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Biomedical subjects

E D Foster

Publications and source records attributed to E D Foster.

At least 37 records · Page 2Linked to original sources
PubMed1986

Risk of noncardiac operation in patients with defined coronary disease: The Coronary Artery Surgery Study (CASS) registry experience.

It has been suggested that coronary artery bypass grafting (CABG) is efficacious in patients with severe coronary artery disease before they undergo a major noncardiac operation. The Coronary Artery Surgery Study (CASS) registry population was reviewed to identify variables affecting operative mortality and cardiovascular morbidity for noncardiac procedures, and to assess the influence of prior CABG on these surgical risks. Major noncardiac operations were performed on 1,600 registry patients between June 30, 1978, and June 30, 1981. Operative mortality for individuals without significant coronary artery disease (Group 1) was 0.5% (2/399) and for patients with such disease having CABG prior to a noncardiac procedure (Group 2), it was 0.9% (7/743) (Group 1 versus Group 2, p = 0.42). Patients with significant coronary artery disease undergoing noncardiac operation without prior CABG (Group 3) had an increased operative mortality, 2.4% (11/458) (p = 0.009). Group 2 patients had more severe angina symptoms (p less than 0.001) and more extensive coronary artery disease (p less than 0.001) on entering CASS than Group 3 patients. Postoperative chest pain occurred in 8.7% (40/458) of the Group 3 patients versus 4.5% (18/399) in Group 1 and 5.1% (38/743) in Group 2 (p = 0.004). No group differences were noted for the incidence of perioperative myocardial infarction or arrhythmias.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Surgical survival in the Coronary Artery Surgery Study (CASS) registry.

The overall surgical survival data in the Coronary Artery Surgery Study (CASS) registry have not been published to date, pending the report of the randomized medical-surgical comparison (CASS randomized trial). Non-randomized surgical survival data from the CASS registry are given in this article. The overall medical survival data from the registry were reported previously as a natural history study. There were 8,991 patients in the registry portion of CASS who had primary isolated coronary artery bypass grafting and 8,971 with follow-up of more than 30 days. The 5-year survival for all 8,971 patients was 90%, and the operative mortality was 2.37%. Patients with left main coronary artery disease had an operative mortality of 3.84% and a 5-year survival of 85%, while patients with lesions in other vessels had an operative mortality of 2.12% and a 5-year survival of 91%. Among patients without left main coronary disease, the 5-year survival was 93% in those with single-vessel and 92% in those with double-vessel disease (operative mortality was 1.50% and 1.92%, respectively) and 88% in patients with triple-vessel disease (operative mortality was 2.62%; p = 0.009). When results for patients with left main coronary artery obstruction were compared with those for triple-vessel disease, the 5-year survival figures were 85% and 88%, respectively (p = 0.02) and the operative mortality, 3.84% and 2.62%, respectively (p = 0.03). Patients with normal or nearly normal left ventricular (LV) function (i.e., LV segmental wall motion scores ranging from 5 through 11) had a 5-year survival of 92% and an operative mortality of 1.97%. Patients with moderate impairment (LV score range, 12 through 16) had a 5-year survival of 80% and an operative mortality of 4.21%. In those with poor ventricular function (LV score of 17 or greater), the 5-year survival was 65% and the operative mortality was 6.21%. The difference in survival among the three groups was significant (p less than 0.0001). Of 29 variables used in a stepwise Cox regression analysis, LV wall motion score, congestive heart failure score, age, number of operable vessels, smoking history, LV end-diastolic pressure, and percent of left main coronary artery stenosis were found to have a significant effect on long-term survival (excluding 30-day mortality), and these variables plus surgical priority and height influenced surgical mortality. When height was used in the Cox proportional hazards model, female sex was no longer a significant variable.

Adult↗
PubMed1985

Survival following coronary artery bypass grafting in patients with severe angina pectoris (CASS). An observational study.

