Biomedical subjects

S F Aranki

Publications and source records attributed to S F Aranki.

58 records · Page 4Linked to original sources

PubMed1992

Acute bacterial endocarditis. Optimizing surgical results.

BACKGROUND: Acute bacterial endocarditis continues to be a condition with high morbidity. Although the majority of patients are treated by high-dose antibiotics, a high-risk patient group requires surgical intervention, which is the subject of this article. METHODS AND RESULTS: From 1972 to 1991, 3,820 patients underwent heart valve replacement at the Brigham and Women's Hospital, Boston. Of this group, 158 patients underwent surgery for acute bacterial endocarditis: 109 had native valve endocarditis (NVE), and 49 had prosthetic valve endocarditis (PVE). There were 108 men and 50 women with a mean age of 49 years (range, 16-79 years); 64% were New York Heart Association functional class IV before surgery, and 12% of the group had a history of intravenous drug abuse. In both NVE and PVE groups, Streptococcus was the predominant infecting agent. Uncontrolled sepsis, progressive congestive failure, peripheral emboli, and echocardiographically demonstrated vegetations were the most common indications for surgery. Eighty-five percent of patients had a single-valve procedure, 15% had a multivalve procedure, and 34 patients had other associated major cardiac procedures. The operative mortality was 6% in NVE and 22% in PVE. Long-term survival at 10 years was 66% for NVE and 29% for PVE. Freedom from recurrent endocarditis at 10 years was 85% for NVE and 82% for PVE. The main factors associated with decreased survival overall were PVE and nonstreptococcal infection. CONCLUSIONS: The morbidity and mortality after surgical treatment of acute endocarditis depend on the site, the severity, and the subject infected. Early aggressive surgical intervention is indicated to optimize surgical results, especially in patients with nonstreptococcal infection or PVE.

Aortic Valve↗

PubMed1991

The long-term follow-up of the Hancock Modified Orifice porcine bioprosthetic valve.

The Hancock Modified Orifice valve is a specially fabricated, trileaflet porcine valve, which has been in clinical use at the Brigham and Women's Hospital since 1976. Three hundred seventy-nine aortic valve replacements with this device were implanted from 1976 to 1985; 305 were isolated aortic valve replacements and 74 were in association with a mitral valve bioprosthesis. The 305 patients undergoing isolated aortic valve replacement, a Food and Drug Administration patient group, are the subject of this article. The mean valve size was 22.5 mm, with 115 21-mm valves used. The mean functional preoperative class was 3.2; 99 of 305 patients (32.5%) underwent concomitant coronary artery bypass grafting. There were six operative deaths (2%). Patients were followed from 6-14 years (mean 7.4 years), and analysis was completed in early 1991. The 10-year actuarial calculation of survival freedom from reoperation, thromboembolism, structural valve degeneration, perivalvular leak, infectious valve degeneration, and total morbidity and mortality are presented.

Actuarial Analysis↗

PubMedDate not supplied

Minimally invasive direct access heart valve surgery.

We review our experience with minimally invasive direct access (MIDA) heart valve surgery in 518 patients. Two hundred fifty-two patients underwent MIDA aortic valve replacement (AVR) or repair and 266 underwent MIDA mitral valve repair or replacement. Among the 250 AVRs, 157 (63%) were men, aged 63.2 +/- 14.6 years, NYHA functional Class 2.4 +/- 0.8. The surgical approach was right parasternal in 36 (14%) or upper hemisternotomy in 216 (86%). There were four (2%) operative deaths. Perioperative complications included 14 (5.6%) reexplorations for bleeding, 7 (3%) chest wound infections, 5 (2%) strokes, and 1 (0.4%) external iliac vein injury. Follow-up was complete in 193 (77%) patients, with a mean follow-up of 12 +/- 8 months. Late complications included 2 (0.8%) nonfatal myocardial infarctions, 4 (2%) reoperations for, respectively, 2 pericardial complications, 1 paravalvar leak, and 1 infected valve. There were five (2%) late deaths from congestive heart failure, pneumonia, hemorrhage, aneurysm, and cancer. Mean follow-up NYHA Class was 1.4 +/- 0.6. For the 266 mitral patients, 145 (54.5%) were men, age 58.7 +/- 13.6 years, functional Class 2.3 +/- 0.5. The surgical approach was right parasternal in 195 (73%), lower hemisternotomy in 53 (20%), right submammary thoracotomy in 9 (3.4%), or full sternotomy through a small skin incision in 9 (3.4%). There were 2 (0.8%) operative deaths. Perioperative complications included 4 (1.5%) reoperations for bleeding, 4 (1.5%) strokes, and 5 (2%) wound infections, and 3 (1%) ascending aortic complications. Follow-up was complete in 202 (76%) patients with a mean follow-up of 9.5 +/- 6.4 months. Late complications included one (0.4%) nonfatal myocardial infarction and three (1%) reoperations all converting repairs to replacements. There were three (1%) late deaths from suicide, pneumonia, and sudden death, respectively. Mean follow-up NYHA functional Class was 1.3 +/- 0.5. We conclude that MIDA heart valve surgery is safe and effective for the majority of patients requiring isolated elective aortic or mitral valve surgery.

Adolescent↗

PubMedDate not supplied

Changing patterns in donor and recipient risk: a 10-year evolution in one heart transplant center.

BACKGROUND: Expansion of the donor pool and liberalization of recipient criteria have occurred since the introduction of cyclosporine for heart transplantation. METHODS: We sought to evaluate the impact of these changes on outcome during a 10-year period in one program. A total of 251 transplantations were retrospectively reviewed and divided into two periods (1984 to 1989 and 1990 to 1994). RESULTS: In the latter period, there were increases in donor and recipient age, degree of weight mismatch, ischemic time, bypass time, and severity of illness in the recipient before transplantation as judged by status at the time of transplantation and preoperative requirements for pharmacologic or mechanical support. Despite these changes, time to hospital discharge decreased and a trend to improved survival was seen with the use of Kaplan-Meier analysis. CONCLUSIONS: These findings suggest that improvements in perioperative and posttransplantation care have permitted a safe expansion of both the donor pool and recipient criteria for transplantation.

Adult↗