Bridge to transplantation with the DeBakey VAD axial pump: a single center report.

AIMS: To report our experience with a left ventricular assist device axial pump as a bridge to transplantation: the DeBakey Ventricular Assist Device (VAD). METHODS: From February 1999 to February 2002, nine patients (among which eight males), with a mean age of 47 years, all in NYHA functional class IV, were proposed for a bridge to transplantation with the DeBakey VAD. Five patients had primary dilated cardiomyopathy, four had ischemic cardiomyopathy. All the patients had inotropic support prior to the intervention (dobutamine with a mean dose of 12 mcg/kg per min), six had an intra-aortic counterpulsation, four presented ventricular rhythm disorders. Interventions were performed through sternotomy alone (no need for an abdominal pocket) under extra-corporeal circulation on beating heart (except in one patient suffering from an apical thrombosis for which cardioplegic arrest was performed) as followed: implantation of the apical inflow cannula, tunneling of the percutaneous cable, implantation of the outflow graft under aortic side clamping, starting of the DeBakey VAD during CPB weaning-off. RESULTS: Mean support duration was 81+/-62 days (16-224 days). Eight reoperations were required (three for bleeding or cardiac tamponade, one for haemoperitoneum, one for aortic bifurcation thrombectomy, one for right ventricular assist device implantation, two for iterative replacements of the DeBakey VAD). A significant hemolysis was observed in two patients. No device infection or dysfunction were observed. Secondary recovery of a pulsed flow was observed either clinically or by Echo-Doppler in six patients. Five patients were transplanted, four died prior to transplantation (three from multi-organ failure on post-operative day 35, 16 and 50, respectively, and the last patient was found disconnected at day 109). CONCLUSIONS: The DeBakey VAD is at the origin of renewed interest for continuous flow assist devices. Still under evaluation, the advantages of miniaturization and facility of implantation of this new device seem to be promising.

[Treatment of false aneurysm of the ascending aorta under circulatory arrest and the Port-access system]. / Traitement d'un faux anévrisme de l'aorte ascendante sous arrêt circulatoire par le système Port-Access.

Pseudo-aneurysms of the ascending aorta after thoracic surgery are rare and pose a problem of surgical strategy with respect to the approach, the myocardial protection and type of repair. The authors have solved the problem by using a new technology, the Post-Access TM system, which, by simply introducing a catheter into the femoral artery, allows endoaortic clamping, the administration of cardioplegic solution, and the drainage of the left heart chambers. The system was used with a good result for treating a pseudo-aneurysm of the proximal anastomosis of a bypass between the ascending aorta and the innominate artery, limiting the duration of circulatory arrest and reducing blood loss.

Aortic valve myxoma.

The authors report a case of aortic valve myxoma discovered in a 34-year-old patient who had suffered a transient ischemic attack. At operation, a heliocoidal gelatinous mass was found attached to the ventricular side of the right coronary cusp of the aortic valve via a pedicle. Through a ministernotomy approach the mass was excised and the cusp was repaired. Recovery was uneventful.

Posterior approach for simultaneous access to the popliteal and anterior tibial arteries: applications to distal arterial bypass.

Arterial surgery to salvage the lower limb tends to make use of the great saphenous vein, harvested with the subject in the supine position. If this is not possible the small saphenous vein is used, harvested with the subject in the prone position, however this requires a perioperative modification of the procedure. A bypass between the popliteal and anterior tibial arteries can be performed using either a lateral or a medial and lateral approach with the patient supine. In the event of trophic disorders of the lateral compartment of the leg, these approaches are not applicable. In such cases we propose a single posterior approach. The single posterior approach was used on 10 lower limbs from 5 cadavers in the prone position. Approach to the lower part of the popliteal artery was undertaken posteriorly between the two heads of gastrocnemius. The small saphenous vein was entirely dissected 10 cm above the lateral malleolus, the Achilles tendon and short fibular vessels were retracted medially to expose the interossous fascia, which was divided over 10 cm. Medial rotation of the limb by 30 degrees exposed the anterior tibial artery. For 3 of the lower limbs an 8 cm fibular resection was necessary, whereas on the remaining 7 medial rotation enabled excellent exposure of the anterior tibial artery. The single posterior approach to the anterior tibial artery can be applied in cases requiring distal bypass, using the small saphenous vein, between the inferior part of the popliteal artery and the anterior tibial artery.

Sudden-onset paraplegia due to thrombosis of false aneurysm: late complication after prosthetic replacement of the descending thoracic aorta.

Traumatic rupture involving the isthmus of the descending thoracic aorta is a rarely treated injury in vehicular accident victims. A possible long-term complication of prosthetic replacement of the damaged aortic segment is false aneurysm. This report describes a case of sudden-onset acute paraplegia resulting from thrombosis of a false aneurysm associated with a prosthesis placed 10 years earlier for repair of traumatic rupture of the aortic isthmus.