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Biomedical subjects

J M Craver

Publications and source records attributed to J M Craver.

At least 73 records · Page 4Linked to original sources
PubMed1984

Clinical, hemodynamic, and operative descriptors affecting outcome of aortic valve replacement in elderly versus young patients.

One hundred and fifty-two patients age 70 years or more underwent aortic valve replacement (AVR) at Emory University Hospital between July 1, 1974 and July 1, 1982. Of these, 98 had isolated AVR (elderly AVR group) and 54 had concomitant coronary artery bypass grafts (elderly AVR/CABG group). Results of surgery in these patients were compared to results in patients aged 20 to 69 years operated on in the same period (young AVR/CABG groups). Comparative descriptors with statistically significant differences included a higher incidence of both stable and unstable angina in patients undergoing concomitant CABGs ; less cardiomegaly in the young AVR/CABG group; less hypertension, a higher incidence of pure aortic regurgitation, and less frequent use of inotropes in the young AVR group; a higher perioperative stroke rate in elderly AVR/CABG patients; a higher perioperative psychosis rate in patients having CABGs regardless of age; and a longer postoperative hospital stay for the elderly patients. There were no significant differences between the four groups for the following descriptors: sex ratio; history of congestive heart failure; the presence of atrial fibrillation; left ventricular end diastolic pressure, ejection fraction and contractility; number of diseased coronary arteries; number of vessels bypassed; use of the intra-aortic balloon pump; re-exploration for hemorrhage; perioperative myocardial infarction rate; and major wound infection rate. Operative mortality was 5.1% for the elderly AVR group, 5.6% for the elderly AVR/CABG group, 1.9% for the young AVR group, and 5.1% for the young AVR/CABG group (p = NS). Overall, hospital mortality was 3.3%. Actuarial survival curves for all elderly versus all young patients showed no significant difference. The curve for elderly patients compares favorably with the actuarial survival of the same age group in the general population. Actuarial survival curves for the four subgroups did not differ significantly when compared at a follow-up of 36 months after surgery. We conclude that AVR with or without concomitant CABGs can be performed in elderly patients with an acceptably low mortality and morbidity, and the postoperative survival compared favorably both with younger patients and with the general population of the same age.

Actuarial Analysis↗
PubMed1984

Surgical management of acute myocardial ischemia following percutaneous transluminal coronary angioplasty. Role of the intra-aortic balloon pump.

Acute myocardial ischemia is a serious complication of percutaneous transluminal coronary angioplasty, often requiring emergency myocardial revascularization. Since our initial report of 17 such patients, we have encountered an additional 32 patients requiring emergency myocardial revascularization since September, 1981. The indication for emergency myocardial revascularization was ischemic chest pain in all 32 patients. Percutaneous transluminal coronary angioplasty resulted in injury to the right coronary artery in 11 patients, the left anterior descending artery in 19 patients, and the left main artery in two patients. The onset of ischemia was immediate in 26 patients but delayed up to 22 hours in six patients. Chest pain was associated with ST-segment elevation in 21 patients, hypotension in 7 patients, and cardiac arrest in 6 patients. Immediate intra-aortic balloon pumping was instituted in the angioplasty suite in 16 patients. The mean time from onset of ischemia to completed revascularization was 156 minutes with a mean of 1.6 grafts performed per patient. Seventeen patients (53%) had enzyme evidence of myocardial infarction postoperatively, with a significantly higher (p less than 0.01) incidence of myocardial infarction in those patients with preoperative ST elevation (76% versus 9%). In the 21 patients with ST-segment elevation, the incidence of Q wave infarction was 20% (3/15) with balloon pumping and 50% (3/6) without balloon pumping. Complications associated with intra-aortic balloon pumping occurred in one patient (6%). There were no hospital or late deaths with follow-up extending 16 months. The spectrum of injury resulting from percutaneous transluminal coronary angioplasty extends from chest pain alone to severe transmural ischemia with hypotension or cardiac arrest. Presentation may be immediate or delayed. Urgent emergency myocardial revascularization remains the accepted therapy for this complication. Immediate preoperative intra-aortic balloon pumping is a useful adjunct to emergency myocardial revascularization in the group of patients with acute ischemia and ST-segment elevation.

Acute Disease↗
PubMed1984

Combined carotid and coronary operations: when are they necessary?

