The Experts below are selected from a list of 297 Experts worldwide ranked by ideXlab platform
Maurice Buchbinder - One of the best experts on this subject based on the ideXlab platform.
-
Role of Intraaortic Balloon Pump counterpulsation in high risk coronary rotational atherectomy
Journal of the American College of Cardiology, 1995Co-Authors: Brian O'murchu, Riley D. Foreman, Richard E. Shaw, David L. Brown, Kirk L. Peterson, Maurice BuchbinderAbstract:Objectives. This study sought to evaluate the role of Intraaortic Balloon Pump counterpulsation in preventing hemodynamic instability and promoting a successful outcome during percutaneous transluminal coronary rotational atherectomy in high risk patients. Background. The application of rotational atherectomy has widened to include patients with complex lesions and left ventricular dysfunction. Although Intraaortic Balloon Pumping has been successfully used to provide hemodynamic support during Balloon angioplasty, its role in high risk rotational atherectomy has not yet been defined. Methods. In a retrospective review of 159 consecutive high risk patients who underwent rotational atherectomy, 28 had an Intraaortic Balloon Pump placed electively before the procedure (Group 1) whereas 131 did not (Group 2). Results. Group 1 was older and more likely to have multivessel disease and left ventricular dysfunction. Augmented diastolic pressure was maintained > 90 mm Hg in all Group 1 patients, and significant procedure-related hypotension was encountered in nine Group 2 patients, requiring an emergency Intraaortic Balloon Pump in five. Procedural success was achieved in all 28 patients in Group 1 and in 118 in Group 2 (p = 0.07). Slow flow occurred in 18% and 17% of Group 1 and 2 patients, respectively. Among patients with slow flow, non-Q wave myocardial infarction occurred only in Group 2 (0% vs. 27%). On multivariate analysis, elective Intraaortic Balloon Pump placement was the only variable to correlate with a successful procedure uncomplicated by hypotension (p Conclusions. Elective placement of an Intraaortic Balloon Pump before coronary rotational atherectomy in selected high risk patients promotes both procedural hemodynamic stability and a successful outcome.
Martin Schmuziger - One of the best experts on this subject based on the ideXlab platform.
-
Economic impact of preoperative Intraaortic Balloon Pump therapy in high-risk coronary patients
The Annals of thoracic surgery, 2000Co-Authors: Jan T. Christenson, François Simonet, Martin SchmuzigerAbstract:Abstract Background . The efficacy of preoperative Intraaortic Balloon Pump therapy in high-risk coronary patients has been demonstrated earlier. Methods . This study investigates the economic aspect by a detailed cost analysis of pooled information from two previously published randomized studies and 144 consecutive low-risk coronary artery bypass graft operations. Costs for patients receiving preoperative Intraaortic Balloon Pump therapy before aortic cross-clamping (n = 62) were compared to those in a control group (n = 50). Detailed cost analysis was based on data provided by the hospital finance department. Results . The total hospital costs were as follows: low-risk coronary artery bypass graft operations cost 35,335 ± 1,694 Swiss francs ($23,400 ± $1,121); high-risk coronary artery bypass graft without preoperative Intraaortic Balloon Pump therapy cost 65,892 ± 31,719 Swiss francs ($43,637 ± $21,006); and high risk coronary artery bypass graft with preoperative Intraaortic Balloon Pump therapy cost 41,948 ± 10,379 Swiss francs ($27,780 ± $6,874) ( p = 0.0015). There were no significant differences in average cost among the preoperative Intraaortic Balloon Pump therapy subgroups. Conclusions . Preoperative Intraaortic Balloon Pump therapy in high risk coronary patients is significantly cost-beneficial, With an average saving of 24,000 Swiss francs ($16,000) on the total hospital cost, a 36% cost reduction.
-
optimal timing of preoperative Intraaortic Balloon Pump support in high risk coronary patients
The Annals of Thoracic Surgery, 1999Co-Authors: Jan T. Christenson, François Simonet, Pierre Badel, Martin SchmuzigerAbstract:Abstract Background . Beneficial effects of preoperative Intraaortic Balloon Pump (IABP) treatment, on outcome and cost, in high-risk patients who have coronary artery bypass grafting have been demonstrated. We conducted a prospective, randomized study to determine the optimal timing for preoperative IABP support in a cohort of high-risk patients. Methods . Sixty consecutive high-risk patients who had coronary artery bypass grafting (presenting with two or more of the following criteria: left ventricular ejection fraction less than 0.30, unstable angina, reoperation, or left main stenosis greater than 70%) entered the study. Thirty patients did not receive preoperative IABP (controls), 30 patients had preoperative IABP therapy starting 2 hours (T2), 12 hours (T12), or 24 hours (T24), by random assignment, before the operation. Fifty patients had preoperative left ventricular ejection fraction mean, less than 0.30 (less than 0.26 ± 0.08), (n = 40) unstable angina, 28% (n = 17) left main stenosis, and 32% (n = 19) were reoperations. Results . Cardiopulmonary bypass was shorter in the IABP groups. There was one death in the IABP group and six in the control group. The complication rate for IABP was 8.3% (n = 5) without group differences. Cardiac index was significantly higher postoperatively ( p p p = 0.211, p p = 0.002, respectively). There were no differences between the IABP subgroups in any of the studied variables. Conclusions . The beneficial effect of preoperative IABP in high-risk patients who have coronary artery bypass grafting was confirmed. There were no differences in outcome between the subgroups; therefore, at 2 hours preoperatively, IABP therapy can be started.
