Biomedical subjects

Daniel Loisance

Publications and source records attributed to Daniel Loisance.

23 records · Page 2Linked to original sources

PubMed2002

Nosocomial infections occurring during receipt of circulatory support with the paracorporeal ventricular assist system.

This retrospective study sought to report the spectrum of infections in a homogenous group of 39 patients who underwent implantation of the Thoratec paracorporeal ventricular assist device system (Thoratec Laboratories) in an emergency setting. Thirty-one of the 39 patients developed a total of 99 nosocomial infections (attack rate, 79.5%; incidence, 4.9 per 100 support-days). The lungs were the most frequently involved site (31.3%), and coagulase-negative Staphylococcus species were the pathogens most frequently isolated (16.2%). Infected patients required more transfusions and chest surgical revisions, as well as a longer duration of mechanical ventilation and a longer stay in the intensive care unit, compared with uninfected patients. Cox regression analysis revealed that chest surgical revision was the only independent risk factor for infection at any site (odds ratio, 2.6; 95% confidence interval, 1.2-5.7). There was no significant effect of infection on heart transplantation rate and overall survival.

Adult↗

PubMed2002

Aortic wall alterations after use of gelatin-resorcinol-formalin glue.

We report the case of a patient who underwent reoperation 8 years after aortic valve replacement because of aneurysmal dilatation of the aortic root. During the initial intervention, gelatin-resorcinol-formalin glue had been applied on the outside of the aortic root. Perioperative examination revealed a necrotic appearance of the right coronary sinus, with contained ruptures at two different sites. Histologic analysis showed major destruction of the aortic root media, leading to vascular wall thinning and rupture. The use of gelatin-resorcinolformalin glue may expose patients to major alterations of the aortic wall.

Aorta, Thoracic↗

PubMed2002

Risk factor analysis for proximal and distal reoperations after surgery for acute type A aortic dissection.

OBJECTIVE: This study was undertaken to determine significant risk factors for proximal or distal reoperations after surgical correction of acute type A aortic dissection. METHODS: Between 1980 and 2000, a total of 160 consecutive patients (mean age 57.5 +/- 13.3 years, 126 men) underwent surgery for acute type A aortic dissection. Proximal repair was performed by means of ascending aorta replacement with valve resuspension in 130 cases (81.3%), composite graft replacement in 19 cases (11.9%), separate aortic valve and ascending aorta replacement in 7 cases (4.4%), and aortic repair in 1 case (0.6%). Distal repair required arch replacement in 23 cases. Follow-up time averaged 4.51 +/- 5.6 years per patient. RESULTS: Survival estimates after initial operation were 66.1% +/- 3.8%, 57.7% +/- 4.2%, 52.2% +/- 4.6%, and 42.5% +/- 5.8% at 1, 5, 10, and 15 years, respectively. Thirty patients required 37 reoperations at a mean interval of 5.7 +/- 4.5 years after the initial operation. Freedoms from reoperation were 96.9% +/- 1.8%, 74.7% +/- 5.3%, 60.8% +/- 6.8%, and 39.3% +/- 9.1% at 1, 5, 10, and 15 years, respectively. Reoperations included procedures on the proximal aorta (aortic root or valve) in 21 cases and on the distal aorta or its side branches in 19 cases. Cox regression analysis distinguished severe preoperative aortic valve insufficiency as the only significant risk factors for proximal reoperation; younger patient age, more distal extent of dissection, and more recent operative date were found to be significant risk factors for distal reoperation. CONCLUSION: Patients with acute type A aortic dissection who have severe aortic valve insufficiency are at increased risk for proximal reoperation. These patients should benefit from a more aggressive proximal repair at initial operation. Distal extent of aortic resection at initial operation did not significantly influence the risk of distal reoperation.

Acute Disease↗

PubMed2002

[From circulatory support to artificial heart].

Various systems of mechanical circulatory support are now available: para-corporel devices, implantable ventricular assist devices, either portable or fully implantable. They allow treatment in a wide range of clinical indications, from untractable cardiac failure to cardiogenic shock. They are used in 3 different intention to treat: bridging to transplantation, bridging to recovery or definitive permanent implant. They are progressively becoming efficacious alternatives to cardiac transplantation. Their efficacy has reduced the actual need for a total artificial heart, which nevertheless keeps few indications. Various problems technological, clinical, economical and ethical have to be solved before a wide application of the method.

Heart Failure↗

PubMedDate not supplied

Management of intracranial hemorrhage in patients with mechanical circulatory support: a role for low-molecular-weight heparins?

Patients on mechanical circulatory support are at high risk of bleeding, particularly intracranial hemorrhage (ICH). The management of ICH in patients needing anticoagulation and antiplatelet therapies remains a challenge. We report our initial experience of ICH management with low-molecular-weight heparin in patients with mechanical circulatory support, without bleeding or thromboembolic complications.

Aged↗