Jérôme Jouan

Hôpital Européen Georges-Pompidou (Hôpitaux Universitaires Paris-Ouest), Lutetia Parisorum, Île-de-France, France

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Publications (23)83.8 Total impact

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    ABSTRACT: Objective: The study objective was to compare the 30-day outcomes of a standardized aortic valve repair technique (REPAIR group) associating root remodeling with an expansible aortic ring annuloplasty versus mechanical composite valve and graft (CVG group) replacement in treating aortic root aneurysms. Methods: A total of 261 consecutive patients with aortic root aneurysm were enrolled in this multicentric prospective cohort (131 in the CVG group, 130 in the REPAIR group) in 20 centers. The main end point is a composite criterion including mortality; reoperation; thromboembolic, hemorrhagic, or infectious events; and heart failure. Secondary end points were major adverse valve-related events. Crude and propensity score adjusted estimates are provided. Results: The mean age was 56.1 years, and the valve was bicuspid in 115 patients (44.7%). The median (interquartile range) preoperative aortic insufficiency grade was 2.0 (1.0-3.0) in the REPAIR group and 3.0 (2.0-3.0) in the CVG group (P = .0002). Thirty-day mortality was 3.8% (n = 5) in both groups (P = 1.00). Despite a learning curve and longer crossclamp times for valve repair (147.7 vs 99.8 minutes, P<.0001), the 2 groups did not differ significantly for the main criterion (odds ratio, 1.31; 95% confidence interval, 0.72-2.40; P = .38) or 30-day mortality (odds ratio, 0.99; 95% confidence interval, 0.28-3053; P = .99), with a trend toward more frequent major adverse valve-related events in the CVG group (odds ratio, 2.52; 95% confidence interval, 0.86-7.40; P = .09). At discharge, 121 patients (96.8%) in the REPAIR group had grade 0 or 1 aortic insufficiency. Conclusions: A new standardized approach to valve repair, combining an expansible aortic annuloplasty ring with the remodeling technique, presented similar 30-day results to mechanical CVG with a trend toward reducing major adverse valve-related events. Analysis of late outcomes is in process for 3- and 10-year follow-ups.
    Journal of Thoracic and Cardiovascular Surgery 08/2014; 149(2). DOI:10.1016/j.jtcvs.2014.07.105 · 3.99 Impact Factor
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    ABSTRACT: No abstract available
    Circulation Heart Failure 11/2013; 1(6):6. · 5.95 Impact Factor
  • Circulation Heart Failure 11/2013; 6(6):e71-e72. DOI:10.1161/CIRCHEARTFAILURE.113.000609 · 5.95 Impact Factor
  • Article: Reply.
    Jerome Jouan · Paul Achouh
    The Annals of thoracic surgery 05/2013; 95(5):1842-3. DOI:10.1016/j.athoracsur.2013.02.009 · 3.65 Impact Factor
  • Jerome Jouan · Paul Achouh
    The Annals of Thoracic Surgery 05/2013; 95(5):1842-1843. · 3.63 Impact Factor
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    ABSTRACT: BACKGROUND: Surgical treatment of retroperitoneal tumors with cavoatrial involvement can be challenging. Completeness of resection of the cava tumor extension is crucial for the patient's survival. We report a monocentric experience with the use of cardiopulmonary bypass and deep hypothermic low flow for the surgical resection of caval and atrial involvement of retroperitoneal tumors. METHODS: Between 2006 and 2011, 9 patients were admitted in our cardiovascular surgery department for retroperitoneal tumors with cavoatrial extension. Every case was performed with cardiopulmonary bypass under deep hypothermia (18°C) with a continuous low-flow perfusion (1 to 1.5 L/min). Cardiopulmonary bypass output was tuned to obtain a nearly bloodless field. Reconstruction of the atriohepatic confluent was carried out with a pericardium patch without inferior vena cava reconstruction. RESULTS: There was no perioperative death. Mean duration of deep hypothermic low flow was 52.2 ± 18.2 minutes. The lowest mean esophageal temperature obtained during procedure was 18.2° ± 1.4°C. No neurologic event was noted postoperatively. Three patients had early complications: one reintervention for bleeding, one reintervention for mediastinitis, and one transient moderate renal failure. After a year, all patients were alive with patent atriohepatic reconstruction. CONCLUSIONS: Cardiopulmonary bypass with deep hypothermic low flow facilitates tumor resection and reconstruction of the atriohepatic confluent. It provides satisfactory postoperative results. It should be considered as an option in the management of these retroperitoneal tumors with cavoatrial involvement.
