Person: KARARMAZ, ALPER
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KARARMAZ
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ALPER
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Publication Open Access EPIDURALS, INTRAOPERATIVE FLUID ADMINISTRATION, AND HYPOTENSION Reply(MOSBY-ELSEVIER, 2015-07) KARARMAZ, ALPER; Arslantas, Mustafa Kemal; Kararmaz, Alper; Batirel, Hasan FevziPublication Metadata only Direct transaortic transcatheter aortic valve implantation(BAYCINAR MEDICAL PUBL-BAYCINAR TIBBI YAYINCILIK, 2014) KARARMAZ, ALPER; Isbir, Selim; Birkan, Yasar; Ak, Koray; Elci, Emre; Kararmaz, AlperTranscatheter aortic valve implantation (TAVI), has emerged as a new treatment option in patients with severe aortic stenosis who are considered to be high-risk for conventional surgery. In recent years, TAVI has been widely used in Turkey as in all the world. Transaortic approach for TAVI is a new approach in patients with poor peripheral vessels. In this article, we report a 82-year-old female case with severe aortic stenosis and coronary artery disease presenting with several comorbidities who was treated with direct transaortic TAVI and off-pump coronary artery bypass grafting for the first time in Turkey.Publication Metadata only Renal Resistive Index Measurement by Transesophageal Echocardiography: Comparison With Trans lumbar Ultrasonography and Relation to Acute Kidney Injury(W B SAUNDERS CO-ELSEVIER INC, 2015) KARARMAZ, ALPER; Kararmaz, Alper; Arslantas, Mustafa Kemal; Cinel, IsmailObjectives: The aim of this study was to evaluate the relationship between transesophageal ultrasonography-derived renal resistive index values (RRITEE) and a standard translumbar renal ultrasound-derived RRI (RRITLUSG). The effectiveness of each method to predict acute kidney injury (AKI) after cardiac surgery also was compared. Design: A prospective observational study. Setting: A teaching university hospital. Participants: Sixty patients undergoing cardiac surgery. Interventions: First, RRI was measured with both methods after anesthesia induction. Second, another measurement was performed with TEE after cardiopulmonary bypass and immediately following the surgery with translumbar ultrasound. To test the correlation between the 2 methods and to plot a Bland-Altman graph, preoperative RRI values measured by both techniques were used. Receiver operating characteristic curves also were plotted to compare the diagnostic values of RRI measured intraoperatively by TEE after cardiopulmonary bypass and by RRITLUSG after surgery. Measurements and Main Results: There was a statistically significant correlation between the 2 RRI measurement approaches (r = 0.86, p < 0.0001). The Bland-Altman plot indicated good agreement between the methods. The area under the curve (AUC) of RRITEE in predicting AKI was 0.82 (95% confidence interval (Cl] = 0.64-0.9, p = 0.001), and the AUC of RRITLUSG after surgery was 0.85 (95% Cl = 0.7-0.98, p < 0.0001). In predicting AKI, an uncertainty zone for RRITEE values between 0.68 and 0.71 was computed by the gray-zone approach. Conclusions: RRITEE showed clinically acceptable agreement with RRITLUSG. Indeed, RRI measured intraoperatively with TEE was comparable to RRITLUSG in terms of detecting postoperative AKI. (C) 2015 Elsevier Inc. All rights reserved.Publication Open Access Prognostic value of the lactate-albumin difference for predicting in-hospital mortality in critically ill patients with sepsis(2022-01-01) ÇORMAN DİNÇER, PELİN; KARARMAZ, ALPER; Tore Altun G., Arslantas M. K., ÇORMAN DİNÇER P., Arslantas R., KARARMAZ A.Objective: To evaluate the prognostic performance of the lactate–albumin difference (LAD), maximum lactate