[Screening for Staphylococcus aureus before heart surgery]. / Dépister le Staphylococcus aureus avant une chirurgie cardiaque.

One patient out of four having to undergo an operation is a carrier of Staphylococcus aureus. This, notably in cases of heart surgery, increases the risk of developing a nosocomial infection with this very germ in the post-operative period. Nurses must implement appropriate care procedures to favour decolonisation and the education of these patients.

Ascending aorto-superior mesenteric artery bypass as a surgical option for revascularization in mesenteric ischemia associated with type B aortic dissection.

We report the case of an acute ischemia of the superior mesenteric artery (SMA) after endovascular fenestration of a complicated acute type B aortic dissection. An initial attempt for endovascular revascularization of the SMA failed, and an ascending aorto-superior mesenteric artery bypass was urgently performed to salvage the small bowel. Surgery of patients in these specific settings is more complex because an adequate, more distal inflow vessel is often not present due to the dissected aorta and iliac arteries. This surgical option could be lifesaving and should be part of the vascular surgeon's armamentarium.

Annuloplasty for valve repair with a new biodegradable ring: an experimental study.

BACKGROUND AND AIM OF THE STUDY: The biodegradable ring was recently developed for mitral and tricuspid annuloplasty. The study aim was to assess the histological biocompatibility of the biodegradable ring and orifice area growth in a porcine model. METHODS: The smallest (size 16) biodegradable ring was implanted into the tricuspid annulus of 16 juvenile pigs. All animals were followed up by transthoracic echocardiography to evaluate tricuspid valve function. Animals were sacrificed at one, three, six, nine and 12 months after implantation. Macroscopic and histological analyses were performed on three sections per ring implantation site. Parameters from the study group were compared to those obtained from control animals that underwent cardiopulmonary bypass without ring implantation. RESULTS: Histological examination showed that the biodegradable ring was gradually replaced by fibrous tissue, with complete hydrolytic degradation within six months. The thickness of the dense fibrous tissue reached that of the initial ring at 12 months. No fibrous tissue development was observed in control animals. Echocardiography showed no signs of tricuspid valve dysfunction, a preserved ventricular contractility, and physiological growth of the tricuspid valve orifice. Macroscopic measurement of the valve orifice area confirmed that the generated fibrous tissue allows for physiological growth of the native annulus. CONCLUSION: The concept of annulus remodeling using a biodegradable ring which preserves the growth potential of the native annulus opens new perspectives for valve repair procedures in the pediatric population. An undoubted contribution is also made to evolving annuloplasty technology.

Long-term outcome after surgical intervention and interventional procedures for the management of Takayasu's arteritis in children.

OBJECTIVE: There is little information available on the results of reconstructive arterial surgery for Takayasu's arteritis in children. This study evaluates midterm to long-term outcome after surgical, as well as interventional, procedures. METHODS: From 1984 through 2004, 10 children (5 boys and 5 girls; age, 12.7 +/- 2.6 years) with Takayasu's arteritis were referred to our center. Baseline cardiovascular assessment included contrast angiography (n = 4), magnetic resonance imaging-angiography (n = 3), and combined contrast angiography plus magnetic resonance imaging-angiography (n = 3). Two patients had disease confined to the thoracic aorta, 4 had disease confined to the abdominal aorta, and 4 had combined thoracoabdominal aortic disease. Steno-occlusive lesions were predominant in 92% of cases. Seven patients were maintained on steroid therapy throughout the follow-up period. Eight children underwent complex surgical procedures, 1 patient had balloon dilatation of the renal and mesenteric arteries, and 1 patient had combined vascular surgery with percutaneous transluminal angioplasty. Overall, 24 grafts (polytetrafluoroethylene, Dacron grafts, and cryopreserved homografts) were implanted in various locations. RESULTS: There were no perioperative deaths. Arterial hypertension regressed in all patients, and cardiac function normalized in all 4 patients with dilative cardiomyopathy. Over a 20-year period, 1 patient presented with sudden death and 2 showed nonfatal disease progression, one of whom required surgical reintervention. The occlusion rate was higher in Dacron grafts. CONCLUSIONS: Our study shows that despite the extent and severity of vascular lesions, children with Takayasu's arteritis could benefit from reconstructive surgery, with low mortality, morbidity, and satisfactory long-term results.

Intra-aortic filtration: capturing particulate emboli during aortic cross-clamping.

