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    Changes in aortic pulse wave velocity and the predictors of improvement in arterial stiffness following aortic valve replacement
    (Japanese Association for Coronary Artery Surgery, 2017) Cantürk, Emir; Çakal, Beytullah; Karaca, Oğuz; Omaygenç, Onur; Salihi, Salih; Özyüksel, Arda; Akçevin, Atıf
    Background: The interaction between valvular aortic stenosis (AS) and arterial stiffness, as well as the impact of aortic valve replacement (AVR) on arterial stiffness, remains unclear. In this study, we aimed to evaluate the degree of AS severity on non-invasive pulse wave velocity (PWV) measurements. We also searched whether the AVR procedure favorably affects PWV. Methods: In all, 38 patients undergoing AVR for chronic AS were included. The degree of aortic stiffness was measured with PWV at both baseline and 6 months after AVR. Improvement in aortic stiffness was defined as the absolute decrease in PWV at 6 months compared to the baseline value. Results: The study population had a mean age of 59 ± 16 years, mean aortic gradient of 47.1 ± 6.4 mmHg, and mean aortic valve area (AVA) index of 0.45 ± 0.11 cm²/m². Baseline PWV values correlated positively with the mean aortic gradient (r = 0.350, p = 0.031) and negatively with the AVA index (r = -0.512, p = 0.001). The mean PWV improved in 20 patients (53%) and worsened in 18 patients (47%). The baseline New York Heart Association (NYHA) class (odds ratio [OR] = 1.023, 95% confidence interval [CI] = 1.005–1.041, p = 0.041) and AVA index (OR = 1.040, 96% CI = 1.023–1.057, p = 0.028) emerged as the independent predictors of improvement in PWV following AVR. Conclusion: The severity of AS was significantly associated with baseline PWV. In general, the mean PWV did not change with AVR. Baseline NYHA class and the AVA index independently predicted PWV improvement following AVR. Since the change in PWV after AVR was polarized based on the patients’ characteristics, such as preoperative NYHA functional class or AVA index, further studies are needed to confirm clinical significance of PWV change following AVR in severe AS patients.
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    Durability of mitral valve repair: A single center experience
    (Bayçınar Medical Publishing, 2019) Salihi, Salih; Güden, Mustafa
    Background: This study aims to present clinical outcomes of mitral valve repair in patients with different etiologies. Methods: Between June 2006 and August 2017, a total of 421 consecutive patients (266 males, 155 females; mean age 53.1±15.6 years; range, 5 to 89 years) who underwent mitral valve repair with or without concomitant cardiac procedures were retrospectively analyzed. All pre-, intra-, and postoperative data were collected. Echocardiographic examinations were performed at discharge and during follow-up. Kaplan-Meier analysis was used to estimate overall survival and from residual severe mitral regurgitation, endocarditis and reoperation-free survival rates. Results: The mean follow-up was 58.9±35.1 months. Of the patients, 12 (2.8%) had previous cardiac operations. The most predominant pathology was degenerative disease in 265 patients (62.9%). Repair techniques included ring annuloplasty (n=366, 86.9%), artificial chordae implantation (n=185, 44%), and commissurotomy (n=38, 9%). Overall in-hospital mortality rate was 1.2% (n=5). Echocardiography before discharge showed no/trivial mitral regurgitation in 64.9% (n=270) and mild mitral regurgitation in 34.85% (n=145) of the patients. At the late postoperative period, transthoracic echocardiography revealed moderate mitral regurgitation in 23 patients (5.7%) and severe in 11 patients (2.7%). The mean late survival and freedom from endocarditis, reoperation, and recurrent severe mitral regurgitation rates were 92±0.03%, 98.5±0.07%, 98.1±0.01%, and 94.7±0.02%, respectively. Conclusion: Our study results suggest that mitral valve repair is a safe and effective procedure associated with favorable longterm outcomes in experienced centers.
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    Effectiveness of artificial neochordae implantation in tricuspid valve repair
    (Texas Hearth Inst, 2019) Salihi, Salih; Kızıltan, Hidayet Tarık; Huraibat, Ahmad; Korkmaz, Aşkın Ali; Kara, İbrahim; Güden, Mustafa
    Various techniques for treating tricuspid regurgitation have been described; however, because of scarce data about the long-term outcomes of different repairs, the optimal technique has not been established. We evaluated the effectiveness and durability of artificial neochordae implantation in the treatment of tricuspid regurgitation. From 2009 through 2014, 507 patients underwent tricuspid valve repair at our institution. Of those, 48 patients implanted with artificial neochordae were included in our study. The median age of the participants was 62 years (range, 4-77 yr) and 50% were women. Thirty patients (63%) were in New York Heart Association functional class III, and 11 (23%) were in class II. The cause of tricuspid regurgitation was functional in 33 patients (69%) and rheumatic in 15 (31%). In 46 patients, neochordae implantation was performed in addition to Kay annuloplasty (n= 13) or ring annuloplasty (n= 33). Forty-two patients were discharged from the hospital with absent or mild tricuspid regurgitation. The mean follow-up period was 44.3 +/- 20.2 months. Follow-up echocardiograms revealed that tricuspid regurgitation was absent, minimal, or mild in 38 patients (80.8%), moderate in 7, and severe in 2. Our results indicate that the use of artificial neochordae implantation as an adjunct procedure to annuloplasty leads to effective and durable repair in comparison with conventional techniques for treating tricuspid regurgitation.
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    Repair of complex mitral valve pathologies: Is it worth to cope with?
    (Sağlık Bilimleri Üniversitesi, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi, 2018) Salihi, Salih; Kızıltan, H. Tarık; Korkmaz, Aşkın Ali; Güden, Mustafa
    Introduction: Mitral valve (MV) repair is preferred over replacement for its benefits of preservation of ventricular function, lower operative mortality, superior long-term survival, and avoidance of anticoagulation. In this study, we aimed to review the repair techniques of complex MV pathologies and their outcomes. Patients and Methods: We retrospectively analyzed 56 patients (mean age 41.8 ± 16.5 years; 33 males) who underwent repair of complex MV pathologies. 44 patients had pure mitral regurgitation (MR), and 12 (21.4%) had mixed mitral disease (mitral stenosis (MS) + MR). Preoperative and operative characteristics, postoperative MR severity, operative mortality, and midterm survival were examined for each patient. Results: There was only one early death (30-day mortality: 1.8%) due to postoperative low cardiac output syndrome. The procedures were successful in all patients who underwent MV repair. Transthoracic echocardiography examinations revealed no/trivial MR in 74.6% and mild MR in 21.8% of patients at discharge. Late follow-up was obtained in 55 patients. The mean follow-up period of patients was 47.9 ± 23.1 months. Mortality developed in one (1.8%) patient with Marfan syndrome who had acute aortic dissection three years after MV surgery. During follow-up visits, mitral repair procedures were successful in 49 (90.7%) patients. Four (7.4%) patients presented with moderate MR. Only one (1.9%) patient needed reoperation because of severe MR. Conclusion: This study showed that repair of complex MV pathologies provides excellent surgical outcomes. Repair of complex MV pathologies is safe and highly effective, but operations require considerable surgical experience.