    The Annals of thoracic surgery 04/2013; 95(6). DOI:10.1016/j.athoracsur.2013.03.012 · 3.65 Impact Factor
  • Jérôme Jouan
    The Journal of thoracic and cardiovascular surgery 09/2012; 144(3):743-4. DOI:10.1016/j.jtcvs.2012.06.019 · 3.99 Impact Factor
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    ABSTRACT: Tricuspid valve surgery in the presence of severe right ventricular dysfunction and pulmonary hypertension secondary to mitral valve stenosis is associated with poor early outcomes. We report the case of a young patient, presenting with severe chronic mitral-tricuspid disease responsible for long-lasting pulmonary hypertension and altered right ventricular function, who initially underwent mitral valve replacement and 7 days later the correction of her tricuspid insufficiency. This 2-staged approach permitted progressive reduction of pulmonary pressure and partial right ventricular remodeling before closing the systolic release valve of the right ventricle represented by tricuspid regurgitation.
    The Annals of thoracic surgery 05/2012; 94(3):992-3. DOI:10.1016/j.athoracsur.2012.01.058 · 3.65 Impact Factor
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    ABSTRACT: Cardiopulmonary bypass remains associated with significant morbidity and mortality, in part caused by a systemic inflammatory response that is unpredictable and variable among patients. Several limited studies have suggested associations of cytokine plasma levels or gene polymorphisms with outcome after cardiopulmonary bypass. The present study was to determine the relationships between several circulating cytokines and their polymorphisms (single nucleotide polymorphisms), and the occurrence of postoperative clinical events in patients who underwent coronary artery bypass grafting under cardiopulmonary bypass. Patients were genotyped for single nucleotide polymorphisms of LTA (Cys13Arg, +252A>G), TNF (-308G>A), IL6 (-597G>A, -572G>C, -174G>C), IL10 (-592C>A, c.∗117C>T), and APOE (Cys112Arg, Arg158Cys). Serum samples were collected preoperatively, immediately after cardiopulmonary bypass, and at different postoperative time points to measure cytokine serum levels by enzyme-linked immunosorbent assay. The clinical end point was the composite of postoperative death, low cardiac output syndrome, myocardial infarction, sepsis, and acute renal insufficiency. Single nucleotide polymorphisms IL6-572GC+CC/IL10-592CC were associated with the clinical end point (P=.032 and P=.009, respectively). In addition to preoperative clinical conditions, the other factor associated with the clinical end point was interleukin-10 plasma levels 24 hours after surgery (P=.017). On the basis of these results, a predictive model of postoperative complications after coronary artery bypass grafting was created. Our data suggest that focused genetic testing of the IL6-572G>C and IL10-592C>A single nucleotide polymorphisms might be a tool for identifying patients at the highest risk of poor tolerance to the inflammatory response to cardiopulmonary bypass and for implementing strategies to mitigate it, provided the generalization of these tests makes them reasonably affordable and thus favorably shifts their cost-to-benefit ratio.
    The Journal of thoracic and cardiovascular surgery 01/2012; 144(2):467-73, 473.e1-2. DOI:10.1016/j.jtcvs.2011.12.022 · 3.99 Impact Factor
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    ABSTRACT: Owing to the complexity of the underlying lesions, Barlow disease remains a challenge for surgeons performing mitral valve repair. We aimed to assess whether our most recent results involving several surgeons were comparable with those of a previous experience in which mitral valve repair was performed by a more limited group of surgeons. From September 2000 to January 2007, 200 patients with Barlow disease (135 men and 65 women; mean age, 56 ± 13 years) were referred to our institution for surgical treatment of their mitral regurgitation. We retrospectively analysed the mitral lesions characteristics, the surgical techniques used, and clinical outcomes. Follow-up echocardiograms were biannually reviewed. Lesions comprised annular dilatation, excess tissue, and leaflet prolapse in all cases. The most frequent prolapsed segments were P2 (88.5%; n = 177) and A2 (55.5%; n = 111). Annular calcifications and restrictive valvular motion were associated in 20% (n = 40). Repair was feasible in 94.7% (n = 179/189) of non-redo interventions. Immediate postoperative echocardiography showed residual mitral regurgitation greater than 1+ in 6 cases; these patients were all reoperated on within the next months. Operative mortality was 1.5% (n = 3). Mean follow-up was 77.5 ± 25.6 months. At 8 years postoperatively, overall survival was 88.6% ± 3.1%, freedom from reintervention was 95.3% ± 1.7%, and freedom from late recurrent moderate mitral regurgitation (>2+) was 90.2% ± 3.1% Provided that the fundamental principles of mitral valve reconstruction are respected, the surgical techniques are highly reproducible with good long-term results, similar to those published during the pioneering phase of this surgery.
