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Biomedical subjects

E A Lefrak

Publications and source records attributed to E A Lefrak.

At least 37 records · Page 2Linked to original sources
PubMed1989

Cardiac transplantation: goals and two-year results.

Results of cardiac transplantation have improved steadily following the first successful operation in 1967. However, rejection, infection, hypertension, hypercholesterolemia and accelerated coronary artery disease remain important late problems after successful heart transplantation. Facilitated patient access to the transplant center based upon geographic proximity to the home, family, and primary care physicians leads to enhanced care by allowing the original transplant team to remain actively involved with ease in the long-term follow-up. With this goal in mind, a cardiac transplantation center was developed with emphasis on developing an organized approach to providing care for patients with refractory congestive heart failure in the Virginia, West Virginia, Washington, D.C., Maryland, and Delaware area. Twenty-one of the 22 patients (95.4 per cent) survived and resumed active lives one to 26 months following heart transplantation. Forty-four rejection episodes occurred and were treated successfully, primarily on an outpatient basis. Only six infections were serious enough to require readmission to Fairfax Hospital, but all responded completely to treatment. Cardiac transplantation at a center focusing on regional patient care is not only less costly and more comfortable for patients and their families, but the continuity of care and comprehensive management of late complications can lead to improved long-term survival rates.

Delaware↗
PubMed1989

Cardiac transplantation in a regional center: goals and results at two years.

Cardiac transplantation moved from the realm of an investigational procedure to a therapeutic modality in the early 1980s. While one-year survival of 80 percent or greater can be expected, close follow-up is required to monitor for rejection, infection, and other late complications. With the need for close surveillance, both short and long-term, improved patient access to the transplantation center based on geographic proximity allows enhanced care by the original transplant team.

Adolescent↗
PubMed1987

The internal mammary artery bypass graft: praise versus practice.

Patency rates and long-term clinical results after coronary artery bypass are superior when the internal mammary artery, rather than the saphenous vein, is used as a bypass graft. Four thousand forty-seven cardiac surgeons were surveyed to assess their theoretical preference of bypass graft, in comparison to their actual practice. The 750 surgeons performing myocardial revascularization who completed the questionnaire had done approximately 122,652 coronary artery bypass operations annually. Six hundred twenty-nine (84%) listed the internal mammary artery as the graft of choice for bypassing the left anterior descending coronary artery, whereas 114 (15%) listed the saphenous vein. Only about half (56%) of the surgeons actually used the internal mammary artery commonly, however, and only 228 (30%) used it in at least 90% of their operations. In actual practice, then, the internal mammary artery is often avoided in situations where it could be used as a coronary artery bypass graft. This practice can be expected to have a negative influence on late postoperative results. (The Texas Heart Institute Journal 1987; 14:139-143)

Journal Article↗
PubMed1979

Current heart valve prostheses.

Current heart valve prostheses may be classified as either mechanical or tissue valves (bioprostheses). The principal advantage of mechanical devices is their established long-term durability; however, chronic anticoagulation is recommended to reduce the incidence of thromboembolic complications. Tissue valves are associated with a relatively low rate of thromboembolism but their durability level has not been determined. All contemporary prosthetic heart valves yield comparable survival rates.

Aortic Valve↗
PubMed1977

Aortic valve replacement: a ten-year follow-up of non-cloth-covered vs cloth-covered caged-ball prostheses.

From 1965 to 1976, 721 isolated aortic valve replacements were performed at the University of Oregon hospitals, utilizing Starr-Edwards caged-ball prostheses. Three models of aortic prostheses were introduced during this period: a non-cloth-covered model has been in continuous use since 1965; a cloth-covered model was begun in 1968 and has been supplanted by the modified composite-strut or "track" model since 1972. The 5-year actuarial survival rate for operative survivors is about 80% for both non-cloth-covered and cloth-covered valves, while the 10-year survival is 61%, based on the older model only. The actuarially-determined percentages of patients experiencing significant thromboembolic episodes (i.e., all except transient ischemic episodes) at 5 years are 7% for the cloth-covered and 9% for the non-cloth-covered model. If transient ischemic attacks are included, the cloth-covered model has only an 8% incidence at 5 years compared to a 22% incidence for the older model. However, the cloth-covered valves are subject to a higher risk of reoperation because of the possibility of cloth injury. The "track" valve, therefore, was designed with exposed metal on the inner surface of each strut to prevent ball-cloth contact. In 107 patients (mean follow-up period 1 year) receiving anticoagulation, this prosthesis has maintained the same low incidence of thromboembolism as the previous cloth-covered model, with no reoperations for valve failure.

Aortic Valve↗
PubMed1976

Knee dislocation. An illusive cause of critical arterial occlusion.

Popliteal artery injury is a hazardous and often subtle complication of traumatic knee dislocation. Review of the literature in which series of knee dislocations were reported has revealed a 28% incidence of thrombosis or rupture of this critical vessel. Fifty-seven percent of these patients required leg amputation. The most frequent cause of limb loss has been absence or delay of direct surgical repair of the associated popliteal artery injury. This report describes a management plan that is intended to minimize the likleihood of future disabling leg amputations following knee dislocation.

Abdominal Injuries↗
PubMed1975

In situ preservation of cadaver kidneys for transplantation: laboratory observations and clinical application.

Many kidneys obtained from cadaver donors undergoing sudden cardiac arrest cannot be transplanted due to the long periods of warm ischemia from the moment of arrest to nephrectomy. A double-ballon-triple-lumen catheter for the rapid in situ preservation of cadaver kidneys has been designed. Used in combination with equipment routinely found in any hospital, it can cool human kidneys in situ to 10-15 C and maintain this temperature until nephrectomy can be performed. Kidenys preserved with this catheter have functioned after transplantation into suitable recipients. This report describes the design and laboratory evaluation of this new device, its clinical effectiveness and technique of insertion.

Adolescent↗
PubMed1975

Surgical technique for creation of an arteriovenous fistula using a looped bovine graft.

We have used bovine grafts in a looped configuration in the forearn in 150 patients for chronic hemodialysis and have evolved a simple technique for their successful implantation. The critical technical points include: 1) use of large-diameter long grafts (7.0-8.0 mm diameter; 34-40 cm in length); maintenance of the heterograft in a distended and pulsating state throughout the procedure to prevent distortion and twisting; 3) creation of a wide smooth-looped tunnel with Bakes dilators; and 4) anastomosis to the largest avialable antecubital vein. Thirteen cases of late graft occlusion (3-36) months) have been found to be produced by a localized obstructive lesion just distal to the venous anastomosis. These grafts were easily restored to a functional status by thrombectomy and patch graft angioplasty of the stenotic segment. The looped graft technique is not applicable to all patients requiring hemodialysis but it is especially helpful when distal vessels have been obliterated by previous procedures or when home-dialysis is planned. This surgical technique should be among the alternatives considered by surgeons concerned with problems of vascular access in patients with chronic renal failure.

Animals↗