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Biomedical subjects

V Parsonnet

Publications and source records attributed to V Parsonnet.

At least 55 records · Page 3Linked to original sources
PubMed1989

Coronary angioplasty versus coronary bypass. Three-year follow-up of a matched series of 250 patients.

Two hundred fifty consecutive patients treated for one or two vessel coronary artery disease with either balloon angioplasty or surgical bypass were monitored for 3 years in a study designed to determine the comparative long-term effectiveness of each treatment. The 125 patients having angioplasty were matched with the 125 patients having bypass, so that both groups had a similar number of patients with single or double vessel disease. The two groups did not significantly differ in age, male:female ratio, New York Heart Association class, or risk factors. The ejection fraction was 54 +/- 11 in the angioplasty group and 49 +/- 12 mmHg in the surgical patients (p = 0.0031). Angioplasty was deemed initially successful in 88% (110/125), unsuccessful in 10% (12/125), and in 2% (3/125) the lesion could not be crossed. Emergency bypass was performed in 10% (12/125). Four of the 125 angioplasty patients (3%) died within 30 days. Coronary artery bypass grafting was successfully performed on the matched set of surgical patients with 99% (124/125) discharged well. There was one (1%, 1/125) surgical death. The average hospital stay per patient was 4.8 +/- 3.1 days for angioplasty and 12.1 +/- 4.2 days for bypass grafting (p = 0.0000). Three-year postprocedure follow-up was obtained on 96% (236) of the 245 patients discharged alive. A second angioplasty was required in 18%, and 11 angioplasty patients subsequently required surgical bypass. Overall, 19% (23/121) of the angioplasty patients ultimately required bypass. Four late deaths occurred in the angioplasty group, which brought the early and late mortality rates to 7% (8/121). There were two late surgical deaths, which brought the combined surgical mortality to 2.5% (3/120), p = 0.1263. Patient evaluation reveals that 63% (76/121) of the angioplasty group are alive and in New York Heart Association class I or II 3 years after one or two angioplasty procedures. This figure compares with 92% (110/120) of surgical patients alive and in the same two New York Heart Association classes (p = 0.0000).

Adult↗
PubMed1989

A method of uniform stratification of risk for evaluating the results of surgery in acquired adult heart disease.

The purpose of the study was to devise a method of stratifying open-heart operations into levels of predicted operative mortality, using objective data that are readily available in any hospital. Following univariate regression analysis of 3,500 consecutive operations, 14 risk factors were chosen that met these conditions. A few factors were excluded because they were insufficiently objective or not always available. An additive model was constructed, using the factors chosen, to calculate the probability of mortality within 30 days. The method was then tested prospectively in 1,332 open-heart procedures at the Newark Beth Israel Medical Center. Patients were categorized in five groups of increasing risk: good (0-4%), fair (5-9%), poor (10-14%), high (15-19%), and extremely high (greater than or equal to 20%). The correlation coefficient of anticipated and observed operative mortality, using the additive model, was 0.99. The operative mortality also correlated closely with complication rates and length of hospital stay. The additive model was compared with a second model based on logistic multiple regression; the resulting correlation coefficient was 0.85. The method was also tested at two other hospitals; although their sample sizes were smaller, the outcomes in each risk group were comparable with those at this institution. The collection of data proved to be acceptably simple for all three centers. This study demonstrates that it is possible to design a simple method of risk stratification of open-heart surgery patients that makes it feasible to analyze operative results by risk groups and to compare results in similar groups between institutions. Wider application of the system is recommended.

Adult↗
PubMed1988

Cardiac pacing practices in the United States in 1985.

Physicians active in pacemaker implantation and follow-up were surveyed to obtain a profile of permanent cardiac pacing practices in the United States during 1985. Questionnaires were sent to 628 physicians, mainly in New Jersey; 145 responses were received and analyzed. A separate questionnaire was sent to 9 pacemaker manufacturers to solicit information concerning the volume of pacemaker sales and their opinions on a variety of subjects. The rate of permanent pacemaker implantation declined for the first time: it dropped from 518 devices per million population in 1981 to 374 in 1985. Sinus node dysfunction was the chief indication for permanent pacing in 52% of primary implantations; conduction disorders of the atrioventricular node and His-Purkinje system accounted for 41% and ventricular tachyarrhythmias for 2%. Dual-chamber pacing modes were used less frequently than was predicted in 1981, accounting for 30% of primary and 19% of replacement pacemakers. More than 43% of programmable pulse generators were never reprogrammed after implantation. Surveys such as this continue to provide useful information despite obstacles encountered in the use of questionnaires. Important differences in practice patterns and outcomes were identified between surgeons and nonsurgeons, and between frequent and infrequent implanters. These differences reinforce the suggestion that implanters should work at a volume sufficient to maintain their expertise, and that cooperation between surgeons and nonsurgeons would lead to improvements in patient selection, surgical results and optimal pacemaker programming and follow-up care. Better results could be achieved by adopting the continent-wide system of a pacemaker registry now used in Eastern Europe and Great Britain.

