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1. Trends in SAVR with biological vs. mechanical valves in middle-aged patients: results from a French large multi-centric survey

Author

Thierry Caus, Yuthiline Chabry, Joseph Nader, Jean François Fusellier, Jean Louis De Brux, for the EpiCard investigators, Paul Achouh, Christophe Baufreton, Eric Bezon, Olivier Bouchot, Thierry Bourguignon, Lionel Camilleri, Nicolas Chavanis, Frédéric Collart, Pierre Corbi, Alain Curtil, Roland Demaria, François Bouchard, Jean-Marc Frapier, Jean-Philippe Frieh, Louis Labrousse, Pascal Leprince, Bertrand Marcheix, Jean Philippe Mazzucotelli, Jean-Christian Roussel, Vito Giovanni Ruggieri, Michel Tapia, Jean-Philippe Verhoye, and Andre Vincentelli

Subjects
aortic valve, surgical aortic replacement, mechanical and biological prosthetic valves, trend, database, France, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background/introductionCurrently, despite continued issues with durability ( 1), biological prosthetic valves are increasingly chosen over mechanical valves for surgical aortic valve replacement (SAVR) in adult patients of all ages, at least in Western countries. For younger patients, this choice means assuming the risks associated with a redo SAVR or valve-in-valve procedure.PurposeTo assess the use of mechanical vs. biological valve prostheses for SAVR relative to patient's age and implant time in a large population extracted from the French National Database EPICARD.MethodsPatients in EPICARD undergoing SAVR from 2007 to 2022 were included from 22 participating public or private centers chosen to represent a balanced representation of centre sizes and geographical discrepancies. Patients with associated pathology of the aorta (aneurysm or dissection) and requiring a vascular aortic prosthesis were excluded. Comparisons were made amongst centers, valve choice, implant date range, and patient age.ResultsWe considered 101,070 valvular heart disease patients and included 72,375 SAVR (mean age 71.4 ± 12.2 years). We observed a mechanical vs. biological prosthesis ratio (MBPR) of 0.14 for the overall population. Before 50 years old (y-o), MBPR was >1.3 (p

Published
2023
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2. Clinical utility of a deep-learning mortality prediction model for cardiac surgery decision making

Author

Nicolas Allou, Jérôme Allyn, Sophie Provenchere, Benjamin Delmas, Eric Braunberger, Matthieu Oliver, Jean Louis De Brux, Cyril Ferdynus, Paul Achouh, Stéphane Aubert, Christophe Baufreton, Eric Bezon, Nicolas Bonnet, Olivier Bouchot, Lionel Camilleri, Thierry Caus, Didier Chatel, Nicolas Chavanis, Sidney Chocron, Pierre Corbi, Alain Curtil, Philippe Delentdecker, Philippe Deleuze, Roland Demaria, Patrice Dervanian, Fabien Doguet, Olivier Fabre, Thierry Folliguet, Jean-Marc Frapier, Jean-Philippe Frieh, Jérôme Jouan, Joël Lapeze, Pascal Leprince, Bertrand Marcheix, Juan Pablo Maureira, Jean-Philippe Mazzucotelli, Patrick Nataf, Jean-François Obadia, Jean-Christian Roussel, Vito Giovanni Ruggieri, Jean-Philippe Verhoye, and André Vincentelli

Subjects
Pulmonary and Respiratory Medicine, Surgery, Cardiology and Cardiovascular Medicine
Published
2023

4. AORTLANTIC: French registry of aortic valve-sparing root replacement, preliminary multicentre results from western France

Author

Clément Dubost, Jacques Tomasi, Antoine Ducroix, Kevin Pluchon, Pierre Escrig, Olivier Fouquet, Arthur Aupart, Alain Mirza, Imen Fellah, Eric Bezon, Christophe Baufreton, Jean Marc El Arid, Jean-Christian Roussel, Jean-Philippe Verhoye, Thomas Senage, Institut du Thorax [Nantes], Centre hospitalier universitaire de Nantes (CHU Nantes), Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Nouvelle Clinique de Tours Saint Gatien-Alliance [Tours] (CTSGA), and Jonchère, Laurent

Subjects
[SDV.IB] Life Sciences [q-bio]/Bioengineering, Pulmonary and Respiratory Medicine, Time Factors, Bicuspid aortic valve, Valve-sparing aortic root replacement, Aortic Valve Insufficiency, Aortic Regurgitation, Middle Aged, French multicentric registry, Aortic Dissection, Blood Vessel Prosthesis Implantation, Treatment Outcome, Bicuspid Aortic Valve Disease, Aortic Valve, Humans, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Surgery, Registries, Cardiology and Cardiovascular Medicine, Acute aortic dissection, David procedure, Retrospective Studies
Abstract

International audience; OBJECTIVES: Aortic root aneurysms often affect younger patients in whom valve-sparing surgery is challenging. Amongst current techniques, aortic valve-sparing root replacement described by Tirone David has shown encouraging results. The AORTLANTIC registry was instituted for a multicentre long-term evaluation of this procedure. The current initial study evaluates the hospital outcomes of the procedure. MATERIAL AND METHOD: This is a retrospective study of patients operated between January 01, 2004, and December 31, 2020, in 6 hospitals in western France. All study data were recorded in the national digital database of the French Society of Cardiac Surgery: EPICARD. RESULTS: 524 consecutive patients with a mean age of 53(15.1) years underwent surgery. 13% (n = 68) patients presented with acute aortic dissection, 16.5% (n = 86) had associated connective tissue pathology and 7.3% (n = 37) had bicuspid aortic valves. Preoperative aortic regurgitation ≥ 2/4 was present in 65.3% (n = 341) of patients. Aortic valvuloplasty was required in 18.6% (n = 95) patients. At discharge, 92.8% (n = 461) patients had no or 1/4 aortic regurgitation. The stroke rate was 1.9% (n = 10). Intra-hospital mortality was 1.9% (n = 10). CONCLUSION: The AORTLANTIC registry includes 6 centers in western France with more than 500 patients. Despite numerous complex cases (acute aortic dissections, bicuspid aortic valves, preoperative aortic regurgitation), aortic valve-sparing root replacement has a low intra-hospital mortality. The initial encouraging results of this multicentre study warrant further long-term evaluation by future studies. CLINICAL REGISTRATION NUMBER: Nov 2021: This registry was approved by an ethics committee mandated by the CNIL (Commission Nationale de l’Informatique et des Libertés) to approve scientific projects of the Nantes Hospital Centre.

Published
2022

5. Perioperative adverse events in percutaneous versus open brachial access

Author

Bahaa Nasr, Mélanie Carret, Kevin Pluchon, Cedric Yven, Eric Bezon, and Yann Gouëffic

Subjects
Surgery, Cardiology and Cardiovascular Medicine
Abstract

The objective of the present study was to compare the incidence of complications at the access site after percutaneous brachial access (PBA) and open brachial access (OBA) in the treatment of peripheral arterial disease.From November 2016 to November 2021, all patients who had undergone peripheral artery revascularization with brachial access were included. The primary outcome was the 30-day rate of postoperative complications at the access site. The complications included hematoma, arteriovenous fistula, and pseudoaneurysms that had resulted in prolonged hospitalization and/or reintervention.Overall, 259 procedures with brachial access had been performed (PBA, n = 101; OBA, n = 158). The baseline clinical and demographic characteristics were well-balanced between the two groups. The sheath size was larger for the OBA procedures. Complications had occurred in 11 of 101 patients (11.1%) in the PBA group and 5 of 158 patients (3.2%) in the OBA group (P = .01). The mean duration of the procedure was significantly shorter for the PBA group (73.5 ± 46.5 minutes vs 101.2 ± 60.8 minutes; P = .0001).For patients who had undergone brachial access for peripheral vascular disease, the rate of access site-related complications was significantly lower for the patients who had undergone open access compared with that for the patients who had undergone percutaneous access.

Published
2023

7. Late Outcomes of Transcatheter Aortic Valve Replacement in High-Risk Patients

Author

Martine Gilard, Hélène Eltchaninoff, Patrick Donzeau-Gouge, Karine Chevreul, Jean Fajadet, Pascal Leprince, Alain Leguerrier, Michel Lievre, Alain Prat, Emmanuel Teiger, Thierry Lefevre, Didier Tchetche, Didier Carrié, Dominique Himbert, Bernard Albat, Alain Cribier, Arnaud Sudre, Didier Blanchard, Gilles Rioufol, Frederic Collet, Remi Houel, Pierre Dos Santos, Nicolas Meneveau, Said Ghostine, Thibaut Manigold, Philippe Guyon, Dominique Grisoli, Herve Le Breton, Stephane Delpine, Romain Didier, Xavier Favereau, Geraud Souteyrand, Patrick Ohlmann, Vincent Doisy, Gilles Grollier, Antoine Gommeaux, Jean-Philippe Claudel, Francois Bourlon, Bernard Bertrand, Marc Laskar, Bernard Iung, Michel Bertrand, Jean Cassagne, Jacques Boschat, Jean Rene Lusson, Pierre Mathieu, Yves Logeais, Jean-Paul Bessou, Bernard Chevalier, Arnaud Farge, Philippe Garot, Thomas Hovasse, Marie Claude Morice, Mauro Romano, Patrick Donzeau Gouge, Olivier Vahdat, Bruno Farah, Didier Carrie, Nicolas Dumonteil, Gérard Fournial, Bertrand Marcheix, Patrick Nataf, Alec Vahanian, Florence Leclercq, Christophe Piot, Laurent Schmutz, Pierre Aubas, A. du Cailar, A. Dubar, N. Durrleman, F. Fargosz, Gilles Levy, Eric Maupas, François Rivalland, G. Robert, Christophe Tron, Francis Juthier, Thomas Modine, Eric Van Belle, Carlo Banfi, Thierry Sallerin, Olivier Bar, Christophe Barbey, Stephan Chassaing, Didier Chatel, Olivier Le Page, Arnaud Tauran, Daniele Cao, Raphael Dauphin, Guy Durand de Gevigney, Gérard Finet, Olivier Jegaden, Jean-François Obadia, Farzin Beygui, Jean-Philippe Collet, Alain Pavie, Frédéric Collet, null Pecheux, null Bayet, Alain Vaillant, Jacques Vicat, Olivier Wittenberg, Rémi Houel, Patrick Joly, Roger Rosario, Patrice Bergeron, Jacques Bille, Richard Gelisse, Jean-Paul Couetil, Jean-Luc Dubois Rande, Delphine Hayat, Emilie Fougeres, Jean-Luc Monin, Gauthier Mouillet, Florence Arsac, Emmanuel Choukroun, Marina Dijos, Jean-Philippe Guibaud, Lionel Leroux, Nicolas Elia, null Descotes Genon, Sidney Chocron, François Schiele, Christophe Caussin, Alexandre Azmoun, Saïd Ghostine, Rémi Nottin, Ashok Tirouvanziam, Dominique Crochet, Régis Gaudin, Jean-Christian Roussel, Nicolas Bonnet, Franck Digne, Patrick Mesnidrey, Thierry Royer, Victor Stratiev, Jean-Louis Bonnet, Thomas Cuisset, Hervé Le Breton, Issal Abouliatim, Marc Bedossa, Dominique Boulmier, Jean Philippe Verhoye, Stéphane Delepine, Jean-Louis Debrux, Alain Furber, Frédéric Pinaud, Eric Bezon, Jean-Noel Choplain, Oliver Bical, Grégoire Dambrin, Philippe Deleuze, Arnaud Jegou, Jean-René Lusson, Kasra Azarnouch, Nicolas Durel, Andrea Innorta, Géraud Souteyrand, Yves Lienhart, Ricardo Roriz, Patrick Staat, Jean-Noël Fabiani, Antoine Lafont, Rachid Zegdi, Didier Heudes, Michel Kindo, Jean-Philippe Mazzucotelli, Michel Zupan, Calin Ivascau, Thérèse Lognone, Massimo Massetti, Rémy Sabatier, Bruno Huret, Philippe Hochart, Damien Bouchayer, François Gabrielle, Franck Pelissier, Guillaume Tremeau, François Bourlon, Gilles Dreyfus, Armand Eker, Yakoub Habib, Nicolas Hugues, Claude Mialhe, Olivier Chavanon, Paolo Porcu, and Gérald Vanzetto

