N Bonnet

Hôpital La Pitié Salpêtrière (Groupe Hospitalier "La Pitié Salpêtrière - Charles Foix"), Lutetia Parisorum, Île-de-France, France

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Publications (59)165.12 Total impact

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    ABSTRACT: Use of cardiac allograft for transplantation from donors after acute poisoning is a matter of debate because of potential toxic organ injuries, especially if death results from massive ingestion of cardiotoxic drugs. We report successful allograft cardiac transplantation from a brain-dead patient after severe flecainide and betaxolol self-poisoning requiring extracorporeal life support. Extracorporeal life support was initiated in the emergency department because of a refractory cardiac arrest caused by the cardiotoxicants' ingestion and continued after the onset of brain death to facilitate organ donation of the heart, liver, and kidneys. Forty-five months later, each organ recipient was alive, with normal graft function.
    Annals of emergency medicine 02/2010; 56(4):409-12. · 4.23 Impact Factor
  • European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 10/2008; 34(5):1109. · 2.40 Impact Factor
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    ABSTRACT: To assess the outcomes and long-term quality-of-life of patients supported by extracorporeal membrane oxygenation (ECMO) for refractory cardiogenic shock. Refractory cardiogenic shock is almost always lethal without emergency circulatory support, e.g., ECMO. ECMO-associated morbidity and mortality plead for identification of early predictors of its failure, and detailed analyses of short- and long-term outcomes to refine patient selection and improve results. Outcomes of 81 patients given ECMO support for medical (n = 55), postcardiotomy (n = 16), or posttransplantation (n = 10) cardiogenic shock were evaluated. Thirty-four (42%) patients survived to hospital discharge; 57% suffered > or = 1 major ECMO-related complications. Independent predictors of intensive care unit death were: device insertion under cardiac massage (odds ratio [OR] = 20.68), 24 hr urine output < 500 mL (OR = 6.52), prothrombin activity < 50% (OR = 3.93), and female sex (OR = 3.89); myocarditides were associated with better outcomes (OR = .13). Sequelae and health-related quality-of-life were evaluated for 28 long-term survivors (median follow-up, 11 months), whose mean Short-Form 36 scores were significantly lower than matched healthy controls for physical role, general health, and social functioning, but higher than those reported for patients on chronic hemodialysis, with advanced heart failure, or after recovery from acute respiratory distress syndrome. ECMO support can rescue 40% of otherwise fatal cardiogenic shock patients but its initiation under cardiac massage or after renal or hepatic failure carried higher risks of intensive care unit death, while fulminant myocarditis had a better prognosis. Despite satisfactory mental health and vitality, long-term survivors' persistent physical and social problems might benefit from tailored medical or psychosocial interventions.
    Critical care medicine 05/2008; 36(5):1404-11. · 6.37 Impact Factor
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    ABSTRACT: A decrease in L-type calcium current (ICaL) is an important mechanism favouring atrial fibrillation (AF). Here, we aimed to identify pathogenic factors associated with ICaL downregulation. Atrial myocytes were isolated from right atrial appendages obtained from 86 adult patients in sinus rhythm with coronary artery disease, aortic valve disease, or mitral valve disease (MVD). Current was recorded in isolated myocytes using the whole-cell patch-clamp technique. The ICaL recorded in the 172 myocytes studied showed a marked variability of peak density ranging from 0.1 to 9.0 pA/pF. The ICaL peak density did not correlate with membrane capacitance or changes in current biophysical properties. The ICaL peak density was homogeneous for a given sample. Small ICaL values were recorded in patients with MVD or with a low left ventricular ejection fraction (<45%). Small ICaL values were more sensitive to the beta-adrenergic agonist, isoproterenol (1 microM), and to the phosphodiesterase inhibitor, 3-isobutyl-1-methyl-xanthine (10 microM). In human atrial myocytes, the variability of ICaL is related to the clinical history of the donors. The downregulation of ICaL is already observed in patients in sinus rhythm with a high risk of AF and is associated with the greatest response to beta-adrenergic agonist.
