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Biomedical subjects

Patrick Nataf

Publications and source records attributed to Patrick Nataf.

8 recordsLinked to original sources
PubMed2005

Thermo-wrap technology preserves normothermia better than routine thermal care in patients undergoing off-pump coronary artery bypass and is associated with lower immune response and lesser myocardial damage.

OBJECTIVE: Perioperative hypothermia might be detrimental to the patient undergoing off-pump coronary artery bypass surgery. We assessed the efficacy of the Allon thermoregulation system (MTRE Advanced Technologies Ltd, Or-Akiva, Israel) compared with that of routine thermal care in maintaining normothermia during and after off-pump coronary artery bypass surgery. METHODS: Patients undergoing off-pump coronary artery bypass surgery were perioperatively and randomly warmed with the 2 techniques (n = 45 per group). Core temperature, hemodynamics, and troponin I, interleukin 6, interleukin 8, and interleukin 10 blood levels were assessed. RESULTS: The mean temperature of the patients in the Allon thermoregulation system group (AT group) was significantly ( P < .005) higher than that of the patients receiving routine thermal care (the RTC group); less than 40% of the latter reached 36 degrees C compared with 100% of the former. The cardiac index was higher and the systemic vascular resistance was lower ( P < .05) by 16% and 25%, respectively, in the individuals in the AT group compared with in the individuals in the RTC group during the 4 postoperative hours. End-of-surgery interleukin 6 levels and 24-hour postoperative troponin I levels were significantly ( P < .01) lower in the patients in the AT group than in the RTC group. The RTC group's troponin levels closely correlated with their interleukin 6 levels at the end of the operation ( R = 0.51, P = .002). CONCLUSIONS: Unlike routine thermal care, the Allon thermoregulation system maintains core normothermia in more than 80% of patients undergoing off-pump coronary artery bypass surgery. Normothermia is associated with better cardiac and vascular conditions, a lower cardiac injury rate, and a lower inflammatory response. The close correlation between the increased interleukin 6 and troponin I levels in the routine thermal care group indicates a potential deleterious effect of lowered temperature on the patient's outcome.

Aged↗
PubMed2005

Outcome after valve replacement for severe aortic stenosis associated with reduced left ventricular ejection fraction.

BACKGROUND AND AIM OF THE STUDY: Because valve replacement for aortic stenosis (AS) remains a difficult surgical challenge in the presence of left ventricular dysfunction, the immediate and long-term outcomes, and evolution of left ventricular ejection fraction (LVEF) in this setting, were analyzed. METHODS: Forty-three consecutive patients with severe AS (valve area < or =1 cm2) and reduced LVEF (< or =40%) who underwent valve replacement surgery at the authors' institution between April 1998 and December 2003 and were studied retrospectively. RESULTS: Preoperative characteristics included: LVEF 33 +/- 6%, mean transaortic pressure gradient 46 +/- 13 mmHg, and aortic valve area 0.58 +/- 0.15 cm2. Concomitant coronary artery bypass grafting was performed in 15 patients (35%). Perioperative (30-day) mortality was 2.3%, with 39.5% morbidity. During a mean follow up of 33.4 +/- 17.6 months, eight patients died. The Kaplan-Meier estimate of five-year survival was 75.3%. Postoperatively, none of the survivors remained in NYHA functional classes III-IV. The postoperative LVEF assessed in 81.8% of survivors had improved. Multivariate analysis associated improved LVEF with a higher preoperative mean transaortic pressure gradient (p = 0.0009) and a higher preoperative LVEF (p = 0.02). CONCLUSION: Patients with severe AS and reduced LVEF can undergo valve replacement with low perioperative mortality and moderate postoperative morbidity. Good long-term survival with good NYHA functional status and improved LVEF can be obtained.

Aged↗
PubMed2004

New trends in non-invasive coronary angiography with multislice CT.

Recent trends in computed tomography (CT) scanner technology has opened new frontiers in the field of non-invasive coronary angiography. Given the relatively important number of negative invasive angiographies performed each year, eliminating the risks inherent to this procedure by non-invasive methods greatly contribute to diminishing the risk. After injection of contrast, the procedure is performed under short apnea and triggered by electrocardiographic (ECG) recording that provides a multitude of possible image reconstructions; ie, volume rendering, virtual angioscopy, and three-dimensional (3D) reconstruction of the heart and coronary vessels. In 100 patients, adequate visualisation of the coronary arteries was achieved in 98%, with the advantage of visualizing the coronary wall as well as the lumen. The main reasons for failure were arrhythmia and excessive motion. Besides evaluating coronary artery atherosclerosis, computed tomography angiography (CTA) allowed the diagnosis of coronary aneurysm and exact localization of postoperative false aneurysm. The main disadvantages of the technique are the absence of dynamic films and exposure to radiation. The increased accuracy and sensitivity of noninvasive coronary angiography make it an excellent diagnostic tool and a probable replacement to invasive procedures. It should reduce the morbidity and mortality as well as the cost of conventional coronary arteriography. Furthermore, it has the added benefit of offering spacial resolution of the examined vessels.

