François Roubertie

Publications (10)30.13 Total impact

• Article: Early to Midterm Results of Total Cavopulmonary Connection in Adult Patients.

  François Roubertie, Julien Peltan, Roland Henaine, Pierre Oses, Xavier Iriart, Jean-Benoît Thambo, Nadir Tafer, Xavier Roques
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  ABSTRACT: BACKGROUND: Total cavopulmonary connection (TCPC) has not been studied in adults. We investigated early and midterm morbidity and mortality in adults undergoing TCPC and assessed risk factors for mortality. METHODS: Between June 1994 and October 2010, 30 adults (21.3 ± 5.5 years) underwent TCPC (extracardiac conduit). Twenty-two patients who had palliated single ventricles underwent TCPC completions and 8 patients underwent TCPC conversions. Preoperative and perioperative data were reviewed retrospectively. RESULTS: Six of 9 patients with preoperative atrial flutter or fibrillation or intraatrial reentry tachycardia were treated in the catheterization room. An aortic cross-clamp was necessary in 12 patients, and 16 TCPCs were fenestrated. Mean follow-up was 51 months (range, 4-198 months). Early mortality was 10%: 2 of 8 conversions and 1 of 22 completions. There was 1 late conversion death (at 56 months postoperatively). Postoperatively, 4 patients required pacemakers and 1 patient required long-term antiarrhythmic medication, but no heart transplantations were necessary. Risk factors for early mortality were arrhythmia (p = 0.02), aortic cross-clamp (p = 0.054), and extracorporeal circulation in hypothermia (p = 0.03). Risk factors for overall mortality were conversion (p = 0.047), absence of fenestration (p = 0.036), surgery before January 2006 (p = 0.036), aortic cross-clamp (p = 0.018), extracorporeal circulation in hypothermia (p = 0.008), and arrhythmia (p = 0.005). New York Heart Association functional class had improved at the last follow-up: preoperatively, 17 patients were in class II and 12 patients were in class III versus 18 patients in class I and 9 patients in class II postoperatively (p < 0.001). At the last clinical visit, systemic ventricular function was maintained, and no late supraventricular arrhythmia was found. CONCLUSIONS: Early and midterm TCPC results for adults are encouraging for completion but are disappointing for conversion. Identified risk factors for mortality should improve patient selection for TCPC.
  The Annals of thoracic surgery 12/2012; · 3.74 Impact Factor
• Article: Late outcome of 132 Senning procedures after 20 years of follow-up.

  François Roubertie, Jean-Benoît Thambo, Alexandre Bretonneau, Xavier Iriart, Nadine Laborde, Eugène Baudet, Xavier Roques
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  ABSTRACT: Risk factors and rates of reoperation, arrhythmias, systemic right ventricular dysfunction (RVD), and late death after a Senning procedure were investigated. One-hundred thirty-two patients underwent a Senning operation between 1977 and 2004 (105 simple and 27 complex transpositions of the great arteries). Mean follow-up time was 19.5 ± 6.6 years. Surviving patients were evaluated by transthoracic echocardiography and electrocardiography. Right ventricular function was assessed in 70 patients by isotopic ventriculography or magnetic resonance imaging. Operative and late mortality were 5.3% (7/132) and 9.6% (12/125), respectively. Nine patients were reoperated for left ventricular outflow tract obstruction or baffle stenosis. Survival rate was 91.5%, 91%, 89%, and 88% at 1, 5, 10, and 20 years, respectively. Probability of maintaining permanent sinus rhythm was 80%, 65%, 55%, and 44%. Twelve patients required pacemaker implantation. Probability of no supraventricular tachycardia, atrial flutter/fibrillation or ventricular tachycardia was 95.5%, 91.5%, 88%, and 75%, respectively. These parameters were similar for simple and complex transposition. Probability of right ventricular ejection fraction >40% was 100% at 5 and 10 years, and 98% at 20 years for simple transposition, and 100%, 92%, and 58% for complex transposition. This difference was statistically significant. Risk factors for RVD were complex transposition (p < 0.001), body weight (p = 0.008), no cardioplegia (p < 0.001), and tricuspid valve regurgitation (p = 0.004). Senning procedure results in very good long-term survival out to 20 years. Both RVD and baffle stenosis were rare, but there was a concerning incidence of arrhythmia over time suggesting careful long-term surveillance.
  The Annals of thoracic surgery 09/2011; 92(6):2206-13; discussion 2213-4. · 3.74 Impact Factor
• Article: Continuous cerebral perfusion for aortic arch repair: hypothermia versus normothermia.

