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Glineur D, Shaw RE, Kuschner CE, Giovanni F, Etienne Y, Papadatos S, Brizzio M, Zapolanski A, Grau JB. Comparing use of BIMA in a Y-graft configuration to BIMA with additional radial artery use during CABG: Two institutional study. J Cardiothorac Surg 2015. [PMCID: PMC4693819 DOI: 10.1186/1749-8090-10-s1-a105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Price J, Glineur D, De Kerchove L, El Khoury G. Mitral Valve Repair is Feasible Following Extensive Decalcification and Reconstruction of the Atrioventricular Groove. THE JOURNAL OF HEART VALVE DISEASE 2015; 24:46-52. [PMID: 26182619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Mitral annular calcification (MAC) represents a significant challenge in mitral valve (MV) surgery. Techniques to decalcify the mitral annulus significantly increase operative complexity and risk. MV repair can be particularly difficult in this setting. Mid-term outcomes following MV surgery with extensive annular decalcification were examined, with attention focused on the feasibility and outcomes of MV repair in this setting. METHODS Among 1,485 patients undergoing MV surgery between 1999 and 2008 at the authors' institutions, 24 (1.6%) underwent complete posterior MV annular decalcification associated with either MV repair (n = 19) or replacement (n = 5). Extensive decalcification was performed from commissure to commissure in all patients. The annulus was reconstructed with pledgeted compression sutures in 17 patients, and with a bovine pericardial patch in seven. RESULTS In-hospital mortality was 12.5%. One patient died in the operating room from atrioventricular groove rupture, and two patients died from low cardiac output postoperatively. During a mean follow up of 4.4 ± 2.7 years, eight patients died; five of these deaths were cardiovascular in nature. After five years the actuarial survival was 56 ± 11%, and freedom from cardiac death 63 ± 11%. Four patients underwent' reoperation because of failure of MV repair (n = 2), endocarditis (n = 1) or hemolysis (n = 1). All survivors were in NYHA class ≤ 2, with none to trivial mitral regurgitation in all MV repairs. The five-year freedom from MV reoperation was 82 ± 8%. CONCLUSION After aggressive decalcification of the posterior MV annulus, both MV repair and replacement were feasible, with acceptable procedure-related mortality. It was clear however, that decalcification increased both complexity and risk. In well-selected patients, an aggressive approach to MV repair might facilitate a high rate of repair with acceptable midterm outcome in this patient population.
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Gaudino M, Massetti M, Farina P, Hanet C, Etienne PY, Mazza A, Glineur D. Chronic competitive flow from a patent arterial or venous graft to the circumflex system does not impair the long-term patency of internal thoracic artery to left anterior descending grafts in patients with isolated predivisional left main disease: Long-term angiographic results of 2 different revascularization strategies. J Thorac Cardiovasc Surg 2014; 148:1856-9. [DOI: 10.1016/j.jtcvs.2014.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 01/20/2014] [Accepted: 02/03/2014] [Indexed: 11/25/2022]
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Vohra HA, deKerchove L, Whistance RN, Glineur D, Noirhomme P, El Khoury G. Effect of preoperative symptoms on outcomes after valve repair for degenerative aortic insufficiency. Eur J Cardiothorac Surg 2013; 45:739-45. [DOI: 10.1093/ejcts/ezt541] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mosala Nezhad Z, Hechadi J, de Kerchove L, Glineur D, Noirhomme P, Rubay J, El Khoury G. 097 * AORTIC VALVE RECONSTRUCTION WITH A PATCH: INDICATION, TECHNIQUES AND DURABILITY. Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt372.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Glineur D. Importance of the third arterial graft in multiple arterial grafting strategies. Ann Cardiothorac Surg 2013; 2:475-80. [PMID: 23977625 DOI: 10.3978/j.issn.2225-319x.2013.07.01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 07/02/2013] [Indexed: 11/14/2022]
Abstract
BACKGROUND The long-term benefit of multiple arterial grafts for coronary artery bypass (CABG) is not clear. This protocol was elaborated to see if multiple arterial grafts would provide better long-term outcomes when compared with conventional strategies. METHODS Prospective data was collected for 588 patients undergoing isolated CABG between 1985 and 1995. We analyzed long term survival and freedom from cardiac death. The analysis compared patients with BITA grafting receiving a right gastro-epiploic artery (RGEA) versus those receiving a saphenous vein graft (SVG) as a third conduit. Cox proportional hazards modelling was used to adjust for relevant confounders. RESULTS The mean age was 59±9 years and 49% received BITA. Mean follow-up was 16.1±5.4 years. Multivariable analysis revealed in that patients receiving the RGEA as a third conduit had superior overall survival (HR, 0.46; P=0.015) and cardiac survival (HR, 0.20; P=0.005) compared to those receiving an SVG. CONCLUSIONS In our experience, the use of multiple arterial grafting is independently associated with superior outcomes. Furthermore, the use of a third arterial conduit targeted to the RCA should be considered to improve long-term survival.
