Increasing evidence suggests that in airways from cystic fibrosis (CF) patients, inflammation may... more Increasing evidence suggests that in airways from cystic fibrosis (CF) patients, inflammation may precede bacterial infection and be related to an endogenous dysregulation of proinflammatory cytokines in airway epithelial cells. Several investigators have reported that, in CF airway fluids, elevated NaCl concentrations may also contribute to the diseased state by inhibiting the bactericidal properties of airway fluid. Because many proinflammatory cytokines are transcriptionally regulated by the NF-κB, we investigated whether an elevated extracellular NaCl content in airway fluids significantly impaired the regulation of the NF-κB/IκBα complex and the chemokine IL-8 production in primary non-CF and CF human bronchial gland epithelial cells. Exposure of non-CF gland cells to hypotonic (85 mM) NaCl solution, compared with isotonic (115 mM) NaCl and hypertonic (170 mM) NaCl solutions, resulted in a significant decrease in IL-8 production that was paralleled by a strong inhibition of act...
OBJECTIVES: The Paris terrorist attacks on 13 November 2015 caused 482 casualties, including 130 ... more OBJECTIVES: The Paris terrorist attacks on 13 November 2015 caused 482 casualties, including 130 deaths and 352 wounded. Facing these multisite terrorist attacks, Parisian public and military hospitals simultaneously managed numerous patients with penetrating thoracic injuries. The aim of this study was to analyse this cohort, the injury patterns, and assess the results of this mobilization. METHODS: The clinical records of all patients admitted to Parisian public and military hospitals with a penetrating thoracic injury related to the Paris 13 November terrorist attacks were reviewed. RESULTS: The study group included 25 patients (7% of the casualties) with a mean age of 34 ± 8 years and a majority of gunshot wounds (n = 20, 80%). Most patients presented with severe thoracic injury (Abbreviated Injury Score Thorax 3.3 ± 1.2), and also associated nonthoracic injuries in 21 cases (84%). The mean Injury Severity Score was 26.8 ± 9.4. Eight patients (32%) were managed with chest tube insertion and 17 (68%) required thoracic surgery. Lung resection, diaphragmatic repair, and lung suture were performed in 6 (36%), 6 (35%), and 5 cases (29%), respectively. Extra-thoracic surgical procedures were performed in 16 patients, mostly for injuries to the extremities. Postoperative mortality was 12% (n = 3) and postoperative morbidity was 60% (n = 15), CONCLUSIONS: The coordination of Parisian military and civilian hospitals allowed the surgical management of 25 patients. The mortality is high but consistent with what has been reported in previous series. The current times expose us to the threat of new terrorist attacks and require that the medical community be prepared.
The Journal of Thoracic and Cardiovascular Surgery, 1998
Minimally invasive surgical techniques aim at reducing the consequences of currently used large i... more Minimally invasive surgical techniques aim at reducing the consequences of currently used large incisions, such as bleeding, pain, and risk of infection. Although this new approach developed rapidly in coronary surgery, it remains questionable in mitral valve surgery. This article reports the longest experience with minimally invasive mitral valve surgery, with particular attention to approach and techniques. Methods: From February 1996, the date of the first case of minimally invasive mitral valve reconstruction, to April 1997, 22 patients with a mean age of 54 ؎ 2.7 years were subjected to mitral valve surgery performed with less invasive techniques. Exposure of the mitral valve was achieved through a minithoracotomy (n ؍ 12) or a ministernotomy (n ؍ 10). Video assistance was used in all cases. Peripheral arterial cannulation (n ؍ 21) and venous drainage (n ؍ 22) were used in most cases. Results: In this series, valve surgery consisted in 19 repairs, two replacements, and one closure of a periprosthetic leak. In two cases it was necessary to convert to a larger incision. The average duration of cardiopulmonary bypass was 157 ؎ 8.2 minutes, ventilatory assistance 16 ؎ 4.6 hours, and intensive care unit stay 2.1 ؎ 0.4 days. Two patients required reoperation for bleeding and another for early recurrence of mitral valve regurgitation. There were no deaths and all patients were discharged with normal valve function. At most recent follow-up, all patients were in functional class I, with resumption of normal activity. Conclusion: Mitral valve surgery can be performed safely by means of less invasive techniques, but with increased technical difficulty. A low asymmetric median sternotomy seems preferable to an anterior thoracotomy. (
