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R Pifarré

Publications and source records attributed to R Pifarré.

At least 55 records · Page 3Linked to original sources
PubMed1988

Perioperative dissection of the ascending aorta: types of repair.

Iatrogenic aortic injury occurring during either coronary bypass grafting or valve replacement is a well-recognized complication of cardiac surgery. We retrospectively reviewed our experience and found 11 cases occurring in a case load of 8,945 hearts (incidence of 0.12%). All 11 cases were repaired, with 10 patients surviving. The type of repair used usually was determined by when the diagnosis was made. When an intraoperative diagnosis was made, a local repair was done in four of six cases. If a postoperative diagnosis was made, then all five patients needed the ascending aorta replaced. With early diagnosis and rapid repair, good surgical results can be achieved.

Academic Medical Centers↗
PubMed1988

Reversal of recalcitrant cardiac allograft rejection with methotrexate.

Refractory cardiac transplant rejection is a major therapeutic dilemma. The effectiveness of methotrexate (MTX) in autoimmune diseases prompted us to explore its efficacy in 10 cardiac transplant recipients, aged 20-53 years (39 +/- 13 years; mean +/- SD), with biopsy evidence of drug-refractory cardiac allograft rejection. Nine cardiac transplant recipients were maintained on triple antirejection therapy (cyclosporine, azathioprine, and prednisone), and the remaining recipient was maintained on cyclosporine and prednisone. Rejection episodes treated with MTX occurred 20-422 days (165 +/- 137 days) after transplantation and were the sixth episode of rejection for one recipient, the third for four recipients, the second for four recipients, and the first for one recipient. Before MTX administration, cardiac allograft rejection persisted despite intensified immunosuppression including OKT3 antibody. MTX, given intravenously, orally, or by both routes at a dose of 10-175 mg (85 +/- 62 mg), reversed rejection in nine of 10 recipients (90%) within 7-63 days (26 +/- 18 days). Elevated pulmonary artery wedge pressures were reduced to normal levels after MTX therapy (15.2 +/- 3.5 before vs. 10.6 +/- 3.0 mm Hg after; p less than 0.05). Leukopenia occurred in five cardiac transplant recipients after treatment with MTX. Adverse reactions to MTX resolved after MTX therapy was discontinued in all but one recipient. This recipient received one of the larger MTX doses (150 mg) and developed fatal Pseudomonas pneumonia. Twelve moderate rejection episodes recurred in nine recipients, seven episodes of which were successfully re-treated with MTX. Two of these seven recipients have now been rejection-free for 15 months. Of five recurrent episodes of cardiac transplant rejection not treated with MTX, two could not be reversed and were fatal. MTX may be a valuable drug for reversing refractory cardiac allograft rejection. Before MTX therapy gains wider use, however, a clearer understanding of its enhanced ability to suppress the bone marrow is needed.

Adult↗
PubMed1988

Effect of preoperative hemodynamic support on survival after cardiac transplantation.

The accessibility and success of cardiac transplantation promotes transplantation for a broad range of recipients, including those requiring intravenous inotropes or mechanical-assist devices. To determine if survival is dependent on preoperative requirements for hemodynamic support, we studied 230 patients who underwent transplant at the Loyola, Stanford, and UTAH programs from December 1, 1984 through November 30, 1986, and who were followed up for 34 months postoperatively. Group 1 (n = 132 of 230, 57%) patients required only oral medical therapy to maintain hemodynamic compensation; Group 2 (n = 69 of 230, 30%) patients were dependent on intravenous inotropic support; and Group 3 (n = 29 of 230, 13%) patients required mechanical assistance. Pretransplant characteristics showed that dilated cardiomyopathy was more common in Group 2 patients, and lower cardiac index and ejection fraction were more prevalent in Group 3 patients as expected. Although survival was lower in Group 3 only at 1 month (Group 1, 98.5%; Group 2, 92.8%; and Group 3, 86.2%; p less than 0.01), the survival advantage in Groups 1 and 2 was lost by 3 months, with 1-year survival rates of 88.6% in Group 1, 81.2% in Group 2, and 82.8% in Group 3. Allograft survival and cause of death were not different among the three groups. Acute rejection occurred at a lower monthly frequency in the first 4 months in Group 3 (Group 1, 0.47 +/- 0.03; Group 2, 0.47 +/- 0.05; and Group 3, 0.29 +/- 0.06; p less than 0.01), whereas infectious complications occurred at similar frequencies.(ABSTRACT TRUNCATED AT 250 WORDS)

Assisted Circulation↗
PubMed1987

Early myocardial revascularization for postinfarction angina.

