Jean RUBAY - Academia.edu (original) (raw)

Papers by Jean RUBAY

Interactive Cardiovascular and Thoracic Surgery, Sep 23, 2014

Objectives: The size of aortic valve (AV) annulus and the type of annuloplasty influence the dura... more Objectives: The size of aortic valve (AV) annulus and the type of annuloplasty influence the durability of bicuspid AV repair. This study sought to assess the effect of annulus size and annuloplasty in tricuspid AV repair. Methods: From 1995 to 2013, 382 patients underwent elective tricuspid AV repair. Pre-and post-repair echocardiographic measurement of aortic annulus was available in 310 patients (study cohort). Of these, 164 had valve sparing reimplantation (VSR), 146 had subcommissural annuloplasty (SCA). Annulus was measured at latest follow-up in a subset of patients (VSR n = 85; SCA n = 80). Median follow-up was 4.7 years. Results: The two groups differed in terms of most preoperative characteristics. Hospital mortality was 1.1%. At 10 years, overall survival (72 ± 9%) and freedom from reoperation (92 ± 4%) were similar between groups (P = ns). In the full cohort, predictors of recurrent aortic regurgitation (AR) >1+ by univariate analysis were cusp repair, SCA, severity of preoperative AR, left ventricular end diastolic diameter (LVEDD). In the SCA group, predictors were preoperative VAJ size, cusp repair, and LVEDD. In the VSR group, the only predictor was cusp thinning or decalcification. In the SCA group, rate of recurrent AR >1+ increased in patients with annular size >28 mm (P = 0.0001, Fig.). During follow-up, patients in the SCA group exhibited a greater increase in annular size compared to those in the VSR group (P < 0.001). Conclusion: In tricuspid AV repair, large annulus predicts recurrent AR in patients having SCA because this technique is unstable over time. A more stable circumferential annuloplasty as in VSR seems recommended in patients with preoperative annular size >28 mm.

Congenital Heart Disease

Background: Most outcome studies in congenital cardiac surgery for "low weight" neonates include ... more Background: Most outcome studies in congenital cardiac surgery for "low weight" neonates include patients undergoing surgery without cardiopulmonary bypass (CPB). The primary objective of our study was to identify risk factors for in-hospital mortality in neonates weighing less than 3 Kg and undergoing surgery with CPB. In addition, we compared the effect of early surgery with CPB (before 37W-gestational age (GA)) for congenital heart disease to delayed surgery until a corrected GA of 37 weeks in an attempt to promote weight gain. Methods: Retrospective single-center study including all patients operated between 1997 and 2017. Uni-and multivariable analysis were used to analyze outcome. Results: 143 patients were included. The median weight was 2.7 Kg and 49 (34.3%) weighted <2.5 Kg. 80% of the patients were Risk stratification STAT categories ≥3. 114 patients (80%) were operated without delay (usual timing, median age 9 days), whereas 29 patients (20%) entered a delayed strategy (median age 30 days). In-hospital mortality was 21.7%. By multivariate analysis, dysmaturity, preoperative positive ventilation, post-operative ECMO requirement or resuscitation, and any residual lesion were predictors of in-hospital death. In-hospital mortality in the usual timing group and the delayed group were 21.1% and 24.1%, respectively (p = 0.71). In-hospital mortality for neonates operated prior to 37W-GA (n = 10) was 27.3%. Conclusions: Predictors of in-hospital mortality in neonates less 3 Kg requiring CPB surgery did not differ from those unveiled in other contemporary studies. Our data demonstrates that a strategy of delaying surgery in selected patients resulted in similar clinical outcome.

