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Biomedical subjects

J N Fabiani

Publications and source records attributed to J N Fabiani.

At least 55 records · Page 3Linked to original sources
PubMed1999

Decreasing occupational risk related to blood-borne viruses in cardiovascular surgery in Paris, France.

BACKGROUND: Surgeons face the risk of patient-to-physician transmission of blood-borne viruses. This risk is related to the seroprevalence of the viruses in the patient population. METHODS: The seroprevalence of the human immunodeficiency virus, hepatitis B virus, and hepatitis C virus were determined in cardiovascular patients at Hôpital Broussais in Paris, France, over a 5-year period (1994 to 1998). RESULTS: Hepatitis C virus is the most prevalent virus in the patient population, whereas human immunodeficiency virus is the least frequent. The seroprevalence of hepatitis C virus and human immunodeficiency virus has decreased over time, whereas hepatitis B virus has remained constant. We apply the seroprevalence data to a mathematical model to estimate the occupational risk of seroconversion faced by surgeons over the length of their career. Our results show that the principal risk faced by the surgeon arises from hepatitis B virus and hepatitis C virus. The decreasing seroprevalence of the hepatitis C virus has resulted in a decrease in the occupational risk. CONCLUSIONS: The probability of becoming infected with a blood-borne virus over the career of the surgeon is notable. The greatest occupational risk to the surgeon is from the hepatitis viruses and not HIV.

Adolescent↗
PubMed1999

Distribution and prevalence of inducible nitric oxide synthase in atherosclerotic vessels of long-term cholesterol-fed rabbits.

The expression of inducible nitric oxide synthase (iNOS) as well as its functional activity has recently been reported in atherosclerotic lesions. The aim of the present study was to evaluate the expression of iNOS in various arteries of rabbits fed a long-term but low-level cholesterol-enriched diet which promotes different types of atherosclerotic lesions resembling human diseased vessels. No iNOS expression was revealed in arteries from control rabbits and in fatty streaks found in carotid and femoral arteries from hypercholesterolemic rabbits. In transitional lesions from the thoracic and abdominal aortas, the coronary and pulmonary arteries, a punctiform iNOS staining was detected in the intima. When lesions were more advanced, iNOS expression was found more intense and diffuse and localized in the subendothelial layer as well as in the media. Smooth muscle cell accumulation in intimal layers of the arteries is a marker of the degree of evolution of the atherosclerotic lesion; since we found a correlation between the smooth muscle cell infiltration in the intima and the iNOS expression in the intima and the subendothelial layer, our results suggest a link between the severity of the lesion and the iNOS expression.

Animals↗
PubMed1999

Cardiac valve papillary fibroelastoma: surgical excision for revealed or potential embolization.

OBJECTIVE: We have reviewed the case histories of 4 patients who underwent operations between September 1994 and November 1997 at Broussais Hospital for cardiac valvular papillary fibroelastoma. METHODS: Diagnosis was strongly suggested by echocardiography. Tumor locations were mitral (1), tricuspid (1), and aortic (2). Indications for operation were previous stroke for the mitral tumor, prophylaxis for the tricuspid tumor, syncopal episodes for the first aortic tumor, and transient ischemic attack and mesenteric ischemia for the second aortic tumor. RESULTS: Surgical excision with a conservative, valve-sparing approach was performed in all cases. For the first aortic tumor, aortic valve reconstruction was achieved with part of a cryopreserved aortic homograft cusp. Intraoperative transesophageal echocardiography showed no evidence of valvular regurgitation after excision in all cases. All patients had uneventful postoperative recoveries. No evidence of regurgitation or recurrence was seen on echocardiography at follow-up. CONCLUSIONS: Despite their histologically benign aspect, cardiac papillary fibroelastomas should be excised because of potential embolic complications. A conservative, valve-sparing approach is recommended, however, because of the absence of recurrence after total excision.

