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Biomedical subjects

F D Loop

Publications and source records attributed to F D Loop.

At least 127 records · Page 7Linked to original sources
PubMed1986

Early results of emergency surgery after coronary angioplasty.

During the period of our study 81 patients undergoing elective coronary artery angioplasty at our institution required emergency revascularization surgery within the ensuing 24 hr. The mean age of the 59 men and 22 women was 57 years (32 to 74 years). The principal indications for the emergency surgery were acute occlusion (n = 36), dissection (n = 28), unstable angina (n = 10), ventricular arrhythmias (n = 4), and unsuccessful balloon dilatation (n = 3). There were two early deaths and in 35 patients the presence of three criteria for myocardial infarction was noted postoperatively. Including these patients, 52 patients surviving their hospital course suffered 75 major complications. Emergency surgery after failed percutaneous transluminal coronary angioplasty can be performed with low mortality, but it carries a high incidence of major postoperative complications.

Adult↗
PubMed1986

Symptomatic coronary-subclavian steal corrected by carotid-subclavian bypass.

Angina recurred after a left internal mammary-to-left anterior descending coronary artery bypass graft. Subsequent development of a subtotal stenosis in the proximal left subclavian artery caused reversal of flow in the patent internal mammary artery graft, which produced an angiographic steal of myocardial perfusion. Angina and ischemia were relieved by reoperation, which consisted of left common carotid-to-left subclavian artery bypass in conjunction with right internal mammary-to-right coronary artery bypass and aorto-to-lateral circumflex coronary artery bypass with reversed saphenous vein.

Carotid Arteries↗
PubMed1986

Perioperative risk of bilateral internal mammary artery grafting: analysis of 500 cases from 1971 to 1984.

The records of the first 500 patients (420 men, 80 women, mean age 55 years, range 24 to 78) undergoing bilateral internal mammary artery (IMA) grafting were reviewed to determine in-hospital morbidity and mortality. Sixty patients (12%) had had previous cardiac operations and 130 (26%) previous saphenous vein removal. From two to seven total grafts (mean 3.2) were performed, including 595 IMA grafts to the anterior descending or diagonal artery, 355 to the circumflex, and 105 to the right coronary system. To assess changing risks, the first 125 patients (group A, 1971 to 1982) were compared with the next 375 (group B, 1982 to 1984). Major complications in groups A and B included stroke, four (3.2%) vs ine (2.4%); wound complications requiring reoperation, three (2.4%) vs five (1.3%); prolonged (greater than 48 hr) respiratory care, seven (5.6%) vs 19 (5.1%); and death, two (1.6%) vs five (1.3%) (no p value less than .05). Complications significantly less frequent in group B were new Q waves in nine (7.2%) vs 10 (2.7%) in group A (p = .02) and reoperation for bleeding in 17 (13.6%) vs 16 (4.3%) in group A (p = .0003). Logistic regression analysis showed that major complications did not correlate with gender, diabetes, number of grafts, or preoperative left ventricular function but were associated with increasing age (p = .0001) and previous cardiac surgery (p = .009) and were decreased by the use of cardioplegia (p = .002). The excellent long-term patency of IMA grafts, combined with low and decreasing perioperative risk, supports the continued use of bilateral IMA grafting.

Adult↗
PubMed1986

Results of mitral valve reconstruction.

To evaluate the early results of mitral valve reconstruction for mitral insufficiency, 117 consecutive cases were analyzed. Sixty-four (57.7%) of the patients were men, and the mean age was 60 +/- 13 years (range 18 to 85). Eighty-nine (76%) of the patients were in NYHA functional class III or IV preoperatively. The cause of the mitral disease was degenerative in 94 (80%) and rheumatic in 13 (11%) patients. Isolated mitral valve repair was performed in 56 patients (47.9%); the remainder underwent associated procedures that included myocardial revascularization in 38 (32.5%). Ninety-nine (85%) underwent a ring annuloplasty but in only seven (6%) was this the only repair technique. Resection of the posterior leaflet was performed in 41 (35%). There were five operative deaths (4.3%); one (1.8%) occurred after isolated repair and four (6.5%) after repair with associated procedures. All deaths occurred in patients greater than 65 years of age who were in NYHA functional class III or IV. Mean follow-up was 13.5 months (range 1 to 62). Two year actuarial survival was 90.6%. Three patients required reoperation (incidence of 2.5% per patient-year). Two patients sustained embolic events (incidence of 1.6% per patient-year). There were no anticoagulant-related complications. After surgery, 100 survivors (96.2%) were in NYHA functional class I or II.

