ABSTRACT
Since the first procedure carried out at La Pitié Hospital, on 27 April 1968, we have performed 1918 heart transplants. We analyzed outcomes in four successive periods: initial experience from 1968 to 1981 (53 patients), using early immunosuppressive regimens; an expansion phase (839 patients) from 1982 to 1992, with the introduction of cyclosporine; a stabilisation phase (522 patients) from 1993 to 2003; and the most recent phase (504 patients) from 2004 to 2010. We focused particularly on the most recent period. National super-emergency "rules were created, and grafts from older," "borderline" donors were used. Hyperimmune recipients started to be grafted, and ECMO was frequently used during the preoperative and postoperative periods. Due to limited organ availability, we have gradually placed more and more patients on mechanical cardiac support as a bridge to transplantation. Their quality of life is improved.
Subject(s)
Heart Transplantation/methods , Heart Transplantation/statistics & numerical data , Adult , Cardiology/trends , Cohort Studies , Extracorporeal Membrane Oxygenation/statistics & numerical data , Female , Heart Transplantation/trends , Hospitals, Teaching/statistics & numerical data , Humans , Immunosuppressive Agents/therapeutic use , Male , Middle Aged , Paris/epidemiology , Postoperative Complications/epidemiology , Retrospective StudiesSubject(s)
Aortic Aneurysm/surgery , Aortic Aneurysm/genetics , Aortic Aneurysm, Abdominal/surgery , Aortic Aneurysm, Abdominal/genetics , Aorta/anatomy & histology , Aorta/physiology , Aorta/physiopathology , Aortic Diseases , Aortic Diseases/surgery , Aortic Diseases/congenital , Aortic Diseases/diagnosis , Aortic Diseases/genetics , Aortic Diseases/therapy , Cardiovascular Surgical Procedures , Prognosis , StentsSubject(s)
Aorta/anatomy & histology , Aorta/physiopathology , Aorta/physiology , Aortic Aneurysm/surgery , Aortic Aneurysm/genetics , Aortic Aneurysm, Abdominal/surgery , Aortic Aneurysm, Abdominal/genetics , Aortic Diseases/surgery , Aortic Diseases/diagnosis , Aortic Diseases/congenital , Aortic Diseases/genetics , Aortic Diseases/therapy , Aortic Diseases , Prognosis , Stents , Cardiovascular Surgical ProceduresSubject(s)
Aorta/anatomy & histology , Aorta/surgery , Aorta/physiopathology , Aorta/pathology , Aorta , Aortic Aneurysm/surgery , Aortic Aneurysm/etiology , Aortic Aneurysm/pathology , Aortic Aneurysm, Abdominal , Aortic Dissection/pathology , Marfan Syndrome/genetics , Coronary Angiography , Tomography, X-Ray Computed , Hematoma/complications , TextbookABSTRACT
La arteria mamaria interna (AMi) es el conducto ideal en la cirugia coronaria por su mayor, temprana y tardia, permeabilidad en comparacion con la vena safena. En este articulo presentamos nuestra experiencia con el proposito de contribuir a la difusion del uso de esta arteria en nuestro medio. Desde 1986 hasta 1992 operamos 486 pacientes quienes recibieron al menos una AMi. 386 pacientes fueron intervenidos en Francia (Grupo I) y 100 en el Perú (Grupo II). En 95 por ciento de casos la arteria mamaria interna izquierda (AMiI) fue colocada en la arteria coronaria descendente anterior, en 4 casos la arteria mamaria derecha se utilizo como puente libre y en 12 casos se empleo asociada a la AMiI. La mortalidad hospitalaria fue de 3.5 por ciento. En el resto hubo minimas complicaciones postoperatorias. La sobrevida actuarial a 7 años, libre de enfermedad cardiaca, fue de 94 por ciento en el grupo II con pocas complicaciones cardiacas tardias comparado con resultados de publicaciones internacionales. El buen uso técnico de la AMi con la indicación apropiada, no aumenta la morbimortalidad temprana de los pacientes operados, y tiene muy buenos resultados a largo plazo, como lo demuestra el seguimiento a siete años de los pacientes del grupo II operados en Lima, Perú