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At least 613 records · Page 34Linked to original sources
PubMed1984

Long-term results of coronary surgery.

Coronary angiography was performed in a total of 3,696 patients at the Institute for Clinical and Experimental Medicine from 1971 to 1980. From this number 720 were in the subsequent period treated surgically for ischaemic heart disease (IHD). In the majority of them myocardial revascularization was performed using saphenous vein aortocoronary bypass graft and in 7% resection of left ventricular aneurysm was carried out, either separately or together with the aortocoronary bypass. The remaining patients with IHD were treated medically. All patients were followed up for a period ranging from 1 to 10 years (mean 50 months). In most of the patients there was symptomatic improvement and increased tolerance of physical exercise. Among patients with double- and triple-vessel disease there was higher survival in those treated surgically. There was no difference in survival between surgically and medically treated patients with single-vessel disease and patients after aneurysmectomy. Neither was there a marked difference in survival symptoms, exercise tolerance and the occurrence of postoperative myocardial infarction between patients with preoperative MI and those without it. No influence was found of surgical treatment of IHD on the occurrence of sudden death.

Adult↗
PubMed1997

[Cardiomyopexy--current status of an indirect revascularization method].

From May 1993 to September 1995, six patients underwent a new myocardial revascularization procedure. These patients were not suitable for direct coronary artery surgery due to diffuse and peripheral coronary stenosis and severe angina pectoris (NYHA classes III-IV). Thus, indirect myocardial revascularization or cardiomyopexy was performed. This consists in the grafting of a free skeletal muscle flap onto the ischemic heart. After harvesting the musculus latissimus dorsi as a free flap, the graft was transplanted onto the heart. The arterial stump of the muscle flap artery was implanted directly into the aorta, venous flow was drained into the right atrium. There to four weeks after the intervention the patients were free from angina. Ischemic ST-segment changes appearing preoperatively at 50 W disappeared 8 weeks later even at a higher exercise tolerance. The two patients that underwent the intervention in 1993 and 1994 are still free from angina. In the present work experimental and clinical experiences with indirect myocardial revascularization are summarized and discussed.

Angina Pectoris↗
PubMed2002

A comprehensive study of patients with surgically treated lumbar spinal stenosis with neurogenic claudication.

BACKGROUND: The relationship between objective measurements and subjective symptoms of patients with spinal stenosis and the degree of narrowing of the spinal canal is not clear. The purpose of this study was to evaluate patients undergoing surgery for lumbar spinal stenosis and intermittent neurogenic claudication with functional testing, quantitative imaging, and patient self-assessment. METHODS: Sixty-two patients with lumbar spinal stenosis and neurogenic claudication were prospectively enrolled in the study. All underwent preoperative magnetic resonance imaging and/or computed tomography myelography, and all were treated with decompressive surgery and were followed for a minimum of two years. The evaluation included treadmill and bicycle exercise tests as well as patient self-assessment with use of the Oswestry Disability Index and a visual analog pain scale preoperatively and postoperatively. RESULTS: Preoperatively fifty-eight (94%) of the patients had a positive result (provocation of symptoms) on the treadmill test and twenty-seven (44%) had a positive result on the bicycle test, whereas postoperatively six and twelve, respectively, had positive results. The mean preoperative scores on the Oswestry Disability Index and visual analog pain scale were 58.4 and 7.1, respectively. Postoperatively, these scores decreased to 21.1 and 2.3, respectively, and both decreases were significant (p < 0.05). Forty-seven (76%) of the patients were seen to have central stenosis on the preoperative imaging studies; forty-one of them had a cross-sectional area of the dural tube of <100 mm (2) at at least one level and twelve had a cross-sectional area of <100 mm (2) at at least two levels. CONCLUSIONS: A positive treadmill test was consistent with a diagnosis of spinal stenosis and neurogenic claudication in >90% of the patients preoperatively. Following surgical decompression of the lumbar spinal stenosis, more functional improvement was demonstrated by the treadmill test than by the bicycle test. The scores on the Oswestry Disability Index and visual analog pain scale also improved postoperatively. The severity of central canal narrowing at a single level does not appear to limit the postoperative improvement in either functional ability or patient self-assessment. Patients with multilevel central stenosis were, on the average, older and walked a shorter distance preoperatively and postoperatively, although the improvement in their postoperative self-assessment scores was similar to that of patients with single-level stenosis.

