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PubMed · 1083230

Left ventricular aneurysmectomy.

J D Marco·G C Kaiser·H E Barner·J E Codd·V L Willman
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Abstract

Comparison of preoperative and postoperative studies in 81 patients undergoing left ventricular aneurysmectomy failed to show consistent hemodynamic trends. The most reliable prognostic indicator for survival (84% early, 71% late) was the function of the basilar ventricular segments. In 62 of the 81 patients, there was concomitant aortocoronary bypass grafting. Eighty-eight percent of the surviving patients are essentially free of symptoms. These findings support the continued surgical treatment of ventricular aneurysm in symptomatic patients, and suggest nonoperative treatment for patients who are asymptomatic.

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Coronary Artery BypassFemaleHeart AneurysmHeart FailureHeart VentriclesHemodynamicsHumansMaleMyocardial InfarctionPostoperative ComplicationsPrognosisJournal ArticleResearch Support, U.S. Gov't, P.H.S.

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J D Marco, G C Kaiser, H E Barner, J E Codd, V L Willman. 1976. Left ventricular aneurysmectomy.. https://doi.org/10.1001/archsurg.1976.01360220115019

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Enrollment in the Health Alliance Plan HMO is not an independent risk factor for coronary artery bypass graft surgery.

BACKGROUND: Henry Ford Hospital is the sole provider of cardiac surgical services for the Health Alliance Plan, a health maintenance organization (HMO) that presently serves 450,000 enrollees. METHODS AND RESULTS: To determine the effect of managed care referral patterns on the outcome of coronary artery bypass graft (CABG) surgery, we retrospectively reviewed two concurrent groups of patients, 569 HMO patients and 225 patients with free-for-service (FFS) insurance, who had undergone isolated primary CABG surgery between January 1, 1990 and January 31, 1994. The 605 patients with Medicare operated on during the same time frame were excluded to obviate age bias. Age, sex, use of cardiac medications, history of prior percutaneous transluminal coronary angioplasty or thrombolytic therapy, history of recent and remote myocardial infarction, extent of coronary disease, presence of preexisting comorbid conditions, and incidence of unstable clinical syndromes and left ventricular dysfunction (ejection fraction < 40%) were comparable for both groups. In hospital mortality (HMO group, 1.9%; FFS group, 2.2%), mean ICU stay (HMO, 2.6 +/- 0.3 days; FFS, 2.3 +/- 0.3 days), and total hospital length of stay (HMO, 9.8 +/- 0.8 days; FFS, 8.6 +/- 0.6 days) were likewise similar. CONCLUSIONS: These data refute the notion that the gate-keeper mentality often associated with managed-care health insurance vehicles results in delayed referral of patients with coronary artery disease and results in suboptimal outcome.

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