Philippe Demers

Hôpital du Sacré-Coeur de Montréal, Montréal, Quebec, Canada

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Publications (83)264.65 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Sutureless aortic valve replacement is an emerging alternative to standard aortic valve replacement in high-risk surgical patients. We present our surgical technique for sutureless aortic valve replacement in patients undergoing triple-valve surgery. This procedure has been performed in six patients with excellent clinical and echocardiographic results. Despite some technical concerns, sutureless aortic valve replacement in the setting of triple-valve surgery is simple and reproducible.
    Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery 09/2015; DOI:10.1097/IMI.0000000000000175
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    Philippe Généreux · Philippe Demers · Frédéric Poulin
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    ABSTRACT: Early discharge after transcatheter aortic valve replacement (TAVR) has been increasingly reported, and is now becoming routinely performed in experienced TAVR centers. However, to the best of our knowledge, no case has been described where a patient was safely discharged on the same the day of the procedure. This report will present the case of a patient who underwent a successful transfemoral TAVR and was safely discharged home the same day. Specific requirements and criteria are proposed to ensure the safety of this approach. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.
    Catheterization and Cardiovascular Interventions 07/2015; DOI:10.1002/ccd.26059 · 2.11 Impact Factor
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    ABSTRACT: Objective: Bicuspid aortic valve (BAV) is generally considered to be a contraindication to sutureless aortic valve replacement (AVR). The aim of this study was to evaluate the feasibility and perioperative outcomes of this technique in patients with BAV. Methods: From June 2011 to January 2014, a total of 25 patients who underwent sutureless AVR had documented BAV. Thirteen patients (52%) had median sternotomy, and 12 patients (48%) a minimally invasive approach. Results: The study population included 17 (68%) men with a median age of 77.8 ± 5.4 years. The mean EuroSCORE II was 3.4% ± 2.6%. Concomitant procedures included coronary artery bypass grafting in 8 patients (32%), 2 AVRs (8%), 1 mitral valve repair (4%), 1 septal myomectomy (4%), and 1 atrial septal defect closure (4%). The mean transaortic valve gradient decreased from 49.4 ± 15.7, to 14.5 ± 5.4 mm Hg postoperatively. The mean aortic valve area increased from 0.78 ± 0.18, to 1.75 ± 0.43 cm(2) postoperatively. Five patients (20%) suffered from atrioventricular block that required permanent pacemaker implantation. Two patients (8%) suffered a stroke. No major paravalvular leakage occurred, and no postoperative valve migration. In-hospital mortality occurred in 1 patient (4%). The mean intensive care unit length of stay was 3 ± 2 days postoperatively. Conclusions: This study demonstrates that a sutureless aortic valve can be deployed in patients with BAV without increasing the risk of paravalvular leakage. BAV should not be considered a contraindication to sutureless AVR.
    The Journal of thoracic and cardiovascular surgery 06/2015; DOI:10.1016/j.jtcvs.2015.05.071 · 4.17 Impact Factor
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    ABSTRACT: The aim of this study was to evaluate our single-center experience with pericardiectomy for constrictive pericarditis. The main objectives of our analysis were long-term survival, clinical outcome, and identification of risk factors. Over a 20-year period, 99 consecutive patients underwent pericardiectomy at the Montreal Heart Institute. The indications for operation were idiopathic pericarditis (61%), postsurgical (13%), infectious (15%), postirradiation (2%), and miscellaneous (9%). Associated procedures were performed in 36% of cases. The duration of symptoms was longer than 6 months in 53% of cases, and two thirds of patients were in New York Heart Association class III or IV. Hospital mortality was 9% in the whole series and 7.9% in case of isolated pericardiectomy. The patients operated on within 6 months after the onset of symptoms showed a lower risk of mortality. Conversely, preoperative hepatomegaly and concomitant valvular operation were associated with significantly higher mortality on both univariate and multivariate analysis. In cases of isolated pericardiectomy, the outcome was mainly conditioned by associated comorbidities. The long-term survival was satisfactory, and the functional status at follow-up was improved in most cases. The clinical outcome of pericardiectomy for constrictive pericarditis is still marked by high operative mortality. Nevertheless, surgical treatment is able to improve the functional class in the majority of late survivors. Preoperative clinical conditions and associated comorbidities are crucial in predicting the risk of mortality, and early operation seems to be the most appropriate choice. The most suitable surgical strategy in cases of associated valvular operation remains to be determined. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
    The Annals of thoracic surgery 05/2015; 100(1). DOI:10.1016/j.athoracsur.2015.02.054 · 3.85 Impact Factor