Aged↗
PubMed1999

Prognostication in 3-vessel coronary artery disease based on left ventricular ejection fraction during exercise : influence of coronary artery bypass grafting.

BACKGROUND: Previous data indicate that left ventricular ejection fraction (LVEF) provides prognostic information among patients with coronary artery disease (CAD), but the value of such testing specifically for defining benefits of coronary artery bypass grafting (CABG) may relate to severity of exercise-inducible ischemia measured noninvasively before surgery. METHODS AND RESULTS: To determine the independent prognostic importance of preoperative ischemia severity for predicting outcomes of CABG among patients with extensive CAD, we monitored 167 stable patients with angiographically documented 3-vessel CAD (average follow-up of 9 years in event-free patients) who previously had undergone rest and exercise radionuclide cineangiography. Their course was correlated with data obtained during initial radionuclide testing, coronary arteriography, and clinical evaluation at study entry. Fifty-two patients received medical treatment only, and 115 underwent CABG (44 early [</=1 month after initial study]). Multivariate Cox model analysis indicated that change (Delta) in LVEF from rest to exercise during radionuclide study was the strongest independent predictor of major cardiac events (P=0.003) before surgery and also predicted magnitude of CABG benefit (P=0.04). Patients with DeltaLVEF -8% or less derived significant survival-prolonging and event-reducing benefit from CABG performed </=1 month after initial testing (P<0.02 for cardiac death and P=0.008 for cardiac events], early CABG versus medical-treatment-only patients); similar benefits were absent among patients with DeltaLVEF more than -8%, and among those in whom CABG was deferred. CONCLUSIONS: Assessment of ischemia severity based on LVEF response to exercise enables effective prognostication among patients with 3-vessel CAD and defines the likelihood of life-prolonging and event-reducing benefits from CABG.

Aged↗
PubMed1994

Exercise cardiorespiratory function before and one year after operation for pectus excavatum.

In 35 patients with pectus excavatum (aged 17.9 +/- 5.6 years) pulmonary function and maximal exercise test results were compared before and at 1 year after operation. The lower posteroanterior chest diameter on the lateral x-ray film was significantly smaller than normal (p < 0.0001) and increased significantly after operation (p < 0.0001). Preoperatively, total lung capacity (86.0% +/- 14.4%; p = 0.0001) and inspiratory vital capacity (79.7% +/- 16.2; p = 0.0001) were significantly smaller than predicted and further decreased after operation (-9.2% +/- 9.2%; p = 0.0001 and -6.6% +/- 10.7%; p = 0.0012, respectively). Arterial blood gas values displayed normal patterns with increasing exercise both before and after operation. Only the arterial pH decreased more after operation than before (p = 0.0026). After operation there was a significant increase in maximal oxygen uptake (oxygen uptake; p = 0.0002 and oxygen uptake per kilogram; p = 0.0025) and oxygen pulse (oxygen uptake/heart rate approximates an indirect parameter for stroke volume; p = 0.0333) during exercise, whereas the maximal work performed was unchanged. Efficiency of breathing (ratio of tidal volume/inspiratory vital capacity) at maximal exercise improved significantly after operation (p = 0.0005). Ventilatory limitation of exercise (defined by an increase in carbon dioxide tension during exercise) was found in 43.9% of the patients before operation. A tendency of improvement was noted (not significant) after operation (difference in carbon dioxide tension 0.6 +/- 0.4 kPa before versus 0.3 +/- 0.5 kPa after operation). However, the group with normal preoperative carbon dioxide elimination had a ventilatory limitation of exercise after operation (difference in carbon dioxide tension -0.4 +/- 0.3 kPa before versus -0.1 +/- 0.3 kPa after operation; p = 0.0128) with a significant increase in oxygen consumption (p = 0.0007). In conclusion the subjective physical improvement after operation is not explained by changes in cardiorespiratory function at exercise. The data suggest a higher work of breathing after operation.

