Biomedical subjects

J Ennker

Publications and source records attributed to J Ennker.

At least 19 recordsLinked to original sources

PubMed2001

[The impact of morbid obesity on the peri- and postoperative course after aortocoronary bypass surgery].

BACKGROUND AND OBJECTIVE: Excessive obesity is considered to be a risk factor in coronary bypass grafting. The aim of the current study was to examine if grossly overweight patients with a body mass index (BMI) > 35 suffer from higher morbidity and mortality when compared with patients with normal body weight (BMI = 20-25). PATIENTS AND METHODS: 206 extremely obese patients (group A) and 206 patients with normal body weight (group B) originating from a total of 5614 patients undergoing coronary bypass grafting in the time span between 1.4.1996-1.10.2000 were studied retrospectively and consecutively. The data were obtained from case histories, questionnaires and interviews. Statistical analysis was performed by the chi 2 test after Pearson, the t test and the Kaplan-Meier method depending on the statistical problem analysed using the SPSS software v. 8.0. RESULTS: The comparison of group A with group B revealed a significantly higher incidence of diabetes mellitus (p < 0.001), hypertension (p < 0.001) and hyperlipidaemia (p < 0.01) in group A. The only significant differences regarding the surgical procedure were the longer operation time (212.3 +/- 44.6 min, mean +/- SD) and aortic cross-clamp time (53.8 +/- 17.4 min, mean +/- SD) in group A (p < 0.05). The duration of mechanical ventilation, the incidence of respiratory insufficiency and the stay in the intensive care unit were not significantly different. The disorders of wound healing both in the sternal and the graft removal regions occurred significantly more frequently in group A (p < 0.001). The 30 days mortality rate in group A (1.5%) was not significantly different from group B (p < 0.001). The 30 days mortality rate in group A (1.5%) was not significantly different from group B (2.9%). The follow-up analysis of the 30 days mortality rate in different age groups revealed no significant differences in patients aged between 60 and 75 years. The mean survival rate after 4 years was 87.2% in group A and 86.4% in group B. CONCLUSION: In spite of higher morbidity our results did not reveal significantly higher mortality in extremely obese patients. After operation the patients considered their state improved, therefore elective coronary surgery in grossly overweight patients seems to be indicated also without previous weight reduction.

Adult↗

PubMed2001

[Short and long term results of aortic valve replacement in patients 80 years of age and older].

BACKGROUND: Due to demographic changes in average life expectancy the age of patients undergoing cardiac surgery is increasing as well. We have reviewed the short- and long-term outcome in patients over 80 years of age after aortic valve replacement with or without concomitant coronary grafting. PATIENTS AND METHOD: From 1.1.1995 until 31.12.1999, 126 patients (93 women, 33 men between 80 and 89 years, 82.8 +/- 2.4) underwent aortic valve replacement. 64 patients (group A) received isolated valve replacement, 62 (group B) underwent myocardial revascularization as well. RESULTS: The 30-day hospital mortality rate was 6.3% for group A and 14.5% for group B. The follow-up time ranged between 3 and 63 months (32 +/- 16). None of the patients had to be reoperated for prosthetic valve dysfunction or endocarditis. Bleeding complications due to anticoagulation therapy were observed by one patient from group A 3 years after the operation. Of the 15 deaths during the follow-up period seven (47%) were cardiac in nature and two (13%) related to stroke. Acturial survival rates for group A were 89%, 85% and 77% at 1, 2 and 3 years, and for group B 76%, 72% and 70%. Permanent nursing care was not required 1 year after the operation by 100% of patients in group A (2 years: 98%, 3 years 95%) and by 100% of patients in group B (2 years: 93%, 3 years: 90%). At an interval of 1 year after the operation 96% of patients in group A had not been hospitalized as a result of cardiac disorders (2 years: 96%, 3 years: 94%). The rates for group B were 88%, 81% and 75%. CONCLUSION: Compared with younger age groups, aortic valve replacement in patients 80 years of age and older is associated with a distinctly increased mortality and morbidity. However, our data suggest that considering the poor prognosis of conservative therapy of symptomatic aortic valve disease, functional status as well as life expectancy in this age group seem to be positively influenced by aortic valve replacement.