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Tamer S, de Kerchove L, Glineur D, El Khoury G. Video-atlas of aortic valve repair. Ann Cardiothorac Surg 2013; 2:124-6. [PMID: 23977569 DOI: 10.3978/j.issn.2225-319x.2013.01.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 01/26/2013] [Indexed: 11/14/2022]
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Astarci P, Etienne PY, Raucent B, Bollen X, Tranduy K, Glineur D, Dekerchove L, Noirhomme P, Elkhoury G. Transcatheter resection of the native aortic valve prior to endovalve implantation - A rational approach to reduce TAVI-induced complications. Ann Cardiothorac Surg 2013; 1:224-30. [PMID: 23977499 DOI: 10.3978/j.issn.2225-319x.2012.06.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 06/29/2012] [Indexed: 11/14/2022]
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Vohra HA, Whistance RN, de Kerchove L, Glineur D, Noirhomme P, El Khoury G. Influence of higher valve gradient on long-term outcome after aortic valve repair. Ann Cardiothorac Surg 2013; 2:30-9. [PMID: 23977556 DOI: 10.3978/j.issn.2225-319x.2012.12.02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Accepted: 12/15/2012] [Indexed: 12/18/2022]
Abstract
BACKGROUND To evaluate the effect of higher post-operative valve gradient on freedom from valve re-intervention and death in patients undergoing aortic valve repair (AVr). METHODS Patients who underwent AVr between March 1996 and June 2010 were divided into 2 groups: I: peak gradient (PG) <20 mmHg (n=358) and II: PG ≥20 mmHg (n=113). Age (53.6±16.0 vs. 50.6±16.4 years; P=0.08), impaired LV (n=44, 12.2% vs. n=12, 10.6%: P=0.73) as well as the body surface area (1.97 vs. 1.95 m(2); P=0.4) were similar. Pre-operative AI >2+ was greater in Group II compared to Group I (n=78, 69.0% vs. n=192, 53.6%; P=0.004). Patients in Group II had higher proportion of bicuspid valves (BV) (n=58, 51.3% vs. n=106, 29.6%; P=0.0001) and restrictive valves (n=34, 30.0% vs. n=52, 14.5%; P=0.0001) while Marfan patients were seen only in Group I (n=19; P=0.010). Mean follow-up for Group I and Group II was 123.1±89.7 and 147.1±108.0 months, respectively. RESULTS In-hospital mortality was n=2 (0.5%) for Group I and none for Group II (P=1.0). Valve-sparing was higher in Group I (P=0.0001) but sub-commissural annuloplasty was similar (P=0.15). Shaving and/or decalcification was performed more in Group II (n=68, 60.1% vs. n=117, 32.6%; P=0.0001). Logistic regression analysis identified calcified, restrictive and bicuspid valves as independent predictors of PG ≥20 mmHg (P=0.04 for each). Predictors of re-operation were increased end-diastolic diameter (P=0.03) and younger age (P=0.007), but not PG ≥20 mmHg (P=0.98) (based on logistic regression). Overall 10-year cardiac survival and freedom from AV re-intervention was 82.3±4.6% vs. 89.5±4.2% (P=0.53) and 89.1±3.0% vs. 76.8±8.4% (P=0.02), in Group I and II, respectively (based on Kaplan-Meier analysis). Sub-group analysis showed that Group II patients requiring re-intervention (n=10) were younger (41.8±13.1 vs. 51.0±16.0 years; P=0.08) with similar proportion of bicuspid valves (n=6; 60%; P=0.74). The main reason for AV re-operation was aortic insufficiency (n=7) and AI + stenosis (n=3). CONCLUSIONS Higher gradient after AVr is associated with a reduced freedom from AV re-intervention, especially in younger patients.
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Van Dyck M, Glineur D, de Kerchove L, El Khoury G. Complications after aortic valve repair and valve-sparing procedures. Ann Cardiothorac Surg 2013; 2:130-9. [PMID: 23977571 DOI: 10.3978/j.issn.2225-319x.2012.12.03] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Accepted: 12/12/2012] [Indexed: 12/18/2022]
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Ngo Nonga B, Pasquet A, De Kherkove L, Glineur D, Debieve F, Hubinont C, El khoury G, Noirhomme P. Emergent cardiac surgery with cardiopulmonary bypass in early pregnancy: report of four cases. Res Cardiovasc Med 2013; 2:140-4. [PMID: 25478510 PMCID: PMC4253769 DOI: 10.5812/cardiovascmed.11281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 04/28/2013] [Accepted: 05/01/2013] [Indexed: 11/16/2022] Open
Abstract
Background: Due to current medical improvements, more women with cardiac disease are being operated during pregnancy. Fetal loss has been found to be significant between 9-30% of them and the surgery is supposed to be done maximal in the first trimester. Objectives: The aim of this study was to report our experience with urgent cardiopulmonary bypass carried out in early pregnancy and to analyze factors that may influence fetal and maternal morbidity and mortality after surgery. Materials and Methods: We have retrospectively reviewed the case notes of the patients who underwent cardiac surgery during early pregnancy in our institution from January 1997 to October 2011. Results: During that period cardiac surgery was done in 305 patients in childbearing age (between 15-50 years) from which 4 were pregnant and in the first half of their pregnancy. All of them had previous surgery due to rhumatismal heart disease .The surgery was emergent in 3 cases and urgent in 1 case. They were operated under normothermic conditions, high flow and hemodynamic stability throughout the procedure. There was no fetal loss but one patient sustained a cardiac arrest secondary to asthma complicated by post-anoxic brain injury. Conclusions: Normothermia and hemodynamic stability are the most important factors which help to reduce fetal loss during open heart surgery in pregnancy. The fetus has an auto-regulation which comes into play when the mother is experiencing shock.
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Astarci P, Glineur D, De Kerchove L, El Khoury G. Transcatheter valve used in a bailout technique during complicated open mitral valve surgery. Interact Cardiovasc Thorac Surg 2013; 17:745-7. [PMID: 23814136 DOI: 10.1093/icvts/ivt249] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Here, we describe the case of a 62-year old woman who required aortic and mitral valve replacement plus coronary artery bypass grafting. Transoesophageal echocardiogram revealed stenosis of the aortic valve (Ao valve area, 0.9 cm(2); PG, 45 mmHg; MG, 25 mmHg) and a diseased calcified mitral valve with stenosis and regurgitation (mitral valve area, 1.1 cm(2); MG, 10 mmHg; RV, 25 ml; ERO, 12 mm(2)). The mitral annulus calcifications were very deep into the left atrium and the left ventricle muscle, around the full annulus circumference. We decided to avoid complete deep mitral annulus decalcification. The left atrium was surgically exposed, and we deployed a 26-mm Edwards SAPIEN XT endovalve through the left atriotomy. To prevent paravalvular leakage, we then used a pericardial patch to close the gap between the endovalve and the calcified mitral annulus. The postoperative echocardiogram showed perfect anchoring of the endovalve in the mitral annulus without any paravalvular leakage.
