Frontiers in Cardiovascular Medicine, May 25, 2022
Objective: The standard treatment for complicated Stanford type B aortic dissection (TBAD) is tho... more Objective: The standard treatment for complicated Stanford type B aortic dissection (TBAD) is thoracic endovascular aortic repair (TEVAR). Functional parameters, specifically blood flow, are not measured in the clinical assessment of TEVAR, yet they are of outmost importance in patient outcome. Consequently, we investigated the impact of TEVAR on the flows in the aorta and its branches in TBAD using 4D Phase-Contrast Magnetic Resonance Imaging (4D Flow MRI). Methods: Seven patients with TBAD scheduled for TEVAR underwent pre and post-operative 4D Flow MRI. An experienced reader assessed the presence of helical flow in the false lumen (FL) using streamlines and measured net flow at specific locations. In addition, forward and reverse flows, stasis, helicity, and absolute helicity were computed automatically along the aorta centerline. Average values were then computed in the segmented vessels. Impact of TEVAR on these parameters was assessed with a Wilcoxon signed rank test. Impact of the metallic stent on the velocity quantification was assessed using intra-class correlation coefficient (ICC) between velocities measured intra-stent and in adjacent stent-free regions. Results: FL helical flow was observed proximally in 6 cases and distally in 2 cases pre-operatively. Helical flow disappeared post-TEVAR proximally, but developed distally for 2 patients. Intra-stent measures were similar to stent-free with a median difference of 0.1 L/min and an ICC equal to 0.967 (p < 0.01). Forward flow increased from 59.9 to 81.6% in the TL and significantly decreased in the FL from 15.9 to 3.3%. Similarly, reverse flow increased in the TL from 4.36 to 10.8% and decreased in the FL from 10.3 to 4.6%. No significant changes were observed in net flow for aortic branches (p > 0.05). A significant increase in FL stasis was observed (p = 0.04). Discussion: TEVAR significantly increased forward flow in the TL and significantly decreased both forward and reverse flows in the FL. Interestingly, reverse flow in the TL increased post-TEVAR, which could be due to increased rigidity of the wall, due to the metallic stent. User independent helicity quantification enabled detection of elevated helicity at the level of secondary entry tears which had been missed by streamline visualization.
We present the case of a 63-year-old woman who was hospitalized five times in 4 months for episod... more We present the case of a 63-year-old woman who was hospitalized five times in 4 months for episodes of heart failure, associated with a sustained hypertension despite a fivefold therapy. The pathophysiological mechanism of the hypertension was a secondary hyperaldosteronism linked to a renal hypoperfusion due to the narrowing of the thoracic aorta by a huge calcified plaque, mimicking an aortic coarctation.
Background Acute type A aortic dissection is associated with high perioperative morbidity and mor... more Background Acute type A aortic dissection is associated with high perioperative morbidity and mortality. Ascyrus Medical Dissection Stent (Cryolife, Kennesaw, USA) is a novel uncovered hybrid stent graft developed to be used as an adjunct to standard surgical approach to promote true lumen expansion and enhance aortic remodeling. Methods From March 2021 to March 2022, four consecutive patients presented with acute Debakey type I aortic dissection and underwent emergent surgical repair with Tirone David procedure and implantation of Ascyrus Medical Dissection Stent. We reviewed patient's files retrospectively and described the perioperative outcomes. Results All four device implantations were successful. Overall 30-day mortality was 0%. Malperfusion that was present in two patients pre-operatively improved after Ascyrus Medical Dissection Stent implantation. No aortic reinterventions were needed. No aortic injury related to the device was noted. Favourable changes in aortic true lumen and false lumen dimensions were found in most of our patients but the stent was compressed at the isthmus in one patient. Conclusion Ascyrus Medical Dissection Stent is a reliable and secure device. However, its benefits remain unclear when it comes to a positive remodeling and seems less likelihood comparable to a frozen elephant trunk. The main reason seems to be an insufficient radial force of the stent.