  Mohamed Ly, François Roubertie, Emre Belli, Oswin Grollmuss, Minh Thanh Bui, Regine Roussin, Emmanuel Lebret, André Capderou, Alain Serraf
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  ABSTRACT: Deep hypothermia with circulatory arrest (CA) is routinely used for aortic arch repair. Antegrade selective cerebral perfusion (ASCP) has been proposed to avoid neurologic complications. The optimal temperature during aortic arch repair with ASCP is not well established. We therefore compared early outcomes of patients undergoing aortic arch repair associated with intracardiac repair with ASCP either with hypothermia (<28°C, group I; n=70) or normothermia (>34°C, group II; n=40). From 2002 to 2008, 110 consecutive patients with interrupted aortic arch (n=40) or coarctation of the aorta (n=70) and cardiac anomalies underwent intracardiac and aortic arch repair without CA. Median age at repair was 12 days. Full cardiopulmonary bypass (CPB), high hematocrit, and high rates of flow were used. ASCP flow was adjusted to maintain arterial pressure at greater than or equal to 50 mm Hg. ASCP was achieved either through a Gore-Tex (W. L. Gore & Associates, Inc., Elkton, MD) graft to the innominate artery (n=36) or by direct cannulation (n=74). An electroencephalogram (EEG) was continuously monitored and 30 patients were monitored by near-infrared spectroscopy (NIRS). Preoperative data were similar in both groups. Group II demonstrated higher ASCP flows (p<0.001). Time to extubation, stay in the intensive care unit (ICU), and postoperative urine output and lactate levels were similar between groups. Mortality was 8.5% in group I versus 10% in group II. During the postoperative course, there were no clinical or electrical neurologic events in either group. Antegrade selective cerebral perfusion can safely avoid CA. No worse, early, or long-term effects of ASCP with normothermia were found.
  The Annals of thoracic surgery 06/2011; 92(3):942-8; discussion 948. · 3.74 Impact Factor
• Article: Anomalous origin of the left coronary artery from the pulmonary artery associated with severe left ventricular dysfunction: results in normothermia.

  Emre Belli, Régine Roussin, Mohammed Ly, François Roubertie, Emmanuel Le Bret, Murat Basaran, Alain Serraf
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  ABSTRACT: Repair of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) carries a high risk of operation, particularly in those with poor left ventricular function. In this study, we assessed the outcomes of patients who presented with severe preoperative left ventricular dysfunction (shortening fraction <15%) who underwent the repair under normothermic bypass. Since September 2002, 21 infants with severe left ventricular dysfunction underwent surgical repair using a direct coronary reimplantation technique. Mean age of patients was 5.3 +/- 3.8 months. Moderate or severe mitral regurgitation present in 5 patients was not addressed at the operation. Repair was performed under normothermic cardiopulmonary bypass and myocardial protection was achieved by intermittent antegrade normothermic blood cardioplegia. Mean cardiopulmonary bypass and cross-clamp times were 153.5 +/- 51 and 50 +/- 14.5 minutes, respectively. There was one (4.7%) early death because of sudden cardiac arrest 48 hours after successful weaning from mechanical ventilation. One patient required urgent left coronary artery stenting on the 34th postoperative day because of early reimplantation failure. There was no late death. Echocardiographic evaluation revealed a significant improvement in terms of shortening fraction (preoperative, 10.3 +/- 3.2% vs follow-up, 33 +/- 7.7%, p < 0.0001). Our results suggest that the repair of anomalous origin of the left coronary artery from the pulmonary artery can be accomplished with acceptable mortality and morbidity rates even in patients having severely depressed left ventricular function. Normothermic cardiopulmonary bypass is safe and effective in children who have a limited tolerance to further ischemic insult.
  The Annals of thoracic surgery 09/2010; 90(3):856-60. · 3.74 Impact Factor
• Article: The performance of Hancock porcine-valved Dacron conduit for right ventricular outflow tract reconstruction.

