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Darras M, Schneider C, Marguerite S, Oulerih W, Collange O, Mertes PM, Mazzucotelli JP, Kindo M. Early chest tube removal on the first postoperative day protocol of an enhanced recovery after cardiac surgery programme is safe. Eur J Cardiothorac Surg 2024:ezae092. [PMID: 38466938 DOI: 10.1093/ejcts/ezae092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/14/2024] [Accepted: 03/08/2024] [Indexed: 03/13/2024] Open
Abstract
OBJECTIVES The aim of this study was to assess the safety of early chest tube removal (CTR) protocol on the first postoperative day (POD1) of our enhanced recovery after surgery (ERAS) programme by comparing the risk of postoperative pneumothorax, pleural and pericardial effusion requiring intervention and hospital mortality. METHODS All consecutive patients undergoing elective coronary revascularization and/or valve surgery between 2015 and 2021 were assessed in terms of their perioperative management pathways: conventional standard of care (control group) versus standardized systematic perioperative ERAS programme including an early CTR on POD1 (ERAS group). A propensity score matching was applied. The primary end-point was a composite of postoperative pneumothorax, pleural and pericardial effusion requiring intervention and hospital mortality. RESULTS A total of 3153 patients were included. Propensity score analysis resulted in two groups well-matched pairs of 1026 patients. CTR on POD1 was significantly increased from 29.5% in the control group to 70.3% in the ERAS group (P < 0.001). The incidence of the primary end-point was 6.4% in the control group and 6.9% in the ERAS group (P = 0.658). Patients in the ERAS group, as compared with control group, had significant lower incidence of bronchopneumonia (9.0% vs 13.5%; P = 0.001) and higher incidence of mechanical ventilation ≤6 hours (84.6% vs 65.2%; P < 0.001), length of intensive care unit ≤1 day (61.2% vs 50.8%; P < 0.001) and hospital ≤6 days (67.3% vs.43.2%; P < 0.001). CONCLUSIONS CTR on POD1 protocol can be safely incorporated into a standardized systematic ERAS programme, enabling early mobilization, and contributing to the improvement of postoperative outcomes.
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Affiliation(s)
- Marc Darras
- Department of Cardiac Surgery, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | - Clément Schneider
- Department of Cardiac Surgery, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | - Sandrine Marguerite
- Department of Anaesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | - Walid Oulerih
- Department of Anaesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | - Olivier Collange
- Department of Anaesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | - Paul-Michel Mertes
- Department of Anaesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | - Jean-Philippe Mazzucotelli
- Department of Cardiac Surgery, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | - Michel Kindo
- Department of Cardiac Surgery, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
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Lacroute J, Marcantoni J, Petitot S, Weber J, Levy P, Dirrenberger B, Tchoumak I, Baron M, Gibert S, Marguerite S, Huppertz J, Gronier O, Derlon A. The carbon footprint of ambulatory gastrointestinal endoscopy. Endoscopy 2023; 55:918-926. [PMID: 37156511 PMCID: PMC10533215 DOI: 10.1055/a-2088-4062] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 05/05/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Endoscopy is considered the third highest generator of waste within healthcare. This is of public importance as approximately 18 million endoscopy procedures are performed yearly in the USA and 2 million in France. However, a precise measure of the carbon footprint of gastrointestinal endoscopy (GIE) is lacking. METHODS This retrospective study for 2021 was conducted in an ambulatory GIE center in France where 8524 procedures were performed on 6070 patients. The annual carbon footprint of GIE was calculated using "Bilan Carbone" of the French Environment and Energy Management Agency. This multi-criteria method accounts for direct and indirect greenhouse gas (GHG) emissions from energy consumption (gas and electricity), medical gases, medical and non-medical equipment, consumables, freight, travel, and waste. RESULTS GHG emissions in 2021 were estimated to be 241.4 tonnes CO2 equivalent (CO2e) at the center, giving a carbon footprint for one GIE procedure of 28.4 kg CO2e. The main GHG emission, 45 % of total emissions, was from travel by patients and center staff to and from the center. Other emission sources, in rank order, were medical and non-medical equipment (32 %), energy consumption (12 %), consumables (7 %), waste (3 %), freight (0.4 %), and medical gases (0.005 %). CONCLUSIONS This is the first multi-criteria analysis assessing the carbon footprint of GIE. It highlights that travel, medical equipment, and energy are major sources of impact, with waste being a minor contributor. This study provides an opportunity to raise awareness among gastroenterologists of the carbon footprint of GIE procedures.