Actuarial Analysis↗

PubMed2001

Aortic valve replacement with or without concomitant coronary artery bypass grafting in the ninth decade of life.

Due to demographic changes in average life expectancy, the age of patients undergoing cardiac surgery is increasing. We have reviewed the short- and long-term outcome after aortic valve replacement with or without concomitant coronary artery bypass grafting in patients over 80 years of age. From 1 January 1995 until 30 June 1999, 114 patients (83 women and 31 men, 80-89 years of age, 82.8+/-2.4 years) with symptomatic aortic valve disease underwent aortic valve replacement. Of these patients, 54% (group A) received isolated valve replacement and 46% (group B) underwent myocardial revascularization as well. The perioperative mortality rate was 4.8% for group A and 7.7% for group B. The 30-day hospital mortality rate was 4.8% for group A and 15.4% for group B. The follow-up time ranged between 3 months and 63 months (32+/-15 months). None of the patients had to be reoperated for prosthetic valve dysfunction or endocarditis. Bleeding complications due to anticoagulation therapy were not observed. Of the 15 deaths during the follow-up period, seven (47%) were cardiac in nature and two (13%) were related to stroke. Actuarial survival rates for group A were 90%, 84%, and 76% at 1, 2, and 3 years, respectively, and for group B were 75%, 71%, and 68%. One year after the operation, permanent nursing care was not required by 100% of patients in group A (2 years, 98%; 3 years, 95%) and by 100% of patients in group B (2 years, 95%; 3 years, 91%). At a 1-year interval after the operation, 98% of patients in group A had not been hospitalized as a result of cardiac disorders (2 years, 98%; 3 years, 95%). The rates for group B were 90%, 85%, and 85%. Compared with younger age groups, aortic valve replacement in patients 80 years of age and older is associated with a distinctly increased mortality and morbidity. However, our data suggest that, considering the poor prognosis of conservative therapy of symptomatic aortic valve disease, functional status as well as life expectancy in this age group seem to be positively influenced by aortic valve replacement.

Actuarial Analysis↗

PubMed2001

Gadolinium-enhanced elliptically reordered three-dimensional MR angiography in the assessment of hand vascularization before radial artery harvest for coronary artery bypass grafting: first experience.

RATIONALE AND OBJECTIVES: To assess the suitability of contrast-enhanced magnetic resonance angiography (MRA) in the preoperative evaluation of hand vasculature in potential candidates for radial artery bypass grafting. METHODS: In 21 patients, gadobenate dimeglumine-enhanced, three-dimensional gradient-echo sequences of both hands were performed, as well as a Doppler ultrasound study with radial artery compression. Doppler findings were correlated with MRA, focusing on the assessment of anastomoses between the vascular bed of the ulnar and radial arteries. RESULTS: One individual had to be excluded because of accidentally disclosed metal foreign bodies. Sufficient depiction of the hand vasculature was achieved in the remainder. Seventeen patients had evidence of adequate collateral flow between the ulnar and radial artery supply on Doppler ultrasound. Three patients exhibited inadequate collateral flow, with angiographic signs of vessel occlusion or missing collaterals between the palmar arches. Two patients presented with stenosis or occlusion of the radial artery. Magnetic resonance angiograms displayed great variations in hand vasculature and collateral formation, with no mismatch compared with Doppler ultrasound results. CONCLUSIONS: Contrast-enhanced MRA displays vascularization of the hand in detail and supplies ultrasound flow measurements for radial artery harvest, with high-resolution angiographic data about possible vessel variations and the presence of anastomoses between the radial or ulnar artery supply.

Adult↗

PubMed2000

[Aortic valve replacement in 80- and over 80-year-old patients. Short-term and long-term results].