This observational study evaluates the effects of the severity of angina pectoris and the treatment method upon the survival of 4,209 patients in the Coronary Artery Surgery Study registry. In this nonrandomized study, these patients met the criteria used in the Coronary Artery Surgery Study randomized trial, except for the degree of angina pectoris and the method of selection of treatment. The 5 year survival rate was greater than or equal to 93% in patients with Class I and II angina pectoris and normal left ventricular function, regardless of the number of involved vessels or treatment received. Late survival of surgically treated patients with Class III and IV angina pectoris and normal left ventricular function was similar, regardless of the number of vessels involved (greater than or equal to 92% at 5 years). Nonoperatively treated patients with Class III and IV angina pectoris and normal left ventricular function had poorer 5 year survival rates, lowest (74%) in patients with three vessel disease (p less than 0.0001). This difference was also observed in patients with abnormal left ventricular function, three vessel disease, and Class III and IV angina pectoris; the 5 year survival rates were 82% for the operative group and 52% for the nonoperative group (p less than 0.0001). These data confirm the importance of clinical as well as anatomic factors in determining the prognosis of patients with ischemic heart disease and indicate that coronary artery bypass grafting can improve late survival in patients with triple vessel disease and severe angina pectoris.

Adult↗
PubMed1985

Reoperation for coronary artery disease.

Repeat coronary artery bypass grafting (CABG) accounts for approximately 5% of all myocardial revascularization procedures in the United States annually; it is estimated that nearly 7000 reoperations will be performed in 1984. Angiographic indications for repeat CABG include primary bypass graft obstruction, progressive coronary arteriosclerosis, and combined graft failure and new coronary artery disease. Saphenous vein obstruction secondary to arteriosclerosis occurs in more than half the bypass grafts at 10 years after CABG. Successful aortocoronary reoperation is dependent on careful attention to special surgical technical considerations such as chest reentry, cardiopulmonary bypass management and myocardial preservation, primary graft handling and identification of the target coronary vessel, choice of available bypass conduits, completeness of revascularization, and hemostasis and blood conservation. Operative mortality for repeat CABG is approximately twice that for an initial aortocoronary bypass procedure. Overall operative morbidity is not significantly different for primary and subsequent myocardial revascularization. Five-year survival after repeat aortocoronary surgery is approximately 90% and compares favorably with survival rates after initial CABG. However, symptomatic relief of angina pectoris is not as effective after a repeat myocardial revascularization as it was after the first CABG; only half the patients are angina-free 5 years after reoperation. As with primary revascularization, long-term graft patency rates after coronary reoperation are superior for the internal artery as compared with the saphenous vein.

Coronary Artery Bypass↗
PubMed1984

Potential for percutaneous transluminal coronary angioplasty before initial and repeat coronary artery bypass grafting in the Coronary Artery Surgery Study (CASS) Registry population.

Retrospective analysis of preoperative angiograms was conducted to determine potential candidacy for PTCA among the NHLBI Coronary Artery Surgery Study (CASS) Registry population undergoing initial and repeat CABG. Conservative criteria believed to be universally acceptable for PTCA were used. Patients were considered potential PTCA candidates if: (1) CABG had been performed to only 1 coronary artery system; (2) the critical disease was localized to the most proximal segment of that coronary artery system; (3) all distal segments of that coronary artery system were free of critical disease; and (4) the morphologic characteristics of the obstructing lesion were discrete and isolated. Left main CAD was excluded. Among persons who underwent initial CABG, 2.8% (261 of 9,369) were PTCA candidates, and 7.1% (20 of 283) of those who underwent repeat CABG were considered suitable for PTCA. The operative mortality risk of the PTCA candidates who underwent initial CABG was 0.4% (1 of 261). No PTCA candidates died during repeat CABG. Perioperative MI occurred in 2.3% (6 of 261) of the PTCA candidates who had initial CABG; none occurred among those who underwent repeat surgery. Total surgical complications occurred in 15.7% (41 of 261) of the PTCA candidates at initial CABG and in 5% (1 of 20) who had repeat CABG. These operative mortality and morbidity risks are lower than those reported for similar patients who undergo PTCA.

Adult↗
PubMed1984

Cardiac rhabdomyoma in the neonate: surgical management.

Rhabdomyoma is the most common cardiac neoplasm in neonates. Tuberous sclerosis is found in half of the patients with rhabdomyomas. We maintain a surgical policy of accepting for operation only neonates in whom it has been demonstrated that the primary cause for hemodynamic compromise is obstructing, intracavitary neoplasms. Only the intracavitary portions of the rhabdomyoma are excised; no effort is made to completely remove all intramural tumors. Rhabdomyomas demonstrate benign pathological characteristics and may regress. Neonates with rhabdomyomas but no hemodynamic impairment, or those in whom only intramural masses can be demonstrated, are not considered surgical candidates. Tuberous sclerosis by itself should not be judged a contraindication to operation. The results of our surgical policy regarding rhabdomyomas in neonates are reported in two case presentations.