Subjects
medicine.medical_specialty, Framingham Risk Score, Transcatheter aortic, business.industry, Incidence (epidemiology), medicine.medical_treatment, 030204 cardiovascular system & hematology, medicine.disease, 3. Good health, Surgery, 03 medical and health sciences, Stenosis, 0302 clinical medicine, Valve replacement, Aortic valve stenosis, medicine, 030212 general & internal medicine, Cardiology and Cardiovascular Medicine, Risk assessment, business, Prospective cohort study
Abstract

BACKGROUND Transcatheter aortic valve replacement (TAVR) has revolutionized management of high-risk patients with severe aortic stenosis. However, survival and the incidence of severe complications have been assessed in relatively small populations and/or with limited follow-up. OBJECTIVES This report details late clinical outcome and its determinants in the FRANCE-2 (FRench Aortic National CoreValve and Edwards) registry. METHODS The FRANCE-2 registry prospectively included all TAVRs performed in France. Follow-up was scheduled at 30 days, at 6 months, and annually from 1 to 5 years. Standardized VARC (Valve Academic Research Consortium) outcome definitions were used. RESULTS A total of 4,201 patients were enrolled between January 2010 and January 2012 in 34 centers. Approaches were transarterial (transfemoral 73%, transapical 18%, subclavian 6%, and transaortic or transcarotid 3%) or, in 18% of patients, transapical. Median follow-up was 3.8 years. Vital status was available for 97.2% of patients at 3 years. The 3-year all-cause mortality was 42.0% and cardiovascular mortality was 17.5%. In a multivariate model, predictors of 3-year all-cause mortality were male sex (p = 2 of 4 (p < 0.001). Severe events according to VARC criteria occurred mainly during the first month and subsequently in < 2% of patients/year. Mean gradient, valve area, and residual aortic regurgitation were stable during follow-up. CONCLUSIONS The FRANCE-2 registry represents the largest database available on late results of TAVR. Late mortality is largely related to noncardiac causes. Incidence rates of severe events are low after the first month. Valve performance remains stable over time. (J Am Coll Cardiol 2016; 68: 1637-47) (C) 2016 by the American College of Cardiology Foundation.

Published
2016

8. Commentary: Which place could the radial artery take in coronary artery bypass grafting?

Author

Bastien Provost, Eric Bezon, and Kevin Pluchon

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, Bypass grafting, business.industry, Coronary Artery Disease, medicine.anatomical_structure, medicine.artery, Internal medicine, Radial Artery, medicine, Cardiology, Humans, Saphenous Vein, Surgery, Coronary Artery Bypass, Radial artery, Cardiology and Cardiovascular Medicine, business, Artery
Published
2019

9. Temporal Trends in Transcatheter Aortic Valve Replacement in France

Author

Vincent Auffret, Thierry Lefevre, Eric Van Belle, Hélène Eltchaninoff, Bernard Iung, René Koning, Pascal Motreff, Pascal Leprince, Jean Philippe Verhoye, Thibaut Manigold, Geraud Souteyrand, Dominique Boulmier, Patrick Joly, Frédéric Pinaud, Dominique Himbert, Jean Philippe Collet, Gilles Rioufol, Said Ghostine, Olivier Bar, Alain Dibie, Didier Champagnac, Lionel Leroux, Frédéric Collet, Emmanuel Teiger, Olivier Darremont, Thierry Folliguet, Florence Leclercq, Thibault Lhermusier, Patrick Olhmann, Bruno Huret, Luc Lorgis, Laurent Drogoul, Bernard Bertrand, Christian Spaulding, Laurent Quilliet, Thomas Cuisset, Maxence Delomez, Farzin Beygui, Jean-Philippe Claudel, Alain Hepp, Arnaud Jegou, Antoine Gommeaux, Anfani Mirode, Luc Christiaens, Charles Christophe, Claude Cassat, Damien Metz, Lionel Mangin, Karl Isaaz, Laurent Jacquemin, Philippe Guyon, Christophe Pouillot, Serge Makowski, Vincent Bataille, Josep Rodés-Cabau, Martine Gilard, Hervé Le Breton, Herve Le Breton, Marc Laskar, Bernard Chevalier, Philippe Garot, Thomas Hovasse, Patrick Donzeau Gouge, Arnaud Farge, Mauro Romano, Bertrand Cormier, Erik Bouvier, Jean-Jacques Bauchart, Jean-Christophe Bodart, Cédric Delhaye, David Houpe, Robert Lallemant, Fabrice Leroy, Arnaud Sudre, Francis Juthier, Mohamed Koussa, Thomas Modine, Natacha Rousse, Jean-Luc Auffray, Marjorie Richardson, Jacques Berland, Mathieu Godin, Jean-Paul Bessou, Vincent Letocart, Jean-Christian Roussel, Philippe Jaafar, Nicolas Combaret, Nicolas D’Ostrevy, Andréa Innorta, Guillaume Clerfond, Charles Vorilhon, Marc Bedossa, Guillaume Leurent, Amedeo Anselmi, Majid Harmouche, Jean-Philippe Verhoye, Erwan Donal, Jacques Bille, Rémi Houel, Bertrand Vilette, Wissam Abi Khalil, Stéphane Delepine, Olivier Fouquet, Frédéric Rouleau, Jérémie Abtan, Marina Urena, Soleiman Alkhoder, Walid Ghodbane, Dimitri Arangalage, Eric Brochet, Coppelia Goublaire, Olivier Barthelemy, Rémi Choussat, Jean-Philippe Collet, Guillaume Lebreton, Chiro Mastrioanni, Richard Isnard, Raphael Dauphin, Olivier Dubreuil, Guy Durand De Gevigney, Gérard Finet, Brahim Harbaoui, Sylvain Ranc, Fadi Farhat, Olivier Jegaden, Jean-François Obadia, Matteo Pozzi, Saïd Ghostine, Philippe Brenot, Sahbi Fradi, Alexandre Azmoun, Philippe Deleuze, Martin Kloeckner, Didier Blanchard, Christophe Barbey, Stephan Chassaing, Didier Chatel, Olivier Le Page, Arnaud Tauran, Didier Bruere, Laurent Bodson, Yvon Meurisse, Aurélien Seemann, Nicolas Amabile, Christophe Caussin, Simon Elhaddad, Luc Drieu, Alice Ohanessian, François Philippe, Aurélie Veugeois, Matthieu Debauchez, Konstantinos Zannis, Daniel Czitrom, Chrystelle Diakov, François Raoux, Yves Lienhart, Patrick Staat, Oualid Zouaghi, Vincent Doisy, Jean Philippe Frieh, Fabrice Wautot, Julie Dementhon, Olivier Garrier, Fadi Jamal, Pierre Yves Leroux, Frédéric Casassus, Benjamin Seguy, Laurent Barandon, Louis Labrousse, Julien Peltan, Claire Cornolle, Marina Dijos, Stéphane Lafitte, Gilles Bayet, Claude Charmasson, Alain Vaillant, Jacques Vicat, Marie Paule Giacomoni, Eric Bergoend, Céline Zerbib, Jean Louis Leymarie, Philippe Clerc, Emmanuel Choukroun, Nicolas Elia, Jean-Philippe Grimaud, Jean-Philippe Guibaud, Stéphane Wroblewski, Eric Abergel, Emmanuel Bogino, Christophe Chauvel, Patrick Dehant, Marc Simon, Michel Angioi, Julien Lemoine, Simon Lemoine, Batric Popovic, Pablo Maureira, Olivier Huttin, Christine Selton Suty, Guillaume Cayla, Delphine Delseny, Gilles Levy, Jean Christophe Macia, Eric Maupas, Christophe Piot, François Rivalland, Gabriel Robert, Laurent Schmutz, Frédéric Targosz, Bernard Albat, Arnaud Dubar, Nicolas Durrleman, Thomas Gandet, Emmanuel Munos, Stéphane Cade, Frédéric Cransac, Frédéric Bouisset, Etienne Grunenwald, Bertrand Marcheix, Pauline Fournier, Olivier Morel, Patrick Ohlmann, Michel Kindo, Minh Tam Hoang, Hélène Petit, Hafida Samet, Anne Trinh, Guillaume Lecoq, Jean François Morelle, Pascal Richard, Thierry Derieux, Emmanuel Monier, Cédric Joret, Olivier Bouchot, Jean Christophe Eicher, Pierre Meyer, Stéphane Lopez, Michel Tapia, Jacques Teboul, Jean-Pierre Elbeze, Alain Mihoubi, Gérald Vanzetto, Olivier Wittenberg, Vincent Bach, Cécile Martin, Carole Sauier, Charlotte Casset, Philippe Castellant, Eric Bezon, Jean-Noel Choplain, Ahmed Kallifa, Bahaa Nasr, Yannick Jobic, Antoine Lafont, Jean-Yves Pagny, Ramzi Abi Akar, Jean-Noël Fabiani, Rachid Zegdi, Alain Berrebi, Tania Puscas, Bernard Desveaux, Fabrice Ivanes, Christophe Saint Etienne, Thierry Bourguignon, Blandine Aupy, Romain Perault, Jean-Louis Bonnet, Marc Lambert, Dominique Grisoli, Nicolas Jaussaud, Erwan Salaun, Amine Laghzaoui, Christine Savoye, Mathieu Bignon, Vincent Roule, Rémy Sabatier, Calin Ivascau, Vladimir Saplacan, Eric Saloux, Damien Bouchayer, Guillaume Tremeau, Camille Diab, Joel Lapeze, Franck Pelissier, Thomas Sassard, Catherine Matz, Nicolas Monsarrat, Ivan Carel, Franck Sibellas, Alain Curtil, Grégoire Dambrin, Xavier Favereau, Gabriel Ghorayeb, Laurent Guesnier, Wassim Khoury, Christophe Kucharski, Bruno Pouzet, Claude Vaislic, Riadh Cheikh-Khelifa, Loïc Hilpert, Philippe Maribas, Gery Hannebicque, Philippe Hochart, Marc Paris, Max Pecheux, Olivier Fabre, Laurent Leborgne, Marcel Peltier, Faouzi Trojette, Doron Carmi, Christophe Tribouilloy, Jean Mergy, Pierre Corbi, Pascale Raud Raynier, Sylvain Carillo, Arnaud Hueber, Fédéric Moulin, Georges Pinelli, Nicole Darodes, Francis Pesteil, Chadi Aludaat, Frédéric Torossian, Loïc Belle, Nicolas Chavanis, Chrystelle Akret, Alexis Cerisier, Jean Pierre Favre, Jean François Fuzellier, Romain Pierrard, Olivier Roth, Jean Yves Wiedemann, Nicolas Bischoff, Georghe Gavra, Nicolas Bourrely, Franck Digne, Mohammed Najjari, Victor Stratiev, Nicolas Bonnet, Patrick Mesnildrey, David Attias, Julien Dreyfus, Daniel Karila Cohen, Thierry Laperche, Julien Nahum, Aliocha Scheuble, Geoffrey Rambaud, Eric Brauberger, Michel Ah Hot, Philippe Allouch, Fabrice Beverelli, Julien Rosencher, Stéphane Aubert, Jean Michel Grinda, Thierry Waldman, Service de cardiologie et maladies vasculaires, Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Maladies infectieuses et vecteurs : écologie, génétique, évolution et contrôle ( MIVEGEC ), Université de Montpellier ( UM ) -Centre National de la Recherche Scientifique ( CNRS ) -Institut de Recherche pour le Développement ( IRD [France-Sud] ), Service de cardiologie [Rouen], CHU Rouen-Université de Rouen Normandie ( UNIROUEN ), Normandie Université ( NU ) -Normandie Université ( NU ), Service de cardiologie, Assistance publique - Hôpitaux de Paris (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris]-Université Paris Diderot - Paris 7 ( UPD7 ), CHU Gabriel Montpied ( CHU ), CHU Clermont-Ferrand, Institut Pascal - Clermont Auvergne ( IP ), Sigma CLERMONT ( Sigma CLERMONT ) -Université Clermont Auvergne ( UCA ) -Centre National de la Recherche Scientifique ( CNRS ), Service de chirurgie cardiaque et thoracique [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Pitié-Salpêtrière [APHP], Laboratoire Traitement du Signal et de l'Image ( LTSI ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Service de chirurgie cardio-vasculaire et thoracique, CHU Angers, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition ( ICAN ), CHU Pitié-Salpêtrière [APHP]-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Assistance publique - Hôpitaux de Paris (AP-HP)-Université Pierre et Marie Curie - Paris 6 ( UPMC ), Adaptation cardiovasculaire à l'ischemie, Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Institut Mondor de recherche biomédicale ( IMRB ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ), Service de cardiologie [Toulouse], Université Paul Sabatier - Toulouse 3 ( UPS ) -CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Cochin [AP-HP], Nutrition, obésité et risque thrombotique ( NORT ), Institut National de la Recherche Agronomique ( INRA ) -Aix Marseille Université ( AMU ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), CHU de Poitiers, Epidémiologie et Biostatistique, Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Epidémiologie et analyses en santé publique : risques, maladies chroniques et handicaps [Toulouse], Université Paul Sabatier - Toulouse 3 ( UPS ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Optimisation des régulations physiologiques ( ORPHY (EA 4324) ), Université de Brest ( UBO ) -Institut Brestois du Numérique et des Mathématiques ( IBNM ), Université de Brest ( UBO ) -Université de Brest ( UBO ), Institut de Chimie de la Matière Condensée de Bordeaux ( ICMCB ), Université de Bordeaux ( UB ) -Centre National de la Recherche Scientifique ( CNRS ), Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille ), Institut national de recherches archéologiques préventives ( Inrap ), Hémostase et pathologie cardiovasculaire, EA2693-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université de Lille, Droit et Santé, Belgian Institute for Space Aeronomy / Institut d'Aéronomie Spatiale de Belgique ( BIRA-IASB ), ONERA - The French Aerospace Lab ( Toulouse ), ONERA, Service de chirurgie thoracique cardiaque et vasculaire [Rennes], Institut de cardiologie [CHU Pitié-Salpêtrière], Service de Chirurgie Thoracique et Cardiovasculaire [CHU Pitié-Salpêtrière], Cardioprotection, Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Cardiovasculaire, métabolisme, diabétologie et nutrition ( CarMeN ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Hospices Civils de Lyon ( HCL ) -Institut National des Sciences Appliquées de Lyon ( INSA Lyon ), Université de Lyon-Institut National des Sciences Appliquées ( INSA ) -Université de Lyon-Institut National des Sciences Appliquées ( INSA ) -Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Institut National de la Recherche Agronomique ( INRA ), Carnegie Mellon University [Pittsburgh] ( CMU ), Hôpital nord, St Etienne, Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ), Clinique du Tonkin, Unité de recherche Phytopharmacie et Médiateurs Chimiques ( UPMC ), Institut National de la Recherche Agronomique ( INRA ), Département de cardiologie, CHU Bordeaux [Bordeaux]-Hôpital Haut-Lévêque [CHU Bordeaux], CHU Bordeaux [Bordeaux], Centre des Sciences des Littératures en Langue Française ( CSLF ), Université Paris Nanterre ( UPN ), Service de Cardiologie [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Saint-Antoine [APHP], Laboratoire de Chimie Physique - Matière et Rayonnement ( LCPMR ), Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Centre National de la Recherche Scientifique ( CNRS ), Laboratoire d'Informatique Fondamentale de Lille ( LIFL ), Université de Lille, Sciences et Technologies-Institut National de Recherche en Informatique et en Automatique ( Inria ) -Université de Lille, Sciences Humaines et Sociales-Centre National de la Recherche Scientifique ( CNRS ), Défaillance Cardiovasculaire Aiguë et Chronique ( DCAC ), Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université de Lorraine ( UL ), Centre Hospitalier Régional Universitaire de Nîmes ( CHRU Nîmes ), Service de chirurgie thoracique et cardio-vasculaire, Université Montpellier 1 ( UM1 ) -Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ) -Hôpital Arnaud de Villeneuve, Institut des Maladies Métaboliques et Cardiovasculaires ( I2MC ), Université Paul Sabatier - Toulouse 3 ( UPS ) -Hôpital de Rangueil-Institut National de la Santé et de la Recherche Médicale ( INSERM ), École de sages-femmes René Rouchy ( ESF Angers ), Université d'Angers ( UA ) -CHU Angers, Laboratoire de Génie Civil et d'Ingénierie Environnementale ( LGCIE ), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon ( INSA Lyon ), Université de Lyon-Institut National des Sciences Appliquées ( INSA ) -Institut National des Sciences Appliquées ( INSA ), Agriculture and Agri-Food [Ottawa] ( AAFC ), Centre d'études et de recherche sur les contentieux - EA 3164 ( CERC ), Université de Toulon ( UTLN ), Radiopharmaceutiques biocliniques, Université Joseph Fourier - Grenoble 1 ( UJF ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Clinique de chirurgie cardiaque, Université Joseph Fourier - Grenoble 1 ( UJF ) -CHU Grenoble, Unité Mixte de Recherches sur les Herbivores ( UMR 1213 Herbivores ), VetAgro Sup ( VAS ) -AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Institut National de la Recherche Agronomique ( INRA ), Université Grenoble Alpes - UFR Médecine ( UGA UFRM ), Université Grenoble Alpes ( UGA ), Développement artériel, Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre de recherche en économie et management ( CREM ), Université de Caen Normandie ( UNICAEN ), Normandie Université ( NU ) -Normandie Université ( NU ) -Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Centre National de la Recherche Scientifique ( CNRS ), Université Pierre et Marie Curie - Paris 6 - UFR de Médecine Pierre et Marie Curie ( UPMC ), Université Pierre et Marie Curie - Paris 6 ( UPMC ), Récepteurs nucléaires, maladies cardiovasculaires et diabète ( EGID ), Université de Lille, Droit et Santé-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Institut Pasteur de Lille, Réseau International des Instituts Pasteur ( RIIP ) -Réseau International des Instituts Pasteur ( RIIP ) -Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille ), Edwards Lifesciences Medtronic Lead-Up Medicines Company French Cardiology Federation (Federation Francaise de Cardiologie) Eli Lilly WebMD Biosensor ACIST Abbott Biosensors Terumo Daichii-Sankyo Boston Scientific St. Jude Medical Bristol-Myers Squibb Bayer AstraZeneca French Ministry of Health Abiomed Zoll Medpass Cordis Servier, Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Assistance publique - Hôpitaux de Paris (AP-HP)-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -CHU Pitié-Salpêtrière [APHP], Centre hospitalier universitaire de Poitiers ( CHU Poitiers ), Institut Pasteur de Lille, and Réseau International des Instituts Pasteur ( RIIP ) -Réseau International des Instituts Pasteur ( RIIP ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille )

Subjects
Aortic valve, medicine.medical_specialty, medicine.medical_treatment, national registry, 030204 cardiovascular system & hematology, outcomes, 03 medical and health sciences, 0302 clinical medicine, Valve replacement, Cardiac tamponade, Medicine, 030212 general & internal medicine, ComputingMilieux_MISCELLANEOUS, Aortic dissection, business.industry, Mortality rate, transfemoral, EuroSCORE, [ SDV.MHEP.CSC ] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, medicine.disease, pacemaker, 3. Good health, Surgery, Stenosis, Catheter, medicine.anatomical_structure, Cardiology and Cardiovascular Medicine, business
Abstract

Background - Transcatheter aortic valve replacement (TAVR) is standard therapy for patients with severe aortic stenosis who are at high surgical risk. However, national data regarding procedural characteristics and clinical outcomes over time are limited. Objectives - The aim of this study was to assess nationwide performance trends and clinical outcomes of TAVR during a 6-year period. Methods - TAVRs performed in 48 centers across France between January 2013 and December 2015 were prospectively included in the FRANCE TAVI (French Transcatheter Aortic Valve Implantation) registry. Findings were further compared with those reported from the FRANCE 2 (French Aortic National CoreValve and Edwards 2) registry, which captured all TAVRs performed from January 2010 to January 2012 across 34 centers. Results - A total of 12,804 patients from FRANCE TAVI and 4,165 patients from FRANCE 2 were included in this analysis. The median age of patients was 84.6 years, and 49.7% were men. FRANCE TAVI participants were older but at lower surgical risk (median logistic European System for Cardiac Operative Risk Evaluation [EuroSCORE]: 15.0% vs. 18.4%; p < 0.001). More than 80% of patients in FRANCE TAVI underwent transfemoral TAVR. Transesophageal echocardiography guidance decreased from 60.7% to 32.3% of cases, whereas more recent procedures were increasingly performed in hybrid operating rooms (15.8% vs. 35.7%). Rates of Valve Academic Research Consortium-defined device success increased from 95.3% in FRANCE 2 to 96.8% in FRANCE TAVI (p < 0.001). In-hospital and 30-day mortality rates were 4.4% and 5.4%, respectively, in FRANCE TAVI compared with 8.2% and 10.1%, respectively, in FRANCE 2 (p

Published
2017

12. Medium-Term Survival of Diffuse Coronary Artery Disease Patients following Coronary Artery Reconstruction with the Internal Thoracic Artery

Author

Eric Bezon, Jean-Christophe Cornily, Jean A. Barra, Ahmed Aziz Khalifa, Jean-Noël Choplain, Charles Henri David, Grégoire Le Gal, Service de Chirurgice Cardiaque, Thoracique et Vasculaire (CHRU - CCTV), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Département de Cardiologie (CHRU - Cardio), Centre d'Investigation Clinique (CIC - Brest), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), Optimisation des régulations physiologiques (ORPHY (EA 4324)), Institut Brestois Santé Agro Matière (IBSAM), and Université de Brest (UBO)-Université de Brest (UBO)-Université de Brest (UBO)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)

Subjects
Male, MESH: Exercise Tolerance, Bypass grafting, Coronary Artery Disease, 030204 cardiovascular system & hematology, Coronary artery disease, Postoperative Complications, 0302 clinical medicine, MESH: Risk Factors, Risk Factors, MESH: Postoperative Complications, Pharmacology (medical), MESH: Coronary Artery Disease, Hospital Mortality, 030212 general & internal medicine, Myocardial infarction, Coronary Artery Bypass, MESH: Treatment Outcome, MESH: Aged, MESH: Middle Aged, Exercise Tolerance, Middle Aged, 3. Good health, Treatment Outcome, surgical procedures, operative, medicine.anatomical_structure, MESH: Survival Analysis, Cardiology, Female, Cardiology and Cardiovascular Medicine, Artery, medicine.medical_specialty, MESH: Mammary Arteries, Internal thoracic artery, Medium term, 03 medical and health sciences, medicine.artery, Internal medicine, medicine, Humans, MESH: Hospital Mortality, Mammary Arteries, Survival analysis, Aged, MESH: Humans, business.industry, MESH: Coronary Artery Bypass, Coronary artery reconstruction, medicine.disease, Survival Analysis, MESH: Male, business, MESH: Female, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

Objective: Diffuse coronary artery disease makes cardiac surgeons hesitant regarding whether coronary artery bypass grafting (CABG) surgery is feasible or not. Coronary artery reconstruction using the internal thoracic artery (ITA) allows bypassing of coronary arteries with diffuse atheromatous plaques without systematically resorting to endarterectomy. The aim of the present study was to evaluate the medium-term results of coronary artery reconstruction. Methods: All patients undergoing coronary artery reconstruction using the ITA between 1999 and 2002 (233 patients) were included in the study. The mean age was 61.9 ± 9.8 years. Two hundred and eighty-one coronary artery reconstructions using the ITA were performed (mean length 3.6 ± 2 cm) for 514 CABGs. Coronary artery reconstruction using the ITA was associated with endarterectomy in 48 cases (17%). Results: In-hospital mortality was 2.6%. Follow-up data were compiled in December 2008. Mean follow-up was 73.4 ± 16.7 months. The actuarial survival rate at 7 years was 89.3 ± 2.1%, and 88% of patients were free of major cardiac events at 7 years. Conclusions: Coronary artery reconstruction gives comparable medium-term results to conventional coronary surgery, even though it is indicated for patients with more severe lesions.