Three groups of patients were analyzed to ascertain the risk of combined carotid/coronary operations and the risk factors for perioperative stroke following coronary artery bypass (CAB). Group 1 (N = 132) had simultaneous carotid endarterectomy and CAB, Group 2 (N = 51) were patients having perioperative stroke following elective CAB, and Group 3 (N = 169) had CAB alone but had prior history of either asymptomatic cervical bruit, stroke/transient cerebral ischemic attack (TIA), or carotid endarterectomy. Hospital mortality and perioperative stroke rate in the combined carotid/coronary group were 3.0% (4/132) and 1.6% (2/126), respectively. These rates were not significantly different from those of a control group having CAB alone. Overall incidence of postoperative stroke in 5,676 patients having CAB alone was 0.9% (51 patients). The incidence of perioperative stroke in patients with asymptomatic bruit or prior history of stroke or TIA undergoing CAB alone was 3.3% (2/60) and 8.6% (6/70), respectively. The majority of strokes following CAB appear to be embolic in origin. Indications for simultaneous carotid/coronary operations are bilateral carotid disease and symptomatic carotid vascular disease associated with unstable angina, left main obstruction, or diffuse multivessel disease. Staged procedures are recommended for patients with stable angina and symptomatic carotid lesions and for difficult carotid revascularization procedures. CAB alone may be performed for most patients with asymptomatic cervical bruit, moderate or mild carotid artery obstruction, and unstable angina associated with prior stroke, although in the third situation postoperative risk of neurological injury may be increased.

Aged↗
PubMed1983

Importance of complete revascularization in performance of the coronary bypass operation.

Cardiac Data Bank records of 1,238 patients with triple-vessel disease (greater than or equal to 50% diameter reduction) who had undergone coronary bypass surgery were reviewed and divided into 2 groups depending on whether complete (n = 773) or incomplete (n = 465) revascularization had been accomplished. Patients with complete revascularization had a higher incidence of a normal preoperative electrocardiogram than did patients with incomplete revascularization (23 versus 14%, respectively, p less than 0.0001). The ejection fraction for both completely and incompletely revascularized patients was good (m = 0.60 and 0.57, respectively). The mean number of grafts per patient for the 2 groups was 3.8 and 2.6 (p less than 0.0001). There was no significant difference between the 2 groups with regard to postoperative inotropic requirements (8 and 7%), ventricular arrhythmias (1.8 and less than 1%), necessity for intraaortic balloon pumping (1.6 and 1.5%, hospital mortality (1.2 and 2.8%), or myocardial infarction (4.3 and 4.8%). Survival at 5 years was significantly greater (p less than 0.001) in patients with complete (88.5%) than in those with incomplete revascularization (83.5%). Reemployment occurred more often in patients with complete (52%) than in those with incomplete revascularization (40%) (p less than 0.001), and more patients were free of angina after complete (70%) than after incomplete revascularization (58%) (p less than 0.0005). Long-term survival appeared to be mediated primarily through improved revascularization rather than through differences in left ventricular function.

Angina Pectoris↗
PubMed1983

Percutaneous saphenous vein angioplasty to avoid reoperative bypass surgery.

Thirty-seven patients with vein graft stenosis following coronary artery bypass underwent percutaneous transluminal vein graft angioplasty to avoid another operation. Location of the stenoses was at the aortic anastomosis in 3 patients, in the vein body in 12, and at the distal anastomosis in 22. All patients had disabling angina pectoris. Initial success (greater than 20% reduction of stenosis) was achieved in 35 patients. Vein graft angioplasty was performed within a year after bypass in 28 patients. The percent of stenosis and the pressure gradient across the obstruction were reduced from 84 to 24% and from 58 to 15 mm Hg, respectively. Complications of the procedure included emergency coronary artery bypass in 2 patients, myocardial infarction in 2, and ventricular fibrillation in 1. There were no deaths. Of 15 patients with stenosis at the aortic anastomosis or vein body, the dilation was initially successful in 14 but restenosis occurred in 7 within the first year after angioplasty. Only 2 of the remaining 7 were asymptomatic after vein graft angioplasty. However, for patients having vein graft angioplasty of the distal anastomosis, restenosis occurred in only 3, while 12 were asymptomatic at the end of the first year. The average hospital cost of a repeat coronary artery bypass operation was 2.8 times the cost of vein graft angioplasty.

Angioplasty, Balloon↗
PubMed1983

Percutaneous transluminal coronary angioplasty in patients with prior coronary bypass surgery.

