Marc Licker

University of Geneva

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John Diaper

University of Geneva

Christoph Ellenberger

University Hospital of Geneva

Anastase Spiliopoulos

Hôpital Beau-Séjour

Denis R. Morel

University Hospital of Geneva

Jean‐Marie Tschopp

Hôpital du Valais

Frédéric Triponez

University Hospital of Geneva

Alexandre Schweizer

University Hospital of Geneva

Marc de Perrot

Toronto General Hospital

Wolfram Karenovicŝ

University Hospital of Geneva

Laurent Höhn

University Hospital of Geneva

Cooperative Institutions

University Hospital of Geneva

University of Geneva

Hôpital Beau-Séjour

Geneva College

St Thomas' Hospital

Inserm

Harvard University

Hospital Clínico Universitario de Valencia

Istituti di Ricovero e Cura a Carattere Scientifico

University of Toronto

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Near-fatal acute dissection of the thoracic aorta involving the right coronary artery

European Journal of Anaesthesiology (2000)

Catherine Chevalley Michel Montessuit Nicolas Mürith Marc Licker

We describe a patient with aortic dissection extending into the right coronary artery who was successfully resuscitated and operated upon after a cardiac arrest during transfer to the operating room. The use of transoesophageal echocardiography was particularly helpful for rapid diagnosis of aortic type A dissection and urgent surgical treatment.

Artery dissection

Thoracic aorta

10.1097/00003643-200011000-00010

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Contents

The Annals of Thoracic Surgery (2011)

Eric Skipper Kevin Accola Robert M. Sade Brendon M. Stiles Farooq Mirza

10.1016/s0003-4975(11)02089-3

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Individualized versus Fixed Positive End-expiratory Pressure for Intraoperative Mechanical Ventilation in Obese Patients: A Secondary Analysis

Anesthesiology (2021)

Philipp Simon Felix Girrbach David Petroff Nadja Schliewe Gunther Hempel

Background General anesthesia may cause atelectasis and deterioration in oxygenation in obese patients. The authors hypothesized that individualized positive end-expiratory pressure (PEEP) improves intraoperative oxygenation and ventilation distribution compared to fixed PEEP. Methods This secondary analysis included all obese patients recruited at University Hospital of Leipzig from the multicenter Protective Intraoperative Ventilation with Higher versus Lower Levels of Positive End-Expiratory Pressure in Obese Patients (PROBESE) trial (n = 42) and likewise all obese patients from a local single-center trial (n = 54). Inclusion criteria for both trials were elective laparoscopic abdominal surgery, body mass index greater than or equal to 35 kg/m2, and Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score greater than or equal to 26. Patients were randomized to PEEP of 4 cm H2O (n = 19) or a recruitment maneuver followed by PEEP of 12 cm H2O (n = 21) in the PROBESE study. In the single-center study, they were randomized to PEEP of 5 cm H2O (n = 25) or a recruitment maneuver followed by individualized PEEP (n = 25) determined by electrical impedance tomography. Primary endpoint was Pao2/inspiratory oxygen fraction before extubation and secondary endpoints included intraoperative tidal volume distribution to dependent lung and driving pressure. Results Ninety patients were evaluated in three groups after combining the two lower PEEP groups. Median individualized PEEP was 18 (interquartile range, 16 to 22; range, 10 to 26) cm H2O. Pao2/inspiratory oxygen fraction before extubation was 515 (individual PEEP), 370 (fixed PEEP of 12 cm H2O), and 305 (fixed PEEP of 4 to 5 cm H2O) mmHg (difference to individualized PEEP, 145; 95% CI, 91 to 200; P < 0.001 for fixed PEEP of 12 cm H2O and 210; 95% CI, 164 to 257; P < 0.001 for fixed PEEP of 4 to 5 cm H2O). Intraoperative tidal volume in the dependent lung areas was 43.9% (individualized PEEP), 25.9% (fixed PEEP of 12 cm H2O) and 26.8% (fixed PEEP of 4 to 5 cm H2O) (difference to individualized PEEP: 18.0%; 95% CI, 8.0 to 20.7; P < 0.001 for fixed PEEP of 12 cm H2O and 17.1%; 95% CI, 10.0 to 20.6; P < 0.001 for fixed PEEP of 4 to 5 cm H2O). Mean intraoperative driving pressure was 9.8 cm H2O (individualized PEEP), 14.4 cm H2O (fixed PEEP of 12 cm H2O), and 18.8 cm H2O (fixed PEEP of 4 to 5 cm H2O), P < 0.001. Conclusions This secondary analysis of obese patients undergoing laparoscopic surgery found better oxygenation, lower driving pressures, and redistribution of ventilation toward dependent lung areas measured by electrical impedance tomography using individualized PEEP. The impact on patient outcome remains unclear. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Positive End-Expiratory Pressure

