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Biomedical subjects

A Deloche

Publications and source records attributed to A Deloche.

At least 91 records · Page 5Linked to original sources
PubMed1986

Retrograde cardioplegia through the right atrium.

Retrograde cardioplegia through the coronary sinus has been shown to overcome the problems of cardioplegia delivery in aortic valve incompetence and coronary stenosis. Since specific complications, such as coronary sinus injury and lack of perfusion of the thebesian veins, may result from its use, we present a technique of cardioplegia delivery through the right atrium after caval and pulmonary artery exclusion that we believe is safer and more reliable than delivery through the coronary sinus.

Cardiopulmonary Bypass↗
PubMed1986

[Low molecular weight heparin in extracorporeal circulation. 1st clinical applications].

The haemorrhagic complications inherent to the use of heparin during cardiac surgery led us, after a pilot experimental study, to try out a low molecular weight heparin (LMWH), PK 10169, which has weaker haemorrhagic effects in vitro. Our initial experience was confined to 23 patients with differing pathologies, undergoing cardiopulmonary bypass lasting 30 to 165 minutes. The modes of injection of YK 10169 varied according to the results, especially with respect to the limitation of peaks of anti-Xa activity; 8 patients were given one bolus intravenous injection, 9 were given a bolus injection and a continuous infusion, and 6 were only given the continuous infusion. Biological monitoring of anticoagulation was based on anti-Xa activity. Analysis of the biological results showed that the principal feature was the partial correction, and occasionally the non-correction of anti-Xa activity by protamine sulphate, with no correlation between this anti-Xa activity and postoperative bleeding. The authors report cases of severe postoperative bleeding despite the supposed theoretical and experimental weakly haemorrhagic properties of LMWH, and also discuss the inefficacy of protamine sulphate. The indications for LMWH for cardiopulmonary bypass which were retained, were the rare cases of heparin-induced thrombocytopaenia. In conclusion, it is possible to use LMWH during cardiac surgery but we do not advise using it routinely as its theoretical advantages are not confirmed in practice.

Adolescent↗
PubMed1985

[Reoperation after saphenous aortocoronary bypass].

The results of a consecutive series of 24 patients reoperated for coronary bypass grafting between May 1977 and February 1983 are reported. The overall incidence of reoperation was 1.4 p. 100 (24 out of 1 716 cases); the incidence is tending to increase (2.3 p. 100 in 1982). Preoperative assessment revealed the persistence of cardiovascular risk factors: 75 p. 100 of patients had continued to smoke; 61 p. 100 had persistent hyperlipidaemia. The usual presenting syndrome was recurrence of chest pain (21 out of 24 cases) leading to control coronary arteriography on the results of which the surgical indication was based. The average time between the two operations was 38.7 months. The patients were classified into two groups; early reoperation (6 cases) for a technical problem or incomplete revascularisation, and late reoperation (8 cases) for disease of the graft and atherosclerosis. Progression of coronary atherosclerosis was the major long-term cause of occlusion of the saphenous graft (10-14 cases). The arteries most commonly bypassed at reoperation were the left anterior descending and right coronary arteries (12 times each). Reoperation comprised single bypass (13 cases), double bypass (10 cases) and triple bypass (1 case) with an average of 1.5 grafts per patient. The most commonly used vein was the internal saphenous vein (32 out of 36 grafts). Myocardial protection was insured by cardioplegia (13 cases) and intermittent clamping (10 cases) after cooling (general hypothermia at 22 degrees C). Global reoperative mortality (4 p. 100) was higher than for elective primary coronary surgery (2.3 p. 100). The incidence of perioperative infarction was 8 p. 100.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Artery Bypass↗
PubMed1985

[Reoperation on valve bioprostheses. Apropos of 64 cases].