-
preoperative Intraaortic Balloon Pump enhances cardiac performance and improves the outcome of redo cabg
The Annals of Thoracic Surgery, 1997Co-Authors: Jan T. Christenson, Pierre Badel, F Simonet, Martin SchmuzigerAbstract:Background Reoperative coronary artery bypass grafting (redo CABG) is associated with an increased operative risk compared with primary CABG. Because the hospital mortality in redo CABG is known to be influenced by poor left ventricular function (left ventricular ejection fraction ≤0.40), unstable angina, and left main stem stenosis greater than or equal to 70%, a preoperative Intraaortic Balloon Pump (IABP) support could be beneficial to improve the outcome in high-risk redo CABG. Methods Between June 1994 and October 1996, 48 high-risk patients underwent redo CABG and were randomized into the following groups: group 1 (24 patients) who received preoperative IABP treatment on average 2hours before cardiopulmonary bypass, and group 2 (24 patients) who received no preoperative IABP and served as controls. Mean age was 65 years and 90% (43 patients) were men. Forty-one patients had preoperative left ventricular ejection fraction less than or equal to 0.40 (85%), 38% (18 patients) had left main stem stenosis greater than or equal to 70%, and 54% (26 patients) had unstable angina preoperatively. Preoperative patient characteristics did not differ between the groups. Results The time on cardiopulmonary bypass was shorter in group 1, 86 versus 110 minutes ( p =0.006). There were no hospital deaths in group 1, but four deaths occurred in the control group ( p =0.049). Cardiac index rose significantly preoperatively after introduction of the IABP in group 1. Cardiac index was significantly higher postoperatively in group 1 compared with group 2 and remained significantly higher during the first 24hours after cardiopulmonary bypass. Significantly fewer patients in the IABP group had postoperative low cardiac output (4 versus 13 patients). Nine patients in group 2 required IABP support postoperatively for 4.1±1.7 days. Only 2 patients in group 1 needed IABP postoperatively, and their IABPs were successfully removed on the first postoperative day. The preoperative IABP-supported patients had a shorter intensive care unit stay, 2.4±0.8 days compared with group 2, 4.5±2.2 days ( p =0.007), as well as a shorter hospital stay. The preoperative IABP treatment was found to be cost-effective. Conclusions Preoperative treatment with IABP in high-risk redo CABG patients is an effective modality to prepare these patients to have their myocardial revascularization in an as nonischemic situation as possible, which resulted in a significantly lower hospital mortality, fewer instances of postoperative low cardiac output, and shorter stays in both the intensive care unit and the hospital.
Joseph N. Cunningham - One of the best experts on this subject based on the ideXlab platform.
-
Transthoracic Intraaortic Balloon Pump: A simplified technique
The Annals of thoracic surgery, 1996Co-Authors: Joshua H. Burack, Pablo Uceda, Joseph N. CunninghamAbstract:A technique of transthoracic Intraaortic Balloon Pump insertion and a clinical experience with 14 patients is reported. The technique of transthoracic Intraaortic Balloon Pump insertion can be done in a rapid and atraumatic fashion. A short prosthetic graft is used, and Intraaortic Balloon Pump removal does not require resternotomy. The technique is a safe alternative in postcardiotomy failure patients with inadequate peripheral arterial access.
Jan T. Christenson - One of the best experts on this subject based on the ideXlab platform.
