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Biomedical subjects

Fadi Farhat

Publications and source records attributed to Fadi Farhat.

14 recordsLinked to original sources
PubMed2006

Should a reimplantation valve sparing procedure be done systematically in type A aortic dissection?

OBJECTIVE: To evaluate the risks and benefits of a systematic reimplantation valve sparing procedure in the surgical treatment of type A aortic dissection (TAAD). PATIENTS AND METHODS: From February December 2005, 15 consecutive patients (mean age 61+/-12 years) who underwent surgery for TAAD were analyzed prospectively. Eleven had a preoperative CT-scan and all had an echography. Eight patients presented with a preoperative aortic insufficiency>2/4 and seven had an ascending aortic aneurysm over 50mm. In 11 cases, arterial cannulation was performed directly into the ascending aorta. Surgical technique included complete resection and replacement of the ascending aorta using a reimplantation valve sparing technique (David), associated in 12 patients with an arch replacement, under mild (29.7+/-3.0 degrees C) hypothermia and cerebral selective antegrade perfusion. RESULTS: Aortic clamping, cerebral perfusion and cardiopulmonary bypass (CPB) times were respectively 93+/-29, 18+/-9, and 131+/-38min. Mean bleeding at 24h was 1165+/-846ml. Troponin I level at 24h was 21+/-30 microg/l. One patient had a right coronary artery bypass for a chronically occluded coronary. Another had a triple arterial revascularisation for pre-existing coronary dissection. One patient presented with a postoperative regressive right hemiparesia (normal CT-scan). Two patients underwent revision for bleeding (one was undergoing treatment by clopidogrel). One patient had at day 7 an implantation of a covered stentgraft on the descending aorta for a concomitant penetrating aortic ulcer. One patient died suddenly on POD 7 during a tracheal aspiration. Intubation and ICU times were respectively 9.5+/-16.3 and 16.2+/-20.9 days. Four patients with severe preoperative co morbidities had long intubations. Echographic and CT-scan control, done in postoperative and after a mean follow up of 11.0+/-4.8 months, did not show any residual aortic insufficiency (actuarial survival rate at 2 years of 93.3%). CONCLUSION: A reimplantation valve sparing procedure in the TAAD seems to be reliable and should be proposed systematically without emphasizing perioperative morbidity.

Aged↗
PubMed2006

A new ultrasonic process for a renewal of aortic valve decalcification.

BACKGROUND: Aortic valve decalcification by ultrasound was given up. We evaluated a new ultrasound microhandpiece (Dissectron Penstyle) to rehabilitate this alternative treatment. METHODS: We used under magnifying lenses the ultrasound microhandpiece to decalcify 30 explanted aortic valves. In the cases with embedded calcifications the thin top of the probe could be introduced into the thickness of the leaflet preserving covering layers. RESULTS: The leaflets were totally decalcified and flexible, and surrounding structures were preserved as assessed by histological examination. CONCLUSION: This new approach of ultrasonic aortic valve decalcification gives good in vitro results which allow to consider a clinical evaluation of this procedure.

Aortic Valve↗
PubMed2006

Prediction of fluid responsiveness using respiratory variations in left ventricular stroke area by transoesophageal echocardiographic automated border detection in mechanically ventilated patients.

BACKGROUND: Left ventricular stroke area by transoesophageal echocardiographic automated border detection has been shown to be strongly correlated to left ventricular stroke volume. Respiratory variations in left ventricular stroke volume or its surrogates are good predictors of fluid responsiveness in mechanically ventilated patients. We hypothesised that respiratory variations in left ventricular stroke area (DeltaSA) can predict fluid responsiveness. METHODS: Eighteen mechanically ventilated patients undergoing coronary artery bypass grafting were studied immediately after induction of anaesthesia. Stroke area was measured on a beat-to-beat basis using transoesophageal echocardiographic automated border detection. Haemodynamic and echocardiographic data were measured at baseline and after volume expansion induced by a passive leg raising manoeuvre. Responders to passive leg raising manoeuvre were defined as patients presenting a more than 15% increase in cardiac output. RESULTS: Cardiac output increased significantly in response to volume expansion induced by passive leg raising (from 2.16 +/- 0.79 litres per minute to 2.78 +/- 1.08 litres per minute; p < 0.01). DeltaSA decreased significantly in response to volume expansion (from 17% +/- 7% to 8% +/- 6%; p < 0.01). DeltaSA was higher in responders than in non-responders (20% +/- 5% versus 10% +/- 5%; p < 0.01). A cutoff DeltaSA value of 16% allowed fluid responsiveness prediction with a sensitivity of 92% and a specificity of 83%. DeltaSA at baseline was related to the percentage increase in cardiac output in response to volume expansion (r = 0.53, p < 0.01). CONCLUSION: DeltaSA by transoesophageal echocardiographic automated border detection is sensitive to changes in preload, can predict fluid responsiveness, and can quantify the effects of volume expansion on cardiac output. It has potential clinical applications.

