Showing papers by "Michael J. Mack published in 2005"
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TL;DR: A joint position statement as discussed by the authors represents the combined efforts of four professional societies (Society of Thoracic Surgeons [STS], American Association for thoracic surgery [AATS], American College of Cardiology [ACC], and Society for Cardiovascular Angiography and Interventions [SCAI]), two government agencies (the U.S. Food and Drug Administration [FDA] and the Centers for Medicare and Medicaid Services [CMS]), and numerous industry representatives to assess the foreseeable directions of a class of emerging technologies being developed to enable the percutaneous treatment of cardiac
54 citations
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TL;DR: Avoidance of CPB in patients with reduced ventricular function undergoing multivessel bypass improves early survival rates and decreases the incidence of reoperation for bleeding, blood product use, and postoperative ventilatory times.
Abstract: Background: Patients with diminished ventricular function represent an increasing percentage of candidates for coronary artery bypass grafting (CABG). We have reviewed our recent experience in CABG in patients with ejection fractions (EF) =30% to identify factors leading to improved outcomes in this high-risk group. Methods: Between January 1997 and September 2002, 990 patients with EF =30% underwent CABG. Univariate and logistic regression analysis was used to analyze data from 204 patients who underwent revascularization off-pump and 713 patients who underwent grafting with cardiopulmonary bypass (CPB) for differences in mortality, morbidity, and length of stay (LOS). Results: Compared with the on-pump patient cohort, patients with depressed ventricular function who underwent revascularization without the use of CPB had a lower operative mortality rate that trended toward significance (2.9% versus 6.3%; P =.06) and a significantly lower risk-adjusted mortality rate (1.47% versus 4.13%; P <.001), despite a higher predicted risk (5.4% +/- 5.5% versus 4.3% +/- 3.7%; P =.01). Additionally, patients who underwent off-pump bypass grafting had a significantly lower incidence of reoperation for bleeding (1.0% versus 4.6%; P =.02), lower blood product use (39.6% versus 66.6%; P <.001), decreased postoperative ventilation times (11.3 +/- 37.4 hours versus 46.1 +/- 156.1 hours; P <.001), and fewer days in the intensive care unit (2.6 +/- 3.8 days versus 4.2 +/- 6.5 days; P <.001). Logistic regression analysis showed that CPB use ( P =.048; odds ratio [OR], 2.4; 95% confidence interval [CI], 1.0-5.8) and previous CABG ( P =.015; OR, 2.6; 95% CI, 1.2-5.7) were independent risk factors for mortality. A trend toward a shorter LOS (7.6 +/- 7.9 days versus 8.9 +/- 9.6 days; P =.06) was also seen in the off-pump patients. Conclusion: Avoidance of CPB in patients with reduced ventricular function undergoing multivessel bypass improves early survival rates and decreases the incidence of reoperation for bleeding, blood product use, and postoperative ventilatory times.
25 citations
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19 citations
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TL;DR: The disruptive technology of percutaneous transluminal intervention (PCI) of coronary artery disease has progressed from the primitive and relatively ineffective use of balloon angioplasty in the late 1970s to the reproducible and largely safe interventions employing drug-eluting stents and platelet inhibitors that are available today for the treatment of a greatly increased proportion of patients with coronary arteries disease.
18 citations