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Christophe Acar

Publications and source records attributed to Christophe Acar.

16 recordsLinked to original sources
PubMed2006

Aortic prosthetic ring annuloplasty: a useful adjunct to a standardized aortic valve-sparing procedure?

OBJECTIVE: Dilation of aortic annulus, sinuses of Valsalva, and sinotubular junction (STJ) diameters are the characteristic lesions of aortic root aneurysm. The remodeling technique reduces STJ diameter and creates three neosinuses of Valsalva. Alternatively, the reimplantation technique reduces both annulus and STJ diameters to the detriment of aortic root dynamics. Although the remodeling technique is recognized as the most physiological valve-sparing procedure, aortic annulus dilation may jeopardize its results. A standardized approach that combines an external subvalvular aortic prosthetic ring annuloplasty with the remodeling technique is suggested. METHODS: Eighty-three patients underwent an elective aortic root remodeling procedure, either isolated (group 1, n=34) or combined with an external subvalvular aortic prosthetic ring annuloplasty (group 2, n=49). Preoperative aortic regurgitation was 1.59+/-1.1 (group 1) and 1.97+/-1.3 (group 2) (NS). The aortic annulus was more dilated in group 2 than in group 1 (27+/-2.77 mm vs 26.4+/-2.3 mm, p<0.01). Residual aortic regurgitation > or =grade II was the conversion criteria for aortic valve replacement. RESULTS: Operative mortality was 3.6% (n=3). Intraoperative conversion for valve replacement was 32.7% in group 1 (n=11) versus 4.2% in group 2 (n=2) (p<0.001). In group 1, preoperative annulus diameter was larger for converted than for valve-spared patients (27.6+/-1.7 mm vs 25.2+/-1.5 mm, p<0.02). In group 2, implanted aortic ring significantly reduced annulus diameter (20.6+/-1.8 mm) without significant aortic valve gradient (8.3+/-3 mmHg). Follow-up was 17.2+/-13.4 months (group 1) and 10.41+/-7.95 months (group 2). Reoperation for recurrent aortic regurgitation was 13% in group 1 (n=3) versus 4.2% in group 2 (n=2). Echocardiographic follow-up found residual aortic regurgitation < or =grade I in 17 patients in group 1 (90%) versus 43 patients in group 2 (95.5%) and of grade II in two patients in group 1 (10%) and two patients in group 2 (4.5%). CONCLUSION: The addition of external aortic prosthetic ring annuloplasty improves the remodeling technique's operative reproducibility and short-term results. Therefore, its use as a systematical adjunct to the remodeling procedure is suggested. However, further long-term evaluation comparing this valve-sparing procedure to composite graft replacement should define the best surgical strategy for aortic root aneurysm.

Adolescent↗
PubMed2005

External aortic annuloplasty ring for valve-sparing procedures.

Two different surgical approaches have been suggested for aortic valve-sparing surgery. My colleagues and I suggest combining the advantages of both approaches by adding an external subvalvular prosthetic ring annuloplasty to the remodeling procedure.

Adult↗
PubMed2005

Mitral valve repair for commissural prolapse: surgical techniques and long term results.

OBJECTIVE: The aim of this study was to describe the pattern of lesions responsible for commissural prolapse, the techniques of valve repair and their long-term results. METHODS: Between 1992 and 2004, 128 mitral valve repairs were consecutively performed for commissural prolapse. There were 86 males and 42 females, the median age was 57.5 years (range 14-84 years). Forty-six percent of patients were in NYHA III or IV, mean ejection fraction was 61+/-9.4%. The diagnosis of commissural prolapse was recognized by preoperative echocardiography in 32% of the patients and was revealed by intraoperative inspection of the valve in the other cases. The site of the prolapse was the posteriomedial commissure (n=94), the anterior commissure (n=30) or both (n=4). The aetiologies were: infective endocarditis (n=56), degenerative (n=46), ischemic (n=25), congenital mitral regurgitation (n=1). The commissural prolapse was associated with another mitral valvular lesion requiring a specific treatment in 61 cases (47.7%). An associated procedure was carried out in 45 patients. RESULTS: The operative treatment of the commissural prolapse included: commissural closure 65 (50.8%), leaflet resection 31 (24.2%), transposition or shortening of chordae 19 (14.8%), reimplantation or shortening of papillary muscles 3 (2.3%), and replacement of the commissural area by a partial mitral homograft 10 (8%). In-hospital mortality included three deaths (2.3%) and four patients (3.1%) were reoperated: three pericardial drainages for hemopericardium and one for mediastinitis. During the follow-up, one patient died (0.8%) from myocardial infarction and eight patients (6.3%) were reoperated including six (4.7%) for recurrent mitral regurgitation. After a median follow-up time of 76.9 months (range from 15 days to 160 months), 116 patients (90.1%) were in NYHA I. Echocardiographs showed no or minimal insufficiency in 112 patients (87.5%) and mild or moderate insufficiency in 10 patients (7.8%). CONCLUSIONS: The diagnosis of commissural prolapse is difficult by preoperative echocardiography. The aetiology of the mitral disease is variable (endocarditis, degenerative or ischemic mitral regurgitation). Using a variety of techniques, commissural prolapse can be repaired with excellent clinical and echographic long-term results.

