RESUMEN
BACKGROUND: Cardiomyoplasty is a potential therapy for heart failure. Its benefits are attributed to systolic augmentation (dynamic cardiomyoplasty) and prevention of cardiac dilatation (static cardiomyoplasty). To evaluate the static component, we used an artificial membrane for cardiac binding in a canine model of heart failure. METHODS: Intracoronary doxorubicin was administered weekly for 4 weeks to induce heart failure in 10 dogs, each of which was assigned to one of two treatment groups: (1) no treatment, or (2) cardiac binding. Hemodynamic data were obtained at operation and at 7 weeks after operation. Echocardiography was performed weekly. RESULTS: Left ventricular end-diastolic pressure and diameter, and right ventricular end-diastolic diameter increased in group 1 (from 9.6 +/- 6.1 to 19.6 +/- 2.3 mm Hg, p = 0.009; from 3.9 +/- 0.4 to 5 +/- 0.3 cm, p = 0.0013; and from 1.6 +/- 0.2 to 1.9 +/- 0.3 cm, p = 0.0036, respectively). Ejection fraction fell in group 1 from 0.60 +/- 0.10 to 0.40 +/- 0.04 (p = 0.0009) and in group 2 from 0.56 +/- 0.02 to 0.40 +/- 0.04 (p = 0.0001), but the difference between groups was not significant. CONCLUSION: Cardiac binding reduces the ventricular dilatation associated with heart failure without exacerbating left ventricular dysfunction.
Asunto(s)
Gasto Cardíaco Bajo/cirugía , Cardiomioplastia/métodos , Membranas Artificiales , Animales , Antibióticos Antineoplásicos , Gasto Cardíaco Bajo/inducido químicamente , Gasto Cardíaco Bajo/fisiopatología , Modelos Animales de Enfermedad , Perros , Doxorrubicina , Hemodinámica , Masculino , Factores de Tiempo , Función Ventricular IzquierdaRESUMEN
Latissimus dorsi muscle (LDM) transformation following chronic stimulation is the critical requirement for its use in cardiac assist procedures. In order to identify one or two molecular markers that can be used to effectively monitor the LDM transformation, the modulation in the expression of creatine kinase (CK) and phospholamban (PLB) genes by semi-quantitative reverse transcriptase polymerase chain reaction (RT-PCR) was examined. Continuous in situ stimulation of left LDM was performed in four dogs for a period of 10 weeks after a vascular delay period of 2 weeks following surgery. For RT-PCR, gene-specific radiolabeled primers and equal amounts of cDNA synthesized from total RNA extracted from the LDM biopsies obtained at 4, 7, and 10 weeks of stimulation were used. A 2.6-fold increase in creatine kinase (brain type) (CK-B) mRNA was observed at transformed LDM compared to the control (P = 0.004) following 10 weeks of stimulation. On the contrary, a 30% decline was observed in creatine kinase (muscle type) (CK-M) mRNA level. An increase up to eight-fold was also observed in PLB mRNA in stimulated LDM compared to the contralateral muscle (P = 0.002). The PLB mRNA level in transformed LDM reached plateau and became comparable to that of normal heart after 7 weeks of stimulation. However, a sustained increase in CK-B mRNA level was observed until 10 weeks of stimulation. The level of beta-actin mRNA used as control remained the same in both stimulated and control samples. Thus the increase in CK-B and PLB mRNA and downregulation of CK-M mRNA in transformed LDM, demonstrated here by RT-PCR, indicate a switch from anaerobic to aerobic potential of transformed LDM along with a change towards slow-twitch phenotype and provide valuable markers to monitor the effectiveness of muscle transformation in cardiomyoplasty.