Adult↗
PubMed1999

Video-assisted replacement or bypass grafting of the descending thoracic aorta with a new sutureless vascular prosthesis: an experimental study.

PURPOSE: The feasibility of the video-assisted insertion of a new sutureless vascular prosthesis was studied. METHODS: Seven sheep, weighing 25 to 35 kg, were operated on under general anesthesia. The animals were intubated with a single-lumen endotracheal tube and placed in the right lateral decubitus position. A thoracoscope was introduced in the 11th intercostal space, and a minithoracotomy (4 to 5 cm) was performed in the seventh intercostal space. After retraction of the lung, a short segment (10 cm) of the descending thoracic aorta was exposed. Our prosthesis was made of Dacron and was specifically designed to be inserted without a suture. After systemic heparinization, the aorta was cross-clamped with two vascular clamps introduced into the thoracic cavity through two 5-mm thoracic incisions. The aorta was either replaced (five cases) or bypass grafted (two cases). At the completion of the procedure, blood pressure was pharmacologically increased (5 mg intravenous bolus of epinephrine), and each anastomosis was checked for bleeding. All animals were killed, and the prosthesis was retrieved for macroscopic examination. RESULTS: The procedure was completed in each case without extension of the minithoracotomy. Insertion of the prosthesis was easy and fast, and completion of each anastomosis required 10 to 15 minutes. A 3- to 4-mm space between each clip was sufficient for proper attachment. All procedures were performed in less than 120 minutes. No bleeding was observed at the level of each anastomosis, even when a sustained high blood pressure was induced. The proper insertion of the prosthesis and the absence of any anastomotic stenosis was confirmed by means of macroscopic examination. CONCLUSION: Video-thoracoscopic replacement or bypass grafting of the descending thoracic aorta was easy with this new sutureless vascular prosthesis. Minimally invasive vascular surgery might be facilitated with such a prosthesis. However, long-term animal studies are required before human implantation can be undertaken.

Animals↗
PubMed1999

Comparison of the acute hemodynamic effects of hypertonic or colloid infusions immediately after mitral valve repair.

OBJECTIVE: To determine the acute hemodynamic effect of hypertonic saline and/or colloid solutions as volume resuscitation in postoperative mitral valve repair patients. DESIGN: Prospective, randomized trial. SETTING: Postoperative cardiac intensive care unit of Broussais Hospital. PATIENTS: Twenty-six patients who underwent mitral valve repair were prospectively studied. Two patients were excluded during the study. INTERVENTIONS: During the immediate postoperative period, when wedge pressure decreases to <8 mm Hg, patients were randomly assigned to receive 250 mL of either hypertonic saline 7.2%-hydroxyethyl starch 6% (molecular weight, 200,000; hydroxyethylation ratio, 0.5) solution (HS-HES group), hypertonic saline 7.2% solution (HS group), or hydroxyethyl starch 6% solution (HES group). The infusion was completed within 15 mins. No additional volume was infused throughout the study. MEASUREMENTS AND MAIN RESULTS: Standard hemodynamic measurements and echocardiographic data demonstrated that HS-HES and HS induced a higher increase in left ventricular end-diastolic area than HES. In the HS-HES and HS groups, systemic vascular resistances decreased significantly and end-systolic area tended to decrease. In the HES group, systemic vascular resistances did not change and end-systolic area tended to increase. Accordingly, ejection fraction increased significantly by 21% and 18% with HS-HES (from 50.5 +/- 5.5 to 61.2 +/- 4.8) and HS (from 49.7 +/- 3.6 to 58.8 +/- 3.3), respectively, and did not change with HES. A major increase in cardiac index was observed after hypertonic solutions infusion, from 2.9 +/- 0.3 to 4.1 +/- 0.4 L/min/m2 in the HS-HES group and from 2.7 +/- 0.3 to 3.8 +/- 0.4 L/min/m2 in the HS group. Then, cardiac index progressively returned to baseline values within the 3 hrs after the infusion. No significant difference was observed between HS-HES and HS. In these groups, plasma sodium increased significantly after the infusion and remained higher than baseline values throughout the study. Adverse events were observed only with hypertonic solution administration: hypotensive episodes, sudden increases in pulmonary capillary wedge pressure, and ventricular arrhythmias. These side effects are likely attributable to a too-high dose and/or rate of infusion. All patients included in the study were discharged from the hospital before the 10th postoperative day. CONCLUSION: We conclude that in patients who have undergone mitral valve repair, postoperative infusion of hypertonic saline solutions increases left ventricular preload and left ventricular ejection fraction. The use of these hypertonic solutions may be of interest in patients with valvular cardiomyopathy. A titrated dose and a low rate of infusion may substantially improve the safety.