Particulate emboli are an important factor in the development of complications after cardiac surgery. The use of an intra-aortic filter during aortic declamping has proved safe and effective in reducing the incidence of embolic complications. Because aortic cross-clamping is also associated with the risk of embolism, we measured the release of particulate emboli at the time of aortic cross-clamping and at declamping. We deployed intra-aortic filters (Edwards EMBOL-X Slim Protection System) at 2 different times during 15 consecutive cardiac procedures with cardiopulmonary bypass. Filter A was inserted before aortic cross-clamping and left in place for a mean time of 3 minutes, and Filter B was inserted before aortic declamping for a mean of 17 minutes. An independent institution performed histopathologic examination. All filters captured particulate emboli, independent of the patients' degree of proximal aortic atherosclerotic disease. Macroscopy showed that Filter A captured more particles (mean, 70 +/- 2.6) in 7 of 15 patients (46.7%), Filter B captured more particles (mean, 6.7 +/- 2.6) in 5 of 15 patients (33.3%), and the filters captured the same number in 3 of 15 patients (20%). Microscopy showed that both filters captured fibrous atheroma or fibrous cap in 10 of 15 patients. We observed no complications related to the use of the filters. Aortic cross-clamping is associated with a high risk of embolism. We suggest that optimal protection against embolism during cardiac surgery can be achieved by applying intra-aortic filtration not only before aortic declamping but also before aortic cross-clamping.

Tricuspid valve replacement with a mitral homograft in children with rheumatic tricuspid valvulopathy.

OBJECTIVE: Tricuspid valve replacement in children is associated with a nonnegligible complication rate because of specific disadvantages of mechanical or biologic prostheses. The objective of this study was to examine the midterm clinical outcomes of tricuspid valve replacement with a mitral homograft in 8 children with unreparable rheumatic tricuspid valve involvement. METHODS: Between 1993 and 2003, tricuspid valve replacement with a mitral homograft was performed in 8 patients (2 male and 6 female patients; mean age, 14.2 years) with rheumatic tricuspid valve disease. All patients were in New York Heart Association class III or IV. In all patients with rheumatic valve disease, conservative operations had previously been performed on the tricuspid valve during concomitant left-sided surgical intervention. Mean follow-up was 56 +/- 12 months and was complete. RESULTS: There were no operative or late deaths. All patients were alive at the most recent follow-up contact and were in New York Heart Association functional class I or II. None of the patients required homograft-related reoperation. At the most recent echocardiograhic examination, 6 patients had trivial residual tricuspid regurgitation, and 2 had mild tricuspid regurgitation. None of the patients had maximal transvalvular tricuspid gradients greater than 2 mm Hg during their yearly follow-up visits. CONCLUSION: On the basis of our midterm results, tricuspid valve replacement with a mitral homograft in children seems to be a valuable alternative surgical option.

Blood group incompatibility and accelerated homograft fibrocalcifications.

OBJECTIVE: Cryopreserved valved homograft has become the conduit of choice for right ventricular outflow tract reconstruction in pediatric cardiac surgery. Aortic homografts have been frequently used in pulmonary position, but accelerated aortic homograft fibrocalcification may occur. Blood group incompatibility between receiver and homograft donor may play a central role in this context. METHODS: Between 1993 and 2000, 59 children (mean age 6.4 +/- 4.4 years) received cryopreserved valved homografts for right ventricular outflow tract reconstruction and were followed from 2 to 10 years clinically, with echocardiography and chest radiography for detection of development of homograft calcifications. Seventeen patients were 3 years or younger. Fifty aortic (85%) and 9 pulmonary homografts were all used in pulmonary position. Thirty-three patients (56%) had the same blood group (ABO) as the homograft donor (iso group), and 26 were blood group-incompatible (non-iso group). RESULTS: No deaths occurred during follow-up. Six patients (10.2%) required homograft replacement because of severe fibrocalcifications, and another 3 showed moderate homograft calcifications (5.1%) at last examination. Freedom from moderate to severe homograft calcification at 8 years (Kaplan-Meier) was 95.2% for the iso group and 72.9% for the non-iso group (P <.0001). Homograft calcifications occurred within 2 years of implantation in 6/9 patients (67%) in the non-iso group. CONCLUSIONS: Blood group incompatibility between receiver and homograft donor seems to play an important role in the development of accelerated fibrocalcifications in cryopreserved homografts, particularly in the very young (3 years old or younger). Blood group compatibility should therefore be respected to avoid accelerated homograft fibrocalcifications.