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Glineur D. The choice of the second graft. ACTA ACUST UNITED AC 2013; 66:427-31. [PMID: 24776043 DOI: 10.1016/j.rec.2012.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 11/22/2012] [Indexed: 11/25/2022]
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Hechadi J, Gerber BL, Coche E, Melchior J, Jashari R, Glineur D, Noirhomme P, Rubay J, El Khoury G, De Kerchove L. Stentless xenografts as an alternative to pulmonary homografts in the Ross operation†. Eur J Cardiothorac Surg 2013; 44:e32-9. [DOI: 10.1093/ejcts/ezt147] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Etienne PY, D'hoore W, Papadatos S, Mairy Y, El Khoury G, Noirhomme P, Hanet C, Glineur D. Five-year follow-up of drug-eluting stents implantation vs minimally invasive direct coronary artery bypass for left anterior descending artery disease: a propensity score analysis. Eur J Cardiothorac Surg 2013; 44:884-90. [PMID: 23492989 DOI: 10.1093/ejcts/ezt137] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The spread of drug-eluting stents (DES) has reduced the incidence of early restenosis following percutaneous coronary interventions (PCI). Meanwhile, development of minimally invasive coronary artery bypass surgery (MIDCAB) has offered a valuable alternative to conventional sternotomy with preservation of the benefit of the internal mammary artery use. Therefore, the revascularization of the left anterior descending (LAD) artery is suitable for both techniques. However, few data with long-term comparison of these two techniques exist. METHODS Prospective data were collected for 456 patients undergoing isolated LAD revascularization between 1997 and 2011. Two hundred and sixty patients were treated with MIDCAB and 196 with first-generation DES implantation. A propensity score model was created to adjust for 19 relevant confounding variables. Primary and secondary end-points were, respectively, 5-year survival and freedom from major adverse cerebro-cardiovascular events (MACCE). RESULTS Both groups were similar in age, EuroSCORE and mean duration of follow-up. Five-year survival was similar after MIDCAB or DES (hazard ratio (HR): 0.95; P = 0.89). Freedom from MACCE was significantly in favour of the MIDCAB group (HR: 0.32, P < 0.0001), mainly triggered by high subsequent need for revascularization of the targeted vessel in the DES group (HR: 0.17, P < 0.0001). CONCLUSIONS MIDCAB and DES implantation showed similar rates of survival but despite an expected lower rate of reintervention on the targeted vessel with DES use, a highly significant higher MACCE rate was observed in the PCI group at 5-year follow-up.
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Navarra E, El Khoury G, Glineur D, Boodhwani M, Van Dyck M, Vanoverschelde JL, Noirhomme P, de Kerchove L. Effect of annulus dimension and annuloplasty on bicuspid aortic valve repair†. Eur J Cardiothorac Surg 2013; 44:316-22; discussion 322-3. [DOI: 10.1093/ejcts/ezt045] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Momeni M, Carlier C, Baele P, Watremez C, Van Dyck M, Matta A, Kahn D, Rennotte MT, Glineur D, de Kerchove L, Jacquet LM, Thiry D, Grégoire A, Eeckhoudt S, Hermans C. Fibrinogen Concentration Significantly Decreases After On-Pump Versus Off-Pump Coronary Artery Bypass Surgery: A Systematic Point-of-Care ROTEM Analysis. J Cardiothorac Vasc Anesth 2013; 27:5-11. [DOI: 10.1053/j.jvca.2012.07.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2012] [Indexed: 11/11/2022]
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Astarci P, Price J, Glineur D, D'Hoore W, Kefer J, Elkhoury G, Grandin C, Vanoverschelde JL. Cerebral embolization during percutaneous valve implantation does not occur during balloon inflation valvuloplasty: prospective diffusion-weighted brain MRI study. THE JOURNAL OF HEART VALVE DISEASE 2013; 22:79-84. [PMID: 23610993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY The study aim was to define the timing of cerebral embolization events during transcatheter aortic valve implantation (TAVI), and to determine if events were more closely associated with valve implantation or with balloon inflation. METHODS Between January 2008 and November 2011, a total of 114 patients underwent TAVI at the author's institution. Of these patients, 44 had previously undergone imaging before and after TAVI, and were included in the study (26 transfemoral (TF); 18 transapical (TA)). Eleven patients who had only balloon valvuloplasty (BV) during the same period were included, as were 22 patients who had open aortic valve replacement (AVR), as controls. All 77 patients underwent neurological examination, and all had cerebral MRIs before and after their procedures. RESULTS Fifty of the 77 patients who underwent postprocedural MRI had new cerebral lesions, as follows: 24/26 (92%) in TF patients; 17/18 (94%) in TA patients; 3/11 (27%) in BV patients; and 6/22 (27%) in AVR patients (TF and TA versus BV and AVR, p < 0.0001). The mean number and volume of embolic lesions per patient were respectively 5.4/438 mm3 for TF, 11.6/3414 mm3 for TA, 0.7/46 mm3 for BV, and 0.4/48 mm3 for AVR (TF versus TA and BV versus AVR, p = NS; TF and TA versus BV and AVR, p < 0.0001). No association was found between either the EuroSCORE or patient age and the number of events. CONCLUSION In the present study, an incidence of silent cerebral embolic lesions after TAVI was identified which was significantly higher than that for BV or AVR. This indicated an association of embolism with valve implantation rather than with balloon inflation.
