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Biomedical subjects

F Laborde

Publications and source records attributed to F Laborde.

At least 19 recordsLinked to original sources
PubMed2006

Pressure-suit combined with pelvic stop-flow: a feasibility study in a bovine model.

BACKGROUND: Isolated pelvic perfusion exposes tissue to high drug doses and may benefit patients with advanced malignancy. However, leakage is a limit to this technique. AIMS: The aim of the study is to increase the perfusion ratio between local and systemic compartments on isolated pelvic perfusion. We hypothesised that an inflated pressure-suit placed above the level of aortic and caval stop flow could decrease leakage from the regional to the systemic blood compartment in a bovine model. METHOD: As the size of the pressure-suit was adapted for use in humans, we performed our experimental study on 6 calves which are big enough to fit into the suit. We used an inflated pressure-suit placed at low (40mmHg) and high pressures (125mmHg) above the level of aortic and caval stop-flow. A pharmacokinetic study with cisplatinum was performed in both compartments. RESULTS: After injection of the drug, the mean ratio of drug concentration in the locoregional/systemic compartment was 43.1. After 30min, this mean ratio was 4 and 9.7 for a pressure-suit pressure of 40mmHg and 125mmHg, respectively. At pressure-suit pressures of 40mmHg and 125mmHg, pelvic perfusion achieved pelvic/systemic exposure ratios of 5.9 and 14.9 at 30min, respectively. Leakage at 30min was higher when the pressure-suit was inflated at low pressure (40mmHg, mean 18%). When the pressure-suit was inflated at high pressure, leakage was lower (125mmHg, mean 7%). CONCLUSIONS: The pressure-suit increased the perfusion ratio between pelvic and systemic compartments in a bovine model.

Animals↗
PubMed2006

[Effects of video information in patients undergoing coronary angiography].

BACKGROUND: informed consent is a fundamental and legal obligation for each interventional cardiologist. The effect of consent form describing risks of invasive procedure on anxiety is controversial. This trial was aimed to assess the added value of video information to the standard informed consent process. METHODS: 200 consecutive patients undergoing coronary angiography were enrolled. The first one hundred were assigned to conventional education conducted by the physician (no video group) and the second one hundred had consent obtained in the conventional manner assisted by video information (video group). The outcome variables for this comparison consisted of a standard anxiety score (Spielberger Statement Anxiety Inventory questionnary) plus hemodynamics measurements of heart rate, systolic and diastolic blood pressure obtained at baseline and immediately after written informed consent In addition, before discharge, patients graded the tolerability and satisfaction on a 4-point scale. RESULTS: The groups were similar with regard to their baseline characteristics and anxity score (37+23 vs 37+23). Patients who had not had prior experience of catheterization had higher baseline anxiety than those who had prior angiography (45 + 22 vs 31 + 20; p = 0.027). Patients who watched the video were significantly less anxious after informed consent (28 + 21 vs 34 + 22; p = 0.048) and had a significantly lower heart rate (65 + 10 vs 71 + 12; p = 0.03). The benefits of video information were especially prominent in those with higher anxiety scores at baseline (score after 45 + 24 vs 57 + 26; p = 0.046). Tolerability were higher in the video group compared with no video group (98% vs 86%; p = 0.003). Finally, satisfaction of information for informed consent process was higher in video group than in no video group (99% vs 76%; p = 0.001). CONCLUSION: a video information decreased anxiety level after written informed consent and improved tolerability and satisfaction scales in patients undergoing coronary angiography. The most likely to benefit from video information are patients with higher anxiety level at baseline. Beneficial effect on informed refusal should be investigated in larger population.

Adaptation, Psychological↗
PubMed2006

[Development and evaluation of a prosthetic valved conduit dilated by percutaneous approach: experimental study in the lamb].