Sixty-four patients with one or more bioprostheses were reoperated between 1970 and 1982. Reoperation was performed for degenerative lesions in cases (48%), for aseptic periprosthetic leaks in 18 cases (28%), for infectious lesions in 13 cases (21%) and for thrombosis in 2 cases (3%). Degenerative and infectious lesions were commoner in aortic bioprostheses whilst periprosthetic leaks were commoner in mitral bioprostheses. The average interval between operations was 38 months. This was shorter in patients reoperated for mechanical problems (6 months) than those with infections (28 months) or degenerative (5 years) complications. At reoperation 14 prostheses were reinserted and 50 were replaced. The global hospital mortality was 21% (14 deaths). The mortality was related to the surgical indication: mechanical lesions (11%), degenerative lesions (16%), infectious endocarditis (38%), thrombosis (100%). The mortality rate also varied with time (36% during the period 1970-1978 and 18% during the period 1979-1982). This improvement was related to two factors: the use of cardioplegic solutions for myocardial protection and earlier recognition of surgical indications before the onset of irreversible haemodynamic complications. When choosing a valvular prosthesis, the mortality of reoperation for degenerative changes is the only disadvantage of the bioprosthesis which is silent, rarely complicated by thromboembolism and which does not require anticoagulant therapy for life. The mortality has decreased with time and will continue to fall if the indications for reoperation are based on stethacoustic, electrical, radiological and echocardiographic criteria of valvular dysfunction and not on the presence of overt cardiac failure as is still often the case.

Adolescent↗
PubMed1985

Comparative evaluation of aortic valve replacement with Starr, Björk, and porcine valve prostheses.

Three groups of 100 consecutive patients with aortic valve disease who were operated on between 1974 and 1978 underwent long-term evaluation. There were 100 aortic valve replacements with porcine bioprosthetic valves (group I), 100 with Starr valves (group II), and 100 with Björk valves (group III). There were no significant differences in the preoperative clinical conditions of the patients in the three groups. Cumulative follow-up was 1688 patient-years. Incidence of valve-related death at 8 years was 4 +/- 2.3% in group I, 13 +/- 3.6% in group II, and 13 +/- 3.8% in group III (p less than .05). At 8 years 95 +/- 2.8% of the patients in group I were free of thromboembolism, compared with 81 +/- 4.8% of those in group II and 84 +/- 4.2% of those in group III (p less than .002). The actuarial risk of a reoperation at 8 years was 16 +/- 6% in group I, 5 +/- 2% in group II, and 2 +/- 1.6% in group III (p less than .025 group I vs group III). At 8 years 98 +/- 1.2% of the patients in group I were free of anticoagulant-related complications, compared with 88 +/- 3.8% of those in group II and 86 +/- 3.9% of those in group III (p less than .005). We conclude that at 8 years porcine bioprosthetic valves performed better than mechanical valves, taking into consideration thromboembolism, anticoagulant-related hemorrhage, and valve-related death.

Actuarial Analysis↗
PubMed1984

[Mitral insufficiency complicating idiopathic subvalvular aneurysm of the left ventricle. Apropos of 5 surgical cases].

The surgical team of Pr Ch. Dubost operated 5 cases of idiopathic subvalvular left ventricular aneurysm with associated mitral incompetence over a 6 year period (from 1976 to 1981). These 5 cases closely resemble Abraham's et al's classical description of "annular subvalvular left ventricular aneurysms". They occur in black Africans, often young adults (mean age of our five cases 31,8 years) in the absence of coronary artery disease. The common feature is the peculiar anatomical localisation of the aneurysm on the posterior or lateral wall of the left ventricle, which explains the common finding of mitral regurgitation. They are often calcified and thrombosed, the thrombosis tending to extend into the left heart chambers. This was the case in 3 of the reported cases. Mitral regurgitation was controlled in one case by closure of a fistula into the left atrium with a very good result, and in 2 cases by simple section-suture of the neck of the aneurysm with good results and a small residual mitral leak. In a fourth case (Case n degree 1) the mitral valve was normal, regurgitation being the result of an extensive thrombosis. The valve was replaced but, in the light of the following cases, it is possible that the valve might have been unnecessarily sacrificed. Despite their sometime vast size and the association with mitral regurgitation, these subvalvular idiopathic left ventricular aneurysms are reasonable surgical indications for the following three reasons: the neck is often narrow, enabling closure under satisfactory surgical conditions; the structure of the valve is normal which, in the majority of cases, means that it can be respected at surgery; the absence of coronary artery disease.