Adolescent↗
PubMed1986

Predictors of reoperation after myocardial revascularization.

The first 1,000 patients undergoing primary isolated myocardial revascularization each year from 1971 to 1978 were analyzed to define the incidence of reoperation and to elucidate the determinants of reoperation and reoperation-free survival. Six hundred sixty-six patients (9.7%) underwent reoperation in a mean of 6.9 +/- 3.2 years. Cumulative percent reoperation was 2.7% at 5 years, 11.4% at 10 years, and 17.3% at 12 years. The annual incidence of reoperation was 1.1% at 5 years and increased to 3.9% at 12 years. Twenty-five patient descriptors were analyzed for predictors of reoperation. Young age was found to be the most important predictor of potential for reoperation. Other risk factors in descending order of significance were absence of an internal mammary artery graft, incomplete revascularization, New York Heart Association Functional Class III/IV, and single or double vessel disease. Absence of an internal mammary artery graft was an important predictor for all age groups. In the multivariate analyses for risk factors for reoperation-free survival, absence of an internal mammary artery graft was the most important predictor. Other factors of major significance were smoking, incomplete revascularization, and moderate/severe left ventricular impairment. Internal mammary artery grafting neutralizes hypertension, serum cholesterol level higher than 300 mg/dl, and smoking as risk factors for reoperation-free survival.

Adult↗
PubMed1986

Surgical management of synchronous carotid and coronary artery disease.

To determine the safest method of treating simultaneously occurring coronary artery disease and asymptomatic carotid stenosis, patients were randomly assigned to either combined operation or a staged procedure with coronary artery surgery done first, followed by carotid endarterectomy. In the initial 70 patients, there were two strokes (5.9%) and two deaths (5.9%) in the combined group and four strokes (11%) and one death (2.8%) in the group with coronary artery surgery performed first.

Carotid Artery Diseases↗
PubMed1985

Prediction of improvement in left ventricular function after ventricular aneurysmectomy using Fourier phase and amplitude analysis of radionuclide cardiac blood pool scans.

Postoperative improvement in left ventricular (LV) function is a common objective of LV aneurysmectomy, but is difficult to predict. The first Fourier component of time-activity curves of pre- and postoperative gated radionuclide angiographic studies was evaluated for this purpose in 20 patients who had undergone aneurysmectomy. LV aneurysms had portions that characteristically exhibited marked phase delay with varying degrees of amplitude. Total aneurysmal amplitude was obtained preoperatively by summing the amplitude component of all pixels that exhibited phase delay, suggesting paradoxical motion. LV ejection fraction (EF) before and after aneurysmectomy and the absolute postoperative increase in LVEF were calculated. Nine of 20 patients had an absolute increase of EF less than 10% despite resection of large aneurysms. A strong correlation was found between the absolute increase in EF after aneurysmectomy and the total amplitude within paradoxically moving areas (r = 0.93, p less than 0.0001). Thus, preoperative measurement of the total paradoxical amplitude predicts absolute change in EF and may be important in selecting patients for aneurysmectomy. The data also suggest that the total aneurysmal amplitude reflects the stroke volume ejected into an aneurysm in systole and that paradoxical expansion of an aneurysm contributes to LV dysfunction in some of these patients.

Adult↗
PubMed1985

Reoperation after previous grafting with the internal mammary artery: technique and early results.

