Patrick Nataf

Paris Diderot University, Lutetia Parisorum, Île-de-France, France

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Publications (101)386.12 Total impact

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    ABSTRACT: The incidence of surgical site infection (SSI) after cardiac surgery depends on the definition used. A distinction is generally made between mediastinitis, as defined by the Centers for Disease Control (CDC), and superficial SSI. Our objective was to decipher these entities in terms of presentation and risk factors. We performed a 7-year single center analysis of prospective surveillance of patients with cardiac surgery via median sternotomy. SSI was defined as the need for reoperation due to infection. Among 7,170 patients, 292 (4.1%) developed SSI, including 145 CDC-defined mediastinitis (CDC+ SSI, 2.0%) and 147 superficial SSI without associated bloodstream infection (CDC- SSI, 2.1%). Median time to reoperation for CDC- SSI was 18 days (IQR, 14-26) and 16 (IQR, 11-24) for CDC+ SSI (p= 0.02). Microorganisms associated with CDC- SSI were mainly skin commensals (62/147, 41%) or originated in the digestive tract (62/147, 42%) and only 6 Staphylococcus aureus (4%), while CDC+ SSI were mostly due to S.aureus (52/145, 36%) and germs from the digestive tract (52/145: 36%). Risk factors for SSI were older age, obesity, chronic obstructive bronchopneumonia, diabetes mellitus, critical pre-operative state, post-operative vasopressive support, transfusion or prolonged ventilation and coronary artery bypass grafting, especially if using both internal thoracic arteries (ITA) in female patients. The number of ITA used and factors affecting wound healing were primarily associated with CDC- SSI, whereas co-morbidities and peri-operative complications were mainly associated with CDC+ SSI. These 2 entities differed in time to revision surgery, bacteriology and risk factors, suggesting a differing pathophysiology. Copyright © 2015. Published by Elsevier Ltd.
    Clinical Microbiology and Infection 04/2015; DOI:10.1016/j.cmi.2015.03.025 · 5.20 Impact Factor
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    ABSTRACT: To assess late outcome after transcatheter aortic valve implantation (TAVI) up to 6 years and to analyse its predictive factors with a particular emphasis on functional status. Very few data exist on the long-term results of TAVI, and these data are crucial for decision making. Between October 2006 and December 2009, 123 consecutive patients were discharged alive after TAVI in our institution. Mean age was 82±8 years, and 88% of patients were highly symptomatic in New York Heart Association (NYHA) class III-IV. Follow-up was complete in 122 patients (99%). The overall 6-year survival rate was 31%±5%, the majority of deaths being non-cardiac. Predictive factors of late mortality were the presence of lower limb arteritis (p=0.009), a higher Charlson comorbidity index (p=0.03) and post-TAVI paraprosthetic aortic regurgitation ≥2/4 (p=0.01). Late outcomes according to Valve Academic Research Consortium-2 criteria were analysed, and the 5-year event-free survival rate was 28%±4%. Finally, the rate of good functional results, defined as survival in NYHA class I or II, was 32%±5% at 5-year follow-up. In the survivors, the EQ-5D questionnaire further confirmed the benefit in terms of quality of life. About one-third of patients discharged alive after TAVI were alive at 6-year follow-up, and the survivors exhibited good functional results assessed by NYHA class and quality-of-life standardised evaluation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
    Heart (British Cardiac Society) 02/2015; DOI:10.1136/heartjnl-2014-306694 · 6.02 Impact Factor
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    ABSTRACT: This study sought to evaluate the feasibility of transfemoral transcatheter heart valve (THV) implantation in failed mitral bioprostheses and ring annuloplasties. Redo mitral surgery may be high risk or contraindicated due to comorbidity. THV implantation has been recently reported in this setting. Transfemoral implantation of Edwards Sapien prosthesis was performed in 17 patients for degenerated mitral bioprosthesis or previous ring annuloplasty (6 bioprostheses, 11 ring annuloplasties). The procedure was elective for 14 patients and attempted as a rescue in 3 patients. Mean age was 61 ± 24 years. All patients were in New York Heart Association class ≥III, and the surgical risk was high (EuroSCORE [European System for Cardiac Operative Risk Evaluation]: 37 ± 29%, Society of Thoracic Surgeons score: 18 ± 22%). Procedure was successful