To improve symptomatic status and avoid reoperation, 122 initial and 7 repeat percutaneous transluminal coronary angioplasty procedures were performed in 116 patients with disabling angina pectoris at a mean of 26.8 months (range 2 to 132) after coronary bypass surgery. Marked angiographic improvement (greater than 30% reduction in diameter stenosis) was obtained in 107 (88%) of the 122 initial procedures and in all 7 repetitions. Mean stenosis was reduced from 78 +/- 13% (mean +/- standard deviation) to 25 +/- 13% (p less than 0.0001) and mean pressure gradient from 49 +/- 15 to 11 +/- 8 mm Hg (p less than 0.0001). Complications were: emergency surgery (three patients), Q wave infarction (one patient), myocardial infarction by enzyme criteria only (four patients) and non-occluding coronary dissection (one patient). There were no neurologic or peripheral vascular complications and no early deaths. One late death occurred 14 months after an unsuccessful but uncomplicated angioplasty procedure. At a mean follow-up of 8.3 months, 88 patients (76%) were free of angina or in improved condition. In patients followed up for at least 6 months, evidence of restenosis occurred in 9 (53%) of 17 saphenous veins, 1 (50%) of 2 proximal graft anastomoses, 4 (18%) of 22 distal graft anastomoses and 5 (14%) of 37 native coronary arteries. When coronary anatomy is suitable, percutaneous transluminal angioplasty is an attractive alternative to reoperation in symptomatic patients with prior coronary bypass surgery.

Adult↗
PubMed1983

Trends in the treatment of coronary disease today. Selective use of PTCA and bypass surgery.

Selection and treatment of patients with ischemic heart disease is presently undergoing an evolutionary trend. Percutaneous transluminal coronary angioplasty (PTCA) has been recommended as the initial procedure for many patients with coronary artery disease (CAD), thus possibly redefining candidates for coronary bypass surgery (CABS). Between October 1980 and June 1982, 777 patients having PTCA and 2068 patients having CABS were analyzed for differences in clinical presentation, complications, and early outcome. Patients having CABS were significantly older, had a higher incidence of hypertension (46% vs. 32%), more multivessel disease (80% vs. 12%), and poorer left ventricular function (nl. wall motion = 88% vs. 52%). The incidence of myocardial infarction in patients after PTCA was 1.0% (8/777). Emergency CAB was required in 5.3% of patients following PTCA. There were no deaths following the angioplasty procedure and 25 deaths in 2068 patients having CABS (hospital mortality rate = 1.2%). Since 1973, there has been a progressive decline in hospital mortality rate (now, less than 1%), postoperative infarction (now, 3%), requirement for inotropic drugs (now, 5%) and frequency of IABP (less than 1%). Increasing ability to achieve complete revascularization now means improved survival and freedom from angina with CAB surgery. PTCA and CAB are both procedures that may be used effectively for selected patients, depending on clinical presentation, extent of CAD, and left ventricular function (LVF). Careful patient selection affords the opportunity for use of PTCA in patients with single-vessel disease (SVD) and good LVF and CABS in patients with multivessel disease, regardless of LVF. Symptomatic patients with SVD and total vessel occlusion are not candidates for PTCA. Our data demonstrate that both PTCA and CABS may be accomplished with very low perioperative complications and hospital mortality.

Adult↗
PubMed1983

Effect of positive end-expiratory pressure on excessive mediastinal bleeding after cardiac operations. A controlled study.

The efficacy of mechanical ventilation with positive end-expiratory pressure (PEEP) in the therapy of excessive mediastinal hemorrhage following cardiac operations remains unproved. One hundred thirty-nine patients undergoing elective myocardial revascularization were divided into two groups on the basis of preoperative hematologic evaluation: Group I, 94 patients with no history of hematologic abnormalities and a normal coagulation profile; Group II, 45 patients with a recent use of antiplatelet medications and/or a prolonged template bleeding time. Both groups were randomized to receive mechanical ventilation with 10 cm H2O of PEEP or no PEEP beginning 1 hour after operation and continuing for an 8 hour study period. Mean blood loss at 8 hours (BVt) was not significantly different between PEEP and control patients in either group. Fifty-seven patients in Groups I and II had mediastinal bleeding in excess of 180 ml/hr at the initiation of the study period. There was no significant difference in mean BVt or mean hourly chest tube output with or without PEEP in either group of this subset. In view of the lack of demonstrable efficacy in decreasing mediastinal hemorrhage and the potential of adverse hemodynamic effects, PEEP should no longer be used for therapy of excessive bleeding after cardiac operation, especially in patients with reduced cardiac reserve.

