Several recent studies conducted on north American populations report that female patients undergoing coronary artery bypass graft (CABG) surgery have increased postoperative morbidity and less complete revascularization than men according to international guidelines. The aim of this study was to investigate whether these differences were found in a French cohort. This is a single-center, retrospective study based on the data contained in our local database. All patients who underwent cardiac surgery with cardiopulmonary bypass are prospectively included in a database. In this study, all isolated CABG surgery patients between 2006 and 2019 were included, without exclusion criteria. Demographic, medical, intraoperative, and postoperative data were collected and then analyzed by patient sex. Continuous variables are expressed as median [interquartile range] and were compared using the Mann–Whitney test. Categorical variables were expressed as numbers and percentages and were compared using the Fisher exact test. This study was approved by an institutional review board. 5722 patients were included, of whom 887 were female (16%) and 4,835 male (84%). The clinical, intra- and postoperative characteristics of the patients are presented in Table 1. Women undergoing CABG surgery were older, had more comorbidities, including more hypertension, diabetes, and chronic obstructive pulmonary disease than men. Their median EuroSCORE II was higher. Although both internal mammary arteries were used as grafts in equal proportions between the groups, women had fewer distal anastomosis, with a lower proportion of patients having at least 5. No sex difference in mortality was found after 28 and 90 days, 1 and 5 years (Figure 1). However, women developed more surgical site infections, and their ICU and hospital lengths of stay were longer. In this study, we did not find excess mortality in female patients after isolated CABG surgery despite a higher proportion of comorbidities. This contrasts with recent findings from studies focused on the north American population. Two hypothesis could explain this result, a better cardiological management with more equitable access to health care in France or a difference in the surgical technique. Indeed, in the United States, women are more at risk of not benefiting from bilateral internal mammary artery graft, unlike those at our center.

Abstract Background The growing use of surgical bioprostheses raises concerns about a future reoperation for bioprosthesis degeneration. There are few data on outcome after transcatheter mitral valve-in-valve implantation (TMVI) compared with redo surgical mitral valve replacement (SMVR). Purpose To compare the feasibility, safety and outcomes of TMVI versus SMVR for degenerated mitral bioprosthesis in high-risk patients. Methods In our institution, 52 patients underwent TMVI by transseptal approach and 33 SMVR for degenerated mitral bioprosthesis. The composite endpoint of event-free survival included cardiovascular mortality, stroke, major bleeding, hospitalization for heart failure or mitral valve reintervention. Results Mean age and EuroSCORE II were higher in TMVI group vs. SMVR group (age 63±21 years vs. 51±15 years, p=0.002; EuroSCORE II 12.5±12.2% vs. 6.2±3.3%, p=0.001) (Table). In-hospital mortality was 3.8% after TMVI vs. 3.0% after SMVR (p=1.0). Median follow-up was 2.2 years. At 5 years, survival was 69.7±9.4% after TMVI vs. 86.6±7.6% after SMVR (p=0.10) and event-free survival was lower after TMVI (40.1±9.9% vs 78.7±8.8% respectively, p=0.003) (Figure). In multivariate analysis, older age (p=0.02), neurologic history (p=0.05) and non-elective procedure (p<0.0001) were associated with lower event-free survival, while TMVI vs. SMVR was no longer significant (p=0.17). At last follow-up, 84% patients from TMVI group and 78% from SMVR group were NYHA I-II class. Mean mitral valve gradient and pulmonary artery systolic pressure were respectively 6.8±2.5 mmHg and 45±14 mmHg in TMVI group, and 4.8±2.0 mmHg and 37±11 mmHg in SMVR group. Conclusion TMVI is an alternative to SMVR in high-risk patients with degenerated mitral bioprosthesis. Comparison of mid-term results of the two techniques must take into account the differences in patient characteristics. Event-free survival Funding Acknowledgement Type of funding source: None

Concerns have been raised regarding the reliability of the logistic Euroscore (Euroscore I) thus the Euroscore II has been recently described to better predict operative mortality after cardiac surgery. However its performance has not been specifically studied in valvular surgery. The predictive