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Affiliation(s)
- Joël Lacroute
- Department of Gastroenterology, Centre d’Endoscopie et de Médecine Ambulatoire, Strasbourg, France
- Department of Gastroenterology, Clinique Sainte Barbe, Strasbourg, France
| | - Juliette Marcantoni
- Department of Anaesthesiology and Reanimation, Centre d’Endoscopie et de Médecine Ambulatoire, Strasbourg, France
- Department of Anaesthesiology and Reanimation, CHU, Strasbourg, France
| | | | | | - Patrick Levy
- Department of Gastroenterology, Centre d’Endoscopie et de Médecine Ambulatoire, Strasbourg, France
| | - Bastien Dirrenberger
- Department of Gastroenterology, Centre d’Endoscopie et de Médecine Ambulatoire, Strasbourg, France
| | - Irina Tchoumak
- Department of Gastroenterology, Centre d’Endoscopie et de Médecine Ambulatoire, Strasbourg, France
| | - Mathilde Baron
- Department of Anaesthesiology and Reanimation, Centre d’Endoscopie et de Médecine Ambulatoire, Strasbourg, France
| | - Stéphanie Gibert
- Department of Anaesthesiology and Reanimation, Centre d’Endoscopie et de Médecine Ambulatoire, Strasbourg, France
| | - Sandrine Marguerite
- Department of Anaesthesiology and Reanimation, Centre d’Endoscopie et de Médecine Ambulatoire, Strasbourg, France
| | - Jérôme Huppertz
- Department of Gastroenterology, Centre d’Endoscopie et de Médecine Ambulatoire, Strasbourg, France
| | - Olivier Gronier
- Department of Gastroenterology, Centre d’Endoscopie et de Médecine Ambulatoire, Strasbourg, France
| | - Anne Derlon
- Department of Gastroenterology, Centre d’Endoscopie et de Médecine Ambulatoire, Strasbourg, France
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Schneider C, Marguerite S, Ramlugun D, Saadé S, Maechel AL, Oulehri W, Collange O, Mertes PM, Mazzucotelli JP, Kindo M. Enhanced recovery after surgery program for patients undergoing isolated elective coronary artery bypass surgery improves postoperative outcomes. J Thorac Cardiovasc Surg 2023:S0022-5223(23)00730-4. [PMID: 37611846 DOI: 10.1016/j.jtcvs.2023.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/02/2023] [Accepted: 08/12/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE To evaluate the effect of a perioperative systematic standardized enhanced recovery after surgery (ERAS) program for patients undergoing isolated elective coronary artery bypass grafting (CABG) in terms of mortality, hospital morbidities, and length of stay. METHODS From January 2015 to September 2020, 1101 patients underwent isolated elective CABG. Our standardized systematic ERAS program was implemented in November 2018. Propensity score matching resulted in well-matched pairs of 362 patients receiving standard perioperative care (control group) and 362 patients on the ERAS program (ERAS group). There were no significant intergroup differences in preoperative and operative data except for the normothermia rate, which was significantly greater in the ERAS group (P < .001). The primary outcome was 3-year mortality. The secondary outcomes were hospital morbidities and length of stay. RESULTS In-hospital and 3-year mortality did not differ between the 2 groups. The ERAS program was associated with a significant relative risk decrease in mechanical ventilation duration (-53.1%, P = .003), length of intensive care unit stay (-28.0%, P = .015), length of hospital stay (-10.5%, P = .046), bronchopneumonia (-51.5%, P < .001), acute respiratory distress syndrome (-50.8%, P = .050), postoperative delirium (-65.4%, P = .011), moderate-to-severe acute kidney injury (-72.0%, P = .009), 24-hour chest tube output (-26.4%, P < .001), and overall red blood cell transfusion rate (-32.4%, P = .005) compared with the control group. CONCLUSIONS A systematic standardized ERAS program for low-risk patients undergoing isolated elective CABG was associated with a significant improvement in postoperative outcomes, reduction in red blood cell transfusion, shorter lengths of intensive care unit and hospital stays, and comparable long-term mortality.
