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Biomedical subjects

A Khayat

Publications and source records attributed to A Khayat.

At least 37 records · Page 2Linked to original sources
PubMed1999

A special adapted retractor for the mini-sternotomy approach.

Minimally invasive cardiac operations are now possible through different approaches. To provide the best exposure and sufficient space to manipulate the heart, a special adapted thoracic retractor has been developed for the ministernotomy approach. It is universally adjustable and provides excellent and consistent exposure especially below the incision edges. The retractor has the further advantage of a very low profile on the surgeon's side and at the cephalic and caudal extremes of the operative field, which permits the greatest possible access through a limited access. We have successfully used this retractor in more than 180 patients. A less invasive median sternotomy through a 6-9-cm incision has been our original approach.

Cardiac Surgical Procedures↗
PubMed1999

Pulmonary artery bullet injury following thoracic gunshot wound.

Thoracic trauma occurs frequently but seldom requires surgery (10-20%, [1]). The mortality rate for gunshot wound of the chest varies from 14.3 to 36.8% [2]. We report, herein an example of bullet injury to the pulmonary artery (PA) following a thoracic gunshot wound. This patient had previous history of coronary surgery. Absolute and relative indications for exploratory thoracotomy in emergency will be reviewed.

Aged↗
PubMed1999

Non-penetrating subclavian artery trauma: management by selective transluminally placed stent device.

Non-penetrating injury to the subclavian artery has not often been reported. The limited experience of surgeons with this type of trauma and the difficult vascular control required for its management make it a surgical challenge. We report on two cases, one after blunt trauma and the other with a subclavian artery aneurysm following anterior dislocation of the shoulder. Percutaneous stent implantation in the subclavian artery was successfully performed with, in the second case, coil embolization of the aneurysm. Follow-up Doppler sonography and angiogram demonstrated patency and luminal integrity of the involved artery. This less invasive procedure may be a significant advance and a new approach in the conservative management of traumatic subclavian injury for selected cases.

Aged↗
PubMed1999

Secondary leukemia or myelodysplastic syndrome after treatment with epipodophyllotoxins.

PURPOSE: The incidence of secondary leukemia after epipodophyllotoxin treatment and the relationship between epipodophyllotoxin cumulative dose and risk are not well characterized. The Cancer Therapy Evaluation Program (CTEP) of the National Cancer Institute (NCI) has developed a monitoring plan to obtain reliable estimates of the risk of secondary leukemia after epipodophyllotoxin treatment. METHODS: Twelve NCI-supported cooperative group clinical trials were identified that use epipodophyllotoxins at low (<1.5 g/m2 etoposide), moderate (1.5 to 2.99 g/m2 etoposide), or higher (> or =3.0 g/m2 etoposide) cumulative doses. Cases of secondary leukemia (including treatment-related myelodysplastic syndrome) occurring on these trials have been reported to CTEP, as has duration of follow-up for all patients, thereby allowing calculation of cumulative 6-year incidence rates of secondary leukemia for each etoposide dose group. RESULTS: The calculated cumulative 6-year risks for development of secondary leukemia for the low, moderate, and higher cumulative dose groups were 3.3%, (95% upper confidence bound of 5.9%), 0.7% (95% upper confidence bound of 1.6%), and 2.2%, (95% upper confidence bound of 4.6%), respectively. CONCLUSION: Within the context of the epipodophyllotoxin cumulative dose range and schedules of administration encompassed by the monitoring plan regimens, and within the context of multiagent chemotherapy regimens that include alkylating agents, doxorubicin, and other agents, factors other than epipodophyllotoxin cumulative dose seem to be of primary importance in determining the risk of secondary leukemia. Data obtained by the CTEP secondary leukemia monitoring plan support the relative safety of using epipodophyllotoxins according to the therapeutic plans outlined in the monitored protocols.

Adolescent↗
PubMed1999

Spontaneous native aortic valve thrombosis.

Spontaneous thrombosis of a native aortic valve is an uncommon event that usually follows local trauma, such as cardiac surgery or left heart catheterization, or occurs as a complication of bacterial endocarditis. We report the case of a 65-year-old woman with a history of retinal artery occlusion and severe aortic valve stenosis, in whom transesophageal echocardiography revealed a mobile mass attached to the ventricular surface of the aortic valve. There was no evidence of any hypercoagulable state or infection process. Surgery was performed and a severely stenotic valve resected; a partially organized and firmly adherent free-floating thrombotic mass was observed on the ventricular surface of the aortic valve. Histologic examination demonstrated an organized thrombus. Eleven months after surgery the patient is doing well.

Aged↗
PubMed1999

Cosmetic aspects in minimally invasive cardiac surgery.

The initial focus of the pioneering cardiac surgeons was appropriately centered on survival as opposed to cosmetic results. A variety of minimally invasive techniques have been introduced to perform cardiac operations through a limited incision. As the results in cardiac surgery improved, cosmetic and psychological implications of surgery become more important in the evaluation of the morbidity of these procedures. Future comparative studies will be mandatory to show whether these small incisions have an actual advantage on recovery or morbidity or whether their interest is entirely aesthetic.

