[Results of coronary artery bypass grafting with left ventricular dysfunction (comparison of off-pump versus on-pump)]. / Résultats du pontage coronaire en cas de dysfonction ventriculaire gauche (comparaison du cœur battant et de la CEC).

BACKGROUND: The aim of this study was to compare the results of myocardial revascularisation with or without cardiopulmonary bypass in patients with impaired left ventricular function. PATIENTS AND METHODS: Five hundred and sixteen consecutive patients who underwent coronary artery bypass grafting from January 2000 through December 2007 were analyzed retrospectively. One hundred and eight cases had a left ventricular EF (ejection fraction) of 45% or less. Of these patients, 78 underwent conventional coronary artery bypass (CCABG) and 30 underwent off-pump procedure (OCABG). The CCABG group received 300IU/kg of heparin while the OCABG received 100IU/kg. The off-pump coronary surgery was carried out using a tissue stabilizer Octopus II. Different pre-, per- and postoperative variables were evaluated among both groups. Statistical analysis was performed by SPSS 11.5. The variables were compared between these two groups using univariate analysis (Chi(2) test, Fisher's test exact) for qualitative variable and (Student's t test, Mann-Whitney's test) for quantitative variable. RESULTS: Patients profiles and risk factors were similar among both groups except for age (CCABG: 57.8±9.2 year vs OCABG: 52±9.9 year; P=0.004) and left ventricular EF (CCABG: 37.4±6.3% vs OCABG: 34±7.8%; P=0.02). The number of grafts performed per patient was significantly more among patients who underwent extracorporeal circulation (CCABG: 2.53±0.7 graft/patient vs OCABG: 1.77±0.8 graft/patient; P<0.0001). The hospital mortality was more among CCABG group 9% vs 3.3% in OCABG but the difference was not significant (P=0.3). However, the operative time and the operative room stay were long in CCABG (252±61min vs 175±38min; P<0.0001 - 389±70min vs 298±54min; P<0.0001). The ventilation time was also long in CCABG (32.3±67hour vs 10.4±5.9hour; P=0.15). There was more postoperative myocardial infarction in CCABG (P=0.008), but the EF increased and was better in CCABG. CONCLUSION: Off-pump coronary artery bypass surgery provides satisfactory operative results for most patients with reduced left ventricular function. Prospective and randomly study will be necessary before concluding.

Traumatic diaphragmatic and aortic rupture: an emerging challenge.

We report a case of traumatic diaphragmatic and aortic rupture in a 27-year-old man after a vehicle accident. The patient underwent successful aortic replacement with a prosthetic graft and diaphragmatic suture. The patient died one month later secondary to rupture of the infected graft. Acute traumatic aortic rupture (TAR) and blunt diaphragmatic rupture (BDR) are life-threatening complications of blunt chest trauma; more than 80 % of patients with these lesions die at the site of accident and only a very small percentage of cases are transferred alive to the emergency unit. In patients with major blunt trauma, aortic rupture and diaphragmatic rupture must be systematically included in the differential diagnosis.

[Antifibrinolytic agents and repeat open-heart surgery: a comparison of tranexamic acid and low dose aprotinin]. / Antifibrinolytiques et réinterventions chirurgicales à coeur ouvert: comparaison de l'acide tranexamique aux faibles doses d'aprotinine.

PURPOSE: This retrospective study has for objective to compare the effect of tranexamic acid with low-dose of aprotinin therapy on blood loss in reoperative cardiac surgery. METHODS: Ninety-one adult patients underwent repeated open-heart surgery. Two groups of patients were collected. The aprotinin group AP (N=60) has received an intravenous full low dose of 500000 UIK of aprotinin. The tranexamic group TA (N=31) has received 30 mg/kg of tranexamic acid. Criteria for assessment included: cumulative blood loss at 4 hours and 20 hours after operation, need for transfusion and parameters of coagulation (platelet, fibrinogen count). RESULTS: Demographics characteristics and echocardiographic data were similar between the tow groups. Postoperative blood loss at 4th hour and at 20th hour were reduced in tranexamic group compared with aprotinin group (P=0,009, P=0,001). The transfusion requirement was frequent in the AP group 39% vs 19.4% in TA group. The TA group received fewer total unit of red blood (0.38 unit RBC/patient vs 1.06 in AP group) [RBC=red blood cells]. There was no statistically significant difference in platelet and fibrinogen profiles. CONCLUSION: This study concludes that tranexamic acid and low dose aprotinin effectively reduces postoperative bleeding in repeat open-heart surgery. However, the marked difference in superiority between these tow drug therapies needs the randomized and controlled study.

[Surgery of active-phase infective endocarditis: report of 13 cases]. / Chirurgie de l'endocardite infectieuse à la phase active: à propos de 13 cas.

OBJECTIVE: Infective endocarditis is always a disease at the present time. In this work we report our initial experience of infective endocarditis surgical treatment during the acute phase. METHODS AND RESULTS: Between September 1993 and December 1997, 13 patients underwent valvular surgery for native infective endocarditis. Mean age was 31 +/- 11 years (range: 9 to 42 years); 92.3% of the patients presented with pre-existing rheumatical valvular lesion. Surgical indication was the occurrence of heart failure in all these patients. Surgery consisted on aortic valvular replacement in four patients, mitral and aortic valvular replacement in nine patients. Tricuspid valvuloplasty was required in two patients. Early mortality was 15% (two patients). A third patient developed cardiac failure and died three years postoperatively. CONCLUSION: This work emphasises the interest of the surgical treatment in the active phase of the infective endocarditis.