Published
2011

13. Cardiac multislice spiral computed tomography as an alternative to coronary angiography in the preoperative assessment of coronary artery disease before aortic valve surgery: A management outcome study

Author

Yves Etienne, Ulric Vinsonneau, Martine Gilard, Virginie Jan, Grégoire Le Gal, Jacques Mansourati, Eric Bezon, Pierre-Yves Pennec, Jacques Boschat, Jean-Christophe Cornily, Jean-Jacques Blanc, Service d'Hémodynamique, Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)-Hôpital de la Cavale Blanche - CHRU Brest (CHU - BREST ), Optimisation des régulations physiologiques (ORPHY (EA 4324)), Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO)-Université de Brest (UBO)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Service de Cardiologie (BREST - Cardio), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Centre d'Investigation Clinique (CIC - Brest), and Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Male, Aortic valve, Valvulopathie aortique, 030204 cardiovascular system & hematology, Coronary Angiography, Coronary artery disease, 0302 clinical medicine, MESH: Child, Image Processing, Computer-Assisted, Prospective Studies, MESH: Coronary Artery Disease, 030212 general & internal medicine, Myocardial infarction, Child, MESH: Aortic Valve Stenosis, MESH: Aged, MESH: Middle Aged, MESH: Aortic Valve Insufficiency, General Medicine, Middle Aged, MESH: Image Processing, Computer-Assisted, Spiral computed tomography, 3. Good health, medicine.anatomical_structure, MESH: Young Adult, Coronaropathie, Cardiology, Female, Radiology, Cardiac multislice spiral computed tomography, Cardiology and Cardiovascular Medicine, Agatston score, Adult, MESH: Preoperative Care, medicine.medical_specialty, Adolescent, Scanner cardiaque, Aortic valve disease, Aortic Valve Insufficiency, Young Adult, 03 medical and health sciences, Internal medicine, Preoperative Care, medicine, Humans, Multislice, Aged, MESH: Adolescent, MESH: Humans, business.industry, MESH: Adult, Aortic Valve Stenosis, Perioperative, medicine.disease, MESH: Male, MESH: Prospective Studies, MESH: Coronary Angiography, Confidence interval, MESH: Tomography, Spiral Computed, business, Tomography, Spiral Computed, MESH: Female, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; BACKGROUND: Conventional coronary angiography (CA) is still recommended before valvular surgery. Preliminary studies suggest that multislice spiral computed tomography coronary angiography (MSCT-CA) can be used to rule out coronary artery disease (CAD). AIM: To assess prospectively the safety of ruling out CAD before surgery solely on the basis of normal MSCT-CA in patients with severe aortic valve disease. METHODS: We included all consecutive patients scheduled for aortic valve surgery. We first estimated the calcium score (Agatston score equivalent [ASE]). Patients underwent injected MSCT if the ASE was or =1000. Of 136 patients who underwent MSCT-CA, 106 (78%) had a normal MSCT-CA and underwent aortic valve surgery without prior CA; CA was performed in 30 patients because of abnormal (n=18) or bad quality (n=12) MSCT-CA. One patient of the 106 (0.94%, 95% confidence interval 0.17-5.15) had a perioperative myocardial infarction. CONCLUSIONS: When the ASE is

Published
2010

14. Acute renal dysfunction after cardiac surgery with cardiopulmonary bypass is associated with plasmatic IL6 increase

Author

Gildas Gueret, Eric Bezon, J. Arvieux, Nathalie Guriec, F. Lion, Raoul Baron, Catherine Guennegan, C.-C. Arvieux, Annabelle Dovergne, Jean-Luc Carré, Service de chirurgie thoracique et cardio vasculaire [Brest] (CCTV - Brest), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Optimisation des régulations physiologiques (ORPHY (EA 4324)), Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO)-Université de Brest (UBO)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), and Service de Biochimie et Biologie Moléculaire

Subjects
Male, medicine.medical_treatment, 030204 cardiovascular system & hematology, Biochemistry, law.invention, Postoperative Complications, 0302 clinical medicine, law, MESH: Postoperative Complications, Urea, Immunology and Allergy, 030212 general & internal medicine, MESH: Aged, Cardiopulmonary Bypass, MESH: Cardiac Surgical Procedures, MESH: Middle Aged, Ejection fraction, Hematology, Acute Kidney Injury, Middle Aged, 3. Good health, Cardiac surgery, medicine.anatomical_structure, Creatinine, Cardiology, Female, medicine.medical_specialty, MESH: Acute Kidney Injury, MESH: Cardiopulmonary Bypass, Immunology, MESH: Creatinine, Excretion, 03 medical and health sciences, Renal injury, Internal medicine, [SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Cardiopulmonary bypass, medicine, Humans, Cardiac Surgical Procedures, Molecular Biology, MESH: Urea, Dialysis, Aged, MESH: Humans, Interleukin-6, business.industry, Perioperative, MESH: Interleukin-6, MESH: Male, Ventricle, business, MESH: Female
Abstract

International audience; BACKGROUND: Acute renal dysfunction (ARD) is common after cardiac surgery with cardiopulmonary bypass (CPB). CPB results in a sudden systemic inflammatory response. Systemic and local pro-inflammatory cytokines synthesis has been linked with sub-clinical renal injury, especially tubular lesions. Therefore, we sought to assess the systemic synthesis pro-inflammatory cytokines and its association with perioperative ARD after cardiac surgery with CPB. METHODS: Sixty-two patients undergoing cardiac surgery with CPB were prospectively included. Four groups of patients were defined according to blood creatinine increase: no ARD (less than 25% increase), faint ARD (25-50% increase), moderate ARD (50-100% increase), severe ARD (more than 100% increase). RESULTS: Within the 48 post-operative hours was ARD observed as no dysfunction (41.9%), faint (32.2%), moderate (16.1%), severe (9.6%). One patient had to undergo a dialysis. Pre-operative characteristics were homogenous between the four groups excepted the left ventricle ejection fraction. ARD was associated with a low urinary output with high sodium excretion fraction. Significant increase of IL-6 level occurred when patients underwent a severe ARD despite no significant differences for the CRP and TNF-alpha concentrations. CONCLUSION: Severe acute renal dysfunction after cardiac surgery with CPB is associated with a significant increased IL-6 systemic production.

Published
2009

15. Comparison of Outcome of Transcatheter Aortic Valve Implantation With Versus Without Previous Coronary Artery Bypass Grafting (from the FRANCE 2 Registry)

Author

Romain Didier, Martine Gilard, Patrick Donzeau-Gouge, Eric Bezon, Philippe Castellant, Karine Chevreul, Emmanuel Teiger, Marc Laskar, Alain Prat, Jean Fajadet, Jacques Boschat, Bernard Iung, Michel Lievre, Hélène Eltchaninoff, Francis Couturaud, Alain Leguerrier, Pascal Leprince, Optimisation des régulations physiologiques (ORPHY (EA 4324)), Université de Brest (UBO)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), Centre d'Investigation Clinique (CIC - Brest), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département de Médecine Interne et Pneumologie [Brest] (DMIP - Brest), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM), Service de cardiologie [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Service de cardiologie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables (ECEVE (U1123 / UMR_S_1123)), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AP-HP Hôpital universitaire Robert-Debré [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre de recherche sur les Ions, les MAtériaux et la Photonique (CIMAP - UMR 6252), Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-École Nationale Supérieure d'Ingénieurs de Caen (ENSICAEN), Normandie Université (NU)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche sur les Matériaux Avancés (IRMA), Normandie Université (NU)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Institut national des sciences appliquées Rouen Normandie (INSA Rouen Normandie), Institut National des Sciences Appliquées (INSA)-Normandie Université (NU)-Institut National des Sciences Appliquées (INSA)-Centre National de la Recherche Scientifique (CNRS)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université de Rouen Normandie (UNIROUEN), Institut National des Sciences Appliquées (INSA)-Normandie Université (NU)-Institut National des Sciences Appliquées (INSA)-Centre National de la Recherche Scientifique (CNRS), Service de chirurgie thoracique cardiaque et vasculaire [Rennes] = Thoracic and Cardiovascular Surgery [Rennes], CHU Pontchaillou [Rennes], Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Evaluation et modélisation des effets thérapeutiques, Département biostatistiques et modélisation pour la santé et l'environnement [LBBE], Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Département de physiologie (CHU Henri Mondor), Hôpital Henri Mondor, Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Service de Chirurgie Thoracique et Vasculaire - Médecine vasculaire [CHU Limoges], CHU Limoges, Equipe de Recherche Médicale Appliquée (ERMA), Université de Limoges (UNILIM)-CHU Limoges-Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST FR CNRS 3503), Service de cardiologie [Brest], Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO)-Université de Brest (UBO)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO), Université Paris Diderot - Paris 7 (UPD7)-AP-HP - Hôpital Bichat - Claude Bernard [Paris]-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Institut National de la Santé et de la Recherche Médicale (INSERM)-AP-HP Hôpital universitaire Robert-Debré [Paris]-Université Paris Diderot - Paris 7 (UPD7), Centre National de la Recherche Scientifique (CNRS)-École Nationale Supérieure d'Ingénieurs de Caen (ENSICAEN), Normandie Université (NU)-Normandie Université (NU)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université de Caen Normandie (UNICAEN), Service de chirurgie thoracique cardiaque et vasculaire [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST FR CNRS 3503)-Université de Limoges (UNILIM)-CHU Limoges, Normandie Université (NU)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM)-AP-HP Hôpital universitaire Robert-Debré [Paris], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)

Subjects
Male, Cardiac Catheterization, medicine.medical_specialty, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Coronary artery bypass grafting, Comorbidity, Coronary Artery Disease, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Risk Assessment, Transcatheter Aortic Valve Replacement, TAVI, 03 medical and health sciences, 0302 clinical medicine, Valve replacement, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Risk Factors, Diabetes mellitus, Internal medicine, medicine, Humans, Prospective Studies, Registries, 030212 general & internal medicine, Myocardial infarction, Coronary Artery Bypass, Stroke, Aged, Aged, 80 and over, Vascular disease, business.industry, Mortality rate, Aortic Valve Stenosis, medicine.disease, 3. Good health, Surgery, Stenosis, Treatment Outcome, medicine.anatomical_structure, Cardiology, Female, France, Cardiology and Cardiovascular Medicine, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Follow-Up Studies, Artery
Abstract

