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See detailWhat is the potential increase in the heart graft pool by cardiac donation after circulatory death?
Noterdaeme, Timothée; HANS, Marie-France ULg; NELLESSEN, Eric ULg et al

Conference (2013, February 09)

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See detailWhat is the potential increase in the heart graft pool by cardiac donation after circulatory death?
NOTERDAEME, Timothée; DETRY, Olivier ULg; HANS, Marie-France ULg et al

in Transplant International (2013), 26(1), 61-66

Heart transplantation remains the only definite treatment option for end-stage heart diseases. The use of hearts procured after donation after circulatory death (DCD) could help decrease the heart graft ... [more ▼]

Heart transplantation remains the only definite treatment option for end-stage heart diseases. The use of hearts procured after donation after circulatory death (DCD) could help decrease the heart graft shortage. The aim of this study was to evaluate the potential increase in heart graft pool by developing DCD heart transplantation. We retrospectively reviewed our local donor database from 2006 to 2011, and screened the complete controlled DCD donor population for potential heart donors, using the same criteria as for donation after brain death (DBD) heart transplantation. Acceptable donation warm ischemic time (DWIT) was limited to 30 min. During this period 177 DBD and 70 DCD were performed. From the 177 DBD, a total of 70 (39.5%) hearts were procured and transplanted. Of the 70 DCD, eight (11%) donors fulfilled the criteria for heart procurement with a DWIT of under 30 min. Within the same period, 82 patients were newly listed for heart transplantation, of which 53 were transplanted, 20 died or were unlisted, and 9 were waiting. It could be estimated that 11% of the DCD might be heart donors, representing a 15% increase in heart transplant activity, as well as potential reduction in the deaths on the waiting list by 40%. [less ▲]

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See detailWhat is the potential increase of the heart graft pool by cardiac donation after circulatory death?
NOTERDAEME, Timothée; NELLESSEN, Eric ULg; HANS, Marie-France ULg et al

in Transplantation (2012, November), 94

Background: Heart transplantation remains to date the only definite treatment option for end-stage heart diseases. Currently only heart procured from brain death (DBD) donors are used. Combined with an ... [more ▼]

Background: Heart transplantation remains to date the only definite treatment option for end-stage heart diseases. Currently only heart procured from brain death (DBD) donors are used. Combined with an increasing demand, the constant heart graft shortage leads to an increase of deaths on cardiac transplantation waiting lists. The use of hearts procured after donation after circulatory death (DCD) could help to partly decrease the heart graft shortage. The aim of this study was to evaluate the potential increase of heart graft pool by development of DCD heart transplantation. Methods: The authors retrospectively reviewed their local donor database for the period 2006-2011, and screened the complete controlled DCD donor population for potential heart donors, using the same criteria as for DBD heart transplantation. The acceptable warm ischemic time (WIT) was limited to 30min from life support withdrawal to aortic cannulation. Results: During the analyzed timespan, 177 DBD and 70 DCD were effectively performed. From the 177 DBD, a total of 70 (39.5%) hearts were procured and transplanted locally or in another center. Out of the 70 DCD, 8 (11%) donors fulfilled the criteria for heart graft procurement and had a WIT of less than 30 minutes. During the same period, 82 patients were newly listed for heart transplantation, of which 53 were transplanted, 20 died or were unlisted, and 9 were still awaiting transplantation. Conclusions: Based on our database and a WIT of less than 30min, it could be estimated that 11% of the DCD might be heart graft donors, representing a 11% increase in heart graft procurement, as well as potential reduction of the deaths on the waiting list by 40%. [less ▲]

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See detailWhat is the potential increase of the heart graft pool by cardiac donation after circulatory death?
NOTERDAEME, Timothée; HANS, Marie-France ULg; NELLESSEN, Eric ULg et al

in Acta Chirurgica Belgica (2012, May), 112(3), 668

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See detailSurgical treatment of cardiovascular complications in patients with Marfan syndrome: a report of two cases and literature review.
BRULS, Samuel ULg; BRULS, Samuel ULg; Radermecker, Marc ULg et al

in Acta Chirurgica Belgica (2012), 112(3), 213-8

Cardiovascular disease is the main cause of morbidity and mortality in patients with Marfan syndrome. The most life threatening complication is aortic root aneurysms leading to aortic dissection or ... [more ▼]