in 14 patients (82%). Two complications occurred during rescue procedures: 1 procedural death and 1 THV migration. One patient had moderate paraprosthetic regurgitation following the procedure, whereas residual regurgitation was trace or less in 11 patients (69%) and mild in 4 patients (25%). Mean gradient decreased from 12 ± 6 mm Hg to 8 ± 3 mm Hg. During a mean follow-up of 22 months, 4 patients died, 3 from cardiac cause. The 18-month survival was 68 ± 14% in the overall population and 78 ± 14% for patients with elective procedure. One patient underwent mitral valve replacement due to periprosthetic mitral regurgitation. At last follow-up, 12 patients were in New York Heart Association class ≤II (75%) and 4 in class III (25%). This single-center series suggests that transfemoral THV implantation for deterioration of mitral bioprosthesis or surgical repair is feasible in selected patients and improves early hemodynamic and midterm functional status. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
    JACC Cardiovascular Interventions 01/2015; 8(1PA):83-91. DOI:10.1016/j.jcin.2014.07.026 · 7.44 Impact Factor
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    ABSTRACT: Aims The presence of intravalve hemorrhage close to calcium crystals has recently been described in calcified aortic valves histologic slides. Those hemorrhages can play a pathogenic and initiating role in calcification process but they could also be a mere consequence of the mechanical damage due to calcifications. We aimed at assessing whether iron deposits are present both in calcified valves and non calcified valves. Methods and results Aortic valves deriving from patients operated at the Bichat Hospital were consecutively (February-April 2014) included in our study (Table 1). We have developed a morphologic analysis technique in 3D whole mounts, using Perls’ blue staining for ferric iron and Alizarin red staining for calcium crystals, in situ. The valves are optically claryfied using benzyl benzoate prior to analysis. Results Ferric iron staining was positive in 18/20 (90%) non-calcified valves. Ferric iron deposits were present in 93% of calcified valves (78% in the group « severe aortic stenosis » and 100% in the group « moderate aortic stenosis »). Ferric iron deposits displayed two types of pattern: either in « close contact » with calcium crystals (74%), or located within the healthy tissue, « distant » from the calcium crystals (42,5%). Both types of pattern were concomitanly present in 30% of all calcified valves. Conclusion Our study shows that ferric iron deposits can be found in non-calcified valves, suggesting that hemorrhage are not necessarily a consequence of valve calcification. The iron deposits that are not spatially associated with calcium crystals may precede the development of calcifications, possibly playing an active role. Abstract 0428 – Table: Baseline characteristicsType of procedureNb (men)Mean age, yearsMean gradient,mmHgMacroscopically calcified valvesAortic valve replacement45 (22)72,546,745Severe aortic stenosis40 (18)7349,540Moderate aortic stenosis5(4)71,5255Bentall procedure16 (14)53–2Explanted heart4 (4)62–0
    Archives of Cardiovascular Diseases Supplements 01/2015; 7(1):49. DOI:10.1016/S1878-6480(15)71627-7
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    Journal of the American College of Cardiology 12/2014; 64(23):2557-8. DOI:10.1016/j.jacc.2014.09.047 · 15.34 Impact Factor
  • EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 09/2014; 10(11). DOI:10.4244/EIJY14M09_03 · 3.76 Impact Factor
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    ABSTRACT: Background Bleeding originating in the gastrointestinal (GI) tract is one of the most common adverse events after left ventricular assist device (LVAD) implantation. In these patients, GI bleeding appears to be the consequence of altered hemostasis on the one hand and alterations of the GI microvasculature on the other.Case ReportWe report the case of a patient who suffered repeated, severe GI bleeding early after implantation of a HeartMate II continuous-flow LVAD.ResultsAfter failure of conventional treatment strategies, GI bleeding was controlled using repeated transfusions of a purified von Willebrand factor (VWF) concentrate, almost devoid of Factor VIII (Wilfactin, LFB). No episodes of pump thrombosis were noted. Subsequent to VWF transfusions, we observed a progressive normalization of circulating vascular endothelial growth factor levels.Conclusions Our data raise the possibility that, in addition to its hemostatic properties, transfusions of VWF might have acted as an antiangiogenic factor.