Aortic valve replacement with Carpentier-Edwards pericardial bioprosthesis was associated with ex... more Aortic valve replacement with Carpentier-Edwards pericardial bioprosthesis was associated with excellent midterm clinical results. Long-term evaluation, however, remained to be determined. We reviewed the first 124 patients who underwent aortic valve replacement with a Carpentier-Edwards bioprosthesis at the HBpital Broussais between 1980 and 1985. There were 67 males (54%) and 57 females (46%). The mean age at operation was 65 years (range, 18-83 years). The operative mortality (30 days) was 4%. All but 2 patients were followed up for an average of 7.7 years and a total of 973 patient years. There were 45 late deaths (4.7%/patient-year) of which 16 were valve-related (1.7%/patient-year). The actuarial survival
Journal of the American College of Cardiology, 2002
Background: Intensive treatment of anthracycline cardiomyopathy may not have had impact on mortal... more Background: Intensive treatment of anthracycline cardiomyopathy may not have had impact on mortality as would have expected and so far cardiovascular death is the second leading cause of death in long term survivors of childhood cancer. So, demonstrating prevention of early cardiac toxicity induced by doxorrubicin may identify a population with less risk for late cardiomyopathy. Methods: 37 patients, part of Brazilian multicenter trial for treatment of ostecgenic sarcoma were studied. 19 patients (11 male, 19,7 ± 4 years) received doxorrubicin (346.47 ± 16 rag/m2) (DOXO), and 18 patients (14 male, 16,8 + 5 years) received doxorrubicin (396,53 ± 15 mg/m2) plus dexrazoxane (DOXO+DEXRA).A low dose dobutamine stress echocardiography (DSE) was performed at least I year after the last chemotherapy (OT). Left ventdcular systolic and diastolic functional parameters were evaluated at rest and after dobutamine infusion. The results were compared against a group of 21 patients (13 male, 15 ± 4 years) with osteogenic sarcoma but before QT (CONTROL). Results: No major side affects were recorded. Rest echocardiogram demonstrated no significant difference between the 3 groups. During DSE. diastolic function had the same response, but a less significant improvement was observed on systolic parameters with DOXO compared to DOXO+DEXRA and CONTROL. DOXO DOXO+DEXRA CONTROL REST Fractional Shortening 34% ± 5% 36% ± 5% 36% ± 3% DSE Fractional Shortening 42% ± 5%* 47% + 7% 47% ± 7% * p<0,05 Conclusions: Low dose DSE was able to identify a better myocardial performance on patients treated with dexrazoxane than those who received antracycline alone.
Saline injection into the left ventricle trough mitral valve (saline test) is the most commonly u... more Saline injection into the left ventricle trough mitral valve (saline test) is the most commonly used intraoperative assessment method in mitral valve repair. However, potential discrepancies between the saline test findings and intraoperative transesophageal echocardiography results after the weaning of cardiopulmonary bypass , remain significant. Here, we describe a new antegrade reperfusion test, reproducing intraoperatively, the physiologic conditions of loaded and beating heart for direct transatrial evaluation of valve tightness. The proposed test is performed by perfusing warm oxygenated blood into the aortic root under cross-clamping. From February 2016 to December 2018, 91 patients (mean age: 63 ± 11 years) underwent mitral valve repair for mitral regurgitation. In all of them, the classic saline test was completed with the newly proposed antegrade test. We report our results with this combined approach. Data were obtained from the medical records and our mitral valve repair database. In 32 (35.1%) patients, evident or undetectable minor regurgitation at the saline test were respectively unconfirmed or detected by the antegrade reperfusion test leading to their complete correction. In only three patients (3.2%) major discrepancies was present between the intraoperative evaluation and the post-pump transesophageal echocardiography. Two of them (2.1%) required a second cardiopulmonary bypass run to fix the residual regurgitation. The antegrade reperfusion test is a simple dynamic intraoperative approach mimicking the physiological conditions of ventricular systole for mitral valve repair evaluation. Combined with the classic saline test, it seems to be a valuable additional intraoperative tool, enabling a more predictable repair result.