This study was undertaken to develop a dilated valved conduit for reconstruction of the right ventricular outflow tract in the animal. The conduits were made by sewing a valved tube (Medtronic Inc) inside a vascular stent (Numed Inc). After preparation, they were inserted surgically in five lambs. The conduits were then dilated 6 weeks and 3 months after their implantation. Before sacrificing the animals at 3 months, a 22 mm valved stent was implanted percutaneously inside the surgical conduits. One animal died suddenly due to kinking of the conduit. Balloon dilatation was performed in the surviving animals. The first dilatation only had a modest impact on valvular function but it was much aggravated after the second dilatation. A valved stent was successfully inserted percutaneously. At sacrifice, all the conduits were completely engulfed in an intense fibrosis. In conclusion, a valved biological conduit for reconstruction of the right ventricular ejection tract has been developed and can be dilated sequentially to follow growth. The new product could have an important role to play in the management of congenital malformations involving the right ventricular outflow tract.

Animals↗
PubMed2005

[Management of acute coronary syndromes in a new French coronary intensive care unit. The first four years of activity in the GRACE registry (Global Registry of Acute Coronary Events)].

UNLABELLED: The GRACE registry provides the opportunity to analyse management of acute coronary syndromes in the real word and the impact of hospital characteristics. In this setting, we compare the activity of a new coronary intensive care unit with regional data. METHODS: From January 2000 to December 2003, 376 eligible patients were involved (22% of regional inclusion). GRACE standard diagnosis were the following, for our centrer (for the cluster): ST elevation myocardial infarction 28% (37%), non-ST elevation myocardial infarction 32% (31%), unstable angina 33% (24%). Demographic characteristics were similar with a median age of 64 (vs 66) and a large majority of male (74 vs 81%). Medical history and cardiovascular risk factors were comparable. Predictors of hospital mortality were observed at the same rate: cardiogenic shock (3 vs 3%), congestive heart failure > Killip 2 (4 vs 4%), left ventricular ejection fraction (LVEF) lower than 40% (17 vs 16%), recurrent ischemic symptoms (8 vs 8%). Coronary artery bypass grafts were required in 5% (vs 2%). RESULTS: Drugs prescription rates were similar: aspirin at admission (95%) and at discharge (95%), betablocker at admission (70%) and at discharge (85%), statin at admission (< 30% in 2000, > 60% in 2003) and at discharge (< 60% in 2000 and > 80% in 2003), ticlopidin-clopidogrel at admission (< 20% in 2000 and > 40% in 2003), ACE inhibitor for LVEF < 40%, intravenous GPIIblIIa, and low molecular weight heparin (90%). Cardiac catheterisation (90%) and percutaneous coronary interventions (80%) were performed at the same rates in our center and in the cluster. Hospital death was similar (2 vs 4%). Discharge status was home for a large majority of patients (63 vs 76%). The median length of stay was five days and shorter than three days for patients with unstable angina. CONCLUSION: Based on GRACE registry data, the present evaluation revealed that our new center offered evidence-based medical and interventional therapy in patients with acute coronary syndromes at the same level than experienced institutions with similar results for hospital death and length of stay.

Aged↗
PubMed2003

Factors influencing fluoroscopy time and dose-area product values during ad hoc one-vessel percutaneous coronary angioplasty.

X-ray exposure during radiologically guided interventional procedures may have some deleterious effects. The aim of our study was to analyse the factors affecting patient dose during percutaneous coronary angioplasty (PTCA). We evaluated radiation dose during coronary angiography followed by one-vessel PTCA in 402 consecutive patients who were treated by three experienced physicians using both femoral and radial techniques. Fluoroscopy time (t) and patient dose measured by a dose-area product (DAP) meter were recorded. A good correlation was observed between t and the DAP (r=0.78, p<0.001). To assess the factors affecting radiation exposure, we studied the differences between operators, arterial catheterization access and stenting strategy. Median (25th to 75th percentiles) values for t were 19 (13 to 26) min and for DAP were 191 (145 to 256) Gy cm(2) for operator 3 compared with t=12 (9 to 18) min and DAP=137 (91 to 208) Gy cm(2) for operator 2 (p<0.005 versus operator 3) and t=13 (9 to 17) min, and DAP=134 (93 to 190) Gy cm(2) for operator 1 (p<0.001 versus operator 3). Differences between the radial and the femoral techniques were: t=17 (13 to 24) min versus 12 (8 to 17) min, (p<0.001) and DAP=175 (128 to 246) Gy cm(2) versus 138 (93 to 197) Gy cm(2), (p<0.001). In comparison with stenting without pre-dilation, direct stenting significantly reduced t and DAP [t=12 (9 to 16) min versus 16 (11 to 22) min, (p<0.001) and DAP=130 (95 to 186) Gy cm(2) versus 163 (119 to 230) Gy cm(2), respectively, (p<0.01)]. Radiation exposure to patients and staff are strongly dependent on operators, stenting strategy and the arterial access chosen for ad hoc one-vessel PTCA.