    Transfusion 08/2014; 55(1). DOI:10.1111/trf.12788 · 3.57 Impact Factor
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    ABSTRACT: BACKGROUND: The Logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) and the Society of Thoracic Surgeons (STS) score are routinely used to identify patients at high surgical risk as potential candidates for transcatheter aortic valve implantation (TAVI). AIMS: To compare the new EuroSCORE II with the Logistic EuroSCORE and the STS score. METHODS: From October 2006 to June 2011, patients with severe symptomatic aortic stenosis who underwent a TAVI were enrolled prospectively. RESULTS: Among 272 patients, the EuroSCORE II was significantly lower and moderately correlated with the Logistic EuroSCORE (9±8% vs. 23±14%, P<0.01; r=0.61, P<0.001), but similar to and poorly correlated with the STS (10±9%, P=0.10; r=0.25, P<0.001). Based on recommended high-risk thresholds (Logistic EuroSCORE≥20%; STS≥10%), a EuroSCORE II≥7% provided the best diagnostic value. However, using the EuroSCORE II, Logistic EuroSCORE or STS score, only 51%, 58% and 37% of patients, respectively, reached these thresholds. Contingency analyses showed that agreements between the EuroSCORE II and the Logistic EuroSCORE or the STS score were modest or poor, respectively, with a risk assessment different in 28% and 36% of patients, respectively. CONCLUSIONS: A EuroSCORE II≥7% corresponded to a Logistic EuroSCORE≥20% or STS score≥10%, but correlations and agreements were at best modest and only approximately half of the patients reached these thresholds. Our results highlight the limits of current scoring systems and reinforce the European guidelines stressing the importance of clinical judgment in addition to risk scores.
    Archives of cardiovascular diseases 07/2014; 107(6-7):353-360. DOI:10.1016/j.acvd.2014.05.002 · 1.66 Impact Factor
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    ABSTRACT: Mitral insufficiency is a frequently occurring valvular disease for which surgery is the reference treatment. A large number of patients are at high risk or even contraindicated for surgery due to comorbidities. The MitraClip procedure reproduces a surgical technique for mitral valve repair. Global experience includes over 12,000 patients and has been mainly reported in registries with limited follow-up. The degree of reduction of mitral insufficiency is less with the MitraClip than with surgery. Safety of the procedure is good in experienced centres. Most patients have functional improvement in the mid-term. The procedure may be considered in patients who are at high risk for surgery and remain symptomatic despite optimal medical treatment. In the future, more data are needed from longer follow-up and randomised trials. Both the technique and the equipment used in the procedure need to improve. In addition, it is hoped that combined percutaneous procedures will be available in the near future.
    La Presse Médicale 05/2014; 43(7-8). DOI:10.1016/j.lpm.2014.03.016 · 1.17 Impact Factor
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    JACC Cardiovascular Interventions 05/2014; 7(6). DOI:10.1016/j.jcin.2013.12.204 · 7.44 Impact Factor
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    ABSTRACT: Mitral insufficiency is a frequently occurring valvular disease for which surgery is the reference treatment. A large number of patients are at high risk or even contraindicated for surgery due to comorbidities. The MitraClip procedure reproduces a surgical technique for mitral valve repair. Global experience includes over 12,000 patients and has been mainly reported in registries with limited follow-up. The degree of reduction of mitral insufficiency is less with the MitraClip than with surgery. Safety of the procedure is good in experienced centres. Most patients have functional improvement in the mid-term. The procedure may be considered in patients who are at high risk for surgery and remain symptomatic despite optimal medical treatment. In the future, more data are needed from longer follow-up and randomised trials. Both the technique and the equipment used in the procedure need to improve. In addition, it is hoped that combined percutaneous procedures will be available in the near future.
  • Archives des Maladies du Coeur et des Vaisseaux - Pratique 12/2013; 2013(223):18–22. DOI:10.1016/S1261-694X(13)70570-4
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    ABSTRACT: Aims: We report a case of emergency transcatheter heart valve implantation in a failing mitral bioprosthesis via a transseptal access complicated by the atrial migration of a prosthesis. Methods and results: A 42-year-old woman was referred for stenotic failure of a mitral bioprosthesis. A transapical valve-in-valve implantation was initially planned. However, due to sudden haemodynamic deterioration, an emergency transseptal implantation via a femoral venous access was undertaken. Following cardiac arrest, the procedure was performed with extracorporeal membrane oxygenation (ECMO), and was complicated by the migration of a valve, which was left moving freely in the left atrium. A second valve was successfully implanted in the mitral bioprosthesis. Following initial clinical recovery, there was a sudden recurrence of heart failure due to entrapment of the migrated valve in the implanted valve in a "reverse position", which was dislodged percutaneously in an emergency procedure. The valve later migrated into the left atrial appendage. Immediate outcome was uneventful, but the patient suddenly died six months later. Conclusions: Transseptal transcatheter mitral valve-in-valve implantation is feasible, even in an emergency setting with ECMO. Valve migration in the left atrium may occur and lead to late entrapment in a "reverse position", with significant haemodynamic consequences.
    EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 09/2013; 9(5):636-42. DOI:10.4244/EIJV9I5A101 · 3.76 Impact Factor
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    ABSTRACT: In selected high-risk patients with aortic stenosis, transcatheter aortic valve implantation (TAVI) can provide comparable functional improvement and early survival after surgical aortic valve replacement. However, the long-term outcome after TAVI is still to be determined and the occurrence of aortic dissection has not been systematically reported. Herein, a case is presented of delayed aortic dissection and rupture several months after an uneventful TAVI in a patient with bicuspid aortic valve stenosis.
    The Journal of heart valve disease 09/2013; 22(5):701-3. · 0.73 Impact Factor
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    ABSTRACT: Peripheral venoarterial extracorporeal membrane oxygenation support provides prolonged support in the event of acute or acute-on-chronic cardiac and/or respiratory failure. This support serves as a bridge to recovery, decision-making, heart transplantation or ventricular-assist device implantation. It can be implanted either through a percutaneous approach using Seldinger's technique or via an open approach via the common femoral artery or the axillary artery. Early and late arterial vascular complications remain an important issue, with rates of up to 28% with femoral and axillary cannulation sites. Among them, limb ischemia requires prompt diagnosis and management to avoid limb amputation. In the case of peripheral artery cannulation, ipsilateral distal limb perfusion to prevent acute limb ischemia can be performed via a single lumen catheter through the artery or via the 'chimney graft' technique during extracorporeal membrane oxygenation implantation.
    Future Cardiology 07/2013; 9(4):489-95. DOI:10.2217/fca.13.34
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    ABSTRACT: Tissue activation of proteolysis is involved in acute intramural rupture (dissections, acute ascending aortic dissection) and in progressive dilation (aneurysms, thoracic aneurysm of the ascending aorta) of human ascending aorta. The translational aim of this study was to characterize the regulation of antiproteolytic serpin expression in normal, aneurysmal, and dissecting aorta. We explored expression of protease nexin-1 (PN-1) and plasminogen activator inhibitor-1 and their regulation by the Smad2 signaling pathway in human tissue and cultured vascular smooth muscle cells (VSMCs) of aneurysms (thoracic aneurysm of the ascending aorta; n=46) and acute dissections (acute ascending aortic dissection; n=10) of the ascending aorta compared with healthy aortas (n=10). Both PN-1 and plasminogen activator inhibitor-1 mRNA and proteins were overexpressed in medial tissue extracts and primary VSMC cultures from thoracic aneurysm of the ascending aorta compared with acute ascending aortic dissection and controls. Transforming growth factor-β induced increased PN-1 expression in control but not in aneurysmal VSMCs. PN-1 and plasminogen activator inhibitor-1 overexpression by aneurysmal VSMCs was associated with increased Smad2 binding on their promoters and, functionally, resulted in VSMC self-protection from plasmin-induced detachment and death. This phenomenon was restricted to aneurysms and not observed in acute dissections. These results demonstrate that epigenetically regulated PN-1 overexpression promotes development of an antiproteolytic VSMC phenotype and might favor progressive aneurysmal dilation, whereas absence of this counter-regulation in dissections would lead to acute wall rupture.
