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Biomedical subjects

A Fiemeyer

Publications and source records attributed to A Fiemeyer.

15 recordsLinked to original sources
PubMed2001

Colonization and infection of pulmonary artery catheter in cardiac surgery patients: epidemiology and multivariate analysis of risk factors.

OBJECTIVE: To assess the incidence and etiology of colonization and infection of pulmonary artery catheters inserted in cardiac surgery patients. To determine the influence of some variables on the risk of developing pulmonary artery catheter colonization and infection. DESIGN: Prospective observational study of pulmonary artery catheters inserted into the internal jugular vein that were in place for >48 hrs over a 13-month period. Data collected included age, gender, nature of the cardiac surgery intervention, duration of extracorporeal circulation, date of insertion and removal, subsequent infection, and curative antimicrobial therapy. End points were pulmonary artery catheter colonization with >or=10(3) colonies on quantitative cultures and pulmonary artery catheter-related bacteremia. Risk factors for colonization were determined by multiple logistic regression. SETTING: A 17-bed cardiac surgery intensive care unit in a 480-bed teaching hospital in Paris. PATIENTS: Patients undergoing cardiac surgery procedures between May 1, 1997, and May 31, 1998. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 164 pulmonary artery catheters inserted in 157 patients, 19 (11.6%) and 1 (0.6%) were associated with colonization (mean duration of catheterization, 7.5 +/- 2.8 days) and bacteremia, respectively. These data represent an incidence of 17.7 and 0.93 episodes per 1000 catheterization-days, respectively. Pulmonary artery catheter colonization was caused by Gram-positive cocci in 48% (67% were coagulase-negative staphylococci), Gram-negative rods in 48%, and Candida albicans in 4%. From multivariate analysis, >4 days of catheterization was the single variable associated with a significantly increased risk of pulmonary artery catheter colonization (odds ratio, 9.81; 95% confidence interval, 1.24-77.5, p = .03). CONCLUSIONS: Our data show that the risk of pulmonary artery catheter-related colonization and bacteremia is quite low despite the use of a high-risk insertion site. In cardiac surgery patient populations, a trial evaluating the impact of a systematic pulmonary artery catheter removal after 4 days is warranted.

Bacteremia↗
PubMed2001

Cardiac troponin I: its contribution to the diagnosis of perioperative myocardial infarction and various complications of cardiac surgery.

OBJECTIVE: To study the value of assaying cardiac troponin I (cTnI) for the early diagnosis of perioperative myocardial infarction (PMI) and various complications of cardiac surgery. DESIGN: A prospective observational clinical study. SETTING: Biochemical laboratory, anesthesia, and cardiac surgery department of Hôpital Broussais. PATIENTS: Two hundred and sixty consecutive patients undergoing cardiac surgery. INTERVENTIONS: All patients underwent coronary artery bypass grafting and/or valvular surgery under extracorporeal circulation. Per-operative and postoperative follow-up consisted of electrocardiogram, echocardiography (mainly by the transesophageal approach), and serial determinations of biochemical markers such as creatinine kinase-MB isoenzyme (CK-MB) and cTnI. PMI, new ST segment changes, and ventricular arrhythmias were considered postoperative adverse cardiac outcome. MEASUREMENTS AND MAIN RESULTS: CTnI was measured before cardiopulmonary bypass (T0) and 12 and 24 hrs after (T12, T24). CK-MB was measured on arrival in the intensive care unit and on the first postoperative day (D1). Patients were divided into three groups according to the type of surgery: coronary artery bypass graft (CABG), valvular surgery (VS), or both procedures. The plasma CK-MB and cTnI concentrations were high in all patients after extracorporeal circulation because of aortic clamping or cardioplegia. The CK-MB and cTnI values were higher in the VS group than in the CABG group. Values peaked at T12 and fell by T24, except when PMI occurred. Eight patients developed a PMI. Patients with PMI had significantly higher cTnI levels at T12 and T24, and higher CK-MB values at D1 than patients without PMI. Cutoff values of cTnI for diagnosing PMI were >19 microg/L at T12 with 100% sensitivity and 73% specificity, and >36 microg/L at T24, with 100% sensitivity and 93% specificity. Lower cTnI values were highly suggestive of the absence of PMI after CABG and/or VS. Other complications such as ST segment changes, ventricular arrhythmias and cardiac failure were indicated by high cTnI levels at T12 and T24. Myocardial protective measures were associated with a nonsignificant increase in cTnI values. CONCLUSIONS: CTnI is more sensitive and specific than CK-MB for diagnosing PMI and other forms of heart failure after cardiac surgery.

Aged↗
PubMed2000

A study of platelet functions with a new analyzer using high shear stress (PFA 100) in patients undergoing coronary artery bypass graft.

