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Biomedical subjects

D L Jeffery

Publications and source records attributed to D L Jeffery.

12 recordsLinked to original sources
PubMed1986

Results of coronary bypass surgery in elderly women.

One hundred two female and 102 male patients all older than 70 years who underwent coronary artery bypass grafting (CABG) between 1978 and 1983 were matched according to age, anginal status, ejection fraction (EF), number of bypass grafts, and year of operation. These 204 patients were characterized by a mean age of 73 years, a mean EF of 64%, a mean of 3.2 bypass grafts per patient, and unstable angina in 82%. Statistical analyses were performed on the following variables in conjunction with patient sex to determine whether the two samples (women and men) can be considered representative of a single patient population: preoperative resting ECG, stress test result, number of diseased vessels, left ventricular end-diastolic pressure, presence of carotid artery disease, use of an internal mammary artery graft, incidence of operative death, perioperative myocardial infarction (MI), hospital complications, late MI, recurrent angina, late death, and cumulative survival. All differences were small and failed to reach statistical significance except that women had a higher incidence of recurrent angina-like chest pain and a higher incidence of ischemic changes in the preoperative ECG and men had a higher incidence of conduction abnormalities. We conclude that in this age group, CABG is equally beneficial to women and men in terms of survival, but may result in less subjective symptomatic benefit in women.

Aged↗
PubMed1983

Surgical treatment of 200 consecutive patients with left main coronary artery disease.

Two hundred consecutive patients underwent myocardial revascularization for left main coronary artery disease between January, 1975, and December, 1981. The mean age of this group was 64 +/- 8 years, and 78.5% of the patients were men. The anginal pattern was chronic stable in 6% of the patients and progressive or unstable in the remainder. Resting electrocardiograms showed prior myocardial infarction in 45.5%. Left ventricular end-diastolic pressure was elevated in 145 patients, and ejection fraction was less than 50% in 40 patients. The mean number of bypass grafts per patient was 3.2 +/- 1.4 (standard deviation). Seventeen patients underwent major concomitant cardiovascular procedures. The operative mortality was 3.5%, and the incidence of perioperative infarction was 3%. Factors associated with reduced operative survival were increased age; unstable angina, or acute myocardial infarction, or both; female sex; circumflex-dominant circulation; and major concomitant procedures. Late mortality at a mean follow-up of 33.5 months was 6%, and 91% of the surviving patients assessed their quality of life as "excellent" or "good."

Adult↗
PubMed1982

Hemostatic and healing studies of sodium amylose succinate (IP760).

Acute and chronic studies were performed in the canine model to evaluate a new topical hemostatic agent in terms of initial hemostatic capability and tissue/material interaction during the healing process. IP760, a porous amylose succinate material, was applied to large splenic surface wounds in six acute and twelve chronic animals. Microfibrillar collagen (Avitene) was used in twelve chronic animals for comparison. While the hemostatic capabilities of the two agents were comparable, marked differences were noted in the healing response. In the IP760-treated wound sites the acute inflammatory response, granulation tissue infiltration with fibrosis and healing occurred earlier and in a more homogeneous manner than in the Avitene-treated wound sites. Healing of the IP760-treated wounds occurred concomitantly with the development of granulation tissue and fibrosis and the rapid resorption of the IP760.

Administration, Topical↗
PubMed1981

Left ventricular myotomy. Physiologic approach to surgical therapy for IHSS.

Twenty patients were operated on for idiopathic hypertrophic subaortic stenosis (IHSS) between 1966 and 1980. All were in New York Heart Association functional class 3 or 4, and 17 had overt congestive failure. The mean resting gradient across the left ventricular (LV) outflow tract preoperatively was 78 mm Hg. Seventeen patients underwent transaortic LV myotomy, one had mitral valve replacement (MVR), and two patients with rheumatic mitral insufficiency (MI) and IHSS underwent myotomy and MVR. There was one operative death (5 percent). Mean follow-up was 5.8 years. Eighteen of 19 survivors were improved to class 1 or 2. One patient whose gradient and symptoms were not relieved by myotomy was improved by myectomy and MVR. The MI was abolished or reduced by myotomy in ten of 13 patients. There were six late deaths, five of which are known or assumed to be cardiac related. We concluded that LV myotomy is a safe and effective technique for surgical management of IHSS. Left ventricular myectomy, MVR, or both are indicated in selected cases.

Adolescent↗
PubMedDate not supplied

Coronary bypass for left main disease in patients over 70 years of age.

Seventy-one consecutive patients over 70 years of age underwent isolated coronary bypass surgery for left main coronary artery (LMCA) disease between September 1975 and December 1982. All patients had angina; 6% were in NYHA functional class II, 30% class III, and 64% class IV. Intravenous nitroglycerin was required in 25% of patients. Resting electrocardiogram was abnormal in 91% of patients and stress testing performed in 24 patients was positive in all. Degree of left main stenosis graded by diameter was 60 to 70% in 24% of patients and greater than 70% in 76%. In addition to left main stenosis 66% of patients had significant triple vessel disease. Left ventricular end diastolic pressure (LVEDP) was elevated in 69% of patients while ejection fraction (EF) was low only 24%, without correlation between high LVEDP and low EF. Mean number of bypass grafts per patient was 3.4 +/- 0.6. Hospital mortality was 7% and mean post-operative stay was 10.4 +/- 2.0 days. Stepwise multiple regression analysis of 12 variables identified only unstable angina requiring intravenous nitroglycerin as a significant predictor of hospital mortality (p less than 0.01). Follow-up was complete with a late cardiac mortality of 4.5%. Seventy-five percent of surviving patients assessed their quality of life as good at a mean follow-up of 26 months. Coronary bypass for LMCA disease in a non-selected elderly population can be performed with low operative mortality and marked improvement in quality of life.

Aged↗
PubMedDate not supplied

Advantages of superior approach for mitral valve surgery.

Technical factors in mitral valve surgery (MVS) which may influence neurological complications, trauma to the left atrium and formation of atrial mural thrombi have not previously been described in detail. We have reviewed the records of 146 patients (pts) undergoing MVS through the superior approach between January 1974 and May 1981. The series consisted of 97 females and 49 males with a mean age of 57 +/- 18 years. All but 4 pts were in New York Heart Association functional class III or IV. Twenty-five pts underwent open mitral commissurotomy, 116 had valve replacement and 5 had annuloplasty. Concomitant procedures were coronary bypass in 47, aortic valve replacement in 18 and resection of left ventricular aneurysm in 3. Left atrial thrombi were removed in 21 pts. Thirteen pts (9%) died postoperatively. The causes of death were left ventricular failure in 7, arrhythmia in 4 and atrio-ventricular disruption in 2. Two of these pts also had cerebral dysfunction. Autopsy examination in 8 pts failed to reveal formation of fresh left atrial septal or posterior mural thrombus. Postoperative complications included transient neurologic injury presumed to be due to air embolus in 3 and postoperative bleeding from atrial suture line in one. The mean follow-up for the survivors has been 30 months. There have been 16 (12%) late deaths from 1 to 72 months (mean 15). Autopsy examination of 4 pts and surgical exploration in one other pt which failed to reveal organized left atrial mural thrombus. Only one late death was related to prosthetic thrombosis. This occurred following cessation of anticoagulations.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