Asunto(s)
Adenosina Trifosfatasas/metabolismo , Proteínas de Unión al Calcio/metabolismo , Creatina Quinasa/metabolismo , Músculo Esquelético/metabolismo , Actinas/metabolismo , Adenosina Trifosfatasas/genética , Animales , Biopsia , Creatina Quinasa/genética , Perros , Activación Enzimática , Músculo Esquelético/fisiología , Reacción en Cadena de la Polimerasa/métodos , ARN Mensajero/análisis , Factores de TiempoRESUMEN
OBJECTIVE: This study was designed to compare the effects of isoflurane and nitroprusside on spinal cord ischemia when they are used to control proximal hypertension during thoracic aortic cross-clamping (TACC). DESIGN: Prospective, randomized, blinded experimental study. SETTING: Laboratory and animal research facility. PARTICIPANTS: Adult mongrel dogs. INTERVENTIONS: Two groups of eight dogs had TACC for 45 minutes. Proximal aortic, distal aortic, and cerebrospinal pressure was calculated as the distal mean pressure minus the CSF pressure. Group 1 received nitroprusside and group 2 received isoflurane to control proximal hypertension during cross-clamping. The dogs were neurologically evaluated 24 and 48 hours later by an observer blinded as to the study group. Spinal cord segments were obtained for histopathologic examination. MEASUREMENTS AND MAIN RESULTS: Distal perfusion pressure and spinal cord perfusion pressure were significantly higher in the isoflurane group (p < .005). At 24 hours, seven of eight dogs in group 1 had severe neurologic injury (ie, paraplegia), with the eight having mild neurologic injury. This is in contrast to group 2, where 6 of 8 dogs had either minimal or no injury, one had mild injury, and one had severe injury. Similar results were observed at 48 hours (p < .005). CONCLUSIONS: Isoflurane, when used to control proximal hypertension during TACC, produces a higher spinal cord perfusion pressure and is associated with a lower incidence of neurologic injury than nitroprusside in this canine model.
Asunto(s)
Antihipertensivos/farmacología , Aorta Torácica/cirugía , Hipertensión/tratamiento farmacológico , Isquemia/tratamiento farmacológico , Isoflurano/farmacología , Nitroprusiato/farmacología , Médula Espinal/irrigación sanguínea , Animales , Antihipertensivos/uso terapéutico , Constricción , Perros , Hemodinámica/efectos de los fármacos , Isquemia/patología , Isoflurano/uso terapéutico , Nitroprusiato/uso terapéutico , Paraplejía/prevención & control , Estudios Prospectivos , Distribución Aleatoria , Médula Espinal/patologíaAsunto(s)
Anticuerpos Heterófilos/sangre , Trasplante de Corazón/inmunología , Trasplante Heterólogo/inmunología , Irradiación Corporal Total , Animales , Anticuerpos Heterófilos/efectos de la radiación , Formación de Anticuerpos , Citotoxicidad Inmunológica , Citometría de Flujo , Supervivencia de Injerto/inmunología , Supervivencia de Injerto/efectos de la radiación , Terapia de Inmunosupresión/métodos , Tejido Linfoide/efectos de la radiación , Papio , Porcinos , Factores de TiempoAsunto(s)
Anticuerpos Heterófilos/sangre , Trasplante de Corazón/inmunología , Trasplante Heterólogo/inmunología , Irradiación Corporal Total , Adsorción , Animales , Anticuerpos Heterófilos/aislamiento & purificación , Inmunoglobulina G/sangre , Inmunoglobulina G/aislamiento & purificación , Inmunoglobulina M/sangre , Inmunoglobulina M/aislamiento & purificación , Tejido Linfoide/efectos de la radiación , Papio , PorcinosRESUMEN
The Nova ISE for IMg2+ was utilized to examine IMg2+ in plasma and serum of patients with a variety of pathophysiologic and disease syndromes (e.g., long-term renal transplants [LTRT], during and before cardiac surgery, migraine headaches, head trauma, pregnancy, chronic fatigue syndrome [CFS], non-insulin dependent diabetes mellitus [NIDDM], asthma and after excessive dietary intake of Mg). The results indicate that LTRT treated with cyclosporin A, migraine, head trauma, pregnancy, NIDDM, diseased pregnant, and asthmatic patients all on the average, exhibit significant depression in IMg2+ but not total Mg (TMg). Patients with CFS failed to exhibit changes in serum IMg2+ or TMg levels. Increased dietary load of Mg, for only 6 days, resulted in significant elevations of serum IMg2+ but not TMg. Correlations between the clinical course of several of these syndromes and the fall in IMg2+ were found. The Ca2+/Mg2+ ratio appears to be an important guide for signs of peripheral vasoconstriction and or spasm and possibly enhanced atherogenesis. Overall, the data point to important uses for ISE's for IMg2+ in the diagnosis and treatment of disease states.
