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Biomedical subjects

A Vargas

Publications and source records attributed to A Vargas.

At least 91 records · Page 5Linked to original sources
PubMed1976

Myocardial revascularization after acute myocardial infarction.

Revascularization of the myocardium was performed in 25 patients two to eight hours after acute myocardial infarction (MI). The intra-aortic balloon pump was used in 11 patients. Thirteen patients received revascularization within four hours of onset of MI; all survived the operation. Seven patients were studied postoperatively; ten of 12 grafts (83%) were patent. There was a considerable decrease in left ventricular (LV) dyskinesis and an improvement in LV function. Among 12 patients in whom revascularization was performed for more than four hours' duration after the onset of MI, ten survived. Six were studied postoperatively; six of nine grafts (66%) were patent. There was an increase in LV dyskinesis, with deterioration in LV function. In three patients, ECG evidence of Q wave persisted in spite of absence of dyskinesis postoperatively. The interval during which revascularization of acute infarction produces acceptable results in less than four hours.

Adult↗
PubMed1976

Clinical and hemodynamic criteria for use of the intra-aortic balloon pump in patients requiring cardiac surgery.

In order to establish criteria for elective use of the intra-aortic balloon pump (IABP) in patients having cardiac surgery, we conducted a retrospective study of 43 patients who required counterpulsation, because of inability to be weaned from cardiopulmonary bypass, between May, 1972, and June, 1974. Patients in cardiogenic shock preoperatively were excluded. The 43 patients included 23 (Group A) who had severe preoperative left ventricular dysfunction with a mean cardiac index less than 1.8 L. per minute per square meter, ejection fraction less than 30 per cent, and end-diastolic pressure greater than 22 mm. Hg; 20 patients (Group B) had a combination of moderate cardiac dysfunction (cardiac index less than 2.2, ejection fraction less than 40, end-diastolic pressure less than 18) in the presence of acute infarction or severe aortic stenosis (gradient greater than 80 mm. Hg) with or without coronary disease. An inverse relationship was noted between survival and delay from completion of operation to the use of 1ABP. Thirty-two of 43 patients were weaned off bypass and were balloon assisted for 12 to 96 hours postoperatively; 25 patients were discharged (58 per cent). In Subgroup A, 14 of 23 (60 per cent) and, in Subgroup B, 9 of 20 (45 per cent) were long-term survivors. Based on these findings, 45 patients were operated upon between June, 1974, and December, 1975, with elective use of 1ABP and were assessed by serial hemodynamic studies. Sixteen had severe preoperative left ventricular dysfunction similar to Subgroup A and 29 had moderate dysfunction in combination with pathology similar to Subgroup B. Fifteen of these patients were hemodynamically unstable at time of arrival in the operating room; 1ABP was inserted under local anesthesia. Thirty-nine patients (87 per cent) were weaned off bypass and were hospital survivors. In Subgroup A, 13 of 16 (81 per cent) and, in Group B, 21 of 29 (72 per cent) were long-term survivors. Criteria for elective use of 1ABP in cardiac surgery should include severe preoperative left ventricular dysfunction or a combination of moderate dysfunction with coronary or valvular pathology. Elective 1ABP improves the survival with trivial iatrogenic morbidity.

Assisted Circulation↗
PubMed1975

Results of direct coronary artery surgery in women.

In the past 4 years, among 260 patients receiving coronary bypass grafts for coronary artery disease and stable angina pectoris, there were 34 women (13 per cent). The operative mortality rate for women was 8 per cent (3 of 34), and one late death due to myocardial infarction occurred in spite of a patent coronary bypass graft. The intraoperative infarction rate was 20 per cent (6 per cent in men). Although preoperative cardiac pump and muscle function parameters were better in women than in men (p less than 0.05), postoperatively only 30 per cent of women showed improvement in function as compared with 50 per cent of men. At 6 to 46 months' follow-up, 84 per cent of women were free of angina in contrast with 94 per cent of men. The early (4 month) graft patency rate was 50 per cent (14 of 27 grafts), as opposed to 80 per cent (20 of 25 grafts) in men. These results indicate that, although coronary artery disease shows anatomic similarity in women and men, the result of coronary revascularization in women is inferior to that in the male population.

Adult↗
PubMed1975

Role of coronary artery surgery in patients surviving unexpected cardiac arrest.

During the past 3-1/2 years, 101 of 199 patients who were successfully resuscitated by fire rescue squads in the community after unexpected cardiac arrest (documented ventricular fibrillation--VF) were admitted to the hospital. Forty-two of these patients ultimately were discharged from the hospital. However, the intermediate and long-term results were disappointing, for their mean survival after discharge was only 12.7 months. Sudden deaths (recurrent unexpected VF) occurred during the first 12 months after discharge in 28 percent of the patients surviving the initial hospitalization. Among the survivors of sudden and unexpected VF (i.e., survivors of the initial hospitalization), 16 patients who had had pre-existing symptoms of coronary heart disease had hemodynamic and coronary angiographic studies. Of these, 11 were considered surgical candidates. This report concerns the follow-up results in these patients with particular emphasis on the eight patients who accepted surgery and had myocardial revascularization. Five patients had moderate hemodynamic abnormalities, but none had had an acute myocardial infarction at the time of the initial arrest. The group of eight patients had a total of 18 vein graft bypasses performed. The significant findings is that all eight survived operation, and there was one late death at 10 months. The remaining patients are alive at 14 to 34 months, and six are free of symptoms. Despite patent vein grafts, one patient has had a second serious arrhythmia. It is concluded that surgical intervention can be done safely and may decrease the high posthospitalization, recurrent arrest, and mortality rates in selected survivors of unexpected cardiac arrest. It is concluded further that all patients sustaining an unexpected arrest should have postarrest coronary catheterization and angiography, and all patients should be on antiarrhythmic agents whether or not they receive myocardial revascularization.

Adult↗