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Biomedical subjects

G Dreyfus

Publications and source records attributed to G Dreyfus.

135 records · Page 8Linked to original sources
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[Arterial hypertension in heart transplant recipients].

Arterial hypertension is frequent after cardiac transplantation. Since cyclosporin was introduced its incidence has risen up to 40 to 100 per cent of the patients. Its date of onset and severity are variable. Arterial hypertension acts on the heart by increasing left ventricular hypertrophy and transplant dysfunction and on the kidney by aggravating the cyclosporin-induced renal impairment which is often present. Several mechanisms have been suggested to account for the occurrence of hypertension in these patients, including poor neurological control of blood pressure, a hypothetical haemodynamic effect and the influence of corticosteroids and cyclosporin. Cyclosporin seems to play the main role. The treatment of this iatrogenic arterial hypertension remains to be precisely determined.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Cardiac assistance by atrial or ventricular cardiomyoplasty.

Dynamic cardiomyoplasty was conceived to enhance cardiac performance by assisting myocardial contraction. Technically, this procedure consists of placing a pedicled latissimus dorsi muscle flap around the heart and subsequent muscle electrostimulation in synchrony with ventricular systole. Three types of dynamic cardiomyoplasty can be considered. (1) Atrial or ventricular reinforcement is accomplished by wrapping the latissimus dorsi muscle flap around the heart to support hypokinetic or akinetic areas secondary to congenital or acquired diseases. The atrial reinforcement may be performed to improve atrial output after Fontan-type procedures. (2) Ventricular substitution is performed to replace a portion of the ventricular wall. Autologous pericardium is used to create a neoendocardium and facilitate hemostatic closure of the ventricle. The pedicled latissimus dorsi is then secured to replace the resected myocardium. (3) The two previous techniques of ventricular substitution and reinforcement are combined. This reconstructive procedure, which normalizes the ventricular geometrical shape, is particularly useful after extended cardiac resections, such as is done in treatment of large ventricular aneurysms, cardiac tumors, or echinococcal cyst formations. At present, improvement in ventricular function has been obtained in 12 patients at our institution. Preoperative severe cardiac dysfunction was present in all of these patients (New York Heart Association functional class III or IV). Postoperative echocardiography, multigated acquisition scan, and hemodynamic studies demonstrate an improvement in ventricular function and no impairment of ventricular compliance by the muscle flap. After a mean follow-up period of 18 months, all patients are in functional class I or II. We believe that dynamic cardiomyoplasty prolongs and improves the quality of life of patients suffering from severe chronic and irreversible myocardial dysfunction by improving ventricular contraction and limiting cardiac dilatation.

Assisted Circulation↗
PubMedDate not supplied

Current practice in Marfan's syndrome and annulo-aortic ectasia: aortic root replacement with a composite graft over a twenty-year period.

BACKGROUND: From October 1973 to December 1995, 251 patients (204 male, 47 female) aged from 10 to 75 years (mean: 46.6 +/- 15) underwent an ascending aortic replacement with a composite graft for: dystrophic aneurysm (AN), 168 cases (66.9%); chronic dissection (CD), 36 cases (14%); and type A acute dissection (AD), 48 cases (19.1%). Fifty-one patients (20.3%) suffered from Marfan's disease (25 AN, 17 AD, 9 CD). Thirty-seven patients (14.7%) had undergone a previous cardiac or aortic operation. The ascending aortic replacement was extended to the transverse arch in 31 patients (12.3%). A mechanical valve was used in 233 patients (92.8%). The classic "Bentall" technique was used in 87 patients (34.6%), the "button" technique in 121 patients (48.2%), the "Cabrol" technique in 26 patients (10.3%) and a "mixed" technique in 17 patients (6.2%). RESULTS: The hospital mortality accounts for 7.2% (18 out of 251) (AN: 4 out of 68, 2.3%, CD: 4 out of 36, 11.1%, AD: 9 out of 48, 18.7%). When emergencies are considered, the hospital mortality is 12 out of 54 (22.2%) versus 6 out of 197 (3%) in elective procedures. The predictors of hospital death were emergency, AD (p < 0.03) and arch replacement (p < 0.02). Mean follow up is 38 +/- 15 months (4-262). The overall long term survival rate is (Kaplan Meïer): 92 +/- 6% at one year, 77.9% +/- 9% at 5 years, 67.7 +/- 12% at 10 years, and 61.3 +/- 15% at 12 years. The 10-year survival rate is significantly higher in patients with AN (93 +/- 6%) than in patients with AD (61.6 +/- 17%) (p < 0.01). The late survival rate is also significantly higher after the "button" (93.8 +/- 5%) or Bentall's reimplantation (88.7 +/- 6%, 83.8 +/- 9%, and 76.6 +/- 12%) than after the "Cabrol" procedure (80 +/- 18%, 63 +/- 21% and 58 +/- 35%) at 1, 5, and 8 years, respectively. CONCLUSION: Ascending aortic replacement with a composite graft is a safe procedure, especially when performed electively in patients with dystrophic aneurysm or Marfan's disease. The technique of coronary reimplantation has a significant influence of the long-term results, with the reimplantation of choice being the "button" technique. The "Cabrol" technique must be used when the "button" or the "Bentall" reimplantation is not feasible.