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Affiliation(s)
- Clément Schneider
- Department of Cardiac Surgery, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | - Sandrine Marguerite
- Department of Anesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | - Dharmesh Ramlugun
- Department of Cardiac Surgery, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | - Saadé Saadé
- Department of Cardiac Surgery, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | - Anne-Lise Maechel
- Department of Anesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | - Walid Oulehri
- Department of Anesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | - Olivier Collange
- Department of Anesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | - Paul-Michel Mertes
- Department of Anesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | - Jean-Philippe Mazzucotelli
- Department of Cardiac Surgery, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | - Michel Kindo
- Department of Cardiac Surgery, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France.
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Giger A, Schneider C, Marguerite S, Ramlugun D, Maechel AL, Collange O, Mertes PM, Mazzucotelli JP, Kindo M. An enhanced recovery programme significantly improves postoperative outcomes after surgical aortic valve replacement. Eur J Cardiothorac Surg 2023; 63:7103309. [PMID: 37014362 DOI: 10.1093/ejcts/ezad125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 03/20/2023] [Accepted: 04/03/2023] [Indexed: 04/05/2023] Open
Abstract
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 (AS) in terms of hospital mortality and morbidity, patient blood management and length of stay. METHODS Patients undergoing isolated elective SAVR for AS between 2015 and 2020 were identified from our database (n = 941). The standardized systematic ERACS programme was implemented in November 2018. Propensity score matching indicated that 259 patients would receive standard perioperative care (control group) and 259 patients would receive the ERACS programme (ERACS group). The primary outcome was hospital mortality. The secondary outcomes were hospital morbidity, patient blood management and length of stay. RESULTS Both groups had similar hospital mortality rates (0.4%). The ERACS group had a significantly lower troponin I peak level (P < 0.001), a larger proportion of improved perioperative left ventricular ejection fractions (P = 0.001), a lower incidence of bronchopneumonia (P = 0.030), a larger proportion of patients with mechanical ventilation <6 hours (P < 0.001), a lower incidence of delirium (P = 0.028) and less acute renal failure (P = 0.013). The ERACS group had a significantly lower rate of red blood cell transfusions (P = 0.002). The intensive care unit stay was significantly shorter in the ERACS group than in the control group (P = 0.039). CONCLUSIONS The standardized systematic ERACS programme significantly improved postoperative outcomes and should become the reference for the perioperative care pathway for patients undergoing SAVR.