Due to demographic changes in average life expectancy, the age of patients undergoing cardiac surgery is increasing as well. We have reviewed the short- and long-term outcome in patients over 80 years of age after aortic valve replacement. From 01 Jan 1995 until 31 Dec 1998, 105 patients (76 women, 29 men between 80 and 89 years, median: 83) underwent aortic valve replacement. 42% presented with aortic stenosis, 58% with combined valve disease with leading stenosis. 53% (group A) received isolated valve replacement, 47% (group B) underwent myocardial revascularization as well. The in-hospital mortality rate was 8.9% for group A and 14.3% for group B. The follow-up time ranged between 10 and 243 weeks (median: 112 weeks). None of the patients had to be reoperated for prosthetic valve dysfunction or endocarditis. Bleeding complications due to anticoagulant therapy were not observed. Of the 11 deaths during the follow-up period, 5 (45%) were cardiac in nature and 2 (18%) related to stroke. Actuarial survival rates for group A were 98, 95 and 88% at 1, 2 and 3 years, and for group B 92, 84 and 84%, respectively. Permanent nursing care was not required 1 year after the operation by 98% of patients in group A (2 years: 95%, 3 years: 88%) and by 100% of patients in group B (2 years: 95%, 3 years: 88%). At an interval of 1 year after the operation 98% of patients in group A had not been hospitalized as a result of cardiac disorders (2 years: 98%, 3 years: 94%). The rates for group B were 90, 82 and 82%. Compared with younger age groups, aortic valve replacement in patients 80 years of age and older is associated with a distinctly increased mortality and morbidity. However, our data suggest that considering the poor prognosis of conservative therapy of symptomatic aortic valve disease, the functional status as well as life expectancy in this age group seems to be positively influenced by aortic valve replacement.

Aged↗

PubMed2000

[Isolated coronary bypass operation in the 9th decade of life].

The average age of patients undergoing cardiac surgery has increased continuously during the last three decades due to a progressively increasing number of older people in the population and the advances in operative and perioperative treatment in open heart surgery. Consequently we have investigated the short- and long-term results of isolated myocardial revascularization in patients who are in their ninth decade of life. Between 1 January 1995 and 31 December 1998, 121 patients (51 women, 70 men, age 80 to 88 years, median: 82 years) underwent isolated coronary artery bypass grafting. As part of the revascularization, a unilateral internal mammary artery graft (IMA) was used in 87% of cases. The in-hospital mortality was 6.6%. Analysis of predictors of mortality unveiled the following factors: ejection fraction less than 50%; history of recent left ventricular failure; extent of coronary artery disease; perioperative use of an intraaortic balloon pump (IABP) and symptomatic pericardial effusion. Use of the IMA revealed no influence on in-hospital mortality. The median follow-up time was 20 months (range: 2-48 months). Survival rates after 1, 2, and 3 years were 93.1%, 87.3% and 73.7% for women and 86.9%, 82.5% and 65.1% for men. These survival rates were comparable with those of the entire 82 year old population. Predictors for late death were male gender, history of stroke, history of arterial embolism, and postoperative pulmonary failure resulting in mechanical ventilation. During the follow-up period myocardial infarcts were subsequently not observed. Freedom from angina after 1, 2 and 3 years was 90.1%, 82.6% and 78.1%, respectively. At an interval of 1 year after the operation 87.6% of patients had not been hospitalized as a result of cardiac disorders (2 years: 80.1%, 3 years: 73.2%). Permanent nursing care was not required 1 year after the operation by 94.3% of patients (2 years: 91.5%, 3 years: 91.5%). Four percent of the survivors suffered from permanent delirium, 3% from depression, 5% from lack of concentration, and 6% from vertigo. In summary this study has revealed that, in patients over eighty years of age suffering from ischemic heart disease, coronary artery bypass grafting has acceptable short- and long-term results. Yearly mortality rates during the first 3 years after the operation are comparable with the expected mortality rate in an age-matched population.

Aged↗

PubMed2000

[Multiple myocardial revascularization on the beating heart: risks, benefits and outlooks].

