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PubMedDate not supplied

Predictors of early post-cardiac transplant exercise capacity.

BACKGROUND: This study was conducted to identify which pre- and perioperative clinical parameters were predictive of predischarge submaximal exercise capacity and early postdischarge maximal exercise capacity in cardiac transplant recipients. METHODS: We studied 24 patients (mean age = 46; 25% African American) who underwent cardiac transplantation followed by an early (immediately posttransplant) postoperative exercise training program. The patients' submaximal exercise capacity was measured at hospital discharge (25 days posttransplant) using the 6-minute distance walk test. Maximal cardiopulmonary exercise testing was done within 4 months of hospital discharge (68 days) to measure peak exercise oxygen consumption (VO2) and to estimate peak exercise capacity as measured by metabolic equivalents (METs). Six clinical variables were assessed for their relationship with predischarge submaximal exercise capacity and 10 clinical variables were evaluated for their relationship with early posttransplant maximal exercise capacity. RESULTS: Predischarge submaximal exercise capacity was correlated with postdischarge estimated METs (r = 0.43; P = 0.04). No predictors of predischarge submaximal exercise capacity were identified. Predictors of estimated peak exercise METs following discharge were younger age, longer time since resolution of rejection, and shorter postoperative hospitalization. Younger age was the only predictor of peak VO2. CONCLUSION: Postoperative physical training may improve exercise capacity early after transplantation and minimize effects of preoperative clinical factors that could negatively affect exercise capacity. Interpretation of these results, however, is limited by the small sample and absence of a nonexercising control group. Older recipients, those with a longer length of hospital stay, and shorter duration of time since resolution of rejection may be at risk of reduced early postoperative maximal exercise capacity. Identification of these predictors is important to maximize early reconditioning efforts and plan outpatient rehabilitation.

Adult↗
PubMed1994

[Pre-operative screening tests for lung cancer using the analysis of expired gas with exercise testing--principally VO2 max/m2].

The analysis of expired gas with exercise testing was conducted preoperatively with lung cancer patients in order to examine the relationship between maximum oxygen consumption (VO2 max) and postoperative complications, determining the cut-off of VO2 max/m2. The usefulness of the test as a preoperative screening test for both pulmonary ventilation and circulation was evaluated in comparison to pulmonary ventilation tests with spirometry and pulmonary circulation tests with Swan-Ganz catheter. Preoperative VO2 max/m2 was calculated from VO2 max in 111 patients with lung cancer who underwent lobectomy of more than one lobe. Also preoperatively conducted were pulmonary ventilation tests by spirometry and pulmonary circulation tests using the Swan-Ganz catheter to measure VC, %VC, FEV1.0, FEV1.0%, mean pulmonary arterial pressure (PPA) and cardiac output coefficient (C.I.). Form theses measurements, VC/m2, FEV1.0/m2 and total pulmonary vascular resistance (TPVR) were calculated. After the cut-off values of VO2 max/m2 were set tentatively at three stages, 600, 650 and 700 ml/min/m2 based on the incidence of postoperative complications, the 111 patients were divided into two groups in each cut-off value; one with VO2 max/m2 greater than the cut-off value and the other less than the cut-off value. Comparison of measurements obtained by spirometry between the two groups disclosed significant differences (p < 0.001) in VC/m2, %VC and FEV1.0/m2 in all cut-off values. Similarly, comparison of measurements obtained using the Swan-Ganz catheter between the two groups yielded significant differences (p < 0.05 to p < 0.01) in PPA and TPVR in all cut-off values.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2003

Evaluation, severity and prognostic significance of silent myocardial ischaemia in vascular patients.

