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Biomedical subjects

L Noyez

Publications and source records attributed to L Noyez.

At least 19 recordsLinked to original sources
PubMed1992

Early results with bilateral internal mammary artery grafting in coronary reoperations.

In recent years, use of the internal mammary artery (IMA) as first graft of choice has been expanded with bilateral and sequential grafts in primary myocardial revascularization. The use of bilateral IMA grafts in reoperation has seldom been reported. The experience and early results with bilateral IMA grafting in 47 patients undergoing coronary reoperation are described. Hospital mortality was 6.3%. Four patients had postoperative signs of low cardiac output, and 4 had a perioperative myocardial infarction. At follow-up (18 +/- 18 months), 2 cardiac-related, late deaths were noted. Thirteen patients (29%) improved 1 New York Heart Association class, and 28 (63%) improved > 1 class. In 1 of 44 surviving patients, operation did not result in a decrease in angina. On the basis of the early results, the bilateral use of the IMA in coronary reoperation appears justified.

Adult↗
PubMed1992

Evaluation of myocardial protection by combination of lidoflazine pretreatment and St. Thomas' Hospital cardioplegia in aorto-coronary bypass grafting.

The concept of pretreatment of the myocardium with a pharmacological agent protecting the cell against ischemic and reperfusion injury is very attractive. Lidoflazine, a calcium overload blocker, predominantly membrane stabilizing, is able to prevent cell damage during ischemic arrest and reperfusion. The purpose of this study was to determine whether the combination of lidoflazine pretreatment and St. Thomas' Hospital cardioplegia can provide, in clinical practice, better myocardial protection in aorto-coronary bypass grafting than St. Thomas' Hospital cardioplegia alone. As indices for myocardial protection, recovery of cardiac function, enzyme release, and clinical outcome were registered. Ninety-three patients undergoing aorto-coronary bypass surgery were studied. These patients were randomized into two groups in a double blind fashion. Patients in group A (n = 48) received lidoflazine 1 mg/kg intravenously over a period of 20 min before initiation of cardiopulmonary bypass. Group B (n = 45) receiving placebo, acted as a control group. Myocardial protection consisted of intermittent infusion of cold 4 degrees C St. Thomas' Hospital cardioplegia, topical slush ice, and systemic hypothermia (28 degrees C rectal). No significant differences between the two groups were noted in terms of recovery of cardiac function, enzyme release, incidence of myocardial infarction, low cardiac output, rhythm, and conduction disturbances. In conclusion, our data suggest that the combination of intravenous pretreatment with lidoflazine and St. Thomas' Hospital cardioplegia did not provide significant additional myocardial protection in the clinical situation.

Aged↗
PubMed1992

Use of internal mammary artery in radiation-induced coronary artery disease.

In 3 patients who had been subjected to mediastinal irradiation for breast cancer, the internal mammary artery was used as a conduit for myocardial revascularization. Intraoperatively, in all patients the internal mammary artery exhibited excellent blood flow and except for mild adhesions between the pericardium and epicardium no unusual technical problems were encountered. Preoperative assessment of the internal mammary artery by angiography is recommended in patients with radiation-induced coronary artery disease who are scheduled to undergo myocardial revascularization with intended use of the internal mammary artery.

Breast Neoplasms↗
PubMed1992

Retrograde coronary sinus cardioplegia in myocardial revascularization: hemodynamic evaluation of the influence on the right-ventricular function.

The problem of the efficacy of right-ventricular protection with retrograde coronary sinus cardioplegia is studied. Sixty patients undergoing myocardial revascularization were prospectively assigned to receive cold St. Thomas' Hospital cardioplegia into the aortic root (30 patients) or retrogradely in the coronary sinus (30 patients). The two groups were similar concerning preoperative and operative data. The hemodynamic recovery postoperatively was good in both groups, the increase of the heart rate, the decrease of the mean aortic pressure and the right-ventricular stroke-work index were not significantly different in the two groups. However, right atrial pressure increased significantly (p less than 0.001) in patients who received cardioplegia anterogradely and decreased, but not significantly, in the retrograde group. The data suggest that the decrease of the right-ventricular stroke-work index in the anterograde group is related to a depressed contractility and in the group with retrograde delivery of cardioplegia to a decreased preload. There were no differences between the groups with respect to clinical outcome. We conclude that retrograde delivery of cardioplegia results in an excellent protection of the right-ventricular function in elective myocardial revascularization.

Adult↗
PubMed1992

Detrimental sequelae on the wall of the internal mammary artery caused by hydrostatic dilation with diluted papaverine solution.

