Fabien Doguet

Place of extracorporeal membrane oxygenation in acute aortic dissection

Coronary artery dissection (CAD) is a rare but serious complication of type A aortic dissection (AD) which may be discovered preoperatively in the presence of clinical or ECG signs of ischemia, or intraoperatively after dissection of the coronary ostium. Treatment of CAD consists of surgical repair with glue and, if necessary, coronary artery bypass graft. No case of AD with CAD complicated by major arrhythmias treated by assisted circulation has been reported in the literature. We report the first case of AD with implementation of extracorporeal membranous oxygenation following cardiotomy with a favorable outcome.

The Ross procedure in endocarditis: a report of 28 cases

OBJECTIVES The Ross procedure has received increasing interest as an attractive alternative to a prosthetic aortic valve. Given its presumably greater resistance to infection, the pulmonary autograft is theoretically preferable for active endocarditis. The objective of this retrospective study was to present our experience in aortic valve endocarditis treated using the Ross procedure. METHODS Between May 1997 and February 2011, the Ross procedure was performed on 142 patients in our institution. Twenty-eight patients had aortic valve endocarditis at the time of operation. Fourteen patients had urgent or emergency procedures, and 13 had active disease at the time of surgery. Twelve patients were alcoholics and/or drug addicts. Eight patients had an abscess of the aortic annulus. Clinical follow-up was complete. RESULTS Hospital mortality was 10.7%. Overall patient survival (± standard deviation) was 47 ± 13% at 10 years with no cardiac-related death during the mean follow-up of 6.4 ± 4.2 years. There were 3 cases of recurrent endocarditis including anterior mitral leaflets endocarditis and right-sided endocarditis to another germ in a drug addict. Four patients required further surgery, 2 on the pulmonary autograft; 18 of the 19 survivors were in New York Heart Association class I. At the final investigation, all patients had no or grade I autograft regurgitation. The mean pressure gradient across the homograft was 9 ± 7.5, 11 ± 9.5 and 15 ± 9.5 mmHg, respectively, for patients between 0-3, 4-9 and >9 years. CONCLUSIONS Endocarditis can be treated with good results using the Ross procedure, with a very low rate of recurrence of endocarditis.

Acute aortic syndrome: a 'last glance' before incision.

Acute aortic syndrome (AAS) (aortic dissection, intramural aortic haematoma, or penetrating atherosclerotic ulcer) is a surgical emergency. Computed tomography (CT) is the reference technique for the diagnosis of this critical situation. However, a few reports of false-positive images leading to unnecessary interventions have been published. It is important to recognize and understand the pitfalls in the CT diagnosis of AAS. We describe the case of a 76-year-old man with clinical signs of AAS and a CT-scan compatible with a diagnosis of aortic intra-mural haematoma, leading to emergency surgery. The peroperative findings revealed a normal aortic wall with the presence of an unusual pericardial recess at the right side of the aorta.

Coronary Artery Dissection After Surgical Cryoablation Procedure

Cryoablation can be used to treat atrial fibrillation (AF) surgically. We describe a 71-year-old woman who underwent cryoablation after 6 months of AF. Four hours post-surgery, electrocardiographic changes were observed in the circumflex artery territory associated with hemodynamic instability, which responded to inotropic agents. Angiography revealed a diffuse circumflex artery spasm with a heterogeneous aspect of the posterior branch evoking a dissection. Platelet anti-aggregant and trinitrine therapy were started. Recovery was uneventful and the patient was discharged on day 13. Cryoablation-associated circumflex artery dissection is rare. Caution is required when locating the ablation lines to avoid coronary artery injury.

Robotic total endoscopic sutureless aortic valve replacement: proof of concept for a future surgical setting

Sutureless valves have recently enabled closed chest aortic valve replacement. This paper evaluates the feasibility of a robotic telemanipulation during thoracoscopic sutureless aortic valve implantation in cadavers.

Isolated ventricular septal rupture secondary to blunt trauma

A ventricular septal rupture (VSR) is a rare complication of blunt chest trauma. We describe the case of a 25-year-old man who developed a VSR as a result of a high-speed road accident. The rupture was closed by left ventricular remodeling and replacement of the diseased myocardium with a Dacron patch. The patch sutures were reinforced with glue. Redo surgery was necessary at nine months due to patch detachment and embolization of the glue in the right lower lobe. The patient is asymptomatic, at 13-month follow-up.

Isolation of the Phrenic Nerve to Suppress Diaphragmatic Contraction Induced by Cardiac Resynchronization

Phrenic Nerve Isolation in Cardiac Resynchronization.

Radiofrequency Ablation under Extracorporeal Membrane Oxygenation for Atrial Tachycardia in Postpartum

Abstract  Tachycardia‐mediated cardiomyopathy associated with cardiogenic shock is a rare but well‐known entity. We report an unusual case of cardiogenic shock with atrial tachycardia in postpartum; the patient underwent successful radiofrequency ablation under extracorporeal membrane oxygenation (ECMO). Radiofrequency ablation is usually used to treat this clinical situation. The use of ECMO has been described only in pediatric case. (J Card Surg 2012;27:647‐649)

Novel approach for atrial fibrillation ablation during open-heart surgery using cryoballoon technology

BACKGROUND The role of cryoballoon pulmonary vein isolation for the treatment of atrial fibrillation (AF) is unclear. METHODS AND RESULTS In a 61-year-old man with persistent AF and severe mitral valve regurgitation, surgical cryoballoon pulmonary vein isolation was performed during open-heart surgery, without complication. CONCLUSION Surgical cryoballoon ablation is feasible and can effectively isolate PV.

Evolution des modèles de prophylaxie de l’endocardite Infectieuse. Point de vue d’experts sur la prise en charge bucco-dentaire des patients valvulaires

La prise en charge des patients valvulaires doit suivre la chronologie de la chirurgie cardiaque (chirurgie urgente ou programmée). Le suivi des patients à haut risque d’EI doit être régulier, le maintien de l’hygiène orale primordial. Dans les recommandations, les modalités de prise en charge bucco dentaires sont peu détaillées ; le groupe de travail propose d’harmoniser dans ce contexte ces consultations spécifiques.