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J F Chassignolle

Publications and source records attributed to J F Chassignolle.

35 records · Page 2Linked to original sources
PubMed1994

[Automatic implantable defibrillators; subdiaphragmatic insertion].

Although the material and techniques of implantation of the electrodes of implantable defibrillators have been improved, the abdominal implantation of the generator remains widely used as described by Mirowski in 1980. Despite a progressive reduction in their size, the generators remain bulky and a source of local complications. The risks and discomfort of implantation in the abdominal wall led the authors to try subdiaphragmatic implantation in 22 patients. There was no morbidity with perfect healing in all 22 cases. The mean follow-up period was 11 months. The patients felt very comfortable, a significant advance with respect to abdominal implantations.

Adolescent↗
PubMed1994

[New approach for implantation of automatic defibrillators using videothoracoscopy].

Nonthoracotomy lead systems are increasingly used in patients (pts) with implantable cardioverter defibrillator (ICD). In this setting, due to high energy requirements, a subcutaneous patch may be necessary in addition to endocardial leads. However in some patients, high defibrillation threshold (DT) may persist leading to thoracotomy for epicardial patch placement. In a preliminary experience, 3 patients with high DT (> 20 J) following endocardial lead system, underwent the insertion of a extrapericardial patch under video-thoracoscopic control. A left subcostal incision extended to the left pleural cavity was performed. Using thoracoscopy the patch was positioned on the pericardium, sutured and connected to the defibrillator. DTs were 10, 10 and 20 J respectively in our 3 patients. Postoperative course was uneventful. Thoracoscopy allows other techniques such as a stellectomy, which we performed in a 33 year old woman with long QT syndrome. Patients were reassessed after 8 days and 2 months. Termination of induced ventricular fibrillation was achieved with the same minimal energy levels used peroperatively. In conclusion, extrapericardial patch insertion using thoracoscopy may help reduce DT in ICD patients with a non thoracotomy lead system. Comparison with other lead configurations requires further investigation.

Adult↗
PubMed1994

[Implantation of automatic defibrillators by means of video-thoracoscopy. Authors' experience].

The implantable cardioverter-defibrillator represents an effective option for some potentially lethal ventricular arrhythmias. Nowadays defibrillation electrodes are often endoluminal only. In some patients, however, the presence of high defibrillation thresholds mandates the implantation of a subcutaneous patch. If the subcutaneous patch does not allow a sufficient decrease in defibrillation threshold, then two epicardial patches are generally implanted by different surgical approaches. Nevertheless surgical trauma could be a serious hazard in unstable patients. In 6 patients in whom endoluminal electrodes did not allow a safe defibrillation threshold, an extrapericardial patch has been implanted by means of a video-thoracoscopic approach: a left subcostal incision is performed and the subdiaphragmatic extraperitoneal space is reached; a patch electrode is then introduced into the left pleural cavity by blunt dissection of the diaphragm. This patch is positioned under thoracoscopic control in contact to the left pericardial surface and fixed by single stitches sutures. The impulse generator is finally implanted into the subdiaphragmatic pocket. In all the patients the patch electrode configuration sufficiently decreased defibrillation thresholds. In one of the patients a stellectomy was thoracoscopically performed to treat the long QT syndrome which was the cause of the ventricular fibrillation episodes. Defibrillation thresholds were confirmed after 8 day and 2 months postoperatively. In conclusion, the thoracoscopic implantation of an extrapericardial patch has allowed a significant reduction of defibrillation thresholds, without recurring to a major surgical procedure.

Defibrillators, Implantable↗
PubMed1993

[New approach to implantation of automatic defibrillators using video-thoracoscopy].

Nonthoracotomy lead systems are increasingly used in patients (pts) with implantable cardioverter defibrillator (ICD). In this setting, due to high energy requirements, a subcutaneous patch may be necessary in addition to endocardial leads. However in some patients, high defibrillation threshold (DT) may persist leading to thoracotomy for epicardial patch placement. In a preliminary experience, 3 patients with high DT (> 20J) following endocardial lead system, underwent the insertion of a extrapericardial patch under video-thoracoscopic control. A left subcostal incision extended to the left pleural cavity was performed. Using thoracoscopy the patch was positioned on the pericardium, sutured and connected to the defibrillator. DTs were 10, 10 and 20 J respectively in our 3 patients. Postoperative course was uneventful. Thoracoscopy allows other techniques such as a stellectomy, which we performed in a 33 year old woman with long QT syndrome. Patients were reassessed after 8 days and 2 months. Termination of induced ventricular fibrillation was achieved with the same minimal energy levels used peroperatively. In conclusion, extrapericardial patch insertion using thoracoscopy may help reduce DT in ICD patients with a non thoracotomy lead system. Comparison with other lead configurations requires further investigation.

Adult↗
PubMed1992

[Use of the internal mammary artery as a free graft with reimplantation of the proximal end onto the ascending aorta. Apropos of 39 cases].

