Search PubMed⌕ Search

Biomedical subjects

M Goormastic

Publications and source records attributed to M Goormastic.

At least 37 records · Page 2Linked to original sources
PubMed1989

Determinants of left ventricular hypertrophy in patients with aortic stenosis.

The determinants of left ventricular (LV) mass were evaluated in 150 patients with aortic stenosis. All patients underwent M-mode, two-dimensional, and Doppler echocardiography. Peak aortic gradients ranged from 9 mmHg to 144 mmHg (mean 52.3 mmHg). The degree of left ventricular hypertrophy, as determined by LV mass index, was compared to several variables, including age, systolic blood pressure, left ventricular function, peak and mean pressure gradients, relative wall thickness, estimated LV systolic pressure, and aortic valve area. The LV mass index varied from 114.1 to 547.2 g/m2 (mean, 159.4 g/m2). Multiple regression analysis revealed that both age and LV function were highly significant predictors of LV mass index. Moreover, LV mass index and systolic blood pressure were significantly greater in patients older than 65 years (P less than .01; P less than .0001, respectively). These results suggest that the severity of left ventricular hypertrophy in the presence of aortic stenosis is multifactorial and not affected only by the hemodynamic severity of aortic stenosis as assessed by aortic valve area or pressure gradient estimation. Patient age, systolic blood pressure, and ventricular function should all be considered when evaluating the degree of left ventricular hypertrophy in patients with aortic stenosis.

Age Factors↗
PubMed1989

Primary isolated aortic valve replacement. Early and late results.

A total of 1689 consecutive patients underwent isolated aortic valve replacement at the Cleveland Clinic Foundation from 1972 through 1986. There were 57 (3.4%) in-hospital deaths. Multivariate analysis identified advanced age (p = 0.0014), preoperative blood urea nitrogen level greater than 25 mg/100 ml (p = 0.008), New York Heart Association function class (p = 0.015), and preoperative atrial fibrillation (p = 0.04) as independent variables associated with increased in-hospital mortality and the use of cardioplegia for myocardial protection (p = 0.006) as a factor decreasing mortality. Follow-up documented survival rates of 85% and 66% and event-free survival rates of 71% and 43% at 5 and 10 postoperative years, respectively. Advanced age, moderate or severe impairment of left ventricular function, coronary artery disease, and preoperative blood urea nitrogen level greater than 25 mg/100 ml were associated with decreased late survival and event-free survival (all p less than 0.05). Patients with bioprostheses had better survival (p = 0.003) and event-free survival (p = 0.0007) rates than patients with mechanical valves. Patients with bioprostheses had superior results only if not receiving warfarin, and they experienced more reoperations and endocarditis; those with mechanical prostheses had more strokes, myocardial infarctions, bleeding complications, and thromboembolic events. Analysis of patients grouped according to age at operation showed that bioprostheses were associated with improved survival and event-free survival for patients 40 years older or older. Younger patients experienced more reoperations and episodes of endocarditis, and older patients more thromboembolic complications. We conclude that 10-year results after isolated aortic valve replacement are influenced by both patient-related and management-related variables, and the impact of these factors is different for patients of different ages.

Adult↗
PubMed1989

Ventricular aneurysm resection. Trends in surgical risk.

From 1972 to 1987, 1,183 patients underwent ventricular aneurysm resection. At 4-year intervals, this series was divided into four subsets that differed in patient and management-related variables. Comparison of patients seen from 1972 to 1975 with those seen in 1984-1987 shows a significant increase in mean age to 59.4 years, with 31.6% older than 65 years, an increase to 43.4% of patients with congestive heart failure, and a decrease to 42.8% of patients with angina. In the most recent interval, 30.7% of patients had mammary grafts, 81.1% had associated grafts, and 47.2% of patients were completely revascularized. Mortality rate, however, increased to 8%. Deaths were attributed to cardiac causes in 59.7% of cases. Multivariate analysis identified emergent procedures, advancing age, left main trunk disease, and history of congestive heart failure as risk factors. We conclude that the incidence of aneurysm resection is decreasing and operative risk has been constant despite advancing patient age and more extensive operative procedure.