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Momeni M, Watremez C, De Kock M, de Kerchove L, Glineur D, Baele P, Kahn D, Van Dyck M, Scholtes JL, Jacquet LM, Liistro G. Increased endogenous erythropoietin concentrations after cardiac surgery: another useful biomarker to be validated. Med Hypotheses 2012; 79:897. [PMID: 23021406 DOI: 10.1016/j.mehy.2012.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 08/27/2012] [Indexed: 10/27/2022]
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Momeni M, Liistro G, Baele P, Matta A, Kahn D, Van Dyck M, De Kock M, De Kerchove L, Glineur D, Thiry D, Gregoire A, Jacquet LM, Laarbui F, Watremez C. An Increase in Endogenous Erythropoietin Concentrations Has No Cardioprotective Effects in Patients Undergoing Coronary Artery Bypass Graft Surgery. J Cardiothorac Vasc Anesth 2012; 26:251-7. [DOI: 10.1053/j.jvca.2011.07.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Indexed: 11/11/2022]
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de Kerchove L, Price J, Tamer S, Glineur D, Momeni M, Noirhomme P, ElKhoury G. Extending the scope of mitral valve repair in active endocarditis. J Thorac Cardiovasc Surg 2012; 143:S91-5. [PMID: 22306214 DOI: 10.1016/j.jtcvs.2012.01.049] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Revised: 12/26/2011] [Accepted: 01/16/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVE During the last 2 decades, we have applied a repair-oriented surgical approach to patients with active mitral valve endocarditis. We retrospectively analyzed the long-term outcomes with this repair-oriented approach. METHOD Between 1991 and 2010, 137 patients underwent operation for active mitral valve endocarditis; of these, 109 patients (80%) had mitral valve repair and represent the study cohort. Repair techniques without patch extension (no-patch techniques) include triangular or quadrangular resection (n = 49), sliding plasty (n = 24), neochordae (n = 18), chordal transfer (n = 12), and others (n = 5). Repair techniques using patch extension (patch techniques) included pericardium (n = 42), tricuspid autograft (n = 8), flip-over technique (n = 7), and partial mitral valve homograft (n = 5). Patches were used in 67 patients (61%). Ring annuloplasty was performed in 60 patients, and a pericardial band was used in 13 patients. Clinical and echocardiographic follow-up were performed. Median follow-up was 48 months. RESULTS Hospital mortality was 16%. At 8 years, overall survival was 62% ± 10% with no differences between patients with or without patch repair (P = .5). Freedom from mitral valve repair failure was 81% ± 14% in patients with patch repair and 90% ± 10% in patients without patch repair (P = .09). The rate of thromboembolic or bleeding event was 1% per patient-year, and the rate of endocarditis recurrence was 0.3% per patient-year. Univariable predictors of mortality were age more than 70 years (P < .0001), perivalvular abscess (P = .002), diabetes mellitus (P = .0002), and renal failure (P = .04). Predictors of repair failure were renal failure (P = .035) and perivalvular abscess (P = .033). CONCLUSIONS In active mitral valve endocarditis, a repair-oriented surgical approach achieves a reparability rate of 80% with acceptable morbidity and good long-term results. The use of patch techniques offers a durability rate that approximates the rate obtained with the no-patch techniques.
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Glineur D, D'hoore W, Price J, Dorméus S, de Kerchove L, Dion R, Noirhomme P, El Khoury G. Survival benefit of multiple arterial grafting in a 25-year single-institutional experience: the importance of the third arterial graft. Eur J Cardiothorac Surg 2012; 42:284-90; discussion 290-1. [PMID: 22290925 DOI: 10.1093/ejcts/ezr302] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The long-term advantages of multiple arterial grafts, particularly a third arterial conduit, for coronary artery bypass (CABG) are not clear. This study was designed to test whether multiple arterial grafts would provide better long-term outcomes when compared with approaches using fewer arterial conduits. METHODS Between 1985 and 1995, prospective data were collected for 588 patients undergoing isolated CABG at our institution. We examined long-term survival and freedom from cardiac death. The primary analysis compared patients receiving bilateral internal thoracic artery (BITA) vs. single ITA (SITA). In a subgroup analysis, BITA patients receiving a right gastroepiploic artery (RGEA) were compared with those receiving a saphenous vein graft (SVG) as a third conduit. Cox proportional hazard modelling was used to adjust for relevant confounders. The Kaplan-Meier method was used to create survival curves over the follow-up period. RESULTS The mean age was 59 ± 9 years and 49% received BITA. Mean follow-up was 16.1 ± 5.4 years. Multivariable analysis revealed that overall survival [hazard ratio (HR): 0.74, P = 0.017] and cardiac survival (HR: 0.61, P = 0.004) was significantly improved in the presence of BITA compared with SITA. The survival at 10 and 20 years was 90.2 ± 3.4 and 56.9 ± 6.4% for the BITA vs. 82 ± 4.4 and 40.9 ± 6% for the SITA, respectively. In the subgroup of BITA patients, those receiving the RGEA as a third conduit had superior overall survival (HR: 0.41, P = 0.0032) and cardiac survival (HR: 0.18, P = 0.004) compared with those receiving an SVG. The survival at 10 and 20 years was 98.9 ± 2 and 68.9 ± 18% for the BITA/RGEA vs. 87.2 ± 4.6 and 50.3 ± 7% for the BITA/SVG, respectively. CONCLUSIONS In a single-institution experience, the use of multiple arterial grafting is independently associated with superior outcomes. Furthermore, the use of a third arterial conduit (RGEA) targeted to the right coronary artery should be considered to improve long-term survival.
