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Biomedical subjects

W A Reed

Publications and source records attributed to W A Reed.

At least 37 records · Page 2Linked to original sources
PubMed1991

Bio-medicus ventricular assist device for salvage of cardiac surgical patients.

Over a 5-year period, 41 (1%) of 4,193 patients undergoing cardiac operations underwent intraoperative or early postoperative insertion of a Bio-Medicus ventricular assist device when it became apparent that the patient could not otherwise survive. Fourteen patients were in cardiogenic shock and 7 were in cardiac arrest at the time of initiation of their primary cardiac surgical procedure, and in no instance was the device planned as a bridge to cardiac transplantation. Bleeding, sepsis, and thromboembolism were frequent postoperative complications. Central nervous system deficits were observed in 16 patients during their postoperative course. Eight patients (19.5%) were long-term survivors. Of the preoperative risk factors evaluated only age was significantly associated with survival, with 7 (33%) of the 21 younger (39 to 63 years) patients surviving. Blood product usage and hospital cost were analyzed in an attempt to assess cost/effectiveness of use of this device for attempted salvage of such desperately ill patients.

Adult↗
PubMed1989

Fifteen-year results of coronary artery bypass for isolated left anterior descending coronary artery disease.

During 1971 through 1975, 266 patients underwent primary coronary artery bypass grafting for occlusive disease confined to the left anterior descending coronary artery. Actuarial survival at 15 years was 72.7% with 60% of survivors being free from angina. Although the cause of death was cardiac related in 50% of the patients who died, survival was comparable with that of an age-matched and sex-matched general population. During follow-up, 48 secondary or tertiary repeat coronary artery bypass as well as 44 percutaneous transluminal coronary angioplasty procedures were performed. Acute event-free status (freedom from acute myocardial infarction, repeat coronary artery bypass grafting, percutaneous transluminal coronary angioplasty, or death) persisted at 15 years in 43.2% of patients. The differences in survival when patients were segregated according to age, sex, number of grafts performed, or graft conduit (internal mammary artery versus vein) were not significant. However, comparison of graft conduits revealed a significantly better (p = 0.02) overall acute event-free survival when the internal mammary artery was used.

Adult↗
PubMed1988

Cutaneous mucormycosis in a heart transplant patient.

We present the first case of cutaneous mucormycosis reported in a patient who had undergone a heart transplant operation. This appeared to be a localized infection without a predisposing local factor such as a surgical adhesive and without evidence of dissemination. Prompt treatment with intravenous amphotericin B resulted in an apparent cure.

Adult↗
PubMed1985

Coronary artery bypass following percutaneous transluminal coronary angioplasty.

During a 4-year period, 286 patients underwent coronary artery bypass grafting (CABG) following percutaneous transluminal coronary angioplasty (PTCA). Seventy-three patients had single-vessel and 213 (74.5%) had multivessel coronary artery disease. Twenty-nine patients underwent PTCA because of an evolving acute myocardial infarction (MI). Forty-two patients had previously undergone 47 CABG procedures. One hundred fifteen patients underwent CABG on an emergency basis. Indications for emergency CABG after PTCA were prolonged chest pain (79.1%), worsening of coronary artery obstruction (59.1%), "current of injury" by electrocardiogram (31.3%), cardiogenic shock (27.8%), and, in a lesser incidence, ventricular fibrillation, coronary artery dissection (without obstruction), heart block, and intractable cardiac arrest. The 286 patients underwent 2.1 CABG procedures per patient with a thirty-day mortality of 6.3% (18 patients). The incidence of acute MI was 43.5 versus 4.1%; low cardiac output syndrome, 34.8 versus 7.0%; and operative death, 11.3 versus 2.9% in the emergency and nonemergency groups, respectively. Other significant predictors of operative death were previous CABG (16.7 versus 4.5%), multivessel coronary artery disease (8.0 versus 1.4%). Late follow-up reveals a mortality of 1.4% per year in those patients who were early survivors of CABG.

Adult↗
PubMed1983

Surgical treatment of papillary muscle rupture.

Between 1971 and 1979, 16 patients underwent mitral valve replacement for papillary muscle rupture after infarction. Nine of these patients were operated on within 3 days of papillary muscle rupture. Eight patients had low cardiac output syndrome prior to operation. Six patients had concomitant coronary artery bypass, and 1 patient had resection of an associated left ventricular aneurysm. There were 3 operative deaths (19% mortality). Surviving patients have been followed for a total of 49 patient-years. There have been 2 late deaths, each a result of coronary artery disease. Six of the 11 surviving patients are asymptomatic; the others are in New York Heart Association Functional Class II or III. The actuarial 5-year survival was 75%. These data support the concept that an aggressive attitude should be taken toward early diagnosis and surgical treatment of postinfarction papillary muscle rupture.

Aged↗
PubMed1982

Coronary artery bypass in women: long-term survival.

During a 6-year period ending December, 1976, 385 female patients underwent coronary artery bypass at the Mid-America Heart Institute. This group constituted 14.6% of the total experience. The operative (thirty day) mortality was 1.3%, which is not significantly greater than that experienced by male patients operated on concurrently. A total follow-up of 2,015 patient-years was obtained. The incidence of nonfatal acute myocardial infarction was 2.0 per 100 patient-years of follow-up, and the incidence of repeat coronary artery bypass was 0.8 per 100 patient-years. The actuarial survival was 90% at 5 years and 75.3% at 10 years. Of the 46 deaths (early or late), 58.7% were cardiac in nature. Although the absolute survival of women is as good as that observed in men, the female patients did not achieve the expected survival pattern of a matched (for age and sex) general population as is observed in our male patients undergoing coronary artery bypass. These results obtained with coronary artery bypass justify the use of similar criteria for the application of this therapy in men and women.

