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Objective: Impact of the interval between interruption of aspirin intake and surgery on postoperative bleeding and transfusion in coronary artery bypass graft (CABG), with extracorporeal circulation (ECC).Study design: Retrospective study.Patients and methods: Four hundred and twelve patients having undergone CABG were retrospectively reviewed. Three groups were evaluated according to the length of the interval defined above : Group I (< 3 days), Group II (3 - 7 days), Group III (> 7 days or without aspirin intake). Postoperative blood loss at 3rd, 6th, 12th, and 24th hour and transfusion requirements were assessed for the 3 groups. Aprotinin (low dose, 2 M KIU) was systematically included in the priming of the ECC circuit.Results: There were no significant differences among groups for weight, size, duration of ECC, and number of bypasses. No significant correlation was noted among the 3 groups for postoperative blood loss and transfusion. Multivariate analysis showed that factors associated to a higher risk of excessive bleeding were ECC duration and number of arterial grafts. Factors associated with a higher risk of transfusion were: emergency, minimum patient temperature during ECC, weight and preoperative haemoglobin level. Aspirine intake was not associated with an increase of bleeding or transfusion.Conclusion: Our study showed that in our practice using systematic low dose of aprotinin when priming the ECC circuit, aspirin did not significantly increase bleeding or transfusion requirements in CABG with ECC, whatever the interval between interruption of aspirin intake and surgery. Consequently, in our practice, aspirin intake is interrupted on hospitalisation, one day before surgery. [Copyright &y& Elsevier]

Summary: Postoperative mediastinitis is one of the most worrisome complications after heart surgery. Until now there is no universally accepted strategy in the management of this infectious complication. Recently, various novel techniques like negative pressure therapy and titanium plates sternal reconstruction have allowed a dramatic decrease of mortality and morbidity after mediastinitis. We report the case of a diabetic patient suffering from morbid obesity who developed a severe postoperative mediastinitis after a coronary artery bypass; she was successfully treated by combining negative pressure therapy, titanium plates osteosynthesis and bilateral pectoral muscle flaps. [ABSTRACT FROM AUTHOR]

Objectifs. – Comparer la durée de ventilation et les complications postopératoires après chirurgie coronaire chez le sujet âgé de 75 ans ou plus, en utilisant une anesthésie par propofol associée au rémifentanil ou à l’alfentanil.Type d’étude. – Étude rétrospective avec groupe témoin historique.Patients. – Au total, 338 patients consécutifs opérés d’une chirurgie coronaire isolée ont été inclus. Cent cinquante-sept patients opérés de janvier 1998 à juin 2000 avaient reçu de l’alfentanil (1 μg/kg par minute) associé à du propofol en concentration massique, 181 opérés entre juillet 2000 et 2002 du rémifentanil 0,25 μg/kg par minute et du propofol en anesthésie intraveineuse à objectif de concentration (AIVOC, concentration plasmatique cible : 1,5 à 2 μg/ml). La prise en charge postopératoire, y compris le protocole de sevrage de la ventilation et d’extubation trachéale, était identique chez tous les patients.Méthodes. – Les deux groupes ont été comparés pour les données préopératoires et chirurgicales. La durée de ventilation et de séjour en réanimation ont été étudiées dans les deux groupes, ainsi que les principales complications postopératoires.Résultats. – La durée de ventilation était diminuée dans le groupe rémifentanil (6 ± 9 heures vs13 ± 63 heures ; p < 0,0001), l’extubation trachéale ayant été réalisée chez 70 % des patients avant la sixième heure postopératoire contre 53 % dans le groupe alfentanil (p = 0,0023). Aucune réduction de la durée de séjour en réanimation ou des complications postopératoires n’a été retrouvée. Une utilisation peropératoire plus fréquente de vasopresseurs ainsi qu’une augmentation postopératoire plus importante de la concentration plasmatique des CPK Mb (35,7 ± 38,2 μg/l, vs 27,7 ± 31,9 μg/l ; p = 0,02) ont été observées dans le groupe rémifentanil (40,2 % vs 2,4 % ; p< 0,0001).Conclusion. – L’association du propofol (AIVOC) et du rémifentanil a permis, par rapport à un protocole utilisant le propofol en concentration massique et l’alfentanil, de réduire la durée de ventilation chez le sujet âgé après chirurgie coronaire sans diminuer les complications postopératoires. Elle a néanmoins nécessité une utilisation accrue de vasopresseurs. [Copyright 2004 Elsevier]

