Progress in surgical treatment of coronary atherosclerosis (Part 2)

The limited impact of percutaneous coronary artery angioplasty on bypass surgery

Although percutaneous transluminal coronary angioplasty has been used successfully now for 10 years, coronary bypass surgery volumes have not diminished greatly. This paper examines the anatomic limitations of percutaneous transluminal coronary angioplasty. Using complete revascularization criteria, angioplasty could be used in only 38% of patients undergoing coronary bypass surgery at the Cleveland Clinic in 1981. The principal anatomic reason for rejecting patients for percutaneous transluminal coronary angioplasty was chronic total occlusion in a vessel suitable for bypass surgery. Angioplasty could be used more frequently in one- and two-vessel bypass patients than in patients receiving more grafts. Percutaneous transluminal coronary angioplasty is currently limited more by its inability to more completely revascularize advanced coronary artery disease than it is from the technical aspects of crossing or dilating stenoses.

Dispositional optimism and physical well-being: the influence of generalized outcome expectancies on health

This article explores the implications that dispositional optimism holds for physical well-being. Research is reviewed that links optimism to a number of different positive health-relevant outcomes, ranging from the development of physical symptoms to recovery from coronary artery bypass surgery. Additional findings are described which suggest that these beneficial effects are partly due to differences between optimists and pessimists in the strategies that they use to cope with stress. A number of other potential mediators are also discussed, including some that are physiologic in nature. The article closes with a discussion of the relationships between our own theoretical account of the effects of optimism and several other conceptual approaches.

Interhospital transport of patients with ongoing intraaortic balloon pumping

During a 5-year period (1979 to 1983), 50 consecutive patients undergoing continuous intraaortic balloon (IAB) pumping were transferred from Evanston Hospital to Northwestern Memorial Hospital (16 miles), where they underwent cardiac operation. All patients had cardiac catheterization before transfer. Indications for IAB were cardiogenic shock (9 patients), postinfarction angina (18 patients), unstable angina (9 patients), evolving myocardial infarction (3 patients), accelerating angina or hemodynamic instability during cardiac catheterization (9 patients) and prophylactic insertion for high-grade left main stenosis (2 patients). Transportation after stabilization was uneventful in all patients. All patients underwent operative coronary revascularization. There was concomitant mitral valve replacement in 3 patients, acute ventricular septal defect repair in 1 patient, aortic valve replacement in 1, and ventricular aneurysmectomy in 1. Three patients (5%) died postoperatively. Nine patients (20%) had complications directly related to IAB insertion. One patient required femoral-femoral arterial bypass preoperatively, 4 patients had postoperative lower limb ischemia treated by IAB removal or thrombectomy and 1 patient had thrombocytopenia (less than 60,000/mm3), 1 false aneurysm, 1 anterior compartment syndrome and 1 prolonged bleeding at the insertion site. Interhospital transfer with IAB pumping in progress should not be restricted to patients with cardiogenic shock, but can be effectively used for all patients who require preoperative IAB insertion.(ABSTRACT TRUNCATED AT 250 WORDS)