Adult↗
PubMed2006

Comparison between 3 aortic clamps for video-assisted cardiac surgery: a histological study in a pig model.

OBJECTIVES: To assess histological traumatic effects of aortic clamps used in video-assisted surgery, an experimental study was undertaken in a pig model, comparing the Portaclamp, Endoclamp, and a metallic clamp. MATERIAL AND METHODS: In 3 groups of 5 pigs each, the descending aorta was exposed through a posterolateral left thoracotomy. External clamps (Portaclamp and metallic clamp) were positioned at the middle of the aorta. Endoclamps were inserted at the top of the descending aorta through a small purse and inflated lower. After 60 minutes of clamping, the clamp was removed and the animal reperfused for 60 minutes. It was then sacrificed and the descending aorta was harvested for blind histological study using hemotoxylin-eosin staining of 4 samples per animal: A, before the clamping spot; B, at the clamping spot; C, after the clamping spot; D, a remote sample as control. RESULTS: In the Portaclamp and metallic clamp groups, there were no lesions of the intima in all aortic samples. In the Endoclamp group, severe lesions of the intima were observed on the clamping spot: endothelium crushing with flattening of cell nucleus (3/5) or endothelium stripping with vanishing of cell nucleus all gathered in 1 point (2/5). Only spongy lesions (clearance between fibers) located on the external third of the media and moderate inflammatory lesions of the adventice were observed with a random distribution in aortic samples without difference between groups. CONCLUSIONS: This study reveals the impressive lesions of the aortic intima due to the Endoclamp. The nonspecific lesions observed in media or adventice may be related to the surgical trauma of the procedure.

Animals↗
PubMed2005

Inferior T hemisternotomy after previous bypass grafting with the in situ RITA in front of the aorta.

Aortic valvular surgery is often challenging in patients with coronary artery bypass (CABG) using in situ right internal thoracic artery (RITA) crossing in front of the aorta to the left anterior descending artery (LAD). Full sternotomy and aortic dissection result sometimes in graft injury and subsequent myocardial ischemia. The benefit of an inferior T hemisternotomy through the second intercostal space is discussed. The grafts are neither dissected nor clamped, and the access to the aortic root is excellent. Graft lesions are avoided. The absence of graft clamping does not seem to impair the myocardial function.

Aged↗
PubMed2004

Totally endoscopic off-pump bilateral internal thoracic artery bypass grafting.

The introduction of robotic assistance has enabled totally endoscopic closed chest procedures, most often by left internal thoracic artery to left (LITA) anterior descending. Endoscopic stabilizers have made off-pump surgery feasible. We report the first case of a totally endoscopic off-pump bilateral ITA grafting in a 58-year-old patient.

Coronary Artery Bypass, Off-Pump↗
PubMed2004

Benefits and complications of total sternotomy and ministernotomy in cardiac surgery.

Ministernotomy (MS) is a well-known procedure developed in the past ten years along with the rise of minimally invasive cardiac surgery. Upper, mid, or inferior partial sternotomies allow coronary surgery, as well as aortic and mitral valve approaches. Contrary to anterior thoracotomy, access to the great vessels is sometimes easy, which renders central cannulation possible. In opposition to total sternotomy (TS), MS could procure better postoperative stability that would aide in reduction of wound infections. Nevertheless, upper MS can be responsible for the lesion of the internal thoracic arteries (ITAs). Moreover, little evidence exists regarding blood sparing in MS approaches. MS presents the problem of hiding a part of the cardiac structures. For example, in the case of aortic surgery by way of upper sternotomy for example, left venting is risky or even impossible. However, partial inferior sternotomy can be interesting for aortic valve surgery in patients with in situ right ITA passing in front of the aorta, protecting the grafts during dissection. In coronary surgery, inferior T sternotomy and C sternotomy allow perfect access to the coronary network. Some authors also have described inferior "T" sternotomy for various congenital lesions. If mini-invasive cardiac surgery can offer reduced postoperative morbidity and faster rehabilitation, the advantages of MS upon TS--except for cosmetic aspects--remain to be defined. Thus, this approach should be reserved for selected patients and lesions.

Angioplasty↗
PubMedDate not supplied

Limits of arterial myocardial revascularization.