OBJECTIVES: To develop and evaluate a novel mitral annuloplasty ring with selective flexibility f... more OBJECTIVES: To develop and evaluate a novel mitral annuloplasty ring with selective flexibility for septal-lateral contraction and rigidity for septal-lateral dilatation in an acute porcine model. METHODS: The novel mitral annuloplasty ring was designed with slits in the luminal posterior segment and annular lateral segments. The slits were designed to allow inward motion during contraction and to block outward motion during dilation. The novel mitral annuloplasty ring was tested in vitro with a dedicated mechanical test bench, followed by in vivo characterization, using sonomicrometry and echocardiography for annular and leaflet geometry, in an acute porcine model. RESULTS: From the in vitro characterization, we verified that the ring could easily contract (0.7 mm/N) in the septal-lateral dimension, while dilatation was restrained (0.4 mm/N). In vivo characterization showed a cyclic range of 2.8 ± 0.0 mm for septal-lateral contraction. CONCLUSIONS: A novel saddle-shaped remodelling mitral annuloplasty ring was developed with selective flexibility for septal-lateral contraction and rigidity for septal-lateral dilatation. The advantages of this specific ring is that it re-establishes the coaptation plane, ensures leaflet mobility and septal-lateral flexibility and at the same time improves tissue adaptation and thereby decreases the risk of ring †Presented at the 29th Annual Meeting of the European Association for Cardio
Background In patients who have chronic heart failure with reduced left ventricular ejection frac... more Background In patients who have chronic heart failure with reduced left ventricular ejection fraction, severe secondary mitral-valve regurgitation is associated with a poor prognosis. Whether percutaneous mitral-valve repair improves clinical outcomes in this patient population is unknown. Methods We randomly assigned patients who had severe secondary mitral regurgitation (defined as an effective regurgitant orifice area of >20 mm or a regurgitant volume of >30 ml per beat), a left ventricular ejection fraction between 15 and 40%, and symptomatic heart failure, in a 1:1 ratio, to undergo percutaneous mitral-valve repair in addition to receiving medical therapy (intervention group; 152 patients) or to receive medical therapy alone (control group; 152 patients). The primary efficacy outcome was a composite of death from any cause or unplanned hospitalization for heart failure at 12 months. Results At 12 months, the rate of the primary outcome was 54.6% (83 of 152 patients) in th...
Increasing evidence suggests that in airways from cystic fibrosis (CF) patients, inflammation may... more Increasing evidence suggests that in airways from cystic fibrosis (CF) patients, inflammation may precede bacterial infection and be related to an endogenous dysregulation of proinflammatory cytokines in airway epithelial cells. Several investigators have reported that, in CF airway fluids, elevated NaCl concentrations may also contribute to the diseased state by inhibiting the bactericidal properties of airway fluid. Because many proinflammatory cytokines are transcriptionally regulated by the NF-κB, we investigated whether an elevated extracellular NaCl content in airway fluids significantly impaired the regulation of the NF-κB/IκBα complex and the chemokine IL-8 production in primary non-CF and CF human bronchial gland epithelial cells. Exposure of non-CF gland cells to hypotonic (85 mM) NaCl solution, compared with isotonic (115 mM) NaCl and hypertonic (170 mM) NaCl solutions, resulted in a significant decrease in IL-8 production that was paralleled by a strong inhibition of act...
OBJECTIVES: The Paris terrorist attacks on 13 November 2015 caused 482 casualties, including 130 ... more OBJECTIVES: The Paris terrorist attacks on 13 November 2015 caused 482 casualties, including 130 deaths and 352 wounded. Facing these multisite terrorist attacks, Parisian public and military hospitals simultaneously managed numerous patients with penetrating thoracic injuries. The aim of this study was to analyse this cohort, the injury patterns, and assess the results of this mobilization. METHODS: The clinical records of all patients admitted to Parisian public and military hospitals with a penetrating thoracic injury related to the Paris 13 November terrorist attacks were reviewed. RESULTS: The study group included 25 patients (7% of the casualties) with a mean age of 34 ± 8 years and a majority of gunshot wounds (n = 20, 80%). Most patients presented with severe thoracic injury (Abbreviated Injury Score Thorax 3.3 ± 1.2), and also associated nonthoracic injuries in 21 cases (84%). The mean Injury Severity Score was 26.8 ± 9.4. Eight patients (32%) were managed with chest tube insertion and 17 (68%) required thoracic surgery. Lung resection, diaphragmatic repair, and lung suture were performed in 6 (36%), 6 (35%), and 5 cases (29%), respectively. Extra-thoracic surgical procedures were performed in 16 patients, mostly for injuries to the extremities. Postoperative mortality was 12% (n = 3) and postoperative morbidity was 60% (n = 15), CONCLUSIONS: The coordination of Parisian military and civilian hospitals allowed the surgical management of 25 patients. The mortality is high but consistent with what has been reported in previous series. The current times expose us to the threat of new terrorist attacks and require that the medical community be prepared.