Cardiovascular disease is the main cause of morbidity and mortality in patients with Marfan syndrome. The most life threatening complication is aortic root aneurysms leading to aortic dissection or rupture. It can be prevented by regular aortic follow-up and prophylactic aortic surgery. Modern aortic surgery has led to a substantial increase in the life expectancy of these patients. We report two cases of Marfan syndrome with cardiovascular complications. Their management is discussed according to the most recent literature. [less ▲]

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See detailBNP et NT-proBNP: valeurs de référence et seuils décisionnels
TEIXEIRA, Jelda ULg; Guillaume, Michèle ULg; NELLESSEN, Eric ULg et al

in Revue Médicale de Liège (2012), 67(1), 38-43

Les peptides natriurétiques, en particulier BNP et NT-proBNP, sont de plus en plus utilisés comme tests de screening chez les patients avec suspicion d’insuffisance cardiaque (IC), afin d’éviter de ... [more ▼]

Les peptides natriurétiques, en particulier BNP et NT-proBNP, sont de plus en plus utilisés comme tests de screening chez les patients avec suspicion d’insuffisance cardiaque (IC), afin d’éviter de recourir d’emblée à des examens spécialisés coûteux tels que l’échocardiographie. Très performants pour la valeur prédictive élevée d’un résultat négatif, permettant ainsi d’exclure l’IC chronique avec une forte probabilité, ces biomarqueurs sont également reconnus pour leur intérêt diagnostique dans cette pathologie. Des taux élevés de peptides natriurétiques sont corrélés avec un risque accru d’hospitalisation pour cause cardiovasculaire et de décès. La stratification du risque chez les patients présentant une insuffisance cardiaque est facilitée par l’utilisation de seuils décisionnels «bas» et «élevé», pour lesquels différentes valeurs ont été proposées dans la littérature. Le présent article a pour objet de faire le point sur le positionnement des seuils décisionnels eu égard aux valeurs de référence de NT-proBNP déterminées dans la population résidant en Province de Liège (Belgique). Les données ont été analysées en fonction de l’âge et du sexe des sujets, deux des facteurs majeurs de variation des concentrations plasmatiques des peptides natriurétiques. [less ▲]

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See detailPRISE EN CHARGE MULTIDISCIPLINAIRE DE L'INSUFFISANCE CARDIAQUE DU SUJET AGE
NELLESSEN, Eric ULg; ENGLEBERT, J; Petermans, Jean ULg

Conference (2011, December 01)

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See detailComment j'explore... une insuffisance cardiaque chronique
ANCION, Arnaud ULg; NELLESSEN, Eric ULg; Lancellotti, Patrizio ULg et al

in Revue Médicale de Liège (2011)

Heart failure is defined by precise criteria associating clinical signs and cardiac abnormalities. The exploration for signs and symptoms must be associated with the systematic realization of an ... [more ▼]

Heart failure is defined by precise criteria associating clinical signs and cardiac abnormalities. The exploration for signs and symptoms must be associated with the systematic realization of an electrocardiogram, a chest X-ray and an echocardiogram to rapidly obtain the diagnosis and direct the patient to an adapted complementary clarification. Other additional tests are available (catheterization, nuclear cardiology imaging,...). The purpose is to confirm the diagnosis, to determine the aetiology and to identify factors of poor prognosis. [less ▲]

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See detailNon complicated large complex tear in an aneurysmal Marfan ascending aorta.
Brüls, Samuel ULg; Radermacher, Vincent ULg; de Leval, Laurence ULg et al

in Annals of Thoracic Surgery (2010), 89(5), 1674

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See detailL’ECMO (ExtraCorporeal Membrane Oxygenation) aux soins intensifs : intérêt chez le patient en choc cardiogénique réfractaire, en hypoxémie réfractaire ou en arrêt cardiaque.
Massion, Paul ULg; Ledoux, Didier ULg; Piret, S. et al

in Revue Médicale de Liège (2010), 65

ExtraCorporeal Membrane Oxygenation (ECMO) is a cardiopulmonary assistance device able to support patients in cardiac arrest, refractory cardiogenic shock or refractory hypoxemia otherwise sentenced to ... [more ▼]

