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Biomedical subjects

D M Cosgrove

Publications and source records attributed to D M Cosgrove.

At least 253 records · Page 14Linked to original sources
PubMed1980

Late survival following use of intraaortic balloon pump in revascularization operations.

The early and late results of intraaortic balloon pump (IABP) support in 197 patients with pure myocardial revascularization were analyzed. Group I, 61 patients, had IABP support initiated preoperatively; Group II, 99 patients, had IABP support in the operating room because of inability to be weaned from bypass; and Group III, 37 patients, had support instituted for persistent low cardiac output state in the postoperative period. The early results showed that 73% were discharged from the hospital and that delayed use of the IABP was associated with a high mortality and high rate of perioperative myocardial infarction. When the results between men and women were compared, no statistical difference was noted. After a mean follow-up of 18 months, there were 9 late deaths. Three were due to noncardiac causes. The two-year cardiac actuarial survival for the hospital survivors was 96% and all three groups had uniformly good symptomatic relief. After hospital discharge, the late results of patients who required use of the IABP in conjunction with pure myocardial revascularization were the same as for patients who did not require IABP support.

Assisted Circulation↗
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↗
PubMed1978

Determinants of long-term survival after ventricular aneurysmectomy.

To determine the effect of aneurysmectomy solely or combined with direct revascularization, 349 consecutive surgical patients treated between 1962 and 1972 were retrospectively reviewed. The minimum follow-up for survivors was 5 years (mean, 7 years). Single-vessel disease occurred in 171 (49%) and only ventricular aneurysmectomy was performed (Group 1). Multiple-vessel disease was found in 178 (51%), of whom 79 (44%) had resection of a ventricular aneurysm and revascularization of all major obstructed vessels (Group 2); 99 (56%) had aneurysm resection and incomplete revascularization (Group 3). Survival at 7 years was 69% for Group 1, 65% for Group 2, and 51% for Group 3. Actuarial survival at 7 years was 70% for patients operated on for angina; 55% for congestive heart failure; 57% for a combination of angina and heart failure; and 64% for ventricular tachycardia. Survival of patients with multiple-vessel disease who underwent aneurysmectomy and complete revascularization was similar to that of patients with single-vessel disease who underwent aneurysmectomy alone. Longevity is adversely influenced by incomplete revascularization (p less than 0.005) and preoperative congestive heart failure (p less than 0.005).

Adult↗
PubMed1978

Emergency revascularization for unstable angina.

Emergency revascularization for unstable angina (defined according to criteria of the National Cooperative Study Group) was performed in 100 consecutive patients. The mean interval from onset of pain to operation was one day. Nineteen patients had single-vessel narrowing of greater than 70% of lumen diameter, 32 double-vessel obstruction and 49 triple-vessel disease. Fourteen of these patients had left main trunk obstruction. Four patients died within 30 days, three from complications of myocardial infarction. Seventeen of 96 (18%) early survivors sustained perioperative infarction. After a mean follow-up of 42 months, four late deaths and three late infarctions occurred. Postoperative angiography in 47 patients (mean interval 14 months) showed 86% graft patency. Of 92 survivors, 72 are symptom-free. Three of the four operative deaths occurred within 24 hours postoperatively; in each of these, postmortem examination confirmed a recent myocardial infarction which antedated the operation, despite the absence of new infarction in the peroperative electrocardiogram or elevation of cardiac enzymes. Results from this emergency series suggest that, although myocardium may be salvaged in some instances, in other cases infarction has already occurred and treatment might better be directed toward alleviation of acute ischemia to provide a stable period in which diagnostic studies are performed and acute myocardial infarction may be ruled out.

Adult↗
PubMed1977

Reoperations for myocardial revascularization.

Reoperations solely for myocardial revascularization were performed in 219 consecutive patients (1967 to 1975). Indications were (1) graft failure, 46 (21 per cent); (2) progressive atherosclerosis, 42 (19 per cent); (3) incomplete revascularization, 39 (18 per cent); and (4) combinations, 92 (42 per cent). Primary operations included bypass grafts in 100 patients; mammary artery implants, 87; and combinations of direct and indirect procedures, 32. Reoperations performed were single bypass, 141 patients; double, 61; and triple or other coronary artery operations, 17. Eight patients died within 30 days of operation (3.7 per cent). Major postoperative complications included hepatitis, 24 (11 per cent); myocardial infarction, 19 (9 per cent); bleeding, 21 (10 per cent); and respiratory insufficiency, 12 (5 per cent). Follow-up for 202 long-term survivors was complete (mean 29 months). In patients who originally underwent direct revascularization, Class I or II (N.Y.H.A.) was attained in 35 of 43 (81 per cent) of those reoperated upon for primary graft failure, in 14 of 15 (93 per cent) of those with progressive atherosclerosis, and in 27 of 33 (82 per cent) of patients with combined indications. Arteriography was performed after the reoperation in 55 patients (mean interval 17 months), and 65 of 77 (84 per cent) grafts were patent. Nineteen of 22 grafts performed for primary graft failure were patent. We have made the following conclusions: (1) Reoperation for direct myocardial revascularization can be accomplished with low mortality rates although morbidity is high; (2) complete relief of symptoms was achieved in 65 per cent of survivors; (3) results in patients reoperated upon for graft failure alone were similar to results in those operated upon for progressive atherosclerosis or combined indications; and (4) high graft patency was found in secondary grafts constructed to arteries involved with primary graft failure.

Adult↗
PubMed1976

The management of Hemophilus influenzae, Type B, pericarditis.

The incidence of Hemophilus influenzae, type B, infections in children has been increasing recently, so the number of cases of pericarditis is likely to rise also. We describe the clinical manifestations and treatment of H. influenzae, type B, pericarditis based on 4 patients and a review of the literature. The most common complication is cardiac tamponade, which requires drainage. All patients should be treated with antibiotics (chloramphenicol, ampicillin) and a drainage procedure. Because of several recently reported cases of subsequent constrictive pericarditis, we recomment anterior interphrenic pericardiectomy both for drainage and to prevent constrictive pericarditis. With appropriate therapy the survival rate should be very high.

Ampicillin↗