The Journal of Thoracic and Cardiovascular Surgery, 1998
Minimally invasive surgical techniques aim at reducing the consequences of currently used large i... more Minimally invasive surgical techniques aim at reducing the consequences of currently used large incisions, such as bleeding, pain, and risk of infection. Although this new approach developed rapidly in coronary surgery, it remains questionable in mitral valve surgery. This article reports the longest experience with minimally invasive mitral valve surgery, with particular attention to approach and techniques. Methods: From February 1996, the date of the first case of minimally invasive mitral valve reconstruction, to April 1997, 22 patients with a mean age of 54 ؎ 2.7 years were subjected to mitral valve surgery performed with less invasive techniques. Exposure of the mitral valve was achieved through a minithoracotomy (n ؍ 12) or a ministernotomy (n ؍ 10). Video assistance was used in all cases. Peripheral arterial cannulation (n ؍ 21) and venous drainage (n ؍ 22) were used in most cases. Results: In this series, valve surgery consisted in 19 repairs, two replacements, and one closure of a periprosthetic leak. In two cases it was necessary to convert to a larger incision. The average duration of cardiopulmonary bypass was 157 ؎ 8.2 minutes, ventilatory assistance 16 ؎ 4.6 hours, and intensive care unit stay 2.1 ؎ 0.4 days. Two patients required reoperation for bleeding and another for early recurrence of mitral valve regurgitation. There were no deaths and all patients were discharged with normal valve function. At most recent follow-up, all patients were in functional class I, with resumption of normal activity. Conclusion: Mitral valve surgery can be performed safely by means of less invasive techniques, but with increased technical difficulty. A low asymmetric median sternotomy seems preferable to an anterior thoracotomy. (
Aortic valve replacement with Carpentier-Edwards pericardial bioprosthesis was associated with ex... more Aortic valve replacement with Carpentier-Edwards pericardial bioprosthesis was associated with excellent midterm clinical results. Long-term evaluation, however, remained to be determined. We reviewed the first 124 patients who underwent aortic valve replacement with a Carpentier-Edwards bioprosthesis at the HBpital Broussais between 1980 and 1985. There were 67 males (54%) and 57 females (46%). The mean age at operation was 65 years (range, 18-83 years). The operative mortality (30 days) was 4%. All but 2 patients were followed up for an average of 7.7 years and a total of 973 patient years. There were 45 late deaths (4.7%/patient-year) of which 16 were valve-related (1.7%/patient-year). The actuarial survival
Journal of the American College of Cardiology, 2002
Background: Intensive treatment of anthracycline cardiomyopathy may not have had impact on mortal... more Background: Intensive treatment of anthracycline cardiomyopathy may not have had impact on mortality as would have expected and so far cardiovascular death is the second leading cause of death in long term survivors of childhood cancer. So, demonstrating prevention of early cardiac toxicity induced by doxorrubicin may identify a population with less risk for late cardiomyopathy. Methods: 37 patients, part of Brazilian multicenter trial for treatment of ostecgenic sarcoma were studied. 19 patients (11 male, 19,7 ± 4 years) received doxorrubicin (346.47 ± 16 rag/m2) (DOXO), and 18 patients (14 male, 16,8 + 5 years) received doxorrubicin (396,53 ± 15 mg/m2) plus dexrazoxane (DOXO+DEXRA).A low dose dobutamine stress echocardiography (DSE) was performed at least I year after the last chemotherapy (OT). Left ventdcular systolic and diastolic functional parameters were evaluated at rest and after dobutamine infusion. The results were compared against a group of 21 patients (13 male, 15 ± 4 years) with osteogenic sarcoma but before QT (CONTROL). Results: No major side affects were recorded. Rest echocardiogram demonstrated no significant difference between the 3 groups. During DSE. diastolic function had the same response, but a less significant improvement was observed on systolic parameters with DOXO compared to DOXO+DEXRA and CONTROL. DOXO DOXO+DEXRA CONTROL REST Fractional Shortening 34% ± 5% 36% ± 5% 36% ± 3% DSE Fractional Shortening 42% ± 5%* 47% + 7% 47% ± 7% * p<0,05 Conclusions: Low dose DSE was able to identify a better myocardial performance on patients treated with dexrazoxane than those who received antracycline alone.