Cardiac Surgical Procedures↗
PubMed1999

[The pericardium: a heterogeneous tissue. Anatomic and morphometric considerations].

BACKGROUND AND AIMS OF THE STUDY: Short-term glutaraldehyde fixed autologous pericardium is widely used in cardiac valve repair or in autologous pericardial bioprosthesis construction. The thinner the tissue, the better the fixation. The aim of this study was to determine thickness and useful surface area of pericardium in relation to harvesting site using a digital thickness counter (0.01 mm precision). Parietal pericardium fragments were obtained from the pericardial sac of six fresh cadavers (group I). In the other groups, pericardial strips (80 x 30 mm) were obtained from patients undergoing surgery: group II patients (n = 5 females) and group III (n = 10 males) were non-cardiomegalic (cardiothoracic ratio (CTR) < 0.5)), while group IV patients (n = 5) were all cardiomegalic (CTR > 0.5). Results were reported on a coloric scale according to measurement position. In group I, mean surface area was 93 +/- 18 cm2, and thickness gradually increased from 0.1 to 0.6 mm, maximally on the diaphragm, along the left heart side. In other groups, a gradual increase in thickness was identified towards the diaphragmatic zone. Significant differences in tissue thickness appear as a result of cardiomegaly, but are not related to the sex of the patients. Pericardium taken from the right anterior aspect of the pericardial sac in patients without cardiomegaly is the most appropriate tissue for valve reconstructive surgery, due to its thin nature and hence better fixation properties.

Analysis of Variance↗
PubMed1999

[Ischemic cholecystitis from cholesterol crystal embolism].

Cholesterol crystal embolism is a serious complication of atherosclerosis resulting in renal, cutaneous and rarely digestive manifestations. We report two cases of systemic cholesterol crystal embolization with gallbladder involvement in two patients with gallstones, severe atherosclerosis with an abdominal aortic aneurysm as well as predisposing factors for cholesterol crystal migration. These two cases show that, like vasculitis, cholesterol crystal embolization may result in ischemic cholecystitis, and that diagnosis of cholesterol crystal embolization on routine cholecystectomy suggests severe systemic involvement and a poor prognosis.

Aged↗
PubMed1998

Comparative study of different biological glues in an experimental model of surgical bleeding in anesthetized rats: platelet-rich and -poor plasma-based glue with and without aprotinin versus commercial fibrinogen-based glue.

