Search PubMed⌕ Search

Biomedical subjects

V Bors

Publications and source records attributed to V Bors.

At least 109 records · Page 6Linked to original sources
PubMed1987

[The low-profile Liotta valve. Mid-term results].

We report the mid-term results obtained with 279 "low profile" Liotta xenografts implanted at the Hôpital de la Pitié, Paris, in 257 patients between February, 1981 and November, 1984. There were 86 aortic, 138 mitral, 11 triscupid and 22 mitral-aortic valve replacements. The wavy suture ring of the prosthesis makes it "low profile". The Liotta valve is of particular interest in certain anatomical situations such as aortic annulus more dilated than the supra-coronary aorta, or small right and left ventricular cavities. The overall operative mortality rate was 8.6%. The 236 survivors were followed up for 3 to 48 months, a total of 374.3 patients-years. The overall actuarial survival rate at 3 years is 92.2%. Although there were few thromboembolic accidents, about one-third of the patients remain under anticoagulant therapy (0.86 episodes for 100 patients-years). Globally, 98.1% of the patients are free of any thromboembolic accident. Deterioration occurred 29 and 44 months respectively after implantation in two patients aged 9 and 20 years (0.57 episodes for 100 patients-years). Three cases of endocarditis on prosthesis were observed. Altogether, almost 91.2% of the patients have had no complication for 3 years, and indeed they functionally improved, most of them now being in class I or II (aortic valve 97%, mitral valve 87.2%). Thirty-eight patients underwent repeated catheterization at rest and during exercise. Mean transvalvular gradient was 12.4 mmHg in aortic valve patients and 5.9 mmHg in mitral valve patients. Mean functional valve area was 1.6 cm in aortic valve patients and 2.1 cm in mitral valve patients, and it clearly increased during exercise.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

Current problems in cardiac transplantation.

In conclusion, after almost 20 years of clinical application and due to much progress during that time by the pioneers of the method, cardiac transplantation is now a safe and reliable treatment for patients in intractable cardiac failure untreatable by other medical or surgical means. Several challenging problems remain to be resolved by the many active and excellent centers now engaged in this promising field.

Heart Transplantation↗
PubMed1987

[Cardiac transplantation. Selection of patients and long-term results].

Performed for the first time in the world, in December 1967, by Barnard in Capetown, and for the first time in Europe by our team in April 1968, cardiac transplantation has now 20 years of clinical applications. A best selection of the recipients, a more precise selection of donors, refinements in surgical technique, a better and earlier diagnosis of post-operative complications, more effective therapeutic means especially cyclosporin, have brought us, from 1981, such major improvements that many teams were prompted to resume the procedure. In our experience of more than 400 transplants at La Pitié Hospital, a five-year follow-up shows that 70 p. cent of the patients are alive, having resumed a normal familial, social, professional and often sporting life. Much progress remains to be achieved, but this procedure now seems to be quite common if not routine, only limited by the insufficient number of donors.

Adult↗
PubMed1986

Long-term results with total replacement of the ascending aorta and reimplantation of the coronary arteries.

From November, 1976, to June, 1983, 100 patients, 84 male and 16 female patients ranging in age from 13 to 74 years, were operated on for aortic insufficiency associated with an aneurysm of the ascending aorta. Twenty patients were in New York Heart Association Class I, 22 in Class II, 51 in Class III, and seven in Class IV. The surgical treatment in all cases consisted of total replacement of the ascending aorta with a tube graft containing a prosthetic aortic valve and reimplantation of the coronary arteries by an intermediate tube graft according to the technique already reported. In 68 patients an uncomplicated annulo-aortic ectasia existed, and in 32, an aortic dissection; nine of the latter group were operated on during the acute phase. The operative mortality for the entire group was 4% (four deaths). One patient has been lost to follow-up during a period ranging from 18 months to 8 years (average 54 months). The late mortality has been 11/96. Among the 84 survivors, clinical improvement is readily apparent (89% are in Class I or II). Twenty-five patients have been restudied by angiography, which revealed a satisfactory coronary and aortic appearance in all cases with neither stenosis nor aneurysm. The actuarial survival rate is 75% at 8 years. In conclusion, the treatment of aortic insufficiency associated with an aneurysm of the ascending aorta by insertion of a composite graft and reimplantation of the coronary arteries through an intermediate Dacron tube is a reliable method with low mortality and excellent long-term results.

