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Joseph F Sabik

Publications and source records attributed to Joseph F Sabik.

29 records · Page 2Linked to original sources
PubMed2004

Equivalent midterm outcomes after off-pump and on-pump coronary surgery.

OBJECTIVE: Multiple reports demonstrate that off-pump surgery reduces the early morbidity associated with coronary artery bypass grafting. To determine if there are any differences in later outcomes, we compared midterm results of propensity-matched patients who underwent off- and on-pump coronary artery bypass grafting. METHODS: From January 1997 to July 2000, 481 patients underwent off-pump coronary artery bypass grafting and 3231 underwent on-pump coronary artery bypass grafting. Propensity matching was used to match 406 patients from each group. Previously, the propensity-matched off-pump patients were found to have had significantly fewer bypass grafts. These 812 patients were followed for time-related events, including death, myocardial infarction, percutaneous coronary intervention, coronary reoperation, and the combined end point of all-cause mortality, myocardial infarction, and all coronary reintervention. Follow-up was 95% complete. RESULTS: At 4 years, survival was 87.5% after off-pump and 91.2% after on-pump coronary artery bypass grafting (P =.2); freedom from myocardial infarction was 92.6% and 95.7% (P =.7), respectively; freedom from percutaneous coronary intervention was 94.3% and 95.5% (P =.9), respectively; freedom from coronary reoperation was 98.1% and 99.0% (P =.4), respectively; and freedom from the combined end point of all-cause mortality, myocardial infarction, and coronary reintervention was 75.2% and 82.9% (P =.14), respectively. CONCLUSIONS: Off-pump and on-pump coronary artery bypass grafting results in equivalent midterm outcomes. Fewer bypass grafts in the off-pump patients did not decrease survival or increase ischemic events at 4 years.

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PubMed2004

Recurrent mitral regurgitation after annuloplasty for functional ischemic mitral regurgitation.

OBJECTIVES: We sought to characterize the temporal return of mitral regurgitation after annuloplasty for functional ischemic mitral regurgitation; to identify its predictors, particularly with respect to annuloplasty type; and to determine whether annuloplasty type influences survival. METHODS: From April 1985 through November 2002, 585 patients underwent annuloplasty alone for repair of functional ischemic mitral regurgitation, generally with concomitant coronary revascularization (95%). A flexible band (Cosgrove) was used in 68%, a rigid ring (Carpentier) in 21%, and bovine pericardial annuloplasty (Peri-Guard) in 11%. Six hundred seventy-eight postoperative echocardiograms were available in 422 patients to assess the time course of postoperative mitral regurgitation and its correlates. Most echocardiograms were performed early after the operation (median, 8 days); 17% were performed at 1 year or beyond. RESULTS: During the first 6 months after repair, the proportion of patients with 0 or 1+ mitral regurgitation decreased from 71% to 41%, whereas the proportion with 3+ or 4+ regurgitation increased from 13% to 28% ( P < .0001); the regurgitation grade was stable thereafter. The temporal pattern of development of 3+ or 4+ regurgitation was similar for Cosgrove bands and Carpentier rings (25%) but substantially worse for Peri-Guard annuloplasties (66%). Small annuloplasty size did not influence postoperative regurgitation grade ( P = .2), although Cosgrove bands were used in most patients receiving 26- and 28-mm annuloplasties. Freedom from reoperation was 97% at 5 years. Annuloplasty type was not associated with survival. CONCLUSIONS: Although initial mitral valve replacement would eliminate the risk of postoperative mitral regurgitation, this strategy has been associated with reduced survival. Therefore the development of additional techniques is necessary to achieve more secure repair of functional ischemic mitral regurgitation.

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PubMed2003

Does competitive flow reduce internal thoracic artery graft patency?

BACKGROUND: In coronary arteries with moderate stenosis, competitive flow may lead to internal thoracic artery (ITA) graft occlusion. The goals of this study were to determine if competitive flow reduces ITA patency, and if there is a degree of coronary stenosis below which ITAs should not be used. METHODS: From 1972 to 1999, 50,278 patients underwent primary coronary artery bypass grafting (CABG). Of these, 2,002 had at least one ITA graft and postoperative angiography before coronary reintervention; 2,999 angiograms of 2,121 ITAs were made. Time-related ITA occlusion was modeled using longitudinal analysis to identify its risk factors while accounting for lack of independence introduced by repeated angiography and multiple ITA anastomoses per patient. Proximal coronary stenosis (maximum preoperative stenosis between ITA anastomosis and aorta) was the surrogate for competitive flow. RESULTS: Unadjusted ITA patency was 93%, 89%, 90%, and 92% at 1, 5, 10, and 15 years after CABG. Risk factors associated with ITA occlusion were lesser degree of proximal coronary stenosis (p < 0.0001); longer time from CABG in grafts to non-left anterior descending coronary arteries (p < 0.0001); female sex (p = 0.0003); later date of CABG (p = 0.01); right ITA (p < 0.0001); and smoking (p < 0.0001). In all arteries, as preoperative proximal coronary stenosis decreased, ITA patency declined; however, at no degree of stenosis was there a sharp decline. CONCLUSIONS: Internal thoracic artery patency decreases as coronary competitive flow increases. However, the nature of this relationship indicates ITAs should not be abandoned at moderate grades of stenosis.