La transfusion sanguine est un des éléments majeurs du soutien médico-chirurgical des militaires en opération extérieure. Les moyens français comportent : des concentrés de globules rouges (CGR), du plasma lyophilisé (PLYO), le sang total (ST), mais ni plaquettes, ni plasma frais congelé. La stratégie transfusionnelle française en opérations militaires extérieures suit l'évolution des savoirs et des moyens. Nous décrivons ici les caractéristiques de la transfusion sanguine à l'hôpital militaire de Kaboul.Étude rétrospective des dossiers des patients transfusés entre octobre 2010 et décembre 2011 à Kaboul, à partir du registre local de la transfusion sanguine. Les variables étudiées ont été : les caractéristiques des patients, la biologie à l'admission, le type et la quantité des produits transfusionnels, l'évolution.Cent vingt-six patients ont été transfusés : majoritairement Afghans (n = 97 ; 77 %), 49 militaires (39 %) dont 22 militaires français (17 %), âge médian 24 ans (3–66). Deux cents soixante-treize CGR provenant de France ont été transfusés et 350, non utilisés, ont été détruits. Les pathologies ayant conduit à une transfusion ont été : 76 blessures de guerre (60 %), 21 traumatismes (17 %) et 29 autres mécanismes (23 %). Dans les 24 premières heures, les patients ont reçu en médiane : deux CGR (0–12), un poche de ST (0–18) et deux PLYO (0–14). Le ratio PLYO/CGR était de 1/1,6. Une transfusion massive (> 10 CGR ou ST) a concerné 9 % des patients. Vingt-sept pour cent des patients ont reçu du ST. On note 17 décès (13,5 %).L'utilisation du ST et du PLYO en substitution, respectivement, des concentrés plaquettaires et des PFC, permet d'apporter des soins de qualité dans un contexte logistiquement contraint tout en maîtrisant les risques et les coûts.Blood transfusion is an aspect of medical care on the battlefield. French assets include: red blood cell units (RBCu), lyophilized plasma (PLYO), fresh whole blood (FWB) but neither fresh-frozen plasma (FFP) nor platelets. French transfusion strategy in military operations follows the evolution of knowledge and resources. We describe the characteristics of the transfusion at the military hospital in Kabul.Retrospective study of records of patients transfused between October 2010 to December 2011 conducted in Kabul from transfusion register. Variables studied were: patient characteristics, biology at admission, type and amount of transfusion products, evolution.One hundred and twenty-six patients were transfused: 49 military (39%) which 22 French soldier (17%), most of time afghan (n = 97; 77%), mean age at 24 years old (3–66). Two hundred and seventy-three RBCu from France were transfused and 350 unused were destroyed. Conditions leading to a transfusion were: 76 war wounds (60%), 21 trauma (17%) and 29 other (23%). In the first 24 hours, patients received in mean: two RBCu (0–12), one unit of FWB (0–18) and two PLYO (0–14). PLYO/RBCu ratio was 1/1.6. A massive transfusion (more than 10 RBCu) concerned 9% of patients. Twenty-seven percent of patients received FWB. We note 17 dead people (13.5%).The use of the FWB and PLYO in substitution of FFP and platelets can provide cares of high quality in a logistically constrained context while controlling costs.

La technique de mesure de la composition corporelle par impédancemétrie bioélectrique (BIA) perd en précision en cas de maigreur ou de forte obésité, du fait des limites du modèle mathématique cylindrique employé. La BIA segmentaire minimise cette cause d'erreur en modélisant le corps comme un assemblage de cinq cylindres. De nouveaux outils, dont l'utilisation est facilitée, permettraient de réaliser les mesures de la composition des différents segments du corps afin d'établir des corrélations avec certains paramètres métaboliques de façon plus aisée en pratique clinique en comparaison avec la DEXA.Chez 36 sujets de 15 à 69 ans couvrant une plage d'Indice de Masse Corporelle (IMC) de 13 à 41 kg/m2 chez qui la composition corporelle est mesurée grâce à la DEXA en comparaison avec la BIA conventionnelle. La composition de chaque segment est précisément prédite (r = 0,726 à 0,987), de même que la masse grasse tronculaire (r = 0,9575 ; erreur moyenne 2,25 [95 %IC : 1,41–3,09]). Pour la masse grasse du corps entier la prédiction est excellente (r2 = 0,9755 ; erreur moyenne 0,532[IC : –0,495–1,56]) et elle reste excellente chez les sujets maigres (r = 0,925 ; pente : 0,953, ordonnée 0,46 ; erreur moyenne 0,015 [IC : –1,1-1,13]). Chez 20 personnes explorées par petit déjeuner standardisé avec modélisation mathématique, l'insulino-sensibilité déterminée par l'oral minimal model (OMM-SI) s'avère davantage corrélée à la MG tronculaire (r = –0,686) qu'à la MG totale où à celle des membres.L'approche segmentaire augmente la précision de la BIA conventionnelle y compris chez les sujets maigres.The technique for measuring body composition by bioelectrical impedance analysis (BIA) loses precision in case of thinness or severe obesity, because of the limitations of the mathematical model which assumes that human