Aged↗
PubMed2003

[Comparison between radial and femoral approaches in ad hoc coronary angioplasty].

Between September 1999 and June 2001, 591 patients required ad hoc coronary angioplasty. The authors compared the group of patients in whom the approach of first intent was radial (n = 328, 55%) with those in whom the femoral approach had been used (n = 263), in terms of immediate local (haematoma or thrombosis requiring surgical intervention or transfusion) and general complications (myocardial infarction, cerebrovascular accident), and major adverse cardiovascular events (infarction, angioplasty, bypass and death) at 1 year. The dose of ionising radiation during the procedures was also compared prospectively. The conversion rate from the radial (R) to the humeral or femoral (F) approach was 10%. The angioplasty, stenting, and stenting without dilatation failure rates were identical in the two groups (5% versus 5%, 0.6% versus 1.9%, 3% versus 4%, respectively). The average irradiation time was greater in the R group than in the F group (23 +/- 12 min vs 17 +/- 4 min, p < 0.001) as was the irradiation per surface unit (242 +/- 137 Gy.cm2 vs 185 +/- 117 Gy.cm2, p < 0.001). The immediate complication rate was comparable in the two groups (2.5% in group R vs 3.6% in group F) as was the major adverse cardiovascular event rate at 1 year (13% in both groups). The authors observed the same rate of immediate complications and late adverse cardiac events in patients undergoing coronary angioplasty followed by immediate angioplasty by the radial or femoral approaches with an acceptable conversion rate from the radial to the femoral approach. The procedures by the radial approach seem to be associated with a greater time and dosage of ionising radiation.

Aged↗
PubMed2003

[Percutaneous artificial heart valves: from animal experimentation to the first human implantation in a case of calcified aortic stenosis].

The development of artificial cardiac valves capable of being positioned by catheter has become an important subject for research, with the objective of treating valvular patients who are not operable or at very high surgical risk. We tested an artificial valve implantable by the percutaneous route, consisting of three leaflets of bovine pericardium sutured to the inside of a stainless steel stent, deployable by inflating a balloon. Following laboratory evaluation, this valve was implanted with success in animals, then for the first time in man, in a case of calcified aortic stenosis. The patient, a 57 year old male in cardiogenic shock, had associated multiple non-cardiac pathology and could not be operated on. Implantation was carried out by the trans-septal anterograde route, the only route available due to severe end stage arteritis. The artificial valve was deposited in the centre of the native aortic valve, without obstructing the coronaries nor reaching the mitral valve. The result was spectacular with instantaneous haemodynamic improvement and excellent valvular function confirmed by transoesophageal echocardiography every 15 days after implantation. Non-cardiac complications marred the progress, dominated by aggravation of pre-existing leg ischaemia, necessitating amputation for which the consequences were fatal at 4 months. This case demonstrates that implantation of a cardiac valve by the percutaneous route is possible in calcified aortic stenosis, and that it brings rapid clinical improvement. This technique could in future constitute an important alternative therapeutic approach for selected patients.

Angioplasty, Balloon↗
PubMed2003

[Results of heart surgery with extracorporeal circulation in octogenarians].