Cardiac Catheterization↗
PubMed1984

Reoperation for aortic coarctation.

Reoperation for aortic coarctation has become common because of several factors: (1) increased physician awareness that hypertensive cardiovascular disease continues to threaten the prognosis of the patient following coarctectomy and that investigation in some symptomatic individuals after coarctectomy will demonstrate a residual or recurrent coarctation, even many years after the primary repair; (2) the widespread application of stress testing, which can reveal marked arm-to-leg pressure gradients not observed at rest, to the routine postcoarctectomy follow-up examination; (3) improved noninvasive aortic evaluation techniques, such as ultrasound; and (4) higher salvage rates among infants undergoing urgent coarctation repairs and the recognition that these children subsequently are at high risk for recoarctation. A surgical decision-making process characterized by flexibility provides maximum patient safety; no single reoperation technique can be applied in all situations. Individual circumstances may dictate recoarctation repair by resection with end-to-end anastomosis, tube graft interposition, aortoplasty, or tube graft bypass. The need for a temporary aortic shunt or partial left atriofemoral bypass to maintain adequate distal aortic perfusion pressure during the repair means that these methods must be available at all reoperations. Diligent efforts to repair all hemodynamically significant residual and recurrent coarctations are necessary if the natural fate of premature death is to be avoided for patients with these lesions.

Aorta, Abdominal↗
PubMed1984

Comparison of operative mortality and morbidity for initial and repeat coronary artery bypass grafting: The Coronary Artery Surgery Study (CASS) registry experience.

The National Heart, Lung, and Blood Institute's Coronary Artery Surgery Study (CASS) registry population was reviewed to allow comparison of operative mortality and morbidity rates for initial and repeat coronary artery bypass grafting (CABG) procedures. Standardized data collection was employed in CASS during patient entry (July 1, 1974, to May 31, 1979) and follow-up (ended November 30, 1982). Initial CABG was performed on 9,369 patients. Mean follow-up was 60.5 months. Repeat CABG was required in 283 patients (3.0%). The mean interval between operations was 39.3 months. Individuals needing reoperation tended to be young (p less than 0.0001) and female (p less than 0.002) and to have less extensive coronary artery disease (p less than or equal to 0.0001), less left ventricular impairment (p less than 0.0001), less evidence of congestive heart failure (p = 0.006), and fewer coronary vessel systems bypassed at the first operation (p less than 0.0001). Repeat CABG carried an increased risk of death compared with initial CABG (5.3% versus 3.1%, respectively; p less than 0.05). However, the rates of perioperative myocardial infarction (6.4% for repeat and 5.8% for initial CABG) and of all surgical complications combined (30.6% versus 27.9%) were not significantly different from those at initial CABG.

Adult↗
PubMed1981

Anomalous right subclavian artery arising proximal to a postductal thoracic aortic coarctation.

Approximately 1% of patients with postductal thoracic aortic coarctation have an associated anomalous right subclavian artery. Previous reports indicated that the aberrant right subclavian vessel arose distal to the coarctation site. The case of a patient is presented in whom the anomalous right subclavian artery originated proximal to the postductal coarctation. We believe this to be among the first reports of this entity. The embryological development pathway and clinical implications of this congenital defect complex are discussed.

Abnormalities, Multiple↗
PubMed1981

Preservation of the myocardium during coronary artery bypass grafting.

The influence of three methods of myocardial preservation used during coronary artery bypass grafting on operative mortality and perioperative myocardial infarction was evaluated in seven institutions participating in the Coronary Artery Surgery Study (CASS). Both operative mortality and perioperative infarctions were comparable with either normothermic and topical hypothermic myocardial preservation. The addition of potassium cardioplegia to hypothermia lowered both operative mortality and perioperative myocardial infarction (p less than 0.01 and p less than 0.001, respectively). Stepwise multivariate discriminant analysis revealed that the high-risk clinical and angiographic variables were the most important determinants of operative mortality, followed by surgical priority and the use of potassium cardioplegia. However, none of the clinical, angiographic and surgical variables other than the use of potassium cardioplegia influenced the incidence of perioperative myocardial infarction.

