PubMed Health⌕ Search

Biomedical subjects

D A Killen

Publications and source records attributed to D A Killen.

At least 19 recordsLinked to original sources
PubMed1992

Risk analysis of operative intervention for failed coronary angioplasty.

To assess the outcome of emergency coronary artery bypass grafting (CABG) after failed percutaneous transluminal coronary angioplasty (PTCA), 91 patients undergoing emergency CABG after failed PTCA over a 30-month period ending July 31, 1991, were studied. For reference, a cohort of patients (91) concurrently undergoing elective CABG equally matched for age, sex, number of grafts, ventricular function, and reoperative status was compared. Specific outcomes including death, hospital length of stay, use of blood products, and development of myocardial infarction were analyzed. More than half the patients undergoing emergency CABG for failed PTCA required three or more grafts. Operative mortality was 12.1% (11/99) for emergency CABG compared with 1% (1/91) for elective case-matched CABG patients (p = 0.007). Emergency CABG patients required frequent use of postoperative inotropes (p = 0.02) and intraaortic balloon counterpulsation (p = 0.001). Length of hospital stay (p = 0.005), administration of blood products (p = 0.009), postoperative myocardial infarction (p = 0.0005), and ventricular arrhythmias (p = 0.0004) were increased after emergency compared with elective CABG. The presence of multivessel disease or use of a reperfusion catheter had no influence on clinical outcome. Despite accumulated experience and improved operative management, patients requiring emergency CABG for failed PTCA remain at increased risk for postoperative complications and death.

Angioplasty, Balloon, Coronary↗
PubMed1991

Bio-medicus ventricular assist device for salvage of cardiac surgical patients.

Over a 5-year period, 41 (1%) of 4,193 patients undergoing cardiac operations underwent intraoperative or early postoperative insertion of a Bio-Medicus ventricular assist device when it became apparent that the patient could not otherwise survive. Fourteen patients were in cardiogenic shock and 7 were in cardiac arrest at the time of initiation of their primary cardiac surgical procedure, and in no instance was the device planned as a bridge to cardiac transplantation. Bleeding, sepsis, and thromboembolism were frequent postoperative complications. Central nervous system deficits were observed in 16 patients during their postoperative course. Eight patients (19.5%) were long-term survivors. Of the preoperative risk factors evaluated only age was significantly associated with survival, with 7 (33%) of the 21 younger (39 to 63 years) patients surviving. Blood product usage and hospital cost were analyzed in an attempt to assess cost/effectiveness of use of this device for attempted salvage of such desperately ill patients.

Adult↗
PubMed1990

Deep femoral to anterior tibial bypass after failed femoropopliteal reconstructions.

Deep femoral to anterior tibial artery bypass is a reconstructive technique occasionally applicable when more conventional attempts at revascularization of the distal portion of the leg have failed. Three such patients, in whom the anterior tibial was the only distal patent branch of the popliteal artery, had severe symptoms of arterial insufficiency. Deep femoral to anterior tibial bypass was done using autogenous The distal portion of the deep femoral artery was exposed through an anteromedial distal thigh approach. The three patients have been followed up for a mean of 20.3 months, and each maintains graft patency and marked symptomatic improvement.

Arterial Occlusive Diseases↗
PubMed1989

Fifteen-year results of coronary artery bypass for isolated left anterior descending coronary artery disease.

During 1971 through 1975, 266 patients underwent primary coronary artery bypass grafting for occlusive disease confined to the left anterior descending coronary artery. Actuarial survival at 15 years was 72.7% with 60% of survivors being free from angina. Although the cause of death was cardiac related in 50% of the patients who died, survival was comparable with that of an age-matched and sex-matched general population. During follow-up, 48 secondary or tertiary repeat coronary artery bypass as well as 44 percutaneous transluminal coronary angioplasty procedures were performed. Acute event-free status (freedom from acute myocardial infarction, repeat coronary artery bypass grafting, percutaneous transluminal coronary angioplasty, or death) persisted at 15 years in 43.2% of patients. The differences in survival when patients were segregated according to age, sex, number of grafts performed, or graft conduit (internal mammary artery versus vein) were not significant. However, comparison of graft conduits revealed a significantly better (p = 0.02) overall acute event-free survival when the internal mammary artery was used.

Adult↗
PubMed1987

Repair of intrapericardial rupture of left sinus of Valsalva aneurysm.

A 62-year-old man with no history of preexisting heart disease was seen in cardiogenic shock. Prompt cardiac catheterization and aortography revealed pericardial tamponade and aneurysms of the right and left sinuses of Valsalva. Immediate sternotomy relieved the tamponade, which was secondary to an aneurysm of the left sinus of Valsalva rupturing into the transverse pericardial sinus. Endoaneurysmorrhaphy was performed successfully.

Aortic Rupture↗
PubMed1987

Fungal endocarditis complicating treatment of prosthetic valve bacterial endocarditis: value of prophylactic oral nystatin.

We describe two patients in whom fungal endocarditis occurred during antibiotic therapy for prosthetic valve bacterial endocarditis. Successful management of both patients was eventually achieved with antifungal therapy and replacement of the prosthetic valves. These cases and review of the literature suggest that (1) high-dose antibacterial therapy predisposes to fungal endocarditis; (2) during prolonged antibiotic therapy in patients predisposed to endocarditis, clinicians should consider the use of oral nystatin as prophylaxis against fungemia and possible fungal endocarditis; and (3) early replacement of prosthetic valves infected with fungi is indicated because chemotherapy alone is predictably inadequate to effect a cure.