Aged↗
PubMed1988

Effects of varying argon ion laser intensity and exposure time on the ablation of atherosclerotic plaque.

Using continuous wave (CW) argon ion laser light, a total of 253 laser exposures of varying power (1.5, 3, 5, 8 or 10 W) and duration (20-1,333 ms) were delivered to four segments of human atheromatous aorta obtained at autopsy. Exposure conditions were controlled by using an optically shielded laser catheter that provided a 500 micron spot of light of known power. Two thresholds for consistently reproducible ablation could be defined-an intensity threshold at 25.5 W/mm2 and a fluence threshold at 3.2 J/mm2. Above threshold, a fluence of 5.1 J/mm2 was found to produce the most efficient ablation, ie, removed the greatest volume (mm3) per energy delivered (J) compared to other fluence levels employed (p less than 0.0001). Between aortic segments, however, considerable variability in efficiency (mm3/J) was observed, possibly owing to different optical properties and/or plaque composition. Low-intensity laser radiation produced inconsistent ablation and extensive coagulation effects to surrounding tissue. When a fluence of 5.1 J/mm2 was constructed with a high-intensity laser beam and a short exposure time, consistent and efficient tissue removal resulted without histologic evidence of coagulation necrosis.

Angioplasty, Balloon↗
PubMed1988

Gas volume quantitation during argon ion laser ablation of atheromatous aorta in blood and 0.9% saline media with an optically shielded catheter.

Using an optically shielded fiber optic laser catheter, the amount of gas produced when firing an argon ion laser into 0.9% saline solution or blood alone and into atheromatous aorta in either a blood or 0.9% saline medium was quantitated. Energies from 0.25 to 4 joules (J) were used at powers of 2, 5, and 8 W. We found that total volume of gas produced is small not only at equilibrium (0.3 +/- 0.1 microliter/J when firing in blood alone and also when ablating aorta in blood or saline media) but also at peak (2.5 +/- 0.2 microliters/J firing in blood alone and 1.0 +/- 0.1 microliter/J or 0.9 +/- 0.1 microliter/J when ablating aorta in saline or blood, respectively). Because these volumes are small, a clinically significant event from a gas embolus is unlikely during intravascular laser ablation of atheromatous plaque in the energy and power range studied. No gas was quantitated when firing the argon ion laser into 0.9% saline solution alone. The peak gas volume when firing in blood alone was significantly greater than that produced in the other chamber environments. This is thought to be due to increased absorption of argon laser light by hemoglobin. The gas volumes produced by lasing aorta in 0.9% saline or blood were not statistically different.

Angioplasty, Balloon↗
PubMed1988

Aortic valve replacement and coronary bypass grafting for patients with aortic stenosis and coronary artery disease: early and late results.

From 1967 to 1981, 294 patients (group A) with aortic stenosis and coronary atherosclerosis underwent aortic valve replacement (AVR) combined with bypass grafting; there were 13 (4.4%) in-hospital deaths. Follow-up of the in-hospital survivors documented late survival of 89%, 79%, and 52% at 2, 5, and 10 postoperative years, respectively. Univariate and multivariate testing identified age greater than or equal to 70 years (P = 0.02) and Class IV symptoms (P = 0.002) as factors decreasing late survival. Patients with bioprostheses who did not take warfarin had the best late survival (P = 0.03) and event-free survival (P = 0.05) and patients with mechanical prostheses who did not take warfarin had the worst (P less than 0.0001) (P = 0.001). From 1981 to 1986, 375 further patients (group B) with aortic stenosis and coronary artery disease underwent AVR and bypass grafting with 20 (5.3%) in-hospital deaths. Group B contained more patients greater than or equal to 70 years (35% vs. 16%) than did group A. Logistic regression analysis identified patients with moderate or severe impairment of left ventricular function and women as sub-groups with increased in-hospital mortality in group B. Patients with aortic stenosis and coronary artery disease can undergo AVR and bypass grafting with a risk slightly increased over that for isolated AVR. Bioprostheses enhance late survival and event-free survival.

