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Biomedical subjects

K V Arom

Publications and source records attributed to K V Arom.

At least 55 records · Page 3Linked to original sources
PubMed1991

Treatment of end-stage chronic obstructive pulmonary disease with double lung transplantation.

Six patients with end-stage emphysema (age 44 +/- 2 years) underwent double lung transplantation (Tx) from June 1988 through May 1990. All suffered from severe inanition and required oxygen therapy. The ischemic time was 193 +/- 28 minutes. Post-Tx immune suppression was OKT3 (14 days), cyclosporine (trough levels of 150 +/- 25 ng/ml), azathioprine to keep WBC at 3,000 to 5,000/cu mm (1 to 3.0 mg/kg/day) and following OKT3, a tapering prednisone regimen. Two rejection episodes that occurred in two patients on post-Tx day 5 and 10 were treated with bolus doses of methylprednisolone. The mean hospital stay was 32 +/- 7 days (range, 20 to 69 days). Four patients required treatment of cytomegalovirus (CMV) infection: gastritis (+donor, +recipient) in one and CMV pneumonia in two (+donor, -recipient). A fourth (+donor, -recipient) had right-sided Candida empyema six weeks post-Tx, developed CMV and staphylococcal sepsis, and died 64 days post-Tx. One patient required pyloroplasty eight weeks post-Tx and one patient underwent tracheal suture line repair at eight weeks. During a follow-up of 81 patients months (range, 8 to 24 months), one patient had developed Epstein-Barr viral (EBV) induced lymphoproliferative disease in the lung and one patient had developed EBV lymphoma. Three patients are at work, one is continuing rehabilitation, and one is at home. Double lung Tx offers a definitive benefit to patients with emphysema; however, a prolonged postoperative course can be expected. Viral infections remain serious but treatable problems.

Adult↗
PubMed1991

Emergency cardiopulmonary bypass support in patients with cardiac arrest.

Emergency percutaneous cardiopulmonary bypass support was instituted in 11 patients in cardiac arrest refractory to conventional resuscitation measures. Emergency percutaneous cardiopulmonary bypass support was used in five patients in whom cardiac arrest occurred as a result of a complication in the cardiac catheterization laboratory (group 1) and in six other patients in cardiac arrest (group II). A 21F cannula and a 17F cannula were percutaneously inserted into the femoral vein and artery. Flow rates of 3 to 5 L/min were achieved with restoration of mean arterial pressure to 70 mm Hg (range 50 to 75). The status of all 11 patients was improved initially both clinically and hemodynamically with percutaneous cardiopulmonary bypass. Of the group II patients, three had anatomy unsuitable for percutaneous transluminal coronary angioplasty or coronary bypass grafting, could not be weaned from cardiopulmonary support, and died; three of these patients had coronary artery bypass grafting and two survived. All five group I patients underwent successful coronary bypass grafting and survived. Of the seven patients with anatomically correctable disease, all seven were discharged from the hospital. With conventional management nearly all seven of these patients would have died. Nine of 11 patients underwent a cardiac operation and seven of the nine survived. The operative mortality rate was 22% and the overall survival rate was 64%. At follow-up (mean 7 months), all seven patients are alive and six have resumed a normal and active life-style. In conclusion, emergency percutaneous cardiopulmonary bypass support is a powerful resuscitative tool that may stabilize the condition of patients in cardiogenic shock and cardiac arrest to allow for definitive intervention.

Cardiac Catheterization↗
PubMed1990

Use of the pericardial fat pad in pulmonary transplantation.

Historically, the healing of tracheal or bronchial anastomoses has been the Achilles heel in pulmonary transplantation. In the past, steps taken to enhance healing of these structures and have allowed single-lung, double-lung, and heart-lung transplantation to be accomplished safely. This report presents a simplified technique for protection of the tracheal anastomosis in heart-lung and double-lung transplantation. This technique, wherein the pericardial fat pad from the right side is utilized to wrap the tracheal anastomosis, not only allows for excellent healing of the anastomosis but separates the aorta from the trachea. In 19 patients having heart-lung (N = 13) or double-lung (N = 6) transplantation there were no tracheal healing problems, dehiscence or stenosis found.

