Biomedical subjects

K D Accola

Publications and source records attributed to K D Accola.

8 recordsLinked to original sources

PubMed1996

Third-time coronary artery bypass operations: surgical strategy and results.

BACKGROUND: Increasingly, patients are returning for a second, third, and even fourth coronary artery bypass graft (CABG) procedure. METHODS: This report reviews the in-hospital and long-term outcomes for 102 patients undergoing a third or fourth CABG at Emory University from December 1977 to April 1994. RESULTS: The mean interval from the first to second CABG was 5.2 +/- 3.5 years and from the second to the third CABG 6.8 +/- 4.1 years. The mean age was 6 +/- 9 years, 91% were male, 33% had hypertension, 16% diabetes, 86% class III or IV angina (Canadian Cardiovascular Society), 4.4% congestive failure (New York Heart Association), and 73% three-vessel disease. The in hospital mortality rate was 9.8%, with a perioperative myocardial infarction rate of 8.8% and a stroke rate of 1.9%. CONCLUSIONS: These perioperative mortality and myocardial infarction rates are several times higher than those reported for initial revascularizations or first-time redo CABG operations. However, the 5- and 10-year survival rates of 79% and 59%, respectively, and a myocardial infarction-free survival of 62% at 5 years, the benefits of a third-time CABG procedure are apparent for this high-risk group of patients.

Aged↗

PubMed1993

Bilateral mammary artery grafting: avoidance of complications with extended use.

This study was undertaken to more clearly define the operative risks and appropriate strategies for the selection of patients who might be candidates for bilateral internal mammary artery grafting. A review of the 674 patients who underwent this procedure was performed over a 10-year period from January 1982 through 1991. These patients represented 5% of the 12,824 patients who underwent bypass grafting during this period. The mean patient age was 54 +/- 9.4 years, and 92% of the patient were male. Diabetes was present in 17.5%, with 24% of this group insulin dependent. The ejection fraction was less than 0.50 in 26.7% and 14% had had previous bypass procedures. Hospital mortality was 1.9% (n = 13). Hospital morbidity included wound infection in 3.6%, reoperation for bleeding in 2.1%, and stroke in 1.6%. Postoperative intraaortic balloon pump support was necessary in 2.8%. Univariate and multivariate analysis revealed that advanced age, an emergent operative status, and the number of diseased vessels (especially left main obstruction) were predictors of hospital death. Except for wound infection (9.3% versus 2.5%) and length of hospital stay (10.8 +/- 11.8 days versus 8.8 +/- 7.6 days), the complications in diabetics were similar to those in patients without diabetes, respectively. At 5 years, freedom from death, death or infarctions, and death, myocardial infarction, or coronary reoperation was 90%, 70%, and 62%, respectively. The only significant multivariate correlates of long-term survival were diabetes and reoperative surgery.

Aged↗

PubMed1993

Coronary revascularization in a patient with porcelain aorta and calcified great vessels.

Calcification of the aorta and great vessels in coronary artery bypass patients remains a challenging dilemma for the surgeon regarding bypass technique, choice of conduit, and available location of proximal anastomotic sites. Internal mammary artery flow may be inadequate, and the risk of systemic emboli from a diseased aorta is substantial. We report a case of a 69-year-old diabetic patient with a porcelain aorta extending into the aortic arch and great vessels who was revascularized using an altered anastomotic technique of right coronary artery endarterectomy for proximal anastomosis of vein grafts. Intraoperative echocardiographic evaluation of the aorta and arch was beneficial in determining extent of calcification.

Aged↗

PubMed1992

Megaaorta and aortoiliac obstruction: alternate method of cannulation.

The case of a 69-year-old man with aneurysms of the ascending aorta, transverse aortic arch, and thoracoabdominal aorta combined with coronary artery disease, aortic insufficiency, and severe aortoiliac occlusive disease is presented. Femoral arterial cannulation was contraindicated owing to the aortoiliac disease. Successful surgical treatment is described using an alternate method of cannulation and perfusion.

Aged↗

PubMed1991

Multiple reoperative coronary artery bypass grafting.

