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Biomedical subjects

C Blanche

Publications and source records attributed to C Blanche.

At least 55 records · Page 3Linked to original sources
PubMed1995

Permanent pacemaker for rejection episodes after heart transplantation: a poor prognostic sign.

BACKGROUND: The development of arrhythmias early or late after heart transplantation has been associated with acute and chronic rejection. This study aims to document the importance of this relationship and its value as a prognostic sign in those patients who required a permanent pacemaker for rejection episodes. METHODS: A retrospective analysis of 158 orthotopic heart transplantations performed in 157 patients between December 1988 and April 1995 was done. The clinical course and the outcome of 6 patients who underwent insertion of a permanent pacemaker for bradyarrhythmias caused by acute or chronic allograft rejection were compared with the course and outcome of 9 patients who had pacemaker placement as a result of sinus node dysfunction not associated with rejection. RESULTS: The mortality rate was 100% for patients whose indication for permanent pacing was severe acute or chronic rejection. Conversely, 8 of the 9 patients who underwent pacemaker placement for sinus node dysfunction not associated with rejection are long-term survivors; the one late death was due to a noncardiac cause. CONCLUSIONS: We observed a strong relationship between bradyarrhythmias requiring a permanent pacemaker and severe acute or chronic allograft rejection. This association suggests a poor prognosis and indicates that these patients should be managed aggressively. Such management includes close immunologic surveillance for cellular and humoral rejection, increased frequency of endomyocardial biopsies and coronary angiography, and early consideration for retransplantation.

Acute Disease↗
PubMed1995

Technique to protect the internal mammary artery pedicle.

A simple technique to protect the internal mammary artery pedicle from injury in reoperative sternotomies is described. It consists of a pericardial window created by two pericardial flaps with displacement of the mammary pedicle away from the midline.

Humans↗
PubMed1995

Heart transplantation for Chagas' cardiomyopathy.

We present 2 patients who underwent orthotopic heart transplantation for end-stage Chagas' cardiomyopathy. Despite immunosuppressive therapy, postoperative prophylaxis with nifurtimox appeared to prevent Trypanosoma cruzi reactivation. Neither patient has shown signs of Chagas' myocarditis, and both are clinically well 12 and 72 months after transplantation. The successful outcome of our patients suggests that heart transplantation is a reasonable therapeutic option in patients with end-stage Chagas' cardiomyopathy.

Adult↗
PubMed1995

Superior vena cava stenosis after orthotopic heart transplantation: complication of an alternative surgical technique.

Superior vena cava stenosis presented as a postoperative complication of orthotopic heart transplantation in a patient in whom a new surgical technique was used. This alternative technique consists of total excision of the recipient's atria, with donor heart implantation performed using bicaval and pulmonary venous anastomoses. This rare complication required surgical repair 1 month after transplantation. The patient remains well on long-term follow-up. The pathogenesis, surgical management and modifications of the alternative technique to prevent this potentially serious complication are discussed.

Constriction, Pathologic↗
PubMed1995

Survival of acute intestinal infarction after cardiac transplantation.

We report the case of a 52-year-old male who underwent total orthotopic heart transplantation for end-stage ischemic cardiomyopathy. The postoperative course was complicated by acute intestinal infarction which was diagnosed after surgical exploration, and treated with a subtotal colectomy with Brooke ileostomy and closure of the distal sigmoid three days posttransplant. The patient survived with nutritional support and broad antibiotic prophylaxis. Review of the literature on acute abdominal complications after operations involving cardiopulmonary bypass suggests that such complications are usually fatal. Detection and diagnosis may be obscured and treatment complicated by immunosuppression after cardiac transplantation. Because of the poor prognosis without appropriate management, a high level of suspicion, early and aggressive diagnostic measures, and swift surgical intervention are essential to survival.

Colon↗
PubMed1995

Heart transplantation after repair of postinfarction ventricular septal defect.

A 68 year-old man underwent surgical repair of a ventricular septal defect following an acute myocardial infarction. Recurrent interventricular septal rupture with significant left-to-right shunting led to progressive deterioration in cardiac function and intractable heart failure. The patient underwent orthotopic heart transplantation three months after his initial operation, and he is clinically well sixteen months after transplantation.

Aged↗
PubMed1994

Combined heart and kidney transplantation with allografts from the same donor.

We present the cases of 3 patients who underwent simultaneous heart and kidney transplantation using allografts from the same donor. This combined approach offers a reasonable option for patients with coexisting end-stage heart and kidney disease. A review of all previously reported cases suggests that survival is similar to that of single-organ transplantation. In addition, there appears to be a low incidence of rejection when multiple allografts from the same donor are used. The heart and kidney can and frequently do reject asynchronously, so rejection monitoring and surveillance should be carried out separately for each transplanted organ.