Adipose Tissue↗
PubMed1989

Ten years' experience with the St. Jude Medical valve prosthesis.

Records of 1,298 consecutive patients who had received the St. Jude Medical prosthesis were reviewed (713 male and 585 female patients; mean age, 61.79 +/- 13.4 years). Early mortality was 5.7% (74 patients). Ninety-three percent complete follow-up was accomplished for the 1,224 patients who left the hospital (4,306.50 patient-years). One hundred ninety-two of these patients died, a late mortality of 16.9%. Sixty-four patients experienced thromboembolic episodes (17 major and 35 permanent). Twenty-four patients had anticoagulant-related bleeding, 4 had valve thrombosis, 7 had prosthetic valve endocarditis, 9 had paravalvular leak, and 10 underwent reoperation. There was no structural valve failure in this series. Twenty-two of the 118 patients who had valve-related complications died; another 15 patients died of sudden and unknown causes. Therefore, the total number of valve-related deaths was 37. Of those patients who survived, New York Heart Association functional class improved significantly (98% in classes II and III preoperatively and 96% in classes I and II postoperatively). Linearized rates for thromboembolism, valve thrombosis, and anticoagulant-related bleeding were 1.49% +/- 0.19%, 0.09% +/- 0.05%, and 0.56% +/- 0.11%/100 patient-years, respectively. The actuarial estimate of incidence free from all complications, operative death, and valve-related death was 66.9% +/- 8.2% at the end of 9 years. In spite of old age and advanced heart disease, the patients who received the St. Jude Medical prosthesis had very good results over a 10-year period.

Actuarial Analysis↗
PubMed1989

Effect of intraoperative intervention on neurological outcome based on electroencephalographic monitoring during cardiopulmonary bypass.

Neurological complications of cardiopulmonary bypass procedures are well documented. The present two-part study was undertaken to (1) determine if on-line computerized electroencephalographic changes correlated with neurological outcome and (2) compare neurological outcome with that of a second group of patients who received intraoperative interventions based on electroencephalographic data. Part 1 consisted of monitoring 50 patients. A power drop index was developed that correlated with new global neurological deficits. New global deficits occurred in 44% of the patients. In part 2, this information was used to design intervention criteria. Treatment protocols used previously accepted methods of increasing cerebral blood flow, ie, increasing pump flow, raising mean arterial pressure, and increasing CO2 content in the ventilator blend. Global neurological deficits were reduced to 5% in a group of 41 clinically similar patients (p less than 0.001). Cerebral perfusion pressures were similar in both groups. The single correlating factor was the power drop index as identified by computerized EEG. Our conclusion is that simple intervention guided by computerized EEG can reduce global neurological deficits in patients having cardiopulmonary bypass procedures.

Aged↗
PubMed1989

Ten-year follow-up study of patients who had double valve replacement with the St. Jude Medical prosthesis.

Records of 100 consecutive patients who had received double valve replacement were reviewed (41 men, 59 women, mean age, 60.86 +/- 13.0 years). The early death rate was 6% (six patients). A completed follow-up rate of 93% was accomplished in these 94 patients who left the hospital (mean, 309.8 patient-years). Twenty-three of these patients died. The late death rate was 26.4%. Four patients experienced thromboembolic episodes (one transient and three permanent; all were minor). One patient had a paravalvular leak (mitral), and another had thrombosis of the tricuspid valve. There was no clinical evidence of hemolysis, infective endocarditis, or structural failure or anticoagulant-related bleeding. One of those 23 patients who died was the patient who had thrombosis of the tricuspid valve. Another three patients died of sudden and unknown causes, 15 of cardiac-related problems and four of noncardiac problems. Of those patients who survived, New York Heart Association functional class improved significantly (from 66% class III before to 85% class I after). Linearized rates for thromboembolism and thrombosis were 1.29 +/- 0.65 and 0.32 +/- 0.32 per 100 patient-years, respectively. The actuarial estimates of incidence free of all complications and valve-related deaths were 77.9% +/- 10.6%. Despite the advanced heart disease involving two native valves, the patients who had double valve replacement with the St. Jude Medical prosthesis had very good results over a 10-year period.

