Publications by authors named "Michel Kindo"
Article Synopsis
- - Pathological tissues produce various substances, including extracellular vesicles (EVs) from active or dying cells.
- - EVs found in diseased heart valves may play a significant role in the development of valve thrombosis.
- - In cases of human aortic stenosis, EVs can activate valvular endothelial cells, causing dysfunction and increasing the chances of blood clotting.
Article Synopsis
- The French National Authority for Health (HAS) has released new guidelines for patient blood management (PBM) during surgeries, focusing on three key areas: optimizing red blood cell count, minimizing blood loss, and managing anemia tolerance.
- Preoperative recommendations include identifying anemia and iron deficiency early, especially for surgeries with a higher risk of bleeding.
- Intraoperative strategies involve using tranexamic acid and certain surgical techniques to control bleeding, while postoperative guidance emphasizes reducing blood sampling and monitoring for anemia to determine if treatments like intravenous iron are needed.
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.
Article Synopsis
- Atrial fibrillation (AF) is linked to heart issues and involves changes in heart tissue; this study explores how activated factor X (FXa) impacts this process in atrial endothelial cells and human heart tissues.
- The researchers used cells from pig hearts and human surgical samples, testing for various proteins, gene expressions, and signs of stress and fibrosis in response to FXa.
- Findings showed that FXa boosts harmful responses like oxidative stress and inflammation in atrial cells while reducing protective factors, and these effects can be blocked by specific inhibitors targeting FXa.
Article Synopsis
- - The study aims to determine if the preoperative pulmonary artery pulsatility index (PAPi) can predict mortality after left ventricular assist device (LVAD) implantation, as right ventricular failure is a significant concern following the procedure.
- - An analysis of 117 patients from 2007 to 2021 revealed that those with a PAPi of 2.84 or higher had a significantly better 3-month survival rate compared to those with lower PAPi levels.
- - Other factors influencing 2-year mortality included systemic hypertension, diabetes, and whether the LVAD was used as a bridge to transplant, with notable differences in survival outcomes between these groups.
Article Synopsis
- The study aimed to evaluate the safety of an early chest tube removal (CTR) protocol on the first postoperative day (POD1) within an Enhanced Recovery After Surgery (ERAS) program, comparing it with traditional care in terms of risks like pneumothorax and hospital mortality.* -
- The research included 3,153 patients, and after matching groups, it was found that the rate of early CTR increased significantly in the ERAS group, yet the overall incidence of complications remained similar between both groups.* -
- Results demonstrated that the ERAS group had better outcomes, including a lower risk of bronchopneumonia and shorter ICU and hospital stays, indicating that early CTR can be safely integrated into ERAS
Article Synopsis
- THC, the primary active ingredient in cannabis, negatively affects heart function, which may be worsened by aging and alcohol consumption.
- In experiments with young and old rats, THC significantly impaired mitochondrial respiration and increased reactive oxygen species (ROS) production, with older rats showing more severe effects.
- The study highlights the heightened risks of combining THC and alcohol, especially for older adults, suggesting that they should be cautious about using THC if they also drink alcohol.
Article Synopsis
- Transcatheter aortic valve replacement (TAVR) is the preferred treatment for severe aortic stenosis, and a study of 705 patients at Strasbourg University Hospital examined long-term survival rates after the procedure.
- The study found a 45.8% all-cause mortality rate over an average of 5.4 years, with no significant survival differences based on the type of valve used.
- Key factors influencing mortality included being aged 90 or older, having diabetes, experiencing post-TAVR stroke, and acute kidney injury, while more than half of the participants survived beyond 5 years post-procedure.
Article Synopsis
- The study aimed to evaluate the impact of a systematic enhanced recovery after surgery (ERAS) program on patients undergoing elective coronary artery bypass grafting (CABG) regarding mortality, complications, and hospital stay length.
- Researchers analyzed data from 1,101 patients, comparing 362 who received standard care with 362 who participated in the ERAS program, finding no significant difference in 3-year mortality but notable improvements in various postoperative outcomes for the ERAS group.
- Key findings included a significant reduction in mechanical ventilation duration, ICU stays, hospital length of stay, and certain complications, while demonstrating that the ERAS program resulted in similar long-term mortality rates compared to standard care.
Heart transplantation as a rescue strategy for patients with refractory electrical storm.