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Affiliation(s)
- Albane Giger
- Department of Cardiac Surgery, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | - Clément Schneider
- Department of Cardiac Surgery, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | - Sandrine Marguerite
- Department of Anaesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | - Dharmesh Ramlugun
- Department of Cardiac Surgery, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | - Anne-Lise Maechel
- Department of Anaesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | - Olivier Collange
- Department of Anaesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | - Paul-Michel Mertes
- Department of Anaesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | - Jean-Philippe Mazzucotelli
- Department of Cardiac Surgery, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | - Michel Kindo
- Department of Cardiac Surgery, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
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Mertes PM, Kindo M, Amour J, Baufreton C, Camilleri L, Caus T, Chatel D, Cholley B, Curtil A, Grimaud JP, Houel R, Kattou F, Fellahi JL, Guidon C, Guinot PG, Lebreton G, Marguerite S, Ouattara A, Provenchère Fruithiot S, Rozec B, Verhoye JP, Vincentelli A, Charbonneau H. Guidelines on enhanced recovery after cardiac surgery under cardiopulmonary bypass or off-pump. Anaesth Crit Care Pain Med 2022; 41:101059. [PMID: 35504126 DOI: 10.1016/j.accpm.2022.101059] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To provide recommendations for enhanced recovery after cardiac surgery (ERACS) based on a multimodal perioperative medicine approach in adult cardiac surgery patients with the aim of improving patient satisfaction, reducing postoperative mortality and morbidity, and reducing the length of hospital stay. DESIGN A consensus committee of 20 experts from the French Society of Anaesthesia and Intensive Care Medicine (Société française d'anesthésie et de réanimation, SFAR) and the French Society of Thoracic and Cardiovascular Surgery (Société française de chirurgie thoracique et cardio-vasculaire, SFCTCV) was convened. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. The entire guideline process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide the assessment of the quality of evidence. METHODS Six fields were defined: (1) selection of the patient pathway and its information; (2) preoperative management and rehabilitation; (3) anaesthesia and analgesia for cardiac surgery; (4) surgical strategy for cardiac surgery and bypass management; (5) patient blood management; and (6) postoperative enhanced recovery. For each field, the objective of the recommendations was to answer questions formulated according to the PICO model (Population, Intervention, Comparison, Outcome). Based on these questions, an extensive bibliographic search was carried out and analyses were performed using the GRADE approach. The recommendations were formulated according to the GRADE methodology and then voted on by all the experts according to the GRADE grid method. RESULTS The SFAR/SFCTCV guideline panel provided 33 recommendations on the management of patients undergoing cardiac surgery under cardiopulmonary bypass or off-pump. After three rounds of voting and several amendments, a strong agreement was reached for the 33 recommendations. Of these recommendations, 10 have a high level of evidence (7 GRADE 1+ and 3 GRADE 1-); 19 have a moderate level of evidence (15 GRADE 2+ and 4 GRADE 2-); and 4 are expert opinions. Finally, no recommendations were provided for 3 questions. CONCLUSIONS Strong agreement existed among the experts to provide recommendations to optimise the complete perioperative management of patients undergoing cardiac surgery.
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Affiliation(s)
- Paul-Michel Mertes
- Department of Anaesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, FMTS de Strasbourg, Strasbourg, France
| | - Michel Kindo
- Department of Cardiac Surgery, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, FMTS de Strasbourg, Strasbourg, France
| | - Julien Amour
- Institut de Perfusion, de Réanimation, d'Anesthésie de Chirurgie Cardiaque Paris Sud, IPRA, Hôpital Privé Jacques Cartier, Massy, France
| | - Christophe Baufreton
- Department of Cardiovascular and Thoracic Surgery, University Hospital, Angers, France; MITOVASC Institute CNRS UMR 6214, INSERM U1083, University, Angers, France
| | - Lionel Camilleri