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Astarci P, Glineur D, Elkhoury G, Raucent B. A novel device for endovascular native aortic valve resection for transapical transcatheter aortic valve implantation. Interact Cardiovasc Thorac Surg 2012; 14:378-80. [PMID: 22235001 DOI: 10.1093/icvts/ivr125] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We developed a novel resection device to use during transapical transcatheter aortic valve implantation (TAVI) using a circular blade. We assessed the device in 15 human cadavers by transapical approach. After the resection, the aortic annulus was measured using standard probes. A careful examination of the aortic wall, left ventricular outflow tract, coronary ostia and mitral valve was performed using an endpoint checklist, developed specifically for the new device. The resection was successfully completed in 14 out of 15 (93%) cases. All the resected leaflets and debris have been successfully evaluated in 15 out of 15 (100%) cases. One case of a bicuspid valve had a prominent calcification of the median raphe. The resection tool could only perform a partial resection. The mean duration of the resection was 45 ± 30 s. The surrounding tissue examination did not reveal any injury to the anatomical structures. Endovascular resection of the native valve using transapical approach is feasible and effective. Further developments are necessary before the definitive clinical use during percutaneous aortic valve implantation.
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Glineur D, D’hoore W, de Kerchove L, Noirhomme P, Price J, Hanet C, El Khoury G. Angiographic predictors of 3-year patency of bypass grafts implanted on the right coronary artery system: A prospective randomized comparison of gastroepiploic artery, saphenous vein, and right internal thoracic artery grafts. J Thorac Cardiovasc Surg 2011; 142:980-8. [PMID: 22014339 DOI: 10.1016/j.jtcvs.2011.07.017] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 06/29/2011] [Accepted: 07/14/2011] [Indexed: 10/16/2022]
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Etienne PY, Papadatos S, Pieters D, El Khoury E, Alexis F, Price J, Glineur D. Embol-X intraaortic filter and transaortic approach for improved cerebral protection in transcatheter aortic valve implantation. Ann Thorac Surg 2011; 92:e95-6. [PMID: 22051319 DOI: 10.1016/j.athoracsur.2011.05.109] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 05/13/2011] [Accepted: 05/25/2011] [Indexed: 10/15/2022]
Abstract
Techniques for transcatheter aortic valve implantation involve manipulation of the native aortic valve and the aortic arch. As a result, excellent technical outcomes of this technique remain counterbalanced by a level of neurologic complications that remain unacceptably high. We present here a report of a new potential combined approach to reduce periprocedural neurologic events. After a 6-cm J-shaped upper-mini-sternotomy, 26-mm Sapien valve (Edwards Lifesciences, Irvine, CA) was deployed through a transaortic approach. In addition, the Embol-X device (Edwards Lifescience) was directly inserted in the distal ascending aorta was deployed during all the procedure. Postoperative evolution was clinically uneventful. Postoperative magnetic resonance imaging revealed no new ischemic lesions in this first patient.
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Price J, De Kerchove L, Glineur D, El Khoury G. 667 Bicuspid aortic valve impacts the incidence of induced leaflet prolapse and leaflet repair following aortic valve-sparring root reconstruction. Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.07.555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Etienne PY, Papadatos S, El Khoury E, Pieters D, Price J, Glineur D. Transaortic Transcatheter Aortic Valve Implantation With the Edwards Sapien Valve: Feasibility, Technical Considerations, and Clinical Advantages. Ann Thorac Surg 2011; 92:746-8. [PMID: 21801942 DOI: 10.1016/j.athoracsur.2011.03.014] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 01/12/2011] [Accepted: 03/08/2011] [Indexed: 11/16/2022]
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Astarci P, Desiron Q, Glineur D, Khoury GE. Transapical explantation of an embolized transcatheter valve. Interact Cardiovasc Thorac Surg 2011; 13:1-2. [DOI: 10.1510/icvts.2011.267757] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Boodhwani M, de Kerchove L, Watremez C, Glineur D, Vanoverschelde JL, Noirhomme P, El Khoury G. Assessment and repair of aortic valve cusp prolapse: Implications for valve-sparing procedures. J Thorac Cardiovasc Surg 2011; 141:917-25. [DOI: 10.1016/j.jtcvs.2010.12.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 09/14/2010] [Accepted: 12/04/2010] [Indexed: 11/24/2022]
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El Oumeiri B, Glineur D, Price J, Boodhwani M, Yves Etienne P, Poncelet A, De Kerchove L, Papadatos S, Noirhomme P, El Khoury G. Recycling of Internal Thoracic Arteries in Reoperative Coronary Surgery: In-Hospital and Midterm Results. Ann Thorac Surg 2011; 91:1165-8. [DOI: 10.1016/j.athoracsur.2010.11.073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 11/25/2010] [Accepted: 11/29/2010] [Indexed: 10/18/2022]
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Glineur D, Djaoudi S, D'horre W, Gurne O, Delouvroy A, de Kerchove L, El Khoury G, Hanet C. Endothelium-dependent and endothelium-independent vasodilator response of left and right internal mammary and internal thoracic arteries used as a composite Y-graft. Eur J Cardiothorac Surg 2011; 40:389-93. [PMID: 21277219 DOI: 10.1016/j.ejcts.2010.11.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 11/16/2010] [Accepted: 11/23/2010] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The manner in which a blood vessel is for used as a coronary graft may be important in maintaining a viable and functional endothelial lining. Composite internal thoracic arteries (ITAs) in a Y-graft configuration are characterized by the connection of an in situ left ITA with preserved innervation and lymphatics and of a free semi-skeletonized right ITA. METHODS To determine whether endothelial function differs between left and right ITA segments in a Y-graft configuration, 11 patients were studied 3 years after surgery. The endothelium-dependent vasodilator substance P was selectively infused (1.4-22.4 pmol min⁻¹ in doubling dose increments) in the ostium of ITA Y-grafts. A maximal endothelium-independent vasodilatory response was then obtained by intragraft infusion of 2mg isosorbide dinitrate (ISDN). Biplane angiograms obtained at 3-min intervals using an automated contrast injection system with fixed preset volume and pressure parameters were analyzed off-line using a quantitative analysis system (CAAS, Pie Medical). RESULTS A similar dose-dependent vasodilatory response to substance P was observed in the left and in the right ITA. No difference in maximal endothelium-dependent response to substance P (7.4 ± 4.3% in the left ITA and 8.1 ± 5.3% in the right ITA) or in maximal endothelium-independent response to ISDN (12.2 ± 4.4% in the left ITA and 10.6 ± 8.1% in the right ITA) was observed. CONCLUSIONS The endothelium-dependent and the endothelium-independent vasodilator capacity of the two branches of a Y-graft ITA configuration appear similar 3 years after bypass surgery. This suggests that the preservation of the ITA pedicle does not significantly affect basal vasomotor tone, long-term endothelial function, or vasodilator reserve.