Adult↗
PubMed1994

Alternative technique for orthotopic heart transplantation.

An alternative technique for orthotopic heart transplantation is described. The principle consists of total excision of the recipient's right atrium with donor heart implantation performed using bicaval anastomoses; the left atrium is done in the standard fashion. This approach is technically simple and preserves the anatomic and physiologic function and integrity of the right atrium, especially the conduction system.

Adult↗
PubMed1994

Postinfarction ventricular septal defect in the elderly: analysis and results.

Fifteen elderly patients (age more than 70 years) underwent surgical repair of postinfarction ventricular septal defects during the years 1980 through 1992. The operative (to discharge or < 30 days) mortality rate was 47%, and the complication rate among survivors was 63%. The probability of survival at 1 year was 47% +/- 13%. Because of the small sample size of our patient population, predictive preoperative risk factors associated with early mortality could not be identified with certainty. However, there is a trend suggesting that high right atrial pressures (p = 0.15) and the need of an intraaortic balloon pump preoperatively (p = 0.12) influence 30-day mortality, as previously described in larger series. Of 5 long-term survivors, 3 are in New York Heart Association functional class I and 2 are in class II. Our experience in this group of patients suggests that in the elderly, a very aggressive approach should be taken in recommending early surgical intervention for postinfarction ventricular septal defect before hemodynamic deterioration ensues and severely compromises chances for survival.

Aged↗
PubMed1994

Heart transplantation for Q fever endocarditis.

A 30-year-old man underwent aortic and mitral valve replacement for the treatment of Q fever endocarditis. Postoperatively, paravalvular leak of the mitral prosthesis, progressive deterioration in cardiac function, and intractable heart failure developed. As a result, the patient underwent orthotopic heart transplantation 15 months after his initial valve operation. The patient is clinically well 14 months after transplantation.

Adult↗
PubMed1994

Orthotopic heart transplantation with bicaval and pulmonary venous anastomoses.

We present our experience with an alternative technique for orthotopic heart transplantation. It consists of total excision of the recipient's atria, with the donor's heart implantation performed using bicaval end-to-end anastomoses as well as pulmonary venous anastomoses. Forty consecutive patients receiving transplants in this fashion were compared with 64 patients who underwent orthotopic transplantation with the standard technique. The incidence of postoperative tricuspid regurgitation was reduced in patients receiving transplants with the new surgical approach (p = 0.003). In addition, the need for pacemaker implantation for severe bradyarrhythmia in the early (0 to 6 weeks) posttransplantation period (p = 0.003) was eliminated. Although not statistically significant, there was a trend in the reduction of postoperative mitral regurgitation in patients who received transplants by the modified technique. Based on this experience, we believe this modified technique for orthotopic heart transplantation has an anatomic and physiologic advantage that may improve long-term hemodynamic results.

Anastomosis, Surgical↗
PubMed1994

Technical considerations of a new technique for orthotopic heart transplantation. Total excision of recipient's atria with bicaval and pulmonary venous anastomoses.

An alternative technique for orthotopic heart transplantation is described. It consists of total excision of the recipient's atria with donor heart transplantation performed using bicaval end-to-end anastomosis, as well as pulmonary venous anastomoses. Thus, total atrial as well as ventricular transplantation is performed. This new surgical approach is technically simple and preserves the anatomic size, geometric configuration and physiologic function of the atria. This technique has the potential to improve the long-term hemodynamic results in heart transplant patients as it reduces the incidence of postoperative atrioventricular valve regurgitation. In addition, the incidence of early posttransplant bradyarrhythmias (within 4 to 6 weeks after transplantation) that require the insertion of a permanent pacemaker is also significantly reduced. This report describes some technical guidelines for harvesting the donor heart, as well as for the implantation of the cardiac allograft, in order to avoid the development of serious intraoperative and postoperative complications directly associated with this technique.

Anastomosis, Surgical↗
PubMed1994

The St. Jude Medical valve. Experience with 1,000 cases.

