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3.
Ann Thorac Cardiovasc Surg ; 7(1): 35-41, 2001 Feb.
Article in English | MEDLINE | ID: mdl-11343564

ABSTRACT

OBJECTIVES: This study evaluated acute results as a function of the number of arterial conduits used to compare procedural differences and the subsequent effects on acute outcomes in selected patient populations. BACKGROUND: All arterial operations may provide better long-term results for younger patients undergoing coronary bypass surgery (CABG). However, concerns regarding additional morbidity when using multiple arterial conduits have inhibited their use. METHODS: The study comprised a retrospective review of patients (2,586) undergoing CABG. Group 1 consists of single artery vein graft (1,755). Group 2: two arteries were used in addition to vein grafts (209). Group 3: three or more arterial conduits were used, with or without vein grafts (116). Group 4: only vein grafts were used (506). RESULTS: Patients undergoing primarily arterial procedures, Group 2 and 3, were younger, had a better exercise profile, less history of myocardial infarction (MI), had less left ventricular dysfunction. There were also fewer emergencies, co-morbidities and associated procedures in this group. The cardiopulmonary bypass and cross clamp times were longer in those procedures with three or more arteries; however, this difference was only thirteen and fourteen minutes, respectively. Post-operative complications were higher in patients in the vein only group. The hospital stay and mortality was equivalent among groups in which an arterial bypass was used and better than those in which only vein grafts were used. CONCLUSIONS: For younger patients, "all arterial operations," require only minimal increases in ischemic and operative times, which do not affect acute outcomes.


Subject(s)
Coronary Artery Bypass , Coronary Vessels/surgery , Coronary Vessels/transplantation , Myocardial Infarction/surgery , Age Factors , Aged , Coronary Artery Bypass/mortality , Humans , Length of Stay , Middle Aged , Retrospective Studies , Time Factors , Treatment Outcome
4.
J Cardiovasc Surg (Torino) ; 42(2): 213-5, 2001 Apr.
Article in English | MEDLINE | ID: mdl-11292937

ABSTRACT

BACKGROUND: To compare surgical techniques for subpectoral implantation of internal cardioverter defibrillator (ICD). METHODS: Sequential comparison with review of the literature. SETTING: University Hospital. PARTICIPANTS: the patients requiring ICD. INTERVENTIONS: ICD insertions and device testing. MEASUREMENTS: defibrillation and pacing thresholds, defibrillator lead impedance, operative time, and proximity of generator site to midline, clinical outcomes. RESULTS: Comparable efficacy in defibrillation, surgical time and medial placement. No wound infections, seromas or lead dislodgments. Preservation of pectoral muscle integrity. CONCLUSIONS: Lateral single incision subpectoral ICD generator placement can be applied consistently with good RESULTS.


Subject(s)
Arrhythmias, Cardiac/therapy , Defibrillators, Implantable , Humans , Pectoralis Muscles/surgery , Prospective Studies
6.
Clin Transplant ; 15(1): 68-71, 2001 Feb.
Article in English | MEDLINE | ID: mdl-11168319

ABSTRACT

PURPOSE: A shortage of suitable donors is the major impediment to clinical lung transplantation. The rate of lung recovery from potential donors is lower than that for other organs. The purpose of this study was to evaluate what factors could be modified to improve the rate of cadaver lung recovery. METHODS: We performed a retrospective review of records from all thoracic organ donors procured by the California Transplant Donor Network between 1 January 1995 and 31 May 1997 (251 donors) to determine which donor management factors were associated with an increased likelihood of successful lung procurement. RESULTS: There were 88 lung donors (L) and 163 donors from which hearts but no lungs were procured (H). Longer time to donor network referral was associated with a reduced chance for successful lung procurement. Donor age, cause of death, and time of admission were not important factors. Most donors in this study had an acceptable A-a gradient at admission to the hospital but lung function deteriorated in group H. Corticosteroid usage and initially clear breath sounds were independent predictors of successful procurement by multivariate analysis. CONCLUSIONS: Early contact with the donor referral network, and corticosteroids may help to improve the lung procurement rate from potential donors.