Platelet dysfunction can be a major factor in excessive bleeding following cardiopulmonary bypass (CBP). A rapid, specific and sensitive method to identify platelet dysfunction would be a useful tool for identifying patients at an increased risk of bleeding. The ability of PFA100, an in vitro bleeding test, to predict increased bleeding risk linked to platelet dysfunction was tested in 146 patients undergoing primary coronary artery bypass graft. Blood samples were taken the day before surgery, and 15 min and 5 h after heparin neutralization. The preoperative closure times (CT), i.e. the time required for platelets in citrated whole blood to occlude an aperture cut into a membrane coated with collagen plus either epinephrine (CTEPI) or adenosine diphosphate (CTADP) were longer in blood-group-O patients than in patients with other groups. The 15 min postoperative values were significantly longer from preoperative values essentially owing to CBP-induced hemodilution. Interestingly, 5 h after CBP, a significant reduction in CT values probably reflected platelet hyperaggregability. No correlation was found between calculated blood loss (CBL) and either preoperative or postoperative PFA values.

Adult↗
PubMed1998

[Computer assisted open heart surgery. First case operated on with success].

The recent development of less invasive intracardiac surgery using small incisions and videoscopic techniques allowed an evaluation of the advantages and limitations of this new approach. Among the limitations was the increased difficulty of the surgical technique when using long instruments through small incisions and ports. We investigated whether computer assisted surgical instruments might bring a solution to this problem. Among the existing systems, we selected the Intuitive System because of two original features. It provides a stable, magnified, three dimensional view of the operating field at a console where the surgeon is seated to operate, and it uses computer assisted instruments having the same dexterity and range of motion as the hand. After 10 months of active work to adapt this system to intracardiac surgery, the first open heart operation using computer assisted instruments was carried out on a 52-year-old woman presenting an aneurysm and a large defect of the atrial septum. The patient was extubated 8 h after the operation, returned to her room 16 h later and was discharged from the hospital 8 d post-operatively with normal heart function and no residual shunt. This preliminary experience showed that computer assisted cardiac surgery is feasible and may open new and promising directions in open heart surgery.

Cardiac Surgical Procedures↗
PubMed1994

[Mid-term results of cardiomyoplasty].

Cardiomyoplasty (CMP) is a technique of circulatory assistance using a pediculated latissimus dorsi muscle wrapped around the heart and electrically stimulated during systole. Sixty-four patients, aged 15 to 69 years (average 50.8 +/- 13 years) with cardiac failure underwent CMP between January 1985 and July 1993. The causes of cardiac failure were : ischaemic heart disease (39 cases), dilated cardiomyopathy (18 cases), cardiomyopathy following valvular heart disease (2 cases), cardiac tumours (4 cases) and congenital heart disease (1 case). Twenty-four patients underwent an associated surgical procedure. Intra and postoperative intra-aortic balloon pumping was required in 27 cases. Hospital mortality (before latissimus dorsi stimulation) was 20.3% (13/64 cases). Evaluation of the survivors 12 months after surgery showed an improvement in functional class (1.,5 versus 3.3 before CMP ; p < 0.05), in isotopic ejection fraction (27 +/- 3% versus 17 +/- 6%, p < 0.05) and cardiac index (2.87 +/- 0.63 l/min/m2 versus 2.38 +/- 0.41 l/min/m2, p < 0.05). There was no significant change in cardiac filling pressures. The number of hospital admissions for congestive cardiac failure in operated patients was 0.4 per patient per year, compared with 2.5 per patient per year (p < 0.05) before CMP. The preoperative predictive factors for late mortality were: permanent functional Class IV (NYHA), severe cardiac dilatation (cardio-thoracic ratio greater than 0.60; left ventricular end diastolic dimension > 75 mm), an isotopic left ventricular ejection fraction < 15%, severe biventricular cardiac failure and irreversible pulmonary hypertension. The actuarial 4 year survival rate was 68.3%.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1991

[Cavo-bipulmonary anastomosis. Apropos of 3 cases].

