 p=0.26) and the duration of aortic cross clamp (64±32.7, 61.6±32.5 p=0.21) were similar. Post-operative complications of pulmonary (%19, %10) and renal (%13, %9) were significantly higher in Group OB (p<0.05), tamponade (%3.1, %0.6) and bleeding revision (%5.7, %1.8) were higher in Group N (p<0.05). Mortality occurred in 27 (5%) patients after surgery. There was no significant difference between mortality rates, ICU and hospital stay (p <0.05).
DISCUSSION AND CONCLUSION: High BMI (≥30 kg/㎡) is associated with respiratory system and renal complications after cardiac surgery, and low BMI(< 30 kg/㎡) is associated with morbidities such as tamponade and bleeding revision.

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Abstract | Full Text PDF

Persistan sol süperiyor vena kava (PSSVK) toraksýn en sýk doðumsal venöz anomalisidir. ‘’Ýzole PSSVK’’ olarak da adlandýrýlan sað süperiyor vena kava (SSVK) yokluðuyla birlikte olan PSSVK nadir görülen bir durumdur ve hastalarýn %0.09-0.13’nde bulunduðu tahmin edilmektedir.
SSVK yokluðuyla birlikte olan PSSVK genellikle asemptomatiktir ancak varlýðý ciddi komplikasyonlara yol açabilir. Bu yazýda, iki olguda saptadýðýmýz SSVK yokluðuyla birlikte olan PSSVK’yý ve klinik önemini tanýmladýk.

Persistent left superior vena cava (PLSVC) is the most common congenital venous anomaly of the thorax. PLSVC with absent right superior vena cava (RSVC) which is also termed as ‘’isolated PLSVC’’ is a rare entity and estimated to be present 0.09-0.13% of patients. PLSVC with absent RSVC is usually asymptomatic but its presence can lead to serious complications. In this report, we describe two cases of PLSVC with absent RSVC and its clinical implications.

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Koroner arter baypas cerrahisi (KAB) ameliyatlarýnda serebral perfüzyon çeþitli nedenlerle bozulmaktadýr. Buna ilaveten karotis darlýðýnýn olmasý perfüzyonu daha da bozar. Bu olgu sunumunda, sað karotis arteri tamamen týkalý olan ve sol karotis arterinde de %50-70 darlýðý olan bir hastada kombine KAB ve sað karotid endarterektomi (KEA) cerrahisi sýrasýndaki yönetimimizi sunmayý amaçladýk.

operations. Coexistence of carotid stenosis further disrupts perfusion. In this case presentation, we aimed to present our anesthetic management during combined CAB and right carotid endarterectomy (CEA) surgery in a patient with a completely occluded right carotid artery and a 50-70% stenosis in the left carotid artery.

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