Adult↗
PubMed1985

Coronary artery bypass following percutaneous transluminal coronary angioplasty.

During a 4-year period, 286 patients underwent coronary artery bypass grafting (CABG) following percutaneous transluminal coronary angioplasty (PTCA). Seventy-three patients had single-vessel and 213 (74.5%) had multivessel coronary artery disease. Twenty-nine patients underwent PTCA because of an evolving acute myocardial infarction (MI). Forty-two patients had previously undergone 47 CABG procedures. One hundred fifteen patients underwent CABG on an emergency basis. Indications for emergency CABG after PTCA were prolonged chest pain (79.1%), worsening of coronary artery obstruction (59.1%), "current of injury" by electrocardiogram (31.3%), cardiogenic shock (27.8%), and, in a lesser incidence, ventricular fibrillation, coronary artery dissection (without obstruction), heart block, and intractable cardiac arrest. The 286 patients underwent 2.1 CABG procedures per patient with a thirty-day mortality of 6.3% (18 patients). The incidence of acute MI was 43.5 versus 4.1%; low cardiac output syndrome, 34.8 versus 7.0%; and operative death, 11.3 versus 2.9% in the emergency and nonemergency groups, respectively. Other significant predictors of operative death were previous CABG (16.7 versus 4.5%), multivessel coronary artery disease (8.0 versus 1.4%). Late follow-up reveals a mortality of 1.4% per year in those patients who were early survivors of CABG.

Adult↗
PubMed1979

Five-year follow-up of patients undergoing coronary artery bypass.

Two hundred eighty-two patients who underwent coronary artery bypass operation between January, 1971, and July, 1972, were followed until the time of death or for 5 years after operation. The angina-free status progressively decreased during the period of follow-up but at 5 years 57% of the survivors were free from angina. The total (early and late) incidence of nonfatal myocardial infarction was 3.3 per 100 patient years of follow-up. Nine (3.2%) of the patients had a repeat coronary artery bypass operation within the first 5 postoperative years. The overall 5-year survival was 86.9%. The expected 5-year survival of the general population, matched by sex and age, is 90.7%. Five-year survival was 97% for single-vessel disease, 87% for double-vessel disease, and 85% for triple-vessel disease.

Adult↗
PubMed1977

Accuracy of treadmill testing in assessment of direct myocardial revascularization.

Near-maximal treadmill exercise tests (TET) performed at the time of coronary arteriography and bypass graft visualization an average of 13 months after direct myocardial revascularization were analyzed in 217 consecutive patients to assess the accuracy of the TET in predicting completeness of revascularization. TET results were correlated with bypass patency and extent of revascularization. Although conversion of a TET from an abnormal to a normal test or relief of TET-induced angina following surgery is closely correlated with bypass graft patency, the high incidence of normal exercise tests in the presence of residual coronary disease limits their usefulness in the individual postoperative patient in estimating the completeness of revascularization.

Adult↗
PubMed1976

Coronary artery bypass surgery for left main coronary artery disease.

The course of 146 consecutive patients with significant occlusive disease of the left main coronary artery who underwent coronary artery bypass surgery during a 4 year period is reviewed. Preoperatively, 11 patients were in New York Heart Association functional class II, 57 in class III and 78 in class IV. Seventy patients had progressive angina and 12 unstable angina. There were two operative deaths (surgical mortality rate 1.4 percent). Seven patients (4.8 percent) had a perioperative acute myocardial infarction. Complete follow-up has been achieved in the surgical survivors over an average period of 18.1 months; 77 percent of the surviving patients are completely asymptomatic and 19 percent are in functional class II. Four patients (2.8 percent) had a nonfatal late postoperative myocardial infarction and five (3.5 percent) died during the late postoperative period (3.3 percent annual mortality rate during a 2 to 47 month follow-up period). Postoperative cardiac catheterization studies performed in 35 patients an average of 12.1 months postoperatively revealed 78 percent of 80 grafts and patency of at least 1 graft in 93 percent of patients. Results of 42 (89 percent) of 47 near maximal treadmill stress tests were abnormal preoperatively compared with results of 14 (26 percent) of 54 postoperatively; in 74 percent of patients having both a preoperative and postoperative stress test, abnormal preoperative test results converted to normal after surgery. This study suggests that direct myocardial revascularization may offer an effective means of improving both the quality and duration of life in a patient with significant occlusive disease of the left main coronary artery.

Adult↗
PubMed1976

Coronary bypass surgery after renal transplantation.

Aortocoronary bypass surgery was performed in three patients with incapacitating angina pectoris who had previously had successful renal transplantation. All patients had initial symptomatic improvement. Although two have mild angina pectoris, there is objective improvement in their exercise tolerance and in ischemic ST-T changes on treadmill exercise testing. One patient, who also had resection of a left ventricular aneurysm, remains free of angina but is symptomatic from congestive heart failure. There were no postoperative complications. To our knowledge, these three cases are the first in which aortocoronary bypass surgery has been performed successfully in patients who have had renal transplantation. Anticipated problems with infection in view of the immunosuppressive therapy and renal problems postoperatively were not encountered.

Adult↗