Coronary Angiography↗
PubMed2003

Efficacy of esmolol as a myocardial protective agent during continuous retrograde blood cardioplegia.

OBJECTIVE: Esmolol, an ultra-short-acting beta-blocker, is known to attenuate myocardial ischemia-reperfusion injury. The aim of this study was to compare the effects of esmolol and potassium on myocardial metabolism during continuous normothermic retrograde blood cardioplegia. METHODS: Forty-one patients operated on for isolated aortic valve stenosis were randomly assigned to continuous coronary infusion with either potassium or esmolol during cardiopulmonary bypass. Myocardial metabolism was assessed by measuring the transmyocardial gradient of oxygen content indexed to left ventricular mass of glucose, lactate, and nitric oxide. To do so, blood samples were simultaneously withdrawn upstream (in the cardioplegia line) and downstream of the myocardium (in the left coronary ostium) 10 and 30 minutes after aortic crossclamping. RESULTS: Although the cardioplegia flow rate and pressure were similar, esmolol markedly reduced the transmyocardial gradient of oxygen content indexed to left ventricular mass compared with potassium: 13 +/- 6 vs 20 +/- 6 mL of oxygen per liter of blood per 100 g of myocardium, respectively, at 10 minutes and 16 +/- 8 vs 24 +/- 8 mL of oxygen per liter of blood per 100 g of myocardium, respectively, at 30 minutes (P =.009). Coronary glucose and lactate transmyocardial gradients were similar in both groups, indicating adequate myocardial perfusion in all patients at all times. In addition, during retrograde cardioplegia, esmolol showed a lower nitric oxide release compared with that caused by potassium (39 +/- 49 micro mol x L(-1) for potassium vs 14 +/- 8 micro mol x L(-1) for esmolol at 10 minutes and 39 +/- 47 micro mol x L(-1) for potassium vs 6 +/- 8 micro mol x L(-1) for esmolol at 30 minutes, P =.05). However, hemodynamic parameters and plasma troponin I levels remained unchanged postoperatively between the 2 types of cardioplegia. CONCLUSION: Esmolol provides potent myocardial protection in hypertrophied hearts, at least in part, by reducing myocardial oxygen metabolism.

Adrenergic beta-Antagonists↗
PubMed2003

Frequency, risk factors, and outcome of hyperlactatemia after cardiac surgery.

STUDY OBJECTIVE: To determine the respective frequencies, risk factors, and outcomes of no hyperlactatemia (NHL), immediate hyperlactatemia (IHL), or late hyperlactatemia (LHL) > 3 mmol/L after cardiac surgery. DESIGN: Prospective and observational study. SETTING: Cardiac surgery ICU in a 130-bed private community nonteaching hospital. PATIENTS: Consecutive patients (n = 325) undergoing cardiopulmonary bypass (CPB) for cardiac surgery. INTERVENTION: None. MEASUREMENTS: Arterial blood gas levels and lactate concentrations were measured at ICU admission, 4 h after surgery, between 6 h and 16 h after surgery, and on day 1. MAIN RESULTS: Sixty-seven patients (20.6%) had an IHL on ICU admission, and 56 patients (17.2%) acquired LHL during their ICU stay. ICU mortality was 1.5% for NHL, 3.6% for LHL, and 14.9% for IHL groups (p < 0.0001). The three groups differed significantly for elective surgery, type of operation, CPB duration, intraoperative mean arterial pressure, and intraoperative and postoperative use of vasopressor. Independent risk factors for IHL were nonelective surgery, CPB duration, and intraoperative use of vasopressor. Logistic regression identified hyperglycemia and epinephrine therapy for LHL as postoperative risk factors. Receiver operating characteristic curves showed that IHL more accurately predicted ICU mortality than LHL. CONCLUSIONS: Hyperlactatemia is common after cardiac surgery. A lactate threshold of 3 mmol/L at ICU admission is able to identify a population at risk of morbidity and mortality after cardiac surgery.

Aged↗
PubMed2003

Segmentation of the left internal thoracic artery: a new technique for maximal arterial grafting.

The left internal thoracic artery lpa r;LITA) is the preferred graft with the best patency rate in coronary artery bypass grafting (CABG). To maximize its use, we developed a technique of grafting 2 distant coronary arteries with the LITA, using its distal portion segmented to construct a Y graft with either the in situ LITA or right internal thoracic artery (RITA). We applied this technique in 51 patients. The distal segment of the LITA was used to create a Y graft in 4 different configurations according to coronary pathology. Offpump grafting was performed in 11% of cases. The use of a distal segment of the LITA was thus extended not only to the left anterior descending artery and branches but also to the circumflex and right coronary artery territories.

Adult↗