Subject(s)
Lung Transplantation , Tissue Donors , Tissue and Organ Procurement/statistics & numerical data , Adult , Cadaver , California , Databases, Factual , Female , Glucocorticoids/therapeutic use , Humans , Lung/drug effects , Male , Methylprednisolone Hemisuccinate/therapeutic use , Retrospective Studies
7.
Cardiovasc Surg ; 9(1): 27-32, 2001 Feb.
Article in English | MEDLINE | ID: mdl-11137805

ABSTRACT

UNLABELLED: There is controversy regarding the flow reserve and capacity of arterial conduits to meet the needs of the myocardium. This study compared flow in 22 free arterial bypasses to 15 saphenous vein grafts in procedures involving twenty patients. To assess the maximal flow possible, (flow capacity) graft flow was measured using a calibrated pump while perfusing blood cardioplegia through the conduit and distal anastomosis during cardiac arrest (no competitive flow). This assessment was subsequently confirmed with whole blood during myocardial contraction while on cardiopulmonary bypass. Twenty-two free arterial grafts were used; 15 right internal mammary artery grafts, 4 right gastroepiploic grafts, 3 inferior epigastric artery grafts, and 3 sequential bypasses. Free arterial conduit flow ranged from 50 to 180cc/ml, with an average flow of 102.5+/-28.5ml/min as compared to saphenous vein graft flow, 102+/-28 ml/min. No correlation of flow with the conduit size was found. Arterial graft flow demonstrated a mild correlation with the size of the native coronary artery bypassed (R=0.47, P

Subject(s)
Arteries/transplantation , Coronary Artery Bypass/methods , Saphenous Vein/transplantation , Adult , Aged , Humans , Middle Aged , Regional Blood Flow
8.
Ann Thorac Cardiovasc Surg ; 7(6): 352-7, 2001 Dec.
Article in English | MEDLINE | ID: mdl-11888475

ABSTRACT

OBJECTIVES: To differentiate surgical bleeding requiring re-exploration from postoperative coagulopathy and determine the differences in patient outcomes. METHODS: This was a retrospective chart review of 2,263 adult patients undergoing elective and emergency open heart procedures encompassing coronary artery bypass, valvular, and a combined procedure to determine the impact of source of bleeding leading to re-exploration. RESULTS: Eighty-two patients (3.6%) required re-exploration. Sixty-six percent had surgical bleeding; the remaining 34% were coagulopathic. Postoperative coagulopathy was associated with preoperative heparin use (37% vs. 19.9% for controls p<0.05). Re-operative procedures combined bypass/ valve (p<0.001) and prolonged cardiopulmonary bypass and aortic cross-clamp times (p<0.05) were more prevalent in the coagulopathy group. Postoperative inotrope use was increased in patients who were re-explored (p<0.001), as were cardiac, pulmonary, renal and abdominal complications (p<0.001), and in all cases those patients with medically related bleeding had worse acute outcomes than the group with surgical causes for re-exploration. The hospital stay was prolonged for both patients with surgical bleeding (23.5 days) and patients with coagulopathy (27.1 days) compared to patients not undergoing re-exploration for bleeding (12.0 days, p<0.001). Survival was 91.3% for patients with surgical bleeding, 87.5% for patients with coagulopathy, and 98.0% for all others (p<0.01). CONCLUSIONS: Severe postoperative hemorrhage is associated with significant morbidity and increased mortality. Postoperative hospital stay, morbidity, and mortality were significantly worse in patients suffering from coagulopathy when compared to those patients with hemorrhage from surgical causes.


Subject(s)
Cardiac Surgical Procedures/adverse effects , Postoperative Hemorrhage/etiology , Coronary Artery Bypass/methods , Coronary Disease/complications , Coronary Disease/surgery , Heparin Antagonists/administration & dosage , Humans , Length of Stay , Postoperative Hemorrhage/prevention & control , Protamines/administration & dosage , Reoperation , Retrospective Studies , Survival Rate , Treatment Outcome
9.
J Econ Entomol ; 93(3): 690-6, 2000 Jun.
Article in English | MEDLINE | ID: mdl-10902317

ABSTRACT

Field tests were conducted in northeastern Louisiana to determine the effects of infestations by Helicoverpa zea (Boddie) on cotton bolls of varying ages. First instars were caged on bolls of nontransgenic ('Deltapine 5415') or transgenic Bacillus thuringiensis Berliner variety kurstaki (Bt) ('NuCOTN 33B') cotton from 29 June to 11 August during 1997 and 1998. Deltapine 5415 bolls that accumulated 179 (7.2 d), 281 (11.2 d), and 253 (10.1 d) heat units beyond anthesis were safe from bollworm-induced abscission at 72 h after infestation, 7 d after infestation, and at the time of harvest, respectively. NuCOTN 33B bolls that accumulated 157 (6.3 d), 185 (7.4 d), and 180 (7.2 d) heat units beyond anthesis were safe from bollworm-induced abscission at 72 h after infestation, 7 d after infestation, and at the time of harvest, respectively. Bollworm larvae reduced seedcotton weights of Deltapine 5415 bolls that accumulated between 58.5 (2.3 d) and 350.5 (14.0 d) heat units beyond anthesis. Seedcotton weights of NuCOTN 33B bolls that accumulated between 0 and 281 (11.2 d) heat units beyond anthesis were reduced by bollworm injury. Deltapine 5415 and NuCOTN 33B bolls that accumulated 426.5 (17.1 d) and 299.5 (12.0 d) heat units beyond anthesis, respectively, before infestation were not injured by first-instar bollworm larvae. These data provide information about late-season insecticide termination strategies for bollworms on nontransgenic and transgenic Bt-cotton. This, in turn, will help pest managers determine when insecticides are no longer economical during the late season.