Actuarial Analysis↗
PubMed1986

[Heart transplantation 1985. Experience of the Pitié].

Heart transplant surgery has come of age over the last four years, after 17 years of clinical application: indications have been specified, techniques systematized and treatment and post-operative follow-ups have been clarified. The results are remarkable: survival at four years is more than 80 per cent, with normal socio-familial and often professional reintegration for almost all heart transplant patients. Increased application of heart transplant surgery in the months to come will transform prognosis in patients presenting irreversible cardiac lesions, but will raise the problem of the supply of donor organs.

Adult↗
PubMed1985

[Choice of a valve prosthesis in patients between 25 and 70 years of age].

In patients over the age of 70, the choice is unanimously in favour of a bioprosthesis. In children and adolescents, the rapid deterioration of bioprostheses makes them unsuitable for these patients. However, between the ages of 25 and 70, the situation is much more open to discussion. In the aortic orifice, because of the low risk of thrombo-embolism, there is a preference for a mechanical valve, except in the case of a young woman wishing to have a child or in the case of a contraindication to anticoagulants. In the mitral orifice, the higher incidence and the greater severity of the thrombo-embolic complications present an argument in favour of bioprostheses, which should be selected in the case of anticoagulant risks (contraindication, exposure to trauma, impossibility of following a female patient who wishes to become pregnant), in the case of a high thrombogenic risk (ectatic thrombosed left auricle or replacement of a thrombosed prosthesis) and, finally, the preference of the patient and the doctor. The bioprosthesis is unequivocally indicated in the case of tricuspid valve replacement.

Adult↗
PubMed1985

[Recurrent post-infarction ventricular tachycardias. Treatment combining circular ventriculotomy, myocardial revascularization and aneurysmal plication].

The efficacy of encircling endocardial ventriculotomy (EEV) with treatment of recurrent persistent post-infarction VT has been established. The relative simplicity of the operation has enables it to be easily integrated into the surgical therapeutic arsenal for the treatment of coronary artery disease and its complications. Several electrophysiological studies have clearly demonstrated the origin of reentry pathways in the border zone of the aneurysm so that peroperative mapping can be dispensed with except in special cases. Sixteen patients with post-infarction LV aneurysm causing recurrent VT resistant to antiarrhythmic therapy for over 3 months were operated between January 1979 and June 1983. The average age was 51 years, range 36 to 70 years. The causal myocardial infarction dated from 3 months to 22 years; the site of infarction was anterior in 12 cases (anteroseptal 5 cases), posterior in 3 cases and circumferential in 1 case. Surgery was performed under cardiopulmonary bypass and comprised EEV in the border zone of the aneurysm without prior mapping studies. A myocardial revascularisation procedure was associated in 10 cases (aortocoronary saphenous vein bypass) with single grafts in 4 patients. Thirteen patients also underwent plicature of the aneurysm to remodel the ventricular cavity. There was one death in the immediate postoperative period due to a low output state (6.25%). The 15 survivors have been followed up for 1 to 45 months during which period 3 deaths occurred, on at the 2nd month due to cardiac failure and 2 sudden deaths at the 5th and 22nd months. These 2 patients had not had recurrences of their arrhythmia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Radiological anatomy of the right gastroepiploic artery.

Most gastroplasties performed to replace the esophagus are vascularized by the right gastroepiploic artery alone. Its origin, course and anatomical relations are classical and subject to little variation. Conversely, its mode of termination and relations to the left gastroepiploic artery have received quite different descriptions in the literature. This report describes the radiological anatomy of the right gastroepiploic artery based on arteriograms in 50 subjects. The right gastroepiploic artery was much larger (diameter 1.7 to 2.6 mm at its origin) than the left (absent in 3 cases) in our series. Direct end-to-end anastomosis of these two arteries, as described in classical reports, was found in only 23.5% of cases.

Angiography↗
PubMed1984

Surgery of prosthetic valve thrombosis.

From January 1978 to August 1983, 41 prosthetic valve thromboses in 34 patients were operated upon in our service. They comprised 15 aortic, 25 mitral and one tricuspid valve thromboses. Seven patients had massive thrombus with dysfunction of the prosthesis; others had small and disseminated thrombi on their prosthesis (34 patients). In the aortic position, valve thrombosis occurred on 10 ball valves and 5 pivoting disc valves. In the mitral position, they occurred on 17 ball valves, 7 pivoting disc valves and one bioprosthesis. In 2 cases, aortic valve thrombectomy was successfully done. Others had valve replacement. Hospital mortality was high: 13 deaths. Survivors are free of recurrent valve thrombosis. One had a minor peripheral embolus. Prosthetic valve thrombosis is a serious condition. There are special problems related to diagnosis and treatment of these patients which we discuss, according to our experience of more than 4000 valvular replacements.