Asunto(s)
Enfermedad , Electrodos de Iones Selectos , Magnesio/sangre , Calcio/sangre , Cuidados Críticos , Femenino , Humanos , Masculino , EmbarazoAsunto(s)
Trasplante de Corazón/inmunología , Inmunoglobulina G/aislamiento & purificación , Inmunoglobulina M/aislamiento & purificación , Trasplante Heterólogo/inmunología , Adsorción , Animales , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Papio , Perfusión/instrumentación , Perfusión/métodos , Plasmaféresis/instrumentación , Plasmaféresis/métodos , Bazo/inmunología , Porcinos , Trasplante HeterotópicoRESUMEN
Internal mammary artery (IMA) bypass to the anterior descending coronary artery (ADA) was performed in 5125 patients from January 1978 to December 1990. The average age of patients was 68 years; males accounted for 68% (3485 patients) and 82% (4203) were NYHA Class III. Left ventricular function was impaired (ejection fraction < 40%) in 68% (3485 patients). The average number of additional saphenous vein graft (SVG) per patient was 2.2. Operative mortality was 1.8%. Mediastinitis occurred in 51 patients (1.0%). Reoperation for bleeding was necessary in 56 patients (1.1%). Perioperative myocardial infarction was seen in 102 patients (2.0%) and neurological complications occurred in 51 patients (1%). Repeat coronary angiography was performed in 1414 patients (28%) and demonstrated a patency rate of 96% in IMA grafts and 75% in SVG grafts (p < 0.001). Survival at 13 years was 80% from all causes and 90% when non-cardiac deaths were excluded. Recurrence of angina occurred in 768 patients (15%) and reoperation or PTCA was performed in 61 (1.2%). During the same time period, 2345 patients underwent coronary artery bypass utilizing solely SVG. Survival at 13 years was 68% from all causes and 78% when non-cardiac deaths were excluded (p < 0.001). Recurrent angina was present in 727 patients (31%) (< 0.001). This data suggests that long-term probability of cumulative survival and occlusion free survival were significantly greater and the probability of recurrent angina and reoperative CABG and death from cardiac causes were significantly less in the IMA patients and should be the conduit of choice in coronary bypass surgery.
Asunto(s)
Angina de Pecho/complicaciones , Puente de Arteria Coronaria/normas , Enfermedad Coronaria/cirugía , Arterias Mamarias/trasplante , Adulto , Anciano , Anciano de 80 o más Años , Angina de Pecho/epidemiología , Angioplastia Coronaria con Balón/estadística & datos numéricos , Cateterismo Cardíaco , Causas de Muerte , Angiografía Coronaria , Puente de Arteria Coronaria/métodos , Puente de Arteria Coronaria/mortalidad , Enfermedad Coronaria/complicaciones , Enfermedad Coronaria/mortalidad , Femenino , Estudios de Seguimiento , Mortalidad Hospitalaria , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/mortalidad , Recurrencia , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Vena Safena/trasplante , Índice de Severidad de la Enfermedad , Tasa de Supervivencia , Grado de Desobstrucción VascularAsunto(s)
Supervivencia de Injerto , Trasplante de Corazón/inmunología , Trasplante Heterólogo/inmunología , Animales , Complemento C3/análisis , Complemento C4/análisis , Ciclosporina/uso terapéutico , Inmunoglobulina G/análisis , Inmunoglobulina M/análisis , Terapia de Inmunosupresión/métodos , Metilprednisolona/uso terapéutico , Papio , Porcinos , Irradiación Corporal TotalRESUMEN
Left internal mammary artery (LIMA) angiography was performed with diagnostic coronary angiography in 130 cases for which the coronary findings made use of the LIMA as a bypass graft a consideration. In 98% of the cases the approach to LIMA angiography was femoral with a 5F LIMA catheter first directed into the proximal subclavian and then advanced over a guidewire placed into the distal subclavian well beyond the origin of the LIMA. After withdrawing the wire the catheter was brought proximally to selectively cannulate and visualize the LIMA with nonionic contrast media. The only complication was a single transient occipital visual field loss. LIMA caliber too narrow to permit use as a graft was found twice, LIMA occlusion unrelated to prior surgery was found once, and LIMA occlusion related to prior surgery was found twice. Subclavian and/or vertebral stenosis was present five times. Large proximal branches of the LIMA best identified prior to surgery were present 12 times. Based on this experience, LIMA angiography 1) can be performed safely with a high degree of success, 2) demonstrates significant findings in 15% of cases, and 3) should therefore be performed whenever coronary angiographic findings make it appropriate to consider LIMA to coronary artery bypass grafting.