    European Heart Journal 05/2008; 29(9):1190-7. · 14.10 Impact Factor
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    ABSTRACT: Optimal treatment of type B dissections is open to debate. The use of endoprostheses is an option that requires evaluation. To report our experience with endoprostheses in type B aortic dissections. We report our short- and medium-term results with covered prostheses for the treatment of acute (n=7) and chronic (n=28) type B aortic dissections. The criteria used to indicate treatment were the same as those usually used for surgery: acute complications or dilated aneurysm. Cover of the main intimal tear was obtained in all cases with an improvement in symptoms in patients with acute dissections. Early mortality was 14.3% (five patients), linked in three cases to the occurrence of a retrograde dissection of the ascending aorta. No neurological complications were observed. Four patients required an additional endovascular and/or surgical procedure. On early control scans, complete thrombosis of the false lumen at the thoracic level was observed in 40% of cases, partial thrombosis in 42.8% and an absence of thrombosis in 11.4%. After a mean follow-up of 20.8 months, one patient died of a pneumopathy. No secondary aneurysm expansion was noted at the thoracic stage whereas three patients presented with dilation of the abdominal aorta. The results of treatment of type B dissections with covered endoprostheses are encouraging. However, the morbimortality associated with treatment and the uncertainty of long-term results do not allow the use of this therapeutic option outside the criteria usually recognized to indicate surgery.
    Archives of Cardiovascular Diseases 03/2008; 101(2):94-9. · 1.66 Impact Factor
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    ABSTRACT: We present a rare case of bullet embolism from the left brachiocephalic vein to the right ventricle, following a chest gunshot wound, in a 56-year-old soldier. The bullet was accidentally discovered on a systematic chest X-ray. The bullet was very close to the tricuspid subvalvular apparatus and was about to come out from the ventricle. We removed it under cardiopulmonary bypass.
    Journal of Cardiac Surgery 01/2008; 23(2):176-7. · 1.35 Impact Factor
  • Journal of Heart and Lung Transplantation - J HEART LUNG TRANSPLANT. 01/2008; 27(2).
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    ABSTRACT: We sought to evaluate the screening modality and outcome of lung cancer occurring in heart transplant recipients (HTR) during a 21-year period. We conducted a retrospective review to investigate the incidence, risk factors, screening modality, treatment, and outcomes in HTR with lung cancer. We compared them with a case-matched HTR control group. Out of 829 recipients of heart transplants, 19 cases of bronchogenic carcinoma were found either by routine chest X-ray (n = 10), chest computed tomographic (CT) scanning (n = 4), or by assessment of clinical symptoms (n = 5). The mean time from transplantation to bronchogenic carcinoma diagnosis was 68.8 +/- 42.4 months. A history of smoking was the only risk factor in HTR with bronchogenic carcinoma compared to their case-matched HTR control group ( P < 0.05). Of 18 patients with non-small cell lung cancer (NSCLC), 13 underwent surgery and 5 with advanced cancer underwent chemotherapy and/or radiotherapy. NSCLC was diagnosed by chest X-ray (n = 10), and 6 of these patients died after an average of 43.7 +/- 62.2 months following cancer detection. NSCLC was also diagnosed on the basis of clinical symptoms (n = 4), and 2 of these patients died after a mean follow-up of 9 +/- 4.2 months after cancer diagnosis. All 4 patients in whom cancer was detected by CT scan were alive at an average of 53.5 +/- 36.7 months following cancer detection. The survival rates did not differ between the study and control groups ( P = 0.5). Optimal outcomes of treatment for primary lung cancer after heart transplantation seem to be related to early detection. A high proportion of deaths from NSCLC may be prevented by chest CT scan screening.