Actuarial Analysis↗
PubMed1987

St. Jude Medical prosthesis: valve-related deaths and complications.

Despite the hemodynamic improvement in cardiac valve prostheses, valve-related deaths and complications have remained a substantial source of morbidity and mortality. This follow-up study was carried out in April, 1986, in a group of 816 patients who received 876 St. Jude Medical prostheses between October, 1977, and October, 1984. One hundred fifty-five patients (37%) of the 422 having aortic valve replacement (AVR) and 88 (29%) of the 300 having mitral valve replacement (MVR) had concomitant coronary artery bypass grafting, and 94 patients (12%) had miscellaneous procedures performed in addition to valve replacement. Sixty-three patients died within the operative period, an operative mortality of 7.7%. Follow-up was complete for 98% of the patients; the mean follow-up was 42 months. At that time, 87 more patients had died, a late mortality of 11.9%. There were 13 valve-related deaths (4 in the AVR group, 7 in the MVR group, and 2 in the miscellaneous group); the causes of death were thromboembolism (7), anticoagulant-related hemorrhage (2), valve thrombosis (2), prosthetic valve endocarditis (1), and perivalvular leak (1). There were 37 thromboembolic episodes (1.78/100 patient-years) and 67 anticoagulant-related hemorrhages (3.22/100 patient-years), 46% of which necessitated transfusion. The incidence of valve thrombosis was 0.6% (4 patients). Perivalvular leak and prosthetic valve endocarditis occurred in 7 patients (1.0%) and 5 patients (0.7%), respectively. Reoperation was carried out in 6 patients (0.8%), but only for perivalvular leak. There were no deaths, no complications, and no clinical evidence of malfunction of the prosthetic valve.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

The comparative influence of prophylactic antibiotics on the prothrombin response to warfarin in the postoperative prosthetic cardiac valve patient. Cefamandole, cefazolin, vancomycin.

A prospective randomized trial was conducted comparing the effect of three antibiotics: cefamandole (CM), cefazolin (CZ), and vancomycin (V), used as prophylaxis for prosthetic valve surgery, on the prothrombin (PT) response to warfarin (W) on the third day of anticoagulant therapy. Twenty patients, with normal preoperative PTs, were randomized to each antibiotic. Their PTs were not significantly different at 2 hours after operation and the morning before W was begun. The three groups received similar W doses for 2 days, and the PT, as percentage of activity, on the morning of the third day demonstrated that V (51 +/- 18%) was significantly greater (p less than 0.005) than CM (29 +/- 14%) or CZ (38 +/- 18%). CM had a significantly greater percentage of change in PT (64 +/- 14%, p less than 0.0001) from the first to third day than either CZ (51.1 +/- 18%) or V (44.6 +/- 19%). CM also had a greater number of patients (6) with PTs greater than or equal to 30 seconds on day 3 than either CZ (1) or V (1). The antibiotic influence on the PT response to W in this study is ranked as CM greater than CZ greater than V.

Aged↗
PubMed1987

Antibiotic prophylaxis in open-heart surgery patients: comparison of cefamandole and cefuroxime.

The efficacy of cefamandole and cefuroxime in preventing postoperative wound infections was compared in 3037 patients undergoing open-heart surgery. Antibiotic prophylaxis in 1467 patients having coronary artery bypass and valve replacement surgery was cefamandole 2 g iv preoperatively followed by 2 g q6h for five days postoperatively; 1570 patients received cefuroxime 1.5 g iv preoperatively then 1.5 g iv q 12h for three days postoperatively. Postoperative wound infections (sternal and leg wounds) were studied in each treatment group. In the cefamandole study group, 27 patients (1.8 percent) developed postoperative wound infections (9 sternal and 18 leg wounds). In the cefuroxime treatment group, 19 patients (1.2 percent) developed postoperative wound infections (9 sternal and 10 leg wounds). Overall, no statistical difference was found between the two antibiotics in preventing postoperative wound infections. However, in patients having valve replacement surgery, cefuroxime was found statistically more effective than cefamandole prophylaxis in preventing sternal wound infections (no infections in 284 patients compared with five infections in 205 patients, respectively, p = 0.01). The most common organism isolated from infected wounds with cefamandole was Staphylococcus aureus followed by S. epidermidis compared with cefuroxime which had S. epidermidis followed by S. aureus. Cefuroxime was found to be as effective as cefamandole and considerably less expensive in preventing postoperative wound infections in patients undergoing open-heart surgery.