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PubMed2003

Repair versus replacement for degenerative mitral valve disease with coexisting ischemic heart disease.

OBJECTIVE: We sought to compare mitral valve repair and replacement as treatments for degenerative mitral valve disease with coexisting ischemic heart disease. Specifically, we sought to (1) identify differences between patients undergoing repair and replacement, (2) determine whether the choice of mitral valve procedure affected survival after adjusting for those differences, and (3) discover which patients were predicted to benefit from mitral valve repair and which from replacement. METHODS: From 1973 to 1999, 679 patients (mean age, 67 +/- 9.1 years; 73% men) with degenerative mitral valve and ischemic heart diseases underwent combined coronary artery bypass grafting and either mitral valve repair (66%) or replacement (34%). Factors associated with repair and replacement were used for multivariable propensity matching. Risk factors for death were identified by means of multivariable, multiphase hazard-function analysis. RESULTS: Patients more likely to undergo repair had isolated posterior chordal rupture (P <.0001) or more recent date of operation (P <.0001); those more likely to undergo replacement were older (P =.0003) or had bileaflet prolapse (P <.0001). Unadjusted survival at 30 days and 1, 5, and 10 years was 97%, 92%, 79%, and 59% after repair and 94%, 88%, 70%, and 37% after replacement. After adjusting for comorbid factors, the extent and effect of ischemic heart disease, and propensity score, the survival benefit of repair became evident after 2 years (P =.01). Eighty-nine percent of patients were predicted to benefit from repair. CONCLUSIONS: In patients with degenerative mitral valve and ischemic heart diseases, mitral valve repair confers a survival advantage over replacement that becomes evident about 2 years after the operation.

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PubMed2002

Endocarditis after mitral valve repair.

BACKGROUND: Native valve endocarditis is frequently managed with antibiotics alone, but prosthetic valve endocarditis usually requires an early operation. What is the best treatment of endocarditis after mitral valve repair? METHODS: From 1986 to 2000, 22 patients were treated for endocarditis affecting a previously repaired mitral valve. Causes of mitral valve dysfunction that led to repair were degenerative (11 patients), ischemic (5 patients), endocarditic (3 patients), rheumatic (2 patients), and functional (1 patient). Endocarditis was active in 21 patients and healed in 1. Interval from initial mitral valve repair to onset of endocarditis ranged from 1 week to 10.3 years (median, 6 months). Pathology included leaflet vegetation (15), annuloplasty vegetation (4), leaflet perforation (5), and abscess (3). Mean follow-up was 3.9 +/- 3.3 years. RESULTS: Fifteen patients underwent repeat mitral valve operations with freedom from mitral valve reoperation of 65%, 41%, and 26% at 30 days, 1 year, and 5 years after onset of endocarditis. After a high early hazard, risk of reoperation fell to 10.8% per year. Seven patients, all with a leaflet vegetation, were treated with antibiotics alone. Antibiotics eradicated infection in all; however all had mitral regurgitation 2+ to 4+. Survival was 96%, 74%, and 68% at 30 days, 1 year, and 5 years. Endocarditis recurred in 1 patient (92% free of event). CONCLUSIONS: Most patients that have endocarditis develop after mitral valve repair require reoperation. However if infection is limited to a leaflet, early reoperation may be unnecessary because antibiotics alone can eradicate infection.

Adolescent↗
PubMed2002

Aortic root replacement with cryopreserved allograft for prosthetic valve endocarditis.

UNLABELLED: BACKGROUND Our strategy has been to treat aortic prosthetic valve endocarditis (PVE) with radical debridement of infected tissue and aortic root replacement with a cryopreserved aortic allograft. This study examines the effectiveness of this strategy on hospital mortality and morbidity, recurrent endocarditis, and survival. METHODS: From 1988 through 2000, 103 patients with aortic PVE underwent root replacement with a cryopreserved aortic allograft. Abscesses were present in 78%, and aortoventricular discontinuity was present in 40%. Thirty-two patients had at least one previous operation for endocarditis. In 23 patients with a history of native valve endocarditis, the allograft was implanted after one episode (17 patients), two episodes (5 patients), or three episodes of PVE (1 patient). In the 80 patients without a history of native valve endocarditis, the allograft was placed after one previous aortic valve replacement (57 patients), two (19), or three (4) previous aortic valve replacements. Among the 92 patients with positive cultures, 52 had staphylococcal organisms, 20 had streptococcal, 6 had fungal, 4 had gram-negative, and 6 had enterococcal organisms. Mean follow-up was 4.3 +/- 2.9 years. RESULTS: Hospital mortality was 3.9%. Permanent pacemakers were required in 31 patients. Survival at 1 year, 2 years, 5 years, and 10 years was 90%, 86%, 73%, and 56%, respectively, with a risk of 5.3% per year after 6 months. Four patients underwent reoperation for recurrent PVE of the allograft (95% freedom from recurrent PVE at > or = 2 years). Risk of recurrent PVE peaked at 9 months and then declined to a low level by 18 months. CONCLUSIONS: A strategy of radical debridement and aortic root replacement with a cryopreserved aortic allograft for aortic PVE is safe, effective, and recommended.