-
Economic impact of preoperative Intraaortic Balloon Pump therapy in high-risk coronary patients
The Annals of thoracic surgery, 2000Co-Authors: Jan T. Christenson, François Simonet, Martin SchmuzigerAbstract:Abstract Background . The efficacy of preoperative Intraaortic Balloon Pump therapy in high-risk coronary patients has been demonstrated earlier. Methods . This study investigates the economic aspect by a detailed cost analysis of pooled information from two previously published randomized studies and 144 consecutive low-risk coronary artery bypass graft operations. Costs for patients receiving preoperative Intraaortic Balloon Pump therapy before aortic cross-clamping (n = 62) were compared to those in a control group (n = 50). Detailed cost analysis was based on data provided by the hospital finance department. Results . The total hospital costs were as follows: low-risk coronary artery bypass graft operations cost 35,335 ± 1,694 Swiss francs ($23,400 ± $1,121); high-risk coronary artery bypass graft without preoperative Intraaortic Balloon Pump therapy cost 65,892 ± 31,719 Swiss francs ($43,637 ± $21,006); and high risk coronary artery bypass graft with preoperative Intraaortic Balloon Pump therapy cost 41,948 ± 10,379 Swiss francs ($27,780 ± $6,874) ( p = 0.0015). There were no significant differences in average cost among the preoperative Intraaortic Balloon Pump therapy subgroups. Conclusions . Preoperative Intraaortic Balloon Pump therapy in high risk coronary patients is significantly cost-beneficial, With an average saving of 24,000 Swiss francs ($16,000) on the total hospital cost, a 36% cost reduction.
-
optimal timing of preoperative Intraaortic Balloon Pump support in high risk coronary patients
The Annals of Thoracic Surgery, 1999Co-Authors: Jan T. Christenson, François Simonet, Pierre Badel, Martin SchmuzigerAbstract:Abstract Background . Beneficial effects of preoperative Intraaortic Balloon Pump (IABP) treatment, on outcome and cost, in high-risk patients who have coronary artery bypass grafting have been demonstrated. We conducted a prospective, randomized study to determine the optimal timing for preoperative IABP support in a cohort of high-risk patients. Methods . Sixty consecutive high-risk patients who had coronary artery bypass grafting (presenting with two or more of the following criteria: left ventricular ejection fraction less than 0.30, unstable angina, reoperation, or left main stenosis greater than 70%) entered the study. Thirty patients did not receive preoperative IABP (controls), 30 patients had preoperative IABP therapy starting 2 hours (T2), 12 hours (T12), or 24 hours (T24), by random assignment, before the operation. Fifty patients had preoperative left ventricular ejection fraction mean, less than 0.30 (less than 0.26 ± 0.08), (n = 40) unstable angina, 28% (n = 17) left main stenosis, and 32% (n = 19) were reoperations. Results . Cardiopulmonary bypass was shorter in the IABP groups. There was one death in the IABP group and six in the control group. The complication rate for IABP was 8.3% (n = 5) without group differences. Cardiac index was significantly higher postoperatively ( p p p = 0.211, p p = 0.002, respectively). There were no differences between the IABP subgroups in any of the studied variables. Conclusions . The beneficial effect of preoperative IABP in high-risk patients who have coronary artery bypass grafting was confirmed. There were no differences in outcome between the subgroups; therefore, at 2 hours preoperatively, IABP therapy can be started.
-
preoperative Intraaortic Balloon Pump enhances cardiac performance and improves the outcome of redo cabg
The Annals of Thoracic Surgery, 1997Co-Authors: Jan T. Christenson, Pierre Badel, F Simonet, Martin SchmuzigerAbstract:Background Reoperative coronary artery bypass grafting (redo CABG) is associated with an increased operative risk compared with primary CABG. Because the hospital mortality in redo CABG is known to be influenced by poor left ventricular function (left ventricular ejection fraction ≤0.40), unstable angina, and left main stem stenosis greater than or equal to 70%, a preoperative Intraaortic Balloon Pump (IABP) support could be beneficial to improve the outcome in high-risk redo CABG. Methods Between June 1994 and October 1996, 48 high-risk patients underwent redo CABG and were randomized into the following groups: group 1 (24 patients) who received preoperative IABP treatment on average 2hours before cardiopulmonary bypass, and group 2 (24 patients) who received no preoperative IABP and served as controls. Mean age was 65 years and 90% (43 patients) were men. Forty-one patients had preoperative left ventricular ejection fraction less than or equal to 0.40 (85%), 38% (18 patients) had left main stem stenosis greater than or equal to 70%, and 54% (26 patients) had unstable angina preoperatively. Preoperative patient characteristics did not differ between the groups. Results The time on cardiopulmonary bypass was shorter in group 1, 86 versus 110 minutes ( p =0.006). There were no hospital deaths in group 1, but four deaths occurred in the control group ( p =0.049). Cardiac index rose significantly preoperatively after introduction of the IABP in group 1. Cardiac index was significantly higher postoperatively in group 1 compared with group 2 and remained significantly higher during the first 24hours after cardiopulmonary bypass. Significantly fewer patients in the IABP group had postoperative low cardiac output (4 versus 13 patients). Nine patients in group 2 required IABP support postoperatively for 4.1±1.7 days. Only 2 patients in group 1 needed IABP postoperatively, and their IABPs were successfully removed on the first postoperative day. The preoperative IABP-supported patients had a shorter intensive care unit stay, 2.4±0.8 days compared with group 2, 4.5±2.2 days ( p =0.007), as well as a shorter hospital stay. The preoperative IABP treatment was found to be cost-effective. Conclusions Preoperative treatment with IABP in high-risk redo CABG patients is an effective modality to prepare these patients to have their myocardial revascularization in an as nonischemic situation as possible, which resulted in a significantly lower hospital mortality, fewer instances of postoperative low cardiac output, and shorter stays in both the intensive care unit and the hospital.