Adult↗
PubMed1988

A multivariate analysis of the risk of cytomegalovirus infection in heart transplant recipients.

Thirty-four consecutive heart transplant recipients were studied over a two-year period for evidence of cytomegalovirus (CMV) infection. Twenty-three episodes of CMV infection were identified; 19 of these occurred within 120 d after transplantation and were statistically analyzed. Fifteen potential risk factors were evaluated, including the following: pretransplant CMV serological status of donor and recipient; recipient's age, sex, race, and cardiac disease; number and type of blood products transfused; type and intensity of immunosuppression; occurrence of rejection; and leukopenia. The Cox proportional hazards model identified both greater than average steroid dosage and positive recipient CMV serology as significant risk factors for CMV infection (P = .014 and .048, respectively). In a separate analysis, however, only greater than average steroid dosage was associated with clinically significant CMV infection (P = .005).

Adrenal Cortex Hormones↗
PubMed1988

A multivariate analysis of risk factors for pneumonia following cardiac transplantation.

Fifty cardiac transplant recipients were followed over a 34-month period for evidence of pneumonia that developed in twelve patients. Potential risk factors evaluated fell into three categories: demographic (age, sex, race, and underlying cardiac disease); pretransplant status (hospitalized, intubated, pulmonary infiltrate, requirement for antibiotics, or the need for a ventricular assist device); and posttransplant therapy (amount and type of blood products, prolonged endotracheal intubation or reintubation, use of ventricular assist devices, immunosuppressive protocols, lymphocyte subset ratios, and occurrence of rejection, leukopenia, or CMV infection). The Cox proportional hazards model identified posttransplant reintubation (P = 0.009) and the use of protocols employing larger steroid dosages (P = 0.02) as significant risk factors for pneumonia. In a separate analysis, the occurrence of pneumonia was shown to be a significant risk factor for mortality (P = 0.018).

Heart Transplantation↗
PubMed1988

Survival of patients with mild angina or myocardial infarction without angina: a comparison of medical and surgical treatment.

A group of 390 patients with mild angina pectoris or myocardial infarction without subsequent angina had early coronary bypass operation. Five year survival was significantly higher (95.4%) than in a similarly selected medically treated group (88.5%) reported before. One death occurred in the 30 day postoperative period. Five year survival in the 179 patients who had internal mammary artery grafts was 98.9%. Survival for patients with mild angina and satisfactory left ventricular function (96.2%) was significantly higher than in the medical subset (91.3%). In the patient population studied, five year survival was higher in patients who had early bypass operations than in those who did not.

Adult↗
PubMed1988

Aortic valve replacement combined with myocardial revascularization. Late results and determinants of risk for 471 in-hospital survivors.

Among 500 patients consecutively undergoing primary aortic valve replacement combined with coronary bypass grafting from 1967 to 1981, there were 29 (5.8%) perioperative deaths. Follow-up of the late survivors ranged from 43 to 181 months (mean 85 months); actuarial survival rates were 88%, 77%, and 52% and event-free survival rates were 80%, 65%, and 32% at 2, 5, and 10 postoperative years. Cox proportional hazard analyses were used to identify determinants of late risk. Patient-related variables associated with decreased late survival rates included advanced age, cardiothoracic ratio 50% or greater, and preoperative New York Heart Association class III or IV symptoms. Moderate or severe impairment of left ventricular function as determined by angiography and advanced age were variables that decreased late event-free survival rates. Patients with bioprostheses had better survival rates (p less than 0.001) and event-free survival rates (p = 0.012) than did patients with mechanical valves. Analyses of subgroups according to the type of valve and postoperative anticoagulant management showed that both survival and event-free survival rates were decreased for patients with mechanical valves who were not taking warfarin and were enhanced for patients with bioprostheses who were not taking warfarin.

Aged↗
PubMed1988

Does bilateral internal mammary artery grafting increase surgical risk?

