Philippe Demers

Montreal Heart Institute, Montréal, Quebec, Canada

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Publications (69)214.24 Total impact

  • [Show abstract] [Hide abstract]
    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
  • 01/2015; 20(1). DOI:10.5812/traumamon.18198
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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 cm(2), 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 · 3.99 Impact Factor
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    ABSTRACT: Structured AbstractOBJECTIVES: 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.RESULTS: Fifty-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; DOI:10.1002/ccd.25632 · 2.40 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; DOI:10.1016/j.cjca.2014.08.010 · 3.94 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 · 3.65 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 · 3.65 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 · 3.99 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 · 3.65 Impact Factor
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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; DOI:10.1177/0218492313481032
  • The Canadian journal of cardiology 10/2013; 29(10):S224. DOI:10.1016/j.cjca.2013.07.689 · 3.94 Impact Factor
  • The Journal of thoracic and cardiovascular surgery 10/2013; 146(4):e27-8. DOI:10.1016/j.jtcvs.2013.06.008 · 3.99 Impact Factor
  • The Canadian journal of cardiology 10/2013; 29(10):S223. DOI:10.1016/j.cjca.2013.07.366 · 3.94 Impact Factor
  • The Canadian journal of cardiology 10/2013; 29(10):S217. DOI:10.1016/j.cjca.2013.07.355 · 3.94 Impact Factor
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    ABSTRACT: The impact of a transvalvular pacemaker lead on the progression of tricuspid regurgitation (TR) after tricuspid valve (TV) repair has not been clearly demonstrated. The aim of this study was to evaluate the presence of a transvalvular pacemaker lead as a risk factor for TR after TV repair in a large patient cohort. A retrospective review included 791 patients who underwent TV repair at our institution from 1977 to 2008. All patients bearing a transvenous pacemaker implanted either preoperatively or within 30 days of surgery were categorized in the "PACE" group (n = 176), the remaining patients were categorized in the "NO PACE" group (n = 615). Mean age was 61 ± 11 years, and 575 patients (73%) were female. Mean follow-up was 5.8 ± 5.5 years. Operative mortality was 13%. At discharge, TR severity was 3+ or greater in 10% and 15% of patients in the PACE and NO PACE groups, respectively (p = 0.19). Multivariate analysis using a Cox regression model identified the presence of a transvenous pacemaker as an independent risk factor for recurrence of TR 2+ or greater (hazard ratio [HR] 1.60, p = 0.008) and TR 3+ or greater (HR 1.47, p = 0.046) at last follow-up. The presence of a transvenous pacemaker was also a significant independent predictor of late mortality (HR 2.12, p = 0.02). In patients undergoing tricuspid valve surgery, the presence of a transvenous pacemaker implanted either preoperatively or within 30 days of surgery is associated with a significantly increased risk of persistent or recurrent TR at late follow-up.
    The Annals of thoracic surgery 07/2013; 96(3). DOI:10.1016/j.athoracsur.2013.04.100 · 3.65 Impact Factor
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    ABSTRACT: Functional ischemic mitral regurgitation (FIMR) increases mortality independently of the baseline characteristics and ventricular function. The effect of treating FIMR with annuloplasty is unclear when mitral regurgitation is moderate. Myocardial revascularization alone has been shown to improve mitral valve function. We randomized 31 patients with moderate (grade 2-4) FIMR to receive either coronary artery bypass grafting (CABG) alone or CABG plus downsizing mitral ring annuloplasty. The patients were followed up for clinical outcomes and echocardiographic assessment of mitral valve function and left ventricular dimensions at 3 and 12 months. Clinical improvement was assessed using the Minnesota quality-of-life questionnaire, 6-minute walk test, and brain natriuretic peptide levels. The clinical course was similar in the 2 groups of patients during the study period. FIMR was perfectly corrected intraoperatively in the ring group. Echocardiographic follow-up at 3 months showed no difference in the FIMR grade between the 2 groups (66% less than grade 2 in the CABG alone and 86% in the CABG plus ring group; P = .316). The improvement in the CABG alone group was even more marked at 12 months (85% less than grade 2 in the CABG group and 85% in the CABG plus ring group). The left ventricular ejection fraction was significantly better at 3 months in the CABG alone group, although at 12 months, the left ventricular ejection fraction in the 2 groups had improved similarly. Although initially effective at reducing moderate FIMR, the addition of a ring did not change the clinical course after CABG surgery. At 12 months, no echocardiographic difference was found in terms of residual mitral regurgitation, left ventricular dimensions and function, or clinical outcomes.