We studied the effect of hydrostatic dilation of the internal mammary artery used for coronary revascularization in 10 patients (aged 45 to 79 years, median 63 years). Diluted papaverine solution was injected in the lumen of distal segments of the internal mammary artery, the musculophrenic artery, or the superior epigastric artery that had been obtained at operation; injection was followed by hydrostatic dilation not exceeding a sheer force of 50 gm. In 12 control patients (aged 42 to 76 years, median 64 years) in whom the internal mammary artery had also been harvested for elective myocardial revascularization, similar arterial segments were wrapped in sponges soaked in papaverine solution of the same dilution. In the nondilated group the median (with interquartile range) number of fenestrations in the internal elastic lamina increased from the elastic (21, 7) to the elastomuscular (41, 11) and muscular segments (89, 12) (elastic-elastomuscular: p = 0.006; elastic-muscular: p = 0.006; elastomuscular-muscular: p = 0.003) (Wilcoxon signed-rank test). In none of the three histologic segments were full-thickness disruptions of the intima and disruptions of the internal elastic lamina seen. Similarly, in the dilated group the number of fenestrations in the internal elastic lamina increased from the elastic (25, 18) to the elastomuscular (43, 9) and muscular (100, 13) segments (p values 0.01, 0.01, and 0.006, respectively). In addition, in 20% of the elastic sections, in 17% of the elastomuscular sections, and in 35% of the muscular sections of the dilated group, disruptions of the intima and internal elastic lamina were seen. Comparison of the number of fenestrations in internal elastic lamina in the three histologic segments between the nondilated and dilated groups revealed a significantly greater value in the muscular segments of the latter group (p = 0.01) (Mann-Whitney U test). We concluded that (1) hydrostatic dilation of the internal mammary, musculophrenic, and superior epigastric arteries may have detrimental effects on the histologic characteristics of the intima and the internal elastic lamina and (2) the number of fenestrations in the internal elastic lamina of these arteries is related to the presence or absence of elastic lamellae in the media.

Aged↗
PubMed1992

Use of internal mammary artery in myocardial revascularization after mediastinal irradiation.

Ten patients with radiation-associated proximal coronary artery disease underwent myocardial revascularization. In seven patients (group A) the internal mammary artery was used and in the other three (group B) only venous conduits were used. Except for mild adhesions between the pericardium and the epicardium, no unusual technical problems were encountered. In all patients in group A the internal mammary artery exhibited excellent flow, and histologic examination in two patients revealed a normal intima and media with only slight fibrosis of the adventitia. In two patients in group B, fibrosis of the internal mammary artery precluded its use, whereas the third patient had contraindications prohibiting use of the internal mammary artery. Long-term follow-up (range 6 to 72 months) revealed that one patient in group A died late of metastatic disease, and of the remainder (nine patients), seven were in New York Heart Association class I and two were in class II. Preoperative assessment of the internal mammary artery by angiography or, alternatively, B-mode imaging with Doppler spectrum analysis is recommended in patients with radiation-induced coronary artery disease who are scheduled to undergo myocardial revascularization with intended use of the internal mammary artery. In our experience, despite previous exposure to irradiation, the internal mammary artery should still be considered as a viable conduit for myocardial revascularization when preoperative assessment shows patency.

Adult↗
PubMed1989

The use of the internal mammary artery for myocardial revascularisation in patients 70 years of age and older. Does it complicate the early post-operative period?

In the last years common agreement has been reached that the internal mammary artery (IMA) is the conduit of choice for elective myocardial revasculariation. This trend has been stimulated by the long-term patency of the IMA grafts and the better long-term survival. However, with the increase in life-expectancy, an increasing number of elderly patients is referred for coronary artery bypass grafting. In this patient population the long-term survival is generally limited, and therefore many surgeons do not use the IMA as graft. However, there is not only the better long-term survival but also a reduction in recurrence of angina, cardiac events, and need for reoperations associated with the IMA use. In this study the perioperative (peroperative and early postoperative) mortality and morbidity of coronary artery surgery with IMA use and without IMA use in patients aged 70 years and older is compared. Based on the early clinical results it is suggested that the use of an IMA graft does not influence the perioperative morbidity and mortality of coronary artery surgery in the patient over 70, who thus should not be denied the conduit of choice on such grounds.

Age Factors↗
PubMed1988

The Ionescu-Shiley pericardial valve: results in 473 patients.

From January 1, 1980, through December 31, 1985, 473 patients underwent valve replacement with an Ionescu-Shiley valve. Overall hospital mortality was 7.8%. Major associated procedures and preoperative New York Heart Association (NYHA) Classes IV and V influenced hospital mortality significantly. The mean follow-up was 2.6 +/- 1.3 years. Late mortality was 5.9%. Overall actuarial survival was 81% at 5 years. A chief cause of reoperation was cusp rupture of a mitral prosthesis in 5 patients (all after aortic and mitral valve replacement). The overall actuarial reoperation-free incidence was 93% at 5 years. Thromboembolic (TB) phenomena occurred at a linear incidence of 1.4 +/- 0.3% per patient-year or an actuarial thromboembolism-free incidence of 92% at 5 years. Univariate and multivariate analyses showed that postoperative NYHA Class, rhythm at follow-up, and anticoagulant therapy significantly influenced the incidence of TE phenomena.

