PubMed Health⌕ Search

Biomedical subjects

Marc S Sussman

Publications and source records attributed to Marc S Sussman.

4 recordsLinked to original sources
PubMed2005

Determining the utility of temporary pacing wires after coronary artery bypass surgery.

BACKGROUND: Temporary epicardial pacing wires are used routinely after coronary artery bypass graft (CABG) surgery and can cause rare, catastrophic complications. This study's purpose was to identify patient characteristics predicting the need for pacing after CABG surgery with the potential to limit their utilization. METHODS: This prospective observational study involved 290 consecutive patients undergoing CABG at our institution from August 2000 to January 2001. Sixty-eight patients were excluded for the following reasons: off-pump CABG, preoperative pacemaker, no pacing wire placement, or incomplete follow-up. Among the remaining 222 patients, the incidence of pacing during the postoperative period was recorded. Univariate and independent multivariate predictors for postoperative pacing were determined using medical records, the Johns Hopkins Hospital cardiac surgery database and the Society of Thoracic Surgery database. RESULTS: In the postoperative period, 19 of 222 patients (8.6%) required pacing. Univariate analysis identified age, cardiomegaly, preoperative antiarrhythmic therapy, diabetes mellitus, preoperative arrhythmia, inotropic agents leaving the operating room, and pacing initialized at the separation from cardiopulmonary bypass as predictors of the need for postoperative pacing. Only diabetes mellitus, preoperative arrhythmia, and pacing utilized to separate from bypass were found to be significant on multivariate analysis. Using this model, if we exclude the patients with any of these three risk factors, only 2.6% of them would have required pacing. CONCLUSIONS: Few patients require temporary epicardial pacing after routine CABG. This study identified specific predictors for postoperative pacing requirements and provides criteria for the selective use of epicardial pacing wires after CABG.

Aged↗
PubMed2003

Cardiac valve replacement in human immunodeficiency virus-infected patients.

BACKGROUND: Valve replacement in human immunodeficiency virus (HIV)-infected patients is being performed with increasing frequency, but the early and late results in these immunocompromised patients are not known. METHODS: A 10-year retrospective clinical review was undertaken; patients and their physicians were contacted for follow-up clinical status. RESULTS: Twenty-two HIV-infected patients underwent valve replacement between 1990 and 1999, with no operative or hospital deaths. Mean patient age was 37.6 years; 15 were men. Indications for operation were heart failure in 59% (13/22) and sepsis in 91% (20/22). There were 12 aortic valve replacements, seven mitral valve replacements, and three double valve replacements. Mechanical valves were used in 11, bioprostheses in seven, and homografts in four. Follow-up information was available in 20 of 22 patients (84%). At mean follow-up of 5 years, there were 10 late deaths, due to: intracerebral hemorrhage (2), heart failure (2), unknown cause (2), renal failure (1), AIDS (1), sepsis (1) and endocarditis (1). Of the 20 patients with active preoperative endocarditis, 4 (20%) developed recurrent endocarditis; freedom from recurrent endocarditis was 83% at 1 year. Intravenous drug abuse was reported in 16 patients; survival among these patients was 94% at 1 month and 50% at 5 years. Recurrent endocarditis was only seen in patients with continued intravenous drug abuse. CONCLUSIONS: Valve replacement in HIV-infected patients has low operative risk, but late results are poor when HIV infection is associated with intravenous drug abuse, probably due to immunocompromise and continued high-risk behavior.

Adult↗