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    ABSTRACT: Sutureless aortic valve replacement (AVR) has recently been introduced as an alternative to standard AVR in elderly high-risk surgical patients. The purpose of this study was to report the early Canadian experience with sutureless AVR. A Canadian multicenter study included 215 consecutive patients from 6 centres who underwent sutureless AVR using the Perceval S bioprosthesis (Sorin Group, Saluggia, Italy) between June 2011 and May 2013. Perioperative clinical and echocardiographic outcomes were assessed in all patients. Mean age was 79 ± 6 years, and 116 patients (54%) were women. Concomitant procedures included coronary artery bypass grafting in 86 patients (40%), multiple valve procedures in 24 (11%) patients, and septal myectomy in 9 (4%) patients. A full sternotomy was used in 173 cases (80%), a minithoracotomy in 23 (11%) cases, and a partial sternotomy in 19 (9%) cases. Nineteen cases (9%) were redo procedures. For isolated AVR, mean aortic cross-clamp time was 41±12 minutes. In-hospital mortality occurred in 9 patients (4%). No postoperative valve migration was reported. A total of 37 patients (17%) underwent postoperative implantation of a permanent pacemaker, including 20 patients (9%) who had complete atrioventricular block. Postoperative stroke occurred in 7 patients (3%). Echocardiographic evaluation demonstrated well-seated valves with no significant (2+) valvular or paravalvular aortic insufficiency and a mean aortic gradient of 13 ± 6 mm Hg. Sutureless AVR using the Perceval S prosthesis is safe and reproducible and results in short operative times. Echocardiographic results are encouraging, with low gradients and no paravalvular aortic insufficiency. However, in this series, sutureless AVR was associated with a high risk of permanent pacemaker implantation. Copyright © 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
    The Canadian journal of cardiology 01/2015; 31(1):63-8. DOI:10.1016/j.cjca.2014.10.030 · 3.94 Impact Factor
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    ABSTRACT: Multiple classifications can be used to define the magnitude of aortic injury. The Vancouver Classification (VC) is a new and simplified computed tomography-based Blunt Aortic Injury (BAI) grading system correlating with clinical outcomes. The objectives of this study are: 1) to describe the severity of aortic injury in a center with a predominantly surgical approach to BAI; 2) to correlate the severity of aortic trauma to hospital survival rate and rate of adverse events according to the type of interventions performed during the hospital stay; and 3) to evaluate VC. All patients referring to the Sacre-Coeur Hospital of Montreal between August 1998 and April 2011 for management of BAI were studied. Two radiologists reviewed all CT scan images individually and classified the aortic injuries using VC. Among the 112 patients presenting with BAI, 39 cases had local CT scans available for reconstruction. Seven patients were identified as suffering from grade I injuries (flap or thrombus of less than 1 cm), 6 from grade II injuries (flap or thrombus of more than 1 cm), and 26 from grade III injuries (pseudoaneurysm). Among the patients with grade I injuries, 57% were treated surgically and 43% medically with a survival rate of 100%. Among the patients with grade II injuries (67% treated surgically and 33% treated medically) survival was also 100%. Among patients with grade III injuries (85% treated surgically, 7% had Thoracic Endovascular Aortic Repair (TEVAR) and 8% treated medically) survival was 95%, 95% and 50%, respectively. There were no significant differences between groups as to clinical outcome. Inter-rater reliability was 0.81. VC is easy to use and has low inter-observer variability. Low grades of injury were associated with low mortality related to medical treatment.
    Trauma Monthly 01/2015; 20(1). DOI:10.5812/traumamon.18198
  • The Canadian journal of cardiology 10/2014; 30(10):S233-S234. DOI:10.1016/j.cjca.2014.07.396 · 3.71 Impact Factor
  • The Canadian journal of cardiology 10/2014; 30(10):S225-S226. DOI:10.1016/j.cjca.2014.07.379 · 3.71 Impact Factor
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    ABSTRACT: Objectives: To review our experience with sutureless aortic valve replacement (AVR) in the setting of concomitant mitral valve (MV) surgery and discuss the technical considerations. Methods: Between January 2012 and March 2013, 10 patients underwent sutureless AVR with the Perceval prosthesis in the setting of concomitant mitral disease. Five patients underwent MV repair, 4 underwent MV replacement, and 1 had a previously implanted mechanical mitral prosthesis. Results: The median age was 79 years and 7 patients (70%) were male. Median logistic EuroSCORE II was 6.2%. All valves were successfully implanted with no 30-day mortality. There was no residual aortic paravalvular leak. Two patients had from third-degree atrioventricular block requiring permanent pacemaker implantation. At a mean follow-up of 8±4 months (range, 2-16 months), the overall survival was 80% with 2 non-valve-related deaths and the mean transaortic gradient and aortic valve area had improved to 11.1±4.6 mm Hg and 1.5±0.3 cm2, respectively. There was no evidence of mitral dysfunction in any patient. Conclusions: In our experience, sutureless AVR in the setting of concomitant mitral surgery is a feasible and reproducible procedure. Elderly patients undergoing multiple valve surgery present a higher operative risk, therefore extending the indication for sutureless AVR to patients with concomitant mitral disease could greatly benefit this specific population.