body has a cylindrical shape. Segmental BIA minimizes this source of error since it modelizes the body as a collection of five cylinders. New devices, whose use becomes easier, become now available. We evaluated the interest and accuracy of a new segmental BIA device, the Biacorpus RX4000, compared with DEXA.In 36 subjects aged 15 to 69 years covering a range of BMI from 13 to 41 kg/m in whom body composition was measured by DEXA compared with the conventional BIA. The composition of each segment is accurately predicted (r = 0.726 to 0.987), as well as truncal fat mass (r = 0.9575; average error 2.25 [95% CI: 1.41–3.09]). For the whole body fat mass prediction is excellent (r2 = 0.9755; average error 0.532 [CI: –0.495–1.56]) and remains high in lean subjects (r = 0,925; slope: 0.953, 0.46 orderly; average error 0015 [CI: –1.1–1.13]). In 20 persons investigated by standardized breakfast with mathematical modeling, insulin sensitivity determined by the oral minimal model (OMM-SI) is more correlated with the truncal fat mass (r = –0686) than to total body fat mass or fat mass of other body segments.This segmental approach increases the accuracy of BIA compared to previous BIA techniques, even in very lean subjects.

The logistic Euroscore (Euroscore I) has been shown to lack accuracy when applied to contemporary patients. The Euroscore II has therefore been recently proposed to improve the prediction of operative mortality, but external validations are scarce. We compared the predictive performances of the Euroscore I and II in our institution. The Euroscore I and II were was computed in 5114 consecutive patients who underwent cardiac surgery over a 5-year period. Discrimination was assessed using the c-index and calibration by comparing predicted and observed mortality. Besides the overall population we also specifically studied elderly patients (age ≥80) and patients with a body mass index (BMI) <25. Mean age was 63±14 years. Mean Euroscore I was 6.8±8.7%, mean Euroscore II 4.6±6.7% and 30-day mortality 4.8% (245 patients). Cindex and comparisons between predicted and observed mortality are detailed in Table 1 for the overall population and for subgroups according to age and BMI. Euroscore II has indeed a better predictive performance than the Euroscore I. Its discrimination and calibration are however less satisfying in patients with BMI<25 or aged ≥80. BMI should thus be taken into account, and in the elderly, other variables such as frailty may help to estimate more accurately surgical risk.

L'enclouage secondaire des fractures de la diaphyse tibiale (ESDT) après fixation externe primaire est discuté, principalement en raison des risques de complications septiques dont le taux n'est pas connu avec précision. Aussi nous avons analysé une série continue d'ESDT afin de déterminer (1) les taux d'infection et de consolidation, (2) si un ESDT réalisé en un temps lors de l'ablation du fixateur augmentait les risques de complications septiques.Il existe des facteurs qui influencent la consolidation et la survenue de complications septiques après ESDT.Nous avons analysé rétrospectivement les ESDT effectués chez des sujets de plus de 16 ans pour des fractures non pathologiques entre 1998 et 2012. Une complication septique sur fiche était un critère d'exclusion. Les fractures étaient classées selon l'A.O. et Gustilo. Nous avons évalué le délai avant l'ESDT, sa réalisation en 1 ou 2 temps, les résultats bactériologiques sur le produit d'alésage, la survenue de complications septiques post-enclouage et le délai de consolidation.Cinquante-cinq patients (55 fractures) ont été inclus. Il y avait 16 fractures fermées et 39 ouvertes (7 stades 1, 26 stades 2 et 6 stades 3 A selon Gustilo). Il s'agissait selon l'AO de 33 fractures type A, 14 type B et 8 type C. Le délai moyen avant l'enclouage était de 9 ± 9,6 semaines (min 4 jours, max 12 mois). L'ESDT était réalisé en 1 temps chez 23 patients et en 2 temps chez 32 avec un délai moyen de 12 jours (4 à 30 jours). Douze bactériologies étaient positives sur le produit d'alésage sans survenue de complication septique secondaire. Il y a eu 4 complications septiques (3 abcès, 1 pandiaphysite) et une pseudarthrose aseptique a du être réenclouée. Le taux de consolidation était de 96 %. Le seul facteur de mauvais pronostique était la gravité de l'ouverture de la fracture. Un enclouage en 1 temps n'augmentait pas le risque septique.Nos résultats sont supérieurs aux séries de la littérature qui ont cependant un pourcentage plus élevé de stade 3A et 3B de Gustilo et de suppurations sur fiches. L'ESDT est une procédure fiable avec un risque infectieux corrélé au stade de Gustilo et à son délai de réalisation. La procédure doit être précoce avant la survenue de suppuration sur fiche. Un ESDT précoce semble pouvoir être réalisé en un temps.Rétrospectif, niveau IV.