    Arteriosclerosis Thrombosis and Vascular Biology 06/2013; 33(9). DOI:10.1161/ATVBAHA.113.301327 · 5.53 Impact Factor
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    ABSTRACT: AIMS: In patients with a suspicion of prosthetic valve endocarditis (PVE), detection of perivalvular infection can be difficult based only on echocardiography. The aim of this retrospective study was to test the interest of radiolabelled leucocyte scintigraphy (LS) for the detection of perivalvular infection in patients with a suspicion of PVE and inconclusive transoesophageal echocardiography (TEE). METHODS AND RESULTS: LS was performed in 42 patients. The results of LS were classified as positive in the cardiac area (intense or mild), or negative. Macroscopical aspects and bacteriology were obtained from patients who underwent cardiac surgery (n = 10). Clinical outcome was collected in patients treated medically (n = 32).Among patients with intense signal with LS who underwent surgery (n = 6), five had an abscess confirmed during intervention and one, post-operatively. Patients with intense accumulation of radiolabelled leucocytes with scintigraphy and treated medically (n = 3) had a poor outcome: death (n = 1); prosthetic valve dehiscence (n = 1); and recurrent endocarditis (n = 1). Among patients with mild activity with LS (n = 5), one patient developed a large prosthetic valve dehiscence during the follow-up. The remaining four patients were treated medically and did not present any recurrent endocarditis after a median follow-up of 14 months. No abscess was detected in patients with negative LS who underwent surgery (n = 4). Among the patients with negative LS treated medically (n = 24), none presented recurrent endocarditis after a mean follow-up of 15 ± 16 months. Patient management was influenced by the results of LS in 12 out of 42 patients (29%). CONCLUSION: This study suggests that LS is useful for the identification of perivalvular infection in patients with a suspicion of PVE and inconclusive TEE.
    03/2013; DOI:10.1093/ehjci/jet029
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    ABSTRACT: OBJECTIVES Sternal wound infections occurring after cardiac surgery have a critical impact on morbidity, mortality and hospital costs. This study evaluated the efficacy of a gentamicin-collagen sponge in decreasing deep sternal-wound infections in high-risk cardiac surgery patients.METHODS We conducted a quasi-experimental single-centre prospective cohort study in diabetic and/or overweight patients undergoing coronary-artery bypass surgery with bilateral internal mammary artery grafts. The end-point was the rate of reoperation for deep sternal wound infection. The period from January 2006 to October 2008, before the introduction of the gentamicin sponge, was compared with the period from November 2008 to December 2010.RESULTSOf 552 patients (median body mass index, 31.5; 37.7% with diabetes requiring insulin), 68 (12.3%) had deep sternal wound infections. Reoperation for deep sternal wound infections occurred in 40/289 (13.8%) preintervention patients and 22/175 (12.6%) patients managed with the sponge. Independent risk factors were female sex and longer time on mechanical ventilation, but not use of the sponge (adjusted odds ratio, 0.95; 95% confidence interval, 0.52-1.73; P = 0.88). The group managed with the sponge had a higher proportion of gentamicin-resistant micro-organisms (21/27, 77.8%) compared with the other patients (23/56, 41.1%; P < 0.01). The median time to reoperation for wound infection was higher with the sponge (21 vs 17 days, P < 0.01).CONCLUSIONSA gentamicin-collagen sponge was not effective in preventing deep sternal wound infections in high-risk patients. Our results suggest that a substantial proportion of wound contaminations occur after bypass surgery with bilateral internal mammary artery grafts.
    Interactive Cardiovascular and Thoracic Surgery 10/2012; 16(2). DOI:10.1093/icvts/ivs449 · 1.11 Impact Factor
  • EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 09/2012; 8(5):638-9. DOI:10.4244/EIJV8I5A97 · 3.76 Impact Factor
  • Journal of the American College of Cardiology 08/2012; 60(13):1205-6. DOI:10.1016/j.jacc.2012.05.033 · 15.34 Impact Factor

Publication Stats

3k Citations
386.12 Total Impact Points

Institutions

  • 2008–2015
    • Paris Diderot University
      Lutetia Parisorum, Île-de-France, France
    • Assistance Publique – Hôpitaux de Paris
      • Department of Cardiology
      Lutetia Parisorum, Île-de-France, France
  • 2010–2014
    • University of Paris-Est
      La Haye-Descartes, Centre, France
  • 2007–2014
    • Hôpital Bichat - Claude-Bernard (Hôpitaux Universitaires Paris Nord Val de Seine)
      • Service de Cardiologie
      Lutetia Parisorum, Île-de-France, France
  • 1993–2000
    • Hôpital La Pitié Salpêtrière (Groupe Hospitalier "La Pitié Salpêtrière - Charles Foix")
      Lutetia Parisorum, Île-de-France, France
  • 1998
    • Loma Linda University
      • Department of Cardiovascular and Thoracic Surgery
      Loma Linda, California, United States
  • 1995–1998
    • Hôpitaux Universitaires La Pitié salpêtrière - Charles Foix
      Lutetia Parisorum, Île-de-France, France