The risk of bilateral internal mammary artery grafting was studied in three groups of patients who were computer matched for recognized risk factors: year of operation, age, gender, extent of coronary artery disease, left ventricular function, completeness of myocardial revascularization, and history of congestive heart failure. The patient groups differed in the fact that they received veins only, one internal mammary artery graft, or two internal mammary artery grafts. The operative mortality rates for these three groups were 1.8%, 0.3%, and 0.9%, respectively (no significant difference). Analysis of perioperative morbidity demonstrated no significant differences except for a slight increase in transfusion requirements in the group receiving two internal mammary artery grafts (p = 0.04). None of the patients with only vein grafts had wound complications. One patient in the group with one internal mammary artery graft had a wound complication (0.03%). Eight patients receiving two internal mammary artery grafts had wound complications (2.4%) (p = 0.002). The prevalence of wound complications in patients with diabetes mellitus was 5.7% and in those without diabetes mellitus, 0.3% (p = 0.01). The prevalence of wound complications in patients less than 60 years of age was 0.2%, in patients in their 60s, 1.6%, and in patients older than 70, 3.1% (p = 0.01). Multivariate logistic regression analysis identified diabetes mellitus and age and not bilateral internal mammary artery grafting as risk factors for wound complications. We conclude that bilateral internal mammary artery grafting does not increase surgical mortality and increases surgical morbidity by a slight increase in the mean transfusion requirement.

Blood Transfusion↗
PubMed1987

Renal transplantation for end-stage polycystic kidney disease.

From 1963 to 1984, 56 renal transplants were performed in 51 patients with end-stage renal failure due to autosomal dominant polycystic kidney disease (ADPKD). There were 49 cadaver and 7 living-related transplants. Overall patient and graft survival was 88 per cent and 66 per cent at one year, 59 per cent and 49 per cent at five years, respectively. There was no significant difference in patient or graft outcome with cadaver versus living-related donor kidneys. One-year graft success with and without pretransplant bilateral nephrectomy (BN) was 78 per cent versus 58 per cent, respectively (n.s.). Patient survival after return to dialysis after graft loss was not compromised by the earlier performance of BN. In patients who did not undergo pretransplant BN, there were no complications from the retained native kidneys after transplantation. In cadaver recipients, the two-year graft success rate with and without preliminary blood transfusions was 54 per cent versus 61 per cent, respectively (n.s.). Cadaver graft survival with and without adjunctive antilymphocyte globulin (ALG), excluding 3 recipients managed with cyclosporine, was 88 per cent versus 50 per cent at one year, and 70 per cent versus 32 per cent at five years, respectively (p less than 0.05). This beneficial effect of ALG was still evident when only transfused cadaver recipients were analyzed and was achieved with no resulting compromise in patient survival. Follow-up computerized tomography (CT) scanning of the transplant kidney in 10 recipients with a long-term (1-9 years) functioning allograft showed no evidence of recurrent ADKPKD.

Adult↗
PubMed1987

Measuring common public misperceptions about cancer.

A 32 item criterion-referenced knowledge questionnaire was developed to measure the level of common misperceptions about the nature of cancer and cancer treatments held by the public. A sample of 353 respondents were contacted and agreed to complete the questionnaire through a random telephone survey technique (Random Digit Dialing). An extensive analysis of the responses to the survey was performed and supported the validity and reliability of the instrument. Results of the survey indicate that the prevalence of misperceptions held by the public is high. The total mean score correct on the questionnaire was only 17.2 out of a possible 32. No differences were found for total mean score on the questionnaire based on the respondents' age, sex, or whether they or someone close to them had ever had cancer. Statistically significant differences, however, were found for the total mean score on the questionnaire based on the respondent's level of education and how they responded to two attitudinal questions on the questionnaire. The most prevalent misperceptions about cancer related to questions about side effects from the treatment for cancer, followed by questions about proven cancer treatments and unproven or quack cancer treatments. The least prevalent misperceptions about cancer related to questions about the nature of cancer.

Adult↗
PubMed1987

Fifteen hundred coronary reoperations. Results and determinants of early and late survival.

