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Y Moshkovitz

Publications and source records attributed to Y Moshkovitz.

29 records · Page 2Linked to original sources
PubMed1995

Coronary artery bypass without cardiopulmonary bypass: analysis of short-term and mid-term outcome in 220 patients.

Two hundred twenty patients, preferentially those with high-risk conditions, underwent coronary artery bypass grafting without cardiopulmonary bypass. Early unfavorable outcome events included operative mortality (7 patients, 3.2%), nonfatal perioperative myocardial infarction (6 patients, 2.7%), cerebrovascular accident (1 patient, 0.4%), and sternal infection (3 patients, 1.4%). There were two deaths (13%) among 15 patients with calcified aorta and four (12%) in 33 patients who underwent emergency operation. Multivariate analysis revealed these two risk factors to be the only predictors of early mortality (odds ratios, 8.0 and 9.8, respectively). Preoperative risk factors such as left ventricular dysfunction (ejection fraction < or = 35%) (40 patients, 18%), congestive heart failure (46 patients, 21%), acute myocardial infarction (59 patients, 27%), cardiogenic shock (7 patients, 3%), age 70 years or older (59 patients, 27%), renal failure (19 patients, 9%), and cerebrovascular accident and carotid disease (11 patients, 5%) were not found to be major predictors of early mortality or unfavorable outcome. During 12 months of follow-up (range 1 to 21 months), there were four cardiac and three noncardiac deaths (1-year actuarial survival 93%) and 17 cases (7.7%) of early return of angina. Calcified aorta, nonuse of the internal mammary artery, reoperation, and diabetes mellitus were independent predictors of unfavorable events. We conclude that coronary artery bypass grafting without cardiopulmonary bypass can be done with relatively low operative mortality, although there seems to be an increased risk for early return of angina. This procedure should therefore be considered for patients with appropriate coronary anatomy, in whom cardiopulmonary bypass poses a high risk. This procedure is still hazardous with calcified aorta or emergency operation.

Adult↗
PubMed1995

[Coronary artery bypass without extra corporeal circulation].

240 patients underwent coronary artery bypass grafting (CABG) without extracorporeal circulation (ECC). Mean grafts per patient was 1.9 (range 1-5). The internal mammary artery (IMA) was used in 210 cases (87%), but in only 53 (22%) were there grafts to the circumflex marginals. Unfavorable results included an operative mortality of 7 cases (2.9%), nonfatal perioperative myocardial infarction (MI) (2.5%), stroke (0.4%), and sternal infection (1.7%). There were 2 deaths among 17 patients (12%) with calcified aorta, and 4 among 40 (10%) who underwent emergency operation. Multivariate analysis showed these 2 risk factors to be the only predictors of early mortality: emergency operation odds ratio 9.8, and calcified aorta odds ratio 8.0. Perioperative risk factors that were not major predictors of early mortality or unfavorable outcome included left ventricular dysfunction (EF < 35%: 52 patients, 22%), congestive heart failure (53, 22%), cardiogenic shock (8, 3%), acute MI (67, 28%), age > 70 years (64, 27%), renal failure (22, 9%), and stroke or carotid disease (12, 5%). Followup ranged from 1-31 months (mean 12). There were 9 late deaths (4 cardiac), and 18 cases (7.5%) of early return of angina. 1-year actuarial survival was 92%; 192 patients (80%) had uneventful outcomes and are doing well. Calcified aorta, nonuse of the IMA, reoperation, and diabetes mellitus were independent predictors of unfavorable events. We conclude that CABG without ECC can be performed with relatively low operative mortality, but there seems to be increased risk of early return of angina. It should therefore be considered for those patients with appropriate coronary anatomy in whom ECC poses a very high risk. However, it is still a hazardous procedure when used as as an emergency operation, and for cases with calcified aorta.

Aortic Diseases↗
PubMed1994

Coronary artery by-pass without cardiopulmonary by-pass for patients with severe left ventricular dysfunction.

