Search PubMed⌕ Search

Biomedical subjects

C Cabrol

Publications and source records attributed to C Cabrol.

At least 127 records · Page 7Linked to original sources
PubMed1989

[Left thoracotomy: an alternative to median sternotomy in coronary bypass in cases of pericardial adhesions].

Coronary bypass on the circumflex artery network was performed by left thoracotomy in 5 patients. All presented with pericardial adhesions due to coronary artery surgery (n = 4) or to mediastinal irradiation (n = 1). The left thoracotomy route provides excellent exposure of the lateral aspect of the heart and may be an advantageous alternative to sternotomy when pericardial adhesions are present.

Coronary Disease↗
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

[Systematic peroperative use of an autotransfusion system in heart surgery. A prospective and comparative study in 283 patients].

A series of 283 patients undergoing cardiac bypass surgery was studied to determine whether intraoperative autotransfusion, haemodilution, and a change in transfusion techniques of the same surgical team could reduce homologous blood requirements. The Cell-Save Haemonetics* system was used systematically in 167 consecutive patients (Group I). This group of autotransfused patients was analysed prospectively and compared with a control group (Group II) of 116 patients operated one year before and analysed retrospectively. During the whole hospitalisation, homologous blood products were required in 40.7% of patients in Group I compared with 73.3% of patients in Group II (p less than 0.0001). The average requirements of packed cells per patient were 2.7 +/- 1.3 in Group I compared with 4.1 +/- 2.5 in Group II (p less than 0.0001). The haematocrit on discharge from the department was 29.9 +/- 4% in Group I compared with 32 +/- 4.5% in Group II (p less than 0.0001). The average volume of blood recovered by the system and then autotransfused was 620.8 +/- 242.6 ml. There was no significant difference in postoperative bleeding in the first 24 hours between the two groups. This study confirms that peroperative autotransfusion during cardiac surgery and the acceptance of a clinically well tolerated normovolumic anaemia are associated with a significant reduction in homologous blood consumption.

Adult↗
PubMed1989

[Coronary endarterectomy using an excimer laser. Preliminary peroperative results].

From experimental and clinical experience, safe coronary angioplasty cannot be performed with CW lasers. The excimer laser does present a number of advantages in vitro: non-thermal ablation of plaques and a linear relationship between the number of pulses and the depth of the crater, so that tissue ablation is quantitatively predictable. A 308 nm, 20 ns pulse duration, 1 to 5 repetition rate laser was specifically designed for clinical application. During cardiopulmonary bypass prior to bypass grafting in 10 symptomatic patients, a 1 mm diameter core UV-tipped fiberoptic was introduced via the coronary arteriotomy and directed in contact with the coronary stenosis. Laser power was progressively increased until the stenosis or occlusion was recanalized. The quality of this angioplasty was controlled by calibration of he neo-lumen, cardioplegia solution flow through the lased segment, and 8th day coronary angiography. The laser treated coronary segments of the first 4 patients showed clearly parallel-lined patent neo-lumen despite competitive bypass graft flow. The main limitation of the method is that laser coronary recanalization is confined to the fiber core diameter. The authors conclude that: 1) excimer laser angioplasty is a safe and efficient intra-operative procedure; 2) the most critical problem for percutaneous laser angioplasty remains flexibility of the apparatus as the fiber diameter must be large enough to provide an adequate arterial neo-lumen.

Aged↗
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↗
PubMed1989

[Heart myxoma. Surgical treatment].

We reviewed all the patients who underwent surgical excision of cardiac myxomas at La Pitié during the last fifteen years. Fifty-one cases were found (32 female and 19 male) aging from 16 to 75 years (mean 51). Congestive heart failure was the primary symptom present in 28 patients. Thirteen patients presented peripheral embolization, four with syncope and 11 with tachyarrhythmias. The diagnosis was made either by echocardiography or angiography. All of them had correct preoperative diagnoses, and no tumors were found incidentally at operation. Forty-six myxomas were localized in the left atrium, four in the right atrium and one in the right ventricle. All the patients underwent open-heart operation and myxomas were successfully removed with excision of a portion of normal atrial septum or wall. Path reconstruction of the atrial septum was required thirty-six times. Mortality after surgical excision is very low. Only one death (1.96%) occurred as a result of a postoperative low output syndrome. Late recurrences have been reported in other series, but no recurrences were diagnosed in our patients up to the present. Although the recurrence rate is low, long-term clinical and echocardiographic follow-up is recommended.

Adolescent↗
PubMed1989

Orthotopic transplantation after implantation of a Jarvik 7 total artificial heart.