Accident of CPB is a reality. It is important to be prepared for discussion with the family, with the hospital administration, eventually with the justice. But we have also to support perfusionnist and anesthetic team in charge of the patient during accident.

HomeCirculationVol. 123, No. 12Two Cases of Valvular Thrombosis Secondary to Heparin-Induced Thrombocytopenia Managed Without Surgery Free AccessBrief ReportPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplementary MaterialsFree AccessBrief ReportPDF/EPUBTwo Cases of Valvular Thrombosis Secondary to Heparin-Induced Thrombocytopenia Managed Without Surgery Sylvie Ricome, MD, S. Provenchere, MD, B. Aubier, MD, N. Ajzenberg, MD, PhD, L. Lepage, MD, M.P. Dilly, MD, G. Dufour, MD, P. Montravers, MD, PhD and D. Longrois, MD, PhD Sylvie RicomeSylvie Ricome From the Medical Intensive Care Unit, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris V René Descartes (S.R.); Anesthesiology and Critical Care Department (S.P., B.A., M.P.D., G.D. P.M., D.L.); Hematology (N.A.); and Cardiology (L.L.), Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris VII Denis Diderot, Paris, France. , S. ProvenchereS. Provenchere From the Medical Intensive Care Unit, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris V René Descartes (S.R.); Anesthesiology and Critical Care Department (S.P., B.A., M.P.D., G.D. P.M., D.L.); Hematology (N.A.); and Cardiology (L.L.), Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris VII Denis Diderot, Paris, France. , B. AubierB. Aubier From the Medical Intensive Care Unit, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris V René Descartes (S.R.); Anesthesiology and Critical Care Department (S.P., B.A., M.P.D., G.D. P.M., D.L.); Hematology (N.A.); and Cardiology (L.L.), Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris VII Denis Diderot, Paris, France. , N. AjzenbergN. Ajzenberg From the Medical Intensive Care Unit, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris V René Descartes (S.R.); Anesthesiology and Critical Care Department (S.P., B.A., M.P.D., G.D. P.M., D.L.); Hematology (N.A.); and Cardiology (L.L.), Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris VII Denis Diderot, Paris, France. , L. LepageL. Lepage From the Medical Intensive Care Unit, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris V René Descartes (S.R.); Anesthesiology and Critical Care Department (S.P., B.A., M.P.D., G.D. P.M., D.L.); Hematology (N.A.); and Cardiology (L.L.), Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris VII Denis Diderot, Paris, France. , M.P. DillyM.P. Dilly From the Medical Intensive Care Unit, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris V René Descartes (S.R.); Anesthesiology and Critical Care Department (S.P., B.A., M.P.D., G.D. P.M., D.L.); Hematology (N.A.); and Cardiology (L.L.), Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris VII Denis Diderot, Paris, France. , G. DufourG. Dufour From the Medical Intensive Care Unit, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris V René Descartes (S.R.); Anesthesiology and Critical Care Department (S.P., B.A., M.P.D., G.D. P.M., D.L.); Hematology (N.A.); and Cardiology (L.L.), Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris VII Denis Diderot, Paris, France. , P. MontraversP. Montravers From the Medical Intensive Care Unit, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris V René Descartes (S.R.); Anesthesiology and Critical Care Department (S.P., B.A., M.P.D., G.D. P.M., D.L.); Hematology (N.A.); and Cardiology (L.L.), Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris VII Denis Diderot, Paris, France. and D. LongroisD. Longrois From the Medical Intensive Care Unit, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris V René Descartes (S.R.); Anesthesiology and Critical Care Department (S.P., B.A., M.P.D., G.D. P.M., D.L.); Hematology (N.A.); and Cardiology (L.L.), Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris VII Denis Diderot, Paris, France. Originally published29 Mar 2011https://doi.org/10.1161/CIRCULATIONAHA.110.966523Circulation. 