Adult↗
PubMed1984

[Open-heart surgery in patients over 65 years of age. Lesions encountered and immediate postoperative mortality].

Open heart surgery after 65 is more and more frequent (16% of our surgical cases). Between January 1971 and December 1982, 8 425 open heart operations were performed in this Department, 1 377 of them in patients over 65. Most were cases of aortic valvulitis (620), and calcific aortic stenosis in particular, but also dystrophic aortic insufficiency; 217 patients underwent surgery for mitral valvulitis (rheumatic or dystrophic in origin) and 84 for involvement of more than one valve. Of the 2 440 patients with coronary lesions who underwent surgery, 255 were over 65; beyond this age, a higher rate of association between coronary lesions and valvular disease was found (167 patients undergoing surgery). Surgical mortality (during the first postoperative month) was higher after 65: 11.1% in patients with valve disease, and 11.4% in those with coronary artery disease, whereas in patients under 65 the figures were 6.5% and 4% respectively. On the other hand, in those undergoing surgery for combined valve and coronary disease, mortality over 65 was hardly any higher than under 65 (13.7% as against 10.4%). This justifies screening for coronary artery disease in any candidate for valve surgery aged over 65. These results were achieved thanks to some technical and anaesthetic precautions, and though they may be less satisfactory than those for younger patients, they justify such surgery for all lesions that threaten survival in the short term.

Aged↗
PubMedDate not supplied

Peripheral extracorporeal membrane oxygenation (ECMO) in patients with posttransplant cardiac graft failure.

INTRODUCTION: We sought to report the usefulness of extracorporeal membrane oxygenation (ECMO) in heart transplant patients. PATIENTS: Between March 2002 and August 2004, 14 heart transplant patients (11 men and three women, 36 +/- 15 years old, range = 12 to 50) with primary graft failure underwent peripheral ECMO implantation. Three patients had pulmonary hypertension and three had been transplanted with hearts from marginal donors. At the time of implantation, all were in severe cardiogenic shock despite maximal inotropic support. In six patients, the ECMO was implanted in the operating room since cardiopulmonary bypass could not be weaned. In the eight remaining patients, ECMO was implanted in the intensive care unit, during the first 48 hours in seven cases. In one patient, implantation was performed during external resuscitation. In all cases, femoral vessels were canulated using the Seldinger technique after anterior wall exposure. Distal arterial perfusion of the lower limb was systematically used. RESULTS: Pump outflow was high enough in all the cases (mean: 2.6 +/- 0.2 L/min/m(2)). Three patients died on circulatory support. One patient was implanted with a total artificial heart after a few hours and another one underwent unsuccessful emergent retransplantation. Nine patients were weaned from ECMO after a mean duration of 5 +/- 2.5 days. Among them, one died of infection at 10 days after weaning and seven others were discharged to rehabilitation centers. CONCLUSION: Fast operating room or bedside implantation of a peripheral ECMO allows the physician to stabilize the hemodynamic status of patients with cardiac graft failure, potentially leading toward myocardial recovery.

Adolescent↗
PubMedDate not supplied

Results of coronary artery surgery in young adults.

To study the results of bypass surgery in young adults, 221 patients undergoing myocardial revascularisation aged 40 or less (1979-1989) were reviewed. The study included 200 men and 21 women. Mean age was 36.2 years. Risk factors were essentially cigarette smoking (69.6%) and hyperlipidaemia (52%). One-hundred and eighteen patients (53.4%) had a history of previous myocardial infarction (MI) and 16 were operated on after an episode of preinfarction angina. One-hundred and twenty-nine patients had three-vessel disease, 59 had double-vessel disease and 33 single-vessel disease. Twenty-three had left main stem coronary artery lesions. Four-hundred and forty-six saphenous vein grafts and 79 internal mammary artery grafts were performed, an average of 2.3 grafts per patient. Operative mortality was 2.7% (6 patients). Deaths were caused in 4 cases by MI. Twelve patients (5.5%) had a non fatal perioperative MI. One-hundred and ninety-nine patients were followed up for a mean of 7.4 years (4838 patients-years). Seventeen late deaths occurred. Six were from cardiac causes. Overall survival was 84% at 9 years. Five patients underwent cardiac reoperation at a mean interval of 6.4 years after the primary procedure. Eighty-five% of patients were free of angina and 11.5% were in an improved condition. In conclusion, coronary revascularisation can be performed at a reduced risk in younger patients. Long-term prognosis seems similar to that of the overall group of patients undergoing bypass surgery.