Cardiac Surgical Procedures↗
PubMed1985

Six years of experience with the St. Jude Medical valvular prosthesis.

The cases of 680 consecutive patients who underwent valve replacement with the St. Jude Medical prostheses by one group of surgeons from October 1977 through October 1983 were reviewed. The operative mortality for the entire group was 6.6% (3.7% for aortic valve replacement [AVR], 1.6% for AVR and coronary artery bypass [CAB], 14.3% for AVR and miscellaneous procedures; 7.9% for mitral valve replacement [MVR], 15.5% for MVR and CAB, 33% for MVR and miscellaneous procedures; 5% for double valve replacement [DVR], 8.3% for DVR and CAB, and 0% for DVR and miscellaneous procedures). Warfarin (Coumadin) anticoagulation was recommended for all the patients. The mean follow-up of 24 months was completed in 95% of the patients (14,737 patient-months). The overall late mortality was 7.7% (6.2% for AVR, 6.3% for AVR and CAB, 8.3% for AVR and miscellaneous procedures; 7.9% for MVR, 6.7% for MVR and CAB, 33% for MVR and miscellaneous procedures; 15.8% for DVR, 18.2% for DVR and CAB, and 0% for DVR and miscellaneous procedures). There were no cases of mechanical prosthetic failure. Clinically significant hemolysis occurred in only five patients (less than 1%) with paravalvular leak after MVR. Only three patients (less than 0.5%) experienced prosthetic infection. Incidence of embolization was 0.7 per 100 patient-years in the patients who underwent AVR and 2.2 per 100 patient-years in those who underwent MVR.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

Should valve replacement and related procedures be performed in elderly patients?

The cases of 135 consecutive elderly patients 70 years old or older who had valve replacement and related surgical procedures from October, 1977, through April, 1982, were reviewed. There were 75 men and 60 women. The mean left ventricular ejection fraction was 50.16 +/- 5%. The overall operative mortality was 8% (11 patients). The early operative deaths were related mainly to cardiac failure, low cardiac output, sepsis, and renal and multiorgan failure. To assess the operative risk, these 135 patients were compared with 312 younger patients (less than 70 years old) who had undergone similar procedures during the same period. The operative mortality in this group was 5.2% (16). In-hospital complications included arrhythmia (13%), psychosis (7.4%), respiratory failure (6.7%), renal failure (6.7%), cerebrovascular accident (5.2%), myocardial infarction (4.4%), and reoperation for bleeding (2.2%). Wound dehiscence occurred in 1.5% of the patients, and pulmonary emboli and sepsis developed in 0.7%. Of these complications, only the incidence of cerebrovascular accident appeared to be more common in the elderly group (5.2% versus 2.8%), but it had no statistical significance (p = 0.18). A follow-up of 3,892 patient-months was completed in 98.4% of the survivors. There were 8 late deaths (6.4%). Six were related to the valve or to ongoing cardiovascular disease. Thirty-four patients subsequently required medical attention: 4 had bleeding because of the anticoagulant; 3 required a blood transfusion; and 27 were hospitalized. Six were admitted for related cardiac conditions and 7, for observation of other conditions; 14 underwent surgical procedures not related to the cardiovascular system.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1984

The influence of prophylactic antibiotics on the warfarin anticoagulation response in the postoperative prosthetic cardiac valve patient. Cefamandole versus vancomycin.