Initial reoperative coronary artery bypass grafting is being performed commonly, and an increasing number of patients are being referred for subsequent reoperative coronary artery bypass grafting. From January 1980 through June 1990, 53 patients (52 male, 1 female) underwent a third or fourth coronary artery bypass operation and were retrospectively reviewed. This represented 0.3% (53/17,102) of the coronary artery bypass procedures done during that time period. The mean age was 59 +/- 8 years. The number of grafts placed ranged from one to four with an average of 2.6 per patient. Internal mammary artery grafts were used in 30 patients (57%). The mean left ventricular ejection fraction was 0.52 +/- 0.13. Intraaortic balloon pump support was necessary in 10 patients postoperatively. There were no intraoperative deaths, although 4 patients died in the postoperative hospitalization period. Perioperative myocardial infarctions were diagnosed in 6 patients, 13 patients had perioperative dysrhythmias, and 2 patients sustained a stroke. Superficial wound infections occurred in 5 patients. Late follow-up in 49 patients revealed that 2 other patients have since died, and no further myocardial infarctions have been reported in the survivors. Postoperative 3-year survival is 85%, whereas 3-year myocardial infarction-free survival is 70%. Although there is increased risk of operative complications and early death after multiple reoperative coronary artery bypass grafting, both in-hospital and long-term results suggest that it is an appropriate therapeutic strategy.

Coronary Artery Bypass↗

PubMed1989

Extraanatomic bypass for peripheral arterial injuries.

Over an 8-year period, extraanatomic bypass grafting was performed for peripheral arterial injuries or infections in 12 patients. The indications for use of the technique were as follows: (1) extensive loss of soft tissue over arterial injury or avulsion; (2) wound infection with rupture of a previous arterial repair; or (3) combined infections in soft tissue and the underlying artery due to illicit drug injection. The technique involved excision of the injured or infected artery beyond the margins of the debrided wound and insertion of an autogenous saphenous vein as an extraanatomic bypass graft in a medial or lateral position around the wound. Shotgun wounds were the mechanism of injury in six patients, whereas an extensive injury or infection in the brachial artery was present in eight patients. Successful wound coverage or closure was accomplished and distal arterial flow preserved in 11 patients, 5 of whom had residual neuromuscular or bony defects related to the magnitude of the original injury.

Adult↗

PubMed1987

Management of injuries to the suprarenal aorta.

During a 12 year period, 79 patients with a diagnosis of a penetrating wound to the suprarenal aorta were treated. An analysis of the records of these patients has led to the following conclusions: With a midline penetrating wound and presence of a supramesocolic hematoma or hemorrhage, injury to the suprarenal aorta should be suspected. If a midline supramesocolic hematoma is present or if hemorrhage can be controlled by direct pressure, a lateral approach with medial mobilization of the intraabdominal viscera on the left side allows rapid vascular control. Although lateral aortorrhaphy is preferred, patch grafting, and end-to-end anastomosis, or insertion of a prosthetic graft was required in 46 percent of the patients who underwent repair. As in all previous series, the insertion of synthetic patches or prostheses was not complicated by infection. The average survival rate for injuries to the suprarenal aorta in series reported since 1974 is 33 percent. Finally, the continuing problem of irreversible shock suggests the need for rapid transport from the field to the hospital for victims of penetrating wounds to the abdomen.

Aorta, Abdominal↗

PubMed1986

Management of injuries to the superior mesenteric artery.

From 1978 through 1984, 22 patients with 20 penetrating and two blunt injuries to the proximal superior mesenteric artery were treated. Patients presented with exsanguinating hemorrhage (19), midline hematomas (two), or 'black bowel' (one). Two other patients developed 'black bowel' during operation. Direct cutdown through the mesentery was the approach in 11 patients, and three survived; a Mattox maneuver was used in ten patients, and five survived. Complex bypass or grafting procedures were performed in nine patients, and two survived. Ten of 15 deaths were secondary to hemorrhagic shock; two of five late deaths were related to problems with the vascular repair in patients with multiple injuries. Interposition grafting near a major pancreatic injury may lead to catastrophic postoperative problems. Bypass grafts from the distal aorta should have retroperitoneal tissue coverage of the suture line.

Abdominal Injuries↗