International audience; Previous coronary artery bypass grafting (CABG) increases operative risk in conventional valve replacement. Transcatheter aortic valve implantation (TAVI) has been shown to be successful in high-risk patient subgroups. The present study compared outcome and overall survival in patients who underwent TAVI with and without history of CABG. From January 2010 to December 2011, 683 of the 3,761 patients selected for TAVI in 34 French centers (18%) had a history of CABG. Outcomes (mortality and complications) were collected prospectively according to the Valve Academic Research Consortium (VARC) criteria. Patients with previous CABG were younger, with higher rates of diabetes and vascular disease and higher logistic European System for Cardiac Operative Risk Evaluation (29.8 ± 16.4 vs 20.1 ± 13.0, p

Published
2015

16. Finegoldia magna, not a well-known infectious agent of bacteriemic post-sternotomy mediastinitis

Author

Rozenn Le Berre, Eric Bezon, Philippe Mondine, Luc de Saint Martin, Zarrin Alavi, Geneviève Héry-Arnaud, Claire de Moreuil, Charles-Henri David, Bastien Provost, Département de Médecine Interne et Pneumologie [Brest] (DMIP - Brest), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Laboratoire Universitaire de Biodiversité et Ecologie Microbienne (LUBEM), Université de Brest (UBO), Service de Chirurgice Cardiaque, Thoracique et Vasculaire (CHRU - CCTV), Université de Lille, Sciences et Technologies, Centre d'Investigation Clinique (CIC - Brest), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), Optimisation des régulations physiologiques (ORPHY (EA 4324)), Institut Brestois Santé Agro Matière (IBSAM), and Université de Brest (UBO)-Université de Brest (UBO)-Université de Brest (UBO)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)

Subjects
Male, medicine.medical_specialty, [SDV]Life Sciences [q-bio], Firmicutes, Microbiology, Postoperative Complications, medicine, Humans, FINEGOLDIA MAGNA, Anaerobes, Gram-Positive Bacterial Infections, reproductive and urinary physiology, Aged, Cross Infection, business.industry, fungi, medicine.disease, Sternotomy, Mediastinitis, 3. Good health, Surgery, Finegoldia magna, Treatment Outcome, Infectious Diseases, business, Infectious agent
Abstract

International audience; Post-sternotomy mediastinitis, a nosocomial infection mostly caused by staphylococci, can be life-threatening. A case of mediastinitis due to Finegoldia magna after a coronary artery bypass graft surgery was reviewed. Although this bacterium is difficult to be isolated from routine blood cultures, a F. magna bacteriemia associated with mediastinitis was diagnosed.

Published
2015

17. Failure of internal thoracic artery grafts: conclusions from coronary angiography mid-term follow-up

Author

Jean A. Barra, Ahmed A. Aziz, Jean Noël Choplain, Eric Bezon, and Yasser A. Maguid

Subjects
Pulmonary and Respiratory Medicine, Coronary angiography, medicine.medical_specialty, Time Factors, education, Internal thoracic artery, Coronary Angiography, Thoracic Arteries, medicine.artery, medicine, Humans, Treatment Failure, Derivation, Retrospective Studies, medicine.diagnostic_test, business.industry, Retrospective cohort study, Surgery, Mid term follow up, surgical procedures, operative, medicine.anatomical_structure, Angiography, Radiology, Cardiology and Cardiovascular Medicine, Complication, business, Follow-Up Studies, Artery
Abstract

The objective of this study was to identify causes of the failures of internal thoracic artery bypass grafts according to operative technique, the internal thoracic artery used, and the coronary artery grafted.This retrospective study concerns 302 follow-up angiographies performed in patients treated with 512 internal thoracic artery bypass grafts: 115 single grafts, 78 sequential grafts, and 109 grafts with two internal thoracic arteries (61 Y grafts). Postoperative angiography was performed after a mean period of 17.3 +/- 4.1 months.Failures consisted of 11 (2%) occluded grafts and 19 (4%) nonfunctioning grafts (threadlike internal thoracic artery). There was no difference in patency among the various types of left anterior descending artery bypass grafts anastomosed with the left internal thoracic artery. The failure rate was higher with the right internal thoracic artery (13%) than with the left internal thoracic artery (4%; p0.05). The failure rate of the left anterior descending artery bypass grafts (3%) was lower than that for the branches of circumflex artery bypass grafts (13%; p0.05). The 19 cases of nonfunctioning grafts did not include significant anastomotic stenosis: 14 were related to competitive blood flow, 4 to a poor recipient coronary arterial bed, and 1 to significant distal coronary stenosis.At least two thirds of failures of bypass grafts could have been avoided by more objective analysis of the coronary stenosis on preoperative coronary angiography and better mastery of the surgical technique.

Published
2003

18. Coronary artery reconstruction for extensive coronary disease: 108 patients and two year follow-up

Author

Ahmed Resk, Eric Bezon, Martine Gilard, Philippe Mondine, Jean-Aubert Barra, and Jacques Boshat

Subjects
Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, medicine.medical_treatment, Myocardial Infarction, Coronary Disease, Arteriotomy, Internal thoracic artery, Coronary Angiography, Angina Pectoris, Angina, Restenosis, medicine.artery, Internal medicine, medicine, Humans, Angina, Unstable, Myocardial infarction, Vascular Patency, business.industry, Unstable angina, Middle Aged, Plastic Surgery Procedures, medicine.disease, Coronary Vessels, Surgery, Coronary arteries, Treatment Outcome, medicine.anatomical_structure, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies, Artery
Abstract

Background . Surgical coronary artery reconstruction for diffuse coronary disease is described and assessed. Methods . A long arteriotomy, internal thoracic artery graft, and exclusion of atheromatous plaques from the coronary lumen are the bases of the technique. One hundred eighteen reconstructions were performed in 108 patients with a mean age of 59 years. Stable angina was present in 62% of patients and unstable angina in 22%. Sixteen percent had had a recent myocardial infarction. The reconstructions involved 94 left anterior descending coronary arteries, 17 marginal, 5 diagonal, and 2 right coronary arteries. Results . The perioperative mortality rate was 3.7% (4 patients). The rate of perioperative myocardial infarction was 6.3%. Mean follow-up was 29 months (standard deviation, 10 months). Two patients were lost to follow-up. Ninety patients were free from angina and cardiac-related events. Five patients sustained a myocardial infarction, 3 were in congestive heart failure, 3 had class II angina, and 1 died of stroke. Seventy-four of the surgical coronary artery reconstructions have been angiographically evaluated (29 months): 94.6% of the internal thoracic artery grafts were completely patent, and 70 of the reconstructions were patent without restenosis. String signs and occlusions were present in two internal thoracic arteries each. Conclusions . This technique allows revascularization of severely and diffusely diseased coronary arteries with encouraging results.

Published
2000

19. Surgical angioplasty with exclusion of atheromatous plaques in case of diffuse disease of the left anterior descending artery: 2 years’ follow-up

Author

Philippe Mondine, Jacques Boshat, Martine Gilard, Jacques Mansourati, Jean-Aubert Barra, Ahmed Resk, and Eric Bezon

Subjects
Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, medicine.medical_treatment, Myocardial Infarction, Infarction, Coronary Disease, Arteriotomy, Coronary Artery Disease, Endarterectomy, Internal thoracic artery, Thoracic Arteries, medicine.artery, Internal medicine, Angioplasty, Humans, Medicine, Angina, Unstable, Prospective Studies, cardiovascular diseases, Myocardial infarction, Coronary Artery Bypass, Aged, business.industry, Unstable angina, Anastomosis, Surgical, Percutaneous coronary intervention, General Medicine, Middle Aged, medicine.disease, Coronary Vessels, Surgery, Treatment Outcome, cardiovascular system, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract

Objective: A new surgical technique of coronary artery angioplasty for diffuse and extensive lesions of the left anterior descending artery (LAD) is evaluated in this study. Method: Ninety-four coronary artery reconstructions (CAR) using a new technique of angioplasty of the LAD were performed: mean age of patients was 59 ^ 8 years, there were 21 patients with unstable angina, and 21 with recent myocardial infarction (MI). Surgical technique: Diseased LAD is bypassed with the internal thoracic artery graft (ITA). The anastomosis is made downstream from the significant proximal lesion of the LAD. A long arteriotomy (from 2 to 12 cm) is performed along the LAD up to the healthy arterial wall, followed by coverage with the onlay graft of ITA in such a fashion as to exclude the plaques from the LAD lumen. The wall of the new reconstructed LAD consisted of 75% of ITA and 25% of native LAD. The remaining part of the native LAD forms a posterior gutter giving the origins of septal and diagonal branches. Results: aortic cross-clamping time was 116 min, operative mortality rate was 3.2% (three patients), peri-operative infarction rate 6.6% (six patients). The follow-up was 29 months (SDa 10). Of the 91 survivors, two were lost for follow-up and one died of non-cardiac causes. Of the 88 patients clinically evaluated, 81 were free from angina and other cardiac events, two had new myocardial infarction in a non-grafted area, two were in congestive heart failure, and three in angina class II. Sixty patients underwent angiography. There were 57 perfect-patency CAR (95%), two ITA string sign (competitive flow), two ITA occlusions (2.5%) and no re-stenosis. Conclusions: CAR allows revascularisation of diffusely diseased LAD with acceptable operative mortality and morbidity, 2 years’ good clinical results and graft patency. In this series, exclusion of plaques prevented plaque complications. q 2000 Elsevier Science B.V. All rights reserved.