Aged↗
PubMed1987

Comparison of quantification methods of 111In-labelled platelet deposition in peripheral bypass grafts.

The action of antithrombotic drugs can be evaluated by measuring the deposition of 111In-labelled platelets on peripheral bypass grafts several days after injection. This evaluation can be performed qualitatively (visual interpretation on the daily images) or quantitatively. Four different methods which calculate the ratio of platelet uptake with a reference region are compared: two methods use a gamma camera and two a detector. A blood sample or the region under the sternal angle are used as reference. The daily ratio of the counts, recorded by a gamma camera in a region of interest covering the graft, and the blood radioactivity interpolated from a platelet survival curve appears to be the most reliable method. The information of all the ratios can be combined in a single thrombogenicity index which reflects the daily rise of a linear or exponential regression versus time.

Aged↗
PubMedDate not supplied

Retrograde delivery of cardioplegia in aortic valve replacement.

Myocardial protection is the corner stone of cardiac surgery. In recent years there has been a renewed interest in the retrograde delivery of cardioplegia in coronary artery surgery and also in aortic valve replacement several reports have suggested the advantages of this technique. We describe our experience with retrograde cardioplegia in 25 patients undergoing aortic valve surgery, and discuss the advantages and limitations of this technique.

Adult↗
PubMedDate not supplied

Management of postcardiotomy cardiogenic shock with a new pulsatile ventricular assist device. Initial clinical results.

The authors began ventricular assist pumping as treatment for postcardiotomy cardiogenic shock in November 1988 with a new automated pulsatile support system, the ABIOMED BVS 5000 Bi-Ventricular Support System. Five patients (0.6% of total cardiac surgery patients) have been placed on support, four after coronary artery bypass grafting, and one after bypass grafting and mitral valve repair. All patients were refractory to pharmacologic and intraaortic balloon pump therapy. Three patients had left ventricular support and two had biventricular support. Four patients were successfully weaned, and three are long-term survivors. Duration of support ranged from 39 to 118 hours (mean, 89.4 hours). Resternotomy was performed in four patients: twice for hemostasis, once for tamponade, and once for inadequate left ventricular drainage. Three patients, two nonsurvivors and one survivor, had perioperative myocardial infarctions. No device related thromboembolic complications, hemolysis, or infection were experienced. Follow-up at more than 1 year demonstrated that all patients are in NYHA Class 1. Ventricular assist pumping with the ABIOMED BVS 5000 Bi-Ventricular Support System is an effective treatment for postcardiotomy cardiogenic shock.

Coronary Artery Bypass↗
PubMedDate not supplied

Perioperative morbidity and mortality of coronary artery surgery after the age of 70 years.

The aim of this study was to compare the actual perioperative (operative and hospital) morbidity and mortality of coronary bypass surgery in patients aged 70 years or older and patients aged 69 years of younger. From January 1987 to September 1988, 102 patients aged 70 years or older underwent isolated aortocoronary bypass surgery. They were compared with the younger patients operated in the same period. Preoperative, operative and postoperative data were analyzed. There was no significant difference between the mortality and morbidity of the two groups. Morbidity was evaluated according to several parameters, low cardiac output, prolonged ventilation, cerebrovascular accident, transient ischemic attacks, pulmonary problems, psychosis, renal failure, wound problems and reoperations. Because this is a limited experience it may be premature to conclude than older patients can be operated on as safely as their young counterparts, but this study shows that age is not in itself a risk factor.

Age Factors↗
PubMedDate not supplied

Value of indium-111-labeled leukocytes scintigraphy in patients after arterial reconstructive surgery.

The study was performed to evaluate the diagnostic value of Indium-111-leukocytes scintigraphy in arterial prosthetic infection. Scintigrams were performed in 19 patients in two groups. Group A consisted of 11 patients, where ten days after uncomplicated graft implantation, an Indium-111-scintigraphy was performed. Group B consisted of 8 patients, where we suspected an infected arterial graft. In group A we had one false-positive scan and in group B one false-negative scan. This gives an accuracy of 89%, a sensitivity of 87% and a specificity of 90%. These results indicate that Indium-111-leukocytes scintigraphy is a favourable test to detect a vascular graft infection.

Aorta↗
PubMedDate not supplied

[Abdominal aneurysms: long-term results].

437 patients who underwent surgery for abdominal aortic aneurysm have been studied. Of these, 206 patients (medium age 63 years) had elective surgery, 231 patients (medium age 73 years) had acute surgery. The five-year survival rate was 65% for the elective group and 40% for the acute group, but these percentages are influenced by the perioperative mortality. When the survival curves of the 198 survivors of elective surgery and the 153 survivors of acute surgery were compared with these of a demographically similar population, we noted lower survival probabilities than for the standard population in the elective group, whereas the patients who underwent emergency surgery have similar survival probabilities as the standard population. The influence of age is especially related to the perioperative period and arteriosclerosis is the most determining factor for long time survival.

Acute Disease↗