Nawwar Al-Attar

Publications (49)178.3 Total impact

• Article: Right papillary muscle sling: proof of concept and pilot clinical experience.

  Nawwar Al-Attar, Ulrik Hvass
  [show abstract] [hide abstract]
  ABSTRACT: OBJECTIVES: Left-sided intraventricular remodelling by papillary muscle approximation associated with annuloplasty of the mitral valve improved outcomes for severe functional mitral regurgitation compared with annuloplasty alone. We conceived of, and studied, a papillary muscle sling on the right side of the heart associated with annuloplasty, seeking to reduce tricuspid valve tethering and right ventricular volumes and to preserve ventricular function. METHODS: An experimental model on ex vivo porcine hearts established the anatomical feasibility of the procedure. A first-in-man clinical series of 5 patients (3 men) with a mean age of 63.3 years (51-73) had mean right ventricular volumes of 320 ml (280-350) and 200 ml (155-250) in diastole and systole, respectively, and an ejection fraction of 30% (25-40). The mean pulmonary artery pressure was 60 mmHg (55-70), and all had Grade IV/IV tricuspid regurgitation (TR). RESULTS: There was no operative mortality. Post-repair, magnetic resonance imaging and echocardiographic studies showed mean right ventricle volumes of 165 ml (155-180) and 124 ml (110-140) in diastole and systole, respectively, and an ejection fraction of 28% (25-35) (P = 0.03). TR was <2, gradient across tricuspid valve was ≤4 mmHg and there was no right ventricular outflow tract obstruction. All patients were in New York Heart Association Class ≤2. CONCLUSION: Intraventricular remodelling with a papillary muscle sling is safe and feasible on the right heart. Short-term follow-up shows that it ameliorates clinical functional status and improves valve competency through reduced tension and tethering of tricuspid leaflets.
  European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 02/2013; · 2.40 Impact Factor
• Article: Actualización de las guías de la Sociedad Europea de Cardiología (ESC) para el manejo de la fibrilación auricular de 2010 Elaborada en colaboración con la Asociación Europea del Ritmo Cardiaco.

  A John Camm, Gregory Y H Lip, Raffaele De Caterina, Irene Savelieva, Dan Atar, Stefan H Hohnloser, Gerhard Hindricks, Paulus Kirchhof, Jeroen J Bax, Helmut Baumgartner, [......], Jean-Yves Le Heuzey, Hercules Mavrakis, Lluís Mont, Pasquale Perrone Filardi, Piotr Ponikowski, Bernard Prendergast, Frans H Rutten, Ulrich Schotten, Isabelle C Van Gelder, Freek W A Verheugt
  Revista Espa de Cardiologia 01/2013; 66(1):54.e1-54.e24. · 2.53 Impact Factor
• Article: Does a gentamicin-impregnated collagen sponge reduce sternal wound infections in high-risk cardiac surgery patients?

  Gabriel Birgand, Costin Radu, Soleiman Alkhoder, Nawwar Al Attar, Richard Raffoul, Marie-Pierre Dilly, Patrick Nataf, Jean-Christophe Lucet
  [show abstract] [hide abstract]
  ABSTRACT: OBJECTIVES Sternal wound infections occurring after cardiac surgery have a critical impact on morbidity, mortality and hospital costs. This study evaluated the efficacy of a gentamicin-collagen sponge in decreasing deep sternal-wound infections in high-risk cardiac surgery patients.METHODS We conducted a quasi-experimental single-centre prospective cohort study in diabetic and/or overweight patients undergoing coronary-artery bypass surgery with bilateral internal mammary artery grafts. The end-point was the rate of reoperation for deep sternal wound infection. The period from January 2006 to October 2008, before the introduction of the gentamicin sponge, was compared with the period from November 2008 to December 2010.RESULTSOf 552 patients (median body mass index, 31.5; 37.7% with diabetes requiring insulin), 68 (12.3%) had deep sternal wound infections. Reoperation for deep sternal wound infections occurred in 40/289 (13.8%) preintervention patients and 22/175 (12.6%) patients managed with the sponge. Independent risk factors were female sex and longer time on mechanical ventilation, but not use of the sponge (adjusted odds ratio, 0.95; 95% confidence interval, 0.52-1.73; P = 0.88). The group managed with the sponge had a higher proportion of gentamicin-resistant micro-organisms (21/27, 77.8%) compared with the other patients (23/56, 41.1%; P < 0.01). The median time to reoperation for wound infection was higher with the sponge (21 vs 17 days, P < 0.01).CONCLUSIONSA gentamicin-collagen sponge was not effective in preventing deep sternal wound infections in high-risk patients. Our results suggest that a substantial proportion of wound contaminations occur after bypass surgery with bilateral internal mammary artery grafts.
  Interactive cardiovascular and thoracic surgery 10/2012;
• Article: Site of paravalvular leak after mitral valve replacement influences leaflet blockage by Amplatzer device.

