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Biomedical subjects

A Pavie

Publications and source records attributed to A Pavie.

At least 127 records · Page 7Linked to original sources
PubMed1990

[Results of thrombo-endarterectomy of chronic pulmonary embolism].

Between 1973 and 1987, 33 patients underwent pulmonary thromboendarterectomy for chronic pulmonary embolism. Twenty-six patients were in Class III of the NYHA Classification, 5 in Class IV with overt right ventricular failure and 2 in Class II. The average pO2 was 60 mmHg under basal conditions without oxygen therapy. The amputation of the pulmonary vascular tree was greater than 50 per cent in all patients. The average systolic pulmonary artery pressure was 70 mmHg. Twenty patients were operated by a lateral thoracotomy without CPB and 6 by sternotomy with CPB under normothermia with or without cardiac fibrillation. The later method avoids having to open the pleura and seemed to give better haemodynamic control. Interruption of the inferior vena cava was systematic in all cases. The global operative mortality was 20 per cent but this seemed to be less in the patients operated by sternotomy under normothermic CPB (no deaths in 6 patients). The authors consider that this technique should be studied in a larger series of patients. Eighteen patients are still being followed up; the clinical and scintigraphic and/or angiographic improvement is clearcut in the majority of cases.

Chronic Disease↗
PubMed1990

[Cardiac surgery in patients over 80 years of age. Experience of a series of 51 patients].

Between January 1980 and June 1988, 51 patients over 80 years of age underwent open heart surgery at the La Pitié hospital (26 women and 25 men; average age 82 +/- 2 years, range 80-90 years). The cardiac pathology was calcific aortic stenosis (AS) in 40 cases, associated with coronary artery disease in 7 cases, mitral valve prolapse in 3 cases, coronary artery disease alone in 6 cases [complicated by a post-infarction ventricular septal defect (VSD) in one patient] or associated with aortic regurgitation in 1 case, and degeneration of an aortic bioprosthetic valve in 1 case. Forty patients (78%) were in Stage III or IV or the NYHA Classification. There was no other major pathology associated with the cardiac disease. Aortic valve replacement (AVR) was carried out in 42 patients, with a bioprosthetic valve in 38 patients. This procedure was associated with coronary bypass surgery in 7 cases and carotid artery surgery in 1 case. A mitral bioprosthesis was implanted in 2 patients and mitral valvuloplasty was carried out in 1 patient. An isolated myocardial revascularisation procedure was performed in 5 cases; the VSD was closed in 1 case. The hospital mortality was 17.6 per cent (9 patients). All deaths were of cardiac origin. Eleven patients had no postoperative complications at all. The 3 year survival rate of those who survived surgery was 71 per cent. Of the current 31 survivors, 29 are in Stage I or II of the NYHA Classification. These results suggest that surgery can be offered to octogenarians with invalidating cardiac disease alone carrying a poor short term prognosis.

Actuarial Analysis↗
PubMed1990

[Value and results of coronary surgery before the repair of abdominal aortic aneurysm].

Seventeen polyarteriosclerotic patients underwent coronary bypass surgery before repair of an abdominal aortic aneurysm between December 1979 and November 1988 in the Cardiovascular Surgical Department of the Pitié Hospital. Sixteen patients had triple vessel disease and 1 patient had single vessel disease but with mitro-aortic valvular disease. The abdominal aortic aneurysm was asymptomatic in 9 cases. The diameter of the aneurysm was over 5 cm in all patients. The average time between the two operations was 6.3 +/- 5.4 months. One myocardial infarction was observed following the coronary bypass surgery. There were no complications related to the coronary artery disease or operative deaths after repair of the abdominal aortic aneurysm. Two late deaths occurred, one due to an aortoduodenal fistula and the other to extra cardiovascular causes. One patient underwent femoro-popliteal bypass surgery 4 years after repair of the aortic aneurysm. One patient had successful percutaneous transluminal angioplasty of an aorto-coronary venous bypass graft 8 years after its implantation. All the other patients are asymptomatic from the coronary and peripheral arterial points of view. The 7 year survival was 85.7 +/- 9.4 per cent. These results seem to justify immediate and late preventive myocardial revascularisation in patients with coronary artery disease requiring surgery prior to repair of an abdominal aortic aneurysm.