Subject(s)
Bacillus thuringiensis , Bacterial Proteins , Bacterial Toxins , Endotoxins , Gossypium , Insecticides , Moths , Pest Control, Biological/methods , Plants, Genetically Modified , Animals , Bacillus thuringiensis Toxins , Bacterial Proteins/genetics , Bacterial Toxins/genetics , Crops, Agricultural/economics , Endotoxins/genetics , Gossypium/genetics , Hemolysin Proteins , Larva
10.
J Cardiovasc Surg (Torino) ; 41(6): 945-52, 2000 Dec.
Article in English | MEDLINE | ID: mdl-11232982

ABSTRACT

Giant tumors of the chest are rare. These tumors comprise a spectrum of disease from benign lesions to highly aggressive malignant tumors with cells of origin in the pleura, pulmonary parenchyma, blood vessels, thymus, and connective tissues. We report four cases of giant tumors of the thorax treated with preoperative arterial embolization followed by complete surgical resection. Their diagnostic and treatment courses, imaging, and pathology are described.


Subject(s)
Embolization, Therapeutic , Polyvinyl Alcohol/administration & dosage , Preoperative Care/methods , Thoracic Neoplasms/therapy , Thoracotomy , Adult , Angiography , Biopsy, Needle , Diagnosis, Differential , Female , Humans , Injections, Intra-Arterial , Magnetic Resonance Imaging , Male , Middle Aged , Thoracic Neoplasms/blood supply , Thoracic Neoplasms/diagnosis , Tomography, X-Ray Computed
11.
J Thorac Cardiovasc Surg ; 119(1): 115-24, 2000 Jan.
Article in English | MEDLINE | ID: mdl-10612769

ABSTRACT

OBJECTIVE: The success of left ventricular aneurysm plication depends on how the procedure affects both end-systolic elastance and diastolic compliance and how those changes affect ventricular function (stroke work/end-diastolic volume [PRSW] and stroke volume/end-diastolic pressure [Starling] relationships). METHODS: Five male Dorsett sheep were surgically instrumented with coronary artery snares, an inferior vena caval occluder, and an ascending aortic ultrasonic flow probe. One week later an anteroapical myocardial infarction was produced by tightening the coronary snares. Ten weeks after myocardial infarction, the left ventricular aneurysm was plicated. Absolute left ventricular volume was measured by long-axis transdiaphragmatic echocardiography, and relative changes in left ventricular volume were measured with a conductance catheter. End-systolic elastance, diastolic compliance, PRSW, and Starling relationships were measured immediately before myocardial infarction, 10 weeks after myocardial infarction (immediately before plication), and immediately after and 6 weeks after aneurysm plication. RESULTS: After plication, end-diastolic and end-systolic left ventricular volumes return to preinfarction values. The slopes of end-systolic elastance, diastolic compliance, and PRSW decrease 10 weeks after myocardial infarction, increase with aneurysm plication, and then decrease 6 weeks after aneurysm plication. The Starling relationship undergoes a downward parallel shift with aneurysm plication. CONCLUSION: Aneurysm plication abruptly decreases left ventricular volume and diastolic compliance, increases end-systolic elastance and PRSW, but decreases the Starling relationship. The net effect on left ventricular function is mixed. Furthermore, left ventricular remodeling 6 weeks after aneurysm plication causes left ventricular volume, end-systolic elastance, diastolic compliance, PRSW, and the Starling relationship to return to preplication values.