INTRODUCTION: Avoidance of extracorporeal circulation during beating heart surgery (OP CAB = Off-Pump Coronary Artery Bypass Surgery) for aortocoronary bypass grafting (ACBG) is gaining increasing importance in modern cardiac surgery. With the development of new mechanical stabilization devices, the revascularization of the posterior wall of the heart and the distal right coronary artery became feasible. Especially high-risk patients with multiple risk factors for open heart surgery will profit from this approach, because the negative effects of the extracorporeal circulation are avoided. METHODS: From 7/97 until 12/99 a total of 158 patients with multivessel-coronary artery disease were operated on the beating heart. In the same time course, a total of 2869 patients were operated conventionally using the extracorporeal circulation as a standard procedure. RESULTS: Due to patient selection, the two groups differ in the preoperative data concerning previous neurologic deficits. None of the patients in the OP CAB group suffered a permanent neurologic deficit after the operation, whereas in the CAB group the rate of stroke was 1.3%. The rate of temporary neurologic deficits, such as TIA (temporary ischemic attack) or PRIND (prolonged reversible neurologic deficit), was higher in the OP CAB group due to patient selection. No surgcially associated aortic dissection was seen in the OP CAB group. CONCLUSIONS: This and other studies have shown the effectiveness of OP CAB surgery concerning perioperative complications and survival rates. Especially high-risk patients with multiple risk factors for a cardiac operation profit from a beating-heart operation avoiding extracorporeal circulation. The question in how far the higher rate of reoccurring angina and the larger number of interventional treatments in OP CAB patients reported in the literature are due to the learning curve remains unanswered. Long-term studies will show whether the result of beating heart surgery is as good as the result of conventional "on-bypass" surgery.

Coronary Artery Bypass↗

PubMed1999

[Arterial myocardial revascularization in the 9th decade of life. Personal results and review of the literature].

The rate of the population being 80 years of age and even older, has an increasing tendency in the Federal Republic of Germany. In 1996, a total of 87,372 patients received surgery supported by the heart-lung-machine, 2,383 patients out of these (2.7%) were 80 years of age and older. In view of the limited life expectance, the arterial revascularization in this age category is faced with controverse discussions. We analysed our patients in relation to this aspect. Between January 1, 1995 and June 30, 1997, 4,338 patients underwent surgery supported by the heart-lung-machine. Hundred and fifty-five out of these (3.6%) were in the 9th decade of life. Seventy-seven patients out of the 155 (49.7%, 34 women, 43 men, 80 to 88 years old, mean: 82 years of age) underwent an isolated myocardial revascularization. We performed 55 (71%) elective, 16 (21%) urgent and 6 (8%) emergency surgeries. Twelve patients (15.6%) solely received venous bypasses (Group I), 65 (84.4%) additionally also received unilateral bypasses of the internal mammaria artery (IMA) (Group II). Three patients died at our facility (3.9%), 3 further patients died during the follow-up treatment in outlying hospitals, the in-patient mortality rate in Group I therefore presented a rate of 8.3%, in Group II 7.7% and in total, a rate of 7.8%. In 1996, the in-patient mortality rate could be reduced to 3.6%. The follow-up observation time ranged between 7 and 138 weeks (median 44 weeks). The survival rate for patients with an IMA-bypass after 1 year was 86.3%, after 2 years 77%, and for the entire collective 85.3% and 75%. Whereas 96% of the patients could pre-operatively be related to Class III or IV of the NYHA-classification, 55 of the 63 survivors (87%) belonged to Class I (6%) or II (81%). Two Group I patients (22.2%), 3 Group II patients (5.6%) and 7.9% of the total collective complained about repeated angina symptoms. The myocardial revascularization with the internal mammaria artery performed on patients in the 9th decade of life, achieves an acceptable morbidity and mortality compared to solely venous coronary bypasses. The more prolonged follow-up observation period will clarify, whether the arterial myocardial revascularization also proves to be the superior method in this age category.