2011;123:1355–1357A 83-year-old woman underwent aortic valvular replacement with a bioprosthesis for symptomatic aortic stenosis. Anesthesia and surgery were uneventful. Unfractionated heparin (UFH) had been administered for cardiopulmonary bypass followed by anticoagulation on day 0 (surgery), and had been continued thereafter. Routine postoperative blood count showed an increase in platelet counts to >200 g/L on day 6. On the ninth day, the patient complained of paresthesia of the left foot. A computed tomography scan with intravenous radiocontrast material was performed. Thrombosis of both iliofemoral axes and a thrombus on the ascending aorta were found (Figure 1 and Figure 2). A blood count on day 9 revealed thrombopenia at 44 G/L; antiPF4 antibodies (Enzyme-Linked ImmunoSorbent Assay HPIA is Heparin Platelet Factor 4 Induced Antibodies [ELISA] Asserachrom HPIA Stago, Asnières France) were positive (optical density >2), and the platelet aggregation test confirmed the diagnosis of heparin-induced thrombocytopenia. Anticoagulation with UFH was stopped and replaced with intravenous sodium danaparoid targeted to anti-Xa concentration of 0.5 to 0.8 IU/mL. The patient underwent surgical iliofemoral thrombectomy that was uneventful.Download figureDownload PowerPointFigure 1. Computed tomography scan performed on postoperative day 9 because of paresthesia of the left foot: coronal view showing thrombosis of both iliofemoral axes.Download figureDownload PowerPointFigure 2. Computed tomography scan of the chest: coronal view with a voluminous thrombus on the ascending aorta.Transoesophageal echocardiography (TOE) revealed thrombosis of the aortic valve (with a thrombus of 18 mm) extending into the first centimeters of the ascending aorta (Figure 3 and online-only Data Supplement Movie I). Because the patient was asymptomatic, and due to the estimated risks of the surgical procedure, the decision to pursue sodium danaparoid treatment was made; the above-mentioned thrombi were to be monitored using TOE. Platelet counts returned to 100 G/L on day 14. Sodium danaparoid was overlapped with antivitamin K (fluindione), which was started on day 18. Sequential TOE revealed total regression of the intracardiac thrombus after 3 weeks (no picture available).Download figureDownload PowerPointFigure 3. Transoesophageal echocardiography performed on postoperative day 9 revealed thrombosis of the bioprosthetic aortic valve.A 54-year-old woman underwent mitral valve replacement for mitral stenosis with a mechanical prosthesis. Anesthesia and surgery were uneventful. Unfractionated heparin had been administered for cardiopulmonary bypass anticoagulation on day 0 (surgery) and continued thereafter. On postoperative day 11, a routine TOE was performed because of an increased valve gradient revealed by previous transthoracic echocardiography; nonobstructive thrombosis of the mitral valve was confirmed (Figure 4A). The patient had been anticoagulated with UFH since day 0, and the platelet counts were 230 G/L. Treatment with aspirin was added while administration of UFH was pursued. Two days later (postoperative day 13), a new TOE revealed thrombus extension with 2 mobile thrombi of 18 mm (Figure 4B; online-only Data Supplement Movie II and Movie III). Platelet counts were >200 g/L, but anti-PF4 antibodies (HIA IgG ELISA kit, Hyphen, Biomed) were positive (optical density =1.25). As a diagnosis of heparin-induced thrombocytopenia with thrombosis (HITT) was highly suspected, treatment with UFH was stopped, and anticoagulation performed with intravenous sodium danaparoid targeted to anti-Xa concentration of 0.5 to 0.8 IU/mL.Download figureDownload PowerPointFigure 4. Transoesophageal echocardiography performed on postoperative day 11 (A) and day 13 (B) show worsening mitral valve thrombosis.Because the patient was asymptomatic, and due to the risk of surgery in patients with HITT, the decision to pursue medical treatment was made, with further monitoring of the patient by TOE. The patient's evolution was favorable, with total disappearance of the thrombi observed on treatment day 32 (Figure 5 and online-only Data Supplement Movie IV).Download figureDownload PowerPointFigure 5. Transoesophageal echocardiography performed on postoperative day 32 showing disappearance of the 2 thrombi on the mechanical prosthetic mitral valve.No clinical thromboembolic event occurred for these 2 patients.These 2 cases illustrate the difficulties encountered every day when diagnosing heparin-induced thrombocytopenia