Asunto(s)
Angiografía Coronaria/métodos , Puente de Arteria Coronaria/métodos , Enfermedad Coronaria/diagnóstico por imagen , Arterias Mamarias/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad Coronaria/cirugía , Femenino , Humanos , Anastomosis Interna Mamario-Coronaria , Masculino , Persona de Mediana Edad , Revascularización Miocárdica , Complicaciones Posoperatorias/diagnóstico por imagenRESUMEN
Aneurysms of the left ventricle may be congenital or may occur after a myocardial infarction, trauma, or endocarditis. Infective endocarditis can cause destructive injury to the heart in various ways. This report describes the formation of an aneurysm of the left ventricle from trauma of a bacterial vegetation of the mitral valve. Early recognition by echocardiography and magnetic resonance imaging led to successful repair and prevented a catastrophic result.
Asunto(s)
Aneurisma Infectado/cirugía , Endocarditis Bacteriana/complicaciones , Aneurisma Cardíaco/cirugía , Infecciones Estafilocócicas , Adolescente , Ventrículos Cardíacos , Humanos , MasculinoRESUMEN
We describe a unique case of a left coronary arteriovenous fistula arising from a left sinus of Valsalva aneurysm in a pregnant woman. The relevant diagnostic contributions of two-dimensional echocardiography, color flow Doppler, magnetic resonance imaging, and angiography are discussed. The hemodynamic manifestations of this anomaly in pregnancy and the eventual surgical correction are reviewed.
Asunto(s)
Aneurisma de la Aorta/congénito , Fístula Arterio-Arterial/patología , Cardiomiopatías/patología , Anomalías de los Vasos Coronarios/patología , Complicaciones Cardiovasculares del Embarazo , Seno Aórtico/patología , Adulto , Aneurisma de la Aorta/patología , Ecocardiografía Doppler , Electrocardiografía , Femenino , Humanos , Imagen por Resonancia Magnética , EmbarazoRESUMEN
Over the past 4-5 years, possibly with the advent of percutaneous transluminal coronary angioplasty (PTCA), there has been a changing patient population for coronary artery bypass surgery (CABS) with a gradual increase in the operative mortality. In an attempt to analyze the changing demographics in patients undergoing CABS and its effect on operative mortality, we analyzed data from 5536 consecutive patients undergoing isolated CABS. There was 4151 patients less than 70 years of age and 1385 patients greater than 70 years. Reoperative CABS procedures were performed in 385 patients, and CABS for post infarction unstable angina pectoris was performed in 578 patients. During the same time period, 2910 patients underwent PTCA. The mean age of bypass patients was 68.5 years with 38% being 70 years or older. The left ventricular ejection fraction in patients undergoing CABS averaged 38%. The average number of bypasses performed was 3.1. In comparison, patients presenting for PTCA were younger (average age 55), had normal ejection fractions (average 55%) and were predominantly treated for single or double vessel disease. The hospital mortality for elective CABS in patients less than 70 years of age was 1.8%, for reoperative CABS 3.6%, for post infarction unstable angina pectoris 4%, and for patients greater than 70 years 8%, for a combined operative mortality of 4.8%. These data suggest that because of the increasing number of elderly patients (greater than 70 years of age), and the increasing number of reoperative CABS cases and acute myocardial infarction patients with unstable angina pectoris presenting for CABS, the operative mortality will continue to rise.