Background Acute type A aortic dissection is associated with high perioperative amorbidity and mo... more Background Acute type A aortic dissection is associated with high perioperative amorbidity and mortality. Ascyrus Medical Dissection Stent is a novel uncovered hybrid stent graft developed to be used as an adjunct to standard surgical approach to promote true lumen expansion and enhance aortic remodeling. Methods From March 2021 to March 2022, four consecutive patients presented with acute Debakey type I aortic dissection and underwent emergent surgical repair with David procedure and implantation of AMDS. We reviewed patient’s files retrospectively and described the perioperative outcomes. Results All four device implantations were successful. Overall 30-day mortality was 0%. Malperfusion that was present in two patients pre-operatively improved after AMDS implantation. No aortic reinterventions were needed. No aortic injury related to the device was noted. Favourable changes in aortic true lumen and false lumen dimensions were found in most of our patients but the AMDS was compres...
Background: Acute type A aortic dissection is associated with a significant perioperative morbidi... more Background: Acute type A aortic dissection is associated with a significant perioperative morbidity and mortality. Ascyrus Medical Dissection Stent (AMDS) is a novel bare stent graft developed to be used as an adjunct to standard surgical approach to promote true lumen expansion and therefor enhance aortic remodeling. Patients and Methods: From March 2021 to March 2022, four consecutive patients who presented with acute Debakey type I aortic dissection underwent emergent surgical repair with an inclusion (David) procedure and implantation of an AMDS. We analysed patient’s files prospectively and described the perioperative outcomes. Results: All four device implantations were successful. Overall 30-day mortality was 0 %. Malperfusion that was present in two patients pre-operatively improved after AMDS implantation. At follow up, no aortic reinterventions were needed. No aortic injury related to the device was noted. Favourable changes in aortic true lumen and false lumen dimensions ...
BackgroundAbout a decade past the first transcatheter aortic valve implantation (TAVI), data are ... more BackgroundAbout a decade past the first transcatheter aortic valve implantation (TAVI), data are limited regarding temporal trends accompanying its evolution from novel technology to mainstream therapy. We evaluated these trends in a large multicenter TAVI registry.Hypothesis TAVI is changing and improving with time.MethodsPatients who underwent TAVI between January 2008 and December 2014 at 3 high‐volume Israeli centers were divided into 5 time quintiles according to procedure date. Outcomes were analyzed and reported according to Valve Academic Research Consortium‐2.ResultsA total of 1285 patients were studied (43% male; mean age, 83 ± 3 years; mean Society of Thoracic Surgeons [STS] score, 5.5 ± 3.6). Over time, there was a shift toward treating patients at lower STS score, increased use of conscious sedation and transfemoral approach, and decreased use of balloon predilatation. The balloon‐expandable to self‐expandable valve utilization ratio decreased, the valve‐in‐valve experi...
Archives des maladies du coeur et des vaisseaux, 2005
The surgical treatment of coronary lesions is based on bypassing the anatomical lesions with auto... more The surgical treatment of coronary lesions is based on bypassing the anatomical lesions with autologous vascular grafts. This procedure has traditionally been "invasive", requiring a micro-surgery technique, institution of extra-corporeal circulation, as well as temporary cardiac arrest with a cardioplegic solution. Recently, an automatic distal anastomosis procedure has been developed (Ventrica, Medtronic Inc.), based on a magnetic coupling with two implanted intravascular magnets, allowing easy connection between the graft and the coronary artery. The immediately obvious advantages are the time saved, ease of use, reproducibility and reliability. The learning curve is fast. Furthermore, the use of this automatic process does not compromise a manual anastomosis in case of implantation failure. The immediate post-operative results, as well as angiography immediately and at 6 months are all satisfactory. This technique is applicable for multiple revascularisations, all type...
