Browsing by Author "Sagbas,E."

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Citation - Scopus: 10
Comparison of Intraoperative Transit-Time Flow Measurement With Early Postoperative Magnetic Resonance Flow Mapping: in Off-Pump Coronary Artery Surgery
(2003) Sanisoglu,I.; Guden,M.; Balci,C.; Sagbas,E.; Duran,C.; Akpinar,B.
The purpose of this prospective study was to evaluate graft patency of off-pump coronary artery surgery intraoperatively by transit-time flow measurement and to compare this technique with postoperative magnetic resonance flow mapping. Twenty patients (13 men and 7 women; mean age, 67.9 ± 7.6 yr) underwent off-pump coronary artery surgery. Intraoperative transit-time flow measurement of grafts was performed measuring maximum, minimum, and mean flows. For each graft, the pulsatile index was calculated by dividing the difference between the maximum and the minimum flow by the mean flow. In the early postoperative period (1st week), magnetic resonance flow mapping was performed using phase contrast flow quantification. Mean intraoperative flow values and mean magnetic resonance flow mapping values were compared. At the same postoperative session, contrast-enhanced magnetic resonance angiography was performed to evaluate graft patency. In 20 patients, a total of 49 coronary graft flows were assessed with intraoperative transit-time flow measurement and postoperative magnetic resonance flow mapping. Upon comparison, there was a strong correlation between techniques, with stable and statistically significant differences between the intraoperative and postoperative flow mapping values. One saphenous vein graft was revised intraoperatively, due to graft failure. Our data suggest that the combined use of intraoperative transit-time flow measurement and postoperative magnetic resonance flow analysis has a potential role in the assessment of graft patency in off-pump coronary artery surgery, although more study is required.
Citation - Scopus: 18
Off-Pump Coronary Artery Bypass Grafting With Use of the Octopus 2 Stabilization System.
(2000) Akpinar,B.; Güden,M.; Sagbas,E.; Sanisoglu,I.; Aytekin,V.; Bayindir,O.
BACKGROUND: The treatment of coronary artery disease has evolved rapidly over the last two decades. The gold standard of surgical revascularization, the on-pump coronary artery bypass graft, has been challenged by the development of percutaneous transluminal coronary angioplasty. Our experience with the alternative of the off-pump ("beating heart") coronary artery bypass (OPCAB) technique during a period of 18 months suggests that OPCAB avoids the complications of cardiopulmonary bypass and offers patients the benefit of long-term graft patency that greatly exceeds that of current endovascular technologies. METHODS: The early results of 126 OPCAB procedures performed through a medial sternotomy incision during a period of 18 months were evaluated. There were 80 male and 46 female patients, with a mean age of 69 +/- 4.3 years. Emergency cases and reoperations were not included. A total of 268 anastomoses were performed, with a mean number of 2.12 anastomoses per patient. Conduits used, with their percentage of use, were: left internal thoracic artery (LITA) (100%), right internal thoracic artery (11.1%), greater saphenous vein (84%), and radial artery (31%). In 72% of the cases, off-pump surgery was chosen because of patient risk factors such as atherosclerotic aortic disease, previous cerebrovascular accident or carotid artery disease, renal dysfunction, malignancy or poor left ventricular function. RESULTS: There was no operative mortality. One-month postoperative mortality was three patients (2.3%). Two died because of mesenteric ischemia, and the other death was due to cardiac failure. Seventy-one patients had a control angiogram before discharge. The patency of LITA anastomosis was 100% while overall patency rate was 95%. In 43 patients for whom an angiogram could not be performed, a Thallum 201 stress test was performed three months postoperatively. Thirty-eight patients had a normal test while five patients showed signs of ischemia. These patients had a control angiogram: in four patients anastomoses were patent, but in one patient there was a severe narrowing of a venous anastomosis to the distal right coronary artery (RCA) which was corrected with angioplasty. In the whole series eight patients (6.3%) refused to have any control examination. CONCLUSIONS: Our early results suggest that off-pump CABG with Octopus 2 (Medtronic, Inc., Minneapolis, MN) can be a good alternative in high risk patients who need multiple vessel revascularization.