Asunto(s)
Puente de Arteria Coronaria/mortalidad , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Angioplastia Coronaria con Balón/estadística & datos numéricos , Enfermedad Coronaria/epidemiología , Enfermedad Coronaria/mortalidad , Enfermedad Coronaria/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Morbilidad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/mortalidad , Estudios Retrospectivos , Factores de TiempoRESUMEN
Internal mammary artery (IMA) bypass grafting to the anterior descending coronary artery was performed in 2,100 patients between January 1978 and July 1986. The average number of additional saphenous vein grafts (SVGs) per patient was 1.8. During the same period, 1,753 patients underwent coronary artery bypass grafting using an SVG (average number of grafts per patient, 3.2). The average patient age was similar: 62.3 years for IMA grafts and 64.7 years for SVGs. Men constituted two thirds of each group. Left ventricular function was impaired (ejection fraction less than 45%) in 1,071 (51%) of IMA grafts and 847 (48.3%) of SVGs. Other aggregate risk factors, ie, elevated blood pressure, diabetes mellitus, previous myocardial infarction, and congestive heart failure, were similar in each group. Operative results and postoperative mortality of the IMA and SVG patients were comparable. However, the long-term probability of cumulative survival and occlusion-free survival were significantly greater and the probability of recurrent angina and reoperative coronary artery bypass grafting were significantly less in IMA graft patients (p less than 0.015). The relative risk of occlusion in an SVG was 4 to 5 times greater than that of the IMA graft. These data indicate that a patent IMA graft to the anterior descending coronary artery protects against recurrent angina and death from cardiac-related causes, and that the IMA should be the conduit of choice.
Asunto(s)
Angina de Pecho/cirugía , Anastomosis Interna Mamario-Coronaria , Adulto , Anciano , Angina de Pecho/mortalidad , Cateterismo Cardíaco , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/mortalidad , Estudios de Evaluación como Asunto , Femenino , Estudios de Seguimiento , Oclusión de Injerto Vascular/epidemiología , Humanos , Anastomosis Interna Mamario-Coronaria/efectos adversos , Anastomosis Interna Mamario-Coronaria/mortalidad , Masculino , Persona de Mediana Edad , Recurrencia , Reoperación , Vena Safena/trasplante , Volumen SistólicoRESUMEN
Internal mammary artery bypass (IMA) to the anterior descending coronary artery was performed in 2900 patients from January 1978 to December 1987. The average age of the patients was 64 years. Males accounted for 68% (1972 patients) and 82% (2378 patients) were in New York Heart Association (NYHA) class III. Left ventricular function was impaired in 51%. The average number of additional saphenous vein grafts per patient was 1.8. The operative mortality was 1.6%. Mediastinitis occurred in 29 patients (1%). Reoperation for bleeding was necessary in 32 patients (1.1%). Perioperative myocardial infarction (MI) was seen in 58 patients (2%) and neurological complications occurred in 32 patients (1.1%). Repeat coronary angiography was performed in 703 patients (25%) and demonstrated a patency rate of 96% in IMA grafts and 81% in saphenous vein grafts (SVG). Survival at 9 years was 90% from all causes and 95% when noncardiac deaths were excluded. Recurrence of angina occurred in 522 patients (18%) and reoperation was performed in 15 patients (0.5%). During the same time period, 1783 patients underwent coronary artery bypass utilizing a SVG. Survival at 9 years was 78% from all causes and 83% when noncardiac deaths were excluded. Recurrent angina was present in 546 patients (39%). These data suggest that a patent-IMA to the anterior descending protects against recurrent angina and death from cardiac causes and should be the conduit of choice.
