Biomedical subjects

Eric Lim

Publications and source records attributed to Eric Lim.

41 records · Page 3Linked to original sources

PubMed2003

Surgery for left ventricular free wall rupture: patch glue repair without extracorporeal circulation.

Left ventricular free wall rupture is a dramatic complication after myocardial infarction. We present our experience with the simple, expedient technique of patch glue repair without extracorporeal circulation. Access is obtained via median sternotomy. Evacuation of blood and haematoma is undertaken and a Goretex patch exceeding the size of infarct is fashioned. The patch is applied to the epicardium using enbrucrilate surgical glue instilled with gentle pressure against the beating heart. We performed this technique on 17 patients from 1993 to 2001, with a operative (30-day) mortality of 23.5% with a post-discharge survival of 85% at 2.2 years.

Aged↗

PubMed2003

Porcine or human stentless valves for aortic valve replacement? Results of a 10-year comparative study.

BACKGROUND AND AIM OF THE STUDY: Stentless porcine valves in the aortic position exhibit similar excellent hemodynamic performance to homografts, but have the advantage of availability. Their performance was compared over a 10-year period in a single-surgeon and single-institution series. METHODS: Demographic, operative and mortality data were obtained retrospectively. Survivors were interviewed by telephone according to a defined protocol. Definitions and analyses were in accordance with joint STS/AATS guidelines. RESULTS: A total of 408 stentless porcine and homograft aortic valve replacements (AVR) was performed between 1991 and 2001. Five patients were excluded due to incomplete data, in addition to 82 patients who underwent AVR with a free-standing root replacement technique. Hence, 321 patients (217 males, 104 females; mean age 67 +/- 12 years) had a subcoronary implant. The median time to follow up was 4.9 years (range: 2.9-6.6 years). No differences were noted between homograft and stentless porcine valves in one- and five-year freedom from structural valve deterioration (99.1 versus 97.2% and 95.7 versus 93.1%; p = 0.10), reoperation (99.2 versus 99.4% and 97.8 versus 96.7%; p = 0.45) and endocarditis (98.3 versus 99.4% and 97.4 versus 99.4%; p = 0.14). Overall one- and five-year survival comparing homograft to stentless porcine valve was 90.4 versus 92.3% and 80.8 versus 73.7%, respectively; p = 0.23. Independent predictors of mortality on multivariate analysis were: ventricular function (p < 0.0001), increasing age (p < 0.001), increasing serum creatinine (p < 0.001) and concomitant coronary surgery (p = 0.05). Treated hypercholesterolemia was independently protective against mortality, with an odds ratio of 0.26 (CI 0.10 to 0.66; p = 0.005). CONCLUSION: The porcine stentless valve, when implanted in the subcoronary position, is an excellent alternative to the homograft and shows excellent clinical performance and durability at mid term.

Age Factors↗

PubMed2002

Evaluating routine diuretics after coronary surgery: a prospective randomized controlled trial.

BACKGROUND: Routine diuretic administration after cardiopulmonary bypass is common despite the lack of evidence for its benefit. We performed a prospective study to evaluate if diuretics assist in weight loss or alter clinical outcome. METHODS: Seventy-nine patients undergoing primary elective coronary bypass surgery were randomized to either diuretic (fusemide and amiloride) or placebo (lactose) postoperatively until preoperative weight was achieved or for 5 days in total. Proportions were compared with chi2 or Fisher's exact test. RESULTS: Forty patients were randomized to diuretics and 39 to placebo. By day 5, 97% of patients (37 of 38) still in the diuretic arm, and 74% of patients (29 of 39) in the placebo arm, achieved preoperative weight (p = 0.02). There were no differences in clinical outcomes. CONCLUSIONS: Routine diuretics promote an earlier diuresis but no clinical benefits are apparent in low risk patients with normal renal function. Clinicians should reconsider routine diuretic prescription in this setting.

Aged↗

PubMed2002

Determinants and assessment of regurgitation after mitral valve repair.