The use of fibrin glue in cardiovascular surgery has been associated with decreased operative time, effective control of localized bleeding, and reduced postoperative blood loss. All preparations of fibrin glue mimic the final common pathway of the coagulation cascade in which fibrinogen is converted to fibrin in the presence of thrombin and calcium. The goal of the study was to compare five different types of fibrin glue, with or without aprotinin, on a surgical bleeding model in the rat. In 70 anesthetized Wistar rats, after laparotomy, a 3 cm liver incision was performed. After randomization, seven groups were studied. In the first group, Biocol was used as a pinpoint application to the bleeding site. Four groups received a fibrin glue obtained from a single human donor plasma using Cell Saver V (Haemonetics). The sealant was applied as a two-component system. The first component of the glue was either platelet-rich-plasma (PRP) or platelet-poor-plasma (PPP). The second component consisted of a mixture of 0.5 ml CaCl 10% with 1000 U of human thrombin, with or without 400KUI of aprotinin (AP). The last two groups, control and aprotinin were treated using saline solution or topical aprotinin respectively. Hemoglobin and hematocrit were measured before surgery and 30 min after application of the glue. The decrease in hemoglobin (Hb) and hematocrit (Hct) was the primary efficacy variable. Before surgery, there was no difference regarding Hb and Hct values between groups. Thirty min after the application of the glue, the decrease in hemoglobin expressed as percent of the control values is only significantly lower in the Biocol group when compared to control. No significant difference was observed with the other groups in comparison to control. The commercial fibrin glue (Biocol) is more efficient than other preparations. This efficacy is likely due to a higher fibrinogen concentration.

Animals↗
PubMed1998

Influence of the status of the contralateral carotid artery on the outcome of carotid surgery.

From 1985 to 1995, 747 carotid arteries were operated on in 694 patients, who were under general anesthesia and continuous electroencephalogram (EEG) monitoring. These patients were divided into three groups according to contralateral carotid status. Group 1 consisted of 58 patients who had contralateral occlusion; group 2, 53 patients who had contralateral stenosis and bilateral staged surgery; and group 3, 583 patients who had nonstenotic contralateral internal carotid artery. All groups were similar with regard to age and sex ratio. There were more asymptomatic patients in group 3 than in group 1 (39.9% vs. 25.8%) (p < 0.05), and less preoperative strokes in group 2 than in the other groups (3.7% vs. 17.2% and 13. 6%, respectively) (p < 0.05). Among risk factors, smoking was less frequent in group 3 (59.5%) than in group 1 (82.7%) and group 2 (77%) (p < 0.01), and coronary artery disease was more frequent in group 2 (60%) than in group 1 (32.7%) and Group 3 (26.4%) (p < 0.01). EEG changes occurred more frequently in group 1 (25.8%) than in group 2 [5.6% (first stage) and 3.8% (second stage)] and in group 3 (4.9%) (p < 0.01). A shunt was used only when EEG changes did not disappear after pharmacologic increasing of central blood pressure, which occurred more frequently in group 1 (10.3%) than in group 2 (0%) and group 3 (0.3%) (p < 0.05). The combined morbidity/mortality rate was similar for groups 1 and 3 (1.7% and 1.5%, respectively), however, transient morbidity was more frequent in group 1 (6.9%) than in group 3 (1.5%) (p < 0.05). The combined morbidity/mortality rate was higher in group 2 than in group 3 (7.5% vs. 1.5%) (p < 0. 05), and all strokes in group 2 were seen during the second-stage operation. In conclusion, contralateral carotid artery occlusion had minimal influence over carotid surgery results. Selective use of a shunt based on EEG monitoring prevented ischemic strokes, with minimal neurologic morbidity. Contralateral carotid stenosis did not affect operative strategy for first stage, but we noted a higher incidence of strokes during the second procedure.

Aged↗
PubMed1998

Effects of cardioplegic solutions on the vasoreactivity of the internal mammary artery.

BACKGROUND: During free internal mammary artery grafting, cardioplegia administration can be performed through the internal mammary artery. The present study examined whether cardioplegic solutions produce arterial graft constriction and functional endothelial damage. METHODS: Forty internal mammary artery segments from 10 patients were incubated in Krebs solution (n=10), University of Wisconsin solution (n=10), Broussais Hospital solution (n=10), or blood cardioplegia (n=10). RESULTS: There was a significant difference in sensitivity to norepinephrine between segments in Krebs solution and those in University of Wisconsin solution or Broussais Hospital solution but not segments in blood cardioplegia. There was a significant difference in relaxation to acetylcholine between segments in Krebs solution and those in the three other cardioplegic solutions and between those in blood cardioplegia and segments in University of Wisconsin solution or Broussais Hospital solution. There was no significant difference in relaxation to sodium nitroprusside between segments in any of the solutions. CONCLUSIONS: These experiments suggest that storage in the different cardioplegic solutions studied does not preserve the initial vasoreactivity of the internal mammary artery. However, blood cardioplegia appears to be less deleterious in regard to endothelial and myogenic vascular function.

