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Biomedical subjects

A Pavie

Publications and source records attributed to A Pavie.

At least 109 records · Page 6Linked to original sources
PubMed1992

[Current role of reconstructive surgery in the treatment of acute mediastinitis after cardiac surgery].

Infected median sternotomy often requires wide debridement. A large thoracic defect usually results with subsequent exposition of heart, great vessels, aortocoronary bypass grafting, vascular prosthesis. Coverage with muscles transplantation was the standard procedure carried out in this series of 150 cases observed between 1983 and 1991. Details of technique are presented as well as a review of our reconstructive options. Rewarding results were observed even in the most challenging circumstances, suggesting that pursuing this aggressive approach was warranted.

Acute Disease↗
PubMed1992

Heart transplantation: update.

Clinical application of heart transplantation goes beyond 25 years experience. The main indications for cardiac transplantation remain idiopathic cardiomyopathies and ischemic diseases. To obtain a suitable donor has become progressively more difficult due to the increase of transplants performed and the shortage of donors. Advances in the detection of early rejection, improved organ preservation procedures, and the introduction of new immunosuppressive therapy protocols have produced dramatic results in heart transplantation. Late graft atherosclerosis remains a serious threat despite retransplantation and, in some cases, mechanical cardiac support.

Adolescent↗
PubMed1992

Heart and heart-lung transplantation in the 1990s.

After 22 years of clinical application in our unit, heart transplantation is now an accepted therapeutic method. Its indications are well established, its surgical technique and post-operative control and treatment well defined, mostly due to better diagnosis of the rejection episodes with the aid of echocardiography and endomyocardial biopsy and the use of cyclosporin. The results are remarkable with a survival rate of 70% at 5 years, and a full rehabilitation into family, social and often professional life for almost all the survivors. Its use has dramatically changed the prognosis of patients with irreversible cardiac failure but underlines the lack of a sufficient number of donors' hearts. The heart-lung transplantation, making use of the progress of heart transplantation, has been used successfully since 1982 and for the first time in Europe by our group. Improvement in the selection of recipients, lung preservation, surgical technique and post-operative management have brought a new and real hope to patients not only irreversible cardiopulmonary lesions but also terminal pulmonary disease.

Heart Transplantation↗
PubMed1992

Survival prediction in staged heart transplantation using Jarvik-7 artificial heart.

BACKGROUND: Because mechanical circulatory assist as a bridge to heart transplantation places a further strain on current donor shortage as well as on medical cost containment, safe and effective use of the device is essential. METHODS AND RESULTS: To predict survival before undertaking staged heart transplantation with the Jarvik-7 artificial heart, our 58 attempts were reviewed retrospectively. Scores of 1-4 were given for six preoperative factors based on results obtained by univariate and multivariate analyses between survivors and nonsurvivors of staged heart transplantation: transplant rejection (scored 4: S4) or postoperative heart failure (S3) as the indication, recipient height < 175 cm (S3), body surface area < 1.8 m2 (S3), hyperbilirubinemia > 24 microM/l (S2), weight < 60 kg (S2), and age > 40 years (S1). Of 14 survivors, 13 had a total score < 4 (sensitivity, 93%), with an average score of 1.6 in contrast to 5.5 for 44 nonsurvivors (p < 0.001). Among 26 patients scored < 4, 21 had heart transplantation, of whom 13 left the hospital. Of 32 patients scored > or = 4, only four could be discharged after transplantation (specificity, 70%). CONCLUSIONS: Multiple preoperative factors successfully predicted transplantability and survival in staged heart transplantation. The results underscore the importance of preoperative condition and patient selection to achieve successful and effective use of Jarvik-7 as a bridge to heart transplantation.

Actuarial Analysis↗
PubMed1992

[Immediate and long-term results of coronary surgery under age 40].

