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Biomedical subjects

H B Barner

Publications and source records attributed to H B Barner.

At least 37 records · Page 2Linked to original sources
PubMed1998

Arterial grafting: techniques and conduits.

The superior long-term patency and survival of the internal thoracic artery in coronary artery bypass grafting, compared with saphenous vein, established the internal thoracic artery as the conduit of choice for myocardial revascularization. Use of the internal thoracic artery has expanded, and the possibility of similar performance by other arteries has motivated surgeons to investigate alternative arterial conduits (eg, the gastroepiploic artery, inferior epigastric artery, and radial artery). Although these grafts have become more technically feasible and have shown benefits, more follow-up data are needed to determine the long-term patency, freedom from arteriosclerosis, and efficacy of alternative conduits.

Arteries↗
PubMed1997

Valve replacement in the small aortic annulus: prospective randomized trial of St. Jude with Medtronic Hall.

OBJECTIVE: The ideal prosthesis for aortic valve replacement in patients with small annuli remains controversial and has yet to be identified. The purpose of this report is to compare the St. Jude (SJ) Medical and Medtronic Hall (MH) valves for aortic valve replacement in the small aortic root. METHODS: From 1986 to 1994 we prospectively randomized 456 patients to receive either the SJ or the MH valve. From this population, 80 patients (SJ, 42 patients; MH 38 patients) had a 19 or 21 mm aortic prosthesis inserted without annulus enlarging procedure. RESULTS: Follow-up was complete in all 80 patients for 270 patient years (mean 40.5 months). Analysis showed that the SJ and MH groups were similar with respect to age, gender, body surface area, valve area, NYHA class, ventricular function, prosthesis size, frequency of revascularization, bypass and global ischemic time. There were two operative deaths (1 SJ, 1 MH). Clinical performance and Dobutamine stress transesophageal doppler echocardiography could not demonstrate a significant advantage of one prosthesis over the other in this population. The change in aortic valve gradient, and left ventricular mass index measured preoperatively and within 12 months postoperatively were not different in both cohorts. CONCLUSION: The study could not detect a difference in the performance of the SJ and MH heart valves for aortic valve replacement in patients with small aortic annuli.

Adult↗
PubMed1996

Defining the role of the radial artery.

Our experience with the radial artery in 172 patients from October 1993 through February 1995 has been favorable, with no early or late deaths in a group of selected patients. In 35 of the first 72 patients, the proximal anastomosis of the radial artery was to the aorta, and in all other patients it was to the left internal thoracic artery (ITA). In the first 72 patients, there were 43 right ITA grafts, 13 gastroepiploic artery grafts, and 6 saphenous vein grafts (3.57 distals per patient). In the last 100 patients, only 2 other conduits (saphenous vein) were used (in addition to left ITA and radial artery) for 3.46 distals per patient, with complete revascularization achieved in all patients requiring it. Five perioperative infarctions, 2 reoperations for bleeding, 6 intra-aortic balloon pumps, 3 instances of myocardial hypoperfusion (1 requiring a balloon pump), and 1 mediastinal wound infection were noted. Four patients required catheterization for recurrent symptoms, and all had patent radial arteries (1 from the aorta and 3 from the left ITA), but 1 ITA was stenotic at the distal anastomosis. One patient was older, with preoperative heart failure that recurred, and 2 were younger, with diffuse coronary disease. This early favorable clinical experience, when combined with the early patency data of others, suggests that continued use of this conduit is appropriate with close observation of outcome.

Adult↗
PubMed1995

Tailoring aortoplasty for repair of fusiform ascending aortic aneurysms.

To evaluate the effectiveness of tailoring aortoplasty used to treat fusiform aneurysms of the ascending aorta, we reviewed the results of operation in 17 patients. Nine patients had tailoring aortoplasty alone, and 8 patients had aortoplasty with Dacron wrap of the ascending aorta. Fourteen of 17 patients were discharged from the hospital, and 12 patients were alive at follow-up between 2 and 120 months. Of two late deaths, neither was due to aneurysmal disease. Actuarial survival at 1 and 10 years was 81% and 63%, respectively. In selected cases, tailoring aortoplasty can achieve long-term results comparable with those of resection and graft replacement of fusiform ascending aortic aneurysms.

Adult↗
PubMed1995

Double-valve replacement with Medtronic-Hall or St. Jude valve.

To define better the performance of the bileaflet St. Jude and the tilting-disc Medtronic-Hall valves, we retrospectively analyzed 122 patients (St. Jude, 80 patients; Medtronic-Hall, 42 patients) who received simultaneous aortic and mitral replacement from May 1984 until June 1994. The two groups were not different with respect to preoperative clinical and hemodynamic parameters and New York Heart Association functional class. The hospital mortality and late mortality were not significantly different. Risk analysis identified advanced age and previous myocardial revascularization as predictors of operative death. Follow-up was complete in 96 of 103 hospital survivors (93%) and was similar in both groups. The actuarial survival, linearized rates of valve-related complications, and actuarial freedom from valve-related complications were similar in both cohorts. The presence of coronary artery disease negatively influenced the actuarial survival after simultaneous aortic and mitral valve replacement. Postoperative New York Heart Association functional class was not significantly different in either group. These data indicate that the Medtronic-Hall and St. Jude prostheses are not significantly different with respect to their clinical performance and valve-related complications for simultaneous double-valve replacement.