Acetylcholine↗
PubMed1998

Does glutaraldehyde induce calcification of bioprosthetic tissues?

BACKGROUND: Glutaraldehyde has been said to be responsible in part for the calcification of glutaraldehyde-treated tissues after implantation in animals or humans. We investigated whether the origin of the tissue, autologous or heterologous, could have a more prominent role in the process of calcification. METHODS: Three-month-old sheep received sheep pericardial samples (n = 133) and human pericardial samples (n = 123) implanted subcutaneously. Samples were treated with 0.6% glutaraldehyde for 5, 10, or 20 minutes or 7 days and then rinsed thoroughly before implantation. Samples were then retrieved after 3 months. Calcium content was assessed by spectrophometry. RESULTS: The results show a low calcium content in the autologous group (mean 1.14+/-2.07) and a high calcium content in the heterologous group (mean 38.97+/-26). These results were the same regardless of the duration of the treatment. CONCLUSIONS: Glutaraldehyde treatment (0.6%) does not play a significant role in the calcification of glutaraldehyde-treated tissue regardless of the origin, autologous or heterologous, of the tissue. Glutaraldehyde-treated autologous tissues are associated with an incidence of calcification lower than heterologous tissues.

Analysis of Variance↗
PubMed1998

The radial artery for coronary artery bypass grafting: clinical and angiographic results at five years.

OBJECTIVE: The aim of this study was to assess the long-term results of use of the radial artery as a conduit for coronary artery bypass grafting. METHODS: After revival of the technique in 1989, the radial artery was used as a conduit in 910 patients undergoing coronary artery bypass grafting. A complete follow-up was obtained for the first 102 consecutive patients from 4 to 7 years after the operation (mean 5.27 +/- 1.30 years). Fifty-nine percent of the patients were receiving calcium-channel inhibitors. An electrocardiographic stress test was obtained for 51 patients, with no contraindications found. Routine follow-up angiography was performed in 50 cases, including those of all patients with symptoms. Thus 64 radial artery and 48 left internal thoracic artery grafts were followed up from 4 to 7 years after the operation (mean 5.6 +/- 1.40 years). RESULTS: The actuarial survival was 91.6% at 5 years, and the actuarial rate of freedom from angina was 88.7% at 5 years. Four patients underwent percutaneous transluminal angioplasty during the period of follow-up, and there were no reoperations for revision of the bypass. The electrocardiographic stress test showed negative results in 73% of cases, electrocardiographic changes alone in 21%, and clinically positive results in 6%. Angiography showed that the patency rate of the radial artery grafts was 83%. The patency rate of the left internal thoracic artery grafts (n = 47) was 91%. The difference in patency could be related to the implantation sites of the grafts, mainly the circumflex artery (51%) for the radial artery grafts and almost exclusively the left anterior descending artery (94%) for the left internal thoracic artery. CONCLUSION: The use of the radial artery for coronary bypass grafting provides excellent clinical and angiographic results at 5 years. Routine use of the radial artery in combination with the left internal thoracic artery can be recommended.

Aged↗
PubMed1998

Autologous pericardial patch harvesting site for cardiac valve repair: anatomic and morphometric considerations.