Adult↗
PubMed1984

[Value of echocardiography in heart surgery].

Between October 15th 1981 and January 31st 1982, 297 echocardiogrammes were performed in the department of cardiac surgery at Broussais Hospital, 31 of which were requested and carried out as emergency procedures by day or night, 187 pre- or postoperatively and 79 in the out-patient clinic. M mode and 2D echocardiographies were performed at the bedside when necessary, namely in the intensive care unit pre- and postoperatively. The examination was performed by trained personnel, both in the out-patient clinic and in the intensive care unit. In the 31 cases in which the examination was requested as an emergency, the information obtained practically always contributed to establishing the right diagnosis and to correct therapeutic intervention. In 24 cases, the emergency occurred in the post-operative period: 18 cases of cardiac failure, of which echocardiography contributed to the indication of reoperation in 4 cases, the contra-indication of reoperation in 11 cases, and the need for emergency catheter studies in 2 cases. In one case the examination was unnecessary. In 6 other cases, suspected intracardiac thrombosis was excluded. There were 7 requests for emergency echocardiography in the preoperative period and the information obtained contributed to the indication for emergency surgery in 3 cases, and guided the operative strategy. The need for urgent surgery was refuted in 3 cases. The examination was unnecessary in 1 case. The results of echocardiography were very reliable. It does not seem to have provided any misleading information; the examination was incomplete in only 10% of cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Surgical Procedures↗
PubMed1984

[Calcified aortic stenosis and coronary disease. Apropos of 115 surgically-treated cases].

The authors studied 115 surgical cases of calcific aortic stenosis (AS) with coronary angiography. Between 1970 and 1981, 56 of these patients also had one or more aortocoronary bypass grafts (ACBG) (Group I). The other 59 cases, recruited from 1978 to 1981, comprise the control group who underwent isolated aortic valve replacement either with a normal coronary angiogram (Group II: 50 cases) or with such extensive coronary artery disease that ACBG was impossible (Group III: 9 cases). 93% of patients in Group I had preoperative angina compared to 80% in Group II and 78% in Group III. The incidence of previous myocardial infarction was 19%, 4% and 44% respectively. The number of main coronary arterial lesions per patient was 2 in Group I and 1.8 in Group III. In Group I, aortic valve replacement (AVR) was associated with a single aorto-coronary bypass in 70% of cases, a double bypass in 27% and a triple bypass in 3% of cases. The revascularisation ratio was 1.3 bypass per patient. The number of "complete" revascularisations rose from 56% (1970-1976) to 73% from 1977 to 1981. Overall hospital mortality per group (less than 1 month) was 16%, 4% and 0% respectively. The mortality rate in Group I fell from 31% (1970-1976) to 10% from 1977 to 1981. The perioperative rate of myocardial infarction in each group was 9%, 0% and 11% respectively. This figure fell considerably in Group I from 12.5% (1970-1976) to 7.5% from 1977 to 1981.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1984

[Acute suppurative mediastinitis in heart surgery performed under extracorporeal circulation].

The incidence of acute suppurative mediastinitis after open heart cardiac surgery in a 5 year retrospective study was found to be 1.56%. The commonest causal agent was the DNAse + coagulase + staphylococcus (68.8%). All cases were treated with bactericidal antibiotics and local measures (dosed chest irrigation-drainage in 1 or 2 stages). Adult men, early and/or late reoperation, immediate postoperative complications (cardiovascular collapse, haemorrhage) were positive risk factors. On the other hand, the type of underlying cardiac disease, the duration of surgery and bypass time, emergency surgery, and protocols of prophylactic antibiotic therapy did not seem to influence this risk. No sources of exogenous contamination, no notions of epidemics or periodicity were discovered in this study. The clinical course may be complicated, especially by renal failure. Thirty-two of the 109 patients studied died. However, the prognosis has improved in the last 5 years in relation to technical advances in intensive care and, above all, to adoption of 1 stage dosed chest irrigation-drainage: the mortality rate has fallen from 37.2% in the first period to 20% more recently. When a cure is obtained, it is complete and there are no sequellae. Nevertheless, irrespective of the adoption of draconian measures of asepsis and protocols of prophylactic antibiotic therapy, the risk of acute postoperative mediastinitis persists. This suggests that the efficacy of the patient's local (and general) anti-infective immunity defenses may vary in the presence of constant mediastinal bacterial contamination despite aleatory preventive measures, due to the remenance of the skin flora.

