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C Vedrinne

Publications and source records attributed to C Vedrinne.

30 records · Page 2Linked to original sources
PubMed1993

Latissimus dorsi cardiomyoplasty. Perioperative management and postoperative evolution.

Twelve men aged 45 to 69 years, NYHA class 3 or 4 with low isotopic ejection fraction (18 +/- 7 percent), underwent cardiomyoplasty. Eight required cardiopulmonary bypass to treat an associated cardiac lesion. Preoperatively, all patients needed inotropic support with dobutamine and half of them vasodilators, increasing cardiac index by nearly 100 percent. The SvO2 remained over 67 percent during the different stages of the surgical procedure. The mean operating time was 438 +/- 75 min. None of the patients required intra-aortic balloon counterpulsation. Inotropic and vasodilator support was continued in the ICU and appeared especially important during weaning from mechanical ventilation. The average stay in ICU was 6.8 +/- 4.0 days. Three patients died of cardiac failure respectively 8, 11 and 15 months after CMP. One patient underwent transplantation. The eight other surviving patients showed clinical improvement from the third month, but objective criteria for hemodynamic improvement were noted only after one year. Cardiomyoplasty can be an alternative treatment for selected cases of cardiomyopathy.

Aged↗
PubMed1992

Cardiomyoplasty does not preclude heart transplantation.

Stimulated skeletal muscle grafts have been proposed to improve left ventricle function in patients with severe myocardial failure. In 1 particular case reported here, however, the postoperative functional improvement was only transient and disabling heart failure recurred after 9 months in spite of a vigorous latissimus muscle contraction. Heart transplantation was proposed to this patient and performed successfully. Technically, the key to heart removal depends on the retrograde dissection of the ventricular cavities, starting from the right atrioventricular groove. The intraoperative observations confirmed the viability of the latissimus dorsi muscle, inefficient on a highly dilated cardiomyopathy. Histopathological examination of the latissimus dorsi muscles showed that the transformation process of the stimulated muscle was good. Thus, severe cardiac dilatation seems to be one of the limitations of cardiomyoplasty. Cardiomyoplasty, when it fails, does not preclude heart transplantation. The histochemical studies confirm the electrophysiologic principle of cardiomyoplasty in humans.

Assisted Circulation↗
PubMed1992

Long-term results of porcine bioprostheses in the tricuspid position.

Between 1974 and 1990, 58 patients underwent tricuspid valve replacement with porcine bioprostheses (Hancock 42, Carpentier-Edwards 16) during multiple valve replacement (double, 21; triple, 37). Perioperative mortality was 12%; 16 patients died later, mostly from cardiac causes. Actuarial survival (1 patient lost to follow-up) was 81% +/- 11% at 5 years, and 60 +/- 17% at 10 years. Reoperation because of Hancock prosthesis deterioration was performed in 2 patients at 11 and 15 years, respectively. At last follow-up (mean 108 +/- 48 months), 82% of survivors (28/34) were functionally improved. Doppler echocardiography was performed in 29 patients in February 1991. In 21 patients, after 88 +/- 40 months of follow-up, the bioprosthesis was normal, there was no leaflet malformation, no significant tricuspid regurgitation and the mean diastolic transprosthetic gradient (DTPG) was 3.8 +/- 1.7 mmHg. In 7 patients (follow-up: 129 +/- 40 months, P less than 0.05), there was moderate dysfunction (all Hancock prostheses) with leaflet sclerosis, tricuspid regurgitation grade 2, and mean DTPG 5.7 +/- 1.8 mmHg (P less than 0.05). Only 1 patient (Hancock prosthesis implanted in 1981) had severe tricuspid prosthesis stenosis with very thickened leaflets and mean DTPG 13 mmHg. Pulmonary artery hypertension (most often fixed) was present in 11 patients, associated with a poor functional result and a significantly higher DTPG. We conclude that porcine bioprostheses in tricuspid position have an acceptable long-term durability and satisfactory performance. Prosthetic dysfunction correlates with the length of follow-up of patients and with the presence of fixed pulmonary artery hypertension.

Adult↗
PubMed1992

Reduction in blood loss and blood use after cardiopulmonary bypass with high-dose aprotinin versus autologous fresh whole blood transfusion.

Ninety patients undergoing cardiac surgery were randomly divided into three groups of 30 patients to compare the effects on bleeding and transfusion requirements of either intraoperative infusion of high-dose aprotinin (GpI) or reinfusion of autologous fresh whole blood (GpII) versus a control group (GpIII). Standardized anesthetic, perfusion, and surgical techniques were used. Platelet counts, hemoglobin concentration, hematocrit, fibrinogen, and Ivy-Nelson bleeding times determined at fixed times perioperatively did not differ among the three groups. The total loss from the chest drains was significantly reduced in GpI (328 +/- 28 mL; mean +/- SEM) as compared with the loss in GpII and GpIII (775 +/- 75 mL and 834 +/- 68 mL, respectively). There was a threefold difference in the total hemoglobin loss (GpI, 14.2 +/- 1.7 g; GpII, 50.1 +/- 5.0 g; GpIII, 45.0 +/- 5.2 g). GpI patients also received less banked blood: 250 +/- 53 mL versus 507 +/- 95 mL in GpII and 557 +/- 75 mL in GpIII. No GpI patient required transfusion of platelets or fresh frozen plasma. Fresh whole autologous blood transfusions had no significant hemostatic effect and failed to reduce the homologous blood requirement. Conversely, high-dose aprotinin reduced blood loss and transfusion requirements.