Cardiac surgery in the octogenarians is increasing in the industrialized countries and therefore represents a growing population. In order to better define the benefits of cardiac surgery in this population, we reviewed all consecutive octogenarians patients operated during the last 10 years. Out of 3,409 patients operated between January 1990 and December 1999, we identified 215 patients (6.3%) aged 80 years or more. Median age was 82.4 +/- 2.45 years, and 52.6% were males. Preoperatively, 52% were in New York Heart Association functional class II, 19.3% in class III, and 28.3% in class IV, with a mean Euroscore score of 7.5 +/- 2.6. Among them, 113 patients (52.5%) had isolated aortic valve replacement, 66 patients (30.6%) had isolated coronary artery bypass graft, 22 patients (10.2%) had aortic valve replacement combined with CABG, and 14 patients (6.5%) had mitral valve operation. The overall hospital mortality was 8%, and multivariate analysis revealed as risk factor for mortality aortic valve replacement combined with coronary artery bypass graft. Median follow up was 36.7 months, with 86% survival at 1 year, 59% at 5 years, and 40% at 7 years. Survival was reduced when aortic valve was combined with revascularisation. Quality of life was improved in 72% of patients. We conclude that for selected octogenarians cardiac surgery can be performed with an acceptable mortality and improves both survival and quality of life.

Age Factors↗
PubMed2002

The effect of a systemic arteriovenous fistula on the pulmonary arterial blood pressure in the fetal sheep.

In order to investigate whether systemic arteriovenous fistula occurring during the fetal period could induce pulmonary hypertension at birth, a fistula was surgically created between the carotid artery and jugular vein of fetal lambs at 120 days' gestation. Mean pressures in the left pulmonary artery, aorta, atrium and ventricles were measured at birth in seven experimental animals and in five control animals. Mean left pulmonary pressure was significantly higher in the lambs with fistula as compared with the control group, suggesting that prenatal occurrence of systemic arteriovenous fistula may induce fetal pulmonary hypertension. The present study provides a new animal model that could be relevant for the study of mechanisms regulating pulmonary vascular tone in the perinatal period.

Animals↗
PubMed2002

Biodegradable polymer (D,L-lactide-epsilon-caprolactone) in aortic vascular prosthesis: morphological evaluation in an animal model.

Biodegradable D,L-Lactide-epsilon-caprolactone copolymer was used in substitution to bovine collagen to seal porosity in nine Dacron vascular Sorin Carbografts. One served as control and 8 were implanted in mini-pigs as vascular by-pass in the thoracic aorta. The grafts were explanted at 7 days (4 animals), 30 (2 animals) and at 90 days (2 animals), and submitted to gross examination, X-ray, histology and electron microscopy. Aim of the study was to assess the safety and the reliability of these polyester vascular prostheses impregnated with the copolymer in terms of containment of the bleeding in the perioperative period, host inflammatory response, copolymer biodegradation and prostheses "healing" All the grafts were patent at angiographic and X-ray examination. At 7 days blood infiltration between Dacron and copolymer lining was detected. Inflammatory granulocyte infiltrates and granulomatous reaction with polymer degradation was observed at 30 days and fibrous tissue healing at 90 days. Luminal surface was covered by thin thrombi at 7 and by a neointima at 30 and 90 days. We conclude that D,L-Lactide-epsilon-caprolactone copolymer is effective in preventing perigraft bleeding, even though an early hematoma between Dacron and the copolymer coating occurs. Copolymer is degraded through a mild inflammatory reaction, with eventual evolution to fibrous healing.

Angiography↗
PubMed2002

[Perforation of the aorta after percutaneous closure of an atrial septal defect with an Amplatz prosthesis, presenting with acute severe hemolysis].

We report a case of aortic perforation three weeks after transcatheter occlusion of an atrial septal defect (ASD) by an Amplatzer device. Revealed by acute hemolysis, this complication needed an emergency surgical operation. The fistula between the no coronary Valsalva sinus of the aorta and the left atrium was repaired. The ASD was closed by patch. This serious accident should consider a short antero-superior rim as a risk factor for aortic perforation in transcatheter closure for ASD.

Acute Disease↗
PubMed2002

[Iatrogenic lesions of the left main coronary artery].

Reoccurrence of ischemic events several months after a percutaneous transcutaneous coronary angioplasty is usually due to a restenosis. Coronary angiography rarely shows a new stenosis on another site or on the left main coronary artery. In this series, we report 5 cases of left main coronary artery stenosis which have occurred from 3 to 12 months after a prior percutaneous angioplasty. This phenomenon which has previously been described after direct cannulation of the coronaries ostia during aortic valve replacement in the 70'. This complication is related to intimal damage caused by traumatic manipulation of the left main, which can be either already minimally altered or normal. This complication is rare after percutaneous transcutaneous coronary angioplasty (0.2-1.7%) according to various series. We compare our cases to the published cases in the literature.