Saline injection into the left ventricle trough mitral valve (saline test) is the most commonly u... more Saline injection into the left ventricle trough mitral valve (saline test) is the most commonly used intraoperative assessment method in mitral valve repair. However, potential discrepancies between the saline test findings and intraoperative transesophageal echocardiography results after the weaning of cardiopulmonary bypass , remain significant. Here, we describe a new antegrade reperfusion test, reproducing intraoperatively, the physiologic conditions of loaded and beating heart for direct transatrial evaluation of valve tightness. The proposed test is performed by perfusing warm oxygenated blood into the aortic root under cross-clamping. From February 2016 to December 2018, 91 patients (mean age: 63 ± 11 years) underwent mitral valve repair for mitral regurgitation. In all of them, the classic saline test was completed with the newly proposed antegrade test. We report our results with this combined approach. Data were obtained from the medical records and our mitral valve repair database. In 32 (35.1%) patients, evident or undetectable minor regurgitation at the saline test were respectively unconfirmed or detected by the antegrade reperfusion test leading to their complete correction. In only three patients (3.2%) major discrepancies was present between the intraoperative evaluation and the post-pump transesophageal echocardiography. Two of them (2.1%) required a second cardiopulmonary bypass run to fix the residual regurgitation. The antegrade reperfusion test is a simple dynamic intraoperative approach mimicking the physiological conditions of ventricular systole for mitral valve repair evaluation. Combined with the classic saline test, it seems to be a valuable additional intraoperative tool, enabling a more predictable repair result.
OBJECTIVES: To develop and evaluate a novel mitral annuloplasty ring with selective flexibility f... more OBJECTIVES: To develop and evaluate a novel mitral annuloplasty ring with selective flexibility for septal-lateral contraction and rigidity for septal-lateral dilatation in an acute porcine model. METHODS: The novel mitral annuloplasty ring was designed with slits in the luminal posterior segment and annular lateral segments. The slits were designed to allow inward motion during contraction and to block outward motion during dilation. The novel mitral annuloplasty ring was tested in vitro with a dedicated mechanical test bench, followed by in vivo characterization, using sonomicrometry and echocardiography for annular and leaflet geometry, in an acute porcine model. RESULTS: From the in vitro characterization, we verified that the ring could easily contract (0.7 mm/N) in the septal-lateral dimension, while dilatation was restrained (0.4 mm/N). In vivo characterization showed a cyclic range of 2.8 ± 0.0 mm for septal-lateral contraction. CONCLUSIONS: A novel saddle-shaped remodelling mitral annuloplasty ring was developed with selective flexibility for septal-lateral contraction and rigidity for septal-lateral dilatation. The advantages of this specific ring is that it re-establishes the coaptation plane, ensures leaflet mobility and septal-lateral flexibility and at the same time improves tissue adaptation and thereby decreases the risk of ring †Presented at the 29th Annual Meeting of the European Association for Cardio
Background In patients who have chronic heart failure with reduced left ventricular ejection frac... more Background In patients who have chronic heart failure with reduced left ventricular ejection fraction, severe secondary mitral-valve regurgitation is associated with a poor prognosis. Whether percutaneous mitral-valve repair improves clinical outcomes in this patient population is unknown. Methods We randomly assigned patients who had severe secondary mitral regurgitation (defined as an effective regurgitant orifice area of >20 mm or a regurgitant volume of >30 ml per beat), a left ventricular ejection fraction between 15 and 40%, and symptomatic heart failure, in a 1:1 ratio, to undergo percutaneous mitral-valve repair in addition to receiving medical therapy (intervention group; 152 patients) or to receive medical therapy alone (control group; 152 patients). The primary efficacy outcome was a composite of death from any cause or unplanned hospitalization for heart failure at 12 months. Results At 12 months, the rate of the primary outcome was 54.6% (83 of 152 patients) in th...
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Papers by Jean Couëtil