Subject(s)
Heart Aneurysm/physiopathology , Heart Aneurysm/surgery , Ventricular Function/physiology , Animals , Cardiac Catheterization , Compliance , Diastole/physiology , Disease Models, Animal , Echocardiography/methods , Elasticity , Heart Aneurysm/diagnostic imaging , Linear Models , Male , Myocardial Infarction/pathology , Sheep , Stroke Volume/physiology , Systole/physiology , Ventricular Pressure/physiology , Ventricular Remodeling/physiology
12.
J Heart Lung Transplant ; 18(10): 972-85, 1999 Oct.
Article in English | MEDLINE | ID: mdl-10561108

ABSTRACT

BACKGROUND: Bronchiolitis obliterans occurs in 30% to 80% of lung-transplant recipients and is a direct cause of death in more than 40% of patients with this complication. This study assessed the potential utility of measuring fibroblast-proliferative activity in bronchoalveolar lavage fluid from lung-transplant recipients to better understand the pathogenesis of this process. METHODS: The capacity of bronchoalveolar lavage fluid obtained from transplant recipients, during routine surveillance bronchoscopy, to stimulate the proliferation of human lung fibroblasts in vitro was assessed retrospectively and compared to that of control subjects. For each recipient, a correlation was made between the fibroblast-proliferative activity in serial lavage samples over time and the other modalities employed for detecting post-transplant complications including spirometry, transbronchial lung biopsy, and high-resolution computed tomography. RESULTS: There was a significant difference in fibroblast-proliferative activity between volunteer and transplant recipient groups (p = 0.002). Further, for each transplant recipient, the decline in the forced expired flow rate between 25% and 75% of expired volume (FEF(25%-75%)) was correlated with the mean fibroblast-proliferative activity during the period of this study (r = 0.83; p = 0.04). CONCLUSIONS: A sustained increase in fibroblast-proliferative activity in lavage supernatant precedes both histologic and physiologic evidence of bronchiolitis obliterans. Relative to an increase in fibroblast-proliferative activity or abnormalities in FEF25%-75%, a decrease in forced expiratory volume in 1 second is a late finding.


Subject(s)
Bronchiolitis Obliterans/pathology , Bronchoalveolar Lavage Fluid/cytology , Lung Transplantation/pathology , Lung/pathology , Biopsy , Bronchiolitis Obliterans/etiology , Bronchoalveolar Lavage/methods , Bronchoalveolar Lavage/statistics & numerical data , Bronchoscopy/methods , Cell Division , Cells, Cultured , Fibroblasts/cytology , Humans , Lung/diagnostic imaging , Lung Transplantation/diagnostic imaging , Lung Transplantation/statistics & numerical data , Retrospective Studies , Statistics, Nonparametric , Time Factors , Tomography, X-Ray Computed/methods
13.
J Cardiovasc Surg (Torino) ; 39(5): 649-50, 1998 Oct.
Article in English | MEDLINE | ID: mdl-9833726

ABSTRACT

OBJECTIVE: To emphasize a potentially lethal condition that is virtually impossible to diagnose preoperatively. DESIGN: Case report with review of the literature. SETTING: University Hospital. PARTICIPANT: The patient requiring urgent surgery for heart failure related to severe aortic stenosis and mild mitral stenosis with poor ventricular function. The patient was elderly and suffered from atrial fibrillation. INTERVENTIONS: Preoperative transesophageal echocardiography followed by mitral valve repair and aortic valve replacement. MEASUREMENTS: Clinical outcome and pathological results. RESULTS: Although preoperative TEE demonstrated no left atrial appendage abnormality. After cardiac manipulation prior to the institution of cardiopulmonary bypass a large left atrial mural thrombus was mobilized from the atrial wall and was free floating in the left atrium. CONCLUSIONS: For high risk patients TEE should be applied intraoperatively to avoid undiagnosed left atrial clot dislodgement.


Subject(s)
Cardiac Surgical Procedures/adverse effects , Heart Atria , Heart Diseases/etiology , Thrombosis/etiology , Aged , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/surgery , Echocardiography, Transesophageal , Follow-Up Studies , Heart Diseases/diagnostic imaging , Humans , Intraoperative Complications , Male , Mitral Valve Stenosis/diagnostic imaging , Mitral Valve Stenosis/surgery , Thrombosis/diagnostic imaging
14.
Arch Surg ; 133(8): 887-93, 1998 Aug.
Article in English | MEDLINE | ID: mdl-9711964