Abscess↗
PubMed2002

Reoperative cryopreserved root and ascending aorta replacement for acute aortic prosthetic valve endocarditis.

BACKGROUND: Prosthetic aortic valve endocarditis (PVE) is an important complication of aortic valve replacement (AVR) and is a particularly difficult situation after an operation combining AVR with ascending aortic replacement. METHODS: From 1988 through 2000, 27 patients with aortic valve PVE after previous ascending aortic replacement (aortic root replacement in 13, aortic valve replacement with a supracoronary graft in 14) underwent reoperation for aortic root replacement with a cryopreserved aortic allograft and prolonged intravenous antibiotic therapy. All patients were considered to have active PVE (25 with positive cultures); root abscess formation was present in 89% and aortoventricular discontinuity in 41%. RESULTS: One patient (3.7%) died in-hospital, and permanent pacemakers were required in 10 patients (37%). Mean postoperative follow-up interval was 3.9 +/- 3.0 years, and survival at 1, 2, 5, and 7.5 years was 92%, 88%, 70%, and 56%, respectively. One patient underwent reoperation for recurrent PVE 8 months after operation. CONCLUSIONS: Radical debridement of infected prosthetic material and tissue, and allograft aortic root and ascending aorta replacement, combined with intravenous antibiotic therapy, appears to achieve a low hospital mortality and a high degree of freedom from recurrent infection for patients with PVE after AVR and ascending aortic replacement.

Abscess↗
PubMed2002

Off-pump coronary revascularization: current state of the art.

Patients presenting for surgical coronary artery bypass grafting (CABG) are older and have more comorbidity than patients in prior decades. Cardiopulmonary bypass (CPB) may add to the elevated morbidity and mortality seen in these higher-risk patients. After the re-introduction of single-vessel bypass without CPB, surgeons have developed techniques for multivessel off-pump coronary artery bypass (OPCAB) through sternotomy. Understanding the causes of the hemodynamic disturbances seen during cardiac displacement has led to surgical techniques that minimize mechanical compression and the effects of temporary regional ischemia. With careful attention to detail, OPCAB has been shown to be feasible in nearly all patients needing coronary artery bypass. The procedure has been demonstrated to be safe and effective. Early outcomes and graft patency rates appear to be at least as good as those seen with traditional CPB-supported CABG. Certain high-risk groups may be better treated with OPCAB, but further studies are necessary to elucidate which patients should be offered OPCAB and which should receive standard CABG.

Anesthesia↗
PubMed2002

Does off-pump coronary surgery reduce morbidity and mortality?

OBJECTIVE: To compare hospital outcomes of on-pump and off-pump coronary artery bypass surgery. METHODS: From 1997 to 2000, primary coronary artery bypass grafting was performed in 481 patients off pump and in 3231 patients on pump. Hospital outcomes were compared between propensity-matched pairs of 406 on-pump and 406 off-pump patients. The 2 groups were similar in age (P =.9), left ventricular function (P =.7), extent of coronary artery disease (P =.5), carotid artery disease (P =.4), and chronic obstructive pulmonary disease (P =.5). However, off-pump patients had more previous strokes (P =.05) and peripheral vascular disease (P =.02); on-pump patients had a higher preoperative New York Heart Association class (P =.01). RESULTS: In the matched pairs the mean number of bypass grafts was 2.8 +/- 1.0 in off-pump patients and 3.5 +/- 1.1 in on-pump patients (P <.001). Fewer grafts were performed to the circumflex (P <.001) and right coronary (P =.006) artery systems in the off-pump patients. Postoperative mortality, stroke, myocardial infarction, and reoperation for bleeding were similar in the 2 groups. There was more encephalopathy (P =.02), sternal wound infection (P =.04), red blood cell use (P =.002), and renal failure requiring dialysis (P =.03) in the on-pump patients. CONCLUSIONS: Both off- and on-pump procedures produced excellent early clinical results with low mortality. An advantage of an off-pump operation was less postoperative morbidity; however, less complete revascularization introduced uncertainty about late results. A disadvantage of on-pump bypass was higher morbidity that seemed attributable to cardiopulmonary bypass.

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