    Journal of Thoracic and Cardiovascular Surgery 10/2014; 148(4):1354-9. DOI:10.1016/j.jtcvs.2013.12.061 · 4.17 Impact Factor
  • The Canadian journal of cardiology 10/2014; 30(10):S130-S131. DOI:10.1016/j.cjca.2014.07.179 · 3.71 Impact Factor
  • The Canadian journal of cardiology 10/2014; 30(10):S239-S240. DOI:10.1016/j.cjca.2014.07.408 · 3.71 Impact Factor
  • A. Nguyen · W. Fortin · A. Mazine · D. Bouchard · P. Demers
    The Canadian journal of cardiology 10/2014; 30(10):S238. DOI:10.1016/j.cjca.2014.07.405 · 3.71 Impact Factor
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    ABSTRACT: Background Following the approval of transcatheter aortic valve replacement (TAVR) for high-risk and inoperable patients with severe aortic stenosis (AS), many low- and moderate-volume TAVR programs have been initiated. Contemporary outcomes from these newly-initiated centers remain unknown. Methods In March 2013, our institution was authorized by the Quebec Ministry of Health to perform 30 TAVR procedures. After thorough clinical screening and imaging evaluation, suitable patients underwent transfemoral TAVR with the balloon-expandable SAPIEN XT transcatheter heart valve. In-hospital and 30-day outcomes were prospectively collected and reported according to Valve Academic Research Consortium-2 guidelines. Results From April 2013 to January 2014, 30 consecutive high-risk (n=16; 53.3%) or inoperable (n=14; 46.7%) patients (mean age 84.6, mean Society of Thoracic Surgery score 7) with symptomatic severe AS underwent transfemoral TAVR. No catastrophic intra-procedural complications such as annulus rupture, valve embolization, aortic dissection, or coronary occlusion occurred, with no death at 30 days. Disabling stroke occurred in one (3.3%) patient 48 hours after THV implantation. Major vascular complication and major bleeding occurred in 1 (3.3%) patient. No moderate or severe paravalvular leak was observed. The median length of stay was 2 [1, 3] days with eight (26.7%) patients discharged within 24 hours post-procedure. Conclusions Excellent outcomes can be achieved in newly initiated, relatively low-volume centers, which compare favorably to previously published large series. Important considerations include appropriate team-training, rigorous patient-screening, use of multimodality imaging techniques, a heart-team approach, constant integration of lessons learned from larger published experiences and maintaining a recommended minimum volume of 25 cases/year.
    The Canadian journal of cardiology 08/2014; 30(12). DOI:10.1016/j.cjca.2014.08.010 · 3.94 Impact Factor
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    ABSTRACT: Objectives The objective of the present study was to assess if the presence and severity of CAD is associated with decreased LVEF recovery after TAVI.Background Coronary artery disease (CAD) and low left ventricular ejection fraction (LVEF) are common findings in patients undergoing transcatheter aortic valve implantation (TAVI). The impact of CAD on LVEF recovery after TAVI has not been specifically evaluated.Methods All patients with LVEF≤50% who underwent TAVI between March 2006 and May 2012 were included in the study. The presence and severity of coronary artery disease was measured using the Duke Myocardial Jeopardy Score (DMJS). A DMJS = 0 corresponds to patients without CAD or complete revascularization and a DMJS > 0 to those with incomplete revascularization. LVEF recovery was assessed by transthoracic echocardiography, measuring the change in LVEF from baseline to 3-months post-TAVI. Myocardial viability was evaluated in a subgroup of patients using cardiac magnetic resonance (CMR) imaging pre-TAVI.ResultsFifty-six patients were included in the study. Twenty-eight patients (50%) had a DMJS > 0. At 3 months, patients with incomplete revascularization (DMJS > 0) demonstrated less LVEF recovery post-TAVI (2.0 ± 9.2% versus 11.7 ± 8.9% if DMJS = 0; P = 0.001). On multivariate analysis, DMJS and presence of significant delayed-enhancement were found to be independent predictors of LVEF recovery. Patients with incomplete revascularization exhibited a worse prognosis with higher mortality at 30-days (22.2% versus 0% if DMJS = 0; P = 0.010) and 1-year (25.9% versus 3.5% if DMJS = 0; P = 0.019).Conclusions The present study demonstrates an independent association between incomplete revascularization and decreased LVEF recovery in patients with left ventricular dysfunction undergoing TAVI for severe aortic stenosis. © 2014 Wiley Periodicals, Inc.