Aged↗

PubMed1999

[Dissection of the sinus valsalvae aortae as a complication of coronary angioplasty].

The localized dissection of the aortic sinus of valsalvae is a rare complication of coronary angioplasty involving mainly the right coronary artery. In all previously published case reports (n = 10), a coronary dissection provided the entry door with subsequent retrograde progression of the dissection into the aortic root. In our case of a 75 year old female patient with symptomatic three vessel disease, a chronic occlusion of a proximal RCA could not be passed by a coronary guide wire. During the procedure an aneurysm of the aortic sinus occurred near the ostium of the RCA. The patient was referred for immediate aortocoronary bypass surgery. The inspection of the aortic sinus showed, as the entry of the dissection, a small puncture hole, adjacent to the ostium of the RCA, probably caused by the stiff 0.014 coronary guide wire, and no retrograde dissection of the right coronary artery. The localized dissection could easily be fixed by a prolene suture during the bypass surgery procedure with an uncomplicated postoperative course. If the entry of the dissection is within the coronary artery, forced contrast injections and balloon inflations promote its propagation and should be avoided. If the entry could be sealed by an intracoronary stent and the aneurysm remained localized, confirmed by echocardiographic controls, the aneurysm tends to resolve spontaneously in the first month without need for surgery. A progression of the aneurysm into the ascending aorta or a failure of an entry sealing with a stent is an indication for urgent surgical treatment.

Aged↗

PubMed1999

The disproportion of female and male surgeons in cardiothoracic surgery.

In ancient times, female medical practitioners and female surgeons were well known. With the introduction of medicine as an academic course and the ban on women studying, the medical career became virtually impossible for women. This condition changed with the general admission for women to colleges, in Germany in 1908. The current situation of women in surgery is presented here, with cardiovascular surgery as an example. Of 302 active cardiothoracic and cardiac surgeons 4.6% are female. According to an inquiry of all German heart institutes, there are 20 female senior registrars and 27 female surgeons as well as 162 female assistants. Most of the medical directors do have a positive opinion about female surgeons, but criticize that only a few women who apply for actually finish surgical training. One reason for this may be the greater difficulties for women to take care of a family and become a surgeon simultaneously. In this regard, an improvement in the position of female doctors is desirable.

Cardiology↗

PubMed1999

Errors of the backextrapolation method in determination of the blood volume.

Backextrapolation is an empirical method to calculate the central volume of distribution (for example the blood volume). It is based on the compartment model, which says that after an injection the substance is distributed instantaneously in the central volume with no time delay. The occurrence of recirculation is not taken into account. The change of concentration with time of indocyanine green (ICG) was observed in an in vitro model, in which the volume was recirculating in 60 s and the clearance of the ICG could be varied. It was found that the higher the elimination of ICG, the higher was the error of the backextrapolation method. The theoretical consideration of Schröder et al (Biomed. Tech. 42 (1997) 7-11) was proved. If the injected substance is eliminated somewhere in the body (i.e. not by radioactive decay), the backextrapolation method produces large errors.

Artifacts↗

PubMed1999

Optimizing deconvolution techniques by the application of the Münchhausen meta algorithm.

A deconvolution applied to disturbed data often gives poor results, due to fundamental difficulties associated with ill-posed problems. Many numerical and theoretical methods have been invented to circumvent this phenomenon. Their performance varies, depending on the given problem and data. The main aim of this paper is to provide a decision rule for choosing a method for deconvolution and application of this method to the same data. We have called this meta-algorithm Münchhausen. In this paper we introduce and describe for the first time the basic principle of artificial disturbance of the data in the set-up of deconvolution. We demonstrate some interesting features of the random procedure Münchhausen, such as the non parametric set-up, robustness to disturbance of the data and last but not least good performance.

Algorithms↗

PubMed1999

Simultaneous myocardial revascularization and aortic valve replacement: stentless versus stented bioprostheses.