Loeckx, Isabelle ; Carbonez, Karlien ; Moniotte, Stéphane ; Rubay, Jean ; Poncelet, Alain ; et. a... more Loeckx, Isabelle ; Carbonez, Karlien ; Moniotte, Stéphane ; Rubay, Jean ; Poncelet, Alain ; et. al. Edwards Valeo Lifestent avoids redo-surgery of RPA stenosis after repair of Berry’s syndrome.40ème Congrès Annuel de la Société Belge de Pédiatrie 2012 ((Belgium) Bruxelles, du 23/03/2012 au 24/03/2012). In: Tijdschrift van de Belgische Kinderarts = Journal du Pédiatre Belge, Vol. 14, no.1, p. 47 (2012) http:// hdl.handle.net/2078.1/159344

Considering the improvements in cardiac surgery over the last few decades, we are now able to car... more Considering the improvements in cardiac surgery over the last few decades, we are now able to care most of the congenital cardiac diseases. However, the occurrence of neurological disabilities in the postoperative period remains high. Even if improvements have been made for the prevention of such complications at the short term, the long term neurological outcome remains a challenge for the next few years.

Anesthesiology, 2019

Editor’s PerspectiveWhat We Already Know about This TopicWhat This Article Tells Us That Is NewBa... more Editor’s PerspectiveWhat We Already Know about This TopicWhat This Article Tells Us That Is NewBackgroundIn congenital cardiac surgery, priming cardiopulmonary bypass (CPB) with fresh frozen plasma (FFP) is performed to prevent coagulation abnormalities. The hypothesis was that CPB priming with crystalloids would be different compared with FFP in terms of bleeding and/or need for blood product transfusion.MethodsIn this parallel-arm double-blinded study, patients weighing between 7 and 15 kg were randomly assigned to a CPB priming with 15 ml · kg−1 PlasmaLyte or 15 ml · kg−1 FFP in addition to a predefined amount of packed red blood cells used in all patients. The decision to transfuse was clinical and guided by point-of-care tests. The primary endpoints included postoperative bleeding tracked by chest tubes, number of patients transfused with any additional blood products, and the total number of additional blood products administered intra- and postoperatively. The postoperative p...

The Journal of Thoracic and Cardiovascular Surgery, 2018

Background: The optimal management and prognostic factors of postsurgical pulmonary vein stenosis... more Background: The optimal management and prognostic factors of postsurgical pulmonary vein stenosis remain controversial. We sought to determine current postsurgical pulmonary vein stenosis outcomes and prognostic factors in a multicentric study in the current era. Methods: Seventy-five patients with postsurgical pulmonary vein stenosis who underwent 103 procedures in 14 European/North American centers (2000-2012) were included retrospectively. A specific pulmonary vein stenosis severity score was developed on the basis of the assessment of each pulmonary vein. End points were death, pulmonary vein reintervention, and restenosis. A univariate and multivariate risk analysis was performed. Results: Some 76% of postsurgical pulmonary vein stenosis occurred after repair of a total anomalous pulmonary venous return. Sutureless repair was used in 42 of 103 procedures (41%), patch veinoplasty was used in 28 procedures (27%), and endarterectomy was used in 16 procedures (16%). Overall pulmonary vein restenosis, reintervention, and mortality occurred in 56% (n ¼ 58/103), 49% (n ¼ 50/103), and 27% (n ¼ 20/75), respectively. Sutureless repair was associated with less restenosis (40% vs 67%; P ¼ .007) and less reintervention (31% vs 61%; P ¼ .003). Mortality after sutureless repair (20%; 7/35) tends to be lower than after nonsutureless repair (33%; 13/40) (P ¼ .22). A high postoperative residual pulmonary vein stenosis score at the time of hospital discharge was an independent risk factor for restenosis (hazard ratio [HR], 1.55; P < 10 À4), reintervention (HR, 1.33; P < 10 À4), and mortality (HR, 1.37; P < 10 À4). The sutureless technique was an independent protective factor against restenosis (HR, 0.27; P ¼ .006). Conclusions: Postsurgical pulmonary vein stenosis still has a guarded prognosis in the current era. The sutureless technique is an independent protective factor against restenosis. The severity of the residual disease evaluated by a new severity score is an independent risk factor for poor outcomes regardless of surgical technique.

