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ABSTRACT: Surgical procedures using the latissimus dorsi (LD) muscle to assist chronic heart failure inflict major trauma on severely sick patients. A less invasive approach may prove beneficial. The aim of this article is to review our clinical and experimental approaches of dynamic aortomyoplasty (AMP) and emphasize the necessity to reorient surgical technique towards new directions and a less invasive thoracoscopic approach.
A clinical pilot study on dynamic descending AMP started in June 1995 and included four patients. Two of them could benefit from LD counterpulsation, surviving 6 months and 18 months. Following this clinical experience, we investigated, on an animal model, minimally invasive thoracoscopic surgery for this procedure. Twelve goats underwent endoscopic LD harvest and video-assisted aortic wrap, and were studied after surgical recovery from an anatomical and functional standpoint.
Clinical AMP using open techniques provided extraaortic counterpulsation in NYHA Class IV patients contraindicated for other surgical therapies. However, surgical technique and strategy needed improvements for optimal cardiac assistance and better patient outcome. Minimally invasive thoracoscopic surgery was feasible and reproducible in goats, achieving improved anatomy and physiology as compared to the open technique in humans. When appropriate the wrapping technique and stimulation protocol were used, an optimal counterpulsation was demonstrated. We concluded that thoracoscopic AMP may provide a minimally invasive approach to cardiac assistance and thus, a new surgical option for patients presenting with chronic heart failure.
Journal of Cardiac Surgery 02/1998; 13(1):60-9. · 0.87 Impact Factor
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ABSTRACT: Active aortic endocarditis is a serious condition that carries a high mortality and morbidity. The aim of this study was to analyse results obtained from 24 patients who underwent aortic valve or root replacement with cryopreserved homograft for aortic endocarditis. Eleven patients had native valve endocarditis, and 13 had prosthetic valve endocarditis. The mean age was 47.7 years: there were seven women and 17 men. Causative organisms were staphylococci (12), streptococci (four), serratia (one), candida (one), pneumococci (one), while no organisms were isolated in the remaining five patients. Complete reconstruction of the aortic annulus with homograft conduits was necessary in 20 patients (six total root and 14 mini-root). Infracoronary homograft aortic valve replacement was performed in the remaining patients. One patient died 1 day after the operation from ventricular failure, and two others died after 4 and 6 months as a result of arrhythmia. One patient died of recurrent endocarditis 1 year after surgery. The actuarial survival rate at 3 years was 83.4%. All survivors are symptom-free, with no evidence of recurrent endocarditis. Doppler echocardiography showed minimal aortic regurgitation in four patients.
Cardiovascular Surgery 01/1998; 5(6):579-83.
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ABSTRACT: This report describes the case of a patient in whom atrial perforation with penetration of the thoracic wall was diagnosed 2 years after the implantation of an Accufix lead. Despite this complication, atrial detection in the bipolar mode and ventricular pacing were normal. Digital fluoroscopy detected a fracture with extrusion of a short segment of the retention wire. The rupture of the retention wire might have been the result, but was not the cause of the perforation.
Pacing and Clinical Electrophysiology 09/1996; 19(8):1268-9. · 1.35 Impact Factor
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Transplantation Proceedings 03/1996; 28(1):48-9. · 1.00 Impact Factor
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Transplantation Proceedings 03/1996; 28(1):367. · 1.00 Impact Factor
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ABSTRACT: To evaluate routine magnetic resonance (MR) imaging for long-term follow-up in patients who undergo surgery for type A aortic dissection.
Ninety-two MR examinations were performed in 36 patients. Standard spin-echo images were obtained with electrocardiographic gating (n = 92) and rapid images with a fast low-angle shot sequence and intravenous administration of gadopentetate dimeglumine (n = 25). All segments of the native thoracic aorta were evaluated. Anastomoses of the prosthesis and periprosthetic hematoma were carefully analyzed.
Of 22 complications that occurred in 18 patients, 18 were diagnosed at MR imaging (nine false aneurysms and nine aneurysms distal to the graft). Nine patients underwent reoperation. The findings at MR imaging correlated with those at surgery.
Routine follow-up with MR imaging should improve long-term survival in patients who survive emergency surgical repair of type A aortic dissection.
Radiology 09/1995; 196(2):363-9. · 5.73 Impact Factor
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Transplantation Proceedings 09/1995; 27(4):2524. · 1.00 Impact Factor
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ABSTRACT: Use of cardiopulmonary support (CPS) by peripheral access with a membrane oxygenator has made considerable progress as a result of the development of centrifugal pumps, percutaneous cannulation, and preheparinized circuits. We have used CPS for resuscitation in 3 cases, for recovery after cardiotomy in 6 cases (myocardial insufficiency, 4; pulmonary arterial hypertension, 1; respiratory insufficiency, 1), and after heart transplantation in 1 case. Of these 10 patients, 3 died during CPS, 5 were successfully weaned, and 2 underwent heart transplantation. Use of CPS is expanding for emergency cardiac assistance. Installation is simple and rapid. It allows recovery of organs pending more invasive and costly techniques.
