Biomedical subjects

A M Mantia

Publications and source records attributed to A M Mantia.

14 recordsLinked to original sources

PubMed1994

An epidemiologic approach to predictors of elective coronary artery bypass mortality in a non-university hospital population.

This investigation was undertaken to determine whether perioperative variables present in patients scheduled for elective coronary artery bypass grafting (CABG) surgery, and documented in earlier studies at university programs, bear any significant relationship to mortality occurring in a population of prospectively monitored non-university hospital patients. The investigation sought to identify the risk factors that might be present in these patients. Toward this purpose, data from 1,095 patients having CABG surgery at four major non-university Pittsburgh hospitals were analyzed using univariate and multivariate analysis to develop a model for predicting survival. From this model, three variables, unstable angina or recent myocardial infarction (< 6 weeks); evidence of chronic heart failure at the time of the preoperative examination; and greater than 65 years of age were found to have high statistical significance (P < 0.02) in predicting mortality in this non-university-hospital population. In summary, the study demonstrated that three variables, previously confirmed as being valuable predictors of risk in university hospital populations, also have significant predictive value in elective non-university CABG survival.

Aged↗

PubMed1989

Aggressive use of intra-aortic balloon pump and emergency coronary bypass surgery. Enhanced survival in acute evolving MI.

This report describes our experience with prophylactic and therapeutic use of IABPs prior to and following coronary artery bypass grafting (CABG) in 39 patients experiencing acute evolving myocardial infarctions (AEMI). All patients showed objective evidence of coronary thrombosis (contrast angiography) followed by later evidence of streptokinase (SK)-induced restoration of antegrade blood flow in the infarct-related coronary artery (as determined by repeat angiography). In these 39 high-risk patients, 38 survived and were discharged. One patient died (2.6 per cent) on the twelfth postoperative day.

Adult↗

PubMed1988

Sternal retraction and pulmonary artery catheter compromise.

Forty-one consecutive open-chest cardiac procedures requiring sternal retractors for visualization were prospectively studied. Chest x-rays demonstrating the course of the introducer sheaths and pulmonary artery catheters (PACs) were taken before and after sternal retractor expansion. Five different introducer sheath insertion sites were monitored (right internal jugular, left internal jugular, left subclavian, right subclavian, and right supraclavicular). The incidence of permanent loss of pulmonary artery (PA) and central venous pressure (CVP) waveforms was recorded after retractor expansion. Forty-five percent of both the left and right subclavian groups suffered loss of the PA and CVP waveforms, whereas none of the other insertion site groups was affected. Therefore, it is recommended that PACs inserted for surgery requiring sternal retractors be placed via nonsubclavian routes.

Cardiac Surgical Procedures↗

PubMed1988

Compromised pulmonary artery catheter injection following sternal retraction.

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Cardiac Output↗

PubMed1987

Coronary artery bypass grafting within 24 hours after intracoronary streptokinase thrombolysis.

Little specific information currently exists describing the management of patients with an evolving acute myocardial infarction (AMI) treated with direct intracoronary infusion of streptokinase (SK) followed by emergency coronary artery bypass grafting (CABG). A total of 194 patients with an evolving AMI underwent emergency coronary artery angiography with infusion of SK. Thirty-four of these patients with partial restoration of orthograde blood flow in the infarct-related coronary artery (as determined by clinical and objective evidence of myocardial salvage) were referred for emergency CABG. Problems related to the surgical and anesthetic care of these high-risk patients involved: (1) management of resuscitation of patients with AMI, (2) SK-induced coagulopathy and ongoing thrombolysis, and (3) timely CABG to preserve myocardial salvage. To highlight comparisons of SK-CABG management, data regarding 34 consecutive patients having routine non-SK-CABG surgery were collected simultaneously during the study. Data collected retrospectively included: anesthetic drug summaries, time frame of events from admission to the emergency room until commencing bypass, use of invasive monitoring and hemodynamic assist devices, induction complications, operative complications, coagulation derangements, volume replacement, and blood loss. Results revealed no deaths up to 24 hours postoperatively in the 34 emergency SK-CABG patients, even though complications were frequent intraoperatively. Furthermore, there were no statistically significant differences in SK patients v non-SK patients in blood lost, banked blood and cell saver blood administered, or platelet transfusions. However, in comparison to the non-SK-CABG patients, the SK patients received significantly larger amounts of fresh frozen plasma, cryoprecipitate, and aminocaproic acid.

Aged↗

PubMed1987