    The Thoracic and Cardiovascular Surgeon 11/2007; 55(7):438-41. · 0.93 Impact Factor
  • Annales de Cardiologie et d Angéiologie 10/2007; 56(4):168-71. · 0.30 Impact Factor
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    ABSTRACT: We sought to evaluate the effect of a strict glycemic control protocol on a series of diabetic patients undergoing surgical myocardial revascularization. Between January 2003 and June 2004, 300 diabetic patients undergoing myocardial revascularization received a local protocol of insulin administration (protocol, group P). Patients were divided into 2 risk classes, according to their additive EuroSCORE value: low-moderate risk (0-4) and moderate-high risk (>4). The logistic EuroSCORE algorithm was used to calculate the expected probability of death. A control group was selected, including a series of 300 consecutive diabetic patients (no protocol group, group NP) who underwent coronary artery bypass grafting between March 2001 and September 2002, just before the introduction of the protocol. A propensity analysis was performed to control for selection bias. Both groups showed similar EuroSCORE risk profiles: mean additive and logistic EuroSCORE values were 4.16 and 4.29 in group P versus 3.93 and 3.91 in group NP. Observed and expected mortalities of group P were 0.6% versus 1.8% (low-moderate risk), 2.5% versus 8.0% (moderate-high risk, P = .03), and 1.3% versus 4.3% (entire group, P = .01). Observed and expected mortalities of group NP were 1.6% versus 1.9% (low-moderate risk), 8.3% versus 7.5% (moderate-high risk), and 4.0% versus 3.9% (entire group). Logistic regression confirmed observed mortality in group P to be significantly lower than the expected logistic EuroSCORE mortality. After risk adjustment, the protocol allowed us to reduce the mortality odds by 72% (odds ratio, 0.282; 95% confidence interval, 0.092-0.859; P < .03). Subgroup analysis for moderate- to high-risk patients showed the protocol to improve mortality (odds ratio, 0.24; P < .05), whereas no significant improvement was found in low- to moderate-risk patients. Addition of the propensity score to the multivariable analysis did not significantly displace P values and odds ratios. Sensitivity analysis of patients who underwent coronary artery bypass grafting without additional procedures showed the protocol to maintain its protective effect (odds ratio, 0.15; P < .05). Optimal glucose control highly reduces EuroSCORE expected mortality in diabetic patients undergoing myocardial revascularization, especially in moderate- to high-risk patients.
    The Journal of thoracic and cardiovascular surgery 07/2007; 134(1):29-37. · 3.41 Impact Factor
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    ABSTRACT: We describe a new technique of aortic valve conservation for ascending aortic aneurysm with aortic valvular insufficiency. This technique allows a total anatomic aortic root reconstruction associated with an aortic annuloplasty preventing late annulus dilation and reoperation. Preliminary results demonstrate the feasibility and the safety of this new original procedure.
    The Annals of thoracic surgery 06/2007; 83(5):1908-10. · 3.45 Impact Factor
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    ABSTRACT: Aspirin combined with clopidogrel is the treatment of choice for acute coronary syndromes. Although the maintenance of aspirin until surgery does not affect postoperative bleeding after coronary artery bypass graft (CABG) surgery, the latter may be dramatically increased when clopidogrel is continued over a period of 5 days preoperatively. This prospective observational study included 217 consecutive patients scheduled for first-time CABG. Postoperative bleeding and blood transfusion requirements were compared (equivalence) between patients pretreated during a period of 5 days prior surgery by either aspirin alone (n = 157) or combined with clopidogrel (n = 60). Aprotinin was systematically used in all these patients considered as high risk for bleeding. We found no significant difference between both groups concerning the preoperative characteristics except for unstable angina (33 vs. 19%, P = 0.02) and left main coronary artery stenosis (27 vs. 13%, P = 0.02), which were more frequent in patients receiving clopidogrel. The median chest tube output was similar in both groups 24 h postoperatively at 350 mL (95% CI 150-850) vs. 375 mL (95% CI 175-875), and the difference between groups (7%, 95% CI -9 to 22) did not encompass the predetermined margins of equivalence (25%). No significant difference was found on blood transfusion use (38 vs. 38%, P = 0.99). After adjustment by a propensity score, we found that clopidogrel was not associated with an increased risk of excessive bleeding. In patients undergoing first-time CABG and treated prophylactically with aprotinin, aspirin and clopidogrel may be continued until surgery without increasing postoperative bleeding or transfusion requirements.
    European Heart Journal 05/2007; 28(8):1025-32. · 14.10 Impact Factor
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    ABSTRACT: We sought to examine the results of orthotopic heart transplantation accepting hearts from donors >50 years of age with special regard to the usefulness of peripheral extracorporeal membrane oxygenation for posttransplant graft dysfunction. Between January 2000 and December 2004, a total of 247 patients underwent orthotopic heart transplantation. In 143 patients (58%) the heart donor was <50 years (group I, mean age of donor hearts 36 +/- 11 years; range, 8-49 years). In 104 recipients (42%) the heart donor was >50 years (group II, mean age of donor hearts 56 +/- 15 years; range, 50-67 years). Pretransplant characteristics of the two groups showed no significant differences. The in-hospital mortality was slightly increased in group II (24% vs 20% in group I, NS) and the 5-year survival rate significantly increased in group I (75% vs 63% in group II). Freedom from transplant vasculopathy after 3 years was similar in both groups (86% in group I vs 87% in group II). A total of 25 patients (17%) in group I and 27 patients (26%) in group II developed graft dysfunction. Eleven patients in group I and 10 patients in group II were treated using peripheral extracorporeal membrane oxygenation, whereas 3 of the 11 patients in group I and 5 of the 10 patients in group II were discharged following a complete recovery. Two patients in group I and 4 patients in group II were survivors beyond year. In our experience it was possible to increase the cardiac donor pool by accepting allografts from donors >50 years of age in selected cases. The incidence of transplant vasculopathy was not increased, whereas in-hospital mortality was slightly higher. In our limited cohort, patients with older donor hearts was developed graft dysfunction profited from primary extracorporeal membrane oxygenation implantation, an indication that should be examined further without delay.
