PubMed Health⌕ Search

Biomedical subjects

D C Wukasch

Publications and source records attributed to D C Wukasch.

At least 55 records · Page 3Linked to original sources
PubMedDate not supplied

Surgical versus medical treatment of coronary artery disease: long-term survival.

In an attempt to answer the question as to whether or not aortocoronary bypass (ACB) does increase life expectancy of patients with coronary artery occlusive disease (CAOD), 4,766 consecutive patients undergoing ACB at the Texas Heart Institute from October, 1969 through June, 1975, were reviewed and followed for five and one half years. Overall early mortality was reduced from 9.7 percent during the first full year (1970) of the study to 3.3 percent during the last full year (1974). Early mortality in males (86.5 percent) was reduced to 3 percent during 1975, but in females only to 8.4 percent. However, late mortality in females was only 2.6 percent as compared to 3.4 percent in males. Long-term survival was similar for both males and females at five and one-half years when early mortality was considered. Males also experienced better symptomatic results than females with 90.3 percent of males remaining asymptomatic, while only 86.6 percent of females remained in this category. Early mortality increased as more vessels were bypassed, but late mortality decreased and symptomatic results improved as more complete revascularization was performed. Only 55 percent of late deaths were cardiac related. Actuarial comparison of this surgical series with the most comparable series in the literature of patients treated medically, demonstrated significant (P less than 0.001) increased survival in the surgical group as compared to medically treated patients at every year up to five and one-half years, for patients with double and triple vessel disease and for the entire series. In those patients with single vessel disease, the survival curves were similar to four years, following which survival was increased in the surgical patients at the end of the fifth and sixth reporting years. In summary, these data appear to suggest that surgical treatment of coronary artery occlusive disease does provide a favorable effect upon life expectancy.

Adult↗
PubMedDate not supplied

The value of moderate hypothermia during anoxic cardiac arrest for coronary artery surgery.

Anoxic cardiac arrest, as opposed to induced ventricular fibrillation, greatly facilitates accurate distal anastomosis in aortocoronary bypass surgery. In order to diminish the anoxic insult, general and topical hypothermia may be used. In an attempt to establish the value of moderate hypothermia during anoxic cardiac arrest two groups of patients were compared. In group I coronary artery bypass procedures were performed under normothermic conditions with anoxic cardiac arrest. Patients in group II underwent similar procedures but under hypothermic conditions. General body hypothermia to an esophageal temperature of 30 degrees C and topical hypothermia with iced saline lavage were used. Using these techniques, the average intramyocardial temperature was 26 degrees C. Nonfatal cardiac complications did not occur more frequently in the hypothermic group. Operative mortality was decreased from 6.3% in the normothermic group to 1.5% in the hypothermic group. However, in group II, in addition to hypothermia, a second factor in the reduction of mortality was the completeness of the revascularization procedure: 58.5% of the patients had three or more bypass grafts in the hypothermic group. The mean anoxic arrest time was over 50 min for all patients--those who survived as well as those who died with postoperative low cardiac output or myocardial infarction. Therefore, anoxic arrest time should be kept as short as possible and certainly less than 50 min. Intermittent aortic occlusion and performance of the proximal anastomoses using a partial occluding clamp on the aorta are currently being used and, together with moderate hypothermia, provide a further reduction in postoperative myocardial complications.

Arrhythmias, Cardiac↗
PubMedDate not supplied

Ischemic myocardial contracture ("stone heart"). A complication of cardiac surgery.

Stone heart or ischemic myocardial contracture is a complication of cardiopulmonary bypass characterized by contracture of the myocardium and inability to obtain cardiac output on manual massage. Stone heart has occurred only during aortic valve replacement and/or coronary artery bypass procedures. Predisposing factors are chronic congestive heart failure and myocardial hypertrophy with fibrosis secondary to longstanding aortic valve disease and/or coronary artery occlusive disease. Although the condition is rare, the outcome is usually fatal. Because of the biochemical and physiological implications of this syndrome, its prevention has been challenging. On the basis of our current concepts, prevention has been afforded by topical and general hypothermia and pretreatment with a small i.v. bolus of propranolol just prior to aortic occlusion. These measures have been utilized in potentially high-risk patients with the predisposition for stone heart and, thus far, the results have been satisfactory. The stone heart syndrome is an entity which should be recognized by all cardiac surgeons. Preventive measures must be aimed at protection of the myocardium during anoxic cardiac arrest.

Cardiac Output↗