Adult↗
PubMed1981

Four-year follow-up on the Albany experience with intrapleural BCG in lung cancer.

One hundred sixty-nine patients were entered into randomized controlled studies of intrapleural bacille Calmette Guérin (BCG) immunotherapy after surgical resection of lung cancer. Long-term follow-up of our initial series of BCG-treated patients with Stage I disease continues to indicate that this treatment was superior to that given to control patients. The recurrence rate in the control population was high, 62% at 3 years. The recurrence rate was 33% at 3 years in the BCG-treated group. A negative preoperative tuberculin test and squamous cell histologic type were favorable prognostic factors for BCG-treated patients. The survival of patients with more advanced disease was not improved by BCG immunotherapy.

BCG Vaccine↗
PubMed1978

Disruption of a normal aortic valve as a result of blunt chest trauma.

Many cardiac lesions may result from nonpenetrating chest trauma. Myocardial contusions and lacerations are most common. Isolated valvular lesions are rare. The most common of these, in surviving patients, is aortic valve disruption (12). The course and management of a patient with a torn aortic valve as a result of nonpenetrating trauma are presented. Surgical replacement (porcine) of the valve and stabilization of the fractured sternum were followed by full recovery at 7 months postinjury.

Adult↗
PubMed1978

Massive impalement wound of the chest. A case report.

A 29-year-old man sustained an impalement wound of the right side of the chest with a 6 foot long, 4 by 4 inch wooden post during a high-speed automobile accident. The post entered the right side of the chest anteriorly and exited posteriorly. The great vessels of the chest were spared, but the right lung was lacerated and contused. Removal of the post, treatment of pulmonary parenchymal damage, and reconstruction of the two large chest wall defects presented problems in management. Rapid transport of the patient to the hospital, effective emergency treatment, surgical repair of the chest injury, and appropriate supportive measures contributed to his survival.

Adult↗
PubMed1978

Atrial septal defect associated with drainage of left superior vena cava to left atrium and absence of the coronary sinus.

Atrial septal defect associated with drainage of the left superior vena cava (LSVC) to the left atrium and absence of the coronary sinus is a rare congenital cardiac complex. Management of the LSVC during operative repair is usuall by one of three methods: (1) an intra-atrial baffle of pericardium to divery flow from the LSVC to the right arrium and to close the atrial septal defect; (2) division and reimplantation of the LSVC into the right atrium; or (3) simple ligation of the LSVC. We will present an example of this cardiac lesion for which successful repair was achieved by end-to-side anastomosis of the LSVC to the main pulmonary artery when none of the aforementioned methods for handling the LSVC was feasible.

Cardiopulmonary Bypass↗
PubMed1977

Polybrene neutralization as a means of monitoring heparin therapy for extracoporeal cirulation.

Dose-response effects of heparin and protamine in 34 adult patients undergoing cardiac operations were monitored by an in vitro analysis utilizing hexadimetharine bromide (Polybrene) neutralization. Heparin administered prior to cannulation for cardiopulmonary bypass in a dose of 3.0 mg (300 units) per kilogram of body weight, and 1.5 mg (150 units) per kilogram for each subsequent hour of bypass, routinely produced circulating heparin concentrations greater than 1.0 units per milliliter of plasma. A protamine dose equal to 80% of the total number of milligrams of heparin given resulted in no detectable plasma heparin in 23 of the 34 patients one-half hour after administration. No patient required protamine in an amount greater than the total number of milligrams in the heparin dose to achieve heparin neutralization. Modest postoperative chest tube drainage (mean, 784 ml in 48 hours) in these patients provides clinical support for low-dose protamine administration for heparin neutralization at the conclusion of cardiopulmonary bypass.

Adult↗
PubMed1977

Traumatic aortic rupture: an additional roentgenographic sign.

Esophageal displacement to the right at the level of the aortic arch and isthmus, as marked by an opaque nasoesophageal tube on anteroposterior chest roentgenogram is a useful sign in diagnosing traumatic aortic rupture. Finding this esophageal displacement in patients with blunt chest trauma warrants an immediate thoracic aortogram for demonstration of possible aortic injury.

Adolescent↗