Ventricular septal rupture (VSR) is a serious complication of ST-elevation myocardial infarction ... more Ventricular septal rupture (VSR) is a serious complication of ST-elevation myocardial infarction (STEMI) and surgery is the reference treatment. We aimed at describing trends in management and mortality during the last four decades and reporting mortality predictors in these patients. We conducted a single-center retrospective study of patients sustaining a VSR from 1981 to 2020. We screened 274 patients and included 265 for analysis. The number of patients decreased over the years: 80, 88, 56, and 50 in each 10-year time span. In-hospital mortality decreased significantly since 1990 (logrank 0.007). The median age was 72.0 years IQR [66–78] and 188 patients (70.9%) were operated on. IABP was used more routinely (p < 0.0001). In-hospital mortality was assessed at 66.8% (177 patients) and main predictors of death were a time from MI to surgery < 8 days HR 2.7 IC95% [1.9–3.8] p < 0.0001, a Killip class > 2 HR 2.5 IC [1.9–3.4] p < 0.0001 and Euroscore 2 > 20 HR 2.4 IC [1.8–3.2] p < 0.0001. A “time from MI to surgery” of 8 days offers the best ability to discriminate between patients with or without mortality. The ability of “Euroscore 2 and Killip” to detect the patients most likely to wait 8 days for surgery was at 0.81 [0.73–0.89] p < 0.0001. Mortality remains high over the years. Euroscore 2, Killip class, and time from MI to surgery are the main mortality predictors. Patients with a Killip < 3 and a Euroscore < 20 should be monitored at least 8 days since MI before being referred to surgery.
Background The benefit of arterial revascularization in coronary surgery remains controversial. T... more Background The benefit of arterial revascularization in coronary surgery remains controversial. The incremental value of additional grafts to the left internal thoracic artery (ITA) has been mainly assessed according to the number of arterial grafts, possibly limiting the detection of its actual impact. We analyzed the influence of the number of distal arterial anastomoses (DAA) performed on late mortality in patients having received from one to three arterial grafts. Methods Retrospective review of 3685 primary isolated coronary artery bypass grafting (CABG) performed from 1989 to 2014 was conducted with a 13-year mean follow-up. One arterial graft (SITA) was used in 969 patients, two arterial grafts, ITA or gastroepiploic artery (GEA), in 1883 patients (BITA: 1644; SITA+GEA: 239), and three arterial grafts in 833 patients (BITA+GEA). Totally, 795 patients (22%) received one DAA, 1142 patients (31%) two, 1337 patients (36%) three, and 411 patients (11%) four or more. A sub-group an...
Although conventional right thoracotomy is a well-known alternative for mid-sternotomy to access ... more Although conventional right thoracotomy is a well-known alternative for mid-sternotomy to access the left atrium, a combined video-assisted mitral and left anterior descending (LAD) approach via Port-Access has not yet been described. We report the case of a 68-year-old patient with severe mitral valve regurgitation due to myxoid degeneration associated with a critical LAD coronary artery stenosis. A totally video-assisted 'true' Port-Access (i.e. no costal retraction) mitral valve repair and direct coronary artery bypass were performed in combination, without complications.
Interactive cardiovascular and thoracic surgery, 2006
Primary spontaneous coronary artery dissection (PSCAD) is an uncommon cause of acute myocardial i... more Primary spontaneous coronary artery dissection (PSCAD) is an uncommon cause of acute myocardial infarction that can lead to fatal course especially because of non-standardized management. We report the case of a 37-year-old woman who presented with a PSCAD of the right coronary artery. A young woman was addressed to our hospital for a PSCAD of the right coronary artery (RCA). During the coronary angiogram, an iatrogenous type II aortic dissection occurred. She was then scheduled for surgery since ascending aortic diameter after the dissection was measured at 52 mm. A David procedure was made to replace the aortic root. Since weaning from cardiopulmonary bypass (CPB) was easy without ischemic signs in the right territory, we didn't systematically graft the RCA. Thirty minutes after the end of the procedure, a cardiogenic shock occurred witnessing a complete thrombosis of the RCA. CPB was restarted and the RCA was grafted on-pump using a right internal thoracic artery (RITA). The ...
The initial aorta (aortic valve, ring, sinuses and ascending aorta) constitutes an inseparable an... more The initial aorta (aortic valve, ring, sinuses and ascending aorta) constitutes an inseparable anatomical-functional entity. The "normal" diameter grows with age and body surface area. Two potential risks: aortic regurgitation (chronic complication) and aortic dissection (acute complication) The aortic diameter is the main factor of aortic dissection. Issues of the recommendations: set thresholds to indicate prophylactic surgery (avoid complication) Betablockers are indicated, especially in cases of hypertension or proven familial dystrophy.