Aortic Valve↗
PubMed1994

Fifteen- to twenty-one-year angiographic assessment of internal thoracic artery as a bypass conduit.

Fifteen patients who had coronary artery bypass grafting with the left internal thoracic artery (2 also had in situ right internal thoracic artery grafts placed) underwent catheterization for recurrent angina 15 to 21 years later. Angiographic assessment revealed widely patent conduits without evidence of conduit atherosclerosis. Translocation of the internal thoracic artery to the coronary circulation does not appear to be associated with accelerated atherosclerosis of the conduit, and freedom from serious conduit atherosclerosis can be anticipated for at least 20 years.

Angina Pectoris↗
PubMed1994

Surgery for ischemic heart disease.

Surgical treatment for ischemic heart disease continues to evolve. The long-term benefit of coronary artery bypass grafting can be shown to extend for 15 to 20 years. The long-term patency achieved with internal thoracic artery grafts has extended the already good results of coronary artery bypass grafting. It is the surgeon's hope that the pursuit of multiple arterial grafting will further extend these results. Operations continue to increase in complexity and include a growing number of reoperations. Techniques to deal with these situations have continued to evolve so that the operative mortality remains low. The role of angioplasty in patients with multiple-vessel coronary artery disease has not been firmly established. However, increasing data indicate that in patients with triple-vessel disease and depressed ventricular function, complete surgical revascularization is the treatment of choice.

Angioplasty, Balloon, Coronary↗
PubMed1994

Prosthetic valves for the small aortic root.

Mechanical aortic valves (AVs) are frequently implanted in small (19 and 21 mm) aortic roots because bioprosthetic valves have unacceptably high gradients and many surgeons do not implant allograft valves. Three mechanical valves in common use today in the United States are the Starr-Edwards (SE), St. Jude Medical (SJ), and the Medtronic-Hall (MH). Clinical hemodynamic studies reveal that the 21-mm SE valve (size 8A) has peak systolic gradients of 13 to 58 mmHg (N = 6) with a calculated effective orifice of 0.7 to 1.4 cm2. The 19-mm SJ valve has a gradient at peak pressure of 17 mmHg and a mean gradient of 22 mmHg (N = 6) with respective exercise gradients of 32 and 38 mmHg (N = 5). For the 21-mm SJ valve the mean gradient was 5.2 +/- 5.3 (N +/- 12) and the gradient at peak pressure was 6.0 mmHg (N = 15). The 21-mm MH valve had resting gradients at peak pressure of 10.5 (N = 3) and 12.4 mmHg (N = 9) and exercise gradients of 15.8 mmHg (N = 9). Six months after AV replacement with small SJ or MH (N = 14) or large (23 mm or greater) (N = 83) valves, cardiac output was 4.7 versus 6.4 L/min (p < 0.03), percent reduction in left ventricular mass index (LVMI) was -8% versus -21% (p < 0.01), exercise duration was 370 versus 555 seconds, and congestive heart failure (CHF) class was 1.9 versus 1.1 (p < 0.0001). Change in LVMI and valve size were the only independent predictors of CHF class.(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Valve↗
PubMed1993

Inferior epigastric artery for myocardial revascularization.

From March 1990 through January 1992, 108 patients undergoing myocardial revascularization had one (91) or both (17) inferior epigastric arteries (IEA) used for myocardial revascularization. The internal thoracic artery (ITA) was used bilaterally in 87 patients. Of the 373 distal anastomoses, 210 (56%) were with the ITA, 130 (35%) with the IEA, and 12 (3%) with the gastroepiploic artery. Nineteen patients (18%) received 21 saphenous veins. When compared with the ITA, the IEA demonstrated a longer harvest time (36.5 vs 29.6 min, P < 0.0001), a shorter usable length (11.9 cm vs 16.5 cm, P < 0.001), and similar flow (49.7 cc/min vs 48.7 cc/min, P = NS). The operative mortality was 2.8%. Two deaths resulted from low cardiac output and the one remaining death from complications of a cerebral vascular accident. The most common major complication was respiratory insufficiency, which occurred in 11 patients (12%). There were two sternal infections (2%), and two abdominal wound infections (2%), none of which were fatal. The IEA is an acceptable additional arterial conduit. It can be safely employed with one or both ITAs. Short-term and long-term patency must be established before preferential use of this conduit is advised.

Aged↗
PubMed1993

Surgery for ischemic heart disease.

Surgical treatment of ischemic heart disease continues to evolve, and specific criteria are available to guide management. The benefit of placing the left internal mammary artery to the left anterior descending artery is well known, and there are newer data, not including survival benefit, supporting the use of two internal mammary arteries. The role of more than two arterial conduits remains to be established. It is hoped that greater use of arterial conduits will reduce the need for reoperation due to saphenous vein graft closure. Operations on older patients and on those with severe impairment of left ventricular function continue to increase. These cases present an ongoing challenge, as do those when operation for acute failure of angioplasty is required.

Angioplasty, Balloon, Coronary↗