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Biomedical subjects

Walter G Wolfe

Publications and source records attributed to Walter G Wolfe.

11 recordsLinked to original sources
PubMed2006

Pathologic nodal status predicts disease-free survival after neoadjuvant chemoradiation for gastroesophageal junction carcinoma.

BACKGROUND: The incidence of carcinoma of the gastroesophageal junction (GEJ) is rapidly increasing, and the prognosis remains poor. We examined outcomes in patients who received neoadjuvant chemoradiation for GEJ tumors to identify factors that predict disease-free (DFS) and overall (OS) survival. METHODS: A retrospective analysis was performed of 101 consecutive patients who received chemoradiation and surgery for GEJ carcinoma between 1992 and 2001. RESULTS: The median DFS and OS of all patients were 16 and 25 months, respectively. Twenty-eight patients with a complete histological response (T0N0) experienced greater DFS compared with all others (P = .02). Node-negative patients, regardless of T stage, experienced improved median DFS (24 months) compared with N1 patients (9 months; P = .01). Preoperative stage, age, tumor location, or Barrett's esophagus did not independently predict OS by univariate analysis. Multivariate analysis demonstrated that only posttreatment nodal status (P = .03)-not the degree of primary tumor response-predicted DFS. CONCLUSIONS: The nodal status of patients with GEJ tumors after neoadjuvant therapy is predictive of DFS after resection. The poor outcome in node-positive patients supports postneoadjuvant therapy nodal staging, because surgical aggressiveness should be tempered by the realization that cure is unlikely and median survival is short.

Adult↗
PubMed2006

Short-term and intermediate-term outcomes of aortic root replacement with St. Jude mechanical conduits and aortic allografts.

BACKGROUND: Few studies have directly evaluated outcomes in patients undergoing aortic root replacement with St. Jude mechanical conduits or aortic allografts (ALLO), yet both approaches have been advocated. The purpose of this study was to provide a detailed description of outcomes in a large series of aortic root replacements performed with either St. Jude mechanical conduits or aortic allografts. METHODS: A retrospective analysis was performed on 172 consecutive adult patients undergoing aortic root replacement with either St. Jude mechanical conduits (n = 73) or aortic allografts (n = 99) from January 1990 to December 2002. Maximal follow-up was 15 years, and median follow-up was 5 years. RESULTS: Both groups were similar with regard to median age, preoperative ejection fraction, and New York Heart Association class. The aortic allograft patient group had a higher proportion (p < 0.05) of women (43% versus 18%), prior sternotomies (52% versus 26%), preoperative renal failure (9% versus 1%), and cerebrovascular disease (16% versus 4%). Operative indications for the aortic allograft group were more frequently endocarditis (29% versus 3%; p < 0.0001) and prosthetic valve dysfunction (13% versus 1%; p < 0.01), and less frequently annuloaortic ectasia (34% versus 60%; p < 0.001) or aortic dissection (3% versus 26%; p < 0.0001). Concomitant coronary artery bypass grafting or other valve surgery was performed in 30% of patients in both groups. Incidence of early postoperative complications, including bleeding, stroke, renal failure, and respiratory failure, was similar in both groups. Thirty-day mortality was 5.5% in the St. Jude mechanical conduit group and 8.1% in the aortic allograft group (p = 0.4). Unadjusted actuarial survival at 1, 5, and 10 years was 90%, 81%, 67%, and 86%, 70%, 67%, for the St. Jude mechanical conduit and aortic allograft groups, respectively (p = 0.09). Event-free survival at 1 and 5 years was similar for both groups (p = 0.4). By multivariate analysis, New York Heart Association class III or IV, emergently performed aortic root replacement, and postoperative respiratory failure, but not valve conduit type (p = 0.3), were independent predictors of mortality. CONCLUSIONS: Aortic root replacement can be safely performed with either allograft or mechanical conduits, even in the setting of acute dissection, redo sternotomy, or endocarditis.

Adult↗
PubMed2006

Reimplantation technique (David operation) for multiple sinus of valsalva aneurysms.