Published
2000

20. Contents Vol. 108, 2007

Author

Thomas William Redpath, Nazmiye Çakmak, Salvatore Angelini, Sait Terzi, Nurten Sayar, Fumin Zhang, Yan-Hong Tang, Roberto Peidro, Ismail Peker, Fu-Chean Chen, Philippe Mondine, Andreas P. Kalogeropoulos, Giovanni Carreras, Zdzisława Kornacewicz-Jach, Harald Darius, John Chiladakis, Henrik Arendrup, Hyuck Moon Kwon, Colin Stirrat, Yong-Guang Zou, Lorenzo López-Bescós, Ali Akdogan, Man-Yi Ren, Agnieszka Bińczak-Kuleta, Israel E. Priel, Nikolaos Koutsogiannis, Alberto Gañán, Zenon S. Kyriakides, Eva Moreno, Sedat Kiraz, Ilknur Can, Mohammad Bagher Sharifkazemi, Arnaldo Angelino, Poul Alstrup, Martine Gilard, Ahmet Mesut Onat, Mahmood Zamirian, Ramón Martos, Yuan-Teh Lee, Klaus Rasmussen, Yan-Bo Li, Hasan Kadi, Sung-Ju Lee, Andrzej Ciechanowicz, Ji-Hyuck Rhee, Jan Madsen, Kirsten Kruszewski, Se-Joong Rim, Eric Bezon, M. Y. Norton, Jong Kwan Park, Jacques Boschat, Miguel Pocovi, Hans-Richard Arntz, Ming-Fong Chen, Arturo Orea-Tejeda, Slavomira Filipova, Wengzhu Ma, Wilmer L. Sibbitt, M. Artieda, Yun Zhang, Fu-Yu Xu, Paraskevi Dafnomili, Ian Topilsky, Ali Oto, Elizabeth Fireman, Tatiana S. Rodriguez-Reyna, Jean A. Barra, Yu-Shuang Lin, Ayşe Emre, Katarzyna Jakubowska, Kejiang Cao, Jia-Ming Zhang, Sami Viskin, Jochen Senges, Shu-Jian Sui, Uwe Zeymer, Erik Hjelms, Stig Haunsø, Dariusz Chlubek, Bum-Kee Hong, Peer Grande, Burak Tangürek, Nuri Kurtoglu, Torsten Toftegaard Nielsen, Beata Loniewska, Jacques Mansourati, Per Fritz-Hansen, Hale Yilmaz, Jiang-Bing Chen, Hsiu-Ching Hsu, Jen-Chen Tsai, Amir Aslani, Yuqing Zhang, Xiang Gao, Enrique Asensio-Lafuente, Necla Ozer, Edyta Czyzycka, Bai-Chin Lee, Huei-Fong Hung, Feng-Chia Chen, Sung Woo Kwon, Lilia Castillo-Martínez, Kemal Üreten, Mohaned Egred, Figen Ciloglu, Graciela Brión, Jae-Youn Moon, Per Thayssen, Lale Tokgozoglu, Ching-Tai Tai, Lutfullah Orhan, Pai-Feng Kao, Joel Dorantes-García, Paul Chan, Peter K. Paulsen, Bilgehan Karadag, Graham S. Hillis, Hyun-seung Kim, Cong-Xin Huang, Ryszard Rzeuski, Carmine Muto, Robert Chait, Antonela Lukic, Janusz Skowronek, Kari Saunamäki, Carlos A. Roldan, Luca Ottaviano, Stamatis Kyrzopoulos, Krzysztof Safranow, Andrzej Wojtarowicz, Ulrik H. Eriksen, Chern-En Chiang, Chuanfu Li, Michelangelo Canciello, Julio Granados-Arriola, Tuba Bilsel, Lykourgos Klamargias, Shih-Ann Chen, Lars Ib Andersen, Oscar Arrieta-Rodríguez, Bernardino Tuccillo, Theodore Lyras, Kudret Aytemir, Jean Christophe Cornily, Kurt Huber, Young Won Yoon, Apostolos Papalois, Kemal Yeşilçimen, José Puzo, Ihsan Ertenli, Lung-Chun Lin, Erika A. Gelgand, Jung-Sun Kim, Justin L. Barclay, Pi-Chang Lee, Se-Jung Yoon, Cheng-Lin Hu, Betau Hwang, Hung-Yuan Li, Qi-Zhu Tang, Uffe Niebuhr-Jørgensen, Razi Khan, Ana Cenarro, Ramasami Nandakumar, Dimitrios Alexopoulos, Mao-Shin Lin, Fernando Civeira, Clifford Qualls, Dingguo Zhang, Eli Kassis, Torben Haghfelt, and S. Walton

Subjects
Traditional medicine, business.industry, Medicine, Pharmacology (medical), Cardiology and Cardiovascular Medicine, business
Published
2007

23. Atrial flutter after non-congenital cardiac surgery: incidence, predictors and outcome

Author

Eric Bezon, Philippe Mondine, Jean-Jacques Blanc, Marjaneh Fatemi, Grégoire Le Gal, Marion Leledy, Service de Cardiologie (BREST - Cardio), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Centre d'Investigation Clinique (CIC - Brest), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), Optimisation des régulations physiologiques (ORPHY (EA 4324)), Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO)-Université de Brest (UBO)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), and Service de Chirurgice Cardiaque, Thoracique et Vasculaire (CHRU - CCTV)

Subjects
Male, Radiofrequency ablation, medicine.medical_treatment, 030204 cardiovascular system & hematology, law.invention, 0302 clinical medicine, MESH: Aged, 80 and over, Postoperative Complications, law, Recurrence, MESH: Postoperative Complications, Medicine, Sinus rhythm, 030212 general & internal medicine, MESH: Incidence, MESH: Treatment Outcome, MESH: Aged, Aged, 80 and over, MESH: Cardiac Surgical Procedures, MESH: Middle Aged, Incidence, Atrial fibrillation, MESH: Follow-Up Studies, Middle Aged, MESH: Predictive Value of Tests, Cardiac surgery, Treatment Outcome, Atrial Flutter, MESH: Atrial Flutter, Cardiology, Female, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, Catheter ablation, 03 medical and health sciences, Predictive Value of Tests, Internal medicine, Humans, Cardiac Surgical Procedures, Aged, Retrospective Studies, MESH: Humans, business.industry, MESH: Retrospective Studies, Odds ratio, medicine.disease, Confidence interval, MESH: Male, MESH: Recurrence, business, MESH: Female, Atrial flutter, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Follow-Up Studies
Abstract

International audience; BACKGROUND: Atrial arrhythmias (AAs) occur frequently after cardiac surgery. However, most authors do not differentiate postoperative atrial fibrillation (AF) from atrial flutter (AFL). Our study sought to investigate the incidence and predictors of AFL following non-congenital cardiac surgery, and the long-term outcome of this arrhythmia. METHODS AND RESULTS: We conducted an observational, retrospective, single-centre study. Among 821 patients in sinus rhythm (SR) before non-congenital cardiac surgery, AFL occurred in 42 patients (5.1%) and AF in 77 (9.4%). Independent predictors of AAs were older age (odds ratio (OR): 1.06, 95% confidence interval (CI): 1.01-1.11, p = 0.02), low postoperative hemoglobin level (OR: 0.43, CI: 0.29-0.63, p < 0.0001) and long cross-clamp time (OR: 1.02, CI: 1.002-1.037, p = 0.03). Compared to AF patients, those with AFL were younger (67 ± 10 versus 72 ± 8 years, p = 0.005) and less likely to have valve surgery (57% versus 76%, p = 0.03). After conversion to SR, of 41/42 patients with AFL, 5 (12%) developed AFL and 5 (12%) had AF within a mean follow-up of 9.6 ± 8.4 months: only 32% of patients were on long-term antiarrhythmic therapy and 5% had radiofrequency ablation of AFL in the early postoperative period. CONCLUSION: AFL following non-congenital cardiac surgery is not frequent. Compared to patients in AF, those with AFL are younger and less likely to have valve surgery. After conversion of AFL to SR, recurrence rate of AAs is relatively low. Therefore, AFL occurring in this setting does not require systematic catheter ablation in the postoperative period.

Published
2009

24. Use of arterial patch to improve re-endothelialization in a sheep model of open carotid endarterectomy. An incentive to use internal thoracic artery as an on-lay patch following coronary endarterecomy?

Author

Ahmed Ismail Abdel Aziz Khalifa, Jean Noël Choplain, Jacques Mansourati, Grégoire Le Gal, Jean Auber Barra, Eric Bezon, Optimisation des régulations physiologiques (ORPHY (EA 4324)), Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO)-Université de Brest (UBO)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Service de Chirurgice Cardiaque, Thoracique et Vasculaire (CHRU - CCTV), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Centre d'Investigation Clinique (CIC - Brest), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Chirurgie Cardiaque, Thoracique et Vasculaire (CHRU - CCTV), and Service de Cardiologie (BREST - Cardio)

Subjects
Time Factors, medicine.medical_treatment, Carotid arteries, Carotid endarterectomy, 030204 cardiovascular system & hematology, Re endothelialization, MESH: Endarterectomy, Carotid, MESH: Blood Vessel Prosthesis, 0302 clinical medicine, Medicine, MESH: Coronary Vessels, MESH: Animals, Polytetrafluoroethylene, Endarterectomy, 0303 health sciences, Endarterectomy, Carotid, Coronary Vessels, MESH: Transplantation, Autologous, Femoral Artery, medicine.anatomical_structure, Carotid Arteries, MESH: Models, Animal, Models, Animal, Cardiology, MESH: Endothelium, Vascular, Cardiology and Cardiovascular Medicine, MESH: Prosthesis Design, Artery, MESH: Femoral Artery, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Endothelium, MESH: Sheep, MESH: Mammary Arteries, Internal thoracic artery, Prosthesis Design, Transplantation, Autologous, MESH: Suture Techniques, 03 medical and health sciences, Blood Vessel Prosthesis Implantation, Internal medicine, medicine.artery, MESH: Cell Proliferation, Animals, Thrombus, Mammary Arteries, 030304 developmental biology, Cell Proliferation, MESH: Carotid Arteries, Sheep, business.industry, MESH: Time Factors, Suture Techniques, MESH: Polytetrafluoroethylene, MESH: Blood Vessel Prosthesis Implantation, medicine.disease, Surgery, Blood Vessel Prosthesis, Endothelium, Vascular, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; To better understand the effect of the internal thoracic artery on endothelial growth after open coronary endarterectomy, we designed an experimental test of the hypothesis that closing an endarterectomized artery by an arterial patch improves re-endothelialization. The two carotid arteries were endarterectomized in nine sheep and were randomly chosen for closure by native arterial femoral (ART) patch or polytetrafluoroethylene (PTFE) patch. Three animals were randomly chosen for sacrifice at 8, 15 and 21 days each. The endarterectomized segments were studied macroscopically and microscopically. The endarterectomized area covered with adhesive thrombus was more extensive in the PTFE than in the ART group (P=0.0117). In the ART group, the regenerated endothelium was normal and sprouted from the edges of both the endarterectomy and the arterial patch towards the central endarterectomized area. In the PTFE group, it sprouted from the edges of the endarterectomy and never reached the central endarterectomized area, where abnormal endothelium was observed. The endarterectomized area covered with normal endothelium was more extensive in the ART than in the PTFE group at 8 days, at 15 days, and 21 days (P

Published
2009

25. Cardiac tamponade in medical patients: a 10-year follow-up survey

Author

Grégoire Le Gal, Martine Gilard, Yannick Jobic, Philippe Castellant, Jean-Christophe Cornily, Jean-Jacques Blanc, Pierre-Yves Pennec, Eric Bezon, Jacques Boschat, Département de Cardiologie (CHRU - Cardio), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Optimisation des régulations physiologiques (ORPHY (EA 4324)), Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO)-Université de Brest (UBO)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Centre d'Investigation Clinique (CIC - Brest), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'Hémodynamique, and Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)-Hôpital de la Cavale Blanche - CHRU Brest (CHU - BREST )

Subjects
Male, medicine.medical_treatment, MESH: Pericardiectomy, MESH: Pericardiocentesis, MESH: Comorbidity, Comorbidity, 030204 cardiovascular system & hematology, Hospitals, University, 0302 clinical medicine, Neoplasms, Cardiac tamponade, Epidemiology, Pharmacology (medical), MESH: Neoplasms, Prospective Studies, 030212 general & internal medicine, Pericardial disease, MESH: Treatment Outcome, MESH: Aged, MESH: Middle Aged, 10 year follow up, MESH: Pericardial Effusion, Pericardiocentesis, MESH: Follow-Up Studies, Middle Aged, 3. Good health, Treatment Outcome, Pericardiectomy, MESH: Survival Analysis, Female, France, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, Malignancy, Pericardial Effusion, 03 medical and health sciences, Pericarditis, medicine, Humans, MESH: Cardiac Tamponade, Prospective survey, Aged, MESH: Hospitals, University, MESH: Humans, business.industry, General surgery, medicine.disease, Survival Analysis, MESH: Prospective Studies, MESH: Male, Cardiac Tamponade, Surgery, MESH: France, business, MESH: Female, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Follow-Up Studies
Abstract

Objectives: Cardiac tamponade represents a life-threatening condition that may complicate almost any cause of pericarditis. We conducted a 10-year prospective survey on patients with cardiac tamponade requiring an emergency drainage. Methods: From 1996 to 2005, 114 consecutive patients were admitted to the University Hospital of Brest for medical cardiac tamponade. Data on medical history, and volume, characteristics and histology of the pericardial fluid as well as short- and long-term follow-up data were collected. Results: Malignant disease was the primary cause of medical tamponade (74 patients; 65%), followed by viral history (11; 10%) and intra-pericardial bleeding due to anti-coagulation treatment (4; 3%). In 12 cases, aetiology remained unknown (10%). Pericardiocentesis was immediately performed in 80 cases and surgical pericardiotomy in 34. The mean volume drained was 593 ± 313 ml. In-hospital mortality was 10% without any difference between malignant and non-malignant diseases (p = 0.8). One-year mortality was 76.5% in patients with malignant disease and 13.3% in those without malignant disease (p < 0.0001). Median survival in case of malignant disease was 150 days. Conclusion: Compared to previously published data, our survey shows a decrease in some historical causes of tamponade such as tuberculosis, myxoedema or uraemia. The leading cause is currently malignant disease, which carries a very poor prognosis.