In 1983 and 1984, coronary artery bypass grafting (CABG) was performed on 107 consecutive patients for postinfarction angina. In each instance, CABG was done within 30 days of infarction. Sixty-three patients (59%) required intravenous administration of nitroglycerin and/or the intraaortic balloon pump (IABP) for relief of angina. Oral medications relieved angina in the remaining 44 patients. Thirty-eight patients underwent CABG 7 days or less after the infarction (Group 1), 25 received it between 8 and 15 days later (Group 2), and 44 had CABG between 16 and 30 days later (Group 3). There were 9 in-hospital deaths: 4 in Group 1, 2 in Group 2, and 3 in Group 3. Thirteen patients needed the IABP for hemodynamic stability as well as relief of angina. Even when the patient was stable hemodynamically, death was more likely to occur among these 13 patients if CABG was conducted within 7 days of infarction. Follow-up was 94% complete at 29.4 months. Eighty-six percent of patients were asymptomatic or in New York Heart Association Functional Class I, and 6% were in Class II. There were 2 late deaths. CABG for angina can be accomplished within 30 days of an acute infarction with good results. The exception to this rule is the patient in whom shock develops after a myocardial infarction and who, despite stabilization, receives CABG within 7 days of the infarction.

Angina Pectoris↗
PubMed1987

Aortic valve replacement in patients 75 years old and older.

A consecutive group of 100 patients in the eighth decade of life who had aortic valve replacement (AVR) from 1975 through 1986 were retrospectively studied. Eighty-five of them were in New York Heart Association (NYHA) Functional Class III or IV. Isolated AVR was performed in 44 patients and AVR with concomitant procedures, in 56. Perioperative mortality (30 days) was 3%, and perioperative morbidity included 83 complications in 60 patients. Long-term follow-up was available on 93 patients, 71 of whom were alive and 22 of whom were dead. Sixty-eight of the 71 long-term survivors are now in NYHA Class I or II. The low rate of perioperative mortality and the improved quality of life after AVR support the performance of this procedure in this older population.

Aged↗
PubMed1987

Multivariate discriminant analysis of risk factors for operative mortality following isolated coronary artery bypass graft. Loyola University Medical Center experience, 1970 to 1984.

The Loyola Open-Heart Registry is a fully operational database that contains detailed data on approximately 9,000 patients who have undergone coronary bypass or cardiac valve replacement from January 1970 to December 1984. We analyzed the registry data using multivariate discriminant analysis to identify and quantitate those factors that might predict operative mortality (OM) for patients undergoing coronary artery bypass grafts at Loyola University Medical Center: Operative mortality was defined as death within 30 days following surgery. A total of 50 clinical and angiographic variables were analyzed for possible univariate association with operative mortality. Twenty-two variables were found to have significant univariate association with OM, and these 22 variables were subjected to multivariate discriminant analysis. For patients undergoing isolated, elective coronary artery bypass, the factors found to be predictive of OM are age (greater than 70) (F = 11.57), severe (more than six stenoses) coronary artery disease (F = 5.81), diffuse disease (F = 5.54), positive family history (F = 5.17), and number of coronary arteries bypassed (F = 4.78).

Coronary Artery Bypass↗
PubMed1986

Subxiphoid pericardiostomy for hemodialysis-associated pericardial effusion.

Sixteen patients receiving maintenance hemodialysis in whom moderate-to-large pericardial effusions developed were treated with short-term drainage via a large-bore tube implanted into the pericardial sac. Drainage tubes were implanted using a subxiphoid approach (subxiphoid pericardiostomy) while the patient was under local anesthesia. In seven patients, triamcinolone hexacetonide was instilled into the pericardial sac through the drainage tube at regular intervals. In all patients, a drainage period of two to four days, with or without instillation of nonabsorbable steroids, was associated with resolution of the pericardial effusion. Only one recurrence of effusion was demonstrable over a follow-up period extending from three months to eight years (median, 4.2 years). Complications of subxiphoid pericardiostomy were minor (incisional hernia, wound infection, and small pneumothorax) and easily treatable. Our results suggest that short-term drainage via a surgically implanted drainage tube is an effective and safe treatment of moderate-to-large hemodialysis-associated pericardial effusion.

Drainage↗
PubMed1983

Management of left ventricular rupture complicating myocardial infarction.

Rupture of the left ventricle secondary to myocardial infarction may occur more often than is suspected. More time than anticipated may be available between rupture and catastrophic deterioration. Hemodynamic stabilization, diagnostic studies, and surgical treatment can be successfully undertaken. Four patients have been successfully treated in our institution. Rupture occurred from 1 to 14 days after infarction. Persistent chest pain was present in all. All were hemodynamically unstable and all stabilized with counterpulsation. One patient was in cardiogenic shock, two had a cardiac arrest, and one presented with cardiac tamponade requiring two emergency pericardiocenteses. Coronary arteriography was done in all four patients. Surgical management consisted of infarctectomy and repair of the ventricular rupture. Additionally, a single aortacoronary bypass graft was needed in two patients and repair of a ventricular septal rupture was necessary in a third. There was no operative mortality. One patient drowned 1 year later. We conclude that successful surgical management requires (1) suspicion of ventricular rupture, (2) hemodynamic stabilization by counterpulsation, (3) coronary arteriography, and (4) combined infarctectomy and repair with revascularization.

