Publications by authors named "Thierry Lepoivre"

11 Publications

  • Page 1 of 1

Success of Thrombectomy in Management of Ischemic Stroke in Two Patients with SynCardia Total Artificial Heart in Bridge-to-Transplantation.

Bioengineering (Basel) 2021 Sep 19;8(9). Epub 2021 Sep 19.

Department of Cardiothoracic Surgery, Nantes University Hospital, 44093 Nantes, France.

Introduction: Circulatory assistance from a SynCardia Total Artificial Heart (SynCardia-TAH) is a reliable bridge-to-transplant solution for patients with end-stage biventricular heart failure. Ischemic strokes affect about 10% of patients with a SynCardia-TAH. We report for the first time in the literature two successful thrombectomies to treat the acute phase of ischemic stroke in two patients treated with a SynCardia-TAH in the bridge-to-transplant (BTT).

Case Report: We follow two patients with circulatory support from a SynCardia-TAH in the bridge-to-transplant for terminal biventricular cardiac failure with ischemic stroke during the support period. An early in-hospital diagnosis enables the completion of a mechanical thrombectomy within the first 6 h of the onset of symptoms. There was no intracranial hemorrhagic complication during or after the procedure and the patients fully recovered from neurological deficits, allowing a successful heart transplant.

Conclusion: This case report describes the possibility of treating ischemic strokes under a SynCardia-TAH by mechanical thrombectomy following the same recommendations as for the general population with excellent results and without any hemorrhagic complication during or after the procedure.
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http://dx.doi.org/10.3390/bioengineering8090126DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8469750PMC
September 2021

Electrical Storm Ablation in a Patient in Cardiogenic Shock Supported by Impella 5.0.

JACC Case Rep 2021 Mar 17;3(3):486-490. Epub 2021 Mar 17.

Department of Cardiology, Nantes University Hospital Center, Saint-Herblain, France.

Intra-axial pumps are increasingly used to support cardiogenic shock. The occurrence of electrical storms in this setting is a rising issue, and data remain scarce about optimal management. We report the feasibility of ventricular tachycardia ablation in the presence of a recent surgically inserted Impella 5.0 device (Abiomed, Danvers, Massachusetts). ().
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http://dx.doi.org/10.1016/j.jaccas.2020.12.032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8311017PMC
March 2021

Impact of early nutrition route in patients receiving extracorporeal membrane oxygenation: A retrospective cohort study.

JPEN J Parenter Enteral Nutr 2021 Jun 24. Epub 2021 Jun 24.

Intensive Care Unit of Cardiothoracic Surgery, Anesthesia and Critical Care Department, Hôpital Nord Laennec, CHU Nantes, Nantes, France.

Background: Early nutrition management in patients receiving extracorporeal membrane oxygenation (ECMO) remains controversial. Despite its potentially beneficial effect, enteral nutrition (EN) could be associated with gastrointestinal (GI) complications. Total daily energy requirements remain difficult to achieve with ECMO support. Analysis of nutrition practices could improve nutrition management of this particular population.

Methods: A monocentric retrospective study of patients requiring ECMO in a cardiac surgery intensive care unit (ICU) between 2010 and 2014 with follow-up ≥6 days. Nutrition support was monitored daily until ECMO weaning. We compared patients exposed (EN group, n = 49) and unexposed (No EN group (NEN), n = 63) with EN, as well as the energy and protein intakes within 4 days after initiation of ECMO. Vital status and nosocomial infections were followed up until ICU discharge. Primary outcome was the incidence of GI intolerance and risk-factor identification. Secondary outcomes included impact of nutrition inadequacy and clinical outcome.

Results: A total 112 patients were analyzed, representing 969 nutrition days. Median ratio of energy and protein prescribed/required daily was 81% (58-113) and 56% (36-86), respectively. GI intolerance was experienced by 53% (26 of 49) of patients in the EN group and was only associated with ECMO duration (odds ratio, 1.14: 95% CI, 1.00-1.31; P = .05). Low-energy and protein days were not associated with clinical outcomes such as nosocomial infections.

Conclusion: EN is associated with almost 50% GI intolerance without clinical benefit for patients receiving ECMO. Adequacy in energy and protein amounts did not affect clinical outcome.
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http://dx.doi.org/10.1002/jpen.2209DOI Listing
June 2021

A heart transplant after total artificial heart support: initial and long-term results.