OBJECTIVES: To evaluate results of coronary artery bypass grafting (CABG) without cardiopulmonary by-pass (CPB) for patients with severe left ventricular dysfunction. MATERIALS AND METHODS: Fifty-three patients with severe LV dysfunction (EF < 35%) underwent CABG without cardiopulmonary by-pass (CPB) between December 1991 and December 1993. They comprise 22% of 242 patients operated on without CPB by one of the authors (RM) in this period. There were 45 (85%) males and eight (15%) females. Twelve (23%) patients were over 70 years. Nine (17%) were re-do CABG. Ten (19%) were referred for operation within the first 24 hours of evolving MI, and 13 (25%) up to two weeks after acute MI. Nine (17%) had preoperative EF < 20%, and six patients (11%) were in cardiogenic shock. Mean number of grafts/pt was 1.8 and IMA was used in 41 (77%). Only 14 patients (26%) received a graft to a circumflex marginal artery. Ischemic time was 8 +/- 4 min/graft (mean +/- SD) when anastomosed to the LAD or RCA, and 14 +/- 7 min/graft when anastomosed to a marginal branch. RESULTS: One patient (1.9%) died perioperatively, and two (3.7%) suffered a non-fatal MI. At two-year follow-up there were three late deaths, one of them from cancer. Three patients had return of angina, two of them were reoperated upon. CONCLUSIONS: These results suggest that CABG without CPB may be advantageous for patients with severe LV dysfunction.

Adult↗
PubMed1994

Coronary by-pass reoperations without cardiopulmonary by-pass: the Israeli experience.

OBJECTIVES: To evaluate results of coronary artery by-pass grafting (CABG) reoperations without cardiopulmonary by-pass (CPB). MATERIALS AND METHODS: Thirty-two patients underwent CABG reoperation with CPB between December 1991 and December 1993. There were 29 (91%) males, and 3 (9%) females. Mean age was 62 +/- 7 years. Five (16%) were operated on emergently, two (6%) of them during cardiogenic shock. Three (9%) were referred for operation up to two weeks following acute MI. Six (19%) had preoperative EF < 35%. Significant associated systemic diseases included previous CVA in two patients (6%), calcified aorta in two (6%), peripheral vascular disease in six (19%), renal failure in one (3%), and severe COPD in one (3%). Mean number of grafts/pt was 1.5 (range 1-3), and IMA was used in 26 (81%) of patients. Only nine patients (28%) received a graft to a circumflex marginal artery, six (66%) of whom were operated on through left thoracotomy. RESULTS: Only two patients (6%) had low output syndrome postoperatively; one was supported with catecholamines, and the other with intraaortic balloon pump. Hospital stay was 6.1 +/- 1.5 days (mean +/- SD). Early unfavorable outcome included operative death in one patient (3.1%), non-fatal MI in two (6%), and sternal infection in one (3%). Follow-up (10 +/- 5 months, mean +/- SD) showed two late deaths (one cardiac, and one carcinoma), one (3%) non-fatal MI, and return of angina in three (9%) patients. CONCLUSIONS: CABG reoperations without CPB should be considered, particularly for revascularization of the LAD and RCA systems. Left thoracotomy is optional for patients with disease confined to circumflex and LAD systems.

Aged↗
PubMed1993

Infarct site-related mortality in patients with recurrent myocardial infarction. SPRINT Study Group.

PURPOSE: The purpose of this study was to determine the effect of acute and old myocardial infarction (MI) sites on early (15 days) mortality in patients with a second MI. PATIENTS AND METHODS: Data are derived from the SPRINT 2 study population that included 1,161 consecutive patients with acute MI, aged 50 to 79 years, recruited from 14 coronary care units in Israel between November 1985 and July 1986. Two hundred twenty-six of these patients (19.5%) had a previous MI prior to the index acute MI. Sixty-two patients were excluded from the analysis either because the MI site was not of anterior or inferior location, or because of incomplete data. In the 164 (73%) remaining patients, acute and old MI locations were determined to be either anterior or inferior and were accordingly divided into 4 groups: acute anterior-old anterior (Group 1-23 patients); acute anterior-old inferior (Group 2-86 patients); acute inferior-old anterior (Group 3-34 patients); acute inferior-old inferior (Group 4-21 patients). RESULTS: Significant differences in clinical parameters among the four groups included a higher proportion of Q-wave MI (p = 0.04), severe congestive heart failure during admission (p = 0.04), and markedly elevated serum lactate dehydrogenase levels (p = 0.05) in Group 3. High-degree atrioventricular block (p = 0.001) and cardiogenic shock (p = 0.05) also developed more often in this group during hospitalization. Twenty-three patients (14%) died within 15 days. Death rates in the acute anterior (Group 1 plus Group 2) and the acute inferior (Group 3 plus Group 4) groups were 11% versus 20%, respectively (NS). However, death rate variability across the four groups was statistically significant (p = 0.018), with the highest mortality observed in Group 3 (old anterior-acute inferior MI-29%). Multivariate analysis identified acute inferior MI following old anterior MI as a strong independent predictor of early death (relative odds vis-à-vis other combinations 5.0, 95% confidence interval 1.5 to 16.6). CONCLUSION: This study identifies a subgroup of patients with acute inferior MI at high risk for early mortality. It is possible that such patients would benefit from early reperfusion therapy.