European Journal of Vascular and Endovascular Surgery, 2019
(26.4%) for a symptomatic stenosis. PCC occurred in 47/1761 patients (2.6%). At univariate analys... more (26.4%) for a symptomatic stenosis. PCC occurred in 47/1761 patients (2.6%). At univariate analysis, symptomatic carotid stenosis (4.5% vs 2%, p¼0.007), chronic hypertension (2.9% vs 0%, p¼0.04), coronary artery disease (3.8% vs 2.1%, p¼0.04) and oral anticoagulant therapy (8.3% vs 2.4%, p¼0.004) were associated to PCC. At multivariate analysis, symptomatic stenosis (0.
We carried out a randomized prospective study in 60 patients who had undergone major abdominal su... more We carried out a randomized prospective study in 60 patients who had undergone major abdominal surgery for cancer. For postoperative pain control, 30 patients received continuous extradural infusion of 0.125% bupivacaine 12.5 mg h 91 and morphine 0.25 mg h 91 (EXI group) and 30 received patient-controlled analgesia (PCA) with intravenous morphine (1 mg bolus, 5-min lock-out and maximum dose 20 mg 4h 91). Both groups had general anaesthesia. The two groups were compared for postoperative pain scores, satisfaction, sedation and oxygen saturation. Oxygen saturation was recorded continuously the night before surgery and for two consecutive postoperative nights. Episodes of moderate desaturation (90%9 2 O S p 85%) were more frequent in the EXI group than in the PCA group (P:0.05). Pain scores were lower in the EXI group compared with the PCA group at rest and while coughing (P:0.05). No significant difference was found for patient sedation and satisfaction. (Br.
Background. Right thoracotomy is a well known alternative to median sternotomy to gain access to ... more Background. Right thoracotomy is a well known alternative to median sternotomy to gain access to the left atrium. To avoid the potential drawbacks associated with sternotomy coupled to the desire for a smaller scar and a more rapid rehabilitation in young and active patients, we investigated the purported advantages in patients undergoing video-assisted Port-Access mitral valve surgery.Methods. Between February 1997
Frontiers in Cardiovascular Medicine, May 25, 2022
Objective: The standard treatment for complicated Stanford type B aortic dissection (TBAD) is tho... more Objective: The standard treatment for complicated Stanford type B aortic dissection (TBAD) is thoracic endovascular aortic repair (TEVAR). Functional parameters, specifically blood flow, are not measured in the clinical assessment of TEVAR, yet they are of outmost importance in patient outcome. Consequently, we investigated the impact of TEVAR on the flows in the aorta and its branches in TBAD using 4D Phase-Contrast Magnetic Resonance Imaging (4D Flow MRI). Methods: Seven patients with TBAD scheduled for TEVAR underwent pre and post-operative 4D Flow MRI. An experienced reader assessed the presence of helical flow in the false lumen (FL) using streamlines and measured net flow at specific locations. In addition, forward and reverse flows, stasis, helicity, and absolute helicity were computed automatically along the aorta centerline. Average values were then computed in the segmented vessels. Impact of TEVAR on these parameters was assessed with a Wilcoxon signed rank test. Impact of the metallic stent on the velocity quantification was assessed using intra-class correlation coefficient (ICC) between velocities measured intra-stent and in adjacent stent-free regions. Results: FL helical flow was observed proximally in 6 cases and distally in 2 cases pre-operatively. Helical flow disappeared post-TEVAR proximally, but developed distally for 2 patients. Intra-stent measures were similar to stent-free with a median difference of 0.1 L/min and an ICC equal to 0.967 (p < 0.01). Forward flow increased from 59.9 to 81.6% in the TL and significantly decreased in the FL from 15.9 to 3.3%. Similarly, reverse flow increased in the TL from 4.36 to 10.8% and decreased in the FL from 10.3 to 4.6%. No significant changes were observed in net flow for aortic branches (p > 0.05). A significant increase in FL stasis was observed (p = 0.04). Discussion: TEVAR significantly increased forward flow in the TL and significantly decreased both forward and reverse flows in the FL. Interestingly, reverse flow in the TL increased post-TEVAR, which could be due to increased rigidity of the wall, due to the metallic stent. User independent helicity quantification enabled detection of elevated helicity at the level of secondary entry tears which had been missed by streamline visualization.