From January 1987 to January 1991, 104 patients received bilateral internal mammary artery grafts and 39 of them had coronary bypass with a free graft implanted on the ascending aorta. There were 35 men, with a mean age of 57.35 years (range 41 to 70 years). 87% of them had stable angina, and 23 had preoperative myocardial infarction. The left ventricular function was good in 77 per cent of cases. 23 patients had three vessel disease (61.5%), 13 two vessel diseases (30.7%), 2 one vessel disease (5.12%) and one a left main coronary stenosis. Left internal mammary artery was used in two patients on the left descending artery and the right internal mammary artery was used in 37 patients: 15 on the circumflex, 15 on the right coronary, 4 on the LDA and 3 on the diagonal artery. Five patients had one graft, 32 two grafts and one three grafts (bilateral mammary and saphenous vein). Hospital mortality was 2.56% (1 patient) and there were 2 late deaths (5.12%). There were 5 perioperative myocardial infractions (12.8%) and no sternal infections. The mean follow up is 21 months (range 3 to 46 months). At follow-up, 34 patients (87.2%) were asymptomatic, and there were no myocardial infarctions. Postoperative angiography in 8 patients (mean postoperative time 2.5 months) showed that all the grafts were patent. This analysis demonstrates that free IMA graft has a low operative risk and provides excellent long term functional improvement and survival.

Adult↗
PubMed1992

[Interposition of a prosthetic graft between the ascending aorta and the abdominal aorta in the treatment of complicated or longstanding coarctations in adults].

Although the direct approach to the aortic isthmus is unquestionable for an isolated coarctation of the thoracic aorta, recurrent coarctations of coarctation with associated cardiac lesions require a concomitant procedure, raise difficult surgical problems and expose to a high operative risk. Another technique consists of performing an ascending aorta-abdominal aorta by-pass, with a prosthetic tube. From 1977 to 1988, this technique was performed in 8 patients: 3 with recurrent coarctations, 4 with coarctation associated with a surgical aortic insufficiency (2 ascending aortic aneurysms with aortic insufficiency) and 1 with abdominal aorta coarctation. The mean age was 48.3 years (range from 31 to 72 years), the mean follow-up was 44.3 months (range from 4 months to 10 years 5 months). There was no mortality and no morbidity during the follow-up. The functional result is good, without high blood pressure and with no blood pressure difference between the arms and the legs. Postoperative angiographies showed that all the by-passed were patent.

Adult↗
PubMed1991

[Whole body and thoracic impedance changes induced by cardiopulmonary bypass].

Impedance is defined as resistance to alternating electrical current. It is inversely proportional to the volume of tissues traversed by the current. Cardiopulmonary bypass, as used in cardiac surgery, results in extravascular fluid overload manifested by a decrease in whole body and thoracic impedance. This non-invasive method has been used in 18 adult patients before, and in the days immediately following cardiopulmonary bypass for non-mitral cardiac surgery. Right and left thoracic impedances were reduced by 32 and 37 percent respectively during the first postoperative hour and returned to preoperative values after the second postoperative day. Whole body impedance was reduced by 14 percent in the first post-operative day, and this was accompanied by 17 percent and 16 percent decreases in the PaO2/PAO2 and PaO2/FIO2 ratios respectively. There was no correlation between impedance and these ratios which reflect pulmonary gases exchanges. Impedance appears to be a simple method to evaluate whole body and thoracic water contents, thereby providing guidance in post-cardiac surgery management.

Adult↗
PubMed1991

[Retrospective study of 412 aortic valve replacements by Bjork-Shiley prosthesis implanted between January 1972 and October 1984. Actuarial survival, mortality, complications].

Between January 1972 and October 1984, 412 aortic valve replacements by Bjork-Shiley disk prosthesis were performed. 183 patients suffered from aortic incompetence, 132 from an aortic disease and 97 from aortic stenosis. 116 associated procedures (28%) were performed = 36 myocardial revascularizations, 61 Bentall operations, 12 patch grafts to the ascending aorta and 7 Wheat operations. The mean age was 53.6 years and 25% of the patients were over the age of 65 years. Fifty percent of the patients had stage III or IV disease according to the NYHA classification. The cardiac index was less than 2.3 l/min/m2 in 44.26% of cases. The early postoperative mortality was 4.85% and 20% of these deaths were related to the prosthesis. The late mortality was 17.25%, with 20% of deaths related to the valve. The mean follow-up 59.75 +/- 2 months (range: 1 to 166 months) with a cumulative survival of 2.092 patients-years. It was significantly influence by the existence of preoperative angina, another operation associated with AVR and a cardiac index less than 2.3 l/min/m2. Seventy-one complications were related to the prosthesis including dysfunction (0.05% patient-year), 3 valve thromboses (0.15% patient-year), 6 infected valves (0.31% patient-year), 12 cases of peri-prosthetic dehiscence (0.61% patient-year), 10 embolic complications (0.61% patient-year) and 37 complications related to anticoagulants, including 26 major complications (1.48% patient-year). The valve failure rate was 1.19% patient-year. The results of our series are comparable to those reported in the literature, which confirm the reliability of the Bjork-Shiley Valve.

