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Biomedical subjects

David A Zvara

Publications and source records attributed to David A Zvara.

8 recordsLinked to original sources
PubMed2006

The degree of atherosclerosis in the descending aorta does not predict poor in-hospital outcome after surgery requiring cardiopulmonary bypass.

OBJECTIVE: This study examined if the degree of atherosclerosis in the descending aorta is an independent predictor of poor in-hospital outcome for patients presenting for surgery involving cardiopulmonary bypass. DESIGN: The degree of atherosclerosis of the descending aorta was retrospectively reviewed in patients presenting for surgical procedures involving cardiopulmonary bypass from January 1, 2000, to December 31, 2003. Preoperative risk factors and in-hospital postoperative outcome parameters were obtained. SETTING: University teaching hospital. PARTICIPANTS: There were 310 consecutive patients enrolled in the study. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Two hundred forty-seven patients had coronary artery bypass grafting with or without valvular surgery, and 63 patients had isolated valvular surgery. The degree of atherosclerosis was rated as normal in 86 (28%), mild in 106 (34%), moderate in 69 (22%), and severe in 49 (16%) patients. Adjusting only for the degree of atherosclerosis, the total intensive care unit (ICU) time and the number of deaths were significantly higher in those patients with severe disease. Multivariable models adjusting for patients' risk factors showed a significant influence of atherosclerosis on total ICU time but not on other outcomes. The strongest predictor of poor outcome was a history of previous stroke (cerebral vascular accident). Other significant factors predicting poor outcome included previous coronary artery bypass surgery, a history of congestive heart failure, a history of dialysis, advanced age, and female sex. CONCLUSIONS: The degree of atherosclerosis in the descending aorta is not an independent predictor of poor in-hospital outcome after surgery involving cardiopulmonary bypass.

Aorta, Thoracic↗
PubMed2006

Anesthetic preconditioning with sevoflurane does not protect the spinal cord after an ischemic-reperfusion injury in the rat.

Anesthetic preconditioning (APC) is a protective mechanism, whereby exposure to a volatile anesthetic renders a tissue resistant to a subsequent ischemic insult. We hypothesized that APC of the rat spinal cord with sevoflurane would reduce neurologic deficit after an ischemic-reperfusion injury. Rats were randomly assigned to 1 of 5 groups. The ischemic preconditioning (IPC) group (n = 14) had 3 min of IPC, 30 min of reperfusion, and 12 min of ischemia. The chronic APC (cSEVO) group (n = 14) had 1 h of APC with 3.5% sevoflurane on each of 2 days before ischemia. The acute APC (aSEVO) group (n = 14) had 1 h of APC with 3.5% sevoflurane followed by a 1-h washout period before the induction of ischemia. The controls (n = 14) underwent no preconditioning before ischemia. IPC attenuated the ischemia-reperfusion injury, whereas aSEVO and cSEVO groups were no better than control animals. Histologic evaluation of the spinal cord showed severe neurologic damage in all groups except for the IPC group and sham-operated rats. APC with sevoflurane did not reduce neurologic injury in a rat model of spinal cord ischemia. Traditional ischemic preconditioning had a strong protective benefit on neurologic outcome.

Anesthetics, Inhalation↗
PubMed2004

Late presentation of esophageal injury after transesophageal echocardiography.

Esophageal injury is a rare complication of intraoperative transesophageal echocardiography (TEE) associated with cardiac surgery. We report two cases of delayed presentation (2 and 6 days after surgery) of esophageal injury that were likely due to TEE. The differential diagnosis of postoperative pleural effusion or anemia must include esophageal injury from TEE, even 6 days after the procedure.

Aged↗
PubMed2003

Diagnosis of an intraoperative aortic dissection by transesophageal echocardiography during routine coronary artery bypass grafting surgery.

UNLABELLED: Acute aortic dissection during coronary artery bypass grafting (CABG), though rare, causes significant morbidity and mortality. We report a case of postcardiopulmonary bypass aortic dissection in a 73-yr-old man who presented for CABG. The diagnosis was made by transesophageal echocardiography and allowed immediate treatment of the potentially lethal complication. IMPLICATIONS: Acute aortic dissection during coronary artery bypass grafting (CABG), though rare causes frequent morbidity and mortality. We report a case of postcardiopulmonary bypass aortic dissection in a 73-yr-old man who presented for CABG. Diagnosis made by transesophageal echocardiography allowed immediate treatment of the potentially lethal complication.

Aged↗
PubMed2002

Dynamic left ventricular outflow obstruction during lumbar laminectomy as an unexpected cause of intraoperative hypotension.

We present a case of previously undiagnosed hypertrophic obstructive cardiomyopathy (HOCM) with left ventricular outflow obstruction in a woman anesthetized for lumbar hemilaminectomy and diskectomy. The treatment of her sudden unexplained hypotension was initially confounded by a diagnosis of compensated congestive heart failure and diuretic therapy. Swift intervention with transesophageal echocardiography revealed the tru pathology altering her intraoperative treatment and her subsequent chronic treatment for her heart condition.

Aged↗
PubMed2002

Thoracoabdominal aneurysm surgery and the risk of paraplegia: contemporary practice and future directions.

Thoracoabdominal aneurysm surgery is associated with a high incidence of morbidity and mortality. Spinal cord ischemia and the risks of paraparesis or paraplegia remain devastating complications. The mechanisms of spinal cord injury involve both acute ischemic injury and delayed reperfusion injury. Blood flow to the spinal cord frequently arises in the segment of the aorta requiring aortic cross clamping. As such, there is an obligate period of blood flow disruption. Multiple strategies have evolved to reduce the ischemic interval and to provide adjunct interventions to reduce the impact of the ischemia. Despite a multidisciplinary approach, a spinal cord ischemia is present in approximately 4 to 16% of patients, depending on the type of aneurysm and other comorbid diseases. Cerebral spinal fluid drainage, distal perfusion techniques, intercostal artery anastomosis, hypothermia techniques, and mechanisms of ischemic preconditioning are interventions employed to reduce the risk of paraplegia after thoracal-abdominal aortic surgery. Surgeons, anesthesiologists, and perfusionist are intimately involved in the decision making as to which interventions will be employed in a given case. Although these adjuncts have been evaluated in multiple animal and human protocols, the efficacy of each intervention when looked at in isolation remains difficult to determine fully. This is attributable, in part, to the complex mechanisms of the patient injury, the inherint risks of the surgical procedure, and the confounding effects of comorbid disease states. Nonetheless, clinicians must have comprehensive understanding of these various interventions and their application. This review serves as an overview of these various interventions with special emphasis on outcome data.

Anastomosis, Surgical↗