Eur J Cardiothorac Surg 2020 12;58(6):1175-1181

Department of Thoracic and Cardiovascular Surgery, Nantes Hospital University, Nantes, France.

Objectives: At our centre, the SynCardia temporary Total Artificial Heart (TAH-t) (SynCardia Systems, LLC, Tucson, AZ, USA) is used to provide long-term support for patients with biventricular failure as a bridge to a transplant. However, a heart transplant (HT) after such support remains challenging. The aim of this retrospective study was to assess the immediate and long-term results following an HT in the cohort of patients who had a TAH-t implant.

Methods: A total of 73 patients were implanted with the TAH-t between 1988 and 2019 in our centre. Of these 73 consecutive patients, 50 (68%) received an HT and are included in this retrospective analysis of prospectively collected data.

Results: In the selected cohort, in-hospital mortality after an HT was 10% (n = 5). The median intensive care unit stay was 33 days (range 5-278). The median hospital stay was 41 days (range 28-650). A partial or total pericardiectomy was performed during the HT procedure in 21 patients (42%) due to a severe pericardial reaction. Long-term survival rates after an HT at 5, 10 and 12 years were 79.1 ± 5.9% (n = 32), 76.5 ± 6.3% (n = 22) and 72.4 ± 7.1% (n = 12), respectively, which was similar to the long-term survival for a primary HT without TAH-t during the same period (n = 686). An HT performed within 3-6 months post-TAH-t implantation appeared to provide the best survival (P = 0.007). Eight (16%) patients required chronic dialysis during the subsequent follow-up period, with 3 patients requiring a kidney transplant.

Conclusions: The long-term outcomes with the SynCardia TAH-t as a bridge to transplant in patients with severe biventricular failure are very encouraging. Our review noted that an HT following TAH-t can be technically challenging, especially in the case of a severe pericardial reaction, with potential pitfalls that should be recognized preoperatively.
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http://dx.doi.org/10.1093/ejcts/ezaa261DOI Listing
December 2020

Donor-imported and transmitted malaria after lung transplantation.

Br J Haematol 2020 08 7;190(4):485. Epub 2020 May 7.

Centre hospitalier universitaire de Nantes, Anesthésie-Réanimation, Nantes, France.

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http://dx.doi.org/10.1111/bjh.16712DOI Listing
August 2020

Romiplostim as a transfusion saving strategy in 20 patients after heart or lung transplantation: a single centre before-after pilot study.

Perfusion 2020 03 30;35(2):121-130. Epub 2019 Jul 30.

Intensive Care Unit of Cardiothoracic Surgery, Anesthesia and Critical Care Department, Hôpital Nord Laennec, Nantes University Hospital, Nantes, France.

Background: Thrombocytopenia is a common disorder after heart or lung transplantation. Platelet transfusion is often required to maintain haemostasis but represents a specific cause of morbidity and mortality in this setting including alloimmunisation and graft rejection.

Study Design And Methods: As part of a health-care quality improvement project, in a single-centre before-after pilot study, the relevance of a platelet transfusion saving strategy based on romiplostim administration after transplantation was assessed in patients with platelet count <100 × 10/L. Transfusions on days 28 and 90 were compared using propensity matched score for adjustment of demographic characteristics at baseline. The primary outcome was platelet transfusion until day 28 after transplantation.

Results: Ninety-three patients were analysed (73 before vs. 20 after). The median [interquartile range] number of platelet concentrate was 1 [0;4.0] before versus 0.5 [0;2.0] in the after period, mean difference 0.5 confidence interval 95% [-0.7 to 1.7], p  0.39. On day 28, median [interquartile range] red blood cell transfusion was significantly higher in the before versus the after period, 7 [2.0;13.5] versus 6 [1.5;8.5], mean difference 3.2 CI 95% [0.4-6.0], p = 0.02. At 6 months, the rate of patients with de novo anti-human leukocyte antigen alloimmunisation was 45% before versus 53% in the after period (p = 0.56). Deep venous thrombosis was detected in nine patients (12%) before versus seven patients (35%) in the after period (p = 0.04).

Conclusion: Romiplostim did not significantly reduce platelet transfusion after heart or lung transplantation. Its relevance and safety in a global transfusion strategy remains to be studied in this setting in a large randomised study.
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http://dx.doi.org/10.1177/0267659119864814DOI Listing
March 2020

High-Flow Therapy by Nasal Cannulae Versus High-Flow Face Mask in Severe Hypoxemia After Cardiac Surgery: A Single-Center Randomized Controlled Study-The HEART FLOW Study.