Asunto(s)
Enfermedad Coronaria/cirugía , Revascularización Miocárdica , Angina de Pecho/diagnóstico , Enfermedad Coronaria/mortalidad , Femenino , Humanos , Anastomosis Interna Mamario-Coronaria , Esperanza de Vida , Masculino , Persona de Mediana Edad , Recurrencia , Factores de TiempoRESUMEN
Elective coronary artery bypass surgery can be performed with an expected operative mortality of 1-3%. However, the effects of age on morbidity and mortality in patients undergoing this procedure remain controversial. To analyze morbidity and mortality in septuagenarians undergoing isolated coronary artery bypass surgery, we compared the results in 685 septuagenarians with those in 3,142 patients under the age of 70 years, all of whom underwent this procedure from January 1981 to December 1986. A larger percentage of elderly patients had triple-vessel disease (89% vs. 71%), left main coronary artery obstruction (34% vs. 16%), and ejection fractions less than 45% (68% vs. 41%). A larger percentage of septuagenarians had perioperative myocardial infarction (8% vs. 2%), required prolonged ventilatory support (10% vs. 3%), and had major neurological complications (4% vs. 1%). Mortality rates were significantly higher in elderly patients (7% vs. 2%) but did not correlate with the severity of coronary artery disease, the anginal pattern, or the diminishment of ventricular function. Major causes of mortality were pulmonary failure, renal failure, or both, sepsis, and neurological complications. These data suggest that elderly patients have an increased risk of cardiac and noncardiac morbidity and mortality after coronary artery bypass surgery. Higher mortality rates in this age group appear attributable to noncardiac organ failure. Late follow-up studies failed to show any significant difference among patients based on age alone.
Asunto(s)
Puente de Arteria Coronaria , Complicaciones Posoperatorias , Anciano , Cateterismo Cardíaco , Gasto Cardíaco , Puente de Arteria Coronaria/mortalidad , Enfermedad Coronaria/mortalidad , Enfermedad Coronaria/fisiopatología , Enfermedad Coronaria/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Contracción Miocárdica , Volumen SistólicoRESUMEN
Left ventricular rupture is reported to occur in 0.5-2% of patients following mitral valve replacement and results in a high mortality rate. Three types of left ventricular rupture have been identified, each attributed to a different mechanism. Failure of repair has been due to repeated tearing of the ventricular muscle and resulting hemorrhage. We describe the repair of left ventricular rupture following mitral valve replacement with buttressed dacron patch. The repair is designed to eliminate the tension placed on the suture line. In addition, specific recommendations are made to avoid left ventricular rupture during mitral valve replacement.
Asunto(s)
Rotura Cardíaca/cirugía , Prótesis Valvulares Cardíacas/efectos adversos , Femenino , Rotura Cardíaca/etiología , Ventrículos Cardíacos , Humanos , Persona de Mediana Edad , Válvula Mitral , Técnicas de Sutura , SuturasRESUMEN
Patients undergoing open heart surgery who have had recent cardiogenic embolic stroke or have central nervous system dysfunction pose a difficult management problem. There is always the risk that cardiopulmonary bypass and heparinization may exacerbate the neurologic injury. There is no clear data indicating what is a safe interval of time from the onset of neurologic symptoms to the time of surgery. Since 1982 we have operated on 15 patients with recent (2 to 28 days, mean 12.7 +/- 7.9 days) neurologic injury. Indications for surgery included recurrent embolization, sepsis, and hemodynamic deterioration. Three patients were comatose with no focal neurologic signs at the time of surgery, and 12 patients had focal neurologic deficits. All patients had preoperative computed tomographic scans. Embolic cerebral infarctions were documented in 12 patients, one patient had evidence of intracranial hemorrhage, and one patient had a subdural hematoma. Fourteen patients had native or prosthetic valvular endocarditis and one patient had a left atrial myxoma. All patients underwent corrective cardiac surgery. One patient died in the postoperative period from multisystem failure; all other patients have been followed since discharge (6 months to 4 years). All surviving patients demonstrated improvement in their neurologic symptoms and eight patients had complete neurologic recovery. The results of this study indicate that open heart surgery can be safely performed in patients with recent neurologic injury.