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, Jan 31, 2018

We retrospectively analysed our 20-year experience on surgical treatment of native mitral valve (... more We retrospectively analysed our 20-year experience on surgical treatment of native mitral valve (MV) endocarditis in a single institution using an early and repair-oriented surgical approach. From August 1991 to December 2015, 192 consecutive patients underwent MV surgery for active endocarditis. Of these, 81% (n = 155) had MV repair while 19% had MV replacement. In-hospital and late outcomes were analysed in the 2 groups and in the subgroups of repair with and without the use of a patch. Study end points were overall survival, MV reoperation and valve-related events. The median follow-up was 122 and 146 months in the repair and replacement groups, respectively. Patients undergoing MV replacement were significantly older with more severe preoperative comorbidities and clinical conditions compared to patients undergoing MV repair (P < 0.05). When the repair and replacement groups were compared, hospital mortality was 11.6% and 29.7%, respectively (P = 0.006); at 15 years, overall ...

Heart (British Cardiac Society), Jul 13, 2016

The objective of this European multicenter study was to report surgical outcomes of Fontan takedo... more The objective of this European multicenter study was to report surgical outcomes of Fontan takedown, Fontan conversion and heart transplantation (HTX) for failing Fontan patients in terms of all-cause mortality and (re-)HTX. A retrospective international study was conducted by the European Congenital Heart Surgeons Association among 22 member centres. Outcome of surgery to address failing Fontan was collected in 225 patients among which were patients with Fontan takedown (n=38; 17%), Fontan conversion (n=137; 61%) or HTX (n=50; 22%). The most prevalent indication for failing Fontan surgery was arrhythmia (43.6%), but indications differed across the surgical groups (p<0.001). Fontan takedown was mostly performed in the early postoperative phase after Fontan completion, while Fontan conversion and HTX were mainly treatment options for late failure. Early (30 days) mortality was high for Fontan takedown (ie, 26%). Median follow-up was 5.9 years (range 0-23.7 years). The combined end...

European Journal of Anaesthesiology, 2014

Pediatric cardiology, Jan 20, 2015

In the presence of new surgical techniques, the treatment of congenital valvular aortic stenosis ... more In the presence of new surgical techniques, the treatment of congenital valvular aortic stenosis is under debate. We reviewed the results and late outcomes of all 93 patients aged 1 day to 18 years, treated with balloon valvuloplasty (BAV) as first-line therapy for congenital aortic valve stenosis in our center from January 1991 to May 2012. Mean age at procedure time was 2.4 years; 37 patients underwent BAV at age ≤30 days (neonates), 29 patients at age ≥1 month and <1 year (infants), and 27 patients were older than 1 year (children). The invasive BAV peak-to-peak aortic valve gradient (mean 59 ± 22 mmHg) was immediately reduced (mean 24 ± 12 mmHg). The observed diminution of gradient was similar for each age group. Four patients had significant post-BAV AI. Mean follow-up after BAV was 11.4 ± 7 years. The last echo peak aortic gradient was 37 ± 18 mmHg and mean gradient was 23 ± 10 mmHg, and two patients had significant AI. Actuarial survival for the whole cohort was 88.2 and 7...

The Journal of heart valve disease, 2004

Right ventricular dilatation observed after tetralogy of Fallot repair regresses after pulmonary ... more Right ventricular dilatation observed after tetralogy of Fallot repair regresses after pulmonary valve implantation, unless the dilation is too severe. The presence of an akinetic patch in the right ventricular outflow tract (RVOT), a known factor promoting right ventricular dilatation, may prevent right ventricular recovery after valve implantation. The exclusion of a large akinetic RVOT area during reoperation of patients presenting with severe post-repair right ventricular dilatation was investigated. Eight patients underwent a pulmonary infundibuloplasty between May 2000 and October 2002. Their mean preoperative cardothoracic index was 0.66 +/- 0.08, and preoperative NYHA class II (n = 4), III (n = 3) or IV (n = 1). Three patients were offered heart transplantation but refused. All had severe pulmonary regurgitation and underwent a RVOT valve implantation except one patient who had a previous homograft pulmonary valve insertion. Concomitant procedures were tricuspid ring implant...