We present the case of a 63-year-old woman who was hospitalized five times in 4 months for episod... more We present the case of a 63-year-old woman who was hospitalized five times in 4 months for episodes of heart failure, associated with a sustained hypertension despite a fivefold therapy. The pathophysiological mechanism of the hypertension was a secondary hyperaldosteronism linked to a renal hypoperfusion due to the narrowing of the thoracic aorta by a huge calcified plaque, mimicking an aortic coarctation.
Background Acute type A aortic dissection is associated with high perioperative morbidity and mor... more Background Acute type A aortic dissection is associated with high perioperative morbidity and mortality. Ascyrus Medical Dissection Stent (Cryolife, Kennesaw, USA) is a novel uncovered hybrid stent graft developed to be used as an adjunct to standard surgical approach to promote true lumen expansion and enhance aortic remodeling. Methods From March 2021 to March 2022, four consecutive patients presented with acute Debakey type I aortic dissection and underwent emergent surgical repair with Tirone David procedure and implantation of Ascyrus Medical Dissection Stent. We reviewed patient's files retrospectively and described the perioperative outcomes. Results All four device implantations were successful. Overall 30-day mortality was 0%. Malperfusion that was present in two patients pre-operatively improved after Ascyrus Medical Dissection Stent implantation. No aortic reinterventions were needed. No aortic injury related to the device was noted. Favourable changes in aortic true lumen and false lumen dimensions were found in most of our patients but the stent was compressed at the isthmus in one patient. Conclusion Ascyrus Medical Dissection Stent is a reliable and secure device. However, its benefits remain unclear when it comes to a positive remodeling and seems less likelihood comparable to a frozen elephant trunk. The main reason seems to be an insufficient radial force of the stent.
Background Acute type A aortic dissection is associated with high perioperative amorbidity and mo... more Background Acute type A aortic dissection is associated with high perioperative amorbidity and mortality. Ascyrus Medical Dissection Stent is a novel uncovered hybrid stent graft developed to be used as an adjunct to standard surgical approach to promote true lumen expansion and enhance aortic remodeling. Methods From March 2021 to March 2022, four consecutive patients presented with acute Debakey type I aortic dissection and underwent emergent surgical repair with David procedure and implantation of AMDS. We reviewed patient’s files retrospectively and described the perioperative outcomes. Results All four device implantations were successful. Overall 30-day mortality was 0%. Malperfusion that was present in two patients pre-operatively improved after AMDS implantation. No aortic reinterventions were needed. No aortic injury related to the device was noted. Favourable changes in aortic true lumen and false lumen dimensions were found in most of our patients but the AMDS was compres...
Background: Acute type A aortic dissection is associated with a significant perioperative morbidi... more Background: Acute type A aortic dissection is associated with a significant perioperative morbidity and mortality. Ascyrus Medical Dissection Stent (AMDS) is a novel bare stent graft developed to be used as an adjunct to standard surgical approach to promote true lumen expansion and therefor enhance aortic remodeling. Patients and Methods: From March 2021 to March 2022, four consecutive patients who presented with acute Debakey type I aortic dissection underwent emergent surgical repair with an inclusion (David) procedure and implantation of an AMDS. We analysed patient’s files prospectively and described the perioperative outcomes. Results: All four device implantations were successful. Overall 30-day mortality was 0 %. Malperfusion that was present in two patients pre-operatively improved after AMDS implantation. At follow up, no aortic reinterventions were needed. No aortic injury related to the device was noted. Favourable changes in aortic true lumen and false lumen dimensions ...