- Department of Cardiovascular Surgery, CHU Clermont-Ferrand, T.G.I, I.P., CNRS, SIGMA, UCA, UMR 6602, Clermont-Ferrand, France
| | - Thierry Caus
- Department of Cardiac Surgery, UPJV, Amiens University Hospital, Amiens Picardy University Hospital, Amiens, France
| | - Didier Chatel
- Department of Cardiac Surgery (D.C.), Institut du Coeur Saint-Gatien, Nouvelle Clinique Tours Plus, Tours, France
| | - Bernard Cholley
- Anaesthesiology and Intensive Care Medicine, Hôpital Européen Georges-Pompidou, AP-HP, Université de Paris, INSERM, IThEM, Paris, France
| | - Alain Curtil
- Department of Cardiac Surgery, Clinique de la Sauvegarde, Lyon, France
| | | | - Rémi Houel
- Department of Cardiac Surgery, Saint Joseph Hospital, Marseille, France
| | - Fehmi Kattou
- Department of Anaesthesia and Intensive Care, Institut Mutualiste Montsouris, Paris, France
| | - Jean-Luc Fellahi
- Service d'Anesthésie-Réanimation, Hôpital Universitaire Louis Pradel, Hospices Civils de Lyon, Lyon, France; Faculté de Médecine Lyon Est, Université Claude-Bernard Lyon 1, Lyon, France
| | - Catherine Guidon
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, Aix Marseille University, Marseille, France
| | - Pierre-Grégoire Guinot
- Department of Anaesthesiology and Intensive Care, Dijon University Hospital, Dijon, France; University of Bourgogne and Franche-Comté, LNC UMR1231, Dijon, France; INSERM, LNC UMR1231, Dijon, France; FCS Bourgogne-Franche Comté, LipSTIC LabEx, Dijon, France
| | - Guillaume Lebreton
- Sorbonne Université, INSERM, Unité mixte de recherche CardioMetabolisme et Nutrition, ICAN, AP-HP, Hôpital Pitié-Salpétrière, Paris, France
| | - Sandrine Marguerite
- Department of Anaesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, FMTS de Strasbourg, Strasbourg, France
| | - Alexandre Ouattara
- CHU Bordeaux, Department of Anaesthesia and Critical Care, Magellan Medico-Surgical Centre, F-33000 Bordeaux, France; Univ. Bordeaux, INSERM, UMR 1034, Biology of Cardiovascular Diseases, F-33600 Pessac, France
| | - Sophie Provenchère Fruithiot
- Department of Anaesthesia, Université de Paris, Bichat-Claude Bernard Hospital, Paris, France; Centre d'Investigation Clinique 1425, INSERM, Université de Paris, Paris, France
| | - Bertrand Rozec
- Service d'Anesthésie-Réanimation, Hôpital Laennec, CHU Nantes, Nantes, France; Université de Nantes, CHU Nantes, CNRS, INSERM, Institut duDu Thorax, Nantes, France
| | - Jean-Philippe Verhoye
- Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - André Vincentelli
- Department of Cardiac Surgery, University of Lille, CHU Lille, Lille, France
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Oulehri W, Cristinar M, Ajob G, Marguerite S, Heger B, Cebula H, Kindo M, Mertes PM. Decompressive hemicraniectomy for acute ischemic stroke in a patient implanted with a left ventricular assist device: a case report. BMC Cardiovasc Disord 2020; 20:281. [PMID: 32522145 PMCID: PMC7285430 DOI: 10.1186/s12872-020-01576-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 06/04/2020] [Indexed: 11/24/2022] Open
Abstract
Background Thromboembolic ischemic stroke (IS) is one of the most feared complications of left ventricular assist device (LVAD) placement and represents a challenge to surgical management because of concomitant anticoagulant therapy. Case presentation A 39-year-old man presented with cardiogenic shock following an out-of-hospital cardiac arrest. After a period of stabilization, the patient was referred for LVAD placement. Upon recovery from anesthesia, he presented with acute neurological deficits suggestive of IS. A brain computed tomography confirmed the diagnosis, and an emergency decompressive hemicraniectomy (DHC) was performed. Anticoagulation was managed empirically. The patient’s neurological status progressively improved and he was referred for heart transplantation at five months from DHC. One month later, cranioplasty was performed. Conclusions This report suggests an anticoagulation management approach in combination with decompressive craniectomy after IS in a patient with LVAD placement was successful. An optimized anticoagulation management and collaborative team-based practice may contribute to successful outcomes in complex cases.
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Affiliation(s)
- Walid Oulehri
- Pôle Anesthésie Réanimation Chirurgicale, service de Réanimation Chirurgicale, Hôpitaux Universitaires de Strasbourg NHC, 1, Place de l'Hôpital, 67000, Strasbourg, France. .,EA 3072, Fédération de Médecine Translationnelle de Strasbourg, Institut de Physiologie, Université de Strasbourg, 67000, Strasbourg, France.