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Astarci P, Glineur D, Kefer J, D'Hoore W, Renkin J, Vanoverschelde JL, El Khoury G, Grandin C. Magnetic resonance imaging evaluation of cerebral embolization during percutaneous aortic valve implantation: comparison of transfemoral and trans-apical approaches using Edwards Sapiens valve. Eur J Cardiothorac Surg 2011; 40:475-9. [PMID: 21256045 DOI: 10.1016/j.ejcts.2010.11.070] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 11/17/2010] [Accepted: 11/23/2010] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Cerebral embolization during trans-catheter aortic valve implantation (TAVI) has not been assessed clearly in the literature. Therefore, we compared the rate of cerebral embolisms with diffusion-weighted magnetic resonance imaging (DWI) in transfemoral (TF) and trans-apical (TA) approaches. METHOD Eighty patients benefited from TAVI between January 2008 and June 2010. Out of these, 35 were included in the study. Twenty-one were TF (group 1) and 14 TA (group 2). During the same period, 285 patients benefited from a conventional aortic valve surgery (aortic valve replacement (AVR)). Thirteen of these were also analyzed and considered as the control group (group 3). We systematically performed a DWI the day before the procedure and 48 h after. DWI studies were blindly analyzed by a neuroradiologist, and all patients had a clinical neurological assessment before and after the procedure, according the National Institutes of Health Stroke Scale (NIHSS). RESULTS Thirty-two patients in the TAVI group had new cerebral lesions: 19 in the TF group and 13 in the trans-apical group (p=NS). Mean number of embolic lesions per patient was 6.6 in group I and 6.0 in group II (p=NS). Mean volume of embolic lesions was 475.0 mm³ in group I and 2170.5 mm³ in group II (p=NS). In group III, one patient had one new cerebral lesion (p<0.05 vs TAVI) of 36.5 mm³ (p=NS vs TAVI). All patients were neurologically asymptomatic. CONCLUSIONS The incidence of silent cerebral embolic lesions after TAVI is significantly higher compared with the standard surgical AVR. The number of emboli is similar in the TF and TA groups but the volume tended to be higher in the TA group. However, there is no clinical impact of those lesions.
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Kefer J, Beauloye C, Astarci P, Renkin J, Glineur D, Dekleermaeker A, Vanoverschelde JL. Usefulness of B-type natriuretic peptide to predict outcome of patients treated by transcatheter aortic valve implantation. Am J Cardiol 2010; 106:1782-6. [PMID: 21055712 DOI: 10.1016/j.amjcard.2010.07.051] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Revised: 07/27/2010] [Accepted: 07/28/2010] [Indexed: 11/18/2022]
Abstract
B-type natriuretic peptide (BNP) has been shown to predict outcomes after conventional aortic valve replacement. The aim of the present study was to investigate whether BNP also predicts the outcomes after transcatheter aortic valve implantation (TAVI). A total of 58 patients (36 men, age 84 ± 5 years) underwent TAVI in our institution for severe aortic stenosis (aortic valve area 0.6 ± 0.1 cm², mean gradient 41 ± 15 mm Hg) at high risk of surgery (logistic European System for Cardiac Operative Risk Evaluation 34 ± 17%). BNP was measured before and 24 hours after TAVI. The 30-day survival rate was 91%. Although the baseline clinical and hemodynamic characteristics were similar among the 30-day survivors (n = 53) and nonsurvivors (n = 5), the BNP levels were significantly lower in the 30-day survivors, at both baseline (463 ± 265 vs 1,067 ± 655 pg/ml; p = 0.005) and 24 hours after TAVI (488 ± 238 vs 1,632 ± 1,028 pg/ml; p <0.0001). The BNP levels were significantly greater in patients experiencing one major adverse event at 30 days. On multivariate analysis, only BNP levels (baseline value and change at 24 hours) were independent predictors of 30-day survival. Kaplan-Meier analysis showed that 30-day survival was significantly lower in patients with than in those without both a baseline BNP level >428 mg/dl (p = 0.04) and a significant BNP increase of >170 pg/ml at 24 hours after TAVI (p = 0.001). In conclusion, BNP is a strong predictor of 30-day outcomes after transcatheter aortic valve implantation, at both baseline and 24 hours after the procedure.