BackgroundAbout a decade past the first transcatheter aortic valve implantation (TAVI), data are ... more BackgroundAbout a decade past the first transcatheter aortic valve implantation (TAVI), data are limited regarding temporal trends accompanying its evolution from novel technology to mainstream therapy. We evaluated these trends in a large multicenter TAVI registry.Hypothesis TAVI is changing and improving with time.MethodsPatients who underwent TAVI between January 2008 and December 2014 at 3 high‐volume Israeli centers were divided into 5 time quintiles according to procedure date. Outcomes were analyzed and reported according to Valve Academic Research Consortium‐2.ResultsA total of 1285 patients were studied (43% male; mean age, 83 ± 3 years; mean Society of Thoracic Surgeons [STS] score, 5.5 ± 3.6). Over time, there was a shift toward treating patients at lower STS score, increased use of conscious sedation and transfemoral approach, and decreased use of balloon predilatation. The balloon‐expandable to self‐expandable valve utilization ratio decreased, the valve‐in‐valve experi...
Archives des maladies du coeur et des vaisseaux, 2005
The surgical treatment of coronary lesions is based on bypassing the anatomical lesions with auto... more The surgical treatment of coronary lesions is based on bypassing the anatomical lesions with autologous vascular grafts. This procedure has traditionally been "invasive", requiring a micro-surgery technique, institution of extra-corporeal circulation, as well as temporary cardiac arrest with a cardioplegic solution. Recently, an automatic distal anastomosis procedure has been developed (Ventrica, Medtronic Inc.), based on a magnetic coupling with two implanted intravascular magnets, allowing easy connection between the graft and the coronary artery. The immediately obvious advantages are the time saved, ease of use, reproducibility and reliability. The learning curve is fast. Furthermore, the use of this automatic process does not compromise a manual anastomosis in case of implantation failure. The immediate post-operative results, as well as angiography immediately and at 6 months are all satisfactory. This technique is applicable for multiple revascularisations, all type...
Ventricular septal rupture (VSR) is a serious complication of ST-elevation myocardial infarction ... more Ventricular septal rupture (VSR) is a serious complication of ST-elevation myocardial infarction (STEMI) and surgery is the reference treatment. We aimed at describing trends in management and mortality during the last four decades and reporting mortality predictors in these patients. We conducted a single-center retrospective study of patients sustaining a VSR from 1981 to 2020. We screened 274 patients and included 265 for analysis. The number of patients decreased over the years: 80, 88, 56, and 50 in each 10-year time span. In-hospital mortality decreased significantly since 1990 (logrank 0.007). The median age was 72.0 years IQR [66–78] and 188 patients (70.9%) were operated on. IABP was used more routinely (p < 0.0001). In-hospital mortality was assessed at 66.8% (177 patients) and main predictors of death were a time from MI to surgery < 8 days HR 2.7 IC95% [1.9–3.8] p < 0.0001, a Killip class > 2 HR 2.5 IC [1.9–3.4] p < 0.0001 and Euroscore 2 > 20 HR 2.4 IC [1.8–3.2] p < 0.0001. A “time from MI to surgery” of 8 days offers the best ability to discriminate between patients with or without mortality. The ability of “Euroscore 2 and Killip” to detect the patients most likely to wait 8 days for surgery was at 0.81 [0.73–0.89] p < 0.0001. Mortality remains high over the years. Euroscore 2, Killip class, and time from MI to surgery are the main mortality predictors. Patients with a Killip < 3 and a Euroscore < 20 should be monitored at least 8 days since MI before being referred to surgery.
Background The benefit of arterial revascularization in coronary surgery remains controversial. T... more Background The benefit of arterial revascularization in coronary surgery remains controversial. The incremental value of additional grafts to the left internal thoracic artery (ITA) has been mainly assessed according to the number of arterial grafts, possibly limiting the detection of its actual impact. We analyzed the influence of the number of distal arterial anastomoses (DAA) performed on late mortality in patients having received from one to three arterial grafts. Methods Retrospective review of 3685 primary isolated coronary artery bypass grafting (CABG) performed from 1989 to 2014 was conducted with a 13-year mean follow-up. One arterial graft (SITA) was used in 969 patients, two arterial grafts, ITA or gastroepiploic artery (GEA), in 1883 patients (BITA: 1644; SITA+GEA: 239), and three arterial grafts in 833 patients (BITA+GEA). Totally, 795 patients (22%) received one DAA, 1142 patients (31%) two, 1337 patients (36%) three, and 411 patients (11%) four or more. A sub-group an...