Published
2008

26. Continuous retrograde blood cardioplegia ensures prolonged aortic cross-clamping time without increasing the operative risk

Author

Ahmed Ismail Abdel Aziz Khalifa, Jean A. Barra, Habib Numa, Nicolas Salley, Jean Noël Choplain, and Eric Bezon

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, Aorta, education.field_of_study, Hyperkalemia, business.industry, Population, EuroSCORE, Confidence interval, law.invention, Reperfusion therapy, law, Internal medicine, medicine.artery, Cardiopulmonary bypass, medicine, Cardiology, Surgery, medicine.symptom, Operative risk, Cardiology and Cardiovascular Medicine, business, education
Abstract

The aim of this study was to assess whether the continuous retrograde blood cardioplegia ensures prolonged aortic cross-clamping time without increasing the operative risk. From 1996 to 2003, 204 consecutive patients who had cardiac procedure requiring aortic cross-clamping timeor = 150 min, were prospectively included in this study: low risk group (EuroSCOREor = 2) 50 patients, medium risk group (EuroSCORE 3-5) 68 patients, high risk group (EuroSCOREor = 6) 86 patients. The myocardial protection associated induction of cardiac arrest by antegrade injection of hyperkalemic warm blood, continuous retrograde intermediate lukewarm (20 degrees C) blood cardioplegia, retrograde warm blood reperfusion and systemic normothermia. The mean aortic clamping time was 187+/-45 min (range 150-436 min). The mean cardiopulmonary bypass time was 245+/-73 min (range 168-653 min). The operative mortality was 8.3% (17 patients). The mean predicted mortality of the population studied (EuroSCORE logistic method) was 8.4%+/-12 (range 0.87%-76.15%) with a 95% confidence interval of 6.7% to 10%. The observed mortality was not different from the predicted mortality. Continuous retrograde intermediate lukewarm blood cardioplegia associated with systemic normothermia allows prolonged aortic clamping time for complex intervention without increase of operative mortality and morbidity.

Published
2007

27. Same-day combined percutaneous coronary intervention and coronary artery surgery

Author

Jean Christophe Cornily, Martine Gilard, Jean A. Barra, Jacques Mansourati, Eric Bezon, Jacques Boschat, Philippe Mondine, Optimisation des régulations physiologiques (ORPHY (EA 4324)), Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO)-Université de Brest (UBO)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Service de Chirurgice Cardiaque, Thoracique et Vasculaire (CHRU - CCTV), and Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Pilot Projects, Coronary Artery Disease, 030204 cardiovascular system & hematology, Revascularization, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Left coronary artery, Internal medicine, medicine.artery, Angioplasty, medicine, [SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Humans, Pharmacology (medical), 030212 general & internal medicine, Myocardial infarction, MESH: Coronary Artery Disease, Angioplasty, Balloon, Coronary, Internal Mammary-Coronary Artery Anastomosis, MESH: Ambulatory Surgical Procedures, Aged, MESH: Aged, MESH: Internal Mammary-Coronary Artery Anastomosis, MESH: Humans, MESH: Middle Aged, business.industry, Percutaneous coronary intervention, Middle Aged, medicine.disease, MESH: Pilot Projects, MESH: Male, 3. Good health, MESH: Angioplasty, Balloon, Coronary, Ambulatory Surgical Procedures, Right coronary artery, Conventional PCI, Cardiology, Feasibility Studies, Female, Cardiology and Cardiovascular Medicine, business, MESH: Feasibility Studies, MESH: Female
Abstract

International audience; BACKGROUND: Either percutaneous coronary intervention (PCI) or coronary artery bypass grafting can be chosen for the treatment of multiple-vessel coronary artery disease. We report the results of a hybrid procedure performed on the same day, combining PCI of the right coronary artery and internal mammary artery bypass grafting of the left coronary artery, for the treatment of diffuse extensive lesions. METHODS AND RESULTS: Since January 2000, 70 patients (53 male, mean age 68.5 +/- 10 years) underwent this hybrid revascularization combining primary right coronary artery PCI and, within the next 16 h, left coronary artery grafting with left and/or right internal mammary artery. Thirty-one patients (98%) were treated on the same day. At a mean follow-up of 33 months (range: 2-70 months), 68 patients (97%) were asymptomatic at the time of writing. Three adverse events were reported: 2 were PCI-related, due to failure to take ticlopidine, and 1 was surgery-related, resulting in the patient's death during hospitalization. CONCLUSION: These preliminary results for a same-day combined procedure in patients with diffuse multivessel coronary artery disease are encouraging. This strategy optimizes revascularization when patients are unstable or present very severe coronary lesions, which requiring rapid treatment and are not ideally suitable for PCI management alone.

Published
2007

28. Heterogeneous geographic distribution of patients with aortic valve stenosis: arguments for new aetiological hypothesis

Author

J-C Cornily, J-A Barra, G. Le Gal, V. Bertault, Eric Bezon, J-J Blanc, Centre d'Investigation Clinique (CIC - Brest), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de chirurgie thoracique et cardio vasculaire [Brest] (CCTV - Brest), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), and Service de Cardiologie (BREST - Cardio)

Subjects
Male, MESH: Chi-Square Distribution, 030204 cardiovascular system & hematology, MESH: Calcinosis, 0302 clinical medicine, Aortic valve replacement, Residence Characteristics, Risk Factors, MESH: Risk Factors, Epidemiology, MESH: Censuses, Prevalence, 030212 general & internal medicine, MESH: Residence Characteristics, ComputingMilieux_MISCELLANEOUS, MESH: Aortic Valve Stenosis, Heart Valve Prosthesis Implantation, MESH: Aged, Calcinosis, Censuses, 3. Good health, Aortic valve stenosis, Female, France, Cardiology and Cardiovascular Medicine, MESH: Heart Valve Prosthesis Implantation, medicine.medical_specialty, 03 medical and health sciences, Scientific Letters, medicine, Humans, MESH: Prevalence, Aged, Chi-Square Distribution, MESH: Humans, Interventional cardiology, Vascular disease, business.industry, General surgery, Calcific aortic valve stenosis, Aortic Valve Stenosis, medicine.disease, MESH: Male, Surgery, MESH: France, Etiology, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, Chi-squared distribution, MESH: Female
Abstract

Calcific aortic valve stenosis is by far the most common valve disease in developed countries.1 The first clinical symptoms usually appear in the late 60s. Prosthetic aortic valve replacement is the only effective treatment at present.2 The reasons for the occurrence of calcifications of the aortic cusps leading eventually after many years to aortic valve stenosis are unknown. Some risk factors, mainly those already recognised in vascular disease, have been found to be associated with aortic valve stenosis and are considered to cause the disease.3,4 However, these factors are totally non-specific and may be confounded with factors leading to other illnesses. Recently a genetic hypothesis has been proposed after observation of a few familial cases5 but remains largely challenged in the absence of gene determination. The aim of our study was to evaluate whether epidemiological data collected in a selected region of France could provide evidence in favour of this hypothesis. The list of all patients who had undergone aortic valve replacement for calcific aortic valve stenosis in the cardiac surgery department of the Brest University Hospital between January 1996 and June 2003 was obtained from the central computerised registration of medical diagnosis and surgical procedures of the hospital, coded according to the International classification of diseases , 10th revision. This list was compared, and if necessary completed, with the diary registries of all the surgical interventions performed in the cardiac surgery department. For each patient, the following data were collected: name, sex, date of surgery, date of birth, and social security number. The social security number is a 15 digit number allowing identification for sex, year and month of birth, and geographic origin (region and commune). France is administratively divided into 22 provinces, about 100 regions, and 36 000 communes. The commune is the …

Published
2005

29. Wrapping of the left internal thoracic artery with an expanded polytetrafluoroethylene membrane

Author

Jean A. Barra, Gildas Gueret, Yasser A. Maguid, Ahmed A. Aziz, Eric Bezon, and Jean Noël Choplain

Subjects
Pulmonary and Respiratory Medicine, Thorax, medicine.medical_specialty, Valve surgery, Gauche effect, Heart Valve Diseases, Coronary Disease, macromolecular substances, Expanded polytetrafluoroethylene, Comorbidity, Constriction, chemistry.chemical_compound, Medicine, Humans, Postoperative Period, Mammary Arteries, Internal Mammary-Coronary Artery Anastomosis, Polytetrafluoroethylene, Aged, Heart Valve Prosthesis Implantation, business.industry, technology, industry, and agriculture, Prostheses and Implants, Middle Aged, equipment and supplies, Bandages, Clamping, Surgery, Left internal thoracic artery, chemistry, biological sciences, Cardiology and Cardiovascular Medicine, business
Abstract

We describe the wrapping of the proximal segment of the left internal thoracic artery graft in a polytetrafluoroethylene membrane. Two groups of patients were compared (99 patients with wrapping, 70 patients as controls). There were no statistical differences between the two groups regarding the postoperative course. Three patients in the polytetrafluoroethylene group and 2 in the control group underwent reoperation for valve surgery. Exposure of the wrapped graft segment for clamping was safer and more rapid than in the control group.