The Journal of heart valve disease, 2000

Repair of the prolapsing anterior leaflet (AML) in degenerative mitral valve disease is more dema... more Repair of the prolapsing anterior leaflet (AML) in degenerative mitral valve disease is more demanding than that of the posterior leaflet. We reviewed our experience in the past eight years, to examine the safety, efficacy and stability of various repair artifices. Between January 1989 and December 1997, 102 patients (mean age 64 years; range: 26-86 years) with mitral regurgitation (MR) due to prolapse of the anterior or both mitral leaflets underwent mitral valve repair. Sixty-six patients were in NYHA class > or =III, and 94 had MR grade >II. Acute endocarditis was present in 12 patients and Barlow disease in 16. Surgical techniques consisted of chordal shortening (n = 36), chordal transposition (n = 16), papillary muscle shortening or plication (n = 10), flip-over (n = 20) and artificial chordae implantation (n = 20). There was no early mortality; one patient required early mitral valve replacement (MVR) for late-appearing systolic anterior motion, and one patient benefited...

Interactive CardioVascular and Thoracic Surgery, 2014

Cardiology in the Young, 2014

Objectives:The improved management of Fontan patients has resulted in good outcome. As such, thes... more Objectives:The improved management of Fontan patients has resulted in good outcome. As such, these patients may necessitate care for non-cardiac surgery. We sought to determine the long-term outcome of our Fontan series palliated with the most recent surgical techniques. Our second objective was to report the incidence and the perioperative course after non-cardiac procedures. We reviewed the records of all patients with either a lateral tunnel or an extracardiac conduit Fontan between 1996 and 2008. Follow-up was recorded until June, 2013, including records regarding non-cardiac interventions.Results:Overall, 58 patients were included. Of them, one patient underwent a takedown of his Fontan, and five patients died in the immediate postoperative course. The cumulative survival of the remaining 52 patients was 81%. There was no significant difference in survival between right and left ventricle morphologies (p=0.56), nor between both types of Fontan (p=0.9). Chronic arrhythmias (25%)...

Cardiovascular Surgery, 1996

, 124 patients (102 men; mean age of 59 years) underwent myocardial revascularization with the us... more , 124 patients (102 men; mean age of 59 years) underwent myocardial revascularization with the use of at least one free internal mammary artery (FIMA). This group represents 4.5% of the 2725 coronary bypasses performed during the same period. Seventy-six patients (61%) had suffered from at least one previous myocardial infarction. Forty-five patients (36%) had unstable angina: three-vessel disease was found in 100 cases (80.5%) and a left ventricular ejection fraction lower than 0.4 in 22 (17.7%). There were 18 (14.5%) redo procedures and 90 (72.5%) bilateral internal mammary artery (IMA) grafts. The reasons for using a FIMA were: too short an internal mammary artery pedicle in 83 patients, IMA injury at harvesting in 30 patients and post-bypass ischaemia in areas grafted with pedicled IMA (PIMA) in 11 patients. Cardiopulmonary bypass, moderate hypothermia (30°C) and crystalloid anterograde and retrograde cardioplegia were used in all cases. Sixty-seven FIMA grafts were anastomosed directly to the ascending aorta; 57 were sutured via a saphenous hood using a running suture of polypropylene 7/O and three were anastomosed end-to-end to a PIMA graft. FIMA grafts were directed to the left anterior descending (34%). the circumflex (37%) and the right coronary artery (29%). In total, 179 anastomoses were constructed using 127 FIMA, 136 using PIMA and 158 using saphenous veins (3.8 anastomoses per patient). Hospital mortality and postoperative myocardial infarction rates were 5.6% (seven patients) and 3.2% (four patients), respectively. Cardiac-related mortality was 3.2% (four patients) ; three of these four patients had been operated on for evolving infarction and one underwent a redo procedure. Four of the 117 survivors died later on; in two, it was cardiac-related and a result of global heart failure at 9 and 12 months. Of the 113 remaining patients, 106 are symptom free after a mean follow-up of 28.2 (range 3-84) months. Fifty-nine patients (50.4%) were restudied by angiography at a mean interval of IS months. Patency rates of FIMA anastomosed either directly to the aorta or via a saphenous hood were 82.8 or 89.7%, respectively. Patency rates of FIMA directed to the left anterior descending, the circumflex and the right coronary artery were 85.7, 88 and 83.3%. respectively. Global FIMA patency was 86.4%. while global PIMA patency was 100%. The FIMA mid-term patency rates compare unfavourably with those of PIMA: FIMA should therefore be restricted to the cases where PIMA or other pedicled arterial grafts are unavailable.