Raphael P Martins Mathilde Hamel-Bougault Francis Bessière Matteo Pozzi Fabrice Extramiana Michel Kindo
Eur Heart J Acute Cardiovasc Care
September 2023
Article Synopsis
- Heart transplantation (HT) may be a lifesaving option for patients experiencing severe refractory electrical storm (ES), a condition characterized by uncontrollable heart arrhythmias, with limited existing data on this approach.
- A retrospective study involving 45 patients from 11 French centers revealed that 28.9% experienced in-hospital mortality, with predictors including kidney function and the need for immediate post-operative support.
- One-year survival after surgery was reported at 68.9%, indicating that while many patients can recover and be discharged, significant risks remain, highlighting the need for larger studies to better understand patient outcomes.
Objectives: Evidence regarding the benefits of an enhanced recovery after cardiac surgery (ERACS) programme is lacking. The aim of this study was to analyse the impact of a systematic standardized ERACS programme for patients undergoing isolated elective surgical aortic valve replacement (SAVR) for aortic stenosis in terms of hospital mortality and morbidity, patient blood management and length of stay.
Methods: Patients undergoing isolated elective SAVR for aortic stenosis between 2015 and 2020 were identified from our database (n = 941).
Article Synopsis
- The study examines mitochondrial function in circulating peripheral blood mononuclear cells (PBMCs) of heart transplant (Htx) patients compared to healthy controls, noting a decrease in complex II respiration and an increase in complex IV respiration in Htx patients.
- Enhanced superoxide anion production and changes in leucocyte-to-lymphocyte ratios were observed in Htx patients, suggesting a correlation between mitochondrial respiration and immune cell dynamics.
- The findings indicate that despite normal systolic function, heart transplant patients exhibit abnormal PBMC mitochondrial respiration, which may be affected by subclinical diastolic dysfunction and the immune response related to the transplant.
Article Synopsis
- A study comparing aortic valve repair and replacement in patients with aortic root aneurysm showed no significant differences in overall patient outcomes up to 4 years, although repairs slightly favored fewer valve-related deaths and major bleeding incidents.
- The multicentric CAVIAAR study included 261 patients, with 130 receiving valve repair and 131 receiving valve replacement, measuring various adverse events and outcomes after the procedures.
- Despite similar primary outcomes, repair patients experienced a notable decrease in certain complications, suggesting potential benefits of valve repair that warrant further long-term research.
Article Synopsis
- The objective of this text is to recommend strategies for enhanced recovery after cardiac surgery (ERACS) using a comprehensive approach aimed at improving patient satisfaction, reducing mortality and morbidity, and decreasing hospital stays.
- A consensus of 20 experts from French medical societies developed these guidelines independently without industry influence, utilizing the GRADE system to evaluate the quality of evidence.
- The guidelines cover six key areas of patient care, leading to 33 specific recommendations focused on improving preoperative, surgical, and postoperative management for cardiac surgery patients.
Article Synopsis
- The study investigates the outcomes of cardiogenic shock patients receiving temporary circulatory support (TCS) as a bridge to left ventricular assist device (LVAD) implantation, comparing them to patients without TCS.
- Out of 329 patients analyzed, those under TCS had similar 30-day survival rates to those who had TCS removed or did not use a bridging strategy but experienced longer ICU stays and increased mechanical ventilation time.
- Key predictors of mortality in the TCS group include combined surgery with LVAD, body mass index (BMI), and duration of heart failure, while the use of TCS itself did not significantly impact survival rates.
Article Synopsis
- Advanced heart failure patients often experience delays in being referred for mechanical circulatory support, specifically left ventricular assist devices (LVAD), which raises concerns about their survival rates post-implantation.
- The study analyzed data from the ASSIST-ICD registry involving 303 non-inotrope-dependent patients, discovering that factors like older age and certain surgical procedures significantly increase mortality risk after receiving an LVAD.
- Despite LVAD support, survival rates over five years remain low, highlighting the need for improved patient selection to enhance outcomes in such high-risk individuals.
Article Synopsis
- LVAD implantation in patients with recently diagnosed cardiomyopathy is under-researched, and this study aims to explore characteristics and outcomes of such patients within 30 days of their diagnosis.
- Out of 652 patients studied, 117 had recently diagnosed cardiomyopathy and experienced LVAD implantation after an average of 15 days, showing they were generally younger and had more severe symptoms compared to those with remote diagnoses.