Although conventional right thoracotomy is a well-known alternative for mid-sternotomy to access ... more Although conventional right thoracotomy is a well-known alternative for mid-sternotomy to access the left atrium, a combined video-assisted mitral and left anterior descending (LAD) approach via Port-Access has not yet been described. We report the case of a 68-year-old patient with severe mitral valve regurgitation due to myxoid degeneration associated with a critical LAD coronary artery stenosis. A totally video-assisted 'true' Port-Access (i.e. no costal retraction) mitral valve repair and direct coronary artery bypass were performed in combination, without complications.
Interactive cardiovascular and thoracic surgery, 2006
Primary spontaneous coronary artery dissection (PSCAD) is an uncommon cause of acute myocardial i... more Primary spontaneous coronary artery dissection (PSCAD) is an uncommon cause of acute myocardial infarction that can lead to fatal course especially because of non-standardized management. We report the case of a 37-year-old woman who presented with a PSCAD of the right coronary artery. A young woman was addressed to our hospital for a PSCAD of the right coronary artery (RCA). During the coronary angiogram, an iatrogenous type II aortic dissection occurred. She was then scheduled for surgery since ascending aortic diameter after the dissection was measured at 52 mm. A David procedure was made to replace the aortic root. Since weaning from cardiopulmonary bypass (CPB) was easy without ischemic signs in the right territory, we didn't systematically graft the RCA. Thirty minutes after the end of the procedure, a cardiogenic shock occurred witnessing a complete thrombosis of the RCA. CPB was restarted and the RCA was grafted on-pump using a right internal thoracic artery (RITA). The ...
The initial aorta (aortic valve, ring, sinuses and ascending aorta) constitutes an inseparable an... more The initial aorta (aortic valve, ring, sinuses and ascending aorta) constitutes an inseparable anatomical-functional entity. The "normal" diameter grows with age and body surface area. Two potential risks: aortic regurgitation (chronic complication) and aortic dissection (acute complication) The aortic diameter is the main factor of aortic dissection. Issues of the recommendations: set thresholds to indicate prophylactic surgery (avoid complication) Betablockers are indicated, especially in cases of hypertension or proven familial dystrophy.
European Journal of Vascular and Endovascular Surgery, 2019
(26.4%) for a symptomatic stenosis. PCC occurred in 47/1761 patients (2.6%). At univariate analys... more (26.4%) for a symptomatic stenosis. PCC occurred in 47/1761 patients (2.6%). At univariate analysis, symptomatic carotid stenosis (4.5% vs 2%, p¼0.007), chronic hypertension (2.9% vs 0%, p¼0.04), coronary artery disease (3.8% vs 2.1%, p¼0.04) and oral anticoagulant therapy (8.3% vs 2.4%, p¼0.004) were associated to PCC. At multivariate analysis, symptomatic stenosis (0.
We carried out a randomized prospective study in 60 patients who had undergone major abdominal su... more We carried out a randomized prospective study in 60 patients who had undergone major abdominal surgery for cancer. For postoperative pain control, 30 patients received continuous extradural infusion of 0.125% bupivacaine 12.5 mg h 91 and morphine 0.25 mg h 91 (EXI group) and 30 received patient-controlled analgesia (PCA) with intravenous morphine (1 mg bolus, 5-min lock-out and maximum dose 20 mg 4h 91). Both groups had general anaesthesia. The two groups were compared for postoperative pain scores, satisfaction, sedation and oxygen saturation. Oxygen saturation was recorded continuously the night before surgery and for two consecutive postoperative nights. Episodes of moderate desaturation (90%9 2 O S p 85%) were more frequent in the EXI group than in the PCA group (P:0.05). Pain scores were lower in the EXI group compared with the PCA group at rest and while coughing (P:0.05). No significant difference was found for patient sedation and satisfaction. (Br.
Background. Right thoracotomy is a well known alternative to median sternotomy to gain access to ... more Background. Right thoracotomy is a well known alternative to median sternotomy to gain access to the left atrium. To avoid the potential drawbacks associated with sternotomy coupled to the desire for a smaller scar and a more rapid rehabilitation in young and active patients, we investigated the purported advantages in patients undergoing video-assisted Port-Access mitral valve surgery.Methods. Between February 1997
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Papers by Fadi Farhat