-
The Intraaortic Balloon Pump for postcardiotomy heart failure. Experience with 169 Intraaortic Balloon Pumps.
The Thoracic and cardiovascular surgeon, 1995Co-Authors: Jan T. Christenson, François Simonet, L Buswell, V Velebit, J Maurice, M SchmuzigerAbstract:The Intraaortic Balloon Pump (IABP) is usually the first mechanical device inserted for perioperative heart failure. In the present study we have reviewed our experience with 169 IABP insertions with emphasis on IABP complications, route of insertion, and identification of predictors of mortality. Between January 1, 1984 and March 31, 1993 3,591 adult patients underwent cardiac surgical procedures, 169 of whom (4.7%) had an IABP inserted preoperatively (7 patients, 4.1%), intraoperatively (109 patients, 64.5%), or postoperatively (53 patients, 31.4%). There were 137 men (81.1%) and the mean age was 60.2 +/- 8.8 years (28-78 years). Operations included 149 coronary bypass grafting (CABG) (4.6%, 149/3,209), 6 valve replacements, single or double (2.4%, 6/255), and 14 valves combined with CABG (11.0%, 14/127). The IABP was used more frequently in reoperations (14.8%, 80/542), compared to primary operations (2.9%, 89/3,049), p < 0.001. It was also more frequently used after emergency operations (50.7%, 39/77), than after elective operations (3.7%, 130/3,514), p < 0.001. In 119 patients femoral insertion was performed (13 percutaneously and 106 surgically), while 50 patients had an Intraaortic insertion. The mean duration of IABP support was 50 hours (0.5-576 hours). There were 8 (4.7%) complications related to the Balloon Pump, all after femoral insertion (3 after transcutaneous and 5 after surgical insertions). Six of the complications occurred when the IABP was inserted intraoperatively and 2 postoperatively. The complications were 7 cases of leg ischemia (88%) and 1 groin wound infection.(ABSTRACT TRUNCATED AT 250 WORDS)
David L. Brown - One of the best experts on this subject based on the ideXlab platform.
-
Role of Intraaortic Balloon Pump Counterpulsation in High Risk Coronary Rotational Atherectomy
2016Co-Authors: Richard E. Shaw, David L. BrownAbstract:Role of Intraaortic Balloon Pump counterpulsation in high risk coronary rotational atherectom
-
Role of Intraaortic Balloon Pump counterpulsation in high risk coronary rotational atherectomy
Journal of the American College of Cardiology, 1995Co-Authors: Brian O'murchu, Riley D. Foreman, Richard E. Shaw, David L. Brown, Kirk L. Peterson, Maurice BuchbinderAbstract:Objectives. This study sought to evaluate the role of Intraaortic Balloon Pump counterpulsation in preventing hemodynamic instability and promoting a successful outcome during percutaneous transluminal coronary rotational atherectomy in high risk patients. Background. The application of rotational atherectomy has widened to include patients with complex lesions and left ventricular dysfunction. Although Intraaortic Balloon Pumping has been successfully used to provide hemodynamic support during Balloon angioplasty, its role in high risk rotational atherectomy has not yet been defined. Methods. In a retrospective review of 159 consecutive high risk patients who underwent rotational atherectomy, 28 had an Intraaortic Balloon Pump placed electively before the procedure (Group 1) whereas 131 did not (Group 2). Results. Group 1 was older and more likely to have multivessel disease and left ventricular dysfunction. Augmented diastolic pressure was maintained > 90 mm Hg in all Group 1 patients, and significant procedure-related hypotension was encountered in nine Group 2 patients, requiring an emergency Intraaortic Balloon Pump in five. Procedural success was achieved in all 28 patients in Group 1 and in 118 in Group 2 (p = 0.07). Slow flow occurred in 18% and 17% of Group 1 and 2 patients, respectively. Among patients with slow flow, non-Q wave myocardial infarction occurred only in Group 2 (0% vs. 27%). On multivariate analysis, elective Intraaortic Balloon Pump placement was the only variable to correlate with a successful procedure uncomplicated by hypotension (p Conclusions. Elective placement of an Intraaortic Balloon Pump before coronary rotational atherectomy in selected high risk patients promotes both procedural hemodynamic stability and a successful outcome.