A prospective study of myocardial blood perfusion after coronary artery bypass graft (CABG) was conducted in two groups of patients. In group 1, a two-year assessment by exercise thallium myocardial scintigraphy without medical treatment was performed in 122 patients who consecutively underwent CABG with exclusive use of both internal mammary arteries (IMA) and gastroepiploic artery (GEA). In group 2, myocardial function and perfusion were determined by radionuclide investigations performed before and one year after CABG in 100 patients with preoperative LV dysfunction (defined as LV ejection fraction (LVEF) less than 0.40), comparing results of myocardial revascularization performed with either exclusive arterial grafts (arterial group, 54 patients) or one arterial graft (IMA) associated with a sequential vein graft (vein group, 46 patients). In group 1, 21% of patients presented silent residual electric ischemia during exercise stress testing and 26% had reversible scintigraphic ischemic defect despite complete revascularization, 18% of those in the inferior wall bypassed with GEA and 8% in the anterior wall bypassed with the right IMA. In group 2, the significant preoperative ischemia significantly decreased in both the vein group and the arterial group. LV function was significantly improved in the vein group; in contrast there was no modification of LV function in the arterial group. A multivariate analysis showed that the surgical technique used and the preoperative LVEF were independent prognostic factors of the postoperative myocardial outcome, with a positive impact of the vein use on the postoperative myocardial function recovery. It is important to recognize that arterial grafts have some limitations in the ability to supply blood flow for coronary circulation that may induce postoperatively silent residual myocardial ischemia and a lack of LV function recovery.

Coronary Artery Bypass↗
PubMedDate not supplied

Prospective comparison between total sternotomy and ministernotomy for aortic valve replacement.

Ministernotomy (MS) is an alternative for total sternotomy (TS) in aortic valve replacement. We compared these two approaches for results and adverse effects in a prospective study. From January to December 2000, 100 patients who underwent aortic valve replacement were included in two groups of 50 according to the surgical approach that used MS or TS; one senior surgeon performed all cases in each group. Valvular pathologies were either stenosis or insufficiency. Mean age was 63 +/- 14 years in MS, 67 +/- 12 in TS (p = ns). NYHA class was 2.7 +/- 0.5 in MS, 2.8 +/- 0.6 in TS (p = ns). Left ventricular ejection fraction was 58 +/- 12% in MS, 57 +/- 12% in TS (p = ns). There was a significant difference between MS and TS in aortic cross-clamping (66 +/- 14 min vs 48 +/- 9 min) and cardiopulmonary bypass (88 +/- 18 min vs 69 +/- 10 min, p < 0.01), but not in intervention times (2.8 +/- 0.4 hours vs 2.7 +/- 0.4 hours). Mean intensive care stay was reduced in MS (1.7 +/- 1.6 days vs 2.6 +/- 6 days, p < 0.05). Intubation times (12 +/- 7 hours vs 14 +/- 9 hours), 24 hours bleeding (394 +/- 219 mL vs 465 +/- 318), reintervention for hemostasis (4% vs 2%), rhythmic complications (14% vs 14%), and mortality at 1 month (2% vs 2%) were comparable in MS and TS. In aortic valve surgery, ministernotomy is technically more demanding and needs more time. It is as safe and as effective as conventional sternotomy but its eventual benefits, excepting upon cosmesis, are still to be defined.

Aged↗
PubMedDate not supplied

Phase II trial of capecitabine and vinorelbine as first-line chemotherapy for metastatic breast cancer patients.

BACKGROUND: Vinorelbine is one of the most active cytotoxic agents in metastatic breast cancer. Its association with 5-Fluorouracil generates objective responses, varying between 44 and 55%, and improves the tolerance profile. The aim of this multicenter phase II trial was to assess the combination of capecitabine and vinorelbine as first-line chemotherapy in patients with metastatic breast cancer (MBC). PATIENTS AND METHODS: Thirty patients with MBC received a 3-week cycle combining capecitabine 825 mg/m2 twice a day on days 1 through 14, with 25 mg/m2 of vinorelbine on days 1 and 8. Treatment continued until progression, unacceptable toxicity or patient refusal to continue. The median age was 54 years (30-77) and the median WHO-PS was 1. Twenty patients (67%) received adjuvant chemotherapy including anthracycline and taxanes. RESULTS: Objective responses occurred in 21 patients (70%). Stable disease lasting more than 6 months was observed in six patients (20%). The clinical benefit rate was 90%. The median progression-free survival and overall survival were 10 months and 30.4 months, respectively. The most frequent treatment-related toxicities were: WHO grades 3 and 4 neutropenia (two patients), febrile neutropenia (two patients), grade 3 asthenia (two patients) and grade 3 nausea/vomiting (one patient). No grade 3 hand-foot syndrome was observed. CONCLUSION: The combination of capecitabine and vinorelbine is an active and safe regimen for first-line treatment of MBC.

Adult↗