Adolescent↗
PubMed1987

Use of radionuclide scanning in the preoperative estimation of pulmonary function after pneumonectomy.

Twenty eight patients with bronchial carcinoma were studied before pneumonectomy. Measurement of spirometric indices, static lung volumes, transfer factor (TLCO), and transfer coefficient (KCO) was undertaken before and four months after pneumonectomy. Fourteen of the patients also performed a symptom limited progressive exercise test on a cycle ergometer before and four months after pneumonectomy. All patients had standard xenon-133 ventilation and technetium-99m perfusion scans performed before operation. Eleven patients had krypton-81m ventilation scans in addition. Significant correlations were seen between changes in FEV1, TLCO and KCO and the preoperative function of the resected lung as determined by percentage preoperative perfusion to that lung (p less than 0.001). There were mean decreases in FEV1 of 22% and in vital capacity (VC) of 28.7% predicted. Estimation of postoperative FEV1 from the preoperative values showed equally good agreement with measured postoperative values whether 99mTc perfusion or 81mKr ventilation scans were used in the 11 patients in whom both scans were available. Significant correlations were seen between change in maximum exercise ventilation (VEmax) or maximum oxygen uptake (VO2max) after pneumonectomy and percentage preoperative perfusion to the resected lung (p less than 0.001). Estimation of postoperative maximum ventilation and maximum oxygen uptake from the postoperative values on the basis of 99mTc perfusion scans showed good agreement with observed values. Perfusion scans are useful in estimating not only the changes in spirometric indices that follow pneumonectomy for bronchial carcinoma but also changes in carbon monoxide transfer and exercise capacity.

Adult↗
PubMed1991

Functional results of muscle flap closure for sternal infection.

The morbidity and mortality of infection after median sternotomy have been substantially reduced with the advent of treatment by wide sternal resection and muscle flap closure. A study was performed comparing the cardiorespiratory function of 13 such patients before and after operation as well as with a control group of 15 patients who underwent similar procedures without complication. The groups were comparable in preoperative pulmonary function, though more patients in the study group had evidence of chronic lung disease. Patients were studied 2 to 39 months after the original procedure. Late postoperative pulmonary function test results, exercise tolerance, and oxygen uptake were not significantly different between the groups, and pulmonary function test results were unchanged in those patients who were tested preoperatively. We conclude that muscle flap reconstruction for sternal infection can be expected to give good long-term functional results. Exercise tolerance and pulmonary function may not differ from a control group of cardiac surgical patients, despite the altered composition of the chest wall. Patients with chronic lung disease may be more prone to have this complication.

Aged↗
PubMed1992

Preoperative assessment of the thoracic surgical patient.

The preoperative assessment before pulmonary resection is both important and difficult. Pulmonary function testing is imperative to assess pulmonary reserve. If the FEV1 is less than 2 L, differential perfusion lung scans are used for a more accurate assessment. Exercise testing may also be used as an adjunct for high-risk patients or procedures. Although a predicted postoperative FEV1 of 800 mL is a widely accepted minimum for resection, it has not been scientifically validated. Lesser procedures (segmentectomy and wedge resection) may be performed with acceptable mortality in patients who were previously not considered surgical candidates.

Exercise Test↗
PubMed1997

Prognostic value of dobutamine-atropine stress echocardiography for peri-operative and late cardiac events in patients scheduled for vascular surgery.