| | - Mircea Cristinar
- Pôle Anesthésie Réanimation Chirurgicale, service de Réanimation Chirurgicale, Hôpitaux Universitaires de Strasbourg NHC, 1, Place de l'Hôpital, 67000, Strasbourg, France
| | - Gharib Ajob
- Pôle Anesthésie Réanimation Chirurgicale, service de Réanimation Chirurgicale, Hôpitaux Universitaires de Strasbourg NHC, 1, Place de l'Hôpital, 67000, Strasbourg, France
| | - Sandrine Marguerite
- Pôle Anesthésie Réanimation Chirurgicale, service de Réanimation Chirurgicale, Hôpitaux Universitaires de Strasbourg NHC, 1, Place de l'Hôpital, 67000, Strasbourg, France
| | - Bob Heger
- Pôle Anesthésie Réanimation Chirurgicale, service de Réanimation Chirurgicale, Hôpitaux Universitaires de Strasbourg NHC, 1, Place de l'Hôpital, 67000, Strasbourg, France.,EA 3072, Fédération de Médecine Translationnelle de Strasbourg, Institut de Physiologie, Université de Strasbourg, 67000, Strasbourg, France
| | - Hélène Cebula
- Pôle Tête et Cou, service de Neurochirurgie, Hôpitaux Universitaires de Strasbourg NHC, 67000, Strasbourg, France
| | - Michel Kindo
- EA 3072, Fédération de Médecine Translationnelle de Strasbourg, Institut de Physiologie, Université de Strasbourg, 67000, Strasbourg, France.,Pôle Cardiologie, service de Chirurgie Cardiovasculaire, Hôpitaux Universitaires de Strasbourg NHC, 67000, Strasbourg, France
| | - Paul Michel Mertes
- Pôle Anesthésie Réanimation Chirurgicale, service de Réanimation Chirurgicale, Hôpitaux Universitaires de Strasbourg NHC, 1, Place de l'Hôpital, 67000, Strasbourg, France.,EA 3072, Fédération de Médecine Translationnelle de Strasbourg, Institut de Physiologie, Université de Strasbourg, 67000, Strasbourg, France
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7
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Rahal A, Ruch Y, Meyer N, Perrier S, Minh TH, Schneider C, Lavigne T, Marguerite S, Ajob G, Cristinar M, Epailly E, Mazzucotelli JP, Kindo M. Left ventricular assist device-associated infections: incidence and risk factors. J Thorac Dis 2020; 12:2654-2662. [PMID: 32642173 PMCID: PMC7330372 DOI: 10.21037/jtd.2020.03.26] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background 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. Infection-related data were retrospectively collected by review of patient's medical files. LVAD-associated infections were classified into three categories: percutaneous driveline infections, pocket infections and pump and/or cannula infections. Results We enrolled 72 patients. Twenty-one (29.2%) patients presented a total of 32 LVAD-associated infections. Eight (38.1%) patients had more than one infection. Five (62.5%) pocket infections and one (50.0%) pump and/or cannula infection were preceded by a driveline infection. The median delay between the operation and LVAD-associated infection was 6.5 (1.4-12.4) months. The probability of having a LVAD-associated infection at one year after receiving an implant was 26.6% (95% CI: 17.5-40.5%). Percutaneous driveline infections represented 68.7% of all LVAD-associated infections. Staphylococcus aureus and coagulase-negative staphylococci were the predominant bacteria in LVAD-associated infections (53.1% and 15.6%, respectively). Hospital length of stay (sdHR =1.22 per 10 days; P=0.001) and postoperative hemodialysis (sdHR =0.17; P=0.004) were statistically associated with infection. Colonization with multidrug-resistant bacteria was more frequent in patients with LVAD-associated infections than in others patients (42.9% vs. 15.7%; P=0.013). Conclusions LVAD-associated infections remain an important complication and are mostly represented by percutaneous driveline infections. Gram-positive cocci are the main pathogens isolated in microbiological samples. Patients with LVAD-associated infections are more frequently colonized with multidrug-resistant bacteria.