Published
2004

30. Subject Index Vol. 108, 2007

Author

Young Won Yoon, Jung-Sun Kim, Justin L. Barclay, Man-Yi Ren, Nazmiye Çakmak, Katarzyna Jakubowska, Kejiang Cao, Fu-Yu Xu, Paraskevi Dafnomili, Pi-Chang Lee, Se-Joong Rim, Hung-Yuan Li, Paul Chan, Fu-Chean Chen, Se-Jung Yoon, Bai-Chin Lee, Philippe Mondine, Dimitrios Alexopoulos, Clifford Qualls, Yan-Hong Tang, Xiang Gao, Enrique Asensio-Lafuente, Necla Ozer, Roberto Peidro, Qi-Zhu Tang, Kudret Aytemir, Ayşe Emre, Israel E. Priel, Klaus Rasmussen, Jan Madsen, Zdzisława Kornacewicz-Jach, Sait Terzi, Nurten Sayar, Harald Darius, Ching-Tai Tai, Graham S. Hillis, Sami Viskin, M. Artieda, Mohammad Bagher Sharifkazemi, Miguel Pocovi, Yong-Guang Zou, Chuanfu Li, Tuba Bilsel, Krzysztof Safranow, Apostolos Papalois, Razi Khan, Lale Tokgozoglu, Kemal Yeşilçimen, Jochen Senges, Pai-Feng Kao, Shu-Jian Sui, Joel Dorantes-García, Jean Christophe Cornily, Bilgehan Karadag, Antonela Lukic, Zenon S. Kyriakides, S. Walton, Kurt Huber, Janusz Skowronek, Dingguo Zhang, Eva Moreno, Lars Ib Andersen, Kirsten Kruszewski, Poul Alstrup, Lung-Chun Lin, John Chiladakis, Lykourgos Klamargias, Ramón Martos, Yuan-Teh Lee, Slavomira Filipova, Oscar Arrieta-Rodríguez, Lilia Castillo-Martínez, Wengzhu Ma, Luca Ottaviano, Hasan Kadi, Beata Loniewska, Wilmer L. Sibbitt, Jiang-Bing Chen, Torben Haghfelt, Torsten Toftegaard Nielsen, Hsiu-Ching Hsu, Cheng-Lin Hu, Sung Woo Kwon, Ramasami Nandakumar, Yu-Shuang Lin, Figen Ciloglu, Ming-Fong Chen, Mao-Shin Lin, Lorenzo López-Bescós, Shih-Ann Chen, Elizabeth Fireman, Stamatis Kyrzopoulos, Chern-En Chiang, Fernando Civeira, Tatiana S. Rodriguez-Reyna, Edyta Czyzycka, Jen-Chen Tsai, Bernardino Tuccillo, Theodore Lyras, Henrik Arendrup, Jean A. Barra, Yan-Bo Li, Uwe Zeymer, Carlos A. Roldan, Mahmood Zamirian, Alberto Gañán, Erik Hjelms, Betau Hwang, Hyuck Moon Kwon, Arturo Orea-Tejeda, Feng-Chia Chen, Stig Haunsø, Ali Akdogan, Kemal Üreten, Jia-Ming Zhang, Nikolaos Koutsogiannis, Robert Chait, Dariusz Chlubek, Bum-Kee Hong, Michelangelo Canciello, Peer Grande, Huei-Fong Hung, Burak Tangürek, Thomas William Redpath, Per Thayssen, Uffe Niebuhr-Jørgensen, Cong-Xin Huang, Ryszard Rzeuski, Carmine Muto, Ana Cenarro, Eli Kassis, Graciela Brión, Giovanni Carreras, Eric Bezon, M. Y. Norton, Yun Zhang, Jong Kwan Park, Jacques Boschat, Jacques Mansourati, Per Fritz-Hansen, Lutfullah Orhan, Hans-Richard Arntz, Salvatore Angelini, Mohaned Egred, Martine Gilard, Ahmet Mesut Onat, Fumin Zhang, Andreas P. Kalogeropoulos, Andrzej Ciechanowicz, Agnieszka Bińczak-Kuleta, Hale Yilmaz, Sedat Kiraz, Ilknur Can, Arnaldo Angelino, Ismail Peker, Sung-Ju Lee, Ian Topilsky, Kari Saunamäki, Andrzej Wojtarowicz, Ulrik H. Eriksen, Julio Granados-Arriola, Ali Oto, Jae-Youn Moon, Nuri Kurtoglu, Colin Stirrat, Peter K. Paulsen, Ji-Hyuck Rhee, Amir Aslani, Hyun-seung Kim, Yuqing Zhang, José Puzo, Ihsan Ertenli, and Erika A. Gelgand

Subjects
Index (economics), business.industry, Statistics, Medicine, Pharmacology (medical), Subject (documents), Cardiology and Cardiovascular Medicine, business
Published
2007

32. Homemade expanded-polytetrafluoroethylene flexible mitral annuloplasty ring

Author

Ahmed Ismail Abdel Aziz Khalifa, Eric Bezon, Jean A. Barra, and Jean Noël Choplain

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, Chirurgie orthopedique, medicine.medical_treatment, Expanded polytetrafluoroethylene, Prosthesis Design, Prosthesis, Mitral annuloplasty ring, Mitral valve, medicine, Humans, cardiovascular diseases, Polytetrafluoroethylene, Wrinkle, Retrospective Studies, Ultrasonography, Heart Valve Prosthesis Implantation, Mitral valve repair, business.industry, Suture Techniques, Mitral Valve Insufficiency, General Medicine, Surgery, Treatment Outcome, medicine.anatomical_structure, Heart Valve Prosthesis, cardiovascular system, Mitral Valve, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract

A homemade mitral annular prosthesis has been developed using expanded-polytetrafluoroethylene material. It is safe in that it avoids the risk of prosthesis wrinkle when stitches are tied. Simultaneously, it is strong enough to prevent future stretching and rupture. This device has been implanted in 60 patients with good and stable results at 42 months of follow-up. Our flexible mitral annular prosthesis is cost-effective and easily available in developing countries.

Published
2006

33. Assessment of different procedures for surgical left atrial appendage exclusion

Author

Jean Jacques Blanc, Pierre Yves Pennec, Eric Bezon, Yannick Jobic, and Jean A. Barra

Subjects
Pulmonary and Respiratory Medicine, Appendage, medicine.medical_specialty, Left atrial, business.industry, Internal medicine, Cardiology, Medicine, Surgery, Cardiology and Cardiovascular Medicine, business
Published
2003

34. Assessment of carotid artery stenosis before coronary artery bypass surgery. Is it always necessary?

Author

Luc Bressollette, Florent Le Ven, Eric Bezon, Jacques Boschat, Jacques Mansourati, Jean-Christophe Cornily, David Le Saux, Grégoire Le Gal, Ulric Vinsonneau, Martine Gilard, Jean-Jacques Blanc, Département de Cardiologie (CHRU - Cardio), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Optimisation des régulations physiologiques (ORPHY (EA 4324)), Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO)-Université de Brest (UBO)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Service de Cardiologie (BREST - Cardio), Département de Cardiologie (HIA - Cardio), Hôpital d'Instruction des armées, Département de Médecine Interne et Pneumologie [Brest] (DMIP - Brest), Centre d'Investigation Clinique (CIC - Brest), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), Service d'Hémodynamique, and Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)-Hôpital de la Cavale Blanche - CHRU Brest (CHU - BREST )

Subjects
Male, MESH: Chi-Square Distribution, medicine.medical_treatment, Coronary artery bypass, 030204 cardiovascular system & hematology, MESH: Risk Assessment, Severity of Illness Index, Coronary artery disease, MESH: Endarterectomy, Carotid, Coronary artery bypass surgery, 0302 clinical medicine, Risk Factors, MESH: Risk Factors, MESH: Carotid Stenosis, Carotid artery disease, Prevalence, Carotid Stenosis, MESH: Coronary Artery Disease, Stroke, Endarterectomy, MESH: Aged, Endarterectomy, Carotid, Ultrasonography, Doppler, Duplex, AVC, General Medicine, MESH: Predictive Value of Tests, 3. Good health, Coronaropathie, Cardiology, cardiovascular system, Female, France, medicine.symptom, Cardiology and Cardiovascular Medicine, Algorithms, MESH: Preoperative Care, medicine.medical_specialty, MESH: Ultrasonography, Doppler, Duplex, MESH: Algorithms, Risk Assessment, MESH: Stroke, 03 medical and health sciences, Predictive Value of Tests, Internal medicine, MESH: Severity of Illness Index, Preoperative Care, medicine, Humans, MESH: Patient Selection, cardiovascular diseases, MESH: Prevalence, Aged, Retrospective Studies, Chi-Square Distribution, MESH: Humans, business.industry, Patient Selection, MESH: Coronary Artery Bypass, MESH: Retrospective Studies, Pontage coronaire, Perioperative, medicine.disease, MESH: Male, Surgery, MESH: France, Stenosis, Carotid bruit, business, Athérosclérose carotidienne, MESH: Female, 030217 neurology & neurosurgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; BACKGROUND: Extracranial internal carotid artery stenosis is a risk factor for perioperative stroke in patients undergoing coronary artery bypass surgery (CAB). Although selective and non-selective methods of preoperative carotid screening have been advocated, it remains unclear if this screening is clinically relevant. AIM: To test whether selective carotid screening is as effective as non-selective screening in detecting significant carotid disease. METHODS: The case records of patients consecutively undergoing CAB were reviewed. Patients were stratified retrospectively into high- or low-risk groups according to risk factors for significant carotid stenosis and perioperative stroke: peripheral vascular disease (PVD), carotid bruit, diabetes mellitus, age >70 years and/or history of cerebrovascular disease. Prevalence of carotid stenosis detected by ultrasonography, surgical management and perioperative stroke rates were determined in each group. RESULTS: Overall, 205 consecutive patients underwent preoperative carotid screening. The prevalence of significant carotid stenosis was 5.8%. Univariate analysis confirmed that PVD (P=0.005), carotid bruit (P=0.003) and diabetes mellitus (P=0.05) were significant risk factors for stenosis. Carotid stenosis was a risk factor for stroke (P=0.03). Prevalence of carotid stenosis was higher in the high-risk group (9.1%) than the low-risk group (1.2%) (P70 years, with carotid bruit, a history of cerebrovascular disease, diabetes mellitus or PVD would have reduced the screening load by 40%, with trivial impact on surgical management or neurological outcomes.

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35. Reimplantation of the right internal thoracic artery as a free graft into the left in situ internal thoracic artery (Y Procedure): One-year angiographic results

Author

Rukbi I, Mondine P, J A Barra, Jacques Mansourati, Y. Youssef, and Eric Bezon

Subjects
Pulmonary and Respiratory Medicine, Male, medicine.medical_specialty, Cardiac Catheterization, Time Factors, Coronary Disease, Internal thoracic artery, Anastomosis, Anterior Descending Coronary Artery, Coronary Angiography, Thoracic Arteries, Internal medicine, medicine.artery, Occlusion, medicine, Myocardial Revascularization, Humans, Prospective Studies, Vascular Patency, medicine.diagnostic_test, business.industry, Anastomosis, Surgical, Graft Occlusion, Vascular, Middle Aged, medicine.disease, Abdominal aortic aneurysm, Surgery, Coronary arteries, medicine.anatomical_structure, Right coronary artery, Angiography, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract

Reimplantation of the right internal thoracic artery, as a free graft, into the left in situ internal thoracic artery (Y procedure) has enabled us to bypass more distant marginal vessels, which was not possible by the bilateral technique alone. This prospective study was aimed at evaluating the clinical state of the patients and the degree of patency of grafts within 16 months of follow-up. All 80 patients who underwent the Y procedure between January 1988 and January 1992 were included. This group represented 10% of the 840 patients having coronary bypass during the same period. A total of 202 coronary anastomoses were performed in this series. Early postoperative (30 days) complications included three deaths (3.75%), eight myocardial infarctions (10%), one case of phrenic nerve paralysis (1.25%), two cases of respiratory failure (2.5%), and six wound infections (7.5%). At 3 months' follow-up, 96% of patients were free of symptoms. During the follow-up period, four patients died of noncardiac causes (lung, pancreatic, and brain cancer and rupture of an abdominal aortic aneurysm). At 1 year, 71 patients were free of symptoms (97%). Sixty-one patients underwent coronary angiography between 12 and 24 months. Six patients with peripheral arterial disease were not suitable for coronary angiography, and six refused to be tested. These 12 patients had normal thallium test results in the bypassed area (stress or dipyridamole test). The patency rate of the left internal thoracic artery was 98.3% ( n = 60), occlusion rate 1.6% ( n = 1), and incidence of threadlike arteries 4.9% ( n = 3). Thus the rate of perfect patency was 93.4%. The patency rate of the right internal thoracic artery as a free graft was 93.4% ( n = 57), occlusion rate 6.5% ( n = 4), and the incidence of threadlike arteries 8% ( n = 5). Thus the rate of perfect patency was 85.2%. A total of 169 anastomoses were studied. The rate of patency of the anastomoses to the left anterior descending coronary artery was 96% ( n = 58) and the occlusion rate, 4% ( n = 2). The patency rate of sequential anastomoses (side to side) to diagonal arteries was 100% ( n = 16). Patency rate of anastomoses to obtuse marginal arteries was 95% ( n = 58) and the rate of occlusion, 4.9% ( n = 3). The patency rate of anastomoses to the posterior descending artery or distal branches of the right coronary artery was 80% ( n = 4/5). We conclude that the Y procedure is a safe technique with an acceptable morbidity and a good patency rate. This procedure can be used when the in situ technique is not possible because of far-reaching distal marginal coronary arteries. (J THORAC CARDIOVASC SURG 1995;109:1042-8)

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