Diagnosis-Related Groups↗
PubMed1988

Implantation of a cardioverter/defibrillator without thoracotomy using a triple electrode system.

This article describes the implantation of an automatic implantable cardioverter/defibrillator in a 69-year-old man with coronary artery disease and recurrent sustained ventricular tachycardia without the need for a thoracotomy/sternotomy and epicardial electrodes. The patient underwent serial electrophysiological evaluation that revealed drug-refractory ventricular tachycardia. Surgical ablation was considered and rejected due to advanced, severe, pulmonary disease. A triple electrode system using two transvenous catheter electrodes and a submuscular patch electrode in the left midaxillary line was employed. A single shock was delivered simultaneously over two spatially distinct current pathways and reproducibly defibrillated ventricular fibrillation with energies less than or equal to 10 J. The automatic implantable cardioverter/defibrillator was implanted in the anterior abdominal wall and demonstrated reproducible termination of ventricular tachycardia and ventricular fibrillation.

Aged↗
PubMed1988

Performance of implantable cardiac rhythm management devices.

Our data represent use, follow-up, and management decisions from eight independently functioning centers and most importantly, actuarial survival of ICRMD's that have been implanted for a sufficient time period to allow assessment of time versus failure. General patterns of possible target durations for adequate performance for present or future generations of similar clinical devices may be suggested by the data that we have presented. However, it would be inappropriate to conclude from these data that any presently implanted ICRMD would have a particular functional reliability. Furthermore, these data only summarized device hardware performance and cannot and must not be used to determine either short-term or long-term individual patient status, management, or outcome.

Electric Countershock↗
PubMed1988

Emergency operation after failed angioplasty.

A group of patients with failed angioplasty who then required emergency coronary bypass was compared with a historically matched group of patients who had had elective bypass grafting. The two groups were well matched in age, sex, ejection fraction, and New York Heart Association classification and in the incidence of diabetes and hypertension. Significant differences were found in the prevalence of mortality (12% versus 1.5%), hemorrhage (28% versus 13%), cardiac tamponade (10.5% versus 1.5%), myocardial infarction (28% versus 9%), and length of hospital stay (15.3 days versus 13.4 days). Cardiogenic shock carries the worst prognosis; four of the five patients with this condition died. Because emergency operation after failed angioplasty carries with it significant postoperative morbidity and mortality, this procedure cannot be considered equivalent to elective coronary bypass grafting.

Angioplasty, Balloon↗
PubMed1987

Femorofemoral grafts for lower limb ischemia caused by intra-aortic balloon pump.

From January 1975 to December 1985, 1454 patients had an intra-aortic balloon inserted for cardiac assistance. Eighty balloon-dependent patients had severe limb ischemia and required a femorofemoral graft (FFG) (5% of the total group of patients). Twenty-nine of the 80 patients with grafts (or 36%) left the hospital and 28 were followed up for an average of 40 months to determine late complications associated with the crossover grafts. All grafts remained patent. The 28 patients were classified into five groups according to the degree and type of lower limb ischemia. Group I consisted of 13 asymptomatic patients (46%); group II had four (14%) patients with mild claudication caused by preexisting peripheral arteriosclerosis; group III comprised four patients (14%) without preexisting disease but claudication subsequent to the FFG; group IV had five patients with irreversible ischemic sequelae before grafting ending in amputation, foot drop, or persistent paresthesia; and group V consisted of two patients with graft infection (7%). The perioperative mortality rate of the balloon-dependent patients with an FFG (64%) reflects the gravity of the cardiac condition. Placement of an FFG to relieve limb ischemia in these patients is followed by few immediate or late complications in the survivors and any persistent limb changes were related to the prolonged ischemia present before revascularization. Our data suggest that in balloon-dependent patients with limb-threatening ischemia, aggressive use of the FFG is limb-saving, durable, and allows continuation of balloon support.

Adult↗
PubMed1987

Performance of implantable cardiac rhythm management devices.

Our data represent use, follow-up, and management decisions from seven independently functioning centers and most importantly, actuarial survival of ICRMDs that have been implanted for sufficient time period to allow assessment of time versus failure. General patterns of possible target durations for adequate performance for present or future generations of similar clinical devices may be suggested by the data that we have presented. However, it would be inappropriate to conclude from these data that any presently implanted ICRMD would have a particular functional reliability. These data, furthermore, only summarized device hardware performance and cannot and must not be used to determine either short-term or long-term individual patient status, management, or outcome.

Actuarial Analysis↗