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M T Janusz

Publications and source records attributed to M T Janusz.

46 records · Page 3Linked to original sources
PubMed1983

Coronary artery bypass in patients over 65 years of age.

At the Vancouver General Hospital 235 consecutive patients (172 men, 63 women) aged 65 years or older underwent aortocoronary bypass grafting between January 1974 and December 1979; 168 were 65 to 69 years of age and 67 were 70 years or older. Concomitant cardiac procedures were carried out in 65 (valve surgery in 53, resection of ventricular aneurysm in 10, repair of ventricular septal defect in 1, excision of left atrial tumour in 1). A mean of 2.6 vessels per patient were grafted. Early mortality was 7.7%. For patients who underwent bypass grafting alone, the mortality for those 65 to 69 years was 5.1% and for those 70 years or older it was 5.9%. For patients who underwent bypass grafting and a concomitant procedure, the mortality for those 65 to 69 years of age was 3.1% and for those 70 years or older 24.2%. At follow-up (mean 30 months) there were 23 late deaths. The 5-year survival (life-table method) for the whole group was 77% including early deaths and 83% excluding early deaths. Late survival in those aged 70 years or older was similar to that in patients aged 65 to 69 years. Improvement in function was good; 92% of patients were in New York Heart Association functional class I or II at follow-up, where 94% had been in class III or IV before operation. Acceptable operative mortality with good long-term survival and lessening of symptoms support the use of aortocoronary bypass grafting in patients over 65 years of age. Complex procedures in those 70 years of age or older carry a high risk.

Age Factors↗
PubMed1982

Experience with the Carpentier-Edwards porcine valve prosthesis in 700 patients.

The Carpentier-Edwards porcine valve prosthesis has afforded our patients a satisfactory quality of life and a low incidence of valve-related complications at follow-up periods of up to five years. From December, 1975 to March, 1980, 768 prosthesis were implanted in 700 patients (aortic valve replacement [AVR], 334; mitral valve replacement [MVR], 292; tricuspid valve replacement [TVR), 6; and multiple valve replacement, 68). One hundred and thirty-seven patients (19.6%) had had previous cardiac operations. Concomitant aortocoronary bypass was performed in 127 patients (18.1%). There were 52 hospital deaths, for a mortality of 7.4% (AVR, 4.8%; MVR, 9.2%; multiple valve replacement, 11.8%). Total follow-up was 1,047 patient-years (range, 6 to 60 months, mean, 19.4 months). There were 33 late deaths (AVR, 1.7% per patient-year; MVR, 4.0% per patient-year; multiple valve replacement, 8.1% per patient-year). Eight percent of AVR patients and 47% of MVR and multiple valve replacement patients were taking anticoagulants. The valve-related complications (expressed as events per 100 patient-years) were as follows: (1) thromboembolism (AVR, 0.94; MVR,. 1.42; multiple valve replacement, 4.62); (2) infective endocarditis (AVR, 0.94; MVR, 0.24; multiple valve replacement, 2.31); (3) periprosthetic leak (AVR, 0.94; MVR, 0.71; multiple valve replacement, 3.46); and (4) valve dysfunction (MVR, 0.24). The only case of valve dysfunction was a calcified mitral prosthesis in a 13-year-old girl. Actuarial survival, including operative deaths, was as follows: AVR, 90.5% at 36 months; MVR, 84% at 36 months; and multiple valve replacement, 74% at 24 months. Of surviving patient, 93.6% were in New York Heart Association Class I or II at follow-up evaluation.

Adolescent↗
PubMed1982

Influence of ischemic heart disease on early and late mortality after surgery for peripheral occlusive vascular disease.

The association of coronary artery disease and peripheral vascular disease was studied to determine the influence of coronary artery disease on early and late mortality rates after surgical reconstruction for peripheral occlusive vascular disease and abdominal aortic aneurysm. Between January 1976 and December 1978, 161 consecutive patients underwent surgery for peripheral occlusive vascular disease or abdominal aortic aneurysm. The patients were 35-86 years old (mean 63.3 years). Thirty patients (18.6%) had abdominal aortic aneurysmectomies, 59 (36.7%) had aortoiliac reconstruction with or without femoropopliteal bypass and 72 (44.7%) had procedures for femoropopliteal disease. The 30-day hospital mortality rate was 6.7% for abdominal aortic aneurysm (n = 2), 3.4% for aortoiliac reconstruction (n = 2) and 1.4% for femoropopliteal procedures (n = 1). Myocardial infarction was the cause of 40% (n = 2) of the early postoperative deaths. The early mortality rate of patients with a history of angina or myocardial infarction was 5.4% (two of 37), while the early mortality rate among patients without such a history was 2.4% (three of 124). The mortality rate from myocardial infarction during the late observation period was 65% (15 of 23). The freedom from myocardial infarction was 90% at 30 months and 75% at 60 months. The overall survival rate was 87% at 30 months and 71% at 60 months. The late mortality rate was assessed with respect to various risk factors: coronary artery disease (n = 31), previous vascular surgery (n = 19) and diabetes mellitus (n = 7). Among the 63 patients who had one or more of the risk factors, the late cardiac mortality rate was 20.6% (n = 13). The late cardiac mortality rate for for the 78 patients with no risk factors was 3.8% (n = 3). An additional 10 patients with previous coronary artery bypass (n = 9) or angiography (n = 1) experienced no early or late mortality. The freedom from late cardiac death at 60 months was 71% for the high-risk group (63% patients) and 96% for the low-risk group. The study shows that coronary artery disease is a major determinant of both early and late mortality after arterial reconstruction. The status of the myocardium should be assessed before peripheral vascular surgery, as selective myocardial revascularization may improve survival in these patients.

