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Biomedical subjects

D B Effler

Publications and source records attributed to D B Effler.

At least 37 records · Page 2Linked to original sources
PubMed1975

The structural study of the saphenous vein.

From November, 1971, to September, 1974, 1,179 patients received aortocoronary saphenous vein bypass grafts at the Cleveland Clinic Hospital. Segments of saphenous vein from each patient were sent for microscopical analysis. These vein segments were classified as normal or abnormal (phlebosclerotic). Four hundred ninety-six normal vein grafts in 295 patients were restudied and had a patency of 87.9%. One hundred forty-four abnormal vein grafts in 86 patients were restudied and showed 89.5% patency. This study suggests that histopathological identification of an abnormal (phlebosclerotic) vein segment does not constitute a determining factor as far as late patency is concerned in a vein segment that is not grossly sclerotic.

Adult↗
PubMed1975

Internal mammary--coronary artery anastomosis. "No-touch" technique.

A simple technique for internal mammary--coronary artery anastomosis that can be applied to all branches of the coronary circulation is described. The anastomosis can be constructed in 10 to 15 minutes. This technique eliminates pinching of the internal mammary artery by forceps.

Humans↗
PubMed1975

Bridge saphenous vein graft.

Single aorta-coronary artery vein grafts (bridge grafts) were constructed to two coronary branches with a side-to-side anastomosis in 250 patients. Most of these grafts were constructed between circumflex branches (96 grafts), circumflex and diagnol branches (47 grafts), and anterior descending and diagonol branches (79 grafts). The aim of the bridge graft is to decrease the number of anastomoses, decrease the operative time, and improve graft patency. The hospital mortality rate in this group of patients was 1.2 per cent, and the incidence of postoperative myocardial infarction was 3.6 per cent. One hundred ten patients were restudied after surgery; the average time of restudy was 1 year. Ninety-two grafts of 83.6 per cent had two anastomosis patent; 6 grafts (5.4 per cent) had one anastomosis patent; and in 12 grafts (10.9 per cent), both anastomoses were occluded. One hundred twenty-six associated grafts were studied all the same time; the patency rate was 84.1 per cent. From this experience, we believe the bridge graft is a useful procedure for bypassing the small coronary artery branches.

Adult↗
PubMed1975

Selection of the candidate for myocardial revascularization; a profile of high risk based on multivariate analysis.

A survey of 60 patients who died from cardiac related causes after vein or artery bypass operations alone (1967 to 1973) was made with respect to 26 clinical, angiographic, and operative variables. These factors were compared with identical characteristics of 1,188 survivors operated upon in 1973. Through discriminant analysis, the various characteristics, isolated or multiple in any combination, have been converted into risk related to operative death. The distinctive features of the mortality group were vastly different from those in the surviving group. Ten patients (16.67 per cent) of the mortality group were in the ninety-ninth percentile of risk, whereas these factors or variables of similar weight produced an equivalent risk of only 0.34 per cent of the survivors; thus, operative death in these circumstances could be predicted with an estimated 98.0 per cent assurance. Each of 6 patients with mortality risks above 0.99999 had (1) marked cardimegaly, (2) uncompensated congestive heart failure (CHF), (3) triple vessel coronary artery disease and/or obstruction of the left main coronary artery, (4) generalized impairment of left ventricular contraction or segmental left ventricular scar, and (5) evelated left ventricular end-diastolic pressure. As a single factor, congestive heart failure (CHF) exerted the most influence on the probability of dying. A new and more desctiptive statistical interpretation of the factors presumed to affect risk is presented.

Age Factors↗
PubMed1975

Rupture of the posterior wall of the left ventricle after mitral valve replacement.

Rupture of the posterior wall of the left ventricle is an unusual but often lethal complication following mitral valve replacement (MVR). We have encountered it six times with a 100 per cent mortality rate in a series of 1,154 operations for MVR. Sites of rupture were located at the base of the resected papilary muscle or close to the artioventricular groove in the area adjacent to the resected posterior mitral leaflet. T stongly indicates the overzealous resection of the mitral leaflets and papillary muscle as an important eitiologic factor. Other possible etiologic factors are discussed and important pitfalls to be avoided during MVR are stressed.

Aged↗
PubMed1975

Myocardial revascularization in patients aged 65 and older.

Experiences with 265 consecutive patients 65 years of age and older who underwent myocardial revascularization surgery have been presented. With proper patient selection, expeditious surgery, and good postoperative management, good surgical results can be obtained that are comparable to any good risk group of patients. This study suggests that age alone is not a contraindication to aggressive surgical treatment of coronary artery disease.

Age Factors↗
PubMed1975

Aorta-coronary bypass grafting with the internal mammary artery: clinical experience in 70 patients.

Clincal and angiographic results in 70 patients who received free internal mammary artery (IMA) grafts are reviewed. One postoperative death occurred, but it was not related to the free IMA technique. Forty-seven patients underwent postoperative arteriography. The average interval between operation and catheterization was 10.7 months, and the patency rate for 49 free IMA grafts was 89.8 per cent. Of the 29 patients who recieved free IMA grafts as the only revascularization procedure, 21 patients (80 per cent) progressed to Functional Class I and only 5 patients did not have improvement in their functional status.

Angiocardiography↗