Adolescent↗
PubMed2005

Percutaneous valve procedures: what is the future?

PURPOSE OF REVIEW: Since its introduction 27 years ago by Andreas Gruntzig, interventional cardiology has expanded its scope from coronary disease to peripheral, congenital, and also valve diseases.Percutaneous mitral commissurotomy and aortic valvuloplasty have been performed since the mid 1980s. Balloon commissurotomy has been used in tens of thousands of patients worldwide and provides good short- and long-term results in a wide range of patients. It has virtually replaced surgical commissurotomy in the management of mitral stenosis. On the other hand, percutaneous aortic valvuloplasty is almost abandoned worldwide due to its lack of efficacy and the risks involved. RECENT FINDINGS: The new techniques of percutaneous valve intervention are aortic valve replacement, and mitral valve repair. Both are at an early stage since the first in-man applications only started in 2002. Preliminary series show that these techniques are feasible; however, they must be further evaluated in comparison with contemporary treatment to accurately assess efficacy and risks. Today potential applications concern high-risk patients, however, after thorough evaluation this may be extended to others in the future. SUMMARY: Therefore, percutaneous interventions already play an important role in management of valvular heart disease, which is likely to grow in the future.

Aortic Valve↗
PubMed2004

Contemporary results of mitral valve repair for infective endocarditis.

OBJECTIVES: We sought to evaluate the feasibility and immediate and late results of mitral valve repair (MVRep) for acute and healed endocarditis. BACKGROUND: Improvements in techniques of MVRep have extended its feasibility in complex lesions, but experience with endocarditis is limited. METHODS: Among 78 patients operated on for mitral endocarditis between 1990 and 1999, 63 underwent MVRep. The repair was performed for acute endocarditis in 25 patients (40%) at a median of 20 days after the onset of treatment and in 38 patients (60%) for healed endocarditis after a median of 11 months. RESULTS: Repair of the mitral valve was feasible in 63 patients (81%). This repair involved annuloplasty in 61 patients (97%), valve resection in 49 (78%), shortening or transposition of chordae in 29 (46%), suture of perforation in 18 (29%), a pericardial patch in 12 (19%), and a partial mitral homograft in 7 (11%). Associated procedures were aortic valve replacement in 11 patients, bypass grafting in 3, and tricuspid repair in 2. Early complications were two deaths (3.2%), one re-operation for severe mitral regurgitation and one re-operation for subsequent aortic endocarditis. The seven-year rate of event-free survival was 78 +/- 6% in the global series. Multivariate predictors of event-free survival were hypertension (p < 0.006) and intervention for acute endocarditis (p < 0.026). Five-year survival rates were 96 +/- 4% after MVRep for acute endocarditis and 91 +/- 5% for healed endocarditis. CONCLUSIONS: Mitral valve repair is frequently feasible and gives good results in patients with infective endocarditis. Patients operated on for acute endocarditis experience more events during follow-up than those operated on after healed endocarditis but have excellent late survival.

Acute Disease↗
PubMed2004

Cellular cardiomyoplasty: clinical application.

Myocardial regeneration can be induced with the implantation of a variety of myogenic and angiogenic cell types. More than 150 patients have been treated with cellular cardiomyoplasty worldwide, 18 patients have been treated by our group. Cellular cardiomyoplasty seems to reduce the size and fibrosis of infarct scars, limit postischemic remodelling, and restore regional myocardial contractility. Techniques for skeletal myoblasts culture and ex vivo expansion using autologous patient serum (obtained from plasmapheresis) have been developed by our group. In this article we propose (1) a total autologous cell culture technique and procedures for cell delivery and (2) a clinical trial with appropriate endpoints structured to determine the efficacy of cellular cardiomyoplasty.

Animals↗
PubMed2004

Ischemic mitral valve prolapse: mechanisms and implications for valve repair.