J Cardiothorac Vasc Anesth 2020 Jan 29;34(1):157-165. Epub 2019 May 29.

Intensive Care Unit of Cardiothoracic Surgery, Department of Anesthesia and Critical Care, Hôpital Laennec, University Hospital of Nantes, Nantes, France.

Objective: To determine whether high-flow oxygen therapy by nasal cannulae (HFNC) is more effective than a high-flow face mask (HFFM) in severe hypoxemia.

Design: Randomized, single-center, open-labeled, controlled trial.

Setting: University Hospital of Nantes, France.

Participants: Cardiac surgery patients presenting oxygen saturation <96% with Venturi mask 50%.

Intervention: Oxygenation by HFNC (45 L/min, FO 100%) or Hudson RCI non-rebreather face mask with a reservoir bag (15 L/min).

Measurements And Main Results: The co-primary outcomes were the PaO/FO ratio at 1 and 24 hours. In the intent-to-treat analysis (90 patients), the mean (standard deviation) PaO/FO ratios were: after 1 hour, 113.4 (50.2) in HFFM versus 137.8 (57.0) in HFNC (mean difference 24.4, CI 97.5% [2.9-45.9], p = 0.03), and after 24 hours, 106.9 (62.6) in HFFM versus 129.9 (54.0) in HFNC (mean difference 23.0, CI 97.5% [1.5-44.6], p = 0.04). After adjustment on baseline PaO/FO this difference persisted at 24 hours (p = 0.04). For secondary outcomes, the PaO/FO ratio after 6 hours was 108.7 (47.9) in HFFM versus 136.0 (45.2) in HFNC (p = 0.01), without difference after 48 hours (p = 0.95). Refractory hypoxemia requiring noninvasive ventilation occurred in 13 (28%) patients in HFNC versus 24 (56%) patients in HFFM (p = 0.007). The HFNC improved satisfaction (p = 0.0002) and reduced mucus dryness (p = 0.003) compared with HFFM.

Conclusion: In patients with severe hypoxemia after cardiac surgery, PaO/FO at 1 and 24 hours were higher and the use of noninvasive ventilation was reduced in HFNC compared with HFFM.
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http://dx.doi.org/10.1053/j.jvca.2019.05.039DOI Listing
January 2020

What is the role of empirical treatment for suspected invasive candidiasis in non-neutropenic non transplanted patients in the intensive care unit?-Empiricus strikes back!

J Thorac Dis 2016 Dec;8(12):E1719-E1722

CHU Nantes, PHU7, Laboratory of Parasitology and Medical Mycologie, Nantes, F-44093, France; ; Parasitology and Medical Mycology Department, Nantes University, Nantes Atlantique University, EA1155-IICiMed, IRS2-Nantes Biotech, Nantes, F-44200, France.

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http://dx.doi.org/10.21037/jtd.2016.12.99DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5227184PMC
December 2016

Severe pulmonary hypertension leading to heart-lung transplantation and revealing breast cancer.

Eur Respir J 2012 Oct;40(4):1057-9

INSERM UMR 915, Université de Nantes, CHU de Nantes, l’institut du thorax, Service de pneumologie, Plate-forme transversale d’allergologie, Centre de Réfrence National Maladies Rares Mucoviscidose, France.

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http://dx.doi.org/10.1183/09031936.00182711DOI Listing
October 2012

Fatal invasive infection with fungemia due to Microascus cirrosus after heart and lung transplantation in a patient with cystic fibrosis.

J Clin Microbiol 2011 Jul 4;49(7):2743-7. Epub 2011 May 4.

Laboratoire de Parasitologie-Mycologie, CHU de Nantes, Nantes, France.

Scopulariopsis species are rarely but increasingly recognized as opportunistic pathogens in immunocompromised patients. We report on a patient suffering from cystic fibrosis who developed disseminated fungal infection due to a rare Scopulariopsis species, Microascus cirrosus, after heart and lung transplantation. Despite antifungal combination therapy with voriconazole and caspofungin, the patient died 4 weeks after transplantation. Diagnostic difficulties and optimal management of disseminated Scopulariopsis/Microascus infections are discussed.
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http://dx.doi.org/10.1128/JCM.00127-11DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3147864PMC
July 2011
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