Artificial Organs 08/1995; 19(7):750-5. · 2.00 Impact Factor
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ABSTRACT: Cardiomyoplasty, in spite of recent improvements, remains a high risk operation. The early postoperative period is sometimes very critical, even for patients selected from preoperative New York Heart Association functional class IV. During the surgical period, poor hemodynamics may be responsible for early death, as well as influence latissimus dorsi muscle long-term viability. Circulatory assist, including pharmacologic support with enoximone, intraaortic balloon counterpulsation (IABP), and ventricular assist devices (VAD), may be needed. From February, 1993 to September, 1994, 14 clinical dynamic cardiomyoplasty procedures were performed using the Medtronic (Minneapolis, MN) system at Hôpital La Timone, Marseille, France. Eight patients suffered from early and severe postoperative heart failure. Enoximone was used in three patients and IABP in five patients. Two days after cardiomyoplasty, one of the IABP patients required an implantable left VAD (Thermocardio Systems, Woburn, MA) as a bridge to cardiac transplantation. Overall hospital mortality was 7%. The authors studied the preoperative clinical data and surgical techniques to find specific risk factors that could have influenced postoperative events. Another aim of this study was to evaluate long-term benefits in these particular patients. Results showed that cardiomyoplasty patients may require complex means to overcome postoperative hemodynamic failure, but without necessarily poor long-term results. This should be an important step in improving future patient selection.
ASAIO Journal 06/1995; 41(3):M469-72. · 1.39 Impact Factor
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ABSTRACT: Use of cardiopulmonary support (CPS) by peripheral access with a membrane oxygenator has made considerable progress as a result of the development of centrifugal pumps, percutaneous cannulation, and pre-heparinized circuits. We have used CPS for resuscitation in 3 cases, for recovery after cardiotomy in 6 cases (myo-cardial insufficiency, 4; pulmonary arterial hypertension, 1; respiratory insufficiency, 1), and after heart transplantation in 1 case. Of these 10 patients, 3 died during CPS, 5 were successfully weaned, and 2 underwent heart transplantation. Use of CPS is expanding for emergency cardiac assistance. Installation is simple and rapid. It allows recovery of organs pending more invasive and costly techniques.
Artificial Organs 06/1995; 19(7):750 - 755. · 2.00 Impact Factor
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ABSTRACT: In order to determine the prognosis of reoperation for valvular replacement, we reviewed the results of a consecutive series of 124 patients operated in the department between 1974 and 1992 (163 multi redo operations). There were 69 women and 55 men, with a mean age 48 years; 77% of the patients were in functional class III or IV. Operations were performed as an emergency in 30% of cases. Endocarditis was found in 24% of cases and was an important risk factor in this content. The main indications for reoperation were periprosthetic leakage in 28.8% of cases and failure of bioprostheses in 23.7%. The valvular replacement was simple in 61%, double in 32% and triple in 7% of cases. An associated procedure was necessary in 27% of cases. Mechanical devices were implanted in 62.3% of cases. Peroperative mortality was 3% and hospital mortality, mainly from cardiac causes, was 21.7% for the second, 20% for the third and 55.6% for the fourth reoperations. Operative mortality was dependent on the number or reoperations, functional class, emergency surgery, duration of bypass and cross-clamping time. Four per cent of patients were lost to follow-up and 30 patients died secondarily. The actuarial survival rate was 52% at 5 years and 33% at 10 years, actuarial survival rate without valvular complication was 41% at 5 years and 19% at 10 years but the functional results remained good with over 90% of patients in functional class I or II at the end of follow-up.
Archives des maladies du coeur et des vaisseaux 02/1995; 88(1):35-41. · 0.40 Impact Factor
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ABSTRACT: The case of a 44-year-old black man who presented with severe dysphagia, cough and chest pain caused by a 12-cm aneurysm developing from a Kommerell's diverticulum at the origin of an aberrant retro-oesophageal left subclavian artery is reported. The aortic arch and descending thoracic aorta were right sided. Diagnosis was established before operation by computed tomography, magnetic resonance imaging and arteriography. The aneurysm extended a considerable distance down the descending aorta and therefore the risk of postoperative paraplegia was considered to be high. Accordingly selective arteriography was performed to locate the Adamkievicz's artery which arose only 2 cm below the end of the aneurysm. Resection grafting of the aneurysm including the upper third of the descending aorta via right thoractomy was performed. The patient made an uneventful recovery and was discharged 20 days later. This case appears to be the first successful operation for this pathology.
Cardiovascular Surgery 03/1994; 2(1):110-3.
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Soins. Chirurgie generale et specialisée 06/1993;
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Soins. Chirurgie generale et specialisée 06/1993;
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Soins. Chirurgie generale et specialisée 06/1993;