Abstract: Paraplegia by medullar ischaemia after cardiac arrest is rarely reported, especially without anoxo-ischaemic cerebral lesions. We report the case of a 17-year-old woman who underwent a 70minutes cardiac arrest with recovery of consciousness, but a symptomatic medullar ischaemia (paraplegia under T4). [Copyright &y& Elsevier]

Abstract: We report the case of a kidney allograft harvesting on a donor patient under cardiopulmonary bypass (CPB) after a cardiac arrest. The two kidneys were successfully transplanted with immediate graft function. CPB may provide an option to expand the number of harvested grafts. [Copyright &y& Elsevier]

Human nocardiosis usually involves the respiratory tract or the skin but may disseminate to virtually any organ, it occurs in immunocompromised hosts as well as individuals with no apparent predisposition. Involvement of the pericardium is uncommon, having been reported infrequently in the past, but mandates a special management. This report describes the first case in Europe of a patient with chronic constrictive pericarditis from nocardia brasiliens, successfully treated with pericardiectomy and appropriate antibiotic therapy., Competing Interests: Conflit d'intérêts Les auteurs déclarent n'avoir aucun conflit d'intérêts., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Objective: To assess the diagnostic delay (between first hospital medical contact and diagnosis) and the surgical delay (between diagnosis and incision) of type A acute aortic syndromes (AAAS) within the RENAU (REseau Nord Alpin des Urgences), organizing the management of emergency medicine care in the French North Alpine Arc., Procedure: Multicenter retrospective study between 2012 and 2016 on the AAAS operated in the RENAU heart surgical centers (Annecy, Grenoble). Post-traumatic, iatrogenic or chronic lesions, incidental discoveries and deaths before surgery were excluded., Results: One hundred and ninety-seven patients were included with a median age [IQR] of 65 years [58; 73] of which 67% were men. The median diagnosis delay was 88min [46;241] and the median surgical delay was 193min [146;249]. Initial management was performed by the SMUR for 102 patients (52%), 7% of whom received a pre-hospital transthoracic ultrasound. 52 patients (26%) presented themselves spontaneously to the emergency department. Patients were initially admitted in a center without cardiac surgery in 65% of cases. The CT scan was the diagnostic test in 81% of cases. The postoperative hospital mortality was 16%., Conclusion: Referring to IRAD data reporting a median diagnostic and surgical delay of 258min each, our study suggests that the RENAU organization may be associated with reduced diagnostic and surgical delays for patients with SAAA., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Pulmonary embolism is one of the differential diagnoses of "acute chest" syndromes. We report a clinical case of contained rupture of ascending aortic aneurysm with pulmonary arteries compression, which was presented as pulmonary embolism, and we well review the literature data of this diagnostic trap.

