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Biomedical subjects

R H Zeff

Publications and source records attributed to R H Zeff.

At least 19 recordsLinked to original sources
PubMed1992

Benefits of combined balloon pumping and percutaneous cardiopulmonary bypass.

Sixteen patients (2 women, 14 men) aged 29 to 72 years with continued cardiogenic shock during intraaortic balloon pumping (IABP) had additional treatment with percutaneous cardiopulmonary bypass (PBY). Cause of cardiogenic shock was myocardial infarction in 7 (3 survived), failed percutaneous transluminal coronary angioplasty requiring emergency coronary artery bypass grafting in 5, postoperative aortic valve replacement in 1, postoperative emergency coronary artery bypass grafting in 1, after cardiac transplantation in 1, and bridging to transplantation in 1. Mean blood pressure with PBY and IABP combined was 75 mm Hg versus 60 mm Hg with IABP off. Percutaneous cardiopulmonary bypass flows ranged from 0.8 to 2.1 L/min with a mean flow of 1.3 L/min. Time on IABP ranged from 24 hours to 1 week. Time on IABP to PBY ranged from 1 to 20 hours, and time on PBY ranged from 65 minutes to 20 hours. Ten of 16 (63%) were successfully weaned, and 3 died after weaning. Seven of 16 (44%) survive. Combined IABP with PBY appears to be a better therapy than either one individually. Staging the therapy as the balloon first in and last out appears to be a good methodology.

Adult↗
PubMed1992

Sheathless insertion of the percutaneous intraaortic balloon pump: an alternate method.

A technique is described that allows insertion of a standard percutaneous intraaortic balloon without use of the larger 12F sheath. Standard 9.5-cm. Percor balloons were inserted in a series of patients without using the provided sheath. Elimination of the sheath reduced the potential vascular complications related to the extra bulk placed in the femoral artery by the sheath. No serious complications were noted in more than 25 patients.

Humans↗
PubMed1990

Correction of total anomalous pulmonary venous connection below the diaphragm.

Six infants with total anomalous pulmonary venous connection below the diaphragm had correction by modification of conventional surgical technique. Catheterization revealed the confluence of the pulmonary veins draining into a descending vein below the diaphragm. Symptoms of pulmonary venous hypertension and low cardiac output were typical. All had repair with circulatory arrest (average time, 32 minutes). Mobilization of the pulmonary veins and the descending vein is important. The descending vein was transected at the diaphragm. Its anterior surface was incised through the confluence of the pulmonary veins, thus creating an open Y incision. This large Y-shaped vein was anastomosed to the left atrium and carried obliquely to the tip of the left atrial appendage. The anastomosis was fashioned so that the long limb of the Y rotated anteriorly and superiorly to substantially enlarge the left atrium, making the total diameter of the anastomosis larger than the mitral valve orifice. This simplified the surgical repair and allowed direct suture closure of the atrial septal defect in all patients, as the left atrial size was at least doubled. No postoperative complications occurred, and the patients were discharged an average of 4.2 days postoperatively. Restudy at an average of 3.5 years revealed normal pressures and normal architecture by angiography. Use of the descending vein as an integral part of the reconstruction and enlargement of the left atrium was the major technical factor leading to a successful outcome in these patients and eliminating a patch or transposition of the atrial septum.

Anastomosis, Surgical↗
PubMed1989

Disrupted coronary artery caused by angioplasty: supportive and surgical considerations.

Of 2,859 patients having percutaneous transluminal coronary angioplasty, 201 (7%) underwent emergency coronary artery bypass grafting. Two categories of patients were reviewed. Group 1 consisted of 126 patients of 2,304 who had immediate coronary artery bypass grafting after failed elective percutaneous transluminal coronary angioplasty. Ninety-eight of these patients had angiographic evidence of occlusion of a coronary artery, and 28 had angiographic evidence of coronary artery dissection. Epicardial hemorrhage was observed at operation in 20% (25 patients). Three deaths (2.4%) occurred in group 1, and an average of 3.3 grafts was performed per patient. Group 2 comprised 75 of 555 patients who had unsuccessful attempted percutaneous transluminal coronary angioplasty during an evolving myocardial infarction and required immediate coronary artery bypass grafting. Angiography revealed coronary artery occlusion in 61 patients with dissection in 14. All group 2 patients had evidence of myocardial injury by electrocardiographic and enzymatic (myocardial-specific isoenzyme of creatine kinase) criteria. Three deaths (4%) occurred in this group, and there was an average of 3.4 grafts per patient. Percutaneous transluminal coronary angioplasty is routinely performed without surgical consultation, although an operating room and team are usually available. Supportive techniques include the intraaortic balloon pump and percutaneous cardiopulmonary bypass. In those patients with coronary artery dissection, care must be taken to reestablish the true lumen of the coronary artery. Hemopericardium should be surgically explored and broken guidewires or other foreign bodies or debris removed. From 1979 through 1986, the number of patients requiring emergency coronary artery bypass grafting after percutaneous transluminal coronary angioplasty steadily declined to less than 5%.

Angioplasty, Balloon↗
PubMed1989

Use of a double-lumen pressure monitoring catheter to facilitate pulmonary artery banding.