Adult↗
PubMed2001

Pericarbon pericardial bioprosthesis: an experience based on the lessons of the past.

BACKGROUND: The Pericarbon pericardial bioprosthesis, at the time of its creation, showed a breakthrough in terms of low calcification deposit rate, absence of valvular tears, and durability. The purpose of this study was to evaluate results after 10 years. METHODS: From September 1988 to December 1997, 277 patients received a total of 287 Pericarbon pericardial valves. There were 224 (80.8%) isolated aortic valve replacements (AVR), 39 isolated mitral valve replacements (MVR), 1 tricuspid valve replacement, 3 pulmonary valve replacements, and 10 aortic and mitral valve replacements. The total cumulative follow-up was 1,221.42 patient-years (mean 4.9+/-2.6 years). RESULTS: Overall hospital mortality was 10.1%. The overall patient survival at 10.8 years was 55.8%+/-4.2%, for AVR it was 60.0%+/-4.5%, and for MVR it was 46.5%+/-11.9%. The freedom from valve-related death for the overall population at 10.8 years was 98.0%+/-1.0%, for AVR 97.6%+/-1.1%, and for MVR 100%. The overall freedom from structural valve deterioration was 96.6%+/-2.4%, for AVR 96.1%+/-2.7%, and for MVR 100%. The overall freedom from embolic events was 96.0%+/-1.5%, for AVR 96.0%+/-1.6%, and for MVR 100%. The overall freedom from reoperation was 88.1%+/-3.8%, for AVR 89.9%+/-4.2%, and for MVR 80.6%+/-7.3%. CONCLUSIONS: These results show that over a period of up to 10 years, the Pericarbon pericardial bioprosthesis is an excellent and safe valve substitute. Developing a detoxification process aimed at improving the biological behavior of the glutaraldehyde-tanned valve may increase those advantages.

Adult↗
PubMed2001

A new percutaneously adjustable, thoracoscopically implantable, pulmonary artery banding: an experimental study.

BACKGROUND: In patients who undergo left ventricular retraining, multiple reoperations are often necessary to adjust the pulmonary artery banding. The availability of a percutaneously adjustable band would be very useful. METHODS: Ten lambs (10 to 25 kg) underwent pulmonary artery banding using a new device, 7 by thoracotomy and 3 by thoracoscopy. The possibility of percutaneously adjusting the band was evaluated immediately after operation in 10 animals and at 3 months in 8 animals. RESULTS: One death occurred on the day of the procedure from displacement of the device and another death was from infection. Immediate hemodynamic studies proved the feasibility of increasing right ventricular afterload in a precise and reversible way. After 3 months the band could still be precisely loosened or tightened in all but 1 animal. Autopsy revealed that all the devices were in the correct position and no fibrosis or adhesions were present around the devices, and there was no residual stenosis noted on the pulmonary artery. CONCLUSIONS: This new device may be a valuable alternative to the repeated pulmonary artery banding needed for ventricular preparation.

Animals↗
PubMed2001

[Use of Organon, a synthetic heparinoid, in two cardiopulmonary bypass procedures in the same patient sensitive to heparin].

We report the case of a patient who underwent two cardiopulmonary bypass (CPB) procedures with Orgaran because of heparin-induced thrombocytopenia. A 38 years-old man with ischemic mitral insufficiency was operated for coronary artery bypass and valvular replacement. The CPB was carried out with heparin. Heparin-induced thrombocytopenia occured and was proven immunologically. Two months later, a new valvular replacement was performed because of paravalvular leak due to endocarditis. The Orgaran-CPB protocol was as follows: 5,000 units before cardiopulmonary bypass, 5,000 units in the priming volume, anti-Xa level between 0.9 and 1.1 units/mL, with injection of 1,500 units if necessary, no administration of protamine. One month later, a new valvular replacement was necessary and performed with the same protocol using Orgaran. No bleeding or thrombotic complication occurred. Orgaran is a safe and reliable anti-thrombotic substitute if anti-Xa activity is closely monitored.

Adult↗