Aged↗
PubMed1993

Arterial embolization in the treatment of Curling's ulcer bleeding in a burn patient.

Curling's ulcer bleeding is a well-known life-threatening complication of the severely thermally injured patient. This report describes a successful left gastric artery embolization in a 70 per cent total body area burn patient with severe gastric bleeding. We discuss the various non-surgical invasive modalities for treating such patients, and emphasize the advantages of arterial embolization over surgery.

Adult↗
PubMed1993

Tricuspid valve surgery: recent experience at the Chaim Sheba Medical Center.

From 1 January 1989 to 30 June 1992, 35 patients underwent cardiac surgery that included a tricuspid valve (TV) procedure. All had severe TV dysfunction documented by echocardiography, and were in NYHA functional class III-IV. The etiology of TV dysfunction was rheumatic-functional in 19 patients, rheumatic-organic in 13, and infective in 3. Nineteen (54%) had had at least one previous cardiac operation, and in 29 an associated procedure (MVR, AVR, DVR, DVR + CABG) had been performed. The TV was repaired in 27 patients, was replaced by a bioprosthesis in 7, and was excised in 1. There were three (8.6%) operative and two late deaths. Except for two, all surviving patients are in NYHA functional class I-II. In two patients with organic lesions who underwent repair, residual moderate tricuspid regurgitation was observed. We conclude that in these critically ill patients TV surgery can be performed with acceptable results. Long-term fate of a bioprosthesis in the tricuspid position is yet to be determined.

Adult↗
PubMed1992

Fresh blood units contain large potent platelets that improve hemostasis after open heart operations.

Twenty units of fresh whole blood were separated into fresh packed red blood cells (PC) and platelet-rich plasma (PRP) and were transfused to 40 patients immediately after coronary bypass grafting. Patients were preoperatively randomized to receive either PRP (group A, 20 patients) or PC (group B, 20 patients). Platelet number in the PRP group was greater, but not significantly greater, than in the PC group (7.5 +/- 3 versus 5.9 +/- 2.2 x 10(10); p = not significant). However, mean platelet volume in the PC group was significantly greater (8.75 +/- 1.1 versus 6 +/- 0.7 fL). Postoperatively, group A patients bled more than group B (566 +/- 164 versus 327 +/- 41 mL; p less than 0.01) and received more red blood cell units (2.7 +/- 1.2 versus 1.6 +/- 0.7 U; p less than 0.05) and a larger number of blood products (5.9 +/- 3.7 versus 2.6 +/- 1.2 U; p less than 0.05). Transfusion of PRP to group A increased platelet count from 128 +/- 20 to 148 +/- 110 x 10(9)/L; however, platelet functions did not improve. Administration of PC to group B increased platelet count from 139 +/- 22 to 156 +/- 23 x 10(9)/L, improved platelet aggregation (with collagen from 33% +/- 20% to 53% +/- 23%, with epinephrine from 36% +/- 24% to 51% +/- 20%; p less than 0.05), and corrected the prolonged bleeding time. The results suggest that the improved hemostasis observed after fresh whole blood administration is related to the large, potent platelets that remained in the PC and were not separated to the PRP during standard platelet concentrate preparation.

Blood↗
PubMedDate not supplied

Prognostic significance of infarction location in patients with recurrent myocardial infarction. SPRINT Study Group. Secondary Prevention Reinfarction Israel Nifedipine Trial.

This study assesses the impact of infarct location on immediate (in-hospital) and 1- and 5-year mortality among patients with reinfarction during the year following discharge from the initial episode of myocardial infarction. The analysis included 192 patients with a second myocardial infarction who were compared in four infarction location groups. The in-hospital mortality associated with reinfarction was higher in patients with a second anterior (32%) than with a second inferior (18%) location, irrespective of the first infarction location (p = 0.03). At 5 years of follow-up, the mortality (65%) tended to be higher in patients with a first anterior-second anterior infarction as compared with patients with all other combinations of location.

Age Factors↗