  Emre Belli, Ece Salihoğlu, Bertrand Leobon, François Roubertie, Mohammed Ly, Régine Roussin, Alain Serraf
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  ABSTRACT: The surgical reconstruction of right ventricle outflow tract (RVOT) often requires the implantation of a valved conduit. Homografts are lacking availability and are associated with limited durability in children. Our experience with the Hancock porcine-valved Dacron (DuPont, Wilmington, DE) conduit (Medtronic, Minneapolis, MN) was retrospectively assessed. Follow-up was studied in 214 survivors who underwent 247 conduit implants between January 1990 and January 2007. Pulmonary atresia/ventricular septal defect was present in 86 (40.2%) and truncus arteriosus in 62 (29%). Conduit implantation was associated with anatomic repair in 136, conduit replacement in 96, and secondary pulmonary valve insertion in 15. Median age at operation was 62.5 months (range, 1 week to 50 years), including 14 neonates (6%). Median conduit size was 17.4 mm because of routine over-sizing. Pulmonary bifurcation patch augmentation was necessary in 26 patients. Periodic echocardiography studies were performed for a median follow-up of 98 months (range, 13 to 142 months). Three (1.4%) late deaths occurred. No conduit-related deaths or complications occurred. Conduit degeneration was associated with increase in valvular gradient. Valve regurgitation was absent or mild. Higher RVOT systolic pressure gradient at discharge did not influence conduit longevity. Conduit reoperation was delayed due to percutaneous balloon dilatation in 14 patients, associated with stenting in 7. Survival with freedom from conduit reoperation was 98% (95% confidence interval [CI], 97% to 100%) at 1 year, 81% (95% CI, 75% to 87%) at 5 years, and 32% (95% CI, 22% to 42%) at 10 years. The Hancock valved conduit is a safe and reliable alternative to homografts. It appears to be appropriate in patients with limited pulmonary vascular bed and high pulmonary artery pressures. Caution is required in neonates because of the rigidity of the Dacron housing. Initial results with secondary percutaneous procedures are encouraging.
  The Annals of thoracic surgery 01/2010; 89(1):152-7; discussion 157-8. · 3.74 Impact Factor
• Article: Supracardiac total anomalous pulmonary venous connection: the transaortopulmonary approach.

  Emmanuel Le Bret, François Roubertie, Emre Belli, Bertrand Stos, Anne Sigal-Cinqualbre, Régine Roussin, Alain Serraf
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  ABSTRACT: We have been confronted with patients in whom classical techniques did not offer optimum exposure to correct supracardiac forms of total anomalous pulmonary venous connection, especially in neonates. Therefore, we present a surgical modification of the superior approach for enhanced exposure as a result of transection of the ascending aorta associated or not with the transection of the pulmonary trunk. The transaortopulmonary approach ensures a perfect exposition without any need to pull on the surrounding structures. Because of the better exposure, most patients do not require circulatory arrest.
  The Annals of thoracic surgery 10/2009; 88(3):e27-8. · 3.74 Impact Factor
• Article: Slide tracheoplasty in infant with congenital tracheal stenosis and tracheomalacia after esophageal atresia with tracheoesophageal fistula repair.

  Emmanuel Le Bret, François Roubertie, Gilles Roger, Anne Sigal-Cinqualbre, Mathieu Coblence, Emre Belli, Noureddine Gharbi, Régine Roussin, Eréa Noel Garabédian, Alain Serraf
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  ABSTRACT: Slide tracheoplasty can be applied successfully to all types of long segment congenital tracheal stenosis. In case of short segment tracheal stenosis, direct resection and anastomosis is often preferred. We report a case illustrating a new side benefit of the slide tracheoplasty in a patient presenting a relatively short hypoplastic tracheal segment coexisting with tracheomalacia after EA with TEF repair.
  Journal of Pediatric Surgery 08/2009; 44(7):e15-7. · 1.45 Impact Factor
• Article: Right aortic arch and isolated left innominate artery from a left sided patent ductus arteriosus: a very rare aortic arch anomaly.

  Emmanuel Le Bret, Bertrand Leobon, François Roubertie, Anne Sigal-Cinqualbre, Bertrand Stos, Lucile Houyel, Alain Serraf
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  ABSTRACT: Malformation of the aortic arch system has been described in details by Stewart et al. in 1964. Innominate artery originating via the ductus arteriosus from the pulmonary artery is a very rare type of congenital aortic arch anomaly that has been seldomly reported. We report the case of an aortic arch anomaly revealed by a pulmonary hypertension because of left to right shunt. Surgical procedure was performed through a median sternotomy, without cardiopulmonary bypass. After section. of the ductus arteriosus, the left innominate artery was extensively dissected and mobilized to be implanted on the left side of the ascending aorta under lateral clamping.
  Journal of Pediatric Surgery 05/2009; 44(4):E29-31. · 1.45 Impact Factor
• Article: Anomalous origin of the left coronary artery from the pulmonary artery: late results with special attention to the mitral valve.