Acute Disease↗
PubMed1984

[Comparative evaluation of various methods of treatment of mitral valve diseases. Apropos of 4 series of 100 patients operated on using the Starr prosthesis, Bjork prosthesis, bioprosthesis and valve reconstruction].

The results of 4 groups of 100 patients undergoing mitral valvuloplasty (group I), isolated mitral valve replacement by a bioprosthesis (group II), a Starr-Edwards prosthesis (group III) and a Björk prosthesis (group IV) between 1974 and 1977 were compared. The selection of patients for each group was identical and made according to strict criteria. The average age was between 47.1 +/- 12.5 years and 51.8 +/- 10.5 years according to the particular group; the average functional classification was 2.4 +/- 0.4 to 2.5 +/- 0.6; the average cardiothoracic ratio was 0.58 +/- 0.07. Most patients were in atrial fibrillation. Ninety-seven per cent of patients were followed-up by questionnaires. The results were expressed with respect to simple clinical events used in all previously reported series. The long-term mortality was identical in the 3 groups undergoing valve replacement (40 p. 100 at 7 years) but was much less in the group undergoing valvuloplasty (18 p. 100 at 7 years). The mortality rate due to valvular problems was significantly less in the valvuloplasty group (2 p. 100 at 7 years) than in the groups with mechanical prostheses (20 p. 100 at 7 years). Intermediate results were observed in the bioprosthetic group (9 p. 100 at 7 years). Thrombo-embolism was significantly less common in the groups undergoing valvuloplasty and bioprosthetic valve replacement (2 p. 100 and 6 p. 100 at 7 years) than in the group with Starr-Edwards and Björk prostheses (30 p. 100 and 32 p. 100 at 7 years).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Comparative evaluation of mitral valve repair and replacement with Starr, Björk, and porcine valve prostheses.

Four hundred consecutive patients with isolated mitral valve disease who were operated on between 1974 and 1977 underwent long-term evaluation. In this group there were 100 valve repairs, 100 porcine valves, 100 Starr valves, and 100 Björk valves. There were no significant differences in the preoperative clinical conditions of the patients in the four groups. Cumulative follow-up was 2058 patient-years. We concluded from the data that mitral valve repair was associated with fewer valve-related complications than valve replacement. Thromboembolism was the most significant parameter with respect to determining long-term results of the use of the porcine, Starr, and Björk valve prostheses.

Actuarial Analysis↗
PubMed1983

[Percutaneous transluminal angioplasty of the iliac arteries. Immediate and long-term results].

Percutaneous transluminal angioplasty (PTA) was performed 30 times in 28 patients aged from 31 to 77 years (mean: 50.8 years) with stenosis of the iliac arteries. All patients were evaluated before and immediately after PTA by measuring the trans-stenotic pressure gradient and the degree of angiographic stenosis (grade 1 less than or equal to 50%; grade 2 = 50 to less than 75% and grade 3 greater than or equal to 75%). Prior to PTA 27 patients had grade 3 and three patients had grade 2 stenosis. The figures after PTA were 23 grade 1 and seven grade 2 stenosis. The mean trans-stenotic pressure gradient was reduced from 43 +/- 35 to 2.3 +/- 5.9 mmHg, the difference being highly significant (p less than 0.001). Eighteen patients were evaluated clinically and angiographically 8.4 +/- 6.1 months after PTA. Considerable clinical improvement was observed in 15, and 16 had a residual stenosis of less than 50%. PTA therefore appears to be a satisfactory treatment of stenosis of the iliac arteries. The long-term results can be assessed by graded intravenous angiography without any risk of damage to the arteries.

Adult↗