Adult↗
PubMedDate not supplied

Mechanical circulatory support as a bridge to transplantation: current status of total artificial heart in 1989 and determinants of survival.

Since April 1986, 40 total artificial hearts (TAH) were implanted as a bridge to transplantation in our institution. In an attempt to identify factors affecting survival of TAH recipients we reviewed our experience over 1000 days of mechanical support. There was no postoperative bleeding requiring surgery nor were there any clinical episodes of thromboembolic complications. Over a total functioning period greater than 3 years there were no mechanical failures in the driving system but one artificial ventricle had to be replaced because of mechanical dysfunction. Infections and multiple organ failure were the primary causes of morbidity and mortality during mechanical support. When the patients who underwent staged transplantation (no. 17) were compared with those who died during mechanical support (no. 23) there were no differences in TAH driving mode or hemodynamic variables between the groups. Although preoperative pulmonary, hepatic and renal functions were found to be similar between the groups, there were significant differences in the early evolution (3 days) of hepatic and renal functions following TAH implant (p less than 0.01). Urinary output was found to be the earliest variable discriminating recovery and survival (p less than 0.01). Finally, univariate analysis indicated age (less than 40 vs greater than 40 years) and modality of cardiac decompensation (acute vs chronic) as the most important factors affecting survival after TAH implantation. Since young patients (less than 40 years of age) with acute decompensation were successfully transplanted in 82% of cases while 100% of older patients with chronic decompensation died before or after transplantation, TAH should be advised in young patients with acute or chronic heart failure and in selected older candidates with recent, acute cardiac failure.

Adolescent↗
PubMedDate not supplied

Liver and kidney function in patients undergoing mechanical circulatory support with Jarvik-7 artificial heart as a bridge to transplantation.

Changes in liver and kidney function were reviewed in 32 patients who received a Jarvik-7 total artificial heart (TAH) as a bridge to transplantation. Preoperatively, seven (22%) had significant isolated kidney dysfunction, five (15%) had isolated liver impairment, and 13 (41%) had combined disorder, affecting 25 (78%) of the 32 recipients. Immediately after TAH implantation, vigorous diuresis occurred, and biochemical indices improved in 17 patients: 71% of isolated kidney, 60% of isolated liver, and 38% of combined organ disorder were reversed irrespective of severity in preoperative dysfunction. In contrast, urine output remained poor, and biochemical indices continued to deteriorate in 15 patients regardless of preoperative status; as a result, kidney (28%), liver (17%), and combined organ failure (33%) accounted for a total of 78% of failure in this series. Although preoperative liver and kidney dysfunction were frequent and severe, they did not correlate with postoperative functional recovery and later transplantation. Recipient body size and initial postoperative urine output were found to be the variables discriminating patients with or without subsequent transplantation. Because liver/kidney failure remained as the leading cause of death, knowledge of the underlying cause of the organ failure would increase the success of TAH as a bridge to transplantation.

Acute Kidney Injury↗
PubMedDate not supplied

Heterotopic heart transplantation: current status in 1988.

Among the 480 patients who underwent heart transplantation in our institution (since 1968), 40 patients received an allograft in the heterotopic position. The recipients were evaluated by using hemodynamics and Doppler echocardiography before and after surgery. Ten to 30 days after surgery, preoperative pulmonary artery pressure, pulmonary artery wedge pressure, and pulmonary vascular resistance (PVR) decreased significantly (p less than 0.005). Cardiac output increased significantly (p less than 0.0001). Postoperative Doppler echocardiography showed that heterotopic hearts had an excellent ejection fraction (mean 73% +/- 11%). No improvement occurred in the left ventricular function of the native heart. Among the factors affecting short-term prognosis of heterotopic heart transplantation (HHT) recipients. PVR seems to be the most important determinant of survival. HHT does not seem to improve the prognosis of patients with elevated PVR. HHT, however, is still indicated in large patients and in emergency situations in which an available donor heart appears unable to support the recipient's circulation if used in the orthotopic position.

Adult↗