BACKGROUND AND AIMS OF THE STUDY: Short-term glutaraldehyde-fixed autologous pericardium is widely used in cardiac valve repair or in autologous pericardial bioprosthesis construction. The thinner the tissue, the better the fixation. The aim of this study was to determine thickness and useful surface area of pericardium in relation to harvesting site using a digital thickness counter (0.01 mm precision). METHODS: Parietal pericardium fragments were obtained from the pericardial sac of six fresh cadavers (group I). In the other groups, pericardial strips (80 x 30 mm) were obtained from patients undergoing surgery: group II patients (n = 5 females) and group III (n = 10 males) were non-cardiomegalic (cardiothoracic ratio (CTR)<0.5), while group IV patients (n = 5) were all cardiomegalic (CTR >0.5). RESULTS: Results were reported on a coloric scale according to measurement position. In group I, mean surface area was 93+/-18 cm2, and thickness gradually increased from 0.1 to 0.6 mm, maximally on the diaphragm, along the left heart side. In other groups, a gradual increase in thickness was identified towards the diaphragmatic zone. Significant differences in tissue thickness appear as a result of cardiomegaly, but are not related to the sex of the patients. CONCLUSIONS: Pericardium taken from the right anterior aspect of the pericardial sac in patients without cardiomegaly is the most appropriate tissue for valve reconstructive surgery, due to its thin nature and hence better fixation properties.

Cadaver↗
PubMed1998

Mechanical modifications to human pericardium after a brief immersion in 0.625% glutaraldehyde.

BACKGROUND AND AIMS OF THE STUDY: The use of human pericardium pretreated for 10 min with 0.625% glutaraldehyde (GLUT) in valvular repair or intracardiac reconstruction has produced good results. However, to date, no investigations have been made to determine the mechanical changes that occur in the tissue following such pretreatment. METHODS: Human pericardial samples were harvested from 25 patients and immersed in GLUT for increasing times (5, 10, 30, 60 min and 6 months). Either untreated human pericardium or bovine pericardium treated for six months with GLUT served as controls. Tensile tests were performed with a uniaxial load machine and a pulsative bench. Fatigue testing was for 14 days; each sample was tested at 1,200 cycles/min at a controlled pressure of 90-120 mmHg. RESULTS: Untreated tissue thickness was 0.44+/-0.16 mm, but after six months GLUT treatment it was 0.53+/-0.15 mm (p<0.001). There was a 13.7% shrinkage of tissue after six months immersion. Strain was significantly greater in treated tissue than in untreated tissue, while stiffness decreased with the duration of GLUT immersion. Young's modulus was significantly lower after six months GLUT treatment (0.26+/-0.06 MPa) compared with untreated, and 5-, 10- and 30-min GLUT treatment (0.32+/-0.15, 0.35+/-0.09, 0.32+/-0.09 and 0.36+/-0.10 MPa (p<0.05)), respectively. Creep was greater after six months GLUT treatment (0.5+/-0.03%) than in untreated and 10-, 30- and 60-min treatments (0.3+/-0.50, 0.27+/-0.01, 0.27+/-0.02, 0.3+/-0.01% (p<0.05)), respectively. Ultimate tensile stress (UTS) was greater in 10-min treated pericardium than in untreated tissue: 38.46+/-11.75 versus 22.17+/-8.30 MPa (p<0.05) respectively. Strain at rupture was greater in the 6-month group (30.62+/-2.54%) than for untreated and 10-, 30- and 60-min GLUT immersion 16.3+/-0.73, 21.85+/-0.75, 20.12+/-1.04 and 18.87+/-0.86% (p<0.05), respectively. Fatigue testing showed an increased length after five and 10 min, and six months, with a lengthening of 14.66, 12.53, 7.66%, respectively compared with 3.5% for untreated tissue (p<0.05). There were three failures in the untreated group (n = 5), none in the 5- and 10-min groups, and one in the 6-month group (p<0.05). CONCLUSION: Brief immersion of human pericardial tissue in 0.625% glutaraldehyde reduces the tissue's stiffness and improves its durability for use in cardiac surgery.

Biomechanical Phenomena↗
PubMed1998

The activity of c-myb antisense oligonucleotide to prevent intimal hyperplasia is nonspecific.

