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From June 1985 to May 1995, 9,814 patients were operated for a cardiac procedure with cardiopulmonary by-pass. Mean age was 61,3 years. The most frequent procedure was coronary surgery (45%), followed by valvular surgery (34%) then combined surgery (11%) and other surgery (4%). 66 cases of mediastinitis were observed: 38 from June 1985 to May 1990 (first group), 28 from June 1990 to May 1995 (second group). The changes between the two groups was antibiotic prophylaxis using Cefuroxime in the first group and Cefamandole in the second and also an impairment of general status of the patients in the second group. Staphylococcus remains the most frequent organism in both groups and for Gram negative bacteria was less frequent in the second group. Several risks factors mediastinitis were identified (males, emergency, diabetes mellitus, obesity, redo, patient of first group, duration of Cardiopulmonary by pass for 100 minutes, mechanical ventilation greater than 48 hours) and the most important factor was the need for mechanical ventilation for more than 48 hours. The mortality rate was 39.4% (26 patients). Identified risk factors of mortality were age over 65 years, females, poor constitution, and cardio/thoracic ratio0.55.Mediastinitis after cardiac surgery remains a serious complication. In this series we observed a decrease of mediastinitis rates, especially in the second group (p0.001). In high risk patients, specific preoperative methods of patient care may be able to prevent such complications. When mediastinitis appears, and when debridement is necessary, a cover procedure seems necessary in elderly or poor constitution patients.

This retrospective study reports the clinical results obtained in a series of 150 heart transplantations performed from October 1986 to January 1995. Overall actuarial survival rate, including operative mortality, was 71% and 57% at 1 and 5 years respectively. Despite a certain level of morbidity, the spectacular functional results in this series are emphasized.

From 1978 to 1992, 121 cases of postinfarction left ventricular aneurysm (99 males, 22 females, mean age 60 years) were operated on. The authors insist on a high rate of clinical arhythmogenicity (31.4%) and associated mechanical complications (21%). 76% of patients were in functional NYHA class III or IV. Resection was performed in 90% of patients, plication in 10%. 58% underwent coronary artery bypass grafting (1.7 graft/patient), 16% encircling ventriculotomy, 8% mitral valve replacement and 13% closure of ventricular septal defect. Operative mortality was 14.9% (10% when other mechanical complications where excluded). 5-year survival is 67.9%. Late cardiac deaths are as follow: left ventricular failure (1.8% A/P), Sudden death (1.4% A/P), Myocardial infarction (0.6% A/P). 82% of survivals are in functional NYHA class I or II. Only functional class NYHA III or IV is predictive of late death. We conclude that postinfarction left ventricular aneurysm remains a high risk complication especially when associated with other mechanical complications. When arhythmogenicity is present we suggest rhythmologic surgery and in all cases, complete revascularization.

Global results of entire series of heart transplantations are essential to better evaluate survival rates. We therefore report the results of our first 100 transplantations.Orthotopic heart transplantation was performed in 82 men and 18 women (age 50.5 +/- 11.4; range 9-65). Sixteen were over 60. Primitive cardiomyopathies (n = 51) and coronary artery disease (n = 44) were the most frequent underlying diseases. Secondary morbidity was evaluated according to the international classification on the basis of pathological examination of endomyocardial biopsies.Immediate post-operative survival rate was 89 percent: there was 1 peroperative death, 7 deaths due to persistent pulmonary hypertension and 4 due to irreversible left ventricular failure. Eight deaths occurred during the 2nd and 3rd postoperative months for an overall early survival rate of 81 percent. After a mean follow-up of 2.4 years (maximum 6.16 yr), the actuarial survival rate at 5 years was 58 percent. Among the 470 biopsies performed, rejection was classified weak or null in 326, moderate in 125 and severe in 19. Pulmonary artery resistance, immunosuppression and, later, the risk of coronary artery disease and intrinsic graft changes were the three major problems encountered in this series.Despite its limits, heart transplantation remains an effective therapeutic option, particularly for young patients in good general health.

The present study uses three techniques of autotransfusion in heart surgery under ECC: peroperative and post-ECC transfusion of blood removed after induction of anaesthesia (group I: 25 patients); postoperative transfusion of extravasated thoracic blood (group II: 24 patients) and a combination of the two (group III: 25 patients). Postoperative bleeding was comparable in all groups; A subset likely to haemorrhage made up of patients who had lost more than one litre of blood was isolated and demonstrated a reduction in the number of homologous red cell concentrates needed for the autotransfused population in comparison with the controls (2.4 +/- 2.6 vs 5.7 +/- 3.5 red cell concentrates, p less than 0.05) and was particularly marked in Group II patients who received 1.9 +/- 2.2 homologous red cell concentrates. None of the techniques caused any side-effects. Combination of the two autotransfusion techniques in heart surgery does not secure any additional advantages compared with postoperative autotransfusion alone.