Interquartile range

Atelectasis

10.1097/aln.0000000000003762

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Safety Of Propofol Sedation Under Bispectral Index (BIS) Monitoring By Non Anesthesiologist Staff For Extensive Endoscopic Procedures

Jean-Marie Schnyder Marc Licker Jean-Georges Frey Jean‐Marie Tschopp

Bispectral index

10.1164/ajrccm-conference.2012.185.1_meetingabstracts.a4488

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Acute effects of transcatheter aortic valve replacement on the ventricular-aortic interaction

AJP Heart and Circulatory Physiology (2020)

Stamatia Pagoulatou Nikolaos Stergiopulos Vasiliki Bikia Georgios Rovas Marc Licker

Transcatheter aortic valve replacement (TAVR) is linked with an immediate increase in aortic systolic blood pressure and maximal flow, as well as steeper aortic pressure and flow wave upstrokes. After TAVR, the forward wave pumped by the heart is enhanced. Although the arterial properties remain unchanged, the central augmentation index (AIx) is markedly decreased after TAVR. This challenges the interpretation of AIx as a solely vascular measure in patients with aortic valve stenosis.

Valve replacement

Aortic pressure

Ventricular pressure

10.1152/ajpheart.00451.2020

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VE/VCO2 slope predicts short- and long-term outcome after anatomical pulmonary resection by VATS

British journal of surgery (2021)

Benoît Bédat Evangelos Koliakos Marc Licker Marco Stefano Demarchi Jean Yannis Perentes

Abstract Objective The ventilation-to-carbon dioxide output (VE/VCO2) slope could predict morbidity and mortality after lung resection. The aim of the study was to identify whether VE/VCO2 slope obtained from cardiopulmonary exercise test (CPET) was an independent predictor of cardiopulmonary complications after anatomical pulmonary resection by video-assisted thoracic surgery (VATS). Methods We reviewed the files of all consecutive patients that underwent pulmonary anatomical resections by VATS between January 2010 and October 2020. The data were extracted from the registry of the Centre for Thoracic Surgery of Western Switzerland. Pneumonectomies were excluded from the study. We used a multivariable Cox regression to investigate the risk of cardiopulmonary complications associated with the VE/VCO2 slope and other possible confounders, including the Charlson Comorbidity Index (CCI), the CPET data and pulmonary functions. Results In total, 1392 patients (mean age: 66±11 years; ratio female: 47%) underwent anatomical resection by VATS. CPET was performed in 204 patients (15%). However, the VE/VCO2 slope data were available in 145 patients, which were included for the analysis. Patients underwent segmentectomies (N = 42) and lobectomies (N = 101) mainly for lung cancer (96%). The average percentage of the predicted VO2max was of 70±17%. Maximal effort during the CPET (respiratory coefficient ratio >1.1) was not reached in 30% of patients, without impact on the VE/VCO2 slope (39±6 vs 37±7, P = 0.21). Cardiopulmonary complications appeared in 32% of patients with no mortality at 90 days. In the multivariate analysis, VE/VCO2 slope >35 was correlated with cardiopulmonary complications (OR 3.5, 95% CI [1.3-9.3], P = 0.012). CCI, pulmonary functions, peak VO2 and the extension of the anatomical resection was not associated with cardiopulmonary complications. Conclusion VE/VCO2 slope above 35 predicts postoperative cardiopulmonary complications in anatomical resections by VATS. The VE/VCO2 slope is independent of the intensity of effort during the CPET. The impact of prehabilitation on the slope should be determined.