Adult↗
PubMed1981

Cardiac valve replacement in the elderly: a review of 320 consecutive cases.

Cardiac valve replacement in 320 consecutive elderly patients (age 65 years and older) was examined retrospectively to determine the results of valvular replacement. From January 1966 to August 1979, 336 valve prostheses (146 mechanical and 190 porcine) were implanted in 320 patients (mean age 68.9 years, range 65-85 years). There were 190 aortic valve replacements (AVR), 116 mitral replacements (MVR) and 16 multiple valve replacements (MR). There were 178 patients ages 65-69 years, 114 patients ages 70-74 years, and 28 patients ages 75 years and older. Twenty (6.3%) had had previous cardiac surgery. Aortocoronary bypass was performed in 59 (18.4%). Twenty-eight patients (8.75%) died in the hospital (AVR 4.7%, MVR 11.4%, MR 37.5%). The mean follow-up was 30.2 months (total 735 patient-years). There were 92 late deaths, or 12.5% per patient year (AVR 11.3%, MVR 14.9%, MR 20.0%). Actuarial survival for all patients at 5 years was 49 +/- 7.6% (AVR 56 +/- 9.7%, MVR 47 +/- 12.5%). Survival at 24 months was 72 +/- 6.3% for ages 65-69 years, 66 +/- 9.2% for ages 70-74 years and 81 +/- 16% for patients 75 years and older. Valve-related complications were infective endocarditis (three mechanical and five porcine), periprosthetic leak (five mechanical and one porcine), valve dysfunction (12 mechanical) and thromboembolism (18 mechanical and seven porcine). At follow-up, 93.2% of surviving patients were in New York Heart Association functional class I or II.

Aged↗
PubMed1981

Embolic complications of porcine heterograft cardiac valves.

From January, 1975, until August, 1978, 509 porcine valves were implanted in 465 patients. Patient follow-up was done at 6 to 45 months (mean 20.2 months), for a total observation of 713 patient-years. There were six early embolic events (mitral four, aortic two). Four of these six patients were in atrial fibrillation and none was receiving anticoagulants at the time of the embolism. There were 18 late emboli. Four occurred in patients with aortic prostheses and produced mild, transient symptoms only. Fourteen occurred in patients with mitral or multiple prostheses. These resulted in death in five patients and permanent sequelae in three. The rate of embolic events was 1.32/100 patient-years for aortic prostheses, 3.27/100 patient-years for mitral prostheses, and 4.91/100 patient-years for multiple prostheses. Thirteen of the 14 patients with emboli were in atrial fibrillation and only three were receiving anticoagulants. Anticoagulation is vital in patients with mitral prostheses who remain in atrial fibrillation, but it appears unnecessary in patients with aortic prostheses and those with mitral or multiple prostheses who remain in sinus rhythm.

Adolescent↗
PubMedDate not supplied

Animal model for investigation of spinal cord injury caused by aortic cross-clamping.

The objective of this experimental protocol was to design a large animal model that could simulate the ischemic condition caused by aortic cross-clamping during the operation for intrathoracic and thoraco-abdominal aneurysm. Domestic swine weighing 25 to 30 kg were used for this model. The thoracic cavity was opened through the fourth intercostal space. Cross-clamp was applied below the left subclavian artery. Duration of cross-clamp was 30 min and the reperfusion period was 24 h. Methods of assessment included Tarlov's criteria, histology transmission electron microscopy, and spinal cord perfusion with microspheres. This model is reproducible. The results of experimental protocols completed using this model are referenced. This article discusses the details of the experimental protocol with steps toward reproduction of the model and rationalization. This animal model can be used for the evaluation of the pathophysiology of spinal cord injury and sensory- and motor-evoked potentials, and most importantly it can also be used for the examination of pharmacological interventions for prevention and treatment of ischemia reperfusion injury caused by aortic cross-clamping.

Animals↗
PubMedDate not supplied

Experimental use of somatosensory evoked potential for intraoperative identification of spinal cord blood supply.

The role of sensory evoked potentials (SEPs) to be used intraoperatively to reliably predict spinal cord ischemia, caused by interruption of intercostal and of lumbar and sacral arteries, was evaluated in a canine model. Two groups were assessed: (A) interruption of intercostal arteries (n = 6) and (B) interruption of all posterior branches (n = 6). SEPs were evaluated intraoperatively as control and interruption of posterior vessel groups, and at 18-22 h after surgery. Neurologic assessment was performed preoperatively and 18-22 h postoperatively by modified Tarlov criteria. Morphological assessments were also performed. The assessment of the groups demonstrated prolongation of latency and loss of amplitude of SEP, but individual changes of SEPs were poor predictors of paraplegia. Ultrastructural changes correlated with neurologic findings. SEPs were unreliable for intraoperative identification of vessels critical to spinal cord blood supply, possibly related to anatomically different blood supply of sensory and motor tracts.

Animals↗