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Trastornos Cerebrovasculares/etiología , Cardiopatías/complicaciones , Adolescente , Adulto , Anciano , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Infarto Cerebral/etiología , Infarto Cerebral/fisiopatología , Trastornos Cerebrovasculares/fisiopatología , Coma/etiología , Endocarditis/complicaciones , Femenino , Cardiopatías/cirugía , Neoplasias Cardíacas/complicaciones , Hemiplejía/etiología , Humanos , Embolia y Trombosis Intracraneal/etiología , Embolia y Trombosis Intracraneal/fisiopatología , Masculino , Persona de Mediana Edad , Mixoma/complicaciones , Células Neoplásicas Circulantes , Complicaciones Posoperatorias , Factores de TiempoRESUMEN
Autologous saphenous vein has proved to be a satisfactory conduit for use in coronary artery bypass grafting. Unfortunately, it is not always available, and substitute material must sometimes be used. When satisfactory autologous veins were not available and the internal mammary arteries were unsuitable, cryopreserved homologous saphenous veins were used in 28 patients. A total of 76 grafts were constructed. Cryopreserved homologous veins were used for 61 grafts, autologous saphenous veins for 11 grafts, and the internal mammary artery for 2 grafts. Coronary angiography was performed 8 to 12 days postoperatively in 16 patients. Of the 31 homografts studied, 8 were occluded (26%), 3 were stenotic (9%), and 20 were normal (65%). The one internal mammary artery and six autologous veins studied were all patent. Six patients underwent late catheterization 6 to 12 months postoperatively. Thirteen homografts were studied at late catheterization: 11 were occluded, 1 was severely stenotic, and 1 was mildly stenotic. At late catheterization, the one internal mammary artery studied was patent, and the one autologous saphenous vein was 95% occluded. Results of both early and late catheterization performed on 18 patients demonstrated that of the 35 homografts studied, 17 (49%) were occluded, 3 (9%) had greater than 70% stenosis, 1 (3%) had mild disease, and 14 (40%) were free of disease. One year follow-up data obtained on 26 patients revealed that 4 patients (15%) died of cardiac causes, 2 patients (8%) died of noncardiac causes, 11 patients (42%) have recurrent angina, and 9 (35%) are asymptomatic. It is concluded that use of cryopreserved homologous saphenous veins for coronary artery bypass grafting should be avoided if at all possible.
Asunto(s)
Puente de Arteria Coronaria , Oclusión de Injerto Vascular/etiología , Vena Safena/trasplante , Conservación de Tejido/métodos , Adulto , Anciano , Prótesis Vascular , Cateterismo Cardíaco , Angiografía Coronaria , Estudios de Evaluación como Asunto , Femenino , Estudios de Seguimiento , Congelación , Humanos , Masculino , Arterias Mamarias/trasplante , Persona de Mediana Edad , Complicaciones Posoperatorias , Reoperación , Factores de Tiempo , Trasplante HomólogoRESUMEN
With increasing frequency more elderly patients are referred for coronary artery bypass surgery. The operative results of 201 patients 70 years of age and over were compared with the results of 1242 patients under 70 years operated on since 1981. A larger percentage of the elderly patients had triple-vessel disease (66.2% vs 51.0%, p less than 0.001), left main coronary artery obstruction (34.8% vs 16.3%, p less than 0.01), and an ejection fraction of less than or equal to 45% (30.8% vs 21.1%, p less than 0.001). An increase percentage of the patients 70 years of age and over had perioperative myocardial infarction (7.9% vs 4.1%, p less than 0.05), required prolonged ventilatory support (7.9% vs 3.1%, NS), and had major neurologic complications (4.0% vs 1.1%, p less than 0.001). The mortality rate was significantly higher in the elderly patients (5.9% vs 1.9%, p less than 0.01) but did not correlate with degree of coronary artery disease, anginal pattern, or preoperative ventricular function. Only 2 of 12 deaths in the elderly patients were from cardiac causes. This data would suggest that elderly patients have an increased risk for significant cardiac and noncardiac morbidity and mortality following coronary artery bypass surgery and that the higher mortality rate in this age group may be a result of noncardiac organ failure.