We analyzed the long-term results of valve replacement with the St. Jude Medical bileaflet valve (St. Jude Medical, Inc., St. Paul, Minn.) in our first 1000 implantations between 1978 and 1992. A total of 399 patients had mitral valve replacement, 471 aortic valve, and 130 double (mitral and aortic) valve replacement. The average patient age was 64 +/- 15 years and the majority of patients (52%) had concomitant coronary disease. With 4328 patient-years of follow-up, 83% of the mitral group, 76% of the aortic group, and 77% of the double valve group were free of thromboembolism at 10 years after operation, and 87% of the mitral group, 82% of the aortic group, and 85% of the double valve group were free of valve-related hemorrhage. At 10 years, 91% of the mitral group, 84% of the aortic group, and 84% of the double valve group were free of valve-related death. However, overall survival at 10 years was only 42% +/- 4% for the mitral group, 43% +/- 4% for the aortic group, and 43% +/- 6% for the double valve group. For all three groups, age was a highly significant factor stratifying survival (p < 0.001), as was the presence of coronary disease (all p < 0.001). The excellent freedom from valve-related death at 10 years of 84% to 91% is in striking contrast to the overall survivals of 42% to 43% at 10 years. This difference suggests that the primary factors limiting long-term survival after valve replacement with the St. Jude Medical valve are not valve-related factors, but other patient factors such as age and concomitant coronary disease.

Aged↗
PubMed1992

Results of early repair of ventricular septal defect after an acute myocardial infarction.

A 10-year experience with early operation for postinfarction ventricular septal defect is reviewed. Twenty-two patients underwent surgical repair; operative mortality was 36% (< 30 days). The actuarial survival was 64% at 1 month, 59% at 1 year, and 47% at 5 years. Risk factors predictive of operative mortality were diabetes (p = 0.001), elevated preoperative right atrial pressure (p = 0.02), the absence of a preoperative intraaortic balloon pump (p = 0.006), and a short time interval between infarct and operation (p = 0.018). Long-term survival was adversely related to diabetes (p = 0.030), elevated preoperative right atrial pressure (p = 0.005), and, surprisingly, survival was better in patients with a greater extent of coronary artery disease (p = 0.023). There were 14 operative survivors (64%) and 11 long-term survivors (3 months to 10 years, mean 6.0 +/- 3.5 years). Six of eleven survivors were in functional New York Heart Association class I, one was in class II, and four were in class III.

Aged↗
PubMed1992

Comparative efficacy of ring and suture annuloplasty for ischemic mitral regurgitation.

BACKGROUND: Patients with ischemic mitral regurgitation (MR) represent a therapeutic challenge, and results after combined valve replacement and revascularization have been poor. Valve repair is a promising approach, but the optimal method of repair is not known. METHODS AND RESULTS: In 60 patients with coronary artery disease and 3+ or 4+ MR, we used intraoperative Doppler echocardiography to study the efficacy of Carpentier-Edwards ring (n = 27) and commissural suture (n = 33) annuloplasty. Patients with ruptured papillary muscles, torn chordae, and ballooning or scalloping of the leaflets were excluded. Ring and suture groups were similar in preoperative ejection fraction (35 +/- 14% and 34 +/- 17%), MR grade (3.5 +/- 0.5 and 3.4 +/- 0.6), and acuity of MR (41% and 33% acute) (p = NS). Postoperatively, the ring group achieved a lower residual MR grade than the suture group (0.5 +/- 0.5 versus 1.5 +/- 1.1; p < 0.001), and the mitral annular diameter was reduced to a greater extent in the ring group (by 1.5 +/- 0.5 cm versus 0.5 +/- 0.4 cm; p < 0.001). Success (> or = 2 grade MR reduction) was more frequent in the ring than in the suture group (96% versus 67%, p < 0.01). One-year survival was similar (74 +/- 9% ring, 71 +/- 8% suture). Follow-up Doppler studies showed a higher mean gradient (4.0 +/- 1.2 mm Hg) and smaller valve area (2.1 +/- 0.5 cm2) in the ring group, but the postoperative New York Heart Association class was similar in both groups (83% versus 74% class I-II). CONCLUSIONS: Ring annuloplasty provides a more effective reduction of ischemic MR and a higher success rate than the suture technique. This may be related to uniform rather than localized shortening of the annulus and a greater reduction in annulus diameter.

Aged↗
PubMed1991

Excimer laser angioplasty during aortocoronary bypass grafting.

Laser coronary angioplasty using the 308-nm Excimer laser was successfully performed intraoperatively during coronary artery bypass grafting. It achieved a reduction of the left anterior descending artery stenosis from 99% to 25% as seen on angioscopy, without evidence of vascular perforation or intimal disruption. The Excimer laser offers the opportunity for intraoperative endovascular remodeling and recanalization and has a potential role as an adjunct to existing standard coronary artery bypass grafting protocol.

Angioplasty, Laser↗