Adolescent↗
PubMed1998

Modified biatrial approach for the extensive resection of left atrial myxomas.

Surgical excision of left atrial myxomas is usually curative. When the root of the pedicle and the full thickness of the adjacent interatrial septum are excised, the repair of the created atrial septal defect requires a pericardial or Dacron patch. The biatrial approach generally has been accepted as the technique having the advantages of well identifying the site of attachment and inspection of the four cardiac chambers. We proposed a modification of this technique that allows the reconstruction of the created septal defect without any foreign patch.

Cardiopulmonary Bypass↗
PubMed1998

Less invasive cardiac operations through a median sternotomy: 100 consecutive cases.

BACKGROUND: In the beginning of 1997, we developed a routine approach to intracardiac operations through a less invasive median sternotomy. A limited (6 to 9 cm) median skin incision followed by a subcomplete (manubrium and body) median sternotomy makes opening and closing of the chest easier; conventional central cardiopulmonary bypass is instituted, and no modifications to the surgical techniques are necessary. METHODS: In 100 consecutive patients (mean age, 62.04 years; range, 9 to 92 years), 70 aortic, 13 mitral, and 17 other cardiac procedures were performed. Surgical technique required many self-made instruments; anesthetic "fast-tracking" management was performed. RESULTS: Four patients died. One conversion to a standard sternotomy and five reoperations for bleeding were necessary. Cross-clamp time ranged from 33 to 140 minutes (mean +/- standard deviation, 69.23 +/- 20.99 minutes) and total drainage loss ranged from 120 to 1,800 mL x m(-2) x 24 h(-1) (mean, 288 mL x m(-2) x 24 h(-1)). The postoperative course was shorter than usual, and one complication in the healing wound was observed. The scar was shorter than 9 cm in all patients. CONCLUSIONS: Our work shows that a less invasive approach to many cardiac operations is possible through a modified median sternotomy. This technique provides many potential and practical advantages: there is less trauma and pain reported by patients, and the small wound reduces the risk of infection and blood loss. Patients are extubated and discharged from the hospital earlier.

Adolescent↗
PubMed1998

Bicarbon valve -- European multicenter clinical evaluation.

OBJECTIVE: Fifteen collaborating centers in eight countries present their pooled experience with the new Bicarbon bileaflet valve. METHODS: Between 4/90 and 4/96, 1351 patients, 806 males and 545 females, aged 10 to 83, mean 58.4 +/- 12.4, underwent valve implantation. OPERATIONS: aortic valve replacement (AVR), 726; mitral valve replacement (MVR), 475; double valve replacement (DVR), 150. Additional procedures: CABG, 211; TV repair, 64; other, 152. RESULTS: Mortality: 67 early (seven valve related) and 56 late (40 valve related). Valve thrombosis: six obstructive, three non-obstructive; embolism: nine major cerebral, 37 other. Major bleeding: 29. Hemolysis: two clinically significant. Non-structural dysfunction: 24 paravalvular leaks, one leaflet interference. No structural failure! Endocarditis: 24. Reoperation 48: 22 non-structural dysfunctions, 14 endocarditis, seven thrombosis and embolism, five other. Estimated 5-year freedom from valve-related deaths is 97.2% for AVR and 92.4% for MVR; 4-year freedom from valve related deaths for DVR is 90.5%. Mean calculated NYHA improvement is 1.24. CONCLUSIONS: The Bicarbon mechanical prosthesis is well designed, durable, has good hemodynamic features and an acceptably low incidence of complications.

Adolescent↗
PubMed1998

Minimally invasive coronary surgery: surgical considerations and assessment of cardiac troponin I.

OBJECTIVE: Minimally invasive coronary artery bypass grafting (MICABG) using internal thoracic artery (ITA) without median sternotomy and cardiopulmonary bypass (CPB) become a viable option for the management of proximal left anterior descending artery (LAD) disease. Recent studies have demonstrated that cardiac troponine I (cTnI), a new highly specific diagnostic marker of cardiomyocyte damage, is a reliable marker of cardiac ischemia during heart operations under CPB. METHODS: Between February 1996 and April 1997, 14 patients (10 males, 4 females aged 41-68) underwent MICABG with single-vessel bypass grafting for LAD stenosis (n = 9) or occlusion (n = 5). Video-assisted surgery with left anterior mini-thoracotomy was performed in ten patients and vertical parasternal thoracotomy in the other four. cTnI was measured before LAD occlusion (T0), during anastomosis (T1) and 10 min (T2), 6 h (T3), 24 h (T4), 48 h (T5), 72 h (T6) after coronary reperfusion. Assay methods used a specific enzyme-linked immunosorbent autoanalyzer (Stratus) in peripheral venous blood. Control coronary angiography was performed in all patients. RESULTS: There were no operative complications, no reoperations for bleeding. cTnI concentrations were expressed in ng/ml +/- SD. Mean cTnI level was <3.85+/-1 ng/ml (range 0-32.8). Values were: T0 = 0, T1 = 0.5+/-0.1, T2 = 1.15+/-0.2, T3 = 2.16+/-0.6, T4 = 1.5+/-0.3, T5 = 0.6+/-0.02, T6 = 0.4+/-0.01. Angiography showed patent grafts in 12 patients. A 'no flow situation' was demonstrated in a cardiac symptom-free patient, with reestablishment of flow on repeat angiogram at 6 months. In the other case, early ITA graft occlusion in a patient with two-vessel disease was correlated with a higher cTnI concentration (17.8 ng/ml). Percutaneous angioplasty was performed on the right coronary artery, complicated with dissection and cardiac failure. This patient died 3 months after the MICABG despite ventricular assist device. CONCLUSION: cTnI did not increase during and after coronary artery occlusion and local immobilization of the heart. It can be used to evaluate postoperative myocardial damage on the beating heart using MICABG.