This paper intends to make an update of recent publications and guidelines for evaluation in coronary symptom-free patients undergoing vascular surgery. It emphasizes the role of preoperative clinical evaluation that should identify the most appropriate testing, and treatment strategies to optimize care of the patient and avoid unnecessary testing in this era of cost containment. Selective preoperative coronary artery disease screening and revascularization achieve excellent perioperative and late results after high-risk vascular surgery. Supplemental preoperative evaluation is discussed (exercise ECG, stress echocardiography and stress tomoscintigraphy). Asymptomatic patients with good functional capacity can undergo intermediate-risk surgery without further non-invasive testing. Conversely, further noninvasive testing is often considered for patients with poor functional capacity or moderate functional capacity but higher-risk surgery especially for patients with 2 or more intermediate risk predictors. Additional testing may be considered on an individual basis for patients without clinical markers but with poor functional capacity prior to vascular surgery, particularly those with several minor clinical risk predictors. Because of a higher prevalence of silent myocardial ischaemia in diabetes mellitus, these patients require specific care. Until further data are available, indications for myocardial revascularization in the perioperative setting are similar to those in the ACC/AHA guidelines for use of myocardial revascularization in general. General practitioners, cardiologists, angiologists, vascular surgeons and anaesthesiologists should collaborate and aim to slow down the progression of atherosclerosis by giving their patients an optimum secondary cardiovascular prevention.

Comorbidity↗
PubMed1978

Comparison of SA nodal and subsidiary atrial pacemaker function and location in the dog.

A 3-4 cm length of sulcus terminalis tissue including the sinoatrial node (SAN) was excised from 14 dogs. After an initial junctional rhythm with SAN excision a P wave emerged within days to weeks in 12 animals. Maximum heart rates of the SAN (preoperative) in response to exercise (276 +/- 15 beats/min), isoproterenol infusion in conscious animals (272 +/- 11 beats/min), and stellate stimulation during anesthesia (273 +/- 9 beats/min) were significantly greater than subsidiary pacemakers (postoperatively) for exercise (219 +/- 9 beats/min), isoproterenol (226 +/- 8 beats/min), and stellate stimulation (197 +/- 9 beats/min). During a final experiment, electrophysiological mapping of the area of earliest epicardial activation (pacemaker location) was carried out. By use of a suction electrode in reference to plunge electrodes located in the anterior interatrial band (AIB), eustachian ridge of the coronary sinus, and limbus of the fossa ovalis, the pacemaker was located at the inferior vena cava-inferior right atrial junction in 80% of the animals mapped. During isoproterenol infusion the foci shifted to regions of the AIB in 70% of the animals mapped. The concept of pacemaker hierarchy is discussed.

Animals↗
PubMed2000

[The effects of coronary artery bypass grafting in men under the age of 45].

In Poland young and middle-aged men are a population at risk of premature development of ischemic heart disease (IHD). This prospective study was designed in order to estimate the effects of coronary artery bypass grafting (CABG) on survival and quality of life in this population. 60 men aged (mean&SD) 41 +/- 3.2 years, operated on in 1993 at the Department of Cardiosurgery, Medical University of Lódź, were enrolled into the study. The study protocol included two postoperative follow-up examinations: after 2 and 5 years. A perioperative mortality rate was 3.3%, 2-years survival rate 92% and 5-years one 87%. Asymptomatic survival rates were 75% et 44%, respectively. During the first follow-up examination a significant improvement of exercise performance compared with preoperative period, was observed. However, at the same time there was no improvement in left ventricular function, measured as its ejection fraction in echocardiography. The effects of CABG procedure on risk factors control, medical treatment and professional activity were also analysed. The long-term results of CABG operations in young men, as far as survival rates are concerned, are good. However, the longer follow-up period was analysed the less beneficial influence of the operations on patients' clinical state and quality of life was observed.

Adult↗
PubMed2003

[New blood transfusion system of the Saku Central Hospital--present conditions and problems].

BACKGROUND: It is important for a hospital to have a well organized blood transfusion service. METHODS: Our hospital adopted the maximum surgical blood order schedule (MSBOS) and type and screen (T & S) systems in April 1999 and opened a division of transfusion therapy, thus introducing an integrated control system for blood transfusion. RESULTS: In the year (2002), the crossmatch-to-transfusion (C/T) ratio has dropped from 3.94 to 2.01, and the volume of blood transported outside the central operating room and that of waste blood have decreased. CONCLUSIONS: The new systems are instrumental in saving preoperatively prepared blood and exercising its qualitative control. From now on, our task is to improve measures to cope with cases of transfusion in excess of MSBOS and reevaluate MSBOS on a regular basis.