Adult↗
PubMed1983

The porcine bioprosthesis. A review of 1,000 consecutive patients undergoing cardiac valve replacement.

Early and late experience with 1,000 patients undergoing porcine xenograft replacement of cardiac valves from 1974 through 1981 at Emory University Hospital is presented. Hemodynamic performance of the modified orifice Hancock and the Carpentier-Edwards valves has been quite satisfactory. There has been a low incidence of thromboembolism in the absence of routine anticoagulation. Less than 20 per cent of our patients are anticoagulated long-term, the primary indication being chronic artrial fibrillation. Endocarditis has developed in 0.7 per cent of patients, an incidence comparing most favorably with that of mechanical prostheses. Valve dysfunction secondary to primary tissue failure is a definite problem. The highest incidence of tissue failure occurred in young patients after six years of implantation. Detailed analysis of long-term patient survival showed a low incidence of valve related deaths. The porcine xenograft is a satisfactory prosthesis for cardiac valve replacement. Our data suggests its use should be limited to older patients or to patients in whom anticoagulation is contraindicated. It should be explained to all patients that long-term durability is unknown and that re-replacement of these bioprostheses within a decade is quite likely.

Adolescent↗
PubMed1983

Recognition and management of ascending aortic dissection complicating cardiac surgical operations.

This study retrospectively reviews the hospital records of 24 patients who developed ascending aortic dissection during or following 6,943 cardiac surgical procedures performed from January, 1971, through December, 1981. Group I consists of 15 patients with ascending aortic dissection presenting intraoperatively during myocardial revascularization. Group II consists of nine patients, seven who underwent myocardial revascularization and two who underwent aortic valve replacement, who developed ascending aortic dissection 30 minutes to 21 days after cardiac operation. Four of these patients had poorly controlled hypertension postoperatively. Surgical repair was attempted in all patients in Group I, with an operative mortality of 33%. The major cause of death was myocardial dysfunction secondary to ischemia. There were no operative deaths among six patients managed with closed plication techniques alone. Four of nine patients in Group II underwent ascending aortic dissection repair with an operative mortality of 50%. The overall mortality in Group II was 78%. The major factor in this high mortality was a delay in diagnosis and surgical therapy. Early diagnosis of the intraoperative or postoperative ascending aortic dissection process is essential to minimize the extent of dissection and prevent delay of definitive surgical therapy. Closed aortic plication of the intimal injury rather than more extensive aortic repair may reduce morbidity and mortality in selected patients.

Adult↗
PubMed1982

Constrictive pericarditis as a complication of cardiac surgery: recognition of an entity.

Among 5,207 adult patients who underwent cardiac surgery, postoperative constrictive pericarditis was recognized in 11 patients (0.2% incidence rate). Seven patients had coronary arterial bypass grafting and 4 had valve replacement; the pericardium was left open in all cases. The average interval between surgery and presentation of pericardial constriction was 82 days (range 14 to 186). M mode echocardiography revealed epicardial and pericardial thickening in 7 cases and variable degrees of posterior pericardial effusion in 5 cases. Cardiac catheterization demonstrated uniformity of diastolic pressures with a characteristic early diastolic dip and late plateau pattern. Two patients responded to medical therapy for chronic pericarditis. One patient had a limited parietal pericardiectomy followed by recurrent constrictive pericarditis that eventually stabilized with medical therapy. The other 8 patients required radical pericardiectomy. The pathophysiology of constriction after surgery is unclear. Its clinical expression involves a wide spectrum of presentation and therapeutic response. Constrictive pericarditis may be a complication of cardiac surgery in spite of an open pericardium and should be considered in postoperative patients who present with deteriorating cardiac function.

Adrenal Cortex Hormones↗
PubMed1982

Porcine cardiac xenograft valves: analysis of survival, valve failure, and explantation.

Porcine cardiac xenografts were used for cardiac valve replacement in 1,093 patients. Hospital mortality for aortic valve replacement (AVR) was 3.7%; for mitral valve replacement (MVR), 7.8%; and for AVR + MVR, 4.7%. Total follow-up was 2,036 patient-years; maximum, 7.3 years; and mean, 1.89 years. Actuarial survival (+/- standard error of the mean) for AVR was 84% +/- 2% at 56 months; for MVR, 84% +/- 3% at 56 months; and for AVR + MVR, 86% +/- 4% at 30 months. Nonfatal thromboembolism occurred in 8 of 1,030 patients (0.78%). Anticoagulation was not routinely employed. Fifty hospital survivors (4.8%) experienced valve dysfunction; 18 of the survivors (1.7%) died; and 32 of the survivors (3.1%) underwent reoperation. The rate of dysfunction increased slowly until the sixth year when an increased rate was observed (p less than 0.0001). Patients less than 34 years old had a higher incidence of dysfunction (p less than 0.01). Thirty-two hospital survivors (3.1%) underwent explantation of the porcine valve for late dysfunction. Valve dysfunction secondary to endocarditis and paravalvular leak occurred early, while leaflet deterioration or thrombosis was more gradual in onset and was noted later. The porcine valve has functioned well for 1 to 7 years with a low incidence of valve related morbidity and mortality without routine anticoagulation in patients older than 34 years of age.

