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Biomedical subjects

D B Effler

Publications and source records attributed to D B Effler.

At least 19 recordsLinked to original sources
PubMed1978

Myocardial revascularization 1978.

After more than ten years of clinical application, direct myocardial revascularization with saphenous or mammary vein grafts is becomining one of the most common types of elective major surgery performed in the United States. The need for and the results of revascularization surgery are determined by cine coronary arteriography. The principles on which this type of surgery is based are simple. Critical occlusion of a coronary artery may produce an arteriographically identifiable area of myocardial perfusion deficit in the left ventricle. The functional demand for blood that results is usually manifested by anginal pain. When the occlusion is reduced by rest and administration of vasodilators, the immediate threat of infarction is alleviated. When pain persists in spite of treatment, direct revascularization surgery should be considered. This type of surgery need not involve ultrasophisticated adjuncts. Some of these adjuncts increase morbidity and contribute appreciably to the cost of operation and hospitalization. The record of myocardial revascularization suggests that the surgical treatment of coronary artery disease can and should be done in qualified community hospitals.

Coronary Disease↗
PubMed1977

Aortic valve replacement combined with myocardial revascularization. Late clinical results and survival of surgically-treated aortic valve patients with and without coronary artery disease.

From 1967 through 1973, 80 consecutive patients underwent simultaneous aortic valve replacement (AVR) and coronary bypass grafting. Fourteen (18%) experienced no angina pectoris and had no history or electrocardiographic evidence of coronary atherosclerosis. Seven of these 14 had severe multiple vessel disease. All operations were performed under normothermic conditions without coronary perfusion. Seven patients (9%) died during operation. Intra-operative myocardial infarction was documented in eight (10%). After a mean follow-up of 35 months, overall mortality was highest in aortic regurgitation patients [seven of 13 (54%)] compared to aortic stenosis [17 of 54 (31%)] (P less than 0.07), and mixed pathology [1 of 13 (8%)]. Thirty-one of 34 (91%) grafts in 25 patients were patent an average of 12 months postoperatively. After 42 months a 65% actuarial survival was found in the combined AVR and graft(s) series versus a 76% survival in 300 AVR patients proven by angiography not to have severe coronary atherosclerosis.

Adult↗
PubMed1975

The structural study of the saphenous vein.

From November, 1971, to September, 1974, 1,179 patients received aortocoronary saphenous vein bypass grafts at the Cleveland Clinic Hospital. Segments of saphenous vein from each patient were sent for microscopical analysis. These vein segments were classified as normal or abnormal (phlebosclerotic). Four hundred ninety-six normal vein grafts in 295 patients were restudied and had a patency of 87.9%. One hundred forty-four abnormal vein grafts in 86 patients were restudied and showed 89.5% patency. This study suggests that histopathological identification of an abnormal (phlebosclerotic) vein segment does not constitute a determining factor as far as late patency is concerned in a vein segment that is not grossly sclerotic.

Adult↗
PubMed1975

Internal mammary--coronary artery anastomosis. "No-touch" technique.

A simple technique for internal mammary--coronary artery anastomosis that can be applied to all branches of the coronary circulation is described. The anastomosis can be constructed in 10 to 15 minutes. This technique eliminates pinching of the internal mammary artery by forceps.

Humans↗
PubMed1975

Bridge saphenous vein graft.

Single aorta-coronary artery vein grafts (bridge grafts) were constructed to two coronary branches with a side-to-side anastomosis in 250 patients. Most of these grafts were constructed between circumflex branches (96 grafts), circumflex and diagnol branches (47 grafts), and anterior descending and diagonol branches (79 grafts). The aim of the bridge graft is to decrease the number of anastomoses, decrease the operative time, and improve graft patency. The hospital mortality rate in this group of patients was 1.2 per cent, and the incidence of postoperative myocardial infarction was 3.6 per cent. One hundred ten patients were restudied after surgery; the average time of restudy was 1 year. Ninety-two grafts of 83.6 per cent had two anastomosis patent; 6 grafts (5.4 per cent) had one anastomosis patent; and in 12 grafts (10.9 per cent), both anastomoses were occluded. One hundred twenty-six associated grafts were studied all the same time; the patency rate was 84.1 per cent. From this experience, we believe the bridge graft is a useful procedure for bypassing the small coronary artery branches.

Adult↗