The results of coronary artery surgery in young adults have not been extensively studied. We analysed the results of 221 patients under 40 years of age operated between 1979 and 1989 at the Pitié-Salpêtrière Hospital. The patients were 200 men and 21 women with an average age of 36.2 years. The most common cardiovascular risk factors were smoking (69.6%) and hyperlipidaemia (52%). One hundred and eighteen patients (53.4%) had previous myocardial infarction (MI). Triple vessel disease was present in 129 cases, double vessel disease in 59 cases and single vessel disease in 33 cases. Twenty three patients had significant left main coronary disease. The number of bypass grafts per patient averaged 2.3. The operative mortality was 2.07% (6 cases), death being due to myocardial infarction in 4 cases. Perioperative myocardial infarction was diagnosed in 12 cases (5.05%). One hundred and ninety nine patients were followed up for an average of 7.4 years. Seven of the 17 late fatalities were of cardiac origin. The actuarial 9 year survival rate was 84%. Five patients were reoperated after an average of 6.4 years. Eighty five per cent of patients were asymptomatic at the last follow-up examination. In conclusion, the symptoms of coronary artery disease in young adults can be effectively treated with a low operative risk by myocardial revascularisation surgery. Long-term follow-up remains essential to define the outcome in these patients. Systematic use of internal mammary artery bypass grafting should improve these results in the future.

Adult↗
PubMed1992

Heart-lung transplantation in situs inversus. A case report in a patient with Kartagener's syndrome.

After a long history of recurrent chronic pulmonary infections in a 25-year-old woman with Kartagener's syndrome, a heart-lung transplantation was performed. A modified surgical procedure was needed to perform transplantation because of the presence of a situs inversus, which is usually associated with bronchiectasis and sinusitis in this congenital syndrome. A large single atrium was created with both the right and left recipient atria used to facilitate anastomosis with the donor's right atrium. The patient was discharged after resolution of early ventilatory complications and is in good condition 8 months after transplantation.

Adult↗
PubMed1991

Cardiac tumors: clinical experience and surgical results in 74 patients.

A series of 75 cardiac tumors in 74 patients were operated on at La Pitie Hospital between 1972 and 1989. There were 73 primary and 2 metastatic tumors. Among the benign neoplasms, 58 were myxomas; seven of the nine malignant tumors were primary heart tumors. The mean age of the patients was 48 years (range, 9 to 75 years); 46 patients were female and 28 male. Fifty-seven percent of the patients had congestive heart failure, 13% had chest pain, 17% had neurological symptoms, and only 1 patient was totally asymptomatic. The cardiac tumors were incidental findings in 3 patients. Complete resection was carried out in 66 benign lesions and only four of the malignant tumors. All patients survived operation, although 4 died in the early postoperative period. Long-term results were excellent in patients with benign lesions, and no recurrences were found. In patients with malignant tumors, surgical procedures were only palliative and aimed at prolonging life; hence, prognosis remained unchanged.

Adolescent↗
PubMed1991

Preoperative risk analysis in patients receiving Jarvik-7 artificial heart as a bridge to transplantation.

To distinguish high-risk patients prior to implantation of a Jarvik-7 artificial heart as a bridge to transplantation, our 37 attempts were reviewed retrospectively. Arbitrary scores of 1 to 4 were given for nine preoperative factors on the basis of results obtained by uni- and multivariate analyses between successful cases and failed attempts; transplant rejection (scored 4: S4) or postoperative heart failure (S3) as the indication, recipient height less than 175 cm (S3), body surface area less than 1.8 m2 (S3), hyperbilirubinemia greater than 24 microM/l (S2), preoperative renal failure requiring dialysis (S2), weight less than 60 kg (S2), and age greater than 40 years (S1). All except one of the 16 patients with successful bridge had a total score of less than 4, with an average score of 1.3 in contrast to 6.6 in the 21 failed cases (p less than 0.001). Among the 17 patients who scored less than 4, 15 received transplants (specificity 90%), while only one qualified for transplantation among 20 patients who scored 4 or more (sensitivity 94%). The two unpredicted failures resulted from mediastinitis and pulmonary infarction, both attributable to postoperative management. Multiple preoperative factors in combination could have successfully predicted the outcome of mechanical support in our experience. These results underscore the importance of patient selection to achieve successful and effective use of the Jarvik-7 as a bridge to heart transplantation.

Adolescent↗
PubMed1991

Prognostic indices of survival in patients supported with temporary devices (TAH, VAD).