Pulmonary artery banding is facilitated by simultaneously measuring the pressure above and below the band. This can be accomplished with a commercially available double-lumen central venous pressure monitoring catheter. This catheter is inserted through the outflow tract of the right ventricle and positioned so that the band will be between the two lumens. Gradual tightening of the band can be accomplished while monitoring the pressures proximal and distal to the band.

Catheterization, Central Venous↗
PubMed1989

Percutaneous cardiopulmonary bypass: application and indication for use.

Percutaneous cardiopulmonary bypass (CPB) was used in 22 patients: 7 patients with cardiac arrest due to acute myocardial infarction; 4 patients in cardiac arrest because of failed angioplasty; 1 patient for high-risk elective angioplasty; 1 patient with massive pulmonary emboli; 2 patients with hypothermia; 2 pediatric patients (1 with sepsis and 1 in combination with extracorporeal membrane oxygenator support); 1 patient with refractory arrhythmia; and 4 patients with trauma. Percutaneous CPB involves a modified Seldinger technique that is easily applied. All patients except those with massive trauma were resuscitated with the use of percutaneous CPB. One patient requiring a very difficult proposed angioplasty received percutaneous CPB support while triple-vessel angioplasty was performed. Percutaneous CPB appears to be beneficial in resuscitating patients with refractory cardiac arrest or other forms of circulatory collapse except trauma. Limited use for brief periods in high-risk patients having elective angioplasty might be applicable.

Angioplasty, Balloon↗
PubMed1979

LV wall rupture.

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Heart Rupture↗
PubMed1979

Anoxic hypothermic cardioplegia compared to intermittent anoxic fibrillatory cardiac arrest. Clinical and metabolic experience with 1080 patients.

Appropriately applied, hypothermic cardioplegia allows an excellent surgical setting that can significantly reduce the myocardial ischemic injury resulting from anoxia. One thousand eighty adult and pediatric patients underwent a variety of corrective cardial surgical procedures utilizing cold potassium cardioplegic solution injected into the coronary arteries via the aortic root. Myocardial septal temperature was maintained at 18--20 degrees during arrested time. This group of patients was compared to a group of 220 patients that underwent intermittent normothermic ischemic arrest to perform cardiac surgical procedures. Significant reduction in morbidity, mortality, perioperative myocardial infarction was noted in favor of the cardioplegic group. Metabolic coronary sinus blood analysis in the group undergoing surgery with cardioplegia revealed favorable changes in myocardial lactate and oxygen extraction.

Adult↗
PubMed1979

Emergency coronary artery revascularization: a possible therapy for acute myocardial infarction.

Cardiac muscle death caused by coronary artery occlusion is a dynamic process that often takes hours or days. Emergency revascularization (saphenous vein bypass graft (SVBG) during acute myocardial infarction (MI) can interrupt myocardial necrosis, salvage ischemic myocardium and revascularize vessels with obstructive lesions not involved in the MI. In this report we describe a preliminary experimental study of 75 patients in which emergency SVBG was the therapy for acute MI. Group 1, 16 patients, required vasoactive medications and/or intraaortic balloon pumping to maintain their blood pressure preoperatively. There was one operative death and two late deaths. Group 2 consisted of 59 hemodynamically stable patients. There were no deaths. The average preop CPK in group 1 was 892 vs 504 in group 2 (p greater than 0.05). Surgical techniques were routine. The average time from the onset of chest pain that continued to surgery was 6.5 hours. Forty patients were restudied. Post- vs presurgical hemodynamics revealed ejection fraction increased by 34% (p greater than 0.05), left ventricular end-diastolic pressure reduced by 40% (p greater than 0.01). End-systolic and end-diastolic volume reduced by 30% (p greater than 0.05), and 15% (p greater than 0.01), and stroke volume improved 25% (p greater than 0.05). Operative mortality was 1.3% and late mortality 2.8%. These results suggest that cautious continued trial of emergency SVBG in patients with evolving MI is warranted.

Acute Disease↗
PubMed1977

A newly designed arterial monitoring/perfusion cannula for cardiac operations.

A newly designed arterial monitoring and perfusion cannula for cardiopulmonary bypass eliminates the need for cannulation of a peripheral artery for pressure monitoring. The double-lumen cannula is designed as follows: the large central lumen (12 to 26f) acts as the arterial inflow conduit from the pump oxygenator, while a second, smaller lumen (18 gauge)constructed in the wall of the first cannula acts as the pressure-monitoring port and the source for blood sampling and drug infusion. This monitoring/perfusion cannula has been used succesfully in more than 250 clinical patients in a variety of settings--total cardiopulmonary bypass, left heart bypass, and when multiple arterial inflow lines were necessary (as in aortic arch replacement). Use of this cannula is advantageous in the infant and pediatric patient or in the emergency setting, when insertion of a peripheral arterial line can be difficult. Used in conjunction with a Doppler system, the cannula provides accurate, dependable blood pressure monitoring.

Blood Pressure↗
PubMed1977

Cardiac hypothermia.

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Cardiac Surgical Procedures↗