ABSTRACT

BACKGROUND: Although cardiac valve procedures are being performed more frequently in the elderly, long-term functional outcomes have not been well characterized. OBJECTIVE: To evaluate changes in quality of life and functional status in octogenarians after cardiac valve surgery. DESIGN: Retrospective medical record review and patient telephone interview. Median follow-up 30 months (range, 6-95 months). SETTING: Tertiary care university hospital. PATIENTS: Octogenarians undergoing cardiac valve surgery (N = 61; mean age, 83.5 years; range, 80-89 years). INTERVENTIONS: Forty-seven patients had aortic valve replacement, 14 had mitral valve replacement and/or repair, and 27 had a combined procedure with coronary artery bypass grafting. OUTCOMES: Actuarial survival, morbidity, length of hospital stay, and discharge disposition were evaluated. Functional status, using the New York Heart Association classification, and Karnofsky performance status were evaluated preoperatively and postoperatively at 1 and 3 months after hospital discharge. RESULTS: Operative (<30 days) mortality occurred in 7 (11.4%) of 61 patients. Preoperative intensive care unit stay (P < .001) and New York Heart Association class 4 (P < .02) were independent predictors of early death by multivariable analysis. Among hospital survivors, there were no major complications in 34 patients (63%), and this group had a mean (+/- SD) postoperative hospital stay of 12.2 +/- 5.5 days. Twenty patients (37%) incurred significant complications, the most common of which were bleeding, pneumonia, and renal insufficiency. The mean (+/- SD) postoperative hospital stay in this group was 25 +/- 17 days. Although significant complications were associated with an increased postoperative stay, this was not predictive of disposition to a skilled nursing facility or the final score on the postoperative Karnofsky performance scale. Actuarial survival was 85% at 1 year and 66% at 5 years. Patients with perioperative complications had significantly decreased actuarial survival by the Cox proportional hazards regression model (P < .001). Among hospital survivors, the score on the Karnofsky performance scale 1 month after discharge had improved 50% from a preoperative median score of 30% (severely disabled, requiring special care) to a postoperative median score of 80% (being able to perform normal activity with only moderate symptoms). The New York Heart Association classification improved a median of 2 classes in this group. These benefits were sustained at the 3-month follow-up. CONCLUSION: Although greater resource expenditure is required for the initial perioperative convalescence, octogenarians can be expected to have an excellent functional outcome and long-term performance status after cardiac valve surgery.


Subject(s)
Heart Valve Diseases/physiopathology , Heart Valve Diseases/surgery , Aged , Aged, 80 and over , Female , Humans , Karnofsky Performance Status , Male , Proportional Hazards Models , Quality of Life , Retrospective Studies , Survival Analysis , Treatment Outcome
15.
Ann Thorac Surg ; 65(5): 1461-4, 1998 May.
Article in English | MEDLINE | ID: mdl-9594894

ABSTRACT

Solitary fibrous tumors of the pleura are rare. Approximately 600 cases have been described in the literature. We report a case of a young man with a giant solitary fibrous tumor of the pleura that filled his entire left hemithorax and anterior mediastinum and extended into the right side of his chest. The diagnostic modalities employed, the operation, and the postoperative management resulting in complete resection of the tumor and full lung reexpansion are described.


Subject(s)
Mesothelioma/diagnosis , Pleural Neoplasms/diagnosis , Adult , Airway Obstruction/diagnosis , Biopsy , Bronchoscopy , Embolization, Therapeutic , Humans , Magnetic Resonance Imaging , Male , Mediastinum/pathology , Mesothelioma/pathology , Mesothelioma/surgery , Mesothelioma/therapy , Pleural Neoplasms/pathology , Pleural Neoplasms/surgery , Pleural Neoplasms/therapy , Pulmonary Atelectasis/therapy , Thoracotomy , Thorax/pathology
17.
Ann Thorac Surg ; 62(5): 1541, 1996 Nov.
Article in English | MEDLINE | ID: mdl-8893610

ABSTRACT

A retractor is presented with features to enhance operative exposure for coronary artery bypass grafting while minimizing sternal and peripheral nerve injuries. The design is aimed at enhancing exposure while minimizing incision size.


Subject(s)
Coronary Artery Bypass/instrumentation , Branchial Region/innervation , Coronary Artery Bypass/adverse effects , Equipment Design , Humans , Sternum/injuries , Ulnar Nerve Compression Syndromes/etiology
20.
Ann Thorac Surg ; 46(6): 684-5, 1988 Dec.
Article in English | MEDLINE | ID: mdl-3196104

ABSTRACT

A substernal goiter may descend into the thorax. However, a truly aberrant intrathoracic thyroid represents a rare and anatomically different entity that requires appropriate modifications in approach and surgical technique.


Subject(s)
Choristoma/diagnosis , Goiter, Substernal/diagnosis , Mediastinal Neoplasms/diagnosis , Thyroid Gland , Adult , Diagnosis, Differential , Female , Humans
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