    Catheterization and Cardiovascular Interventions 08/2014; 85(3). DOI:10.1002/ccd.25632 · 2.11 Impact Factor
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    ABSTRACT: With improved durability of contemporary bioprostheses, surgeons are now recommending biologic valves in younger patients. However, long-term outcomes of patients younger than 60 years old undergoing biologic aortic valve implantation are not well known. From November 1991 to March 2011, 144 patients less than 60 years old underwent aortic valve replacement (AVR) with Carpentier-Edwards pericardial valves (Edwards Lifesciences, Irvine, CA). Mean follow-up was 10 ± 4 years. Outcomes were reported according to published guidelines. Seventy-five percent of patients were male, with a mean age of 51 ± 9 years. Actuarial survival rates including early deaths were 89% ± 3%, 79% ± 4%, and 57% ± 6% after 5, 10, and 15 years of follow-up, respectively. Survival of patients was comparatively lower than a gender- and age-matched general population at all time points. The freedom from major adverse cardiac events (myocardial infarction, heart failure, hemorrhage, thromboembolic event, and endocarditis) was 89% ± 3%, 87% ± 3%, and 75% ± 6% at 5, 10, and 15 years after surgery. The freedom rate from prosthetic valve dysfunction was 97% ± 2%, 84% ± 4%, and 57% ± 6% at 5, 10, and 15 years after surgery. Patients with a diagnosis of structural valve deterioration (29 of 37, 78%) underwent reoperation 11 ± 5 years after the initial valve replacement with no perioperative mortality. In patients younger than 60 years undergoing AVR, the Carpentier-Edwards Perimount bioprosthesis provided satisfactory clinical outcomes. However, late survival was inferior to an age- and gender-matched population. Structural valve deterioration and the need for reintervention were common late after implantation, but reoperation for prosthetic valve dysfunction was associated with a very low risk of mortality.
    The Annals of thoracic surgery 03/2014; 97(5). DOI:10.1016/j.athoracsur.2014.02.019 · 3.85 Impact Factor
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    ABSTRACT: Transcatheter aortic valve implantation (TAVI) is an accepted alternative treatment for severe symptomatic aortic stenosis in high-risk and inoperable patients. Femoral or transapical accesses are commonly used. We report our initial clinical experience with TAVI using the left-axillary artery approach. A single-center, retrospective study of patients undergoing transaxillary TAVI between January 2010 and December 2012 was performed. Procedural success was defined as successful device implantation with reduction in the mean aortic gradient and without need for conversion to open-heart surgery. Short-term echocardiographic follow-up was obtained in all patients. A total of 18 consecutive patients with severe aortic stenosis who were not candidates for surgical replacement underwent transaxillary TAVI. Mean age was 81.1 ± 7.3 years and 14 patients (78%) were male. Median logistic European System for Cardiac Operative Risk Evaluation was 8.5% (range, 1.5% to 54.1%). Procedural success was obtained in 17 out of 18 patients (94%). There was no in-hospital or 30-day mortality. One major bleeding complication in the form of an upper gastrointestinal bleeding was observed. No stroke or major vascular complication was reported. Postoperative implantation of a permanent pacemaker was performed in 7 patients (39%). At a mean follow-up of 326 ± 213 days, mean aortic gradient was 10.8 ± 4.8 mm Hg. Mean aortic valve area was 1.7 ± 0.4 cm(2) and aortic insufficiency grade was mild or less in all but 1 patient, who showed moderate regurgitation. The transaxillary approach for TAVI is associated with high procedural success and low rates of stroke, vascular, or bleeding complications. This approach is an appealing alternative to the commonly used transfemoral and transapical TAVI.
