Publications by authors named "Pascal lePrince"
Objective: The study objective was to evaluate outcomes of patients directly bridged with venoarterial extracorporeal membrane oxygenation to heart transplantation.
Methods: A single-center retrospective study was performed on 1152 adult patients undergoing isolated cardiac transplantation between January 2007 and December 2021. Among these, patients bridged with an extracorporeal membrane oxygenation to transplantation (extracorporeal membrane oxygenation group, n = 317) were compared with standard cohorts of patients (no extracorporeal membrane oxygenation group, n = 835).
Background: Lower mini-sternotomy offers the advantage of providing excellent visualization of the 4 cardiac cavities, allowing surgical treatment of aortic, mitral and tricuspid valves as well as any intra-cavitary procedure. Technical issues, as well as safety and echocardiographic results of this approach, are lacking. The aim of this retrospective study was to describe outcomes of lower mini-sternotomy to treat valvulopathies and other intracardiac surgeries.
View Article and Find Full Text PDFPurpose: Whether skin disinfection of the surgical site using chlorhexidine-alcohol is superior to povidone-iodine-alcohol in reducing reoperation and surgical site infection rates after major cardiac surgery remains unclear.
Methods: CLEAN 2 was a multicenter, open-label, randomized, two-arm, assessor-blind, superiority trial conducted in eight French hospitals. We randomly assigned adult patients undergoing major heart or aortic surgery via sternotomy, with or without saphenous vein or radial artery harvesting, to have all surgical sites disinfected with either 2% chlorhexidine-alcohol or 5% povidone-iodine-alcohol.
Article Synopsis
- This study examines the effectiveness of switching patients from peripheral veno-arterial ECMO (pECMO) to central ECMO (cECMO) as a treatment strategy for refractory cardiogenic shock (rCS).
- Out of 80 patients analyzed, only 38% were successfully bridged to recovery, heart transplantation, or a ventricle assist device, while the remaining 62% died during cECMO treatment.
- Complications were common, with high rates of renal issues and bleeding, and the study found that myocardial infarction significantly increased the risk of in-hospital mortality.
Article Synopsis
- Type A acute aortic dissection (TAAAD) is a serious medical emergency requiring immediate surgical intervention, and understanding treatment options is crucial for improving patient outcomes.
- A multicenter observational registry called AoArch has been established, combining data from four cardiac surgery centers in Europe to analyze the effects of hemiarch repair (HAR) versus extended arch repair (EAR) on patient outcomes following TAAAD surgery.
- The study will assess various factors, such as patient co-morbidities and surgical strategies, to measure both early and late adverse events, with a focus on defining mortality rates and complications related to TAAAD treatments.
Article Synopsis
- The study focuses on the incidence and outcomes of prosthetic valve thrombosis in patients who received peripheral veno-arterial extracorporeal membrane oxygenation (pVA-ECMO) after valve replacement surgery for postcardiotomy cardiogenic shock (PCCS).
- It involved a retrospective analysis of 549 patients, with 152 having valve replacements, and found that 9 developed thrombosis, resulting in a 30-day thrombosis incidence of approximately 7.5%.
- The findings suggest that using an intra-aortic balloon pump (IABP) in conjunction with pVA-ECMO significantly reduces the risk of valve thrombosis and is linked to lower hospital mortality rates.
Article Synopsis
- High-risk pulmonary embolism (PE) patients can experience hemodynamic instability despite treatment; VA-ECMO is explored as a life-saving intervention, but pre-treatment with systemic thrombolysis poses risks of bleeding.
- A study covering 72 patients assessed ECMO complications and survival rates, revealing similar 90-day survival rates and bleeding incidents between those treated with systemic thrombolysis and those without.
- Long-term quality of life for survivors was found to be acceptable, indicating that recent systemic thrombolysis shouldn't be deemed a contraindication for VA-ECMO in high-risk PE cases.
Article Synopsis
- Right ventricular failure (RVF) is a critical issue leading to high mortality rates shortly after heart transplantation, and the study explores how isoproterenol (Iso) can help improve heart function in these patients.
- A retrospective study over one year evaluated the hemodynamic effects of Iso in 25 patients with early RVF, comparing no Iso treatment to low and high doses of Iso.
- Results showed that Iso significantly increased heart rate and cardiac index, indicating improved heart function, while its effects on pulmonary pressures were minimal, highlighting its potential as a beneficial treatment for RVF post-heart transplant.
Objectives: This study aimed to identify perioperative risk factors of acute kidney injury after heart transplantation and to evaluate 1-year clinical outcomes.
Design: A retrospective single-center cohort study.
Setting: At a university hospital.
Article Synopsis
- Management of dual antiplatelet therapy (DAPT) in VA-ECMO patients post-acute myocardial infarction (AMI) presents challenges, with significant occurrences of severe bleeding and coagulation issues.
- A study analyzed 176 post-AMI patients on VA-ECMO, finding nearly 39% experienced severe bleeding and a high mortality rate of 49%.