    Transplantation Proceedings 04/2007; 39(2):549-53. · 0.95 Impact Factor
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    ABSTRACT: Acute massive pulmonary embolism has a high mortality rate despite advances in diagnosis and therapy. Thrombolysis and catheter embolectomy have recently shown various degrees of failure and adverse effect. Surgical embolectomy has now been liberalised for haemodynamic stable patients with right ventricular dysfunction. We report our surgical experience in the last ten years including massive and sub-massive pulmonary embolism. A retrospective review of charts of all patients undergoing pulmonary embolectomy at our institution over the last ten years was performed. Patients were followed up until December 2005, end point of our study. Between March 1995 and December 2005, 21 patients underwent pulmonary embolectomy. Fourteen patients had a massive pulmonary embolism and were in cardiogenic shock (group A). Seven patients had a sub-massive embolism and were haemodynamically stable with right ventricular dysfunction (group B). In group A, 43% of patients survived and were discharged from the hospital. In group B, all the patients survived and were discharged from the hospital. After a follow-up of 57+/-12 months no late death linked to pulmonary embolism was observed. Our approach by initial surgical embolectomy improved outcome in sub-massive PE. Rescue embolectomy for very compromised patients remains a current treatment for massive PE. Furthermore, surgical embolectomy in haemodynamically stable patients is an immediate and definitive treatment for PE, with excellent long-term results. Keeping in mind that thrombolysis and catheter embolectomy have varying degrees of failure and risk, we propose surgical embolectomy in (sub)massive pulmonary embolism as an alternative procedure, or even as a primary treatment.
    Interactive Cardiovascular and Thoracic Surgery 03/2007; 6(1):27-9. · 1.11 Impact Factor
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    ABSTRACT: Heart transplantation remains the best treatment for terminal heat failure. Ischemic and idiopathic cardiomyopathies are the main indications. Contraindications are due to immunosuppressive treatment and fixed pulmonary hypertension. After clinical evaluation, the patient is put on the waiting list controlled by the French Biomedicine Agency. Acute rejection had decrease due to the improvement of immunosuppressive treatments. The incidence of severe acute rejection is 5%. Chronic rejection is the main cause of morbidity and mortality. The rate at 5 years is about 40-50%. Survival at one year is 80%. The rate of mortality per year is 4%. Survival at 5 and 10 years are respectively 65 and 50%.
    La Revue du praticien 03/2007; 57(3):287-93.
  • A Pavie, F Doguet, N Bonnet
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    ABSTRACT: During these 10 last years, even though patients had a more and more severe condition, the results of coronary artery bypass surgery have continuously improved. According to Society of Thoracic Surgeons data, the operative risk increased by 1/3 (2.6% in 1990 vs. 3.4% in 1999), whereas the per-operative mortality was reduced by 1/4 (3.9% in 1990 vs. 3% in 1999), and is currently stabilized around 2.5-3%. The incidence of complications is a non-negligible marker. The complications observed are mostly neurological (2%), renal (4%), myocardial (4%), infectious (0.5 to 2%), and respiratory (10%). Their occurrence is related to the presence of preoperative risk factors: age (>60 years), sex (female), EF <50%, diabetes, severe obesity, lung disease, renal failure, recent myocardial infarction, redo and/or emergency surgery... The detection and peri-operative control of these factors permit a reduction of complications incidence and limit the length of stay; a better management of per-operative blood glucose in diabetic patients reduced significantly the morbidity. These factors are used in different scores, such as the Euroscore, which seems to be the best predictor of mortality. Patients stratification according to their risk profile permits to inform the patient and his/her family regarding the operative risk and take peri-operative therapeutic decisions, in order to reduce the morbidity and mortality during coronary artery bypass surgery.