  Walid Ben Ali, Olivier Metton, François Roubertie, Philippe Pouard, Daniel Sidi, Olivier Raisky, Pascal R Vouhé
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  ABSTRACT: Evaluate the late results of a uniform approach to the surgical management of children with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). Between 1986 and 2007, 62 children with ALCAPA underwent surgery. The median age at operation was 16 months (range 10 days to 11 years). A uniform approach was applied, including (1) immediate surgery as soon as the diagnosis was established, (2) direct aortic reimplantation of the anomalous artery, when technically feasible (61/62, 98%), and (3) no concomitant mitral valve surgery, regardless of the severity of mitral regurgitation (59/62, 95%). The mean follow-up was 9.7 years (range 3 months to 21 years) and was 98% complete. There were six hospital deaths (9.7%). Left ventricular assistance was used in four patients; two died of related complications. The poor left ventricular ejection fraction was an incremental risk factor for early mortality (p = 0.043); severity of mitral regurgitation was not. There were two late deaths, yielding an actuarial survival rate of 86% at 15 years. Five patients underwent reoperation (mitral valve repair in three, coronary procedure in two); the actuarial freedom from reoperation was 89% at 15 years. Left ventricular function recovered in all survivors. In the 50 late survivors who did not undergo mitral surgery at initial operation, the severity of mitral regurgitation decreased in 58%, remained unchanged in 40% (of which 3 patients underwent reoperation for mitral valve repair) and worsened in 2%; at last follow-up, mitral regurgitation was absent or trivial in 42%, mild in 50%, moderate in 8% and severe in 0%. (1) Early mortality is related to the severity of preoperative left ventricular dysfunction; it may be reduced by a careful use of postoperative cardiac support techniques. (2) Late results are satisfactory and left ventricular function always recovers. (3) Mitral regurgitation improves along with left ventricular function, but recovery may be incomplete and need reoperation. The data suggest that mitral valve surgery is probably not indicated at initial surgery, except in selected cases with a low potential of recovery (severe regurgitation with relatively well-preserved left ventricular function).
  European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 05/2009; 36(2):244-8; discussion 248-9. · 2.40 Impact Factor
• Article: Aortic root replacement in children: a word of caution about valve-sparing procedures.

  François Roubertie, Walid Ben Ali, Olivier Raisky, Daniel Tamisier, Daniel Sidi, Pascal R Vouhé
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  ABSTRACT: Evaluate the results of various surgical procedures used for aortic root replacement in children with aortic root aneurysm. Between 1986 and 2007, 23 children (less than 16 years of age, mean age: 8.1+/-5.1 years) underwent elective aortic root replacement for aortic root aneurysm (with associated aortic insufficiency in 10 patients). All had connective tissue defect syndromes. Nine patients underwent composite valve graft repair using a mechanical valve. Fourteen children underwent valve-sparing aortic root replacement (remodeling procedure in 11, reimplantation procedure in 3). Mean follow-up (100% complete) was 7.3+/-5.5 years (range 6 months-21 years). There was one early death (4.3%)(after valve-sparing remodeling) and no late mortality. Following valve-sparing remodeling operation (10 patients, mean follow-up: 7.8+/-3.0 years), there were 9 reoperations in 6 patients and only 5 patients retained their native aortic valve. In patients who underwent valve-sparing reimplantation operation (three patients, mean follow-up: 2.1+/-0.3 years), one underwent reoperation for endocarditis. Fifteen patients had composite valve graft replacement either as a primary operation (nine cases) or at reoperation for valve-sparing failure (six cases); mean follow-up was 8.2+/-6.2 years; there was no thrombo-embolic or hemorrhagic event and one reoperation for patient-prosthesis mismatch. (1) composite valve graft aortic root replacement provides excellent long-term results in children with aortic root aneurysm due to connective tissue disorder. This remains the first choice procedure in patients with more than minimal aortic insufficiency, with distorted aortic leaflets or needing concomitant mitral valve replacement. (2) Valve-sparing remodeling surgery yields disappointing results and should probably be abandoned in the pediatric population. (3) Valve-sparing reimplantation repair may achieve superior outcome but needs further evaluation.
  European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 12/2008; 35(1):136-40. · 2.40 Impact Factor