Implantation of stentless aortic valve prostheses is more time-consuming than implantation of conventional stented bioprostheses. Simultaneous myocardial revascularization can result in a considerably prolonged operation time. We reviewed our patients with regard to surgical aspects in the specific patient cohorts. From April 1996 to April 1999, 303 patients were operated for aortic valve disease with or without concomitant coronary artery revascularization. Mean age was 75 years, ranging between 36 and 90 years. Using the Medtronic Freestyle valve, the following techniques of implantation were used: subcoronary technique, 163 patients, 61.5%; root inclusion technique, 7 patients, 3.5%; total root replacement, 30 patients, 15%. Total hospital mortality rate was 5.6%, reflecting age and concomitant disease of these patients. For isolated aortic valve replacement, the mortality rate was 4.7% and 6.7% for combined procedures. Coronary artery patients who are not suitable for stentless valve implantation owing to extensive aortic root calcification have a higher perioperative mortality rate. Compared with the isolated valve replacement and despite more extensive surgery and prolonged operative time, simultaneous myocardial revascularization in patients with stentless prostheses implantation can be performed without an increased risk.

Adult↗

PubMed1996

Characteristics of patients younger than 40 years of age operated for coronary artery disease.

This study reviews data on 126 patients (107 men, 19 women) younger than 40 years of age who underwent coronary artery bypass grafting during an 8-year period. They were matched to a control group which also consisted of 126 operated patients but exceeding the age of 39. The majority of the patients in the study group presented with angina; 85.9% were CCS III or IV compared to 61.9% in the control group. More than 3 fourths of the patients (80.5%) had experienced at least 1 myocardial infarction. There was a high incidence of coronary risk factors, especially hyperlipoproteinemia (88.5%), smoking (85.1%), and hypertension (83.1%), whereas in the control group these risk factors occurred in only 49.2%, 21.4%, and 53.2% of the patients, respectively. Other risk factors like diabetes mellitus or family history of coronary artery disease were found in 10.3% and 48.6% of the young patients. While 23.0% of the patients had varying degrees of left main stenosis, 9.5%, 18.3%, and 72.2% had single, double, and triple vessel disease, respectively. Left ventriculograms showed serious functional impairment (ejection fraction less than 40%) in 22.2% of the patients. A total of 286 saphenous vein grafts (2.3 grafts per patient) and 126 internal mammarian grafts were implanted, whereby an internal mammarian graft was always used. In 6 patients we used an intermittent mechanical support system (intraaortic balloon pump in 5 patients and an assist device in 1). In-hospital mortality rate was 1.6% (2 patients); long-term mortality rate 5.2% (mean follow-up interval 54 +/- 20 months). Actuarial survival was 93.0%, 89.8%, and 89.8% at 3,5, and 7 years, respectively. Survival in patients with normal and impaired ejection fraction was significantly different (p < 0.035) for 5-year and 7-year survival (100% vs. 81.8%). We observed encouraging intermediate term results in young adult patients after coronary revascularization. This may have been due to the consistent use of internal mammary artery grafts.

Actuarial Analysis↗

PubMed1994

Formaldehyde-free collagen glue in experimental lung gluing.

Because of the well-known limitations of the adhesive strength of fibrin glue, it is imperative to develop a stronger glue with acceptable biocompatibility. This was accomplished by removing the formaldehyde component from gelatin-resorcinol-formaldehyde glue and replacing it by two less toxic aldehydes--pentanedial and ethanedial. To evaluate the adhesive strength of this new glue, GR-DIAL, lung incisions in rabbit hybrids were glued together. Each group (n = 5) was examined histologically after 2 days and 1, 2, and 4 weeks. The glue disintegrated gradually with good bioresorption when the incision was closed with a thin layer of glue. The healing process was favorable, indicating good biocompatibility. Therefore, GR-DIAL glue is capable of enhancing the use of surgical glues in the field of thoracic surgery by enabling surgeons to close larger parenchymal lesions than with fibrin glue.

Animals↗

PubMed1994

The impact of gelatin-resorcinol glue on aortic tissue: a histomorphologic evaluation.