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Affiliation(s)
- Andréa Rahal
- Equipe Opérationnelle D'Hygiène, CHU de Strasbourg, 1, Place de l'Hôpital, 67091, Strasbourg, France
| | - Yvon Ruch
- Department of Infectious Diseases, University Hospital, Nouvel Hôpital Civil, Strasbourg, France
| | - Nicolas Meyer
- ICube, UMR7357, Université de Strasbourg, Strasbourg, France
| | - Stéphanie Perrier
- Department of Cardiovascular Surgery, University Hospitals of Strasbourg, Strasbourg, France
| | - Tam Hoang Minh
- Department of Cardiovascular Surgery, University Hospitals of Strasbourg, Strasbourg, France
| | - Clément Schneider
- Department of Cardiovascular Surgery, University Hospitals of Strasbourg, Strasbourg, France
| | - Thierry Lavigne
- Equipe Opérationnelle D'Hygiène, CHU de Strasbourg, 1, Place de l'Hôpital, 67091, Strasbourg, France
| | - Sandrine Marguerite
- Department of Anesthesia and Intensive Care Unit, University Hospitals of Strasbourg, Strasbourg, France
| | - Gharib Ajob
- Department of Anesthesia and Intensive Care Unit, University Hospitals of Strasbourg, Strasbourg, France
| | - Mircea Cristinar
- Department of Anesthesia and Intensive Care Unit, University Hospitals of Strasbourg, Strasbourg, France
| | - Eric Epailly
- Department of Cardiovascular Surgery, University Hospitals of Strasbourg, Strasbourg, France
| | | | - Michel Kindo
- Department of Cardiovascular Surgery, University Hospitals of Strasbourg, Strasbourg, France
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Carmona A, Hoang Minh T, Perrier S, Schneider C, Marguerite S, Ajob G, Mircea C, Mertes PM, Ramlugun D, Atlan J, Von Hunolstein JJ, Epailly E, Mazzucotelli JP, Kindo M. Minimally invasive surgery for left ventricular assist device implantation is safe and associated with a decreased risk of right ventricular failure. J Thorac Dis 2020; 12:1496-1506. [PMID: 32395287 PMCID: PMC7212123 DOI: 10.21037/jtd.2020.02.32] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Right ventricular failure (RVF) after left ventricular assist device (LVAD) implantation is associated with significant mortality and morbidity. The objective of this study was to determine pre- and postoperative risk factors associated with the occurrence of RVF after LVAD implantation. Methods This retrospective study included 68 patients who received LVADs between 2010 and 2018 either for bridge to transplant (40 patients, 58.8%) or bridge to destination therapy (28 patients, 41.2%). RVF after LVAD implantation was defined according to the INTERMACS classification. The primary endpoint was the occurrence of RVF. The secondary endpoints were hospital mortality and morbidity and long-term survival. Results The majority of patients (61.8%) had an INTERMACS profile 1 (36.8%) or 2 (25.0%). The LVAD was implanted either by sternotomy (37 patients, 54.4%) or thoracotomy (31 patients, 45.6%). RVF after LVAD implantation was observed in 32 patients (47.1%). In univariate analysis, an elevated serum glutamic oxaloacetic transaminase (SGOT) (P=0.028) and a high preoperative vasoactive inotropic score (VIS) (P=0.028) were significantly associated with an increased risk of RVF, whereas the implantation of LVAD through a thoracotomy approach was associated with a significant reduction in this risk (P=0.006). The multivariate analysis demonstrated that only the thoracotomy approach was significantly associated with decreased risk of RVF (odds ratio =0.33, 95% confidence interval: 0.17–0.96; P=0.042). Hospital mortality was 53.1% and 5.6% in the RVF and control groups, respectively (P<0.0001). The incidence of stroke and postoperative acute renal failure were significantly increased in the RVF group compared with the control group. The survival after LVAD implantation was 33.5%±9.0% and 85.4%±6.0% at 1 year in the RVF and control groups, respectively (P<0.0001). Conclusions LVAD implantation by thoracotomy significantly reduced the risk of postoperative RVF. This surgical approach should, therefore, be favored.