Aged↗
PubMed1990

Factors affecting survival in total artificial heart recipients before transplantation.

To identify factors affecting the successful bridge to transplantation, experience with 32 recipients of the Jarvik-7 artificial heart was reviewed. Between patients with and without a successful bridge, there were no significant differences in preoperative hepatorenal function or postoperative hemodynamics, but there were significant differences in body size. When recipients were divided according to body surface areas of less than or greater than 1.8 m2, the smaller patients more frequently developed respirator dependence (73% vs. 18%, p less than 0.01), renal failure (53% vs. 18%, p less than 0.05), and hepatic failure and sepsis, resulting in less frequent qualification for transplantation (20% vs. 65%, p less than 0.05). There were no successful bridge operations in seven patients with body surface areas of less than 1.7 m2, and only one success in nine patients who were less than 170 cm in height, despite use of a smaller stroke volume model. The smaller patients had poorer ventricular filling, which was largely compensated for by the drive controls set for significantly longer diastole and higher vacuum, resulting in similar hemodynamics between the groups. The results suggest that device fitting as manifested by body size is an important factor affecting major organ recovery and subsequent transplantation in recipients of the Jarvik-7 artificial heart. A paracorporeal device may be advisable for patients with body surface areas of less than 1.8 m2 or who were less than 175 cm in height until an even smaller model with a better fit in the thorax becomes available.

Adult↗
PubMed1990

Heart transplantation: La Pitié experience, 1968-1989.

Heart transplantation is now an accepted therapeutic modality for end-stage heart disease. However, better immunosuppressive treatments and new methods to monitor rejection or detect early atherosclerosis must be developed to improve the long-term results after heart transplantation.

Cardiomyopathies↗
PubMed1989

[Should mild acute rejection of a cardiac graft be treated?].

With no additional therapy, mild acute cardiac allograft rejection progresses in 30 per cent of the cases towards moderate rejection. Three hundred mild rejections which occurred in 120 patients between May 1987 and May 1989 were studied and divided into 3 groups according to their treatment. Group I rejections (n = 108) were left untreated. In group II rejections (n = 186), the dose of oral corticosteroid therapy was increased, and in group III rejections (n = 6) major immunosuppressive treatment with methylprednisolone and antilymphocyte globulins (or Orthoclone OKT3) were initiated in view of the clinical and echocardiographic severity of the rejection. In the untreated group, 20 per cent of mild rejection progressed to moderate rejection, while 67 per cent are still at a mild stage in control myocardial biopsies. In group II, only 5 per cent of mild rejections have become moderate, and 19 per cent persisted as mild in control biopsies (p less than 0.05). The treatment of group III rejections resulted in complete disappearance of signs of heart failure and improvement of right and left ventricular contractile functions, proving that severe rejection was cured. This study demonstrates the effectiveness of increased oral corticosteroid therapy in minimal acute cardiac allograft rejections, without significant increase in infection or mortality rate. The principal reason for treating mild acute cardiac allograft rejections is to prevent their progression towards moderate rejections which require major immunosuppressive treatments and therefore have higher post-transplantation infection and mortality rates.

Adrenal Cortex Hormones↗
PubMed1989

[Heart transplant. Long-term follow-up].

The use of cyclosporin in the immuno-suppressive treatment has resulted in a spectacular improvement of the outcome of cardiac transplantation. But a number of complications, if they have become less severe, have note however totally disappeared. In order to detect them at an early stage, a strict monitoring is necessary. Systematic ambulatory visit are organized in the transplant center. In the interval between visits, a medical follow-up by cardiologist and attending physician is absolutely necessary.

Aftercare↗
PubMed1989

Total artificial heart: survival and complications.