Fifteen hundred consecutive patients undergoing a first reoperation for coronary revascularization were reviewed to determine early and late results and predictors of survival. Patients were subdivided into cohorts on the basis of the year of reoperation: Group A (1967 to 1978, 436 patients); Group B (1979 to 1981, 439 patients); and Group C (1982 to 1984, 625 patients). Overall operative mortality was 3.4% (51 deaths): 4.6%, 2.3%, and 3.4% for Groups A, B, and C, respectively. Group C had significantly more women (p = 0.01) and patients with triple-vessel disease, left main coronary artery stenosis (greater than or equal to 50%), abnormal left ventricular function, age greater than or equal to 70 years, and graft failure as a surgical indication (all p less than 0.001). The mean interval between operations increased from 50 months for Group A to 84 months for Group C. At reoperation, Group C patients received more grafts, more internal mammary artery grafts, and had a higher prevalence of complete revascularization (all p less than 0.001). Univariate and multivariate analyses identified left main stenosis (p less than 0.0001), Class III or IV symptoms (p = 0.0002), advanced age (p = 0.0006), Group A (p = 0.02), and incomplete revascularization (p = 0.004) as predictors of increased in-hospital mortality. Follow-up of in-hospital survivors (mean interval 54 months, range 13 to 171 months) documented a 5 year survival rate of 90% and a 10 year survival rate of 75%. Multivariate testing identified advanced age (p less than 0.0001), hypertension (p less than 0.0001), and abnormal left ventricular function (p less than 0.0001) as predictors of decreased late survival.

Aged↗
PubMed1987

Repeat mitral commissurotomy: long-term results.

Fifty-three patients underwent reoperation for open mitral commissurotomy (OMC) with one (1.9%) in-hospital death. The previous mitral operation was an OMC in 14 patients and a closed commissurotomy in 39. Mean age at the time of repeat OMC was 46 years (range 27 to 64), and NYHA functional class was II in 19 patients, III in 31, and IV in three. Follow-up of the 52 in-hospital survivors at a postoperative interval of 1 to 23 years (mean 10) documented 13 late deaths (mean interval 117 months, range 17 to 209) and survival of 96%, 83%, and 63% at 5, 10, and 15 postoperative years, respectively. Sixteen patients underwent subsequent mitral valve surgery (one OMC and 15 mitral valve replacements) 1 to 223 months after repeat OMC (mean 99), three patients within 5 years of repeat OMC. Reoperation-free survival was 94%, 74%, and 52% at 5, 10, and 15 postoperative years, respectively. Univariate testing did not document any correlation between age, functional class, rhythm, and either survival or reoperation-free survival. When feasible, repeat OMC can afford patients excellent long-term survival and relative freedom from prosthetic valve replacement.

Adult↗
PubMed1986

Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events.

We compared patients who received an internal-mammary-artery graft to the anterior descending coronary artery alone or combined with one or more saphenous-vein grafts (n = 2306) with patients who had only saphenous-vein bypass grafts (n = 3625). The 10-year actuarial survival rate among the group receiving the internal-mammary-artery graft, as compared with the group who received the vein grafts (exclusive of hospital deaths), was 93.4 percent versus 88.0 percent (P = 0.05) for those with one-vessel disease; 90.0 percent versus 79.5 percent (P less than 0.0001) for those with two-vessel disease; and 82.6 percent versus 71.0 percent (P less than 0.0001) for those with three-vessel disease. After an adjustment for demographic and clinical differences by Cox multivariate analysis, we found that patients who had only vein grafts had a 1.61 times greater risk of death throughout the 10 years, as compared with those who received an internal-mammary-artery graft. In addition, patients who received only vein grafts had 1.41 times the risk of late myocardial infarction (P less than 0.0001), 1.25 times the risk of hospitalization for cardiac events (P less than 0.0001), 2.00 times the risk of cardiac reoperation (P less than 0.0001), and 1.27 times the risk of all late cardiac events (P less than 0.0001), as compared with patients who received internal-mammary-artery grafts. Internal-mammary-artery grafting for lesions of the anterior descending coronary artery is preferable whenever indicated and technically feasible.

Coronary Artery Bypass↗