Effects of the self-myocardial retroperfusion with aortic-coronary sinus shunt on cardiac output and ischemic events in high-risk patients undergoing OPCAB surgery.

AIM: Despite controversies, off-pump coronary artery bypass (OPCAB) surgery has become a routine procedure. Obvious advantages have been demonstrated in high-risk patients. However, OPCAB surgery has limitations in specific high-risk situations with hazards of operative deleterious events. We describe an innovative procedure of self-myocardial retroperfusion (SMR) with an aortic-coronary sinus shunt (ACSS). We prospectively evaluated the protective effects and benefits of SMR in high-risk coronary patients with impaired LVEF. METHODS: Eighteen consecutive high-risk (ES>10) coronary patients (mean age: 65.94 years; range: 34-85; mean ES: 26.97%) with LVEF≤35% who were not eligible for IABP were assigned for OPCAB surgery. Following sternotomy, the cardiac indexes (CI) were measured before, during SMR and after completion of coronary artery bypasses. Operative events with and without SMR were accurately collected, and postoperative cardiac Troponin T release was measured. RESULTS: OPCAB procedures were performed in all patients. Intraoperative use of SMR significantly increased CI (P=3.1041810.10-8) and reversed deleterious operative events (ECG changes/low cardiac output). Hospital mortality was 0%. Incidence of transient atrial fibrillation was 33.33%. Neither stroke nor renal insufficiency was observed. The mean graft number/patient was 2.05. Mean postoperative cardiac Troponin T value was 0.79 µg/L. Beating heart preservation optimized by SMR contributed to reduce ischemia-reperfusion injury, as validated by an immediate increase of CI after completion of coronary bypasses (P=3.35009.10-9). CONCLUSION: The concept of SMR with an ACSS during OPCAB procedures definitely improved CI and reversed ischemic features in high-risk patients and should be considered as an operative temporary myocardial assistance.

Pulmonary Artery Aneurysm : A Case Report and Management of this Uncommon Pathology.

Pulmonary artery aneurysm is a rare pathology and the optimal treatment approach remains unclear in the absence of clear guidelines. We report a case of pulmonary aneurysm and discuss the treatment options.

[Use of rFVIIa in intractable hemorrhage in patients on central veno-arterial ECMO]. / Utilisation du facteur VIIa en cas d'hémorragie réfractaire sous ECMO centrale veino-artérielle.

OBJECTIVE: The purpose of our study is to describe the use of recombinant factor VIIa (rFVIIa) in patients on central veno-arterial ECMO with a particular attention on associated thrombotic complications. STUDY DESIGN: Monocentric retrospective study. PATIENTS AND METHODS: We examined 91 files of patients on ECMO between 2005 and 2010. During this period, eight patients presented refractory bleeding and benefited from rFVIIa treatment. RESULTS: In six of the eight patients, the bleeding stopped. A decrease of the bleeding was noticed after the treatment of rFVIIa (before rFVIIa: 40.1±33.1mL/kg per 3 hours after rFVIIa: 5.4±3.2mL/kg per 3 hours (P=0.01). The transfusional needs were decreased after administration of rFVIIa. No thrombotic event was detected. Fibrinogen, d-dimers, platelet count and lactate were not modified by the treatment. Two patients were weaned from ECMO. One patient died 17 days after the weaning. The other patient survived without neurological damages. CONCLUSION: The rFVIIa is a treatment of exception for patients on central veno-arterial ECMO and could be a last-resort treatment in the presence of a not curable massive bleeding.

Survival and quality of life after palliative surgery for neoplastic gastrointestinal obstruction.

OBJECTIVE: The aim was to identify the prognostic factors which relate to the results, in terms of survival and quality of life, of palliative surgery in cancer patients presenting with an occlusion. METHODS: The files of 109 patients with a neoplasm who were operated on for occlusion between 1990 and 2000 have been re-examined. The prognostic factors studied were age, sex, the location of the primary tumour, the extension of the cancer at the time of the operation, and the surgical procedure carried out. The impact on the quality of life was assessed by the resumption of transit and the return home. RESULTS: The median survival was 64 days and the peroperative mortality was 21%. The quality of life of patients has been improved in 65% of cases. The only factors clearly correlating to survival and the success of the operation are the aetiological diagnosis of the occlusion (local recurrence better than carcinomatosis) and the type of procedure it was possible to carry out (resection better than bypass). CONCLUSION: Palliative surgery can, in a certain number of cases, improve the quality of life of patients, but it has not been possible for us to demonstrate prognostic factors which would allow the selection of patients who could benefit the most from such surgery.