- Factors such as female sex, duration on ECMO, and certain biomarkers were linked to an increased risk of severe bleeding, which led to the discontinuation of antiplatelet therapy in one-third of the cases.
Article Synopsis
- The EFCAD registry is a study aimed at understanding how transit-time flow measurement (TTFM) impacts the outcomes of coronary artery bypass grafting (CABG) surgeries.
- The study collected data from 1616 patients across 9 centers, analyzing factors like major adverse cardiac events and graft revisions, with significant findings linked to graft flow measurements.
- Results indicated that inadequate flow in left anterior descending artery grafts negatively affects patient outcomes, suggesting that TTFM should be routinely employed in CABG procedures for better results.
Article Synopsis
- Type A acute aortic dissection (TAAAD) is a life-threatening condition that requires urgent treatment, with a current survival rate post-surgery around 20%, and high arterial lactate levels are identified as a crucial predictor of poor outcomes.
- The study evaluated 633 patients over a 17-year period, focusing on those with complete preoperative data, revealing that early postoperative mortality was 24.5% with malperfusion significantly affecting survival rates.
- Results showed that while there was no notable difference in mortality between conservative and extensive surgical approaches, elevated preoperative arterial lactates correlated with malperfusion and increased risk of death, warranting further investigation into its prognostic relevance.
Article Synopsis
- Fulminant myocarditis is a serious condition that requires accurate diagnosis, typically through a myocardial biopsy, but the procedure carries risks, and its effectiveness for treatment is unclear.
- A study at a French ICU examined patients who were on mechanical circulatory support (MCS) and underwent biopsy, finding that while the diagnosis of definite myocarditis increased significantly after biopsy, the actual change in treatment was minimal.
- The study concluded that the risks associated with myocardial biopsy may outweigh its benefits in these vulnerable patients, suggesting a need for more caution in deciding to perform the procedure.
Background: Although, valve sparing is commonly performed in patients with Marfan syndrome, feasibility and results of cusp repair for aortic insufficiency have not been studied.
Aim: To report on the outcomes and durability of aortic cusp repair in valve sparing in patients with Marfan syndrome.
Methods: All consecutive adult patients with Marfan syndrome who underwent remodelling and annuloplasty with aortic valve repair for aortic insufficiency between May 2005 and December 2020 were included.
Background: A retrieval programme was developed in Martinique (French West Indies) to provide extracorporeal membrane oxygenation for patients in the Caribbean, where heart transplantation and ventricular assist devices are not available. In 2011, the Department of Cardiac Surgery at the University Hospital of Fort-de-France (Martinique) developed a transfer programme to Paris (France) on an airliner, to refer patients for whom extracorporeal membrane oxygenation was not weanable to heart transplantation or a ventricular assist device.
Aim: To report this unique experience of transportation of patients under extracorporeal membrane oxygenation support on an airliner from the French West Indies to Paris.
Aims: The epidemiology of sudden cardiac death (SCD) after heart transplantation (HTx) remains imprecisely described. We aimed to assess the incidence and determinants of SCD in a large cohort of HTx recipients, compared with the general population.
Methods And Results: Consecutive HTx recipients (n = 1246, 2 centres) transplanted between 2004 and 2016 were included.
Background: The 2018 World Symposium on Pulmonary Hypertension (WSPH) changed the definition of pulmonary hypertension (PH) with a new threshold of mean pulmonary artery pressure (mPAP) above 20 mmHg.
Objective: To evaluate the profile and prognosis of patients with chronic heart failure (HF) considered for heart transplantation with the new definition of PH.
Methods: Patients with chronic HF considered for heart transplantation were classified as mPAP, mPAP , and mPAP.
Association between vasoactive-inotropic score, morbidity and mortality after heart transplantation.
Interdiscip Cardiovasc Thorac Surg
April 2023
Objectives: The aim of this study was to evaluate the association between vasoactive-inotropic score (VIS), calculated in the 24 h after heart transplantation, and post-transplant mortality and morbidity.
Methods: This was an observational single-centre retrospective study. Patients admitted to surgical intensive care unit after transplantation, between January 2015 and December 2018, were reviewed consecutively.
Background: In 2018, a cardiac allocation scheme based on an individual score considering the risk of death both on the waitlist and after heart transplantation was implemented in France.
Aims: To analyse the practical application of the pre- and post-transplant risk score in a French high-volume heart transplantation centre.
Methods: All consecutive adult patients listed for a first non-combined heart transplantation between 02 January 2018 and 30 June 2022 at our centre were included.
Article Synopsis
- A new continuous flow mini pump has been created to help improve conditions for patients with Heart Failure with Preserved Ejection Fraction (HFpEF), for which no current treatments exist.
- The pump works by discharging a limited amount of blood from the left atrium to the subclavian artery, aimed at enhancing blood flow.
- The article details the pump's design, performance testing through in vitro circulation loops, computer simulations, and compares two pump configurations based on hemocompatibility indicators.