Adult↗
PubMed1992

[Clinical and hemodynamic prognosis after tricuspid valve replacement with bioprosthesis].

Between 1974 and 1990, 58 patients underwent tricuspid valve replacement with a porcine bioprosthesis (Hancock 42, Carpentier-Edwards 16) in the course of polyvalvular replacement (double 21, triple 37). Early postoperative mortality was 12%: 16 patients died secondarily, usually of cardiac causes. The actuarial survival (1 patient lost to follow-up) was 81 +/- 11% at 5 years and 60 +/- 17% at 10 years. Two patients were reoperated for dysfunction of a Hancock bioprosthesis, 11 and 15 years after implantation. At long-term, with an average follow-up of 108 +/- 48 months, 82% of survivors (28/34) were clinically improved. Doppler echocardiography was performed in 29 patients in February 1991. In 21 cases, with a follow-up of 88 +/- 40 months, the bioprosthesis was normal with an average diastolic transprosthetic pressure gradient of 3.8 +/- 1.7 mmHg. In 7 patients followed up for 129 +/- 40 months (p < 0.05) moderate dysfunction of the Hancock prosthesis was observed with a mean diastolic pressure. Severe dysfunction of a Hancock prosthesis was observed in 1 case. Fixed pulmonary hypertension was noted in 11 cases and was associated with a poor clinical result and a raised mean diastolic transprosthetic pressure gradient. The durability and haemodynamic performance of tricuspid porcine bioprostheses are satisfactory in the long term. Prosthetic dysfunction is correlated to the duration of implantation of the bioprosthesis and to persistent pulmonary hypertension.

Actuarial Analysis↗
PubMed1991

Latissimus dorsi cardiomyoplasty in severe congestive heart failure: the Lyon experience.

Eleven male patients, New York Heart Association (NYHA) Class III, have undergone cardiomyoplasty (Chachques and Carpentier technique). There were no deaths. Two patients suffered from low cardiac output, one patient suffered a massive aortic bifurcation embolism, and one patient had a Legionella pneumonia. All patients recovered well. The follow-up was 6.9 +/- 2.3 months. One patient had a Cardiomyostimulator Pulse Train Generator failure and had it replaced. The first seven patients were evaluated 6 months after surgery. They all improved (Class II) except for one, who was transplanted. The maximal level of exercise was improved (92 +/- 18 W vs 60 +/- 24 W), as was the heart rate-systolic blood pressure product (30,262 +/- 3,119 vs 19,908 +/- 4,190), mainly due to an increase in systolic blood pressure (200.0 +/- 25.5 vs 141.5 +/- 20.3 mmHg). Echographic parameters, maximal oxygen consumption, left ventricular ejection fraction (LVEF), cardiac index, oxygen arteriovenous difference, and cardiac filling pressures did not change. The left ventricular (LV) angiography always showed good contraction of the latissimus dorsi. A problem needing investigation is the principle of cardiomyoplasty (CMP) itself, as the muscle acts more as a lift than as pincers. Our patients, and patients from other series, improved functionally, and they exercised more. Improvement in survival can be studied only by a randomized clinical trial.

Aged↗
PubMed1990

[Frequency of infections in intensive care units: an incidence survey].

During a nine months period, 568 patients entered the Polyvalent Intensive Care Unit and were prospectively studied: 153 became infected and 289 infections were diagnosed. Urinary tract infections (31%) in patients with indwelling catheter, lower respiratory tract infections (22%) in tracheally intubated and ventilated patients and bacteremias (19%) totalized 75% of all I.C.U. acquired infections. Post operative and trauma patients were more frequently infected than medical patients. E. coli (19%), S. aureus (14%), Enterococcus (13%) and P. aeruginosa (12%) were isolated and resistance to antibiotics was not always important. The prescribed treatment was an association of antibiotics in 55% of cases. The group whose patients were infected had a longer stay in I.C.U. and a higher mortality rate than group of uninfected patients.

Cross Infection↗
PubMed1989

Nitrogen-sparing effect of epidural administration of local anesthetics in colon surgery.

A nitrogen-sparing effect of epidural anesthesia has been clearly demonstrated in gynecological and lower abdominal surgery. To determine if epidural anesthesia also has a protein-sparing effect during major upper or mid-abdominal surgery, postoperative nitrogen balance and 3-methylhistidine urinary excretion (an index of skeletal muscle protein catabolism) were measured for 6 days in 28 patients who had undergone colon resection for cancer with general anesthesia (N2O-O2-1% enflurane) either supplemented with low dose fentanyl plus intermittent systemic pentazocine for postoperative pain (n = 13), or the same general anesthetic plus epidural injection of either etidocaine 1% intraoperatively and bupivacaine 0.25% postoperatively (n = 8) or meperidine (n = 7) for 48 hr after skin incision. The cumulative 6-day nitrogen balance and the cumulative 3-methylhistidine urinary excretion were significantly less after epidural injection of etidocaine intraoperatively and bupivacaine postoperatively than in the two other groups. There was a significant correlation between the daily urinary excretion of 3-methylhistidine and the daily nitrogen balance in the three groups. This study suggests that in colon surgery, epidural analgesia with local anesthetics in the postoperative period improves nitrogen balance and this effect takes place partly in the muscle.

Aged↗