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Kefer J, Astarci P, Renkin J, Glineur D, Pierard S, Seldrum S, Vanoverschelde JL. Thrombotic Aortic Restenosis After Transapical Sapien Valve Implantation. Circ Cardiovasc Interv 2010; 3:289-92. [DOI: 10.1161/circinterventions.109.935031] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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de Kerchove L, Boodhwani M, Etienne PY, Poncelet A, Glineur D, Noirhomme P, Rubay J, El Khoury G. Preservation of the pulmonary autograft after failure of the Ross procedure. Eur J Cardiothorac Surg 2010; 38:326-32. [PMID: 20353892 DOI: 10.1016/j.ejcts.2010.02.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 01/29/2010] [Accepted: 02/01/2010] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Failure of the pulmonary autograft following the Ross Procedure is mainly due to dilatation and/or cusp prolapse causing insufficiency. We analysed the result of pulmonary autograft valve sparing and repair, using techniques developed for native aortic root and valve. METHODS Of a total of 275 patients who underwent Ross operation between 1991 and 2009, 31 needed autograft re-operation. Of the 28 patients re-operated in our centre, 26 (93%) had autograft valve preservation and they represent the study cohort. At the initial Ross procedure, root remplacement technique was performed in 20 patients and autograft inclusion technique was performed in 6. Mean redo interval was 9.3 + or - 3.5 years and mean age at redo was 44 + or - 13 years. Indications for re-operations were neo-aorta dilatation (n=12; 46%), autograft insufficiency (n=4; 15%) and dilatation with autograft insufficiency (n=10; 40%). Neo-aorta dilatation was repaired using valve-sparing root replacement (n=12, 46%) or ascending aorta replacement (n=10; 40%). Cusp prolapse was repaired by commissural re-suspension (n=1), free margin plication (n=10) or re-suspension with polytetrafluoroethylene (PTFE; n=6). Cusp repair was performed in isolation (n=4) or in association with sparing (n=5) or ascending aorta replacement (n=4). RESULTS There was no in-hospital mortality. Two patients having undergone isolated cusp repair needed valve replacement for recurrent insufficiency after 5 days and 8 years postoperatively. At follow-up (100% complete, median: 27 months) all patients were alive, in New York Heart Association (NYHA) class I (n=22; 84%) or II (n=4; 16%). No autograft regurgitation was present in nine patients (five sparing and four ascending aorta replacement); grade I insufficiency was present in 11 (six sparing and five ascending aorta replacement), grade 2 in two (one sparing and one isolated cusp repair) and grade 3 in two (one ascending aorta replacement and one isolated cusp repair). At 3 years, overall freedom from autograft insufficiency > or = grade 3 was 80%. CONCLUSION Preservation of the pulmonary autograft valve can be safely performed in selected patients. At midterm, repair of neo-aorta dilatation using valve-sparing root replacement or ascending aorta replacement showed acceptable results. In contrast, results of cusp repair for isolated autograft insufficiency were unsatisfactory.
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Astarci P, Glineur D, Kefer J, Renkin J, Vanoverschelde JL, Khoury GE. “Ring Pledget” a New Concept for Secure Apex Closure during Transapical Aortic Valve Implantation. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2010. [DOI: 10.1177/155698451000500215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Etienne PY, Glineur D, Papadatos S, Kalscheuer G, Mairy Y, Boodhwani M, Khoury GE, Noirhomme P, Hanet C. Comparison of Minimally Invasive Direct Coronary Artery Bypass Surgery with Implantation of Drug-Eluting Stents in Patients with Left Anterior Descending Coronary Artery Disease. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2009. [DOI: 10.1177/155698450900400609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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90
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Glineur D, Hanet C, D’hoore W, Poncelet A, De Kerchove L, Etienne PY, Noirhomme P, El Khoury G. Causes of non-functioning right internal mammary used in a Y-graft configuration: insight from a 6-month systematic angiographic trial☆☆☆. Eur J Cardiothorac Surg 2009; 36:129-35; discussion 135-6. [DOI: 10.1016/j.ejcts.2009.02.041] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Revised: 01/23/2009] [Accepted: 02/16/2009] [Indexed: 11/30/2022] Open
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Astarci P, Lacroix V, Glineur D, Poncelet A, Rubay J, El Khoury G, Noirhomme P, Verhels R. Endovascular treatment of acute aortic isthmic rupture: concerning midterm results. Ann Vasc Surg 2009; 23:634-8. [PMID: 19467828 DOI: 10.1016/j.avsg.2009.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Revised: 03/06/2009] [Accepted: 03/23/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND We evaluated midterm results of endovascular management of traumatic aortic isthmic ruptures. METHODS Between 2001 and 2008, 10 patients (seven males, mean age 38 years) underwent endovascular treatment of an acute aortic rupture. Eight procedures were emergent, with four cases of hemodynamic instability with Glasgow scores of 3, 5, and 7. Associated traumas were severe brain, liver, and pelvic bone injuries. All procedures were performed with transoesophageal echocardiography monitoring. We used two AneuRx and nine Medtronic Talent or Valiant stent grafts. RESULTS All patients survived their traumatic isthmic rupture. In nine patients, stent-graft deployment was successful. One patient experienced a distal migration needing a laparotomy and deployment of an additional new thoracic stent graft. The mean intensive care unit stay was 48 hr (range 24-168). The mean hospital stay was 11 days (range 8-43). All patients were controlled clinically and by contrast computed tomography (CT) according to the EUROSTAR protocol. There were no endoleaks, stent graft-related complications, or late deaths during a mean follow-up of 49 months. The control CT showed a lack of apposition of the proximal part of the stent graft at the inner curve of the aortic arch in three patients. CONCLUSION The midterm results of endovascular treatment of acute traumatic aortic isthmic rupture are encouraging and compare favorably to the surgical approach. Late follow-up is required to exclude possible stent-graft complications, especially in young patients with angulated aortic arches.