OBJECTIVE: The aim of this study was to assess the mechanisms of prolapse in ischemic mitral valve regurgitation (MR) and the techniques of valve repair. METHODS: Out of 121 patients operated upon for ischemic MR, a prolapse was present in 44 patients (36.4%). The operation was performed emergently in four cases (9.1%) and electively in 40 patients (90.9%). Fifteen patients (34.1%) were operated upon within 60 days following acute myocardial infarction. RESULTS: The diagnosis of prolapse had been overlooked by echography in five cases (11.4%). A commissural area was involved as the site of prolapse in 31 cases (70.4%). The mechanism of prolapse was a papillary muscle (PM) lesion in 38 cases (86.4%) (anterior PM: n=8, posterior PM n=36) or a chordal lesion in six cases (13.6%). PM injury was elongation (n=16), or rupture (total n=1, partial n=21, incomplete n=4). The operative technique was mitral valve repair with Carpentier's techniques in 42 cases (95.5%) or replacement in two cases (4.5%). Hospital mortality was 11.4% (n=4). The mean follow-up was to 44.7+/-29.6 months. Overall survival and freedom from reoperation were 68.3+/-9.0 and 89.9+/-5.7% at 5 years, respectively. Freedom from MR equal or > grade 2 was 69.7+/-9.5% at 5 years. CONCLUSIONS: The mechanisms of ischemic mitral valve prolapse were variable and tightly linked to the PM anatomy. A reliable mitral valve repair could be achieved in most cases with acceptable mid-term results.

Aged↗
PubMed2004

Homograft replacement of the mitral valve: eight-year results.

OBJECTIVE: The objective of this study was to assess whether the mitral homograft represents a valuable alternative for complete or partial mitral valve replacement. METHODS: Since 1993, 104 patients underwent mitral homograft replacement surgery. The mean age was 38 +/- 15 years. The causes of mitral valve disease were rheumatic disease (n = 76), infective endocarditis (n = 24), and others (n = 4). Sixty-five of these procedures were total homografts, and 39 were partial homografts. RESULTS: The mean follow-up was 52 +/- 35 months (maximum, 117 months). Overall hospital mortality was 4 (3.8%) of 104 patients and 2.5% versus 8.7% for patients without endocarditis and with endocarditis, respectively (P <.19). There were 9 late deaths (cardiac, 4; noncardiac, 5). There have been 5 early (<3 months) and 10 late reoperations. Of the remaining 77 patients, New York Heart Association class was I in 61, II in 14, and III in 2. Four patients had endocarditis, and 5 had an ischemic or hemorrhagic event. Freedom from major cardiac events was 71% +/- 6% at 8 years (partial at 81% vs total at 63%, P <.19). Among patients with a total homograft, freedom from major cardiac events was 61% +/- 9% and 85% +/- 8% at 6 years in patients younger than and older than 40 years, respectively (P =.09). CONCLUSION: The risk of early dysfunction related to a mismatch between the mitral homograft and the patient's valve is the main pitfall of the technique. Beyond that stage, the results were comparable with those of bioprostheses in a cohort of young patients.

Adult↗
PubMed2004

Anterior leaflet augmentation with autologous pericardium for mitral repair in rheumatic valve insufficiency.

BACKGROUND AND AIM OF THE STUDY: The mechanism of insufficiency in rheumatic valve disease includes annulus dilatation and restricted leaflet motion. In order to improve the treatment of restriction, the anterior mitral leaflet (AML) can be augmented with a piece of glutaraldehyde-treated autologous pericardium. METHODS: Between January 1995 and December 1999, among 274 patients referred for rheumatic mitral disease, 143 (52%) underwent a valve repair. Of these patients, 81% had pure regurgitation and 19% had significant associated stenosis. Ring annuloplasty was used in all cases. Techniques used to treat the restrictive component of the regurgitation were compared in two consecutive cohorts of patients, either with (n = 62) or without (n = 81) AML augmentation. Mean patient age was 42 +/- 3 years, and all preoperative variables were comparable except for the incidence of redo patients, who all underwent AML extension. RESULTS: In-hospital mortality was 0.7% (n = 1 with AML extension), and there was one early reoperation for pericardial patch dehiscence. After a mean follow up of 3.2 years, there was one sudden death (no AML extension). The reoperation rate was lower with (2.5%) than without (12.9%) AML augmentation (p <0.05). Echocardiography showed a lower incidence in recurrence of mitral insufficiency when AML augmentation was performed (grade 2, 9% versus grade 3, 3%) as compared to no AML augmentation (grade 2, 35% versus grade 3, 14%) (p <0.05). The mitral orifice area was larger (AML augmentation 2.2 +/- 0.3 cm versus no AML augmentation 1.8 +/- 0.4 cm2). CONCLUSION: Ring annuloplasty alone failed to correct rheumatic mitral insufficiency in all cases. AML augmentation improved the quality of the repair, and decreased the risk of reoperation.

Adolescent↗
PubMed2003

Recurrent valvular replacement due to exacerbation of Behcet's disease by Streptococcus agalactiae infection.

Valvular heart complications in Behcet's disease are rarely reported. Moreover, the risk of dehiscence in postoperative valvular replacement is high in Behcet's disease. We report a case of recurrent aortic prosthetic dehiscence revealing Behcet's disease in a young woman. Each disease exacerbation was concomitant to a Streptococcus agalactiae infection. This infection appears to act as a trigger for Behcet's disease exacerbation. The patient was successfully treated with immunosuppression plus antibiotic therapy.

Journal Article↗