Kamlesh Shah

A review of pulmonary artery catheterization in 6,245 patients.

From July 1977 to December 1982, 6,245 patients requiring cardiac and noncardiac operations had pulmonary artery (PA) catheterizations for perioperative monitoring. Their ages ranged from 4 to 94 years. PA catheters were inserted through the external or internal jugular vein in 6,146 patients, while arm veins were used in 99 patients. Complications included persistent PVCs requiring therapy in 193 (3.1%), right bundle branch blocks in three (0.048%), left bundle branch and complete heart block each in one patient (0.016%), intrapulmonary hemorrhage in four (0.064%), minor pulmonary infarcts in four (0.064%), perforation of right ventricle in one (0.016%), and death from uncontrollable pulmonary hemorrhage in one patient (0.016%). This investigation reveals a low incidence of morbidity associated with PA catheterization.

Angina and other risk factors in patients with cardiac diseases undergoing noncardiac operations.

Six hundred eighty-eight consecutive patients with cardiac diseases or who wer, ′older than 70 yr of age, all of whom were undergoing noncardiac operations, were studied. Twenty-four preopeiative risk factors were analyzed for the outcome of perioperative myocardial infarction (PMI) or cardiac death using stepwise logistic regression. Old age, emergency operation, angina, previous myocardial infarction, electrocardiographic signs of ischemia, type of surgical procedure, and hypokalemia were identified as individual factors useful in predicting outcome. Thirty-two patients (4.65%) developed PMI. Seven of these 32 patients (21.9%) and eight more patients without PMI—a total of 15 patients (2.2%)—died a cardiac death. Nonfatal but serious complications occurred in 23% of the patients. Patients undergoing emergency operations and patients with chronic stable angina, previous myocardial infarction, and electrocardio- graphic signs of ischemia were found to be at increased risk for PMI and cardiac death.

Reevaluation of perioperative myocardial infarction in patients with prior myocardial infarction undergoing noncardiac operations

We studied 275 patients with prior myocardial infarctions undergoing noncardiac operations to determine the incidence and outcome of perioperative myocardial reinfarction. Perioperative myocardial reinfarction developed in 13 patients (4.7%) of whom 3 (23%) died of cardiac causes. When time between prior myocardial infarction and the date of anesthesia was analyzed, the incidence of perioperative myocardial reinfarction was 4.3% at 0–3 mo, 0 at 4–6 mo, 5.7% at >6 mo, and 3.3% at an indeterminate exact interval. None of the variables analyzed showed any significant correlation with the rate of reinfarction. The urgency of operation and aortic or vascular procedures were the only variables that approached, but failed to achieve, statistical significance.

Reduction in mortality from cardiac causes in Goldman class IV patients

In 1977, Goldman et al evaluated cardiac patients for non-cardiac operations and showed a high incidence of cardiac death in high-risk cardiac patients (Goldman class IV). The present study was designed to prospectively evaluate the incidence of cardiac death as well as overall mortality in 49 patients belonging to Goldman class IV at the present time. Four patients of 49 (8.2%) died of cardiac causes, and seven other patients died of non-cardiac causes. Thus, the overall mortality rate was 22.4% (11/49). There has been a marked reduction in cardiac mortality from 56% in Goldman et als 1977 data to 8.2% in the present data. All of the developments and advances in patient care over the past 10 years probably contributed to this reduction in mortality from cardiac causes.