Browsing by Author "Biccard, Bruce McClure."

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Cardiopulmonary exercise testing for high-risk South African surgical patients.
(2007) Biccard, Bruce McClure.
Aim: To determine the prognostic value of cardiopulmonary exercise testing (CPET) for major vascular surgery in South African patients. Methods: CPET has been used in Durban since October 2004 to predict cardiac risk for high-risk patients undergoing major vascular surgery. A submaximal 'anaerobic threshold' (AT) test was conducted on all high-risk patients. Patients were classified into two groups: 'low AT' where the oxygen consumption at the AT was <1 lml.kg^.min"1 for cycling or < 9ml.kg"1.mkf1 for arm cranking and 'high AT' when the patient surpassed these targets. Analysis of all in-hospital deaths following surgery was conducted by two independent assessors blinded to the CPET test result. Deaths classified as primarily 'cardiac in origin' have been used in this retrospective cohort analysis. Results: The AT measured during CPET was not a statistically significant pre-operative prognostic marker of cardiac mortality. However, the survivors of the patients with a 'low AT' may be identified by their response to increasing metabolic demand between 5 and 7 ml.kg^.min"1. Survivors were more dependent on increasing heart rate, while non-survivors were more dependent on oxygen extraction. When this information is added to the AT, CPET was the only test statistically associated with cardiac mortality, in comparison to Lee's Revised Cardiac Risk Index and the resting left ventricular ejection fraction which were not statistically associated with cardiac death. A hundred percent of patients with a positive test died of cardiac causes, while 11% of the patients with a negative test had cardiac deaths. The risk ratio associated with cardiac death following a positive test was 8.00 [95% CI 3.8-16.9]. The sensitivity was 0.25 [95% CI 0.04-0.64], the specificity was 1.00 [95% CI 0.90-1.00], the positive predictive value was 1.00 [95% CI 0.20-0.95] and the negative predictive value was 0.88 [95% CI 0.74-0.95]. Conclusions: CPET provides valuable prognostic information in our surgical population.
Management of haemoptysis : a retrospective analysis of the efficacy of current treatment modalities.
(2012) Alexander, Gerard.; Biccard, Bruce McClure.; Harillall, Yakeen.
Massive haemoptysis is a life-threatening condition that requires timeous and appropriate intervention. Bronchial artery embolisation (BAE) has been advocated as initial therapy, in preference over lung resection, in all patients presenting with massive and minor haemoptysis. This is despite the relatively high incidence of early recurrence of haemoptysis following treatment with BAE. Though emergency lung resection for active massive haemoptysis has been associated with a high mortality, the literature has failed to detail the pre-operative evaluation which may have been inadequate and resulted in unsuitable surgical candidates. This has diminished enthusiasm for lung resection as a primary treatment modality for active massive haemoptysis. Case records from 01 January 2005 to 31 October 2007 of all patients admitted with haemoptysis, to the Department of Cardiothoracic Surgery, Inkosi Albert Luthuli Central Hospital were reviewed retrospectively and analysed. The decision regarding the type of emergency treatment was at the discretion of the attending Cardiothoracic Consultant. Following clinical examination and basic investigations patients were treated accordingly. Those who were haemodynamically stable were discussed at a Consultant forum and treatment was based on consensus. Group 1 included 281 patients with massive haemoptysis and group 2 included 222 with minor haemoptysis. Group one 15 of the 20 patients who were temporised with BAE (75%) had recurrent haemoptysis whereas 1 of the 41 patients (2.44%) who underwent lung resection without BAE developed recurrent haemoptysis (p-value < 0.0001). In patients undergoing BAE and lung resection, there was 1 death and 2 patients developed a post resection empyema thoracis (5% mortality; 10% morbidity) compared to 2 deaths; 1 post resection empyema thoracis and 1 deep thoracotomy wound infection in patients’ undergoing lung resection alone (4.88% mortality; 4.88% morbidity). This was not statistically significant (p-value 0.6736). Group 2 7 of the 8 patients who were temporised with BAE (87.50%) had recurrent haemoptysis. None of the 44 patients who underwent lung resection alone, developed recurrent haemoptysis (p-value < 0.0001). There were no deaths or surgical complications other than recurrent haemoptysis in patients who underwent BAE prior to lung resection. Though there were no deaths in patients who underwent lung resection alone, 2 patients developed a post resection bronchopleural fistula and 1 patient developed a post resection empyema thoracis (6.82% morbidity). This was not statistically significant (p-value 1.0000). 3 These preliminary data suggests that patients presenting with radiologically localised disease and massive haemoptysis, who are deemed suitable for surgery, should undergo emergency lung resection. This data also suggests that BAE is probably best utilised as a temporising measure in patients unsuitable for emergency lung resection. This also appears applicable to patients presenting with minor haemoptysis. In this scenario however, lung resection may be electively undertaken. Furthermore, this study emphasises the need for further prospective studies to clarify these issues.
Peri-operative studies of hypertension.
(2015) Moodley, Yoshan.; Biccard, Bruce McClure.
Abstract available in PDF file.