In an attempt to identify current indications and patient selection criteria for the use of mechanical circulatory support, we reviewed our experience in 83 patients who received a total artificial heart (TAH; n = 43), ventricular assist device (VAD) (n = 13), centrifugal pump (n = 17) or extracorporeal membrane oxigenation (ECMO) (n = 8) as a bridge to transplantation (Group I, n = 50) or for recovery from heart failure (Group II, n = 33). Comparing patients successfully transplanted (n = 20) or weaned (n = 9) who survived initial hospitalization, and those who died on mechanical support, there were no differences in preoperative renal, hepatic or pulmonary functions. Postoperative urinary output and bilirubin levels were the earliest variables affecting survival, and urinary output 24 hours after implant was discriminative in patients who survived (p less than 0.01). Age (above or below 40 years) and modality of terminal heart failure (acute versus chronic) were the most important factors affecting survival in the bridge to transplant group: 82% of young patients with acute decompensation were transplanted and 63% are long-term survivors while all patients over 40 years with chronic heart failure died on mechanical support (MS). In postcardiotomy patients, duration of cardiopulmonary by-pass (CPB) was significantly different comparing survivors with those who died in either bridge or recovery groups and all patients who had a CPB greater than 4 hours died on MS or after transplantation or weaning. In conclusion, preoperative indices indicating reversibility of multiple organ dysfunction remain to be identified.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Value of the association of blood cardioplegia and energetic warm reperfusion in cardiac transplantation].

Blood cardioplegia at 8 degrees C results in cardiac standstill whilst maintaining minimal metabolic functions of the cardiac cell. Reinjection every 20 minutes allows cellular reoxygenation, the delivery of essential elements (Tham, CPD), and the elimination of products of myocardial degradation accumulated during ischemia. Before declamping the aorta, a reperfusion with warm blood (34 degrees C) containing glutamate and GTN enables restocking of the energy reserves (Krebs' cycle) and a lowering of coronary and systemic resistances. This technique used systematically if even more effective when the ischemic time is prolonged as is the case in cardiac transplantation. The 50 transplants performed since January 1989 with this form of myocardial protection were compared with 50 procedures performed in 1988 with crystalloid cardioplegia. There was no significant difference in the duration of ischemia or of cardiopulmonary bypass between the two groups. Patients benefitting from blood cardioplegia defibrillated spontaneously more frequently, required lower doses of Dopamine for shorter periods and were extubated earlier.

Adult↗
PubMed1991

[Our experience with bioprostheses in French Polynesia. A follow-up study from 1975 to 1988].

French Polynesia has unique social, cultural and geographic features. The prevalence of acute rheumatic fever (ARF) of 1.2 % population justified the health authorities' classification of this endemic as "major, severe, and prioritary" in 1984. Seventy per cent of patients with ARF develop cardiac sequellae which require surgery in 25 per cent of cases. Bioprostheses were considered from 1975 as the ideal valve replacement for these young, often undisciplined patients with no facilities for haemostatic control. Reoperation for valve degeneration has been increasingly frequent since 1982 and poses an acute problem leading to this statistic study and to a reflection as to the value of continuing to use this type of valve in this population. Analysis of 178 Polynesians with one or more cardiac bioprostheses in 1988, totalling 221 valves with a mean follow-up of 55 months, shows an actuarial survival rate excluding operative mortality of 86.7 +/- 3 % at 5 years (93.8 +/- 2.5 % in patients under 25 years of age, p = 0.001). Fifty-two patients (29 %) have been reoperated with a probability of being free of reoperation at 5 years of 70.1 +/- 4.2% (85.2 +/- 3.9 % in patients over 25 years of age and 43.8 +/- 7.8 % in patients under the age of 25, p = 0.002). The authors discuss the alternative of bioprostheses in this population : mechanical valves with anti-coagulant or anti-aggregant therapy, frozen aortic homografts, mitral valvuloplasty.

Actuarial Analysis↗
PubMed1990

[Surgical strategy in polyarterial disease. Value and results of combined surgery].