OBJECTIVES: The ability to detect residual regurgitation is important in the management of patients after mitral valve repair. We performed a study of 264 patients to determine the risk factors and to compare the accuracy of clinical assessment with that of echocardiography. METHODS: Operative details and valve pathologic data were obtained from individual patient case notes. Clinical assessment consisted of history, examination, and electrocardiography. The presence of regurgitation was ranked in 7 grades, from none to severe. Transthoracic echocardiography was performed blinded to and independently of clinical assessment on the same visit and was graded similarly. Univariate analyses of demographic, etiologic, and operative variables were performed. Significant factors were entered into a multivariate logistic regression model. Sensitivities and specificities were calculated for each diagnostic modality, and the kappa statistic was used to express agreement. RESULTS: Mean (+/- SE) freedoms from regurgitation at 1 and 5 years were 91.5% +/- 1.7% and 47.5% +/- 3.2%. Factors independently associated with postoperative regurgitation were poor ventricular function (P =.04), increased age (P =.01), and chordal procedures (P =.006). When assessing the presence of regurgitation, auscultation conferred a specificity of 78%, a sensitivity of 77%, and a kappa of 0.43 relative to echocardiography. Electrocardiographic criteria for left ventricular hypertrophy were superior, with a complete specificity of 100% but a low sensitivity of 15%. Agreement within 7 grades of severity was moderate, with a weighted kappa value of 0.42. CONCLUSIONS: The hazard function for regurgitation after mitral repair increases steadily after the third year, with ventricular function, age and chordal procedures as independent risks. Clinical assessment and electrocardiography are excellent in identifying regurgitation, but their agreement is less when grading severity.

Aged↗

PubMedDate not supplied

Prevalence of silent myocardial ischemia in asymptomatic individuals with subclinical atherosclerosis detected by electron beam tomography.

BACKGROUND: Electron beam tomography coronary calcium imaging is an evolving technique for the early detection of coronary atherosclerosis, and recent studies have established its prognostic value in asymptomatic individuals. The relationship of coronary artery calcium scores (CAC) to obstructive coronary artery disease (CAD) has been poorly studied but is clinically relevant because it determines which individuals are likely to benefit from revascularization procedures. Hence, we prospectively evaluated the prevalence of myocardial ischemia in asymptomatic patients with cardiovascular risk factors and subclinical atherosclerosis. METHODS AND RESULTS: We studied 864 asymptomatic patients with no previous CAD but with cardiovascular risk factors, referred for electron beam tomography coronary calcium imaging to our institution over an 18-month period. From this group, 220 consecutive patients (85% men; mean age, 61 +/- 9 years; age range, 31-84 years) with moderate to severe atherosclerotic disease (coronary calcium score > or =100 Agatston units) were prospectively evaluated by technetium 99m sestamibi single photon emission computed tomography (SPECT). Patients were followed up (mean follow-up, 14 months) and data regarding their subsequent clinical management recorded. Of the 220 patients, 119 had moderate atherosclerosis (CAC score of 100-400 Agatston units) and 101 had severe atherosclerosis (CAC score > or =400 Agatston units). Abnormal SPECT findings were seen in 18% of patients with moderate atherosclerosis (n = 21) and 45% of patients with severe atherosclerosis (n = 45). Increasing severity of atherosclerosis was related to increasing ischemic burden (summed difference score = 1 +/- 0.2 for CAC score of 100-400 Agatston units and 3.2 +/- 0.5 for CAC score > or =400 Agatston units). In a multivariate linear regression model incorporating risk factors, CAC was the only predictor of silent ischemia. CONCLUSION: In comparison to previously published data, we detected a higher prevalence of silent ischemia even in patients with moderate coronary atherosclerosis (18%). This may reflect the differing risk factor profile of our patient population. When coronary calcium screening is used to preselect asymptomatic patients with cardiovascular risk factors for myocardial perfusion imaging, the optimum coronary calcium score threshold will depend on the population prevalence of risk factors and asymptomatic obstructive CAD.

Adult↗