Coronary Disease↗
PubMed1998

Less-invasive heart surgery: the preservation of median approach.

OBJECTIVE: Cardiac surgery has been traditionally performed via a median sternotomy incision where a large exposure of the mediastinum assured most of the cardiac procedures. Recently, the concepts of less-invasive surgery, well affirmed in many surgical specialties, led cardiac surgeons to develop limited accesses in coronary, valves and congenital operations. METHODS: Between January and May 1997, 30 patients were operated on with a less-invasive approach. A short (6-9 cm) median incision followed by a subcomplete sternotomy permitted a limited opening of the chest without compromising the surgical exposure; a conventional central CPB was instituted and valve surgery and most of intracardiac procedures were performed without modification of the standard technique. RESULTS: No mortality was observed; morbidity was minimal. Cardiopulmonary bypass time and aortic cross-clamp time averaged 84+/-9 and 61+/-11 min, respectively. The majority of patients were extubated and discharged from the ICU early. Chest drainage lost on average 290+/-180 ml/m2. CONCLUSIONS: Despite our limited initial experience, this technique seems to provide several potential and practical advantages: there is less trauma and pain reported by patients; the small wound reduces the potential for wound infection and blood loss. Patients are extubated and discharged from the hospital earlier with lower overall costs.

Aged↗
PubMed1998

Safety of beating heart anastomosis during video-assisted coronary surgery attested by cardiac troponin I.

Our objective was to evaluate the safety of coronary anastomosis on the beating heart by measuring the release of cardiac troponin I during minimally invasive coronary artery bypass grafting (MICABG). Cardiac troponin I (cTnI) is a reliable marker of cardiac ischemia during heart operations under cardiopulmonary bypass (CPB). Ten patients (8 males and 2 females, aged 41-63) underwent MICABG with single vessel bypass grafting for left anterior descending coronary artery (LAD) stenosis (n = 7) or occlusion (n = 3). Video-assisted surgery with left anterior minithoracotomy was performed in all patients. Serial venous blood samples were collected for measurement of cTnI before LAD occlusion (T0), during anastomosis (T1) and 10 min (T2), 6 h (T3), 24 h (T4), 48 h (T5), and 72 h (T6) after coronary reperfusion. The assay method used a specific enzyme-linked immunosorbent Stratus autoanalyzer. Control coronary angiography was performed in all patients. There were no operative complications or reoperations for bleeding. The cTnI concentrations were expressed in ng/ml +/- SD. The mean cTnI level was less than 3.05 +/- 0.2 ng/ml (range 0-32.8). Values were T0 = 0, T1 = 0.4 +/- 0.03, T2 = 1.15 +/- 0.2, T3 = 2.16 +/- 0.6, T4 = 1.5 +/- 0.3, T5 = 0.6 +/- 0.02, and T6 = 0.4 +/- 0.01. Angiography showed patent grafts in 9 patients. In one case, early internal thoracic artery (ITA) graft occlusion in a patient with 2 vessel disease was correlated with a higher cTnI concentration (17.8 ng/ml). Percutaneous angioplasty was performed on the right coronary artery, complicated with dissection and cardiac failure. This patient died 3 months after the MICABG despite support from a ventricular assist device. In conclusion, collateral circulation developed in the setting of chronic coronary occlusion may be efficient for myocardial preservation during short periods such as coronary anastomosis. cTnI immunoassay confirmed the safety of coronary anastomosis on the beating heart during minimally invasive coronary operations.

Adult↗
PubMed1998

Pulmonary artery trunk leiomyosarcoma.

Pulmonary artery leiomyosarcomas are rare tumors. They cause symptoms suggestive of recurrent pulmonary emboli. As in the case reported here, the diagnosis is virtually never considered initially, despite modern diagnostic imaging methods, but usually made at autopsy or at histologic examination of material removed from the pulmonary artery at surgery. The prognosis remains poor and prolongation of life up to 6 months has not been clearly demonstrated with radical excision in conjunction with radiotherapy. The difficulty is the accurate diagnosis required to consider these tumors for curative resection, which is the only hope for a longer disease-free course.

Adult↗