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Affiliation(s)
- Adrien Carmona
- Department of Cardiovascular Surgery, University Hospitals of Strasbourg, Strasbourg, France.,Department of Cardiology, University Hospitals of Strasbourg, Strasbourg, France
| | - Tam Hoang Minh
- Department of Cardiovascular Surgery, University Hospitals of Strasbourg, Strasbourg, France
| | - Stéphanie Perrier
- Department of Cardiovascular Surgery, University Hospitals of Strasbourg, Strasbourg, France
| | - Clément Schneider
- Department of Cardiovascular Surgery, University Hospitals of Strasbourg, Strasbourg, France
| | - Sandrine Marguerite
- Department of Anesthesia and Intensive Care Unit, University Hospitals of Strasbourg, Strasbourg, France
| | - Gharib Ajob
- Department of Anesthesia and Intensive Care Unit, University Hospitals of Strasbourg, Strasbourg, France
| | - Cristinar Mircea
- Department of Anesthesia and Intensive Care Unit, University Hospitals of Strasbourg, Strasbourg, France
| | - Paul-Michel Mertes
- Department of Anesthesia and Intensive Care Unit, University Hospitals of Strasbourg, Strasbourg, France
| | - Darmesh Ramlugun
- Department of Cardiovascular Surgery, University Hospitals of Strasbourg, Strasbourg, France
| | - Joseph Atlan
- Department of Cardiovascular Surgery, University Hospitals of Strasbourg, Strasbourg, France
| | | | - Eric Epailly
- Department of Cardiovascular Surgery, University Hospitals of Strasbourg, Strasbourg, France
| | | | - Michel Kindo
- Department of Cardiovascular Surgery, University Hospitals of Strasbourg, Strasbourg, France
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Rahal A, Ruch Y, Meyer N, Perrier S, Hoang Minh T, Schneider C, Lavigne T, Marguerite S, Ajob G, Cristinar M, Epailly E, Mazzucotelli JP, Kindo M. Infections associées aux assistances ventriculaires gauches : incidence et facteurs de risques. Rev Epidemiol Sante Publique 2020. [DOI: 10.1016/j.respe.2019.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Marguerite S, Levy F, Quessard A, Dupeyron JP, Gros C, Steib A. Impact of a phosphorylcholine-coated cardiac bypass circuit on blood loss and platelet function: a prospective, randomized study. J Extra Corpor Technol 2012; 44:5-9. [PMID: 22730857 PMCID: PMC4557439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 02/01/2012] [Indexed: 06/01/2023]
Abstract
Platelet dysfunction due to cardiopulmonary bypass (CPB) surgery increases the risk of bleeding. This study analyzed the effect of a phosphorylcholine (PC)-coated CPB circuit on blood loss, transfusion needs, and platelet function. We performed a prospective, randomized study at Strasbourg University Hospital, which included 40 adults undergoing coronary artery bypass graft surgery (CABG) (n = 20) or mitral valve repair (n = 20) using CPB. Patients were randomized either to PC-coated CPB or uncoated CPB (10 CABG patients and 10 mitral valve repair patients in each group). Blood loss and transfusion needs were evaluated intra- and postoperatively. Markers of platelet activation and thrombin generation were measured at anesthesia induction, at the beginning and end of CPB, on skin closure, and on days 0, 1, and 5. Comparisons were made by Student's t test or covariance analysis (significance threshold p < or = .05). Blood loss was significantly lower in the PC group during the first 6 postoperative hours (171 +/- 102 vs. 285 +/- 193 mL, p = .024), at the threshold of significance from 6-24 hours (p = .052), and similar in both groups after 24 hours. During CPB, platelet count decreased by 48% in both groups. There was no difference in markers of platelet activation, thrombin generation, or transfusion needs between the two groups. Norepinephrine use was more frequent in the control group (63% vs. 33%) but not significantly. PC-coating of the CPB surface reduced early postoperative bleeding, especially in CABG patients, but had no significant effect on platelet function because of large interindividual variations that prevented the establishment of a causal relationship.
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Affiliation(s)
- Sandrine Marguerite
- Department of Surgical Anesthesia and Intensive Care, Civil Hospital, Strasbourg University Hospital, Strasbourg, France.
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