ExtraCorporeal Membrane Oxygenation (ECMO) is a cardiopulmonary assistance device able to support patients in cardiac arrest, refractory cardiogenic shock or refractory hypoxemia otherwise sentenced to death. Recent technical progresses, early indication decision, bedside multidisciplinary implant, specific complications screening and echocardiographic weaning testing are crucial points to allow success of this exceptional technique. [less ▲]

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See detailMyocardial contractile reserve during exercise predicts left ventricular reserve remodelling after cardiac resynchromization therapy
Lancellotti, Patrizio ULg; Senechal, Mario; Moonen, Marie ULg et al

in European Journal of Echocardiography (2009), 10(5), 663-8

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See detailImpact of contractile reserve on acute response to cardiac resynchronization therapy
Moonen, Marie ULg; Senechal, Mario; Cosyns, Bernard et al

in Cardiovascular Ultrasound (2008), 6(65),

Background: Cardiac resynchronization therapy (CRT) provides benefit for congestive heart failure, but still 30% of patients failed to respond to such therapy. This lack of response may be due to the ... [more ▼]

Background: Cardiac resynchronization therapy (CRT) provides benefit for congestive heart failure, but still 30% of patients failed to respond to such therapy. This lack of response may be due to the presence of significant amount of scar or fibrotic tissue at myocardial level. This study sought to investigate the potential impact of myocardial contractile reserve as assessed during exercise echocardiography on acute response following CRT implantation. Methods: Fifty-one consecutive patients with heart failure (LV ejection fraction 27% ± 5%, 67% ischemic cardiomyopathy) underwent exercise Doppler echocardiography before CRT implantation to assess global contractile reserve (improvement in LV ejection fraction) and local contractile reserve in the region of the LV pacing lead (assessed by radial strain using speckle tracking analysis). Responders were defined by an increase in stroke volume ≥15% after CRT. Results: Compared with nonresponders, responders (25 patients) showed a greater exercise-induced increase in LV ejection fraction, a higher degree of mitral regurgitation and a significant extent of LV dyssynchrony. The presence of contractile reserve was directly related to the acute increase in stroke volume (r = 0.48, p<0.001). Baseline myocardial deformation as well as contractile reserve in the LV pacing lead region was greater in responders during exercise than in nonresponders (p<0.0001). Conclusions: Heart failure patients referred to CRT have less chance of improving under therapy if they have no significant mitral regurgitation, no LV dyssynchrony and no contractile myocardial recruitment at exercise. [less ▲]

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See detailIs cystatin C useful for the detection and the estimation of low glomerular filtration rate in heart transplant patients?
Delanaye, Pierre ULg; Nellessen, Eric ULg; Cavalier, Etienne ULg et al

in Transplantation (2007), 83(5), 641-644

Although previously studied in patients with chronic kidney disease, there is less data for the use of cystatin C and cystatin C-based formulas in heart transplant recipients. The ability of creatinine ... [more ▼]

Although previously studied in patients with chronic kidney disease, there is less data for the use of cystatin C and cystatin C-based formulas in heart transplant recipients. The ability of creatinine and cystatin C to detect renal failure (glomerular filtration rate [GFR] below 60 mL/min/1.73 m(2)) in heart transplant patients has been compared. The accuracy and precision of a creatinine-based formula (Modification of Diet in Renal Disease [MDRD]) versus a cystatin C-based formula (Rule's formula) to estimate GFR have also been studied. GFR was measured using the (51)Crethylenediamine tetraacetic acid tracer in 27 patients. There was no significant difference between GFR and the reciprocal of creatinine or cystatin C. Receiver operating characteristic curves for cystatin C and creatinine were similar. Both formulas were well correlated with the GFR. The bias of the cystatin C-based was significantly better than one of the MDRD formula, but the standard deviation appeared better for the MDRD formula (bias of +3.9 mL/min/1.73 m(2) versus +12 mL/min/1.73 m(2) and SD of 8.5 versus 11.6, respectively). Plasma cystatin C has no clear advantage over serum creatinine to detect renal failure in heart transplanted patients. [less ▲]