Cavo-bipulmonary anastomosis (CBPA) in an anastomosis between the superior vena cava and the right pulmonary artery in continuity with the left pulmonary artery. This shunt is used in complex cyanotic congenital heart disease with pulmonary stenosis. It is the first stage of a total cavo-pulmonary shunt (TCPS). Thirty patients underwent this procedure at Laënnec Hospital between April 1988 and April 1990. The surgical indications were retained when TCPS appeared to be too risky, mainly because of the associated malformations, the correction of which was performed at the same time. There were to early deaths; one patient was lost to follow-up and 27 patients have been followed up for an average period of 12 +/- 6 months. The surgical result was judged according to the degree of cyanosis; a poor result was defined as systemic saturation of less than 75% and a haematocrit of over 55%. One child died 5 months after surgery; there were 16 good results and 10 poor results. Seven patients were reoperated to carry out the second stage of the TCPS. The average gain in saturation was 9.7% in our series. Analysis of the patients who died or who had poor surgical results showed an anatomic cause in 11 of the 13 cases (pulmonary arteriovenous fistula, stenosis of the branches of the pulmonary artery, regurgitation of an atrioventricular valve) or a physiopathological cause (mean pulmonary artery pressure greater than 20 mmHg, or ventricular failure). The CBPA is a palliative procedure to reduce ventricular load, repair stenosis of the right pulmonary artery and to prepare the patient for a total cavopulmonary shunt.

Adolescent↗
PubMed1984

[Sodium nitroprusside in hypothermic surgery under extracorporeal circulation].

Sodium nitroprusside (SNP) is a vasodilator widely used in heart surgery. Its effects before and after bypass at normal temperature have been reported. This prospective study compares 15 patients who received SNP with 5 controls. SNP's efficacy on the systemic arterial resistance index is demonstrated during cooling and rewarming. Vasoconstriction at the end of persistent hypothermia does not respond to SNP. No signs of toxicity, neither biological (metabolic acidosis) nor clinical (respiratory or cardiac problems) were observed. SNP lowers pulmonary artery resistance index during normothermia and pulsed cardiac output, but a rebound appears 45 minutes after SNP withdrawal. SNP is usefull for anaesthesia in heart surgery with hypothermia.

Adult↗
PubMed1980

[Anesthesia of more than 8 hours in cardiac surgery for babies 10 kg or less (author's transl)].

25 cases of total correction of complex congenital heart disease operated from January 77 to May 79 at Laënnec Hospital in Professor J. Mathey's department of thoracic and cardiovascular surgery. All 25 cases were of small weight: to kg or less. We studied the following problems: --Anaesthetic technics --Methods and means of observation --The different anomalies: .pulmonary .haemodynamical .metabolical .renal .neurological --and the different causes of death. 16 of the 25 patients studied died, 11 of whom within the first 48 hours after surgery. We concluded that in no case death can be attributed to the long duration of anaesthesia. Complications due to long-duration anaesthesia can be avoided by systematically controlling the haemodynamical, respiratory and metabolical parameters, and maintaining the viral functions within physiological limits.

Anesthesia, General↗
PubMed1979

[Accidents and complications during aorto-coronary bypass surgery. 100 cases].

Using a series of 100 patients undergoing aorto-coronary bypass surgery in the department of Professor MATHEY at Laennec Hospital, the authors analyse the incidence of accidents and complications during the per- and postoperative phases. Acute hypertensive crises accounted for the most common complication, occurring in 49 per cent of cases. The authors attribute these hypertensive crises to inadequate neuroplegia in the anaesthetic protocol. Other complications are analysed in relation to the type of myocardial protection.

Adult↗
PubMed1979

[Risk factors in coronary artery bypass surgery. 55 observations].

The incidence of complications after aorto-coronary bypass surgery were studied in a series of 55 patients in relation to the duration of extra-corporeal circulation and the value of myocardial protection. The length of the period of extra-corporeal circulation played a significant role in the onset of complications whilst there was no significant difference between the group of patients operated upon under hypothermia and those in normothermia.

Coronary Artery Bypass↗
PubMed1979

[Prevention of complications following aorto-coronary bypass surgery. Proposed solutions].

In the light of per- and post-operative complications seen in the past, the most suitable anaesthetic protocol for aorto-coronary bypass surgery would appear to be neuroleptanalgesia. This anaesthetic technique appears to decrease the incidence of per- and postoperative hypertensive crises. In addition, the use of cardioplegia also made it possible to decrease the incidence of postoperative complications in a recent group of 39 patients.

Coronary Artery Bypass↗
PubMed1975

[Congenital cardiopathies appearing during the neonatal period. The view points of the cardiologist, the hemodynamics specialist, the surgeon, and the anesthetist].

The best chances of survival for a new-born depend on the following factors: the possibility of clinical and haemodynamic diagnosis of the malformation, adequate reanimation and surgery. All this must be carried out as early as possible. Although catheterization is very risky it should be complete and as fast as possible, under monitoring of ventilation and haemodynamies. Reanimation is very important before, during and after surgery; it should be more preventive than curative. Very often, surgery is only palliative at this age. Taking into account progress in surgical techniques, the authors report their experience in anaesthesia and ressuscitation of 100 patients under 10 days old. They were all operated on in Laennec in Professor MATHEY's department but only some of them were catheterized there.

Anesthesia, General↗