A total artificial heart was used to support the circulation in 33 heart transplantation candidates who were expected to die before procurement of a donor heart. Twelve of these patients (mean age 35 +/- 10 years) underwent cardiac transplantation. Another patient is still being supported with the total artificial heart 90 days after implantation. The other 20 patients died during mechanical support because their condition could not be stabilized for transplantation, despite blood flow restoration. Fifty-six percent of the patients younger than 40 years underwent successful transplantation and six of nine patients are long-term survivors. By comparison, in the older group, 17.6% of patients underwent transplantation and one of three survived long term. Forty-four percent of patients in the acute decompensation group had successful transplantation and four of seven patients are long-term survivors. In the chronic decompensation group these figures were 29.4% and three of five patients. All patients who were heavily immunosuppressed (n = 4) died of sepsis. Transplantation was considered and performed only when the patient's condition was correct and stable. In six patients an infection developed in the immediate posttransplant period. Three of the infections were resolved with antibiotic therapy. One originated in the mediastinum and is still unresolved, although the patient's condition is improving. Another patient died of an anoxic coma caused by ventilatory problems. There were two late deaths at 14 and 19 months, one resulting from a combination of toxoplasmosis and rejection and the other from a Kaposi sarcoma caused by azathioprine treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

Surgical treatment for chronic pulmonary thromboembolism.

Thrombo-endarterectomy for chronic thromboembolism of the pulmonary artery can be recommended in patients with NYHA classification III or IV symptoms, mean pulmonary artery pressure greater than 30 mmHg and proximal, greater than 50% obstruction of the pulmonary arterial bed. Pulmonary angiography for localization of thrombi is prerequisite. Surgical techniques encompass lateral thoracotomy with or without extracorporeal circulation and median sternotomy with extracorporeal circulation. As an adjunctive measure, an interruptive procedure for the vena cava is performed. Currently we prefer to operate with the beating heart and normothermia. The most frequent complications are congestive heart failure and hemorrhagic pulmonary edema. In 33 patients total mortality was 20%. On use of a median sternotomy, with normothermia and beating heart there were no deaths. In the presence of distally-localized obstruction, thrombectomy cannot be performed.

Chronic Disease↗
PubMed1989

Hemodynamic characteristics of the Jarvik-7 total artificial heart.

To identify the optimal means of artificial circulation, driving controls and resultant hemodynamics were correlated with clinical outcomes in 37 Jarvik-7 recipients up to 72 hours after implantation. When patients with subsequent transplantation (n = 16) were compared with those who died on the Jarvik-7 heart (n = 21), there were no significant differences in total artificial heart driving mode such as frequency, ventricular driving pressures, systolic-diastolic ratio, or vacuum use, nor were there any differences in the hemodynamics achieved, such as device output (cardiac output) or atrial filling pressures, throughout the observation. However, improvements of other organ functions, especially kidney and liver, were remarkable in that transplant patients immediately experienced increased urine output and reversal of secondary organ dysfunction. The nontransplant group failed to diurese and continued to deteriorate despite similar hemodynamics. When a smaller model of the Jarvik-7 (volume of 70 ml, n = 18) was compared with the standard model (volume of 100 ml, n = 19), again there were no significant differences except that ventricular stroke volume was consistently less for the 70-ml model. Because of a slightly higher heart rate in the smaller model, device output did not differ between recipients of the two types. The results suggest that once successfully implanted, the Jarvik-7 provides adequate perfusion without associated mortality from circulatory failure, regardless of the size of the ventricle. Recovery from other organ failure appears to be independent of postimplant hemodynamics, a phenomenon that suggests the importance of preimplant status and patient selection.

Adult↗
PubMed1989

Results of the first 100 patients who received Symbion Total Artificial Hearts as a bridge to cardiac transplantation.

Between August 8, 1985 and April 1, 1988, 100 patients in 22 centers underwent Symbion Total Artificial Heart (TAH) (Symbion, Inc., Salt Lake City, Utah) implantation as a bridge to cardiac transplant. Thirty patients received the Symbion J7-100, and 70 patients received Symbion J7-70 implants. Eighty-seven patients were men and 13 were women; mean age was 42 years, and mean weight was 73 kg. The time spent on the device ranged from 1 to 243 days, for a mean of 23 days. Sixty-eight patients underwent cardiac transplantation, with a 69% 30-day survival rate and a 46% (31 of 68) long-term survival rate. The majority of the patients had ischemic (52) or idiopathic (36) cardiomyopathies. Indications for implantation of the TAH occurred most frequently in patients whose condition deteriorated while awaiting transplant (34) or who were admitted in acute cardiogenic shock (27). There was an 8.7% incidence of thromboembolic events (four cerebrovascular accidents, five transient ischemic attacks). Multivariant analysis was performed to determine the effect of various factors on the patients' ability to undergo transplantation and then ultimate survival. The results indicate a need for further clinical investigation in patient selection and appropriate timing for implantation of the TAH.

Adult↗