The influence of cefamandole and vancomycin used for prophylaxis on the warfarin anticoagulation response in 60 cardiac valve replacement patients during the postoperative period is presented. Patients were divided into two groups, hyper-responders prothrombin time (PT) greater than or equal to 32 sec, 48 hr after the initial warfarin dose (GrIHR), or normal responders PT less than 32 sec (GrIINR). Fifteen patients (25%) were in GrIHR (PT 44.3 +/- 10.5) and 45 in GrIINR (21 +/- 5). Fourteen of the 15 GrIHR patients received cefamandole and 1 of the 15 GrIHR patients received vancomycin p less than 0.05, as prophylaxis. Warfarin sensitivity was assessed using a warfarin dose index (WDI) calculated in the initial postoperative period (WDIINT) and at discharge (WDIDIS). GrIHR patients had greater WDIINT and WDIDIS compared to GrIINR p less than 0.001. Baseline prothrombin time measured 8 hours prior to start of warfarin therapy (PTBL), was linearly correlated to the WDIINT with r = 0.8, p less than 0.001 in cefamandole patients only. The data suggests that cefamandole increases warfarin sensitivity early in the postoperative course of oral anticoagulation therapy, which may lead to excessively high prothrombin times with the possibility for serious bleeding.

Blood Coagulation↗
PubMed1982

Myocardial vs serum digoxin concentrations in infants and adults.

To establish whether there is a difference between infants and adults in the relationship of serum levels of digoxin to dosage or the ratio of myocardial to serum digoxin levels, the concentrations of digoxin in right atrial appendage (RAA) and serum were measured in 12 infants and 17 adults undergoing open heart surgery. Although the daily digoxin dose per weight for the infant was significantly greater than that for adults, there was no difference in the serum digoxin levels for the two groups. We found, however, a considerable difference in myocardial digoxin levels. The RAA digoxin levels were 211.8 +/- 72.1 ng/g of wet weight in infants and 35.1 +/- 7.7 ng/g of wet weight in adults. Similarly, the RAA-serum digoxin ratio was much higher in infants (149 +/- 30) than in adults (28 +/- 5). These data indicate discrepancies between infants and adults in the pharmacokinetics of digoxin, especially with respect to myocardial uptake.

Adult↗
PubMed1982

Effect of sodium nitroprusside during the payback period of cardiopulmonary bypass on the incidence of postoperative arrhythmias.

This study was designed to determine whether a sodium nitropruside infusion during the reperfusion (payback) period of cardiopulmonary bypass would minimize arrhythmias during the early postoperative period of coronary artery bypass surgery. A double-blind randomized study was carried out in 38 patients with no previous history of ventricular arrhythmias. Seventeen received 5% dextrose in water (D5W) and 21 received sodium nitroprusside at the rate of 2 microgram per kilogram per minute during the payback period. The pump flow was kept constant at 2.2 liters per square meter per minute, and mean pressure was maintained at greater than 50 mm Hg. There was a statistically significant difference between the two groups in the number of patients who developed ventricular arrhythmias (13 of 17, or 76%, in the D5W group versus 6 of 21, or 29%, in the sodium nitroprusside group; p less than 0.005). Twelve of the 13 patients in the D5W group experienced arrhythmias (6 ventricular tachycardia and 6 ventricular premature depolarization) within the first 24 hours, compared to 5 of 12 patients in the nitroprusside group (3 ventricular tachycardia and 2 ventricular premature depolarization). Only 1 patient in each group developed ventricular arrhythmia after the first postoperative day. One patient in each group experienced atrial arrhythmia during the first 24 hours. After 24 hours, atrial arrhythmias developed in 5 patients in the D5W group (35%) and 3 patients in the sodium nitroprusside group (17%) (p greater than 0.05). The arterial pH ranged from 7.35 to 7.55, with a Po2 greater than 70 torr and a serum potassium of 3.7 +/- 0.36 mEq per liter in the D5W group and 3.4 +/- 0.34 mEq per liter in the nitroprusside group during the period of arrhythmias. Sodium nitroprusside given during the payback period of cardiopulmonary bypass appears to minimize ventricular arrhythmias in the early postoperative period of coronary artery bypass surgery.

Arrhythmias, Cardiac↗
PubMed1981

Aorto-coronary vein fistula. A complication of coronary artery bypass graft surgery.

We report two cases of the inadvertent insertion of a saphenous vein bypass graft into the anterior cardiac vein creating an aortocoronary vein fistula. The clinical recognition, evaluation, and management are discussed. Suggestions on surgical technique to help minimize or eliminate this potential complication during saphenous vein bypass surgery are proposed.

Aged↗