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Biomedical subjects

R De Geest

Publications and source records attributed to R De Geest.

35 records · Page 2Linked to original sources
PubMed1989

Surgical correction of descending thoracic aortic aneurysms under simple aortic cross-clamping.

Between June 1983 and December 1987, 52 patients underwent resection of a descending thoracic aortic aneurysm under simple aortic cross-clamping without the use of shunting or bypass techniques. The 30-day mortality rate was 11.5%; 4.8% for elective cases and 36.5% for patients operated on in emergency. Two patients (4%) had spinal cord injury. One patient had paraplegia, and the other had mild paraparesis but completely recovered. Both patients were operated on for ruptured aneurysms. Four patients (7.5%) had severe postoperative renal dysfunction that was strongly related to intraoperative hypotension. The cumulative proportional survival rate was 81% at 1 year and 66% at 2 years for the total group. 85% at 1 year and 72% at 2 years for the patients first seen with nonruptured aneurysms. Aneurysms of the descending thoracic aorta can be safely resected without the use of shunting or bypass techniques. Surgery definitely improves the outcome for these patients who have a poor prognosis if left untreated.

Adult↗
PubMed1988

Thoraco-abdominal aortic approach for the treatment of pararenal aneurysm.

The results of a thoraco-abdominal retroperitoneal approach for the treatment of pararenal aneurysms are discussed. Fifteen patients with juxtarenal (7 pts) and suprarenal (8 pts) aneurysms were operated on by a left side thoracolaparotomy with retrocolic dissection. In 12 patients suprarenal aortic cross clamping was necessary for 10 to 60 minutes. Seven tube and eight bifurcation grafts were implanted using the inlay technique. There were no postoperative deaths; only one patient had a severe complication with total renal failure for which hemodialysis was started. In our experience the thoraco-abdominal aortic approach is a safe method for the treatment of patients with pararenal aneurysm.

Aged↗
PubMed1986

Results of prosthetic grafts in femoro-crural bypass operations as compared to autogenous saphenous vein grafts.

Since 1971 175 femoro-crural bypasses were performed. Rest pain and gangrene were present in 90% of the cases; 28% had undergone previous surgery for ischemia of the same limb. The autogenous saphenous vein was the first choice and could be used in 81% of cases. Prosthetic material consisted consecutively of the regular PTFE (N = 12), the Dardik biograft (N = 13) and the thin-walled reinforced PTFE (N = 7). One dacron prosthesis was used. The two-year patency (Life-table) for the prostheses was 18%. Results of the composite grafts were as poor as those of complete prosthetic grafts. Saphenous vein grafts had a two-year patency of 70% and a five-year patency of 59%. Veno-venous anastomoses had no adverse influence on patency. Exploration of both legs for acceptable parts of the saphenous vein is indicated before the use of prosthetic material is justified.

Bioprosthesis↗
PubMed1984

Surgical treatment of infected pseudoaneurysms after replacement of the ascending aorta.

The best management of infected pseudoaneurysms after prosthetic graft replacement of the ascending aorta has not yet been established. The successful surgical treatment of three patients with this complication following replacement of the aortic valve and ascending aorta is reported. Because of the poor preoperative clinical condition of these patients, an effort was made to carry out the operative repair as expeditiously as possible. The prosthetic material was never entirely removed and replaced, but less radical operations were performed in combination with extensive and accurate debridement of the mediastinum and local antiseptic irrigation.

Aorta↗
PubMed1980

Extensive myocardial revascularization--influence of cardioplegia on operative results.

Experience with extensive myocardial revascularization (5 or more distal anastomoses) during a one-year period is reviewed. Intermittent hypothermic aortic occlusion was used in 68 patients (non-cardioplegia group), and cold cardioplegia in 70 patients. The 2 groups were similar in regard to age, sex, extension of coronary artery disease, number of previous myocardial infarctions, preoperative diagnosis of impending myocardial infarction and preoperative left ventricular function. Five patients in the non-cardioplegia group died early postoperatively, while no cardiac death occurred in the cardioplegia group (p = 0.02). The incidence of perioperative infarction and postoperative catecholamine requirement was lower in the cardioplegia group (p-values 0.04 and < 0.01 respectively). The major determinant of the postoperative catecholamine requirement in the non-cardioplegia group was the total aortic cross-clamp time, while in the cardioplegia group it was the preoperative left ventricular end-diastolic pressure. A policy of "complete revascularization" in diffuse coronary artery disease seems to be justified only if cold cardioplegia is used for myocardial preservation.

Cardiopulmonary Bypass↗
PubMedDate not supplied

Surgical treatment of recurrence of an aneurysm of aberrant right subclavian artery.