Sinus of Valsalva aneurysms are relatively uncommon, and surgical repair is indicated at the time of diagnosis whether or not symptoms are present. This generally entails closure using a patch technique because usually only one sinus is involved. We report here the successful treatment of multiple sinus of Valsalva aneurysms using a David reimplantation valve-sparing root replacement.

Aortic Aneurysm↗
PubMed2005

Low morbidity and mortality for bronchoplastic procedures with and without induction therapy.

BACKGROUND: The safety of bronchoplastic procedures after induction chemoradiotherapy is uncertain. This study examines short- and long-term outcomes after bronchoplastic procedures with and without induction therapy. METHODS: Between January 1997 and September 2004, more than 1,300 anatomic pulmonary resections for cancer were performed at a single institution. Of these, 73 patients required either sleeve lobectomy (57) or bronchoplasty (16), and were retrospectively analyzed. Nineteen patients (26%) received induction therapy; 15 received chemotherapy and radiation therapy and 4 received chemotherapy alone. Fifty-four patients underwent the bronchoplastic procedure without induction therapy. Mortality and early and late morbidity were analyzed. RESULTS: Mean follow-up was 25 months. Histology was nonsmall cell cancer in 62 (85%), carcinoid in 8 (11%), and renal cell cancer, schwannoma, and mucoepidermoid cancer in 1 patient each. There were 2 (2.7%) 30-day deaths, both in the group not receiving induction therapy. Of the surviving 71 patients, 70 had functional reconstructions at last follow-up. The overall 30-day complication rate was 30% (19 of 54) in patients not receiving induction therapy (no bronchopleural fistulas) and 42% (8 of 19) occurring in those receiving induction therapy (1 bronchopleural fistula). The long-term complication rate was 20% (11 of 54) among patients not receiving induction therapy and 5% (1 of 19) among those receiving induction therapy (completion pneumonectomy). There were no bronchovascular complications. Interventional bronchoscopy was required in 7 patients not receiving induction therapy, and was required in none of the patients receiving induction therapy. CONCLUSIONS: Anatomic pulmonary resections utilizing bronchoplastic techniques can be performed with low morbidity and mortality rates even after induction therapy.

Adolescent↗
PubMed2004

A man with saphenous vein graft aneurysms after bypass surgery.

Saphenous vein graft (SVG) aneurysms are a rare complication of coronary artery bypass graft surgery. Patients in whom these aneurysms form a fistula with either a cardiac chamber or mediastinal vessel are even more uncommon and present a difficult diagnostic and therapeutic challenge. We present a patient with SVG aneurysms and a fistula to the left atrium.

Cardiomyopathies↗
PubMed2003

Evaluation of vacuum-assisted closure in the treatment of poststernotomy mediastinitis.

OBJECTIVE: Poststernotomy mediastinitis, although infrequent, is a potentially life-threatening complication of cardiac surgery that continues to have a significant morbidity and mortality despite aggressive therapy. Vacuum-assisted closure uses controlled suction to provide evacuation of wound fluid, decrease bacterial colonization, stimulate granulation tissue, and reduce the need for dressing changes. METHODS: One hundred two patients from Duke University Hospital, The Durham Veterans Administration Hospital, and referring institutions underwent vacuum-assisted closure treatment. There were 63 men and 39 women, with a mean age of 67. The infection was noticed between postoperative days 8 and 34, at which time the wounds were opened and debrided. RESULTS: Ninety-six of the 102 patients received vacuum-assisted therapy while the remaining 6 underwent daily multiple dressing changes without vacuum-assisted therapy. Fifty-three of the 96 patients required only sternal debridement, followed by wound vacuum therapy and closure by secondary intention, while the remaining 43 had an additional procedure. Of these, 33 patients underwent omental transposition and 10 patients had a pectoralis flap. The length of stay for all patients was 27 +/- 12 days. This was related in part to intravenous antibiotics. Hospital mortality for all patients was 3.7% (4 patients). Two of these patients underwent vascular flap and succumbed to multisystemic organ failure, while the other 2 received only wound vacuum therapy following debridement and succumbed to overwhelming sepsis. CONCLUSION: Vacuum-assisted drainage is an effective therapy for mediastinitis following debridement or before placement of a vascularized tissue flap.