Acute Disease↗
PubMedDate not supplied

The proper use of glue: a 20-year experience with the GRF glue in acute aortic dissection.

BACKGROUND: In 1977, the use of Gelatine-Resorcine-Formaline (GRF) biological glue during surgery of acute Type A aortic dissection was proposed. The present study retrospectively analyzes the late results obtained with this adjunct in an experience extending over a twenty-year period of time. PATIENTS AND METHODS: From January 1977 to March 1996, 171 patients (124 males and 47 females) aged from 15-79 years (mean age: 53 +/- 14 years) underwent an emergency operation for type A aortic dissection in our institution. All patients suffered from acute type A dissection and 144 (84%) were operated on within 48 hours after the onset of symptoms. Twenty-six patients (15.2%) had Marfan's syndrome. The ascending aorta was replaced in all patients and the aortic stumps were reinforced with the GRF glue. In 39 patients (23%), the aortic valve was replaced either independently (5 cases, 3%) or by means of a composite graft (34 cases, 19.8%). Because of the location of the intimal tear, the aortic replacement was extended to the transverse arch in 58 patients (33.9%). RESULTS: Hospital mortality amounts to 21% (36 patients), 22.8% in patients with arch replacement and 21.1% in patients without arch replacement (n.s). One hundred thirty-five patients were discharged and surveyed from 2 months to 19 years postoperatively (cumulative follow-up: 856 patients/years. Mean follow-up: 79 +/- 66 months). During this period of time, 22 patients (16.1%) had to be reoperated on for a total of 28 reoperations. Six of those (27.2%) died at reoperation. At univariate analysis, presence of Marfan's syndrome (p < 0.05) and absence of arch replacement (p < 0.02) were determinant risk factors for reoperation. Emergency (p < 0.01) and thoracoabdominal replacement (p < 0.04) were determinant risk factors of death at reoperation. The acturial freedom from reoperation (Kaplan-Meier, CI: 95%) is: 96.08% (90.9-98.2), 87.6% (79.8-92.7), 80.9% (70.8-86.1), 66.4% (51.1-78.9) at 1, 5, 10, and 15 years respectively. A total of 36 patients (27.7%) died during follow-up. Presence of Marfan's syndrome (p < 0.01), reoperation (p < 0.02), stroke (p < 0.05), cardiac failure (p < 0.05) were determinant risk factors of late mortality. The actuarial late survival rate (K-M. C.I.: 95%), including hospital mortality, is: 71.5% (64.3-77.8), 66% (58.3-73), 56.4% (47.7-64.7), 46.3% (36.4-56.5) at 1, 10 and 15 years. CONCLUSIONS: The GRF glue has proved to be extremely useful during emergency initial surgery for acute type A dissection, making the procedure much easier and safer. Through this operative improvement, the use of the GRF glue seems to have a beneficial influence on the late results which however, depend mainly on the patient's basic condition.

Actuarial Analysis↗