Patients with coronary disease associated with carotid artery stenosis and/or abdominal aortic aneurysm often raise problems of operative strategy; in particular, the order in which these lesions must be treated is a frequent source of controversy. We report the results of sequential or simultaneous combined surgery for multiple arterial lesions. Between 1979 and 1988, 65 patients with such lesions underwent either cerebral revascularization simultaneously with coronary bypass (n = 48) or repair of infrarenal aortic aneurysm a few weeks after myocardial revascularization (n = 17). After simultaneous surgery on the carotid and coronary arteries, the postoperative mortality rate was 4.2 per cent (2 patients). Myocardial infarction occurred in 3 cases (6.2 per cent). No neurological disorder consecutive to carotid endarterectomy was observed. Late postoperative mortality involved 5 patients; in 2 of these the cause of death was non-cardiovascular. No other late complication due to coronary or carotid artery disease was noted. The 5-year survival rate, operative mortality included, was 74.8 +/- 8.6 per cent. After coronary bypass followed by abdominal aortic aneurysm repair, there was no operative death, and no perioperative complication due to coronary disease was observed. Late mortality involved 2 patients. One patient underwent bilateral femoro-popliteal bypass 4 years after repair of an aortic aneurysm. Percutaneous angioplasty for proximal stenosis of a venous coronary graft implanted 8 years previously was performed in one patient with primary success. All other patients are now asymptomatic as regards both coronary and peripheral arteries. The 7-year survival rate is 85.7 +/- 9.4 per cent. The absence of neurological disorders after simultaneous myocardial and cerebral revascularization, and the absence of cardiac complications after aortic aneurysm repair preceded by coronary bypass enable us to recommend systematic combined or sequential vascular surgery. The long-term survival rate obtained in this series supports this recommendation.

Aged↗
PubMed1990

Surgical treatment of chronic aortic dissections.

Between January 1976 and March 1987, 78 patients underwent surgery for chronic aortic dissection at our institution. The ascending aorta was involved in 66 cases (Stanford type A) and was not involved in 12 cases (Stanford type B), wherever the initial dissection was suspected. Aortography remains the main preoperative investigation. The surgical technique varies according to the type of dissection. It seems essential to exclude the primary intimal tear and all dilated segments of the aorta must be replaced. The overall operative mortality was 11.5% (7.5% in type A, 33.3% in type B dissection). Sixty-three patients have been followed for a period varying between 6 months and 10 years (mean 5 years). The overall survival at 6 years is 60% +/- 5.6%. Because of the ultimate risk of aneurysmal dilatation of the false channel, these patients must be followed by CT scanning, colour flow Doppler echocardiography, magnetic resonance imaging, and in some cases, aortography.

Aortic Dissection↗
PubMed1990

Approach to advanced aortic root infection.

Among our first 11,620 cases of valvular replacement, we observed 285 cases of valvular endocarditis and 59 cases (20.7%) in which the importance of the infectious lesions of the aortic or mitral annulus required complex valvular repair. In 23 patients with aortic valvular endocarditis, the presence of an abcess of the aortic annulus required its closure with a patch resulting in one early and one late death and five reinterventions with one death. Twenty patients are alive and well, 1 to 9 years after operation. In 11 patients, the extent of annular abcesses required the insertion of a subcoronary valved conduit. After a maximum follow-up of 8 years there were two early deaths, two late deaths, one reoperation, and seven good results. Twelve patients had a supracoronary valved conduit resulting in four early deaths, one late death, and two reoperations; seven are alive and well, 2 to 6 years later. Three patients previously operated on had a left ventricular abdominal aorta valved conduit, two of them are alive and well up to 6 years later. Severe infectious lesions of the valvular rings (aortic root) can require complex repairs that can be lifesaving and provide excellent long-term results.

Abscess↗
PubMed1990

Ablation of the slow-conduction area in chronic ventricular tachycardia.

The ablation techniques, which derive from surgical approach in the treatment of ventricular tachycardia, were originally based on the modification of conduction in the so-called site of origin of the arrhythmia. A reentrant tachycardia involves two areas of conduction, one which consists of normal tissue, and the other with slow-conduction properties isolated from the previous structure. We now think that a more appropriate place to deliver the shock should be the area of slow conduction. The purpose of this paper is to review the main electrophysiological characteristics of this tissue, which could be interesting markers to identify the site where the shock should be delivered.

Action Potentials↗
PubMed1990

[Intracardiac myxoma: surgical treatment with trans-septal approach].

In the last 15 years, fifty-two cases of cardiac myxoma underwent surgical excision at La Pitié Hospital-Paris. They were 19 male and 32 female aging from 16 to 75 years (mean 15 +/- 10). Symptoms were congestive heart failure (55%), constitutional syndrome (35%), peripheral embolization (25%) and syncopal episodes (7%). Echocardiographic diagnosis was done in almost all cases. 47 tumors were found in the left atrium, 4 in the right and 1 in the right ventricule. Transeptal approach was used in most of the patients and myxomas were totally removed including a part of atrial septum, requiring patch reconstruction in 35 patients. Postoperative mortality was very low (1.9%). No complications nor recurrences have been reported in the long-term follow-up.

Adolescent↗