Aged↗
PubMed1982

Acute coronary artery occlusion secondary to blunt chest trauma.

Two patients suffered an acute transmural MI due to complete occlusion of the proximal LAD after blunt chest trauma. One developed a rupture of the ventricular septum with a ventricular aneurysm and the other an acute ventricular aneurysm, both accompanied by congestive heart failure. Neither had a history of ischemic heart disease; both had normal right and circumflex coronary arteries by arteriography. An intimal tear or subintimal hemorrhage with luminal thrombosis, or both, are the suggested mechanisms of coronary artery occlusion. Both patients were operated upon successfully. Patient 1 underwent closure of the VSD and resection of the ventricular aneurysm. The LAD had returned to normal and required no aortocoronary bypass graft. Patient 2 underwent arteriotomy of the LAD with Fogarty catheter embolectomy and aortocoronary bypass graft, combined with resection of the ventricular aneurysm. We recommend that patients who suffer blunt chest trauma and show ECG changes should undergo cardiac catheterization and coronary arteriography, followed by the pertinent treatment.

Accidents, Traffic↗
PubMed1981

Left atrial myxoma and coronary artery disease: combined surgical treatment.

The ages and the symptoms of patients who have left atrial myxomas and coronary artery disease are similar. Two patients in whom both lesions coexisted were successfully operated on. Based on this experience, it is recommended that coronary cineangiography be performed on patients with left atrial myoxmas when a positive anginal history is obtained or when the patient is over 35 years of age. In the patient with coexisting myxoma and coronary artery disease, careful preoperative planning for myocardial protection is advised.

Aged↗
PubMed1981

Constrictive pericarditis following cardiac surgery.

Five patients with constriction secondary to pericarditis or membrane formation following cardiac surgical procedures are reported. In 4 of the 5 patients, a postpericardiotomy syndrome developed after the original procedure. Constriction occurred from ten weeks to almost 6 years after the cardiac operation. Clinicians should watch carefully for the delayed onset of constriction in patients with a postpericardiotomy syndrome after cardiac operation.

Cardiac Surgical Procedures↗
PubMed1981

Management of endobronchial hemorrhage during cardiopulmonary bypass.

Massive endobronchial bleeding during cardiopulmonary bypass was encountered in one patient following pulmonary embolectomy and in another following an elective aorta-coronary bypass procedure. Successful management of this complication necessitates control of ventilation by prolonging cardiopulmonary bypass to ensure adequate oxygenation, suctioning the airway to clear blood from the major tracheobronchial tree, and immediately instituting 20 cm H2O of positive end-expiratory pressure (PEEP) to control endobronchial bleeding.

Bronchial Diseases↗
PubMed1981

Management of postoperative heparin rebound following cardiopulmonary bypass.

Postoperative heparin rebound was investigated in 50 adult patients undergoing cardiopulmonary bypass with the use of the Hepcon heparin analyzer. Prior to bypass each patient received 2 mg/kg of heparin. During bypass, the activated clotting time (ACT) was utilized to assess the need for additional heparin to maintain the value between 300 and 400 seconds. The average amount of heparin given was 160 mg. Once cardiopulmonary bypass was terminated the Hepcon unit was employed to determine the actual amount of active circulating heparin and to calculate the dose of protamine sulfate. The average amount of protamine administered intraoperatively was 200 mg. The overall mean ratio of protamine-to-heparin was 1.25 : 1. Once hemostasis was achieved, no circulating heparin was measured with the Hepcon unit, and the ACT value had returned to its baseline, the incisions were closed and the patients were transferred to the intensive care unit. One hour later a blood sample was obtained and analyzed by the Hepcon unit for any heparin rebound. We found that 26 patients (52%) had circulating heparin and required an additional dose of protamine, averaging 70 mg. Drainage from the thoracotomy tubes averaged 400 cc in the first 24 hours, and a mean of 2 units of packed cells was infused. Three patients (6%) did not require any blood transfusions. The use of the Hepcon unit has produced a safe and expedient method of analyzing and neutralizing active circulating heparin in patients following cardiopulmonary bypass. It is a useful adjunct in blood conservation because it reduces excessive postoperative blood loss associated with heparin rebound.

Blood Transfusion↗
PubMed1980

Coronary embolism: surgical management.

The successful use of Fogarty catheter embolectomy combined with aortocoronary vein bypass graft in 4 patients with an acute myocardial infarction is presented. Three patients sustained acute occlusion of the coronary artery secondary to an embolus during cardiac catheterization. In the fourth patient, the left anterior descending coronary artery was occluded with a fragment of calcium debris during aortic valve replacement. All patients survived the operation. Acute occlusion of the coronary artery secondary to an embolus is uncommon, but its early recognition and appropriate surgical management may be lifesaving.

Acute Disease↗