levels, and the Sequential Organ Failure Assessment (SOFA) score taken on the first day in critically ill patients with sepsis, on in-hospital mortality and 90-day survival. Patients and Methods: Data from the Medical Information Mart for Intensive Care III (MIMIC III) version 1.4 were evaluated retrospectively. The first day data of adult patients with sepsis diagnosed according to the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) criteria were recorded. The effectiveness of all diagnostic modalities on admission was analyzed to predict in-hospital mortality and 90-day survival. Results: In-hospital mortality was 20.3% among the 2270 patients included in this study. The area below the receiver operating characteristic curve (AUC) value of the LAD was higher than lactate for predicting mortality (AUC, 0.691; 95% confidence interval [CI], 0.663–0.718; p< 0.01, and AUC, 0.675; 95% CI, 0.646–0.703; p< 0.01, respectively), and the AUC of SOFA score was the highest (AUC, 0.716; 95% CI, 0.663–0.718). The optimal cutoff of LAD was 0.7. Conclusion: In addition to its easy and simple calculability relative to the SOFA, the prognostic performance of LAD was superior to maximum lactate levels for predicting in-hospital mortality and 90-day survival in adult patients with sepsis.Publication Metadata only İntraoperatif dönemde transözefageal ekokardiyografi ile ilk kez ventriküler septal defekt tanısı konan olgu(2017-05-27) ORHON ERGÜN, MELİHA; KARARMAZ, ALPER; ORHON ERGÜN M., KARARMAZ A., HIZAL A.Publication Metadata only Transatrial balloon atrial septostomy to facilitate weaning off venoarterial ECMO after pulmonary endarterectomy(2022-10-01) AK, KORAY; TİRE, YAKUP; KARARMAZ, ALPER; YILDIZELİ, BEDRETTİN; AK K., Arslanhan G., TİRE Y., Tosun S., KARARMAZ A., HANTA İ., YILDIZELİ B.Atrial septostomy has been the last resort in the management of patients with the right ventricular failure related to pulmonary hypertension before lung transplantation. In this paper, we present a simple and safe technique (transatrial approach) for balloon atrial septostomy in a patient who required central venoarterial extracorporeal membrane oxygenation after pulmonary endarterectomy.Publication Metadata only Comparison of bretschneider HTK and blood cardioplegia (4:1): A prospective randomized study(2023-01-01) AK, KORAY; KARARMAZ, ALPER; ARSAN, SİNAN; AK K., Dericioǧlu O., Midi A., KARARMAZ A., ER Z. C., Doǧusan Z., ARSAN S.Background We compared the effect of intermittent blood and histidine-tryptophan-ketoglutarate (HTK) solution of Bretschneider on myocardial histopathology and perioperative outcome. Methods Forty adult cardiac surgery patients were grouped into two (n = 20 for each): (1) Intermittent blood cardioplegia (IBC): had repeated cold 4:1 blood cardioplegia and (2) HTK: had a single dose of cold HTK for cardioprotection. Creatine kinase (CK)-MB, Troponin-I (cTn-I), pH, and lactate were studied in coronary sinus blood before and after aortic cross-clamping (AXC) and systemic blood at postoperative 6th, 24th, and 48thhours. Myocardial biopsy was performed before and after AXC for light microscopy. Vacuolation, inflammation, edema, and glycogen were graded semiquantitatively (from 0 to 3). The myocardial apoptotic index was evaluated via the terminal deoxynucleotidyl transferase dUTP nick end labeling. Results There were no differences in perioperative clinical outcomes between the groups. The coronary sinus samples after AXC were more acidotic (7.15 ± 0.14 vs. 7.32 ± 0.07, p = 0.001) and revealed higher CK-MB (21.0 ± 12.81 vs. 12.60 ± 11.80, p = 0.008) in HTK compared with IBC. The HTK had significantly a higher amount of erythrocyte suspension intraoperatively