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Biomedical subjects

D A Killen

Publications and source records attributed to D A Killen.

At least 37 records · Page 2Linked to original sources
PubMed1982

Coronary artery bypass in women: long-term survival.

During a 6-year period ending December, 1976, 385 female patients underwent coronary artery bypass at the Mid-America Heart Institute. This group constituted 14.6% of the total experience. The operative (thirty day) mortality was 1.3%, which is not significantly greater than that experienced by male patients operated on concurrently. A total follow-up of 2,015 patient-years was obtained. The incidence of nonfatal acute myocardial infarction was 2.0 per 100 patient-years of follow-up, and the incidence of repeat coronary artery bypass was 0.8 per 100 patient-years. The actuarial survival was 90% at 5 years and 75.3% at 10 years. Of the 46 deaths (early or late), 58.7% were cardiac in nature. Although the absolute survival of women is as good as that observed in men, the female patients did not achieve the expected survival pattern of a matched (for age and sex) general population as is observed in our male patients undergoing coronary artery bypass. These results obtained with coronary artery bypass justify the use of similar criteria for the application of this therapy in men and women.

Actuarial Analysis↗
PubMed1982

Normal survival curve after coronary artery bypass.

A consecutive series of 2,628 patients subjected to isolated coronary artery bypass have had follow-up for a total of 13,915.5 patient-years. The number of patients surviving without angina decreased from 81% at one year to 36.9% at nine years after operation. Nonfatal myocardial infarction occurred at a rate of 3.1% per year, and the incidence of repeat coronary artery bypass was approximately 1% per year. The ratio of the five-year actuarial survival to that expected for a normal population, matched by age and sex, was 1.03 for single vessel disease, 1.00 for double vessel disease, and 1.00 for triple vessel disease. The survival ratio at ten years postoperatively was 1.13, 0.99, and 0.85 for single, double, and triple vessel disease, respectively. Cardiac causes accounted for 44.4%, 68.9%, and 65.7% of deaths in patients with single, double, and triple vessel disease, respectively.

Adult↗
PubMed1982

Operative experience with 50 thoracic aortic dissections.

From 1971 to 1981, 46 patients were subjected to 50 operations (graft replacement, 31; patch aortoplasty, ten; suture aortorraphy, six; bypass, one; and nonthoracic vascular procedure, two) for thoracic aortic dissection. Four patients had two separate dissections. Dissections were classified as type A (ascending thoracic aortic, 38) or type B (descending thoracic aortic, 12) and subgrouped as acute (less than 2 weeks) or chronic (greater than 2 weeks). There were seven hospital deaths and an operative mortality of 14%. The operative mortality for acute type A dissections was 20% and for chronic type A, 7%. There was one operative death in the 12 type B dissections. Four of the seven deaths occurred in patients with an iatrogenic dissection. Overall cumulative survival was 70% at four years, but dropped to 45% at six years. Survival was poorest in the acute type A group and was only 38.9% at five years.

Adolescent↗
PubMed1982

Myocardial revascularization: results relative to extensiveness.

We analyzed 13,788 patient-years of follow-up of 2,628 consecutive patients who had had primary isolated coronary artery bypass. We then assessed late results relative to the number of coronary artery bypasses done. There were no significant differences in the incidence of survival, angina-free status, nonfatal acute myocardial infarction, repeat coronary artery bypass, or cardiac deaths relative to the number of bypasses in patients with single or double vessel disease. Patients with three vessel disease had significantly increased incidence of angina-free status and significantly decreased incidences of nonfatal acute myocardial infarctions and repeat coronary artery bypass with increasing number of bypasses performed. In this study, we found no advantage in performing increasing numbers of bypasses in patients with single or double vessel disease, but there was definitely such an advantage in patients with triple vessel disease.

Coronary Artery Bypass↗
PubMed1980

Surgical therapy for left main coronary artery disease.

The course of a consecutive series of 271 patients who underwent coronary artery bypass for left main coronary artery obstruction (greater than or equal to 50% luminal diameter stenosis) between January, 1971, and December, 1976, at the Mid-America Heart Institute is reported. There were four (1.5%) operative deaths. All patients have been followed until their death or for 2 to 5 years with a mean follow-up of 3.8 years. There has been an incidence of acute myocardial infarction of 2.2 per 100 patient-years of follow-up, and four patients (1.5%) have required a second coronary artery bypass procedure. There have been 19 late deaths. Death was more frequent in women and in patients who had fewer than three bypasses performed. Actuarial survival at 5 years for the entire group was 88.8%. The expected survival rate of a general population matched for age and sex at 5 years is 88.4%. It is concluded that coronary artery bypass for left main coronary artery disease favorably affects longevity.