Cardiothoracic surgery

10.1093/bjs/znab202.073

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A Case of Persistence of Normal Tissue Oxygenation Monitored by Near-Infrared Spectroscopy (NIRS) Values Despite Prolonged Perioperative Cardiac Arrest

American Journal of Case Reports (2019)

Julien Maillard Tornike Sologashvili John Diaper Marc Licker Gleicy Keli Barcelos

BACKGROUND Patients undergoing cardiac surgery are at risk of adverse perioperative neurological complications. Cerebral oximetry monitoring is increasingly used in these patients to detect intraoperative cerebral hypoxia or ischemic events. Near-infrared spectroscopy (NIRS) uses the near-infrared region of the electromagnetic spectrum for oximetry imaging. A case is reported of the persistence of normal tissue oxygenation monitored by NIRS values despite a prolonged perioperative cardiac arrest. CASE REPORT A 65-year-old man was admitted to the Emergency Department with dysarthria, left facial ptosis, left hemiplegia, and arterial hypotension of 75/50 mmHg. Computed tomography (CT) angiography showed a Stanford type A aortic dissection extending to the right common carotid artery. Shortly after arrival in the operating room, his hemodynamic condition rapidly deteriorated resulting in cardiac arrest. Despite the rapid onset of extracorporeal circulation, adequate systemic blood flow could not be restored. Cerebral NIRS values remained within the normal range (70-80%) from the start of emergency resuscitation, during a prolonged period of extremely low global blood perfusion values, and until all resuscitation ceased. CONCLUSIONS Cerebral oximetry values reflect a balance between cerebral oxygen delivery and consumption. This case demonstrated the persistence of normal tissue oxygenation monitored by NIRS values despite a prolonged perioperative cardiac arrest.

Persistence (discontinuity)

10.12659/ajcr.911399

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Long-term Angiotensin-converting Enzyme Inhibitor Treatment Attenuates Adrenergic Responsiveness without Altering Hemodynamic Control in Patients Undergoing Cardiac Surgery

Anesthesiology (1996)

