Publications by authors named "Alexandre Sebestyen"

Background: Skiing can cause aortic syndromes. The pre-hospital management of these patients may be compromised by the mountainous terrain. A regional emergency care network helps to optimize time frames, especially in a challenging geography.

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Article Synopsis
  • Predicting outcomes for patients receiving Left Ventricular Assist Devices (LVADs) is crucial, but current methods focusing on right ventricular function are lacking in prognostic value.
  • The study utilized data from the ASSIST-ICD registry to evaluate right ventriculoarterial coupling as a potential predictor of all-cause mortality upon LVAD implantation.
  • Findings showed that while some measures like TAPSE/sPAP and PAPi were not linked to long-term survival, the ratio of right atrial pressure to pulmonary capillary wedge pressure (RAP/PCWP) was significantly associated with increased mortality, maintaining its relevance even after adjusting for other risk factors.
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A 64-year-old patient required emergency surgery with high risk of intubation failure, without any possibility to perform neither a direct transtracheal access nor VV-ECMO canulation. The patient was managed thanks to a VA-ECMO despite the absence of cardiac function impairment. This report describes perioperative challenges and management of this unconventional case with favorable outcome.

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Background: Anticoagulation for cardiopulmonary bypass (CPB) in cases of heparin-induced thrombocytopenia (HIT) is challenging as no convenient and proven alternative, such as heparin alone, exists. A "platelet anesthesia" concept using antiplatelet agent cangrelor with heparin has been successfully reported in this setting.

Key Clinical Question: In cases of acute HIT, is CPB with cangrelor plus heparin effective and safe?.

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Background: Extubation strategy in extracorporeal life support patients remains unclear, and literature only reports studies with significant biases.

Objectives: To explore the prognostic impact of an early ventilator-weaning strategy in assisted patients after controlling for confounding factors.

Methods: A 10-year retrospective study included 241 patients receiving extracorporeal life support for at least 48 h, corresponding to a total of 977 days spent on assistance.

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Aortic pseudoaneurysms after acute Type A aortic dissection (ATAAD) repair have been reported as high as 10-24% and surgical treatment is usually recommended. The objective of this article is to examine the safety and efficacy of a conservative approach to aortic pseudoaneurysm and to compare this approach to standard surgical treatment. We retrospectively examined 39 patients who had an aortic pseudoaneurysm after ATAAD surgery in order to examine outcomes (baseline characteristics, presentation and freedom from aortic events and mortality).

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Objectives: Liver cirrhosis is a well-known risk factor of mortality after cardiac surgery, but not considered in the widely used EuroSCOREII (ESII). The objective was to analyse the performance of the ESII, the Child-Pugh-Turcotte (CPT) and the Model of End-stage Liver Disease (MELD) scores to predict hospital mortality in cardiac surgery for cirrhotic patients and to analyse the survival according to the preoperative cirrhosis status.

Methods: Preoperative and cirrhosis characteristics and postoperative outcomes were compared according to hospital mortality.

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Objective: Atrioventricular valve surgery poses a risk of myocardial infarction due to the proximity of the coronary arteries. Percutaneous techniques also present a risk of coronary injury. Our objective was to identify, on the mitral and the tricuspid annuli, the zones of high risk given their proximity to the circumflex artery and the right coronary artery, respectively.

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Cardiac pseudoaneurysm is a contained rupture of the cardiac wall. Rarely symptomatic, the risk of death by stroke or rupture is high and suggests surgical treatment. Surgical strategy depends on its anatomical considerations.

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Heparin anticoagulation followed by protamine reversal is commonly used in cardiopulmonary bypass (CPB). As an alternative to protamine, a recombinant inactive antithrombin (riAT) was designed as an antidote to heparin and was previously shown to be as potent as protamine in-vitro. In the present study, riAT was assessed for its ability to neutralize heparin after CPB in a rat model.

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