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Biomedical subjects

B W Lytle

Publications and source records attributed to B W Lytle.

162 records · Page 9Linked to original sources
PubMed1980

Isolated left anterior descending coronary atherosclerosis: long-term comparison of internal mammary artery and venous autografts.

A consecutive series of 100 patients receiving left internal mammary artery grafts and a consecutive series of 100 patients receiving saphenous vein grafts as treatment of isolated left anterior descending coronary artery stenosis were reviewed to determine survival, graft patency, disease progression and New York Heart Association functional class. The mean follow-up was 67 months, and the mean catheterization interval was 20 months. Recommendations for revascularization can be made selectively to patients with critical isolated left anterior descending stenoses who have limiting symptoms and large areas of viable myocardium at risk.

Angina Pectoris↗
PubMed1979

Atherosclerosis of the left main coronary artery: 5 years results of surgical treatment.

Three hundred consecutive patients received coronary arterial bypass grafts as treatment for stenosis of the left main coronary artery. Ostial stenosis was more prevalent among women (P less than 0.001). Operative (hospital) mortality was 4 percent (12 of 300). Among 148 survivors who underwent recatheterization after a mean interval of 16.5 months, the graft patency rate was 88 percent. After a minimal follow-up period of 49 months and a mean interval of 69 months, 75 percent of the survivors were asymptomatic and 94 percent were employed or fully active. The actuarial 5 year survival rate was 88.2 percent. The presence of right coronary artery disease, abnormal preoperative ventricular function and incomplete revascularization adversely affected survival, but the differences did not reach statistical significance. Comparison of this long-term follow-up study with controlled and noncontrolled studies of nonsurgical treatment of obstructions of the left main coronary artery indicates that myocardial revascularization alleviates cardiac symptoms and increases life expectancy in patients with severe atherosclerosis of this artery.

Adult↗
PubMed1979

Autotransfusion following cardiac operations: a randomized, prospective study.

To evaluate the safety and effectiveness of the collection and retransfusion of postoperatively shed mediastinal blood as part of a multifaceted approach to blood conservation following cardiac operation, 113 patients were randomized into either an autotransfusion group (54 patients) or a control group (59 patients). Intraoperative and postoperative hemodilution was practiced in all patients. The clinical safety of this technique was confirmed by the lack of septic, hematological, pulmonary, renal, or hepatic complications. However, in this setting where blood conservation is already aggressively practiced, the ability of the technique to further reduce the use of banked blood following cardiac surgical procedures was not demonstrated.

Adult↗
PubMed1979

Blood conservation during myocardial revascularization.

A prospective study of blood utilization in 50 consecutive patients undergoing elective coronary artery bypass was undertaken. Blood was removed from all patients during induction of anesthesia and reinfused after bypass (mean, 675 ml). Intraoperatively, all discard suction was routed through a regionally heparinized collecting and processing system, and the resulting red cell concentrate was transfused. At the conclusion of bypass, all blood remaining in the pump oxygenator was retained for transfusion. After operation, shed mediastinal blood was collected in a sterile, filtered collection system and transfused. Normovolemic anemia was accepted in hemodynamically stable patients. The mean amount of patients' blood salvaged by the intraoperative system was 259 ml (range, 0 to 724 ml) and by the postoperative system, 194 ml (range, 0 to 564 ml). Ninety-four percent (47/50) of the patients received no bank blood or blood products during their hospital stay. No patients received bank blood intraoperatively or during the first 24 hours following operation. There were no complications attributable to blood salvage techniques.

Adult↗
PubMed1979

An 11 year evolution of coronary arterial surgery (1968-1978).

All patients who underwent isolated myocardial revascularization procedures from 1967-70 (n = 741) were compared with the first 1,000 patients who received similar elective operations each year from 1971 through 1978. Data from these eight years were processed through a computerized cardiovascular information registry. Median age increased from 50 to 56 years, multiple-vessel disease increased from 44 to 89%, and left ventricular asynergy from 41 to 54%. The number of grafts per patient increased from 1.5 to 2.5 and yet morbidity declined in every category except neurologic deficit. Operative mortality was 1.1% from 1967 through 1978 and 0.9% from 1971 through 1978. Graft patency was determined for 475 patients from 1967-70, 553 patients from 1971, 519 from 1972, and 540 from 1973. Patency rates after a mean catheterization interval of 21 months were 77, 77, 84, and 87% respectively. Higher graft patency coincides with introduction of the internal mammary artery graft. Five year follow-up was completed for the 1967-1970 series and 1971, 1972, and 1973 cohorts. Actuarial five year survival was 89.6, 91.6, 93.2, and 91.7%. Five year survival comparisons between 1967-1970 patients and 1971-1973 patients in single-, double-, and triplevessel disease categories show significant extended longevity in the later experience. Abnormal ventricular function and incomplete revascularization adversely influenced longevity (p < 0.05) in all years surveyed. In those series the percentage of asymptomatic patients at five years was 66, 65, 69, and 67%. Lower risk and higher five year survival are attributed to greater technical experience, changing technology, and improved management rather than to selection of lower risk cases.