    The Annals of thoracic surgery 01/2014; 97(5). DOI:10.1016/j.athoracsur.2013.11.019 · 3.85 Impact Factor
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    ABSTRACT: The aim of this study was to determine long-term survival and clinical outcomes after elective isolated mechanical aortic valve replacement in young adults. A clinical observational study was conducted in a cohort of 450 consecutive adults less than 65 years of age who had undergone elective isolated mechanical aortic valve replacement (AVR) between 1997 and 2006. Patients who had undergone previous cardiac surgery, and those undergoing concomitant procedures or urgent surgery were excluded. Follow-up was 93.3% complete with a mean follow-up of 9.1 ± 3.5 years. The primary end point was survival. Life table analyses were used to determine age- and gender-matched general population survival. Secondary end points were reoperation and valve-related complications. Overall actuarial survival at 1, 5, and 10 years was 98% ± 1%, 95% ± 1%, and 87% ± 1%, respectively, which was lower than expected in the age- and gender-matched general population in Quebec. Actuarial freedom from prosthetic valve dysfunction was 99% ± 0.4%, 95% ± 1%, and 91% ± 1% at 1, 5, and 10 years, respectively. Actuarial freedom from valve reintervention was 98% ± 1%, 96% ± 1%, and 94% ± 1% at 1, 5 and 10 years, respectively. Actuarial survival free from reoperation at 10 years was 82% ± 2%. Actuarial freedom from major hemorrhage was 98% ± 1%, 96% ± 1%, and 90% ± 2% at 1, 5, and 10 years, respectively. In young adults undergoing elective isolated mechanical AVR, survival remains suboptimal compared with an age- and gender-matched general population. Furthermore, there is a low but constant hazard of prosthetic valve reintervention after mechanical AVR.
    The Journal of thoracic and cardiovascular surgery 12/2013; 148(4). DOI:10.1016/j.jtcvs.2013.10.064 · 4.17 Impact Factor
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    ABSTRACT: The CarboMedics mechanical prosthesis (CarboMedics Inc, Austin, TX) has been used for mitral and aortic valve replacement for more than 20 years in our institution. This study describes the long-term survival of patients with this prosthesis as well as the valve-related events. Between June 1988 and May 2010, 3,297 patients underwent either single aortic valve replacement (AVR) (2,242 patients) or mitral valve replacement (MVR) (1,055 patients) with the CarboMedics mechanical valve prosthesis. They were followed annually for valve-related complications at the Montreal Heart Institute valve clinic. Operative mortality was 4% with AVR and 7% with MVR. Total follow-up was 23,671 patient-years (range, 1 month to 21 years; average, 7.5 ± 5.3 years). At 20 years, patient freedom from late mortality was 43.2% in the AVR group and 40.9% in the MVR group. Freedom from valve-related mortality was 78.3% for AVR and 74.6% for MVR. Freedom from thromboembolic event was 91.6% for AVR and 88.5% for MVR. Freedom from reoperation was 89.2% for AVR and 80.3% for MVR. Freedom from bleeding event was 89.5% for AVR and 88% for MVR. Freedom from endocarditis was 97.3% for both AVR and MVR. Freedom from valve thrombosis was 98.9% for AVR and 91.4% for MVR. There was no structural valve failure in our cohort. The CarboMedics valve is an effective and durable mechanical valve prosthesis with a low event rate and no structural failure at 20 years.
    The Annals of thoracic surgery 11/2013; 97(3). DOI:10.1016/j.athoracsur.2013.09.098 · 3.85 Impact Factor
  • Feras Khaliel · Emmanuel Moss · Philippe Demers · Denis Bouchard
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    ABSTRACT: The femoral artery has been the traditional approach for implantation of the Impella left ventricular assist device. We describe the case of a young man with toxic (cocaine-related) cardiomyopathy, severe left ventricular dysfunction, and moderate mitral insufficiency who received a transfemoral Impella left ventricular assist device that was relocated to the right axillary artery due to uncontrolled femoral access bleeding. The patient immediately stabilized post-implantation and was successfully bridged to a full recovery 6 days later.
    Asian cardiovascular & thoracic annals 10/2013; 22(6). DOI:10.1177/0218492313481032
  • The Canadian journal of cardiology 10/2013; 29(10):S224. DOI:10.1016/j.cjca.2013.07.689 · 3.71 Impact Factor

Publication Stats

584 Citations
264.65 Total Impact Points


  • 2015
    • Hôpital du Sacré-Coeur de Montréal
      Montréal, Quebec, Canada
  • 1999–2015
    • Montreal Heart Institute
      • Department of Cardiac Surgery
      Montréal, Quebec, Canada
  • 2007–2014
    • Université de Montréal
      • Department of Surgery
      Montréal, Quebec, Canada
  • 2009
    • Université du Québec à Montréal
      Montréal, Quebec, Canada
  • 2007–2008
    • Vrije Universiteit Brussel
      Bruxelles, Brussels Capital Region, Belgium