Cardiac events in the peri-operative phase and late after non-cardiac vascular surgery are a major cause of morbidity and mortality. Numerous tests and diagnostic strategies--usually consisting of a combination of analysis of clinical risk factors and additional non-exercise dependent stress testing, such as thallium scintigraphy, or stress echocardiography--have been developed to preoperatively identify patients with increased risk. The tests ideally should identify three subpopulations in a group with a high prevalence of coronary artery disease; (1) low-risk patients who can be referred for surgery without extra cardiac intervention. (2) patients whose peri-operative cardiac risk outweighs the potential benefits of vascular surgery, (3) patients whose risk may be reduced by peri-operative therapeutic interventions. This review will discuss the prognostic value of dobutamine stress echocardiography for risk stratification in patients scheduled for non-cardiac vascular surgery and discuss guidelines for future management.

Atropine↗
PubMed2002

Implementing ACC/AHA guidelines for the preoperative management of patients with coronary artery disease scheduled for noncardiac surgery: effect on perioperative outcome.

STUDY OBJECTIVE: To review the new consensus guidelines for cardiac testing for the patient with cardiac disease scheduled for elective, noncardiac surgery, and their impact on cardiac functional testing. DESIGN: Retrospective chart review study. SETTING: Tertiary care medical center. PATIENTS: 181 patients scheduled for elective, major surgery who met American College of Cardiology/American Heart Association (ACC/AHA) criteria for a preoperative stress test. INTERVENTIONS: A variety of tests were ordered, including treadmill stress testing, persantine-thallium imaging, dobutamine echocardiography, and exercise stress echocardiography. MEASUREMENTS: The numbers of and outcome of the stress tests and the cardiac outcome of the patients who underwent cardiac testing and surgery were recorded. MAIN RESULTS: Abnormal tests occurred in 27 patients. Two patients declined treatment, eight patients had primary medical management, and the remainder (17) had cardiac catheterization. Results included no lesion (2 patients), angioplasty (4 patients), angioplasty plus stenting (1 patient), coronary artery bypass grafting (CABG) (4 patients), and delineated lesions treated with medical optimization (6 patients). One patient had CABG and declined further surgery. One patient had myocardial infarction 6 months after surgery that was treated by medical management after cardiac catheterization. The other 23 patients had surgery without cardiac complication within 1 year of surgery. Only 15% (27/180) of the patients with indications for a stress test had a positive result. Even fewer patients had any alteration of the perioperative period. Despite this finding, cardiac morbidity was very low. CONCLUSIONS: The guidelines for stress test may be over-sensitive, and further prospective clinical studies are indicated.

Coronary Disease↗
PubMed1980

Preoperative diagnosis and management of infants with critical congenital heart disease.

Operative repair with an associated low morbidity and mortality is available now for most infants with congenital cardiac defects. Precise preoperative diagnosis is an essential part of continuing attempts to lower the operative risk for these patients. In this review we cover major areas of concern in regard to preoperative diagnosis and management. Long-term follow-up studies with clinical, hemodynamic, electrophysiological, and exercise data are required to assess current diagnostic and therapeutic practices.

Aortic Coarctation↗
PubMed2003

Exercise testing as a predictor of surgical risk after pneumonectomy for bronchogenic carcinoma.

The aim of the present investigation was to evaluate the predictive value of a symptom-limited exercise test in predicting postoperative morbidity and mortality in patients submitted to pneumonectomy. The study was conducted in 150 patients (mean age, 57.1). Forty-four patients (29.3%) had postoperative complications. Four patients (2.7%) died within one month of the pneumonectomy. Patients with complications had significantly lower VO2max. The incidence of complications in relation to the amount of oxygen consumption showed that with the progressive decrease of oxygen consumption there was a progressive increase in frequency of complications. In particular patients with VO2max < 50% of predicted should be considered at high risk of morbidity and mortality from cardiopulmonary causes. This predictive capacity of VO2max was more evident in patients with a preoperative FEV1 less than 70% of predicted. The present data support the suggestion that exercise testing could be a useful adjunt in the evaluation of postoperative risk for pneumonectomy, especially in patients with obstructive pulmonary disease.

Adult↗