    Archives des maladies du coeur et des vaisseaux 03/2007; 100(2):128-32. · 0.40 Impact Factor
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    ABSTRACT: The antimalarial agents, chloroquine (CQ) and hydroxychloroquine (HCQ) are used in long-term treatment of connective tissue diseases and dermatological disorders and are generally regarded as safe. We present one case of cardiotoxicity in a 59-year-old woman treated with antimalarials during 13 years for a discoid lupus erythematosus. She progressively developed conduction disturbances and congestive heart failure (CHF). When the diagnosis of antimalarials toxicity was suspected, CQ was withdrawn. However, heart transplantation had to be performed in the following 4 months for severe CHF. Indeed, rare but severe cardiotoxicity may develop following prolonged use of antimalarials with both conduction disturbances (45 patients) and CHF (25 patients). These cardiac toxic effects have been reported with CQ and less frequently with HCQ use alone. Diagnoses are often delayed since the toxicity of the drug might be misattributed to other factors in these patients. The endomyocardial biopsy, or in some cases the muscle biopsy, are essential to confirm the antimalarials toxicity. Antimalarials have been stopped in 12 cases of CHF, leading to improvement in 8 cases (within 3 months to 5 years) and to deaths or to heart transplantation in 4 cases (within 1 week to 3 months). In the latter cases, as in our patient, the lack of improvement may have been explained by the severity of the cardiomyopathy at diagnosis and the short delay since withdrawal. As a consequence, the potential for reversibility and the severity in undiagnosed cases of these toxic cardiomyopathies emphasize the importance of recognizing early signs of toxicity in order to withdraw antimalarials before the occurrence of life-threatening CHF.
    Cardiology 02/2007; 107(2):73-80. · 1.52 Impact Factor
  • Journal of Heart and Lung Transplantation - J HEART LUNG TRANSPLANT. 01/2007; 26(2).
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    ABSTRACT: Nonagenarians represent a growing part of the population. However, it is assumed that they present a poorer functional class to cope with the stress inferred by surgical interventions. The aim of this study was to review our experience with nonagenarians concerning postoperative morbidities, mortality, and long-term survival status. Retrospective data from 30 consecutive nonagenarians who underwent cardiac surgery between January 1990 and December 2002, and their long-term follow-up was analysed. There were 18 women (60%) and 11 men. Left ventricle ejection fraction (LVEF) was 50.3+/-10.5%. Fifty percent of the patients were in NYHA functional class III or IV. There were nine coronary artery bypass grafting (CABG) procedures (30%), 16 aortic valve replacements (AVR), (53%), one double valve procedure and one replacement of infected intracavitary pace-maker leads. In-hospital mortality rate was 20% (6/30). Mean follow-up was 21.5+/-19 months (r: 2.2 to 68). Actuarial survival rate at 12, 24 and 60 months was 67%, 43% and 30%, respectively. Surviving patients referred quality of life as good, all but one were in NYHA functional class I. Nonagenarians undergoing cardiac surgery have higher mortality and morbidity rates than younger patients. However, in a carefully selected group of patients, the operative risk remains acceptable.
    Interactive Cardiovascular and Thoracic Surgery 01/2007; 5(6):696-9. · 1.11 Impact Factor
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    ABSTRACT: alve-sparing operation of the aortic root is frequently proposed to young patients with Marfan syndrome as an alternative to aortic root replacement, notwith- standing the complex problems and complications with the remaining aorta. We report the case of a young woman with Marfan syndrome who, 1 year after having undergone a Yacoub procedure, became pregnant and had a recurrence of the aortic insufficiency (AI). Clinical Summary
    The Journal of thoracic and cardiovascular surgery 10/2006; 132(3):683-4. · 3.41 Impact Factor

Publication Stats

745 Citations
165.12 Total Impact Points

Institutions

  • 1999–2010
    • Hôpital La Pitié Salpêtrière (Groupe Hospitalier "La Pitié Salpêtrière - Charles Foix")
      Lutetia Parisorum, Île-de-France, France
  • 2007
    • Hôpitaux Universitaires La Pitié salpêtrière - Charles Foix
      Lutetia Parisorum, Île-de-France, France
    • Pierre and Marie Curie University - Paris 6
      Lutetia Parisorum, Île-de-France, France
  • 2006
    • Institute of Heart Sciences
      Valladolid, Castille and León, Spain
  • 2005
    • Académie Nationale de Médecine
      Lutetia Parisorum, Île-de-France, France
  • 1997
    • Centre Chirurgical Marie Lannelongue
      Plessis-Robinson, Île-de-France, France