Objective: Type A or B aortic dissection can extend to renal arteries, causing a renal ischemia which treatment is usually endovascular. The aim of our study is to show the interest of the renal volumetry in the follow-up of these patients., Patients and Methods: Twenty-two patients (16 men, mean age 63.4±11.8years, BMI 25.2±3.4kg/m(2)) with a type A or B aortic dissection spread to one or to both renal arteries and followed at Grenoble university hospital were consecutively included. All patients underwent renal angiography with aorto-renal pressure gradients measurements and follow-up by renal volumetry (scanner Siemens(®)). A renal ischemia was defined by a decrease of 20% or more of the volumetry., Results: Sixteen patients (73%) were hypertensive before the aortic dissection among which ten (62%) were treated. Eight patients (36%) have a significant renal pressure gradient among which five (62%) underwent renal endovascular therapy. The renal volumetry of these five patients remained unchanged while six of 17 patients (36%) without angioplasty have a decreasing volumetry., Conclusion: Renal volumetry appeared an effective and attractive option for the follow-up of the patients with aortic dissection spread to the renal arteries. These results should be taken into account to put the indication of an endovascular treatment., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Peripartum cardiomyopathy (PPCMP) is a dilated and hypokinetic cardiomyopathy occurring during pregnancy or after delivery, with an estimated incidence between 1/1000 and 1/4000 births. It has been defined as a new onset of heart failure in the month preceding or following delivery, without demonstrated aetiology nor previously known heart disease, and with echocardiographic evidences of left ventricular (LV) dysfunction (LV ejection fraction<0.45). It's a multifactorial disease, immunologic, hormonal, and possibly viral mechanisms playing a determinant pathophysiological role. The classical clinical presentation is a rapid and unexpected onset of heart failure in a previously healthy woman, echocardiography being the key examination for positive and differential diagnosis, prognostication, therapeutic decision-making, and follow-up. The potential severity of PPCMP, and its unpredictable evolution in the first days following diagnosis, require that patients be referred to a tertiary care centre with a high skill in intensive cardiology care. Therapeutic management of PPCMP does not offer any specificity when compared to other causes of acute or chronic heart failure (from diuretics to extracorporeal life support), except for ACE-inhibitors, that are contraindicated before delivery. The high incidence of thrombo-embolic complications observed in the disease requires however rapid and curative anticoagulation, and immuno-suppressive treatment has been proposed in fulminant and highly inflammatory presentation, but its efficacy remains controversial. Very recently, promising results have been reported with bromocriptin-a prolactin secretion inhibitor-for reducing 6-month morbidity and mortality, but these findings have to be confirmed in larger scale randomised trials. As for the long-term evolution, approximately half of the patients will heal, while half of the women will keep some degree of LV dysfunction, 25% of them developing moderate to severe chronic heart failure., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Background: Extracorporeal life support (ECLS) is a circulatory assistance device that is increasingly used in adults undergoing cardiopulmonary arrest (CPA) or hemodynamic collapse when conventional therapies fail., Objectives: To assess the feasibility and outcomes of 100 consecutive arteriovenous percutaneous ECLS procedures at the Grenoble University Hospital between January 2002 and September 2007., Methods: Monocentric descriptive registry with one-year prospective follow-up., Results: An ECLS device was successfully used in 93% of patients. Its indication was cardiogenic shock in 50% of the cases, CPA in 38% of the cases and unsuccessful weaning of cardiopulmonary bypass (CPB) after cardiothoracic surgery in 12% of the cases. Direct complications of ECLS were observed in 56% of patients, the most frequent being hemorrhage at the intravenous puncture site requiring red blood cell transfusions (26%), and lower limb ischemia (19%). Weaning from ECLS was achieved in 33 patients (44% cardiogenic shocks, 13% CPAs, 50% CPB weaning failures) and 20 patients were discharged from the hospital (26% cardiogenic shocks, 10.5% CPAs and 25% CPB weaning failures). All are still living without any serious sequelae (mean follow-up period of 16.8 months)., Conclusion: The use of ECLS in CPA patients, especially with cardiogenic shock, is feasible with satisfactory survival rates, given the extreme severity of their initial state.

Background: There are almost three million octogenarians living in France, many of whom present with a coronaropathy. Moreover, it appears that life expectancy at 80 years of age is still important., Objective: To evaluate the results of coronary surgery among these patients., Methods: Eighty-eight consecutive octogenarians who had an isolated coronary artery bypass surgery between 1996 and 2002 were compared with 165 patients 60 to 70 years of age; the two groups had been paired according to the main risk factors. Patients were contacted by telephone and then received a quality-of-life-related questionnaire., Results: Operative mortality was 2.3% in the octogenarian versus 1.2% in the 60- to 70-year-old group (P not significant). There was more low cardiac output syndrome, postoperative acute renal failure and transfusion in octogenarians. Long-term survival (average duration of follow-up was 3.8 years) was higher in the 60- to 70-year-old group: 89.7% versus 77.9% (P=0.025). Four independent risk factors of long-term increased mortality were found: age, diabetes, history of stroke and postoperative blood transfusion. Finally, the long-term survival in the octogenarians who had this surgery was higher than in the octogenarians of the general French population to a significant degree, with a quality of life considered to be satisfactory., Conclusion: For selected octogenarians, an isolated coronary surgery can be proposed, with short- and long-term results comparable with those of a younger population.

