Search PubMed⌕ Search

Biomedical subjects

J K Clarebrough

Publications and source records attributed to J K Clarebrough.

At least 19 recordsLinked to original sources
PubMed1989

Early and late survival after coronary-artery surgery.

Between 1970 and 1985, 1801 patients underwent coronary-artery surgery without associated valvular surgery. Eighty-four per cent of patients were male and the mean (+/- SD) age was 55.7 +/- 8.3 years. Of the patients, 18.7% were from the Coronary Care Unit and 6.5% had diabetes. The hospital mortality rate for the whole group was 3.5%. Patients from the Coronary Care Unit had the highest (8.9%) hospital mortality rate compared with those patients who were not from the Coronary Care Unit (2.1%; P less than 0.001). Other factors which increased the hospital mortality rate significantly were the number of diseased vessels (P less than 0.01), the degree of left main coronary-artery stenosis (P less than 0.001), an earlier year of surgery (P less than 0.01) and female sex (P less than 0.01). After these were taken into account, no other factors (for example, age, preoperative infarction, presence of left-ventricular aneurysm, left-ventricular end-diastolic pressure, diabetes, use of mammary-arterial grafts or the need for endarterectomy) affected the mortality rate. Patients were followed-up for a mean (+/- SD) of 4.4 +/- 2.8 years. The five-year survival rate for all patients was 88% and the 10-year survival rate was 65%. Cox regression analysis showed that the significant indicators of decreased long-term survival were undergoing operation directly from the Coronary Care Unit (P less than 0.001), left main coronary-artery stenosis (P less than 0.01), the number of grafted vessels (P less than 0.01), concomitant surgery for aneurysm (P less than 0.001), year of surgery (P less than 0.01). Seventy-nine per cent of patients were free of angina pectoris at five years after operation. The year of surgery (P less than 0.001) and preoperative myocardial infarction (P less than 0.05) were the best predictors of recurrent angina. In the long term, recurrent angina remains a problem, although this may change with the increased use of mammary-arterial grafts.

Actuarial Analysis↗
PubMed1987

Open heart surgery in the elderly.

Of 3254 open heart surgical cases performed since 1972, 126 patients (3.9%) were 70 years of age or older. The mean age was 72 years, the oldest being 82. Sixty-seven per cent were male. The following procedures were performed: coronary artery bypass grafting (CABG) 51, aortic valve replacement (AVR) 44, AVR + CABG 16, mitral valve replacement (MVR) 3, MVR + CABG 6, MVR + AVR 4, and other, 2. Of those undergoing CABG, 33% came from the Coronary Care Unit and 24% had left main coronary artery stenosis. There was one peri-operative death (2.0%). Of those undergoing AVR, 43% had coronary artery disease and 13% triple vessel disease. Operative mortality for AVR, and AVR + CABG was 11.4% (5/44) and 18.8% (3/16), respectively. Twenty-six per cent of operative survivors had significant postoperative complications (excluding atrial arrhythmias). The postoperative hospital stay for CABG, AVR and other cases was 11, 13 and 16 days, respectively. Seven year survival of all patients was 61.2 +/- 6.5% (+/- 1 SE) and for AVR +/- CABG was 51.5 +/- 8.6%. Five year survival for CABG was 83.9 +/- 6.3%. We conclude that, in selected cases, CABG can be performed safely in the elderly. Although valvular and combined surgery may result in significant morbidity and mortality, the satisfactory long term results in survivors justifies surgery in this group of patients.

Aged↗
PubMed1987

Combined carotid and coronary surgery.

A retrospective review of 40 consecutive patients undergoing combined coronary artery bypass grafting (CABG) and unilateral carotid endarterectomy (CEA) was carried out to determine the stroke rate for the procedure. Patients presenting with severe coronary artery disease judged to be at risk of imminent myocardial infarction, who had signs of cerebral ischaemia (70%) or asymptomatic carotid bruits (30%), were investigated for extracranial carotid vascular disease. Patients with severe stenotic carotid lesions associated with high risk coronary artery disease underwent combined CEA/CABG. Three patients had a previous contralateral CEA. The average age of the patients was 62 years, and there were 31 males and nine females. CEA was completed prior to CABG under the same general anaesthetic. There were 24 CEAs on the left and 16 on the right. Six patients suffered a postoperative cerebral ischaemic event (15.4%): a reversible ischaemic neurological deficit in three (7.7%), a transient ischaemic cerebral event in two (5.1%), and a permanent stroke occurred in one (2.6%). Two deaths occurred and both were cardiac related. Combined CEA/CABG in patients with stenotic lesions of the coronary and extra-cranial carotid vascular systems who are at risk of cerebral or myocardial infarction, can be performed with a permanent stroke rate within the published range for either CEA or CABG alone and with a mortality of 5%.

Aged↗
PubMed1980

Cardiac valve replacement and coronary bypass grafts.

A retrospective, six-year survey of 72 patients who underwent combined cardiac valve replacement and coronary artery bypass grafting is presented. The average age was 58 years with a male to female ratio of 3.5:1. Eighteen patients were angina-free, their coronary disease being found by routine coronary arteriography. Fifty-eight patients (81%) had aortic valve replacements, 13 patients (18%) had mitral valve replacements, and one patient had a double valve replacement. Forty-one patients (58%) had a single coronary bypass graft. Total cardiopulmonary bypass times averaged two hours, and the average cold myocardial ischaemic time was 60 minutes. The operative mortality in the group was 8%, which did not differ significantly (chi 2 = 0.25; P greater than 0.6) from the operative mortality of 6% in 1400 operations either for single valve replacement or for isolated coronary grafts which were performed in the same six-year period.

Adult↗
PubMed1977

Surgery for unstable angina.

A series of 84 patients with unstable angina, treated surgically by grafting procedures between October 1970 and September 1976, have been reviewed. The study indicates that extensive coronary artery disease is common in these patients, and suggests that operation may favourably influence mortality, both immediate and delayed, but does not reduce the risk of myocardial infarction. Eighty per cent of the patients were relieved of angina and able to lead a reasonably normal existence.

Angina Pectoris↗
PubMed1975

Subvalvular left ventricular aneurysm following mitral valve replacement.

Two cases are presented which represent different aspects of damage to the posterior wall of the left ventricle following mitral valve replacement. In the first case rupture of the ventricle occurred in the immediate postoperative period with a fatal result, while in the second, delayed aneurysm formation occurred with embolic and haemodynamic complications. This patient also did not survive. A review of the literature reveals four similar cases previously recorded. Possible aetiological factors are considered, including operative trauma, ischaemic damage, rupture of unsupported muscle, previous surgery with the development of pericardial adhesions and fixing of the valve ring, and finally abscess formation. The indications for operative intervention and possible complications of the aneurysm are noted.

Aged↗