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Boodhwani M, de Kerchove L, Glineur D, Poncelet A, Rubay J, Astarci P, Verhelst R, Noirhomme P, El Khoury G. Repair-oriented classification of aortic insufficiency: Impact on surgical techniques and clinical outcomes. J Thorac Cardiovasc Surg 2009; 137:286-94. [DOI: 10.1016/j.jtcvs.2008.08.054] [Citation(s) in RCA: 256] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Revised: 07/30/2008] [Accepted: 08/31/2008] [Indexed: 11/26/2022]
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Boodhwani M, de Kerchove L, Glineur D, Noirhomme P, El Khoury G. Repair of aortic valve cusp prolapse. Multimed Man Cardiothorac Surg 2009; 2009:mmcts.2008.003806. [PMID: 24413473 DOI: 10.1510/mmcts.2008.003806] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Aortic valve preservation and repair is emerging as a feasible and attractive alternative to aortic valve replacement in young patients with aortic valve insufficiency. Cusp pathology requiring repair is present in up to 50% of patients undergoing aortic valve repair or valve preserving surgery and may occur in isolation or in conjunction with ascending aortic disease. Diagnosis of cusp prolapse can usually be made on preoperative echocardiography and is confirmed on surgical inspection. Techniques available for the correction of cusp prolapse in a trileaflet aortic valve include free margin plication, and free-margin resuspension. These techniques can be used alone or in combination and both provide stable mid-term results. Choice of technique may, therefore, be tailored to the cusp pathology encountered.
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Glineur D, D'hoore W, El Khoury G, Sondji S, Funken JC, Rubay J, Poncelet A, Astarci P, Verhelst R, Noirhomme P, Hanet C. Reply. J Am Coll Cardiol 2008. [DOI: 10.1016/j.jacc.2008.05.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Glineur D, Hanet C, Poncelet A, D'hoore W, Funken JC, Rubay J, Astarci P, Lacroix V, Verhelst R, Etienne PY, Noirhomme P, El Khoury G. Comparison of saphenous vein graft versus right gastroepiploic artery to revascularize the right coronary artery: A prospective randomized clinical, functional, and angiographic midterm evaluation. J Thorac Cardiovasc Surg 2008; 136:482-8. [PMID: 18692661 DOI: 10.1016/j.jtcvs.2008.01.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2007] [Revised: 12/26/2007] [Accepted: 01/07/2008] [Indexed: 10/22/2022]
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Poncelet AJ, Lengele B, Delaere B, Zech F, Glineur D, Funken JC, El Khoury G, Noirhomme P. Algorithm for primary closure in sternal wound infection: a single institution 10-year experience. Eur J Cardiothorac Surg 2008; 33:232-8. [DOI: 10.1016/j.ejcts.2007.11.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Revised: 11/21/2007] [Accepted: 11/22/2007] [Indexed: 10/22/2022] Open
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Gummert JF, Falk V, Jacquet LM, Pörner T, Doll S, Glineur D, Fischer K, Crane D, Zwiers L. Pilot study of chronic direct monitoring of left ventricular pressure using an implantable device in heart failure patients. Thorac Cardiovasc Surg 2008. [DOI: 10.1055/s-2008-1037740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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98
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Astarci P, Guerit JM, Robert A, Elkhoury G, Noirhomme P, Rubay J, Lacroix V, Poncelet A, Funker JC, Glineur D, Verhelst R. Stump pressure and somatosensory evoked potentials for predicting the use of shunt during carotid surgery. Ann Vasc Surg 2007; 21:312-7. [PMID: 17484967 DOI: 10.1016/j.avsg.2006.07.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2005] [Revised: 06/30/2006] [Accepted: 07/06/2006] [Indexed: 11/15/2022]
Abstract
The aim of this study is to compare measurement of stump pressure (SP) and somatosensory evoked potentials (SSEP) made during carotid surgery as criteria upon which to base the decision whether or not to use a shunt. We included 288 patients who underwent for carotid surgery under general anaesthesia. We performed 247 endarterectomies with patch closure (85.7%), 25 carotid transsection with reimplantation (8.7%), and 16 carotid bypasses (5.6%). SSEP monitoring showed no modification in 225/288 patients (78.1%), moderate modification in 32/288 patients (11.1%), and severe modification in 31/288 patients (10.8%). Shunt was used if there was moderate or severe SSEP modification in response to carotid clamping, which represents 63 patients in our series. A shunt was used in 47/288 patients (16.3%). In 16 patients, despite SSEP modifications, the shunt was not used because these SSEP modifications occurred only in the last minutes of the procedure just before off clamping the carotid. The mean SP for all patients was 51 mm Hg. In the shunted patients, the mean SP was 33 mm Hg. Variation of SP was correlated with the SSEP modifications. There was just one perioperative stroke in this series (1/288 = 0.3%). We concluded that the threshold of SP below which shunting is indicated in our study was 44 mm Hg with 81% sensibility and 68% specificity.
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Glineur D, Hanet C. Reply to Poullis and Warwick. Eur J Cardiothorac Surg 2007. [DOI: 10.1016/j.ejcts.2007.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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100
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Falk V, Doll S, Gummert J, Jacquet LM, Glineur D, Fisher K, Shipkowitz T, Crane D, Belalcazar A. Pilot Study of Chronic Monitoring of Left Ventricular Pressure in Heart Failure Patients. J Card Fail 2007. [DOI: 10.1016/j.cardfail.2007.06.466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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