Blood Grouping and Crossmatching↗
PubMed1994

[Autotransfusion with leap-frog technique in patients with coronary heart disease and planned aortocoronary venous bypass].

OBJECTIVE: The goal of the study is to test and control the quality of a special leap-frog technique which enables saving heterologous blood. DESIGN: In a randomized double-blind placebo-controlled study homologous blood was taken in 40 out of 100 patients with coronary heart disease before aortocoronary bypass operation. The leap-frog technique was used. Within 8 weeks 3-4 erythrocyte concentrates and 0.9-1.2 liters plasma were sampled. The volume (verum: HES 200/0.5 10%; placebo: 0.9% NaCl solution) substituted corresponding to the volume of blood donated. Each patient received 200 mg Fe2+/day p.o. RESULTS: Clinically, only patients treated with HES in stage of autologous blood sampling benefited significantly. Two patients showed adverse effects. The peri- and postoperative course was comparable. In the NaCl group one of the patients received homologous erythrocyte concentrates. None of the patients died pre-, peri- or post-operatively. CONCLUSIONS: 40% of the cardiosurgical patients could be considered for autologous blood donation. Isovolemic hemodilution with HES 200/0.5 10% was a suitable and safe measure in preoperative blood sampling. Physical exercise should be performed before and after autologous blood donation. A reduced exercise tolerance suggests that autologous blood donation should be stopped.

Adult↗
PubMed1993

[Experience with the Ender hooked plate in the management of 42 scaphoid pseudarthroses].

To treat the pseudarthrosis of scaphoid, there exist many operative procedures. We describe the method of H. G. Ender: A hook plate fixes the main bone fragments and exerts a pressure on the in-between lying bone transplant. We report on 42 patients operated on using the Ender-plate. In 39 cases a follow-up was possible. 95% of the patients had a consolidation of the bone, in two cases a further operation was required. 36 patients complained preoperatively of pain during exercise and only seven patients had the same complaints after the operation. In some cases, a minor reduction of the motion had to be taken into account to achieve painfree movement.

Adult↗
PubMed1994

[Autotransfusion using the bocksprung technique in patients with coronary heart disease and coronary artery bypass grafting].

Clinically, only patients treated with HES in stage of autologous blood sampling benefited significantly. Two patients showed adverse effects. The peri- and postoperative course was comparable. In the NaCl group one of the patients received homologous erythrocyte concentrates. None of the patients died pre-, peri- or postoperatively. 40% of the cardiosurgical patients could be considered for autologous blood donation. Isovolemic hemodilution with HES 200/0.5 10% was a suitable and safe measure in preoperative blood sampling. Physical exercise test should be performed before and after autologous blood donation. A reduced exercise tolerance suggests to stop autologous blood donation.

Blood Banks↗
PubMed1976

Four years' experience of valve replacement with the Björk-Shiley tilting-disc prosthesis.

105 valve replacements with the Björk-Shiley tilting-disc prosthesis have been performed in 99 patients with an overall mortality of 12%. The hospital mortality for 73 single aortic valve replacements was 10%, for 24 single mitral valve replacements 13%, and for 5 double valve operations 20%. One late death (1%) occurred in a case with single aortic valve replacement. The follow-up period of the first patients with aortic valve replacement is 4 1/2 years, and that of those with mitral valve replacement over 2 1/2 years. The most common late complication in patients with mitral valve replacement was a paravalvular leak (19%), whereas in patients with aortic valve replacement slight haemolytic anaemia (4%) and late thromboembolism (3%) occurred most frequently. 84 of the 87 survivors showed manifest clinical improvement in their preoperative status and increased exercise tolerance.

Adolescent↗
PubMed2006

Effect of lung resection on exercise capacity and on carbon monoxide diffusing capacity during exercise.

