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Biomedical subjects

G Mishkel

Publications and source records attributed to G Mishkel.

5 recordsLinked to original sources
PubMed1999

Outpatient coronary stenting: femoral approach with vascular sealing.

Miniaturized devices and pressures for increased patient convenience and lowered cost have shortened length of stay for coronary interventions. A cohort of 60 patients was recruited to assess the feasibility of outpatient stenting with vascular sealing. Patients with stable and unstable angina or myocardial infarction > 24 hours were considered for this strategy. Mean time to hemostasis, ambulation and discharge were 6.1, 256 and 296 minutes, respectively, for the 6F group, and 11.0, 351 and 489 minutes for the 7 to 8F group. No acute procedural complications occurred, and there were no ischemic complications at 24 hours or 1 month. There was 1 pseudoaneurysm requiring surgical correction, but no other access site requiring treatment. The cost saved using the 6F approach is estimated at $478 and using the 8F approach, $437. Outpatient stenting using vascular sealing is feasible and safe, and may lead to significant nationwide cost reductions in the range of $40,000,000 yearly.

Ambulatory Care↗
PubMed1999

Outpatient coronary stenting using the femoral approach with vascular sealing.

PURPOSE: We report here the use of vascular sealing devices in conjunction with the use of small transfemoral guiding catheters to decrease time to ambulation, decrease cost associated with hospitalization and achieve early discharge. METHODS: Fifty patients were enrolled in this pilot project from two busy interventional practices between May 1997 and February 1999. Patients with stable or unstable angina or positive ETT and with recent myocardial infarction greater than 24 hours from the time of the procedure were included. Excluded patients included those who had received glycoprotein IIb/IIIa platelet inhibitors and those with intra-procedure access site complications. RESULTS: Of the 50 patients originally recruited, 49 underwent vascular sealing for hemostasis and 45 were discharged on the same day, as planned. Early home telephone follow-up was available on 41 of the 45 same-day discharge patients, of whom 30 noted no complaints. One patient, who had been re-accessed in the right femoral artery after a previous intervention, developed a pseudoaneurysm requiring surgical repair. One-month follow-up was available on all patients. No patient suffered a late ischemic event or access site complication requiring treatment. There were no instances of stent loss, acute closure or subacute thrombosis. CONCLUSION: Though limited by small numbers, this pilot study shows that selected patients undergoing coronary stenting via the femoral approach can be safely treated on an outpatient basis using vascular sealing devices. Cost savings may be significant using this strategy.

Ambulatory Surgical Procedures↗
PubMed1989

Recovery of elevated atrial natriuretic peptide in pressure-overload right heart failure.

Elevation of the plasma concentrations of immunoreactive atrial natriuretic peptide (ANP) was observed in canine chronic right heart failure (RHF) secondary to right ventricular (RV) pressure overload. Pressure overload on the right heart was gradually increased using an inflatable cuff. The interval between banding and the onset of RHF was 152 +/- 52 days. Seventeen RHF dogs were produced and divided into Group I (n = 11) and Group II (n = 6). At the onset of RHF, Group I dogs were either sacrificed for study of the heart, or unbanded to allow recovery from RHF. The dogs in Group II were maintained in RHF for 3 additional months before being either sacrificed or unbanded. Following unbanding, the ANP level of Group I recovered from 108 +/- 36 (n = 11) to 20 +/- 6 pg/ml (n = 6) at 1 month and was maintained at 27 +/- 7 pg/ml (baseline, 21 +/- 5 pg/ml, n = 11) at 4 months. ANP levels of Group II declined from 165 +/- 55 (n = 6) to 87 +/- 2 pg/ml (n = 3) at 1 month and further decreased to 42 +/- 14 pg/ml (n = 3) 4 months after unbanding. Thus, compared to Group I, Group II had a high ANP level before unbanding and a delay in recovery of the ANP levels despite normalization of the right atrial pressure (RAP). Four months after release of pressure overload, the right atrial hypertrophy persisted in the unbanded dogs; however, Group I unbanded dogs showed a better reversal of the right atrial hypertrophy than Group II unbanded dogs.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

A simplified concept for a bileaflet atrioventricular valve that maintains annular-papillary muscle continuity.

We have developed a simplified concept for a bileaflet atrioventricular prosthesis that can be constructed from a simple sheet of glutaraldehyde preserved pericardium. The valve has no rigid ring or stent and no cloth sewing ring. Insertion of the valve reestablishes normal continuity between the annulus and the papillary muscles. We have replaced the mitral valve in nine dogs using this prosthesis. All valves have been competent with excellent valve opening areas as confirmed by echo-Doppler assessment. Studies up to 4 1/2 months have confirmed excellent hemodynamics and there has been no evidence of early tissue failure. Possible advantages of this simple valve design are improved hemodynamics, ease of construction and insertion, and low cost.

Animals↗