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See detailAnemie et insuffisance cardiaque
Nellessen, Eric ULg; Pierard, Luc ULg

in Revue Médicale de Liège (2006), 61(3), 154-8

The prevalence of heart failure is increasing. Anemia is often present, particularly in severe cases. The Fick equation illustrates the relationship between anemia and heart failure. The concepts of ... [more ▼]

The prevalence of heart failure is increasing. Anemia is often present, particularly in severe cases. The Fick equation illustrates the relationship between anemia and heart failure. The concepts of cardiorenal syndrome and erythropoietin resistance are parts of the physiopathology. Anemia is associated with a bad prognosis in heart failure. Nevertheless, it is too early to know precisely whether anemia represents a simple marker of severity or if specific treatment, especially with erythropoietin, is useful in terms of morbidity and mortality. Current guidelines recommend the correction of secondary causes when anemia is present in a heart failure patient. [less ▲]

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See detailCreatinine-based formulae for the estimation of glomerular filtration rate in heart transplant recipients
Delanaye, Pierre ULg; Nellessen, Eric ULg; Grosch, Stéphanie ULg et al

in Clinical Transplantation (2006), 20(5, Sep-Oct), 596-603

Chronic renal failure (CRF) is a common complication in heart transplant patients. Serum creatinine has clear limitations for the detection and estimation of glomerular filtration rate (GFR). Various ... [more ▼]

Chronic renal failure (CRF) is a common complication in heart transplant patients. Serum creatinine has clear limitations for the detection and estimation of glomerular filtration rate (GFR). Various creatinine-based formulae are classically used for GFR estimation, but little scientific evidence exists for such use in a heart transplant population. GFR was measured using the plasmatic clearance of the glomerular tracer Cr-51-EDTA in 27 heart transplant patients with two measures for 22 of the patients. Forty-nine measures were thus available for analysis. The precision and accuracy (Bland and Altman analysis) of the Cockcroft, simplified Modified Diet in Renal Diseases (MDRD) and new Mayo Clinic formulae were compared. The mean GFR of the population was 39 +/- 15 mL/min/1.73 m(2). All formulae were well correlated with the GFR. With the Bland and Altman analysis, the accuracy of the MDRD formula appeared higher than that of the Cockcroft or the Mayo Clinic formulae (bias of +12 mL/min/1.73 m(2), vs. +19.9 mL/min/1.73 m(2), and +22.1 mL/min/1.73 m(2), respectively). The difference between the estimated and measured GFR was higher than 20 mL/min/1.73 m(2) in 51% and 55% cases when using the Cockcroft and the Mayo Clinic formulae respectively, whereas the difference was only noted in 14% cases when the MDRD was used. Among creatinine-based formulae, the MDRD appears the most precise and accurate for estimating the GFR in heart transplant patients. However, when the GFR must be measured with high accuracy, we recommend the use of a reference method like inulin or Cr-51-EDTA plasma clearance techniques. [less ▲]

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See detailTransplantation cardiaque: prevention secondaire
Nellessen, Eric ULg; Lancellotti, Patrizio ULg; Demoulin, J. C. et al

in Revue Médicale de Liège (2003), 58(6), 429-34

Cardiac transplantation is the treatment of choice for refractory heart failure. An immunosuppressive therapy must be given in the perioperative course to avoid graft rejection. In this article, we review ... [more ▼]

Cardiac transplantation is the treatment of choice for refractory heart failure. An immunosuppressive therapy must be given in the perioperative course to avoid graft rejection. In this article, we review the main classes of immunosuppressive agents (calcineurin inhibitors, anti-metabolities, corticoids) and their side effects. The general preventive measures and the different kinds of rejection (hyperacute, acute vascular, acute cellular and chronical) are discussed. The current bacterial, protozoarian, mycotic and viral infections are described. We finish with the risk of cancer, mainly skin tumours and non-Hodgkinian lymphomas. [less ▲]

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