Actuarial Analysis↗
PubMed1982

Normal survival curve after coronary artery bypass.

A consecutive series of 2,628 patients subjected to isolated coronary artery bypass have had follow-up for a total of 13,915.5 patient-years. The number of patients surviving without angina decreased from 81% at one year to 36.9% at nine years after operation. Nonfatal myocardial infarction occurred at a rate of 3.1% per year, and the incidence of repeat coronary artery bypass was approximately 1% per year. The ratio of the five-year actuarial survival to that expected for a normal population, matched by age and sex, was 1.03 for single vessel disease, 1.00 for double vessel disease, and 1.00 for triple vessel disease. The survival ratio at ten years postoperatively was 1.13, 0.99, and 0.85 for single, double, and triple vessel disease, respectively. Cardiac causes accounted for 44.4%, 68.9%, and 65.7% of deaths in patients with single, double, and triple vessel disease, respectively.

Adult↗
PubMed1982

Operative experience with 50 thoracic aortic dissections.

From 1971 to 1981, 46 patients were subjected to 50 operations (graft replacement, 31; patch aortoplasty, ten; suture aortorraphy, six; bypass, one; and nonthoracic vascular procedure, two) for thoracic aortic dissection. Four patients had two separate dissections. Dissections were classified as type A (ascending thoracic aortic, 38) or type B (descending thoracic aortic, 12) and subgrouped as acute (less than 2 weeks) or chronic (greater than 2 weeks). There were seven hospital deaths and an operative mortality of 14%. The operative mortality for acute type A dissections was 20% and for chronic type A, 7%. There was one operative death in the 12 type B dissections. Four of the seven deaths occurred in patients with an iatrogenic dissection. Overall cumulative survival was 70% at four years, but dropped to 45% at six years. Survival was poorest in the acute type A group and was only 38.9% at five years.

Adolescent↗
PubMed1982

Myocardial revascularization: results relative to extensiveness.

We analyzed 13,788 patient-years of follow-up of 2,628 consecutive patients who had had primary isolated coronary artery bypass. We then assessed late results relative to the number of coronary artery bypasses done. There were no significant differences in the incidence of survival, angina-free status, nonfatal acute myocardial infarction, repeat coronary artery bypass, or cardiac deaths relative to the number of bypasses in patients with single or double vessel disease. Patients with three vessel disease had significantly increased incidence of angina-free status and significantly decreased incidences of nonfatal acute myocardial infarctions and repeat coronary artery bypass with increasing number of bypasses performed. In this study, we found no advantage in performing increasing numbers of bypasses in patients with single or double vessel disease, but there was definitely such an advantage in patients with triple vessel disease.

Coronary Artery Bypass↗
PubMed1980

Anaesthesia for day-care surgery: a symposium (III). Anaesthesia for adult surgical out-patients.

This discussion is based on the experience of the Phoenix Surgicenter, where over 60,000 patients have been anaesthetized since 1970. Patients accepted for out-patient surgery are ASA Status I or II, although status III patients may be included if their co-existing disability is under excellent control. Eighty-five per cent of adult patients receive general anaesthesia. A wide variety of local and regional anaesthetic techniques may be used. Efforts during recovery are directed towards preparing the patient for discharge in a "home ready" condition for safe handling by attending relatives. The common complications have been postoperative nausea or emesis and hypotension. The hospital transfer rate has been 0.2 per cent.

Ambulatory Surgical Procedures↗
PubMed1980

Surgical therapy for left main coronary artery disease.

The course of a consecutive series of 271 patients who underwent coronary artery bypass for left main coronary artery obstruction (greater than or equal to 50% luminal diameter stenosis) between January, 1971, and December, 1976, at the Mid-America Heart Institute is reported. There were four (1.5%) operative deaths. All patients have been followed until their death or for 2 to 5 years with a mean follow-up of 3.8 years. There has been an incidence of acute myocardial infarction of 2.2 per 100 patient-years of follow-up, and four patients (1.5%) have required a second coronary artery bypass procedure. There have been 19 late deaths. Death was more frequent in women and in patients who had fewer than three bypasses performed. Actuarial survival at 5 years for the entire group was 88.8%. The expected survival rate of a general population matched for age and sex at 5 years is 88.4%. It is concluded that coronary artery bypass for left main coronary artery disease favorably affects longevity.

Adult↗
PubMed1979

Five-year follow-up of patients undergoing coronary artery bypass.

Two hundred eighty-two patients who underwent coronary artery bypass operation between January, 1971, and July, 1972, were followed until the time of death or for 5 years after operation. The angina-free status progressively decreased during the period of follow-up but at 5 years 57% of the survivors were free from angina. The total (early and late) incidence of nonfatal myocardial infarction was 3.3 per 100 patient years of follow-up. Nine (3.2%) of the patients had a repeat coronary artery bypass operation within the first 5 postoperative years. The overall 5-year survival was 86.9%. The expected 5-year survival of the general population, matched by sex and age, is 90.7%. Five-year survival was 97% for single-vessel disease, 87% for double-vessel disease, and 85% for triple-vessel disease.

Adult↗