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Biomedical subjects

Per Erling Dahl

Publications and source records attributed to Per Erling Dahl.

5 recordsLinked to original sources
PubMed2005

[Carotid endarterectomy in patients with coronary heart disease].

BACKGROUND: Patients with coexistent coronary and carotid artery disease are at high risk of developing stroke following coronary artery bypass grafting (CABG) and at the same time at increased risk of myocardial infarction when subjected to carotid endarterectomy (CEA). In patients with pronounced symptoms from both vascular territories, some institutions advocate a combined approach, with both CABG and CEA performed during the same period of anaesthesia. MATERIAL AND METHODS: We reviewed the medical records of patients who underwent the combined procedure between 1986 and 2004 (n = 37; group 1) and compared them to patients with coronary artery disease who underwent isolated CEA over the same period of time (n = 118; group 2). RESULTS: The ASA score, NYHA class, prevalence of peripheral artery disease, atrial fibrillation and contralateral carotid occlusion were significantly higher in group 1. Two patients (5.4%) in group 1 and five patients (4.2%) in group 2 suffered a stroke. Five of these were ipsilateral to the CEA. Six patients had a perioperative myocardial infarction, one in group 1 (2.7%) and five (4.2%) in group 2 (ns). There were no deaths in group 1 and three deaths (2.5%) in group 2 during the first 30 days after surgery. The cumulative risk of death, stroke and myocardial infarction within 30 days was 8.1% in group 1 and 11.0% in group 2. INTERPRETATION: Patients with coexistent atherosclerosis of the coronary and carotid arteries who underwent the combined procedure seem to have the same perioperative risk as patients with coronary artery disease who underwent isolated CEA, in spite of the fact that the former had a more generalised atherosclerotic disease.

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PubMed2003

[Elective stent treatment of abdominal aortic aneurysm].

BACKGROUND: First described in 1991, endovascular treatment is a simplified method for abdominal aortic aneurysm repair (EVAR). The enthusiasm created by few complications and early mobilisation was replaced by scepticism because of the high frequency of secondary complications such as endoleak, stenosis, graft migration, aneurysm enlargement and late rupture. Though the method still is considered experimental, thousands of grafts are inserted every year. MATERIAL AND METHODS: From 1998, 53 patients underwent EVAR electively at our institution, 17 of whom were for medical reasons considered inoperable in open surgery. They were followed up with CT scans, which together with angiograms were evaluated retrospectively. Co-morbidity and complications were registered. Follow up was at 26 (4-50) months for 49 patients. RESULTS: Two patients died. There were two other complications in addition to two superficial wound infections. There were no surgical conversions. 18 patients had 25 secondary interventions. Cumulative intervention rate was 25% after 12 months, 28% after 24 months and 53% after 36 months. Four stenoses were seen the first 6 months. 19 patients had an endoleak (1 had type I after 24 months, 6 had type II endoleak, 5 had type III endoleak of which two appeared after 3 years). Graft migration was observed in 9 patients (5 at 3 years control). Two ruptures were corrected with endovascular technique. Survival and interventions were equal among inoperable and operable patients. INTERPRETATION: Few early complications are overshadowed by the frequent and unpredictable late complications after EVAR; patients have to be followed up for years. For patients unfit for open surgery this is, however, an optional treatment if intervention is otherwise indicated.

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PubMed2003

[Cardiac surgery in octogenarians].

BACKGROUND: Increasing numbers of octogenarians are referred to cardiac surgery in Norway. Little is known about short and long term results. METHODS: We retrospectively identified 47 patients (20 women, 27 men) aged 80 to 87.5 (81.5 +/- 1.3) years. RESULTS: The median observation time was 700 days. 28 patients were in NYHA class IV and the rest in class III. Urgent operations were performed on 19 patients (60 %). Operative mortality was 10.5 %; prolonged cardiopulmonary bypass time was a predictor of early death. The most common complication was atrial fibrillation. Median intubation time was 5 hours, length of stay in the intensive care unit 2 days, and postoperative length of stay 4 days. Survival at 1 year was 85 % and 60 % at 5 years. Follow-up telephone interviews were 100 % complete. 34 patients (92 %) reported improved health after surgery. All but one lived in their own homes. 32 patients (86.5 %) were in NYHA class I or II at follow up. INTERPRETATION: Strictly selected octogenarians may undergo cardiac surgery at reasonable risk. They will benefit from improved functional status and quality of life.

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