The Journal of Thoracic and Cardiovascular Surgery, 2006

This study analyzes the results of the arterial switch operation for transposition of the great a... more This study analyzes the results of the arterial switch operation for transposition of the great arteries in member institutions of the European Congenital Heart Surgeons Association. Methods: The records of 613 patients who underwent primary arterial switch operations in each of 19 participating institutions in the period from January 1998 through December 2000 were reviewed retrospectively. Results: A ventricular septal defect was present in 186 (30%) patients. Coronary anatomy was type A in 69% of the patients, and aortic arch pathology was present in 20% of patients with ventricular septal defect. Rashkind septostomy was performed in 75% of the patients, and 69% received prostaglandin. There were 37 hospital deaths (operative mortality, 6%), 13 (3%) for patients with an intact ventricular septum and 24 (13%) for those with a ventricular septal defect (P Ͻ .001). In 36% delayed sternal closure was performed, 8% required peritoneal dialysis, and 2% required mechanical circulatory support. Median ventilation time was 58 hours, and intensive care and hospital stay were 6 and 14 days, respectively. Although of various preoperative risk factors the presence of a ventricular septal defect, arch pathology, and coronary anomalies were univariate predictors of operative mortality, only the presence of a ventricular septal defect approached statistical significance (P ϭ .06) on multivariable analysis. Of various operative parameters, aortic crossclamp time and delayed sternal closure were also univariate predictors; however, only the latter was an independent statistically significant predictor of death. Conclusions: Results of the procedure in European centers are compatible with those in the literature. The presence of a ventricular septal defect is the clinically most important preoperative risk factor for operative death, approaching statistical significance on multivariable analysis.

The Journal of Thoracic and Cardiovascular Surgery, 2008

The Journal of Thoracic and Cardiovascular Surgery, 2013

The minimally invasive surgical approach is an effective option even in elderly patients with int... more The minimally invasive surgical approach is an effective option even in elderly patients with intractable secondary pneumothorax. References 1. Dillman RO, Zusman DR, McClure SE. Surgical resection and long-term survival for octogenarians who undergo surgery for non-small-cell lung cancer.

Journal of the American College of Cardiology, 2001

treatment. Nonetheless, among the subgroup of patients who underwent monitoring during both the i... more treatment. Nonetheless, among the subgroup of patients who underwent monitoring during both the initial treatment and study drug discontinuation periods (n ϭ 163), ischemia was less frequently observed during both monitoring periods in the enoxaparin group (18.4% vs. 32.2%, p ϭ 0.045 and 25% vs. 46%, p ϭ 0.005, respectively). Further, the time to first ischemic episode was significantly earlier among UFH-treated patients, consistent with a superior early antithrombotic effect of enoxaparin and a reduction in the composite clinical end point of death, myocardial infarction (MI), and need for urgent revascularization (3). Therefore, we believe that enoxaparin has been shown to be superior to UFH based upon the consistent and statistically significant reductions in the composite and double (death/MI) end points in ESSENCE and TIMI 11B (4). In contrast, "extending the duration and slower weaning" of UFH is an unproven method of administration, and, in fact, the cost-savings realized with enoxaparin ultimately make it the less expensive option (5).