A total artificial heart was implanted in 28 patients as a bridge to transplantation. Mean time of mechanical support was 14.8 +/- 10 days. The 70-mL Jarvik-7 was used in 12 patients and the 100-mL Jarvik-7 in the remaining 16. No clinical thromboembolic complications occurred during implantation. There was no postoperative bleeding requiring operation. Both survival and the rate of complications were similar in the two Jarvik-7 groups. Eleven patients underwent successful transplantation, and 1 patient is still on mechanical support. Sepsis and multiple-organ failure were the most important causes of death. All patients receiving the total artificial heart for severe acute rejection after transplantation died of infection. Early implantation of the total artificial heart is advised in younger patients and in older patients with acute cardiac failure. The use of this device should be contraindicated in immunosuppressed patients because of the high risk of infection.

Adult↗
PubMed1989

Current problems in cardiac transplantation.

Since our initial orthotopic heart transplant (OHT) in 1968, the first in Europe, 1130 patients with ages ranging from 1 month to 66 years have been referred to us. The cause of irreversible myocardial damage was idiopathic cardiomyopathy in 74%, ischemic heart disease in 19% and left ventricular failure after valvular replacement in 7%. A total of 540 transplantations, 463 orthotopic, 40 heterotopic and 37 heart-lungs were carried out. Features of the early post-operative course include temporary (first week) cardiac instability treated by isoproterenol. Later complications included rejection (95%) and side-effects of immunosuppressive therapy; infection (83%), osteoporosis, malignancy, graft atherosclerosis (2%). Cyclosporine (Cy) was responsible for diastolic hypertension, renal dysfunction, hirsutism, hyperplasia of the gingiva, hepatic dysfunction, and seizures. The survival rate of the Cy-treated patients was 68% at 7 years. All survivors have virtually normal social and professional lives, included the longest survivor 14 years after the operation. Recently in 34 patients in acute irreversible cardiac failure and who cannot have a transplant in time, we implant a total artificial heart (TAH) type JARVIK 7 during a period from 1-150 days. There has been no mechanical failure, hemolysis or thrombo-embolism and only one right ventricular device malposition; 20 patients died before transplantation, 13 were successfully transplanted, 1 is still on the artificial heart. Heart transplantation, and TAH used as a bridge to transplantation are now an accepted therapeutic means for irreversibly cardiac failure in selected patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Heart Transplantation↗
PubMed1989

Heart transplantation: update.

Clinical application of heart transplantation goes beyond 20 years of experience. The results achieved on the first 8,000 transplanted patients are impressive with a 70% survival rate at 7 years of follow-up. Indications for transplantation are less restrictive and include diabetics and patients older than age 60. Pulmonary hypertension still remains difficult to define. Immunosuppressive therapy, now including OKT3 monoclonal antibody in addition to conventional drugs and cyclosporine, lessened the frequency and severity of rejection and infection but still need improvements. Late graft arteriosclerosis remains a serious threat despite the use of retransplantation and, in some cases, mechanical cardiac support.

Adult↗
PubMed1989

[Spontaneous development and prognostic factors in patients needing heart transplantation. Multivariate analysis of 171 patients].

In an attempt to determine predictive factors of spontaneous death in patients needing heart transplantation, we studied 27 clinical and paraclinical variables in 171 patients aged from 14 to 61 years. Sixty-one of these patients died before transplantation could be performed, 59 were still alive awaiting transplantation and 51 received a heart transplant. The actuarial survival rate with or without transplantation was 65 percent at 1 year and 51 percent at 2 years. Univariate analysis showed that the following factors were associated with a higher mortality rate: age, history or symptoms of right heart failure, poor general condition, end-diastolic left ventricular diameter and ejection fraction. There was no correlation between high mortality rate and type of heart disease, sex, duration of symptoms, NYHA functional class, cardiothoracic ratio and data obtained from electrocardiography and right heart catheterization. At multivariate analysis (Cox's model), no variable could be selected as predictive factor of mortality. The natural outcome of patients needing heart transplantation therefore is globally unfavourable. This means that once has been decided to perform heart transplantation the operation should not be delayed.