Aortic Valve↗
PubMed1982

Unstable angina pectoris: comparison with the National Cooperative Study.

Seventy-eight patients having prolonged pain (greater than 20 minutes) with transient S-T segment and T-wave changes and coronary artery bypass were compared to 288 patients previously reported in the National Cooperative Study on the treatment of unstable angina pectoris. Clinical characteristics observed in the present study that differed from those of the National Cooperative Study included a more chronic anginal pattern, slightly older age, greater number of women, and higher incidence of prior myocardial infarction. The severity of vessel disease was the same for both groups. Left ventricular function was slightly better in the present series. The incidence of perioperative infarction in the present series (3.8%) was significantly less than that for surgical patients reported in the National Cooperative Study (17%). Hospital mortality was also less: 1.2% versus 2.0 and 3.0% for the medical and surgical patients, respectively, in the National Cooperative Study. Late myocardial infarction was 11% and 13% at 30 months for medical and surgical patients in the National Cooperative Study, and only 3% at 43 months in the present surgical series. Actuarial survival for the entire patient population was 95% at 42 months. The reduced hospital mortality and perioperative infarction rates were attributed to immediate operation once acute myocardial infarction has been ruled out, advances in surgical and anesthetic technique, selection of patients with preserved left ventricular function, and a trend toward complete revascularization.

Angina Pectoris↗
PubMed1982

Percutaneous transluminal coronary angioplasty: role of the surgeon.

Over a recent one-year period, 339 patients underwent percutaneous transluminal coronary angioplasty (PTCA) and were compared with 338 patients having isolated coronary artery bypass surgery. Patients undergoing PTCA had a shorter duration of angina, a lower number of prior myocardial infarctions, and better left ventricular function (p less than 0.01); PTCA was considered initially successful in 87% (295/339) of patients. Repeat angioplasty was performed in 18% of patients (34/339), with a successful outcome in all but 1. The most common finding at operation in those with failed angioplasty and urgent or emergency revascularization was dissection of an atheromatous plaque. There were 28 early failures (operation performed within 24 hours) and 24 late failures (operation at more than 24 hours), for early and late failure rates of 8.3% and 7.1%, respectively. Although the cumulative frequency of new Q-waves in the entire angioplasty series was low (2.7%), the incidence was high in those with angioplasty failure and subsequent operation (18%), and was significantly greater than in patients having elective coronary bypass (3.6%). Use of inotropic agents and lidocaine treatment for ventricular arrhythmias was also significantly higher in patients with unsuccessful PTCA who required operation than in those undergoing elective bypass (10% versus 3% and 10% versus 1.5%, respectively; p less than 0.01). Eleven of the 28 patients who were early failures were totally revascularized within 2 hours of angioplasty failure. Facilities and staff available for expedient revascularization accounted for the low morbidity and lack of mortality in PTCA failures.

Angina Pectoris↗
PubMed1982

Concomitant carotid and coronary artery reconstruction.