Marc Licker P. Neidhart S. Lustenberger Michael B. Valloton Tshibambula Kalonji

Background The sympathoadrenal and the renin-angiotensin systems are involved in blood pressure regulation and are known to be markedly activated during cardiac surgery. Because unexpected hypotensive events have been reported repeatedly during anesthesia in patients chronically treated with angiotensin-converting enzyme (ACE) inhibitors, the authors questioned whether renin-angiotensin system blockade would alter the hemodynamic control through attenuation of the endocrine response to surgery and/or through attenuation of the pressor effects of exogenous catecholamines. Methods Patients with preserved left ventricular function undergoing mitral valve replacement or coronary revascularization were divided into two groups according to preoperative drug therapy: patients receiving ACE inhibitors for at least 3 months (ACEI) group, n = 22) and those receiving other cardiovascular drug therapy (control group, n = 19). Anesthesia was induced using fentanyl and midazolam. Systemic hemodynamic variables were recorded before surgery, after anesthesia induction, during sternotomy, after aortic cross-clamping, after aortic unclamping, as well as after separation from cardiopulmonary bypass (CPB) and during skin closure. Blood was sampled repeatedly up to 24 h after surgery for hormone analysis. To test adrenergic responsiveness, incremental doses of norepinephrine were infused intravenously during hypothermic CPB and after separation from CPB. From the dose-response curves, pressor (defined as mean arterial pressure changes), and vasoconstrictor (defined as systemic vascular resistance changes) effects were analyzed, and the slopes and the dose of norepinephrine required to increase mean arterial pressure by 20% were calculated (PD(20)). Results At no time did the systemic hemodynamics and the need for vasopressor support differ between the two treatment groups. However, for anesthesia induction, significantly less fentanyl and midazolam were given in the ACEI group. Although plasma renin activity was significantly greater in the ACEI group throughout the whole 24-h study period, plasma concentrations of angiotensin II did not differ between the two groups. Similar changes in catecholamines angiotensin II, and plasma renin activity were found in the two groups in response to surgery and CPB. The pressor and constrictor effects of norepinephrine infusion were attenuated markedly in the ACEI group: the dose-response curves were shifted to the right and the slopes were decreased at the two study periods; PD(20) was significantly greater during hypothermic CPB (0.08 micro/kg in the ACEI group vs. 0.03 micro/kg in the control group; P < 0.05) and after separation from CPB (0.52 micro/kg in the ACEI group vs. 0.1 micro/kg in the control group; P < 0.05). In both groups, PD(20) was significantly less during hypothermic CPB than in the period immediately after CPB. Conclusions Long-term ACE inhibitor treatment in patients with preserved left ventricular function alters neither the endocrine response nor the hemodynamic stability during cardiac surgery. However, a significantly attenuated adrenergic responsiveness associated with incomplete blockade of the plasma renin-angiotensin system supports the hypothesis that inhibition of angiotensin II generation and of bradykinin degradation within the vascular wall mediates some of the vasodilatory effects of ACE inhibitors.

10.1097/00000542-199604000-00005

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The Role of Intra-Aortic Counterpulsation in High-Risk OPCAB Surgery:

Journal of Cardiac Surgery (2003)

Jan T. Christenson Marc Licker Afksendiyos Kalangos

Abstract Background: High-risk patients would benefit the most of OPCAB revascularization. This prospective and randomized study evaluates the efficacy and safety of pre- and perioperative IABC in high-risk OPCAB. Material: Group A—IABC started prior to induction of anesthesia (n = 15); group B—no preoperative IABC (n = 15). Adult high-risk coronary patients to undergo OPCAB. High risk = (minimum 2) EF < 0.30, left main stenosis, unstable angina, redo. Bailout if hemodynamic instability CPB or IABC in group B. Study endpoints (a) cardiac protection (troponin 1, cardiac index (CI), ECG), (b) inflammatory response (lactate, IL-6), (c) clinical outcome (mortality, morbidity). Emergency operations 33%, re-operation 13%, unstable angina 100%, left main 60% and EF 0.29, without group differences. Results: No bailout group A, 10 in group B, p < 0.0001. Postoperative IABC six (group A) and seven patients (group B), during 6.8 ± 5.1 hours (group A) versus 41.2 ± 25.5 hours (group B), p = 0.0110. Myocardial protection without group differences, but CI significantly better in group A. Inflammatory response significantly less in group A. Clinical outcomes: one death, one MI and two renal failure in group B, none in group A. Intensive care unit (ICU) stay 27 ± 3 hours (group A) versus 65 ± 28 hours (group B), p = 0.0017. LOS 8 ± 2 days (group A) versus 15 ± 10 (group B), p = 0.0351. No IABC related complications. Conclusions: Pre- and perioperative IABC therapy offers efficient hemodynamic support during high-risk OPCAB surgery, lowers the risk of hemodynamic instability, is safe and shortens both ICU and hospital length of stay significantly, and is a cost-effective therapy. (J Card Surg 2003; 18:286-294)

Unstable angina

Group B

10.1046/j.1540-8191.2003.02030.x

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Citations (90)

Where Should I Send My Patient After the Operation?

Springer eBooks (2017)

Lukas Kreienbühl Tiziano Cassina Marc Licker

Patient Care

Cardiothoracic surgery

10.1007/978-3-319-19908-5_2

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Citations (1)