A 52-year-old woman underwent incomplete resection of an aneurysm of the aberrant right subclavian artery. Three years later she was hospitalized because of a right superior mediastinal mass on the chest X-ray and a new angiography revealed dilatation of the remaining part of the aberrant right subclavian artery near its origin and involving the adjacent thoracic aorta and the distal aortic arch. At surgery, a left posterolateral thoracotomy in the fourth intercostal space was performed. Using deep hypothermia and circulatory arrest the aneurysm was excised and the aortic tract adjacent to the aneurysm was replaced with a Dacron prosthesis.

Aneurysm↗
PubMedDate not supplied

Minimally invasive video-assisted mitral valve surgery: from Port-Access towards a totally endoscopic procedure.

UNLABELLED: Right thoracotomy is an alternative to mid-sternotomy for left atrium access. The Port-Access approach is an option that reduces the skin incision and obviates rib spreading. PATIENTS AND METHODS: From February 1997 until November 1999, 121 patients underwent mitral valve surgery through a right antero-lateral thoracotomy using the Heartport cardiopulmonary bypass (CPB) system. Mean age was 60 years (31-84). Most patients had normal ejection fractions and were in NYHA Class II or III. Seventy-five patients had valve repair (62%) and 46 (38%) had valve replacement. Pathologies were myxoid (n = 80), rheumatic (n = 30), chronic endocarditis (n = 5), annular dilatation (n = 3), sclerotic (n = 1), ingrowing myxoma (n = 1), and one closure of a paravalvular leak. RESULTS: Two patients had conversion to sternotomy for aortic dissection (one died) with the Endo-Aortic Clamp, and two others for peripheral vascular problems. One patient died at postoperative day 1 after reoperation for failed repair, another with double valve surgery on postoperative day 4 after two revisions for bleeding. Twelve underwent revision for bleeding (10%). Three had prolonged ICU stay for respiratory insufficiency. Two late valve replacements for endocarditis occurred. Echographic control revealed residual insufficiencies (grade 1-2) in two valvular repairs. There were neither paravalvular leaks nor myocardial infarcts. There were no cerebrovascular accidents due to embolic phenomena. Mean ICU and hospital stay were 2.1 and 8.7 days, with a major difference between the first 30 patients and those who followed. CONCLUSION: Port-Access mitral valve surgery can be a valid alternative to conventional sternotomy and seems to be an important improvement in minimally invasive cardiac surgery.

Adult↗
PubMedDate not supplied

Heart transplantation.

From September 1988 until March 1990, 22 orthotopic heart transplantations (HTX) were performed in 20 patients (18 male and 2 female). Median age was 56.5 years (23-66). The indication for HTX was an end-stage ischemic disease in 7 pts. a dilated cardiomyopathy in 13 pts, and a retransplantation in 2 pts. The mean waiting time was 58 days. Immunosuppressive therapy included OKT3, prednisone and azathioprine. Cyclosporine was introduced at day 10. Donor hearts were obtained from our institution in 5 cases, from other hospitals in Belgium in 9 cases, and from other European countries in 8 cases. The mean ischemic time was 129 +/- 28 min. No patient died in the operating room. During the first postoperative month, weekly endomyocardial biopsies were performed to detect early rejection. Five patients died in the early postoperative period, mainly from rejection. After a mean hospital stay of 23 days, 15 patients (75%) were discharged. During the late follow-up, 3 patients died: 1 from chronic mediasdinitis, 1 from hypoglycemia, and 1 from cardiac arrest following non-compliance with the medical treatment. In conclusion, early acute rejection after HTX still remains a major cause of death.

Adult↗
PubMedDate not supplied

Surgical treatment of left ventricular aneurysm and ischemic mitral incompetence.

Chronic left ventricular aneurysm and ischemic mitral valve incompetence have been treated during the last 2 years with more physiologic techniques. Left ventricular reconstruction with the endoaneurysmorrhaphy technique was carried out in 20 patients. Sixteen patients had additional procedures. Early mortality was 5% and functional results are encouraging with 18 patients in NYHA class I of II. Mitral valve repair was carried out in combination with myocardial revascularization in 15 patients. All patients had a Carpentier Edwards annuloplasty ring implanted. Nine patients needed additional reconstructive procedures. There were no early or late deaths neither reoperations. Late functional results are good with all patients in NYHA, class I or II. Three patients present a mild mitral regurgitation on echo. This physiologic approach to restore volume, size and shape of the left ventricle and the mitral valve can be combined with CABG without additional operative risk and excellent results up to 2 years.

Adult↗
PubMedDate not supplied

The right gastroepiploic artery: an alternative conduit for myocardial revascularization.

