Preoperative diastolic function predicts the onset of left ventricular dysfunction following aortic valve replacement in high-risk patients with aortic stenosis

INTRODUCTION: Left ventricular (LV) dysfunction frequently occurs after cardiac surgery, requiring inotropic treatment and/or mechanical circulatory support. In this study, we aimed to identify clinical, surgical and echocardiographic factors that are associated with LV dysfunction during weaning from cardiopulmonary bypass (CPB) in high-risk patients undergoing valve replacement for aortic stenosis. METHODS: Perioperative data were prospectively collected in 108 surgical candidates with an expected operative mortality ≥ 9%. All anesthetic and surgical techniques were standardized. Reduced LV systolic function was defined by an ejection fraction <40%. Diastolic function of the LV was assessed using standard Doppler-derived parameters, tissue Doppler Imaging (TDI) and transmitral flow propagation velocity (Vp). RESULTS: Doppler-derived pulmonary flow indices and TDI could not be obtained in 14 patients. In the remaining 94 patients, poor systolic LV was documented in 14% (n = 12) and diastolic dysfunction in 84% of patients (n = 89), all of whom had Vp <50 cm/s. During weaning from CPB, 38 patients (40%) required inotropic and/or mechanical circulatory support. By multivariate regression analysis, we identified three independent predictors of LV systolic dysfunction: age (Odds ratio [OR] = 1.11; 95% confidence interval (CI), 1.01 to 1.22), aortic clamping time (OR = 1.04; 95% CI, 1.00 to 1.08) and Vp (OR = 0.65; 95% CI, 0.52 to 0.81). Among echocardiographic measurements, Vp was found to be superior in terms of prognostic value and reliability. The best cut-off value for Vp to predict LV dysfunction was 40 cm/s (sensitivity of 72% and specificity 94%). Patients who experienced LV dysfunction presented higher in-hospital mortality (18.4% vs. 3.6% in patients without LV dysfunction, P = 0.044) and an increased incidence of serious cardiac events (81.6 vs. 28.6%, P < 0.001). CONCLUSIONS: This study provides the first evidence that, besides advanced age and prolonged myocardial ischemic time, LV diastolic dysfunction characterized by Vp ≤ 40 cm/sec identifies patients who will require cardiovascular support following valve replacement for aortic stenosis

Etude de l'impact de l'administration de cisapride ou d'un placebo sur la vidange gastrique et la nutrition entérale précoce chez des patients de soins intensifs sous ventilation mécanique

Un stress métabolique intense est observé chez les patients hospitalisés aux soins intensifs. Le catabolisme qui en résulte s'additionne à la pathologie de base et concoure à en aggraver l'évolution par une dénutrition. Plusieurs raisons sont invoquées pour expliquer le lien existant entre le catabolisme et la dénutrition. Elles peuvent être regroupées en deux catégories : les troubles en relation directe avec le catabolisme (redistribution du métabolisme, inflammation etc.) et ceux altérant la progression du bolus alimentaire. Le présent travail tente de diminuer les effets observés dans la seconde catégorie. Après avoir revu les bases pathophysiologiques ainsi que les effets du métabolisme augmenté lors de la maladie aiguë du patient de soins intensifs, une étude clinique est présentée. Elle teste l'hypothèse que l'administration de cisapride, médicament procinétique, augmente la vidange gastrique chez les patients bénéficiant d'une ventilation mécanique. Les résultats obtenus ont confirmé cette hypothèse sans effets secondaires remarquables

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Lack of Effect of Platelet Transfusions and Desmopressin on Intracranial Bleeding in a Patient Receiving Ticagrelor

We describe a case of a 67-year-old man who required emergency surgery for acute intracranial bleeding after having received a loading dose of aspirin and ticagrelor for an acute ST-elevation myocardial infarction. Before and during the craniocervical decompression, the assessment of platelet function was performed using the Multiplate® analyzer. Biological evaluation of platelet function was consistent with the clinical impression, suggesting that platelet transfusion and desmopressin administration in the presence of ticagrelor had very little, if any, hemostatic effect

Simulation-based medical education training improves short and long-term competency in, and knowledge of central venous catheter insertion: A before and after intervention study

Multimodal educational interventions have been shown to improve short-term competency in, and knowledge of central venous catheter (CVC) insertion

Connaître, documenter et conserver la photographie de studio indienne : l’exploration d’un fonds photographique d’Inde du Sud

International audienceDeux pans importants de la photographie en Inde sont encore peu ou mal connus : l’histoire de la photographie commerciale de studio et les conditions de conservation des matériaux photographiques, dans un contexte climatique propice à leur dégradation. Un fonds récemment constitué à partir d’archives de studios photographiques du Tamil Nadu (Inde du Sud) éclaire ces deux thématiques. Il permet d’étudier la production et la consommation courantes de photographie en Inde aux périodes coloniale et postcoloniale. Il soulève également des problématiques particulières de conservation, soulignant l’importance et l’intérêt de croiser les regards et les expertises sur cet objet d’étude