compared with IBC (0.21 ± 0.53 vs. 1.68 ± 0.93 U, p = 0.001). Microscopically, myocardial edema was more pronounced in HTK compared with IBC after AXC (2.25 ± 0.91 vs. 1.50 ± 0.04, p = 0.013). While a significant increase in the apoptotic index was seen after AXC in both groups (p = 0.001), no difference was detected between the groups (p = 0.417). Conclusion IBC and HTK have a similar clinical outcome and protective effect, except for more pronounced myocardial edema and increased need for intraoperative transfusion with HTK.Publication Metadata only Direct Transapical Implantation of an Endocardial Pacing Lead to the Left Ventricle: An Alternate Pacing Site After Tricuspid Valve Replacement(WILEY-BLACKWELL, 2014) ÇİNÇİN, AHMET ALTUĞ; Ak, Koray; Isbir, Selim; Cincin, Altug; Kararmaz, Alper; Arsan, SinanIn this paper, we report an alternative approach for implantation of ventricular pacing lead for complete atrioventricular block after tricuspid valve replacement. doi: 10.1111/jocs.12288 (J Card Surg 2014;29:290-292)Publication Open Access Effect of the amount of intraoperative fluid administration on postoperative pulmonary complications following anatomic lung resections(MOSBY-ELSEVIER, 2015-01) KARARMAZ, ALPER; Arslantas, Mustafa Kemal; Kara, Hasan Volkan; Tuncer, Beliz Bilgili; Yildizeli, Bedrettin; Yuksel, Mustafa; Bostanci, Korkut; Bekiroglu, Nural; Kararmaz, Alper; Cinel, Ismail; Batirel, Hasan F.Objective: Excessive fluid administration during lung resections is a risk for pulmonary injury. We analyzed the effect of intraoperative fluids on postoperative pulmonary complications (PCs). Methods: Patients who underwent anatomic pulmonary resections during 2012 to 2013 were included. Age, weight, pulmonary function data, smoking (pack-years), the infusion rate and the total amount of intraoperative fluids (including crystalloid, colloid, and blood products), duration of anesthesia, hospital stay, PCs, and mortality were recorded. PCs were defined as acute respiratory distress syndrome, need for intubation, bronchoscopy, atelectasis, pneumonia, prolonged air leak, and failure to expand. Univariate analyses and multivariate logistic regression were performed. A Lowess curve was drawn for intraoperative fluid threshold. Results: In 139 patients, types of resections were segmentectomy-lobectomy (n = 69; extended n = 37; video-assisted thoracoscopic surgery n = 19) and pneumonectomy (n = 9; extended n = 5). One hundred sixty-one PCs were observed in 76 patients (acute respiratory distress syndrome [n = 5], need for intubation [n = 9], atelectasis [n = 60], need for bronchoscopy [n = 19], pneumonia [n = 26], prolonged air leak [n = 19], and failure to expand [n = 23]). Overall mortality was 4.3% (6 out of 139 patients). Mean hospital stay was 8.5 +/- 4.8 days. Univariate analyses showed that smoking, intraoperative total amount of fluids, crystalloids, blood products, and infusion rate as well as total amount of crystalloids and infusion rate during the postoperative first 48 hours were significant for PCs (P = .033, P < .0001, P = .001, P = .03, P < .0001, P = .002, and P < .0001, respectively). In multivariate logistic regression analysis intraoperative infusion rate (P < .0001) and smoking were significant (P = .023). An infusion rate of 6 mL/kg/h was found to be the threshold. Conclusions: The occurrence of postoperative PCs is seen more frequently if the intraoperative infusion rate of fluids exceeds 6 mL/kg/h.Publication Metadata only Aort kapak replasmanı yapılan bir hastada protez kapaktaki yetmezliğin erken dönemde transözefageal ekokardiyografi ile tanınması(2017-05-28) ORHON ERGÜN, MELİHA; KARARMAZ, ALPER; ORHON ERGÜN M., KARARMAZ A., altıntaş m.