    The Journal of thoracic and cardiovascular surgery 07/2013; 147(5). DOI:10.1016/j.jtcvs.2013.05.024 · 3.99 Impact Factor
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    ABSTRACT: BACKGROUND: The Carpentier-Edwards pericardial valve was designed to minimize structural valve deterioration. Excellent durability and low incidence of valve-related complications have been reported. The objective of the present study was to analyze clinical results after 25 years of experience with this valve implanted in the aortic position. The effect of patient age at the time of surgery was also evaluated. METHODS: This is a retrospective cohort study of 2,405 patients from November 1981 to March 2011. Primary outcomes of interest were survival and freedom from major adverse effects such as thromboembolic, endocarditis, and reoperation. RESULTS: Sixty percent were male, with a mean age of 71 ± 9 years old. Actuarial survival rates including early deaths averaged 78% ± 2%, 55% ± 2%, and 16 % ± 2% after 5, 10, and 20 years of follow-up, respectively. The freedom rate of valve reoperation for prosthesis dysfunction and all other causes averaged 98 % ± 0.2%, 96% ± 1%, and 67% ± 4% at 5, 10, and 20 years. Patients younger than 60 years of age had a 15-year survival averaging 54% ± 5% compared with patients aged between 60 and 70 years of age averaging 46% ± 3% and with patients older than 70 years of age averaging 28% ± 3% (p = 0.001). Survival at 5, 10, and 20 years for patients who had concomitant CABG [coronary artery bypass grafting] were 78% ± 1%, 55% ± 2%, and 9% ± 3% compared with no concomitant CABG (84% ± 1%, 62% ± 2%, and 22% ± 3% (p < 0.001)). CONCLUSIONS: Carpentier-Edwards pericardial valve implantation in the aortic position is secure and durable. The effects of age influence reoperation rate and survival as well as a concomitant coronary artery bypass procedure.
    The Annals of thoracic surgery 05/2013; 96(2). DOI:10.1016/j.athoracsur.2013.03.032 · 3.65 Impact Factor
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    ABSTRACT: Mediastinal drainage following cardiac surgery with traditional large-bore plastic tubes can be painful and cumbersome. This study was designed to determine whether prolonged drainage (5 days) with a silastic tube decreased the incidence of significant pericardial effusion and tamponade following aortic or valvular surgery. One hundred and fifty patients undergoing valvular or aortic surgery in a tertiary cardiac surgery institution were randomized to receive a conventional mediastinal tube plus a silastic Blake drain (n = 75), or two conventional tubes (n = 75). Conventional drains were removed on postoperative day (POD) 1, while Blake drains were removed on POD 5. The primary end-point was the combined incidence of significant pericardial effusion (>= 15 mm) or tamponade through POD 5. Secondary end-points included total mediastinal drainage, postoperative atrial fibrillation (AF) and pain. Analysis was performed for 67 patients in the Blake group and 73 in the conventional group. There was no difference between the two groups in the combined end-point of significant effusion or tamponade (7.4 vs 8.3%, P = 0.74), or in the incidence of AF (47 vs 46%, P = 0.89). Mean 24-h drainage was greater in the Blake group than in the conventional group (749 +/- 444 ml vs 645 +/- 618 ml, P < 0.01). Overall incidence of significant pericardial effusion at 30 days was 12.1% (n = 17), with 5% (n = 7) requiring drainage. The Blake group had a numerically lower incidence of effusion requiring drainage at POD 30 (3.0 vs 6.8%, P = 0.44). Postoperative pain was similar between groups. In patients undergoing ascending aortic or valvular surgery, prolonged drainage with silastic tubes is safe and does not increase postoperative pain. There was no difference between the Blake and conventional drains with regard to significant pericardial effusion or tamponade in this cohort; however, this conclusion is limited by the low overall incidence of the primary outcome in this cohort.
    Interactive Cardiovascular and Thoracic Surgery 04/2013; 17(1). DOI:10.1093/icvts/ivt123 · 1.11 Impact Factor
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    ABSTRACT: We report a case of an elderly male with significant comorbidities and a dominant aberrant left vertebral artery originating on an aneurysmal aortic arch. The patient underwent a successful staged hybrid procedure with aortic arch debranching and left vertebral artery transposition onto the left common carotid artery, followed by endovascular aneurysmal repair.
    Journal of Cardiac Surgery 01/2013; 28(2):o0-o3. DOI:10.1111/jocs.12053 · 0.89 Impact Factor
  • Archives of Cardiovascular Diseases Supplements 01/2013; 5(1):43. DOI:10.1016/S1878-6480(13)71061-9

Publication Stats

534 Citations
214.24 Total Impact Points


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