Aged↗
PubMed2002

Mitral surgery after prior cardiac operation: port-access versus sternotomy or thoracotomy.

BACKGROUND: In reoperation for mitral valve disease, minimally invasive Port-Access (PORT) is a new alternative to standard median sternotomy (STER) or right thoracotomy (THOR); yet, the results of PORT in this setting have not been defined. The aim of this study was to evaluate the results of minimally invasive thoracotomy in reoperation for mitral valve disease. METHODS: Retrospective results are reported for three consecutive series of patients undergoing reoperation for mitral disease using either PORT (n = 60, 1996 to 2001), THOR (n = 37, 1985 to 1997), or STER (n = 155, 1985 to 1997). RESULTS: Red cell transfusion was 3 +/- 4, 14 +/- 13, and 12 +/- 12 units for PORT, THOR, and STER, respectively. Chest tube output was 352 +/- 361, 2048 +/- 3166, and 1683 +/- 3939 mL, respectively. Cardiopulmonary bypass times for these groups were 208 +/- 76 vs. 158 +/- 56 vs. 157 +/- 53 minutes. Thirty-day mortality was 0/60 (0%), 8/37 (22%), and 21/155 (14%), respectively. CONCLUSIONS: This early clinical experience suggests that PORT is an acceptable alternative to THOR or STERN in reoperation for mitral valve disease, with potential advantages of avoiding redo sternotomy and reducing the surgical incision. However, these benefits may come at the expense of longer cardiopulmonary bypass times.

Cardiac Surgical Procedures↗
PubMed2002

Control of the pleural space after pneumonectomy.

The authors believe that most patients who undergo pneumonectomy do not require drainage of the postpneumonectomy space. Needle or catheter aspiration is simple and usually adequate. In cases in which significant bleeding, rapid pleural fluid accumulation, or contamination is expected, however, drainage of the space is recommended. If drainage is used, the tube probably should be connected to a balanced drainage system to ensure proper physiologic positioning of the mediastinum during the critical immediate postoperative period.

Female↗
PubMed2002

Comparison of port access to sternotomy in tricuspid or mitral/tricuspid operations.

BACKGROUND: Outcomes for a port-access (PA) approach for tricuspid valve operations have not been reported or compared to those using median sternotomy (MS). METHODS: Retrospective analysis was performed for 88 consecutive patients undergoing tricuspid valve repair or replacement using port-access techniques (n = 27, 1997-2000) versus sternotomy (n = 61, 1990-1997). PA procedures were performed through a 6 cm right fourth interspace thoracotomy. RESULTS: PA patients had lower ejection fractions (46% +/- 11% vs. 54% +/- 10%, p = 0.02), but had a similar incidence of previous surgery (17/27 (63%) vs. 33/61 (54%), p = 0.4). PA patients had more frequent concurrent mitral valve operations (22/27 (82%) vs. 37/61 (61%), p <0.05) and more tricuspid repairs versus replacement (24/27 (89%) vs. 29/61 (48%), p <0.01). PA patients had longer pump times (254 min. +/- 82 vs. 162 min. +/- 61, p = 0.001) but comparable clamp times (65 min. +/- 15 vs. 63 min. +/- 41, p = 0.9), lengths of stay (14 days +/- 14 vs. 16 days +/- 16, p = 0.6), mortality (2/27 (7%) vs. 9/61 (15%), p = 0.3), strokes (3/27 (11%) vs. 4/59 (7%), p = 0.9), and need for new pacemaker implantation (5/27 (19%) vs. 12/61 (20%), p = 0.9). CONCLUSIONS: PA provided excellent short-term results comparable to MS in relatively high-risk tricuspid valve patients. For tricuspid operations, PA may have the advantage of avoiding sternotomy or reoperative sternotomy at the expense of longer pump times.

Female↗