Adult↗
PubMed1980

Innominate artery-coronary artery bypass graft in a patient with calcific aortitis.

Calcification of the ascending thoracic aorta may make aortic cross-clamping dangerous and aorta-coronary artery bypass grafting impossible. A patient with a severely calcified ascending aorta owing to syphilitic aortitis presented such a problem. Sequential saphenous vein grafting was done to three coronary arteries, the proximal anastomosis being made to the noncalcified innominate artery. This technique may offer a practical solution to this problem.

Aged↗
PubMed1979

Five-year follow-up of patients undergoing coronary artery bypass.

Two hundred eighty-two patients who underwent coronary artery bypass operation between January, 1971, and July, 1972, were followed until the time of death or for 5 years after operation. The angina-free status progressively decreased during the period of follow-up but at 5 years 57% of the survivors were free from angina. The total (early and late) incidence of nonfatal myocardial infarction was 3.3 per 100 patient years of follow-up. Nine (3.2%) of the patients had a repeat coronary artery bypass operation within the first 5 postoperative years. The overall 5-year survival was 86.9%. The expected 5-year survival of the general population, matched by sex and age, is 90.7%. Five-year survival was 97% for single-vessel disease, 87% for double-vessel disease, and 85% for triple-vessel disease.

Adult↗
PubMed1977

Accuracy of treadmill testing in assessment of direct myocardial revascularization.

Near-maximal treadmill exercise tests (TET) performed at the time of coronary arteriography and bypass graft visualization an average of 13 months after direct myocardial revascularization were analyzed in 217 consecutive patients to assess the accuracy of the TET in predicting completeness of revascularization. TET results were correlated with bypass patency and extent of revascularization. Although conversion of a TET from an abnormal to a normal test or relief of TET-induced angina following surgery is closely correlated with bypass graft patency, the high incidence of normal exercise tests in the presence of residual coronary disease limits their usefulness in the individual postoperative patient in estimating the completeness of revascularization.

Adult↗
PubMed1976

Coronary artery bypass surgery for left main coronary artery disease.

The course of 146 consecutive patients with significant occlusive disease of the left main coronary artery who underwent coronary artery bypass surgery during a 4 year period is reviewed. Preoperatively, 11 patients were in New York Heart Association functional class II, 57 in class III and 78 in class IV. Seventy patients had progressive angina and 12 unstable angina. There were two operative deaths (surgical mortality rate 1.4 percent). Seven patients (4.8 percent) had a perioperative acute myocardial infarction. Complete follow-up has been achieved in the surgical survivors over an average period of 18.1 months; 77 percent of the surviving patients are completely asymptomatic and 19 percent are in functional class II. Four patients (2.8 percent) had a nonfatal late postoperative myocardial infarction and five (3.5 percent) died during the late postoperative period (3.3 percent annual mortality rate during a 2 to 47 month follow-up period). Postoperative cardiac catheterization studies performed in 35 patients an average of 12.1 months postoperatively revealed 78 percent of 80 grafts and patency of at least 1 graft in 93 percent of patients. Results of 42 (89 percent) of 47 near maximal treadmill stress tests were abnormal preoperatively compared with results of 14 (26 percent) of 54 postoperatively; in 74 percent of patients having both a preoperative and postoperative stress test, abnormal preoperative test results converted to normal after surgery. This study suggests that direct myocardial revascularization may offer an effective means of improving both the quality and duration of life in a patient with significant occlusive disease of the left main coronary artery.

Adult↗
PubMed1976

Coronary bypass surgery after renal transplantation.

Aortocoronary bypass surgery was performed in three patients with incapacitating angina pectoris who had previously had successful renal transplantation. All patients had initial symptomatic improvement. Although two have mild angina pectoris, there is objective improvement in their exercise tolerance and in ischemic ST-T changes on treadmill exercise testing. One patient, who also had resection of a left ventricular aneurysm, remains free of angina but is symptomatic from congestive heart failure. There were no postoperative complications. To our knowledge, these three cases are the first in which aortocoronary bypass surgery has been performed successfully in patients who have had renal transplantation. Anticipated problems with infection in view of the immunosuppressive therapy and renal problems postoperatively were not encountered.

Adult↗