    The Journal of thoracic and cardiovascular surgery 12/2011; 143(4 Suppl):S17-20. DOI:10.1016/j.jtcvs.2011.11.016 · 3.99 Impact Factor
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    Circulation 05/2011; 123(19):2164-6. DOI:10.1161/CIRCULATIONAHA.110.991257 · 14.95 Impact Factor
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    ABSTRACT: To report a case of retrograde acute Stanford type A aortic dissection treated without hypothermic circulatory arrest. A 55-year-old man presented with a retrograde acute type A aortic dissection with an entry tear 30 mm below the left subclavian artery. A concurrent emergent endovascular and surgical treatment was performed, excluding the entry tear with retrograde delivery of a stent-graft and replacing the ascending aorta with a Dacron tube without circulatory arrest. Avoiding hypothermic circulatory arrest was the main advantage of this hybrid therapeutic choice. This combined technique may be of interest in acute retrograde type A dissections that present complications such as impending rupture or visceral malperfusion. A close collaboration between endovascular specialists and cardiac surgeons is essential for such a hybrid strategy.
    Journal of Endovascular Therapy 12/2010; 17(6):755-8. DOI:10.1583/10-3194.1 · 3.59 Impact Factor
  • The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation 09/2009; 29(1):135-6. DOI:10.1016/j.healun.2009.06.007 · 5.61 Impact Factor
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    ABSTRACT: Thoracic duct ligation for chylothorax is considered a safe and efficient procedure. However, we observed two cases that were complicated by intractable chylous ascites. Refractory chylous ascites are usually cured by surgical peritoneovenous shunting, but in both patients successful treatment required peritoneoatrial shunting. Actually, a peritoneovenous shunt was impossible because of extensive venous thrombosis in jugular and superior vena cava in one patient and failed because of constrictive pericarditis requiring pericardectomy in the other, both underlying diseases also accounting for the thoracic duct ligation complications.
    The Annals of thoracic surgery 06/2009; 87(5):1601-3. DOI:10.1016/j.athoracsur.2008.09.029 · 3.65 Impact Factor
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    ABSTRACT: Cardiac transplantation is an ever more frequent requirment for patients presenting with end-stage right systemic ventricular failure late after atrial switch operations. But as the time on the donor waiting list lengthens, the clinical conditions of these patients can easily and abruptly deteriorate, sometimes requiring systemic ventricular assistance. We document the first case of right systemic ventricular assistance with a De Bakey VAD axial pump in a patient presenting with systemic ventricular failure 23 years after procedure. He rapidly recovered total autonomy and was thus able to participate in a rehabilitation program to optimize his condition for heart transplantation.