Actuarial Analysis↗
PubMed1984

[Course of the results observed in the 1st 100 coronary angioplasties performed in 96 patients. Experience in Lyons].

TCA is an original method of myocardial revascularisation which, when successful, enables coronary bypass surgery to be avoided. However, a certain number of failures and complications are inherent to the development of a new therapeutic technique. The object of this study is to analyse the evolution of our results with this technique to determine which factors changed as our experience increased. The methodology used was that initially described by A. Gruntzig. TCA was carried out 72 times on the left anterior descending, 20 times on the right coronary and 8 on the left circumflex coronary artery (72 single vessel, 28 multivessel disease). The primary success rate was 75% (72% for the first 50 and 78% for the second 50 procedures). Coronary bypass surgery was required within the first 24 hours of TCA in 7% of cases. Myocardial infarction (Q wave changes) was observed in 5% of cases. One patient died on the third day (occlusion of an aorto-coronary venous graft). In retrospect, taking into account the experience gained and the development of the material now available, a certain number of failures and complications could probably have been avoided. However, a certain number of complications seems to be unavoidable. TCA remains an inviting but not infallible alternative in the treatment of coronary artery disease and should be included in the medico-surgical management of this condition.

Adult↗
PubMed1981

[Tricuspid valve replacement by Hancock's prosthesis].

The medium term results of tricuspid valve replacement with the Hancock bioprosthesis are reported. Twenty eight patients underwent tricuspid valve replacement with this prosthesis between December 1974 and January 1978: mitral valve replacement with a Starr-Edwards or Cooley-Cutter prosthesis was associated in all cases and aortic valve replacement with a Björk-Shiley prosthesis in 11 cases. Follow-up at an average of 36,2 months after operation examined functional status, cardiac size and haemodynamics (in 12 patients). Three patients died in the immediate postoperative period and four others died later: the number of survivors was greater in the triple valve replacement (9/11) than in the double valve replacement group (12/17) but the difference was not statistically significant. Of the 23 surviving patients (average follow-up of 36,2 +/- 9,6 months), 17 were classified in functional Classes I or II of the NYHA classification. All patients had been Class III or IV before operation. The cardiothoracic ratio did not decrease significantly in patients undergoing triple valve replacement. Control cardiac catheterisation showed a significant increase in cardiac index (2,53 +/- 0,11 1/mn/m2, compared to 1,87 +/- 0,35 1/mn/m2 before operation; p less than 0,001) without significant reduction in pulmonary artery or right atrial pressures. The resting gradient across the Hancock bioprosthesis was not related to the size of the prosthesis (No 29-30: 2,17 +/- 2,57 mm Hg; No 31-33: 2,78 +/- 3,53 mm Hg) or with the quality of the functional result. However, on exercise, the gradient across the prosthesis was high, reaching an average of 10,3 +/- 5,2 mm Hg). The operative mortality of tricuspid valve replacement is relatively bioprosthesis associated with mitral and/or aortic valve replacement is relatively bioprosthesis associated with mitral and/or aortic valve replacement is relatively low (about 10%) and could be an argument in favour of broadening the indications for tricuspid valve replacement as resting tricuspid function with a bioprosthesis is satisfactory. However, the stenotic effects on exercise and the uncertainty over the long-term outcome of bioprostheses suggest that surgery should be limited to severe tricuspid stenoses and/or major tricuspid regurgitation organic or functional uncontrolled by digitalis and diuretic therapy.

Adult↗
PubMed1976

[Myocardial protection by coronary perfusion and specific problems of myocardial protection in combined valvular and coronary surgery].

The quality of the myocardial protection by bilateral coronary perfusion was studied in a consecutive series of 80 patients treated by isolated aortic replacements (47 cases) or multiple replacements (mitro-aortic, or mitro-aortic and tricuspid) 33 cases. Four low outputs (5 p. 100) were observed with only one death. Five post-operative necroses (6.25) were noted. The overall surgical mortality was 6.25 p. 100 (5 cases out of 80). There were two deaths in the series of the 47 single replacements and three deaths (9) in the series of multiple replacements. At the same time, the myocardial protection was studied in a consecutive series of 12 cases of valvular replacements combined with coronary shunts. In all of the cases, the shunt or shunts were carried out first, the myocardial protection was subsequently ensured by a coronary perfusion carried out by means of the shunts and directly through the coronary orifices. There were 2 deaths (16), 2 necroses (16) both responsible for deaths and no low output in the 10 survivors. Coronary perfusion very certainly ensures an excellent quality of myocardial protection if certain criteria are respected: hypothermia, moderate (28 degrees) bilateral perfusion with a mean perfusion pressure above 100 also ensuring a good flow through the sub-endocardial layer, which remains particularly sensitive to ischiemia. In cases of associated shunts, they must be carried out, first of all, in cases of tight senoses, over 60.

Coronary Vessels↗