- Although immediate postoperative survival rates were similar between groups, patients with recently diagnosed cardiomyopathy had improved long-term survival, with certain factors like sudden cardiac arrest identified as risk indicators for higher mortality.
Article Synopsis
- The study examines the effective orifice area (EOA) and mean transvalvular aortic gradient (MG) of three types of transcatheter heart valves (Sapien 3, CoreValve, and Evolut R) in patients with severe aortic stenosis undergoing TAVI.
- Using Doppler echocardiography, measurements were taken at multiple time points (discharge, 1 month, 6 months, and 1 year) for 260 patients.
- Results indicated that larger prostheses had higher EOAs and lower MGs, with the CoreValve and Evolut R performing better in smaller aortic annulus cases, while there were no significant differences in all-cause mortality between the valve types
Article Synopsis
- LVAD implantation can be a viable treatment option for elderly patients (70+) with heart failure who aren't suitable for heart transplants.
- An observational study analyzed 652 patients from 2006 to 2016, with 74 (11.3%) being elderly, showing similar hospitalization patterns and complication rates between elderly and younger patients.
- The findings indicate that elderly patients receiving LVADs have comparable mid-term survival rates to younger patients, supporting the use of LVADs in this age group.
Article Synopsis
- The study examined how low and high body mass index (BMI) affect survival outcomes in patients who underwent left-ventricular assist device (LVAD) surgery across 19 medical centers from 2006 to 2016.
- Out of 652 patients studied, those with high BMI typically had more co-existing health issues and were mostly male, while underweight patients had the lowest survival rates overall.
- Four key predictors of mortality were identified for patients with abnormal BMI: high total bilirubin levels, hypertension, whether they were receiving LVAD as destination therapy, and previous cardiac surgeries, categorizing patients into low, intermediate, and high risk for 1-year mortality.
Article Synopsis
- Stroke is a significant concern for patients undergoing transcatheter aortic valve replacement (TAVR), and this study identifies predictors for these ischemic neurological events, focusing on von Willebrand factor (VWF) defects.
- In a study of 565 TAVR patients, 3.7% experienced ischemic strokes or transient ischemic attacks (TIAs) within 30 days, with these events linked to major bleeding complications and prolonged closure time measurements (CT-ADP) post-procedure.
- The findings highlight that major/life-threatening bleeding complications and a CT-ADP greater than 180 seconds are independent risk factors for ischemic strokes or TIAs in TAVR patients, suggesting VWF defects may
Pulsatile Carmat bioprosthetic total artificial heart (C-TAH) is designed to be implanted in patients with biventricular end-stage heart failure. Since flow variation might contribute to endothelial dysfunction, we explored circulating endothelial biomarkers after C-TAH implantation in seven patients and compared the manual and autoregulated mode. Markers of endothelial dysfunction and regeneration were compared before and during a 6- to 9-month follow-up after implantation.
View Article and Find Full Text PDFBackground: Left ventricular assist device (LVAD)-associated infections are major complications that can lead to critical outcomes. The aims of this study were to assess the incidence of and to determine the risk factors for LVAD-associated infections.
Methods: We included all consecutive patients undergoing LVAD implantation between January 1, 2010, and January 1, 2019, in a single institution.
Implantable cardiac defibrillator leads dysfunction after LVAD implantation.
Pacing Clin Electrophysiol
November 2020
Article Synopsis
- * Out of 401 patients with an ICD before LVAD, 122 had their ICD checked before and after implantation, with 55% showing significant lead dysfunction, including issues with sensing and pacing.
- * Despite the lead dysfunction observed, it did not result in severe clinical problems, indicating that management of these issues was effective and conservative.
Article Synopsis
- Thromboembolic ischemic stroke (IS) is a serious risk following the placement of a left ventricular assist device (LVAD), complicating surgical treatment due to the use of anticoagulants.
- A 39-year-old man experienced cardiogenic shock and underwent LVAD placement, but developed acute neurological deficits indicative of IS, which was confirmed by a CT scan; he then underwent emergency decompressive hemicraniectomy.
- The case highlights that a careful approach to anticoagulation and teamwork in managing post-stroke care following LVAD surgery can lead to improved patient outcomes, including eventual heart transplantation.