PURPOSE: Although gelatin-resorcinol-formaldehyde glue has been used to treat acute aortic dissections for some time, concerns about formaldehyde's mutagenicity and carcinogenicity made it imperative to develop a new glue compound. Gelatin-dialdehyde glue was produced by omitting the formaldehyde component and replacing it with two less toxic aldehydes, glutaraldehyde and glyoxal. This study evaluated the histomorphologic effects of the new glue through in vivo use on the aortic tissue of domestic pigs. METHODS: Each animal's infrarenal aorta was glued around an implanted prosthesis. Histomorphologic evaluation was performed after operation after 1 and 4 weeks. RESULTS: The results demonstrated that the clinically observed tanning effect can be attributed primarily to the disintegration of the fiber texture, specifically collagenous, as well as smooth muscle fibers, and to the reciprocal alterations of the proteoglycan interstitial substance in the aortic wall. Macroscopic, microscopic, and electron microscopic analysis of the gluing process revealed an adequate healing process without any morphologically significant difference between formaldehyde and formaldehyde-free gelatin-resorcinol glue. CONCLUSIONS: Gelatin-dialdehyde glue is able to produce the same effects in the area of the aortic wall as the substantially more toxic gelatin-resorcinol-formaldehyde glue and thus could be recommended for clinical trials for treating acute aortic dissections thus far yielding excellent initial results.

Animals↗

PubMed1994

Coronary artery bypass grafting and heart transplantation in end-stage coronary artery disease: a comparison of hemodynamic improvement and ventricular function.

Heart transplantation has now become an accepted treatment for end-stage coronary heart disease (CAD). However, the limited supply of suitable donor organs imposes constraints upon the decision of whether patients are selected for transplantation or for coronary artery bypass grafting (CABG). From April 1986 until the end of March 1992, 265 patients with end-stage CAD involving left ventricular ejection fraction (LVEF) 10% to 30% and predominant angina pectoris underwent CABG. All patients received an average of 2.9 +/- 0.3 venous grafts. Intraaortic balloon pumps were implanted in 30 patients (11.3%) who began to develop low cardiac output syndrome intraoperatively. The actuarial survival rate was 87.8% after 2 years and 86.9% after 3 years. LVEF was measured in 35 patients via left heart catheterization 12 months after their operations and was found to have increased from a mean of 23.8% to 38.1%. Left ventricular end-diastolic pressure had decreased from 16.2 mmHg to an average of 12.1 mmHg. Swan-Ganz catheterization was performed on 120 patients 6 months postoperatively. The pulmonary wedge pressure had reduced significantly from 18.1 mmHg to a mean of 12.7 mmHg (p < 0.01). From 1990 until the end of March 1992, 55 patients with CAD and predominant heart failure received transplants. Their 2-year survival rate was 66.3%. Mean LVEF was 55.6% postoperatively. We conclude that CABG is adequate for patients who have end-stage CAD and angina pectoris symptoms, and that it significantly improves hemodynamic functions. Patients suffering predominantly from heart failure (NYHA Class IV) can be transplanted and subsequently regain normal heart function.

Actuarial Analysis↗

PubMed1994

Diagnostic evaluation and surgical management of the aberrant right subclavian artery.

A case of dysphagia and dyspnea secondary to compression of the esophagus and the trachea by an aberrant right subclavian artery is presented. As the pathology of the aberrant right subclavian artery is extremely diverse, the diagnosis without radiologic investigation is hardly feasible. Conventional angiography of the aortic arch may be avoided by 3-dimensional magnetic resonance angiography, that is a suitable noninvasive method to diagnose and visualize the vascular pathology and the postoperative results after corrective vascular surgery. With the use of a Gore-Tex prosthesis the right aberrant subclavian artery was successfully translocated to the ascending aorta through a mid-sternal, transmediastinal approach. In contrast to previous reports the retro-esophageal vascular segment was kept in situ. The literature is reviewed with the reference to the diagnostic procedure and the treatment of dysphagia lusoria.

Adult↗