BACKGROUND: We sought to determine the efficacy and specificity of a new c-myb antisense by inhibiting neointimal hyperplasia in a rat abdominal aorta injury model. Using c-myb antisense oligonucleotides, inhibition of vascular smooth muscle cell proliferation has been reported. METHODS: Sixty-six male Wistar rats had a de-endothelialization of the abdominal aorta. Following a double blind randomization protocol, F127 pluronic gel containing one of the five oligonucleotides or plain gel was applied around the aorta: 1) 18-mer c-myb antisense (AS18) with four contiguous guanosines (G-quartet); 2) 15-mer c-myb antisense (AS15) without G-quartet; 3) 1-bp mismatch AS15 without G-quartet (MM1); 4) an oligonucleotide with G-quartet (4G), whereas the other bases were chosen at random; 5) 1-bp mismatch 4G without G-quartet (MM2). After 21 days all rats were sacrificed and aortas harvested for histomorphometric evaluation. Four rats were given fluorescent-labeled oligonucleotides to study in vivo localization after local advential delivery. RESULTS: Morphometric analysis showed significant suppression of neointimal hyperplasia in AS18 and 4G and MM2 groups compared with GEL, AS15 and MM1 groups (p<0.05). The oligonucleotide-labeled aortas showed penetration of the oligonucleotides into the media which increased with time. CONCLUSIONS: Our findings pointed to the potential non specificity of the c-myb antisense oligonucleotide in vivo. Such results will minimize the importance of antisense strategy as a potential therapeutic for preventing neointimal hyperplasia. The two oligonucleotides with a G-quartet inhibited neointimal hyperplasia in our model. Exploring a non-antisense mechanism, G-quartet oligonucleotides as potential drugs to reduce neointimal hyperplasia is attractive.

Animals↗
PubMed1998

Aortic valve surgery in osteogenesis imperfecta: report of two cases and review of the literature.

Aortic insufficiency is a well known but uncommon valvular dysfunction in patients with osteogenesis imperfecta. In such cases, aortic valve surgery has rarely been performed, and carries a high risk of perioperative complications. We report two patients with osteogenesis imperfecta, who underwent elective successful aortic valve replacement. The surgical problems encountered in this connective tissue disorder are also reviewed.

Adolescent↗
PubMed1998

[Coronary reoperation: indications, methods and immediate postoperative prognosis. Retrospective study of 184 reoperations].

The authors performed 184 coronary reoperations (172 redux, 12 tridux) between January 1986 and december 1995 in 177 patients (165 men, 12 women) with an average age at surgery of 62.9 +/- 7.6 years. The average interval between the surgical procedures was 9.5 +/- 4.5 years. The symptoms were recurrent angina, stable in 44%, unstable in 51%, and cardiac failure, 7%. Graft dysfunction was the cause in 94.5% of cases with progression of atheroma of the native coronary vessels in only 5.6% of cases. At reoperation 389 bypass procedures were performed (venous 39.5%, arterial 60.5%) (2.1 +/- 0.6 per patient) with 10 associated procedures (3 mitral valvuloplasties, 2 left ventricular aneurysmectomy, 3 aortic valve replacements, 1 replacement of the ascending aorta, 1 carotid endarteriectomy). The operative mortality was 10.9%. The causes of the 20 deaths were myocardial infarction (7), left ventricular failure (8), arrhythmias (2), mediastinitis (1) and multi-organ failure (2). The risk factors for death were: the date of surgery (19% before 1991 and 8% after: p = 0.03), age (18% after 60 years, 2% before: p = 0.015), the interval between the surgical procedures (33% after 15 years, p = 0.02), anterograde cardioplegic injection alone (15% versus 4.5% when mixed antero and retrograde perfusion was used: p = 0.02). The morbidity was 28% (52/184 patients); 132 patients (72%) had uncomplicated postoperative courses. The incidence of repeat coronary artery surgery is in constant progression. Improved medico-surgical management should continue to reduce the mortality which is still high.

Aged↗