OBJECTIVE: To evaluate the effect of lung resection on lung function and exercise capacity values, including diffusion capacity of the lung for carbon monoxide (Dlco), during exercise, and to determine whether postoperative lung function, including exercise capacity and Dlco during exercise, could be predicted from preoperative lung function and the number of functional segments resected. DESIGN: Prospective study. SETTING: Clinical pulmonary function laboratory in a university teaching hospital. PATIENTS: Twenty-eight patients undergoing lung resection at Vancouver General Hospital from October 1998 to May 1999, were studied preoperatively and 1-year postoperatively. INTERVENTIONS: We determined FEV(1) and FVC, and maximal oxygen uptake (Vo(2)max) and maximal workload (Wmax) achieved during incremental exercise testing. We used the three-equation modification of the single-breath Dlco technique to determine Dlco at rest (RDlco) and during steady-state exercise at 70% of Wmax, and the increase in Dlco from rest to exercise (ie, the mean increase in Dlco percent predicted at 70% of Wmax from resting Dlco percent predicted [(70%-R)Dlco]). We calculated the predicted postoperative (PPO) values for all the above parameters using the preoperative test data and the extent of functioning bronchopulmonary segments resected, and compared the results with the actual 1-year postoperative results. RESULTS: Following lung resection, there was a significant reduction in FEV(1), FVC, and Dlco with decreases of 12%, 13%, and 22% predicted, respectively. There were also significant decreases in Vo(2)max per kilogram of 2.1 mL/min/kg (8% of predicted Vo(2)max) and in Wmax of 12 W (7% of predicted Wmax). However, (70%-R)Dlco did not significantly decrease after lobectomy but decreased after pneumonectomy. The calculated PPO values significantly underestimated postoperative values after pneumonectomy but were acceptable for lobectomy. CONCLUSIONS: Exercise tests may be better indicators of functional capacity after lung resection than measurements of FEV(1) and FVC or RDlco. PPO results calculated by estimating the functional contribution of the resected segments, are comparable with those obtained using ventilation-perfusion lung scanning and significantly underestimate postoperative lung function after pneumonectomy, but are acceptable for lobectomy.

Aged↗
PubMed1985

Prognostic significance of exercise-induced left ventricular dysfunction in chronic aortic regurgitation.

Twenty-three patients with hemodynamically significant aortic regurgitation (AR) underwent gated equilibrium radionuclide angiography to assess rest and exercise left ventricular ejection fraction (LVEF) before and after aortic valve replacement. Preoperatively, LVEF decreased from 54 +/- 3% at rest to 45 +/- 3% during exercise (p less than 0.001). Two patients died at operation. Postoperatively, after 5.7 +/- 1.6 months, LVEF was 62 +/- 5% at rest and 60 +/- 4% during exercise (difference not significant). Exercise LVEF improved significantly postoperatively (p less than 0.01). The patients were followed for a mean of 30 months (range 1 to 56), after valve replacement and during this period, 13 patients were in functional class I, 5 patients were in class II and 2 patients were in class III. One late death occurred and was unrelated to myocardial failure. Thus, in most patients with AR, exercise LVEF improves after aortic valve replacement. A preoperative decrease in LVEF during exercise in patients with significant AR does not predict a poor postoperative outcome.

Adult↗
PubMed1978

Hemodynamic evaluation of the Ionescu-Shiley pericardial xenograft in the mitral position.

Hemodynamic studies were performed in 27 patients at a mean interval of 40.3 (range 24 to 59) months following mitral valve replacement with pericardial xenografts. Six patients had sequential studies, one before operation and two separate investigations at mean intervals of 11.2 and 42.8 months following valve replacement. The results showed significant increase in cardiac index, reduction in mean pulmonary artery and wedge pressures, and decrease in pulmonary vascular resistance both at rest and during exercise, when compared with the preoperative values. The mean diastolic gradient across the pericardial xenografts was 6.4 mm. Hg at rest and 15.3 mm. Hg during exercise. The calculated xenograft surface area was 2.0 and 2.3 cm.2, respectively. The sequential studies established that the maximum hemodynamic improvement was achieved within the first year following valve replacement and that the functional performance of the xenografts was maintained, unaltered, with the passage of time.

Adult↗
PubMed1997

Cardiorespiratory response to exercise after modified Fontan operation: determinants of performance.