or HITT in cardiac surgery patients. They also raise the question of the adequate strategy when HITT presents with valvular thrombosis. In the case of the non- HITT-related valvular thrombosis, treatment is usually discussed as being between a medical or a surgical strategy. Roudaut et al recommended taking into account the size of the thrombus in the presence of nonobstructive thrombosis.1 For thrombi <5 mm, a medical strategy is recommended with echocardiography follow-up and antiplatelet therapy; for thrombi >5 mm, especially when thrombi are large, mobile, and pedunculated, surgical strategy would be the preferable choice. Taking into account these recommendations, both patients should have undergone surgical thrombectomy, even without HITT.The specificities of HITT-related valvular thrombosis are not well documented. Because of difficulties of anticoagulation during cardiopulmonary bypass in patients with heparin-induced thrombocytopenia (risk of severe hemorrhage and transfusion)2 the medical strategy was considered to be the best option for these 2 patients. The favorable evolution in both cases with medical treatment alone highlights the need for a specific strategy for valvular thrombosis in the context of HITT.These 2 cases confirm several other reports in which nonsurgical therapy was successful in patients with HITT-related prosthetic valvular thrombosis3 and left atrial thrombosis.4 Taken together, these reports suggest that when analyzing the risk-to-benefit ratios of different strategies in patients with valve thrombosis after cardiac surgery secondary to HITT, medical therapy alone may be considered as an acceptable alternative.DisclosuresNone.FootnotesThe online-only Data Supplement is available with this article at http://circ.ahajournals.org/cgi/content/full/123/12/1355/DC1.Correspondence to Dan Longrois, MD, PhD, Département d'Anesthésie-Réanimation, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôôpitaux de Paris, Université Paris VII Denis Diderot, 46, rue Henri Huchard, 75877 Paris Cedex 18, France. E-mail dan.[email protected]aphp.fr and sylvie.[email protected]aphp.frReferences1. Roudaut R, Serri K, Lafitte S. Thrombosis of prosthetic heart valves: diagnosis and therapeutic considerations. Heart. 2007; 93: 137– 142.CrossrefMedlineGoogle Scholar2. Kurup V, Transue S, Wu Y, Rinder H, Barash P, Dewar M. Cardiac surgery in a patient with heparin-induced thrombocytopenia–cautions with use of the direct thrombin inhibitor, argatroban. Conn Med. 2006; 70: 245– 250.MedlineGoogle Scholar3. Zlotnick AY, Shehadeh J, Flugelman MY, Bursztein-De Myttenaere SA, Gaspar T, Shiran A. Images in cardiovascular medicine. Acute reversible bioprosthetic mitral valve stenosis caused by heparin-induced thrombocytopenia. Circulation. 2008; 118: e73– e75.LinkGoogle Scholar4. Abraham B, Chow C, Latter D, Mazer C. Natural course of left atrial thrombi after bioprosthetic mitral valve replacement in a patient with heparin-induced thrombocytopenia. Can J Cardiol. 2005; 21: 1307– 1308.MedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Bäck M, Hashem M, Giani A, Pawelzik S and Franco-Cereceda A (2022) Calcific aortic valve stenosis and COVID-19: clinical management, valvular damage, and pathophysiological mechanisms, Cardiology Plus, 10.1097/CP9.0000000000000001, 7:1, (3-11), Online publication date: 1-Mar-2022. Arangalage D, Lepage L, Faille D, Cimadevilla C, Dilly M, Papy E, Alhenc-Gelas M, Ghodbane W, Nataf P, Iung B, Steg P, Vahanian A, Ajzenberg N and Messika-Zeitoun D (2016) Presentation, management and outcome of heparin-induced thrombocytopenia after valvular heart surgery, European Journal of Cardio-Thoracic Surgery, 10.1093/ejcts/ezw200, 50:6, (1132-1138), Online publication date: 1-Dec-2016. Gonsalves W and Patnaik M (2014) Drugs that affect blood coagulation, fibrinolysis, and hemostasis A worldwide yearly survey of new data in adverse drug reactions and interactions, 10.1016/B978-0-444-62635-6.00035-8, (617-631), . March 29, 2011Vol 123, Issue 12 Advertisement Article InformationMetrics © 2011 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.110.966523PMID: 21444894 Originally publishedMarch 29, 2011 PDF download Advertisement SubjectsAnticoagulantsCardiovascular SurgeryComputerized Tomography (CT)EchocardiographyPlateletsThrombosis