Data are presented on 68 patients who underwent concomitant carotid endarterectomy (CE) and coronary artery bypass surgery (CAB) at Emory University Hospital from January 1974 to February 1981. This group is then compared with a randomly selected, matched population without known carotid disease who underwent CAB alone. Asymptomatic bruit was the reason for investigation in 40 patients (59%); another 23 patients (34%) experienced transient cerebral ischemic attacks (TIAs); and five patients (7%) had TIA and prior stroke. Carotid stenoses (>75% luminal narrowing) were demonstrated as follows: isolated left, 24 patients; isolated right, 27 patients; and bilateral lesions, 16 patients. One patient had innominate artery stenosis. Associated total occlusion of one or both vertebral arteries was demonstrated in six patients. Ninety-seven per cent of patients had disabling angina pectoris prior to operation; the angina was unstable in 57%, 15% had congestive heart failure, and 54% had had at least one prior myocardial infarction (MI). Single-vessel coronary disease was present in 12.5% of patients, double in 37.5%, triple in 41.1%, and left main stenosis in 9%; 43% of patients had abnormal ventricular contractility. CE was performed on 67 patients (36 left and 31 right); aortocarotid bypass was performed on one. The CE procedures were performed immediately prior to the sternotomy for CAB under the same anesthesia. CAB consisted of single bypass in eight patients (11.8%); double in 16 patients (23.5%); triple in 22 patients (32.4%); and quadruple or more in 22 patients (32.4%) (mean = 2.9 grafts per patient). There was no hospital mortality. Perioperative MI occurred in 2.0% and stroke with residual deficit in 1.3%. Cumulative survival is 98.5% at two years. Sixty-three patients (92%) reported improvement or elimination of anginal symptoms after operation. Rehospitalization for stroke was necessary in 3.7% patients. Postoperative activity levels are; self-care only, 3.9%; normal daily activity only, 17.6%; moderate exercise capability, 45%; and vigorous exercise capability, 33%. Comparison was made with a group of 84 randomly selected patients who underwent CAB alone during the same time interval. Data revealed no significant difference between the groups regarding sex, angina subset, ventricular function, coronary anatomy, vessels grafted, perioperative stroke or MI, mortality, or postoperative activity capability. Older age (59.8 vs. 55.6, p < 0.01) and less complete coronary revascularization possible (66 vs. 84%, p < 0.05) in the CECAB group were the only significant differences. Carotid stenosis co-existing in patients requiring CAB should be concomitantly corrected with the same risk and results expected from CAB alone.

Aged↗
PubMed1982

Surgical revascularization following unsuccessful percutaneous transluminal coronary angioplasty.

From September, 1980, through August, 1981, 353 patients underwent attempted percutaneous transluminal coronary angioplasty (PTCA). Twenty-seven patients (7.6%) subsequently underwent elective myocardial revascularization without death or complicating PTCA. Surgical support in the first 2 months involved a fully-staffed operating room standing idle. During the last 10 months, patients requiring emergency revascularization were accommodated in the first operating room available. All 17 patients undergoing emergency revascularization had severe chest pain and 12 patients had ST-segment elevation on the electrocardiogram. The average time from onset of ischemia to revascularization was 135 minutes and did not change over the period of study. Improvement in the electrocardiogram and myocardial function were frequently noted with restoration of flow by the vein graft. Two patients (12%) required inotropic drug support following revascularization. All 12 patients with ST-segment elevation preoperatively had elevated myocardial enzyme levels postoperatively, including five patients (29%) with new Q waves on the electrocardiogram. Myocardial necrosis did not correlate with time to revascularization, number of diseased vessels, the artery being instrumented, the mechanism of ischemia, or the presence of collateral flow. There were no deaths. Because of the high incidence of myocardial infarction despite prompt revascularization, we now routinely insert the intra-aortic balloon pump in the catheterization laboratory in patients with refractory myocardial ischemia requiring emergency revascularization. Prompt safe revascularization for acute ischemia following PTCA can be achieved without expensive and inefficient standby of cardiac surgical facilities. Transmural myocardial ischemia following complicated PTCA is frequently associated with evidence of myocardial necrosis despite prompt surgical revascularization. Greater salvage of ischemic myocardium may be possible if the intra-aortic balloon pump is used in the interval between PTCA-induced injury and surgical revascularization.

Adult↗
PubMed1982

Clinical evaluation of a new fiberoptic catheter oximeter during cardiac surgery.

A new pulmonary arterial catheter (Opticath), containing the standard pulmonary artery catheter features plus two fiberoptic filaments to permit continuous measurement of oxygen saturation (SVO2) by a companion oximeter, was studied in 13 patients undergoing elective coronary bypass surgery. The study was designed to evaluate the accuracy of Opticath SVO2 measurements, to determine the incidence of catheter-related problems, and to correlate changes in SVO2 with hemodynamic changes. A good correlation was found between the SVO2 determined by the Opticath and that measured by American Optical and Radiometer Oximeters (r = 0.92 and 0.89 respectively; p less than 0.0001). There was a significant correlation between increases or decreases in values of SVO2 greater than or equal to 5% and corresponding changes in cardiac index, stroke index, and left ventricular stroke work index (p less than 0.001), and an 86% probability that SVO2 decrease greater than or equal to 5% reflected a significant decline in cardiac index.

Cardiac Catheterization↗