OBJECTIVES: This study sought to measure the cardiorespiratory responses to exercise and to identify the perioperative determinants of exercise performance in children, adolescents and young adults who underwent the modified Fontan operation. BACKGROUND: Several studies of the cardiorespiratory responses to exercise after the Fontan operation have demonstrated subnormal maximal oxygen uptake and exercise heart rate, but the perioperative variables that ultimately affect exercise responses have not been assessed systematically. METHODS: The study included 59 of the 548 patients who underwent a modified Fontan operation between January 1, 1984 and December 31, 1993 at the Mayo Clinic. Spirometry was performed at rest in all patients before exercise testing. The patients then exercised using a previously calibrated cycle ergometer and a 3-min incremental cycle exercise protocol. Multiple linear regression analysis was used to determine a subset of variables associated with oxygen uptake at peak exercise (VO2max), blood oxygen saturation (O2sat) and heart rate at peak exercise (HRmax). RESULTS: VO2max ranged from 29% to 95% of normal value; O2sat at peak exercise ranged from 77% to 96%; and HRmax ranged from 39.7% to 97.4% of normal value. Multivariate analysis showed that log VO2max/kg2/3 was associated with age at exercise, male gender, body surface area, preoperative confluent pulmonary arteries and rest VO2max/kg2/3. Preoperative left pulmonary artery stenosis, the presence of a classic Glenn anastomosis at exercise and rest O2sat were associated with O2sat at peak exercise. Age, body surface area at exercise, heart rate at rest and diastolic blood pressure were associated with HRmax at exercise. CONCLUSIONS: Subnormal VO2max and HRmax values were demonstrated at peak exercise. Several perioperative variables were associated with VO2max and O2sat at peak exercise. The presence of a classic Glenn anastomosis was associated with decreased O2sat at peak exercise, suggesting intrapulmonary shunting with the classic Glenn anastomosis.

Adolescent↗
PubMed1976

[The effects of preoperative treatment and physical training to operability in patients with bronchial carcinomas (author's transl)].

Training effects of preoperative treatment, especially of breathing exercises in 52 patients with bronchial carcinoma were controlled by bodyplethysmography, measurements of the thoracic and abdominal circumferences in inspiration and expiration before and after the training program. In patients with obstructive ventilation disorders the expiratory resistance came to be reduced significantly. The mobility of the thoracic wall and of diaphragm increased in all patient-groups, but not in patients with restrictive ventilation disorders. After introducing the complex program the complication rate seems to drop to half of the previous rate.

Adolescent↗
PubMed1985

Failure of alpha-methyltyrosine to prevent hypertensive crisis in pheochromocytoma.

Sudden onset of a hypertensive crisis occurred shortly after induction of anesthesia in a patient with malignant pheochromocytoma, despite preoperative medical preparation with alpha-methyltyrosine (alpha-methyl-p-tyrosine) and propranolol hydrochloride. Other investigators have advocated alpha-methyltyrosine as the medical therapy of choice in the preoperative preparation of patients with pheochromocytoma. This case emphasizes the caution that should be exercised when using alpha-methyltyrosine preoperatively, without concurrent alpha-adrenergic blocking agents, to prevent intraoperative hypertensive crisis.

Adrenal Gland Neoplasms↗
PubMed1985

Detection of coronary artery disease by means of exercise ECG in patients with aortic stenosis.

In a preoperative evaluation, 35 consecutive patients with aortic stenosis were examined by means of exercise ECG, Doppler and direct manometric measurements of the pressure difference over the aortic valve (delta P) and angiocardiography. Coronary artery disease (CAD) was found in 43% of the patients. Those with CAD had a lower mean maximum physical performance expressed as a percentage of the normal value (Wmax%), larger ST depressions and a higher effort angina (EA) score at the exercise test than the non-CAD group. Mean delta P was equal in the two groups. A myocardial coronary obstruction score covariated positively with a coronary insufficiency index (CT index = 100 X STdepr/Wmax%) and the EA score. There was no correlation between delta P and the EA score or the CI index. A CI index less than 3 and an EA score less than 2 were found in 49% of the patients and excluded the presence of CAD with a predictive accuracy of 88%, a better diagnostic complement to coronary arteriography than a history of EA.

Aged↗