Gérard Fournial

Endovascular treatment of thoracic aortic fistulas.

Aortoesophageal and aortobronchial fistulas constitute a problem in therapy because of the high rates of morbidity and mortality associated with operation. From May 1996 to March 2000, we treated by an endovascular procedure one aortoesophageal and three aortobronchial fistulas. There was no postoperative death. We noted one peripheral vascular complication that required a surgical procedure, one postoperative confusion, and one inflammatory syndrome. In one case, because of a persistent leakage after 21 months, we had to implant a second endovascular stent graft. A few weeks later the reopening of this patients esophageal fistula led to his death by mediastinitis 25 months after the first procedure. The few cases published seem to bear out the interest, observed in our 4 patients, of an endovascular approach to treat complex lesions such as fistulas of the thoracic aorta especially in emergency or palliative cases.

New Helper Instrument in Cardiac Surgery

A new instrument has been designed for cardiac surgery. It frees the hands of the surgical assistant and is effective either for valve replacement or coronary graft anastomosis. The use of this instrument makes the operation quicker and easier.

Type-A acute aortic dissection: combined operation plus stent management

When the port of entry of acute type-A aortic dissection is at the level of the horizontal portion of the aortic arch, the latter should be replaced by a prosthesis. To avoid performing this difficult procedure in an emergency situation, we place a stent in the aortic arch. Then we replace the ascending aorta by a prosthesis.

Homemade mitral ring

A simple and quick technique to fashion a mitral ring was developed using a stainless steel wire covered by a Gore-Tex strip. This technique allows a 15-fold reduction in the cost of a mitral ring compared with commercially available rings. As such, cardiac surgery becomes more readily available to patients in developing countries such as Africa and Asia. These homemade rings were implanted in 6 patients with similar results to commercially available rings.

New technique for sternal osteosynthesis.

In our department, we have developed a new method for sternal osteosynthesis. This technique uses steel threads and a sternal retractor. The removable valves are removed and placed with a two-pulley device, which allows good osteosynthesis without assistance or effort.

Results of radiofrequency ablation for permanent atrial fibrillation in patients undergoing mitral valve surgery.

Objectives — The study aim was to evaluate the safety and feasibility of radiofrequency ablation for the surgical treatment of permanent atrial fibrillation in patients with degenerative mitral valve disease. Design — From August 2000 to August 2003, 40 consecutive patients (mean age 69.0 ± 9.3 years) with permanent atrial fibrillation and degenerative mitral valve disease underwent surgical radiofrequency ablation in conjunction with 22 mitral valve repairs and 18 mitral valve replacements. The mean duration of chronic AF was 5.1 ± 3.4 years.The completeness of follow-up was 100%.The mean follow-up time was 4.6 ± 2.0 years (range 0 to 7.8 years). Results — Thirty-day mortality was 2.5% (1 patient), the cause of death was cardiac failure. Cardiac failure and temporary A-V block were the most common postoperative complications. Both occurred in 10% (4 patients). No complication was related to the ablation procedure.At discharge, 65% (26/40) of the patients were in sinus rhythm. Overall incidence of sinus rhythm at the end of the follow-up was 56.4% (22/39). The 1-, 3- and 5-year survival was 97.5%, 91.8% and 85.9%, respectively. Conclusion — Mitral valve surgery combined with radiofrequency ablation is a safe and effective procedure in patients with permanent atrial fibrillation and degenerative mitral valve disease.The result is encouraging in restoring sinus rhythm, and an excellent postoperative survival rate can be achieved.

Cardiac surgical aids: Heart cup and stentless valve holder

We present two new cardiac surgery instruments that we perfected in our department. The heart cup holds the donors heart vertically within a cold saline solution, thus allowing adequate preparation of the heart for transplantation, as well as the excision of valvular homografts from the recipients heart. The stentless valve holder is used to hold valvular homografts to ease both their preparation and implantation.