Actuarial Analysis↗
PubMed1989

[Results of simultaneous myocardial and cerebral revascularization surgery].

Out of 3,678 patients who underwent aorto-coronary bypass between May, 1979 and October, 1987 at the La Pitié Hospital, Paris, 48 had simultaneous myocardial and cerebral revascularization. Operative mortality rate was 4.2 p. 100. Peri-operative myocardial infarction occurred in 3 cases (6.2 p. 100). No neurological complication was observed. The survival rate at 5 years (operative mortality included) was 74.8 +/- 8.66 p. 100. These results obtained in patients with multiple arterial disease are in agreement with those found in the literature. The lack of neurological complications is in favour of a systematic combined surgical treatment of severe carotid and coronary lesions.

Aged↗
PubMed1989

[Delayed autotransfusion associated with the cell-saver method in cardiovascular surgery. Values, methods, initial results].

The aim of deferred autotransfusion associated with the Cell-Saver system, i.e. the recovery of intraoperative blood loss, is to avoid using external homologous blood products. Transfusion-transmitted diseases and immunisation problems can be avoided: normovolumic haemodilution is an advantage in patients with coronary artery disease and economies can be made in the use of homologous blood. This technique has been in use in Professor Cabrol's department since 1987 with the help of the Blood Transfusion Centre of the Pitié Hospital. The contraindications are unstable angina, severe cardiac failure and anaemia of less than 11 g Hb at the first consultation. A review of the first 65 patients included in the protocol showed that deferred autotransfusion was well tolerated in all cases and that only 10 per cent of patients required transfusion with homologous blood. Autotransfusion associated with the Cell-Saver system is therefore a good method which should be extended to the largest possible number of patients referred for elective cardiac surgery.

Adult↗
PubMed1989

Heart and unilateral lung transplantation in patients with end-stage cardiopulmonary disease and previous thoracic operations.

Orthotopic en bloc transplantation of the heart and one lung has been done in two patients with end-stage cardiopulmonary disease and a prior thoracic operation. The first patient had undergone right pulmonary thromboembolectomy with caval ligation 5 years earlier, and the second had had left lower lobectomy for bronchiectasis 15 years before the heart and contralateral lung transplantation. Surgical procedures followed the techniques that had been developed in animals. Transplantation of the unoperated contralateral lung made it possible to avoid dissection in the obliterated pleural space and to minimize bleeding, which simplified the procedure considerably. Dramatic reduction in pulmonary artery pressure and improved respiratory function allowed both patients to be weaned from cardiopulmonary bypass without problems. Although the first patient died of liver and renal failure soon after the operation, an intact cough reflex facilitated recovery in the second patient, who has been discharged with essentially normal respiratory function. This report describes heart and unilateral lung transplantation as a procedure of choice for patients with extensive pleural adhesions that made total cardiopulmonary replacement unfeasible.

Adult↗
PubMed1989

[Use of 2 internal mammary arteries in coronary bypass. Combination with a bypass using the gastroepiploic artery in 2 cases].

Coronary revascularisation by bilateral internal mammary artery grafting was performed in 39 patients. The left internal mammary was anastomosed to the left anterior descending (N = 22), the left lateral (N = 12) or diagonal artery (N = 5). The right internal mammary was implanted on the right coronary (N = 17), the left anterior descending (N = 16), the left lateral (N = 3) or diagonal artery (N = 3). In two cases, the inferior myocardial segments were revascularised by grafting the gastroepiploic artery. Three patients died and one patient had signs of postoperative myocardial infarction. Respiratory complications, usually mild, occurred in 5 patients. Bilateral internal mammary artery grafting should be reserved for: 1) young patients, 2) those without usable leg veins (varicose veins, previous stripping or coronary bypass surgery). The gastroepiploic artery is a useful arterial graft for revascularizing regions of the heart inaccessible to the internal mammary arteries.

Adult↗