The initial experience in 18 patients undergoing coronary artery bypass surgery with the right gastroepiploic artery (RGEA) between April 1988 and August 1989 is reported. The indication for RGEA-use included the aim to obtain complete arterial revascularization in 15 patients and absence of suitable veins in 3 patients. Twelve patients had at least one previous CABG-operation. The average number of distal arterial anastomoses per patient was 2.5. The RGEA was connected to the right coronary artery (RCA) or its terminal branches in 13 patients, to the circumflex (CX) in 2 and sequentially to RCA and CX in 3 patients. In combination to the RGEA, 8 patients received bilateral internal mammary grafts and 6 patients received a single IMA-graft. There was one hospital death and there were no major early or late complications related to the RGEA-use. Postoperative angiographic controls in 16 patients revealed only one early RGEA-graft occlusion due to inadequate diameter and low run-off. There was one demonstrated late occlusion. These early results suggest that the RGEA can be used as an in situ graft to the posterior coronary vessels. Indications can be extended in function of the longterm patency and functional results.

Adult↗
PubMedDate not supplied

[One stage operation of bilateral carotid lesions (author's transl)].

Bilateral one stage carotid endarteriectomy was performed in 11 patients presenting with bilateral symptomatics stenoses without neurological nor cardiac major complications. We only found one such experience in the literature (1). The choice of a simultaneous procedure is based solely on electroencephalogram analysis and on the residual pressure after the test of carotid occlusion; the side where occlusion is tolerated and/or where the residual pressure is highest, is operated first. This simultaneous bilateral procedure carries the theoretical risk of ischemia. It has the advantage of decreasing the cardiac complications and the risk of neurological deficit and at the same token avoids intercurrent controlateral thrombosis and recurrent symptoms between two non-simultaneous procedures. In cases of symptomatic lesions, the indication of surgery is evident; for asymptomatic lesions we only consider a simultaneous procedure in special cases where there exists a threat of neurological complications.

Aged↗
PubMedDate not supplied

Surgical treatment of patients with a carotid artery occlusion and a contralateral stenosis.

Patients with a carotid artery occlusion and a haemodynamically significant contralateral stenosis have an increased risk of incurring a stroke. Based on the results of a series of 33 patients our conclusion is that the surgical therapy of choice should be endarterectomy of the stenotic artery irrespective of which side the symptoms are located on. Only those patients who continue to have TIA's on the side of the occlusion after endarterectomy of the stenotic side should be considered for an ECIC bypass.

Carotid Artery Diseases↗
PubMedDate not supplied

A comparison of conventional and digital intravenous arteriography in the follow-up of femoro-crural bypass operations.

The value of intravenous arteriography, otherwise known as digital vascular imaging (DVI) in the late postoperative control of femoro-crural bypass operations is determined by comparing its results with those of conventional arteriography. Ten patients with 12 grafts were studied by both methods after a mean postoperative follow-up period of 83.5 months. DVI was 100% accurate in the determination of graft patency. In most patients it provided reliable information regarding the status of the distal anastomosis and the patency of the distal runoff. Since DVI has been proven accurate, has a good patient acceptance, and can be performed as an outpatient procedure, it is preferable to conventional arteriography for the objective documentation of long-term graft patency.

Aged↗
PubMedDate not supplied

Abdominal aortic aneurysm, an absolute surgical indication?

In a retrospective study, 155 patients operated for infrarenal abdominal aortic aneurysm during a 5.5-year period (jan. 1986-->oct. 1991) were reviewed. In our series, 111 patients underwent elective (EL) surgery, 44 patients had an emergency (EM) operation. Male/female ratio was 10/1. Mean age in the EL group and EM was 68.1 years and 71.82 years respectively (p < 0.05). In the EL group, 68 (= 61%) patients were asymptomatic. All patients in the EM group had symptoms: shock + syncope in 28 patients, acute back pain in 4 patients, acute abdominal pain in 12 patients. Aneurysm diameter > or = 8 cm was present in 33% of the EL group, but in 57% of the EM group. Early mortality for the EL and EM group was 3.6% and 23% respectively (p < 0.001). Major postoperative complications were present in 13% in the EL group, in 55% in the EM group (p < 0.001). During a 5-year follow-up of 135 patients (= 96%), 22 patients died. Cardiac problems (7/22) and cancer (5/22) were most prominent. 5-year survival for the entire group was 83%; EL (85%) and EM (76%) were not significant. None of the patients subsequently underwent an operation related to the abdominal aortic intervention.

Acute Disease↗
PubMedDate not supplied

Pulmonary actinomycosis. Case report.

Pulmonary actinomycosis. Case report. Pulmonary actinomycosis is a rare infectious disease. The major difficulty is mainly the diagnosis. A high dose of suspicion is required in each intrathoracic process showing malignant behaviour, despite benign histology. Especially if the process extends through normal tissue planes, actinomycosis should be suspected. The therapy of choice should consist in high dose of antibiotics for several months, occasionally followed by surgery. Often though, surgery is the first treatment because of the unability to differentiate the lesion from malignant tumor. Surgery should always be followed by long term antibiotic therapy.

Actinomycosis↗