We report the case of a kidney allograft harvesting on a donor patient under cardiopulmonary bypass (CPB) after a cardiac arrest. The two kidneys were successfully transplanted with immediate graft function. CPB may provide an option to expand the number of harvested grafts.

Objectives: Comparison of the length of mechanical ventilation and postoperative complications after coronary surgery in elderly patients anaesthetised with propofol associated with either alfentanil or remifentanil., Study Design: Retrospective study with an historic control group., Patients: Three hundred thirty-eight consecutive patients (75-year-old or more) undergoing isolated coronary surgery. One hundred and fifty seven patients operated between January 1998 and June 2000 received alfentanil (1 microg/kg/minute) with a manually control infusion of propofol, 181 operated between July 2000 and 2002, remifentanil 0.25 microg/kg/minute with target controlled infusion of propofol (target blood concentration: 1.5 to 2 microg/ml)., Methods: The two groups were compared for preoperative and surgical data. The length of mechanical ventilation, stay in ICU and the main postoperative complications were compared between the two groups., Results: Length of mechanical ventilation was significantly reduced in the remifentanil group (6 +/- 9 h vs. 13 +/- 63 h ; p <0.0001), 70% of the patients were extubated before the 6th postoperative hours against 53% in the alfentanil group (p =0.0023). This was not associated with a reduction of stay in ICU or postoperative complications. During surgery, an increased used of vasopressor was observed in the remifentanil group (40.2% vs 2.4% ; p <0.0001) with a postoperative elevation of blood concentration of CKMb (35.7 +/- 38.2 microg/l, vs. 27.7 +/- 31.9 microg/l, p =0.02)., Conclusion: Elderly patients undergoing coronary surgery were extubated earlier with remifentanil. However, this had no effect on duration of ICU stay but was associated with an increased used of vasopressor.

Introduction: The spontaneous prognosis of pulmonary embolism associated with mobile intra-cardiac thrombus is most severe, and the choice of a therapeutic strategy is often difficult., Observation: The treatment of a patient with intravenous fibrinolytics for massive pulmonary embolism and right atrium thrombus was complicated by his early death. We attributed his death to the migration of the intra-cardiac thrombus. Indeed, the cardiac ultrasound, performed when the patient's hemodynamic state had worsened, revealed the complete disappearance of the thrombus too early to correspond to its complete lysis (30th minute of fibrinolysis)., Comments: In this pathology, several therapeutic approaches are possible. Surgical removal of the embolus has been validated, but cannot be proposed to all patients since it is a high-risk intervention. Fibrinolysis is generally efficient but exposes the patient to the risk of migration of the intra-cavity thrombus with occasionally deleterious evolution (as in our patient). Heparin treatment alone has been proposed as an alternative when the other two techniques are contraindicated. These techniques currently require assessment in a randomized study, in order to define the appropriate therapeutic strategy.

Background: Basaloid cancer of the esophagus is exceptional. The tumor probably develops from epithelial basal cells. This histological type is generally observed in ENT or bronchial localizations., Case Report: A 62-year-old man underwent total pharyngo-laryngo-esophagectomy for a double tumor localization of a basaloid carcinoma of the esophagus and a hypophyayngeal squamous cell carcinoma., Discussion: Basaloid carcinoma has specific histological features difficult to recognize at the pathology examination. Because of the high risk of metastasis, it may be important to propose radiotherapy and/or chemotherapy after surgical excision.

The authors report a new case of cardiac sarcoma treated by cardiac transplantation. This treatment has been proposed for these malignant tumours of poor prognosis when simple excision is impossible, with variable results. This patient is in good general condition 20 months after transplantation. Transplantation is a therapeutic procedure which should be considered in malignant tumours limited to the heart.

We observed a case of aortitis due to Salmonella in a patient with spondylodiscitis. Outcome was fatal despite resection and grafting, extensive drainage and adapted but unsuccessful antibiotic treatment. Based on the literature, suggested treatment for patients with spondylodiscitis includes extra-anatomic bypass combined with resection of the infected tissue and adapted antibiotherapy. In these emergency cases, computed tomography is the most useful exploration and also gives the diagnosis of spondylodiscitis. It is also necessary to identify the infectious agent to adapt the antibiotics.