    The International journal of artificial organs 05/2009; 32(4):243-5. · 1.45 Impact Factor
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    ABSTRACT: Severely depressed left ventricular ejection fraction (EF</=20%) has historically been a major risk factor for morbidity and mortality in medically and surgically managed coronary artery disease. Recent studies have suggested that outcomes in patients with EF less or equal to 20% undergoing coronary artery bypass graft (CABG) surgery are improving, but the trend in the outcomes remains unclear. We retrospectively analysed prospectively collected data from 2909 consecutive patients undergoing isolated CABG between January 1998 and August 2006. One hundred and eighty five patients (6.4%) had an ejection fraction less or equal to 20%. Primary outcome measures for this study included hospital mortality, major postoperative complications, and long-term survival. The median age in the overall patient population was 65 years (interquartile range 58-73) and 69% (n=2015) of patients were male. The overall hospital mortality among our study population was 2.3% (n=67). The mortality among patients with EF less or equal to 20 was 5% (n=11) compared to 2% (n=56) in patients with EF above 20% (p=0.001). The proportion of patients with a high EuroSCORE (>9%) was significantly greater in the group with EF less or equal to 20% (49%) than in the group with EF above 20% (20%). EF less or equal to 20% was not shown by multivariable logistic regression analysis to be an independent predictor of operative mortality. Survival rates at one year were 85+/-2.8%, 93+/-0.9%, and 98%+/-0.3% for patients with EF less or equal to 20%, over 20-40% and greater than 40% respectively; and at five years: 72+/-0.4%, 81+/-0.2% and 89+/-0.1%, respectively (p<0.001). We demonstrate acceptable mortality rates in patients with an EF less or equal to 20%, and show that EF less or equal to 20% does not appear to be an independent predictor of hospital mortality in our practice. Incremental changes in practice including improved patient selection and peroperative management may have reduced the impact of EF less or equal to 20% on mortality following CABG.
    Archives of Cardiovascular Diseases 10/2008; 101(9):547-56. DOI:10.1016/j.acvd.2008.09.008 · 1.66 Impact Factor
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    ABSTRACT: Congenital mitral valve regurgitation (MVR) is a rare disease occurring in infancy or childhood. Although congenital MVR has been described in adults, no surgical series has been reported so far. We describe here a 6-year surgical experience of congenital MVR in adults at a single institution. We reviewed the data of 15 consecutive patients (8 men), aged more than 16 years (median: 38 years; range: 16-70 years) operated on for severe congenital MVR from June 2000 to March 2006. Congenital MVR represented 2.1% of mitral valve surgery performed in adults during the same period. Patients with atrio-ventricular septal defect or atrio-ventricular discordance were excluded. The congenital MVR was preoperatively diagnosed in six (40%) cases. Two (13%) patients had a Williams-Beuren syndrome. The lesions consisted in annular dilation (100%), prolapsed leaflet (87%), chordal abnormalities (80%), papillary muscle abnormalities (40%) or valvular cleft (33%). Mitral valve repair was performed in all cases using Carpentier's techniques. There was no hospital death or late mortality. At last follow-up (median: 60 months; range: 6-83 months), all patients were in NYHA functional class I or II and in a sinus rhythm. On transthoracic echocardiography, 11 (73%) patients had no or trivial MVR. Mild MVR was present in four (27%) patients. No patient was reoperated and endocarditis did not occur. Congenital MVR is rare in adults, often misdiagnosed and accessible to valve repair with excellent mid-term results.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 09/2008; 34(4):751-4. DOI:10.1016/j.ejcts.2008.06.014 · 2.81 Impact Factor
  • European Journal of Cardio-Thoracic Surgery 05/2007; 31(4):740. DOI:10.1016/j.ejcts.2007.01.001 · 2.81 Impact Factor
  • C. Latrémouille · J. Jouan
    01/2006; 1(3):1-11. DOI:10.1016/S1241-8226(06)21819-X
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    ABSTRACT: Mechanical circulatory assistances now belong to the therapeutic stock in case of advanced heart failure. Their mainspring lays on the substitution of the failing left and/or right ventricle function with a pump. The goal being to maintain or restore the system main functions. Their main indication is a bridge to transplant mechanical circulatory assistance, allowing the patient to await transplantation. However, indications for definitive implantation appear in case of transplantation counter indication, mechanical circulatory assistances already emerging as a possible alternative to transplantation. For over 10 years, we have used pulsatile flow assistances, either with pneumatic ventricles or electro-mechanic implantable left ventricles. We henceforth observe the development of a new generation of implantable assistance providing a non-pulsatile flow. These are axial pumps. We evaluated the first model, the DeBakey axial pump which became the most used axial pump worldwide. We now observe the development of other axial pumps as well as the development of new implantable centrifugal pumps.
    Archives des maladies du coeur et des vaisseaux 11/2005; 98(10):1008-12. · 0.40 Impact Factor