  Nawwar Al-Attar, Ghada Al-Salih, Soleiman Alkhoder, Costin Radu, Richard Raffoul, Patrick Nataf
  EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 09/2012; 8(5):638-9. · 3.29 Impact Factor
• Article: 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: An update of the 2010 ESC Guidelines for the management of atrial fibrillation * Developed with the special contribution of the European Heart Rhythm Association.

  A John Camm, Gregory Y H Lip, Raffaele De Caterina, Irene Savelieva, Dan Atar, Stefan H Hohnloser, Gerhard Hindricks, Paulus Kirchhof, Jeroen J Bax, Helmut Baumgartner, [......], Jean-Yves Le Heuzey, Hercules Mavrakis, Lluís Mont, Pasquale Perrone Filardi, Piotr Ponikowski, Bernard Prendergast, Frans H Rutten, Ulrich Schotten, Isabelle C Van Gelder, Freek W A Verheugt
  European Heart Journal 08/2012; · 10.48 Impact Factor
• Article: 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: An update of the 2010 ESC Guidelines for the management of atrial fibrillation * Developed with the special contribution of the European Heart Rhythm Association.

  A John Camm, Gregory Y H Lip, Raffaele De Caterina, Irene Savelieva, Dan Atar, Stefan H Hohnloser, Gerhard Hindricks, Paulus Kirchhof, Jeroen J Bax, Helmut Baumgartner, [......], Jean-Yves Le Heuzey, Hercules Mavrakis, Lluís Mont, Pasquale Perrone Filardi, Piotr Ponikowski, Bernard Prendergast, Frans H Rutten, Ulrich Schotten, Isabelle C Van Gelder, Freek W A Verheugt
  Europace 08/2012; 14(10):1385-413. · 1.98 Impact Factor
• Article: Reply to attia and bapat.

  Nawwar Al-Attar, Soleiman Alkhoder, Patrick Nataf
  European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 03/2012; 41(3):715-6. · 2.40 Impact Factor
• Article: Early and mid-term outcomes in patients undergoing transcatheter aortic valve implantation after previous coronary artery bypass grafting.

  Gregory Ducrocq, Nawwar Al-Attar, Dominique Himbert, David Messika-Zeitoun, Bernard Iung, Fleur Descoutures, Patrick Nataf, Alec Vahanian
  [show abstract] [hide abstract]
  ABSTRACT: Surgical aortic valve replacement in patients with previous coronary artery bypass grafting (CABG) carries a high mortality. Transcatheter aortic valve implantation (TAVI) has been shown to be successful in high risk subgroups of patients. Our goal is therefore to evaluate the impact of a history of CABG on the outcome of patients who undergo TAVI. From October 2006 to June 2010, among the 201 patients selected to undergo TAVI, 54 (27%) had a history of CABG. Outcomes were prospectively collected. The 30-day outcome was not different between patients with previous CABG vs. those without, in particular as regards mortality (respectively, 5.6% vs. 10.9%; P = 0.25). Mid-term survival (mean FU: 7 ± 9 months) was not different at 2 years between patients with previous CABG vs. patients without (65.7 ± 6.2% vs