Aged↗
PubMed1979

Asymptomatic coronary artery disease managed by myocardial revascularization: results at 5 years.

A consecutive series of 17 patients surgically treated for asymptomatic coronary artery disease was surveyed for survival, clinical status, and graft patency after a mean follow-up of 75 months. Documented myocardial infarction (MI), 14 transmural and 3 subendocardial, was the major indication for catheterization. All patients were asymptomatic for at least 4 months prior to surgery. Six patients had greater than 70% obstruction in one vessel, seven in two vessels, and four in three vessels. The indication for revascularization was critical stenoses in vessels supplying large areas of viable myocardium. All patients received left internal mammary artery (LIMA) grafts to the left anterior descending coronary artery; seven patients also received saphenous vein grafts (SVG) to other vessels. There was no operative or late mortality. In 12 patients, postoperative angiography (mean interval, 12 1/2 months) showed 11/12 LIMA and all SVG patent. One incompletely revascularized patient with an occluded LIMA is symptomatic. All others are fully active without symptoms or interval MI after a minimum follow-up of 5 1/2 years. The safety and long-term results of myocardial revascularization warrant its consideration for selected asymptomatic postinfarction patients.

Adult↗
PubMedDate not supplied

Transesophageal echocardiographic guidance of closed mitral commissurotomy.

We describe the utility of transesophageal echocardiography in a patient undergoing emergent closed mitral commissurotomy. Two-dimensional images provided an assessment of valve morphology and mobility while Doppler echocardiography was used to monitor the occurrence of mitral regurgitation and changes in valve gradient and area.

Adult↗
PubMedDate not supplied

A novel synthetic sealant to treat air leaks at cardiac reoperation.

PURPOSE: Pulmonary injury with resultant air leak is common at cardiac reoperation. Sequelae of this complication include prolonged chest tube drainage and time to ambulation, extended hospitalization and increased costs, and mediastinitis. The purpose of this study was to test the efficacy of a new synthetic absorbable sealant at treatment air leaks occurring at cardiac reoperation. PATIENTS AND METHODS: Fifteen patients having cardiac reoperation had lung injuries repaired with FocalSeal-L Sealant (Focal, Inc., Lexington, MA). Mean age was 61+/-15 years, and mean interval from the previous to the current operation was 44+/-38 months. RESULTS: In all patients, FocalSeal-L Sealant was successful at sealing intraoperative air leaks. Postoperatively, 73% of patients had no air leak. Four patients (27%) developed a recurrent air leak, three on postoperative day 1 and one on postoperative day 2. In three of these patients, the air leak sealed within 3 days. In the fourth patient, an immunosuppressed heart transplant recipient with mediastinitis, the air leak never sealed; that patient died of sepsis after an omental flap failed to control the air leak. In patients without air leak, chest tubes were removed on postoperative day 1 (9 patients) or 2 (1 patient). CONCLUSION: This novel synthetic sealant prevents postoperative air leaks in the majority of patients suffering lung injury at cardiac reoperation.

Biocompatible Materials↗
PubMedDate not supplied

Thoracic aortic disease: evaluation using a single MRA volume series.

OBJECTIVE: Use of MRA for thoracic aortic disease (TAD) evaluation has been limited. This report describes an initial experience with TAD evaluation using a single MRA volume series. MATERIALS AND METHODS: A single volume series, based on sequential 2D TOF MRA, was acquired in 30 cases (28 with suspected TAD and 2 normals). Each series was processed using multiplanar reconstruction (MPR) and maximum intensity projection (MIP); resulting tomographic (one base and two MPR) and MIP sets were blindly interpreted by four reviewers to detect TAD and, if present, to diagnose its specific form. For cases incorrectly interpreted, the standard MR images were subsequently interpreted. RESULTS: The TAD categories included aneurysm (n = 13), dissection (n = 9), and arch anomalies (n = 5). Sensitivities were high for TAD overall (89-100%) and TAD in ascending and descending portions; sensitivities were lower for TAD of the arch (two of four reviewers > or = 90% for TAD overall and descending TAD). Specificities for TAD overall had a wider range (67-100%), but were high for ascending, arch, and descending portions (three to four of four reviewers > or = 90% for each). Sensitivities for aneurysms (69-92%) and dissections overall (67-100%) were comparable, as they were in ascending and arch portions; descending dissection was better detected than descending aneurysm (two of four reviewers > or = 90% for ascending or arch aneurysm and for descending dissection); overall specificities (88-100 vs. 81-95%) and specificities in ascending, arch, and descending portions were also comparable (three to four of four reviewers > or = 90% for both in each portion; two of four reviewers > or = 90% for dissection overall). Each reviewer achieved > or = 70% diagnostic accuracy for TAD (one of four reviewers = 85%); accuracies for each category were comparable. Interpretation of standard MR images corrected all detection and most diagnostic (> or = 63%) errors. CONCLUSION: This initial experience with conventional TOF MRA for TAD evaluation is encouraging, but it indicates the potential for advancements in data acquisition and/or postprocessing.

Adolescent↗