Among 1,006 patients undergoing coronary bypass reoperation from 1968 through 1982, 100 had a patent internal mammary artery graft. There were 88 men and 12 women with a mean age of 53.4 years and a mean interval between first and second operations of 56.6 months. Reasons for reoperation were vein graft closure in 26% of the patients, progressive disease in previously ungrafted arteries in 48%, and combined indications in 26%. One operative death occurred. There was no significant difference in morbidity when compared with a reference group of 906 reoperations in patients without IMA grafting. Complete revascularization was achieved in 64% of the patients; the mean number of grafts per patient was 1.6. Seven patients had a perioperative myocardial infarction, and eight mammary artery pedicles were damaged during reoperation.

Coronary Disease↗
PubMed1985

Determinants of blood utilization during myocardial revascularization.

Blood transfusion during cardiac surgical procedures has steadily decreased, but little information is available regarding the factors that determine its necessity or amount. To determine the predictors of blood utilization during myocardial revascularization, 441 consecutive patients undergoing primary myocardial revascularization were studied. Forty-four patients (10%) received blood during hospitalization with a mean transfusion of 0.3 +/- 1.4 units per patient. Age, sex, weight, body surface area, preoperative hematocrit, blood volume, and red blood cell volume were examined univariately for trends. All demonstrated a statistically significant trend for both need and amount of transfusion (p less than 0.001). Neither number of grafts nor duration of cardiopulmonary bypass demonstrated statistically significant trends. All univariately significant factors were evaluated by multivariate logistic regression analysis. Red cell volume was the best predictor of the need for transfusion (p less than 0.001), followed by age. No other factors improved predictive capabilities. We conclude that preoperative red cell mass and age are the principal determinants of the need for and quantity of blood transfused during myocardial revascularization. Use of this information may greatly improve the efficiency of ordering blood before operation.

Adult↗
PubMed1985

Techniques to maximize mammary artery length.

The available length of the internal mammary artery has limited its versatility as a bypass conduit. Several techniques for increasing usable internal mammary artery length are described.

Fasciotomy↗
PubMed1985

Determinants of 10-year survival after primary myocardial revascularization.

The first 1000 patients undergoing primary isolated myocardial revascularization each year from 1971 to 1978 were analyzed to elucidate the determinants of long-term survival. Five-year survival was 93.2%, and 10-year survival was 79.3%. Five-year survivals were 96.1%, 94.2%, 92.1%, and 90.8%, respectively, for single, double, triple, and left main disease. Ten-year survivals for the same subsets were 88.6%, 83.0%, 74.9%, and 70.9%. Five-year survivals were 95.3%, 92.4%, 88.0%, and 81.3% for patients with normal, mild, moderate, and severe impairment of the left ventricle. Ten-year survivals for the same subsets were 84.1%, 76.5%, 65.8% and 53.6%. Patients receiving internal mammary artery grafts had 95.6% and 85.8% 5- and 10-year survivals that were superior to 92.0% and 76.2% in patients with only vein grafts. Patients completely revascularized had 95.0% and 82.5% 5- and 10-year survivals, while incompletely revascularized patients had lower (90.5% and 75.2%) 5- and 10-year survivals. Advancing age was the most important factor influencing late survival. Other risk factors in descending order of significance were impaired left ventricular function, no mammary artery graft, smoking, abnormal EKG, three vessel or left main disease, left ventricular end diastolic pressure (LVEDP) greater than 24, hypertension, 1971 to 1974 surgical era, cholesterol greater than 300, incomplete revascularization, and two vessel disease.

Adult↗
PubMed1985

Mitral valve replacement combined with myocardial revascularization: early and late results for 300 patients, 1970 to 1983.

Of 300 consecutive patients undergoing primary operation for mitral valve replacement combined with coronary bypass grafting, 22 (7.3%) died in-hospital. Multivariate testing of preoperative and operative descriptors identified radiographic cardiac enlargement, preoperative paced rhythm or atrial fibrillation, 70% or more left main coronary obstruction, and serum bilirubin of more than 2 mg% as factors associated with an increase in in-hospital mortality. Follow-up of the 278 hospital survivors (mean interval 48 months, range 2 to 165 months) documented survival of 85%, 66%, and 31% and an event-free survival of 65%, 46%, and 21% at 2, 5, and 10 postoperative years, respectively. Cox proportional-hazard regression models of late risk implicated in-hospital ventricular arrhythmias, left ventricular dysfunction, and rheumatic or ischemic causes of mitral valve disease in decreasing long-term survival. In addition, patients with bioprostheses without warfarin anticoagulation had better survival and event-free survival than those with bioprostheses taking warfarin and those with mechanical prostheses with or without warfarin.

Aged↗
PubMed1985

Long-term (5 to 12 years) serial studies of internal mammary artery and saphenous vein coronary bypass grafts.

Serial arteriograms were obtained in 501 patients after coronary bypass grafting. Study I within 5 years of operation (mean interval 15 months) and Study II more than 5 years after (mean interval 88 months, range 60 to 147 months). One hundred patients received both internal mammary artery and saphenous vein grafts: 37, mammary artery grafts only, and 364, vein grafts only. In Study I, 645 (82%) of 786 vein grafts were patent, 42 (5%) stenotic or irregular, and 99 (13%) occluded. Of 140 mammary artery grafts, 136 (97%) were patent, two (2%) stenotic, and two (2%) occluded. Of the 645 vein grafts patent in Study I, 357 (55%) remained patent in Study II, 119 (18%) were stenotic or irregular, and 169 (26%) were occluded. Of 136 mammary artery grafts patent in Study I, 130 (96%) were unchanged, one was stenotic, and five (4%) were occluded in Study II. Early vein graft patency was influenced by the coronary artery grafted and by angina. Progression of vein grafts patent at Study I to stenosis or occlusion at Study II was associated with increasing postoperative interval (p less than 0.00001), interval myocardial infarction (p less than 0.001), angina (p less than 0.001), diabetes (p less than 0.004), hypercholesterolemia (p less than 0.006), and hypertriglyceridemia (p less than 0.02); it was not influenced by the coronary artery grafted. Within 5 years of operation, mammary artery graft patency exceeded vein graft patency. Between 5 and 12 years after operation, the attrition rate of vein grafts greatly exceeded that of mammary artery grafts (p less than 0.0001).

Adult↗
PubMed1985

CASS continued.

Explore the source record for details and available documents.

Angina Pectoris↗
PubMed1985

Does mammary artery grafting increase surgical risk?

From 1980 through 1982, 7105 patients underwent primary isolated myocardial revascularization. Of these, 49.2% received only vein grafts and 50.2% received at least one internal mammary artery graft. The incidence of mammary artery grafting increased from 33.5% in 1980 to 67.1% in 1982. The operative mortality rate was 1.4% in the vein group and 0.2% in the mammary artery group (p less than .0001). A multivariate analysis identified six incremental risk factors for operative mortality. After adjusting for these risk factors, the use of vein grafts only was found to be an incremental risk factor (p less than .0001). In a subset of patients without major risk factors, there was no difference in the incidence of perioperative infarction, respiratory insufficiency, wound complication, stroke, use of intra-aortic balloon, reoperation for bleeding, or blood requirements. We conclude that internal mammary artery grafting is safe and is not associated with increased surgical morbidity or mortality.

Adult↗
PubMed1985

Myocardial revascularization: evolution of a surgical procedure.

Since its inception, myocardial revascularization has steadily evolved. The patient population is older with more extensive cardiac disease. Surgical mortality is currently 1% with a less than 1% perioperative myocardial infarction rate. The number of grafts done per patient has increased to more than three with 80% of the patients being completely revascularized. Ninety percent of the patients receive at least one internal mammary artery graft. With more complete revascularization and greater use of the internal mammary artery, the prospects for long-term survival and palliation have improved.

Adult↗
PubMed1985

Successful acute heart-lung transplantation after six hours preservation.

The lack of an appropriate and effective technique for prolonged heart-lung preservation has been one of the factors limiting the use of this therapeutic modality. Presently, the donor is transported to the transplant center, which is often an unacceptable burden to the donor's family. A reliable preservation technique that would allow long-distance procurement would markedly increase the use of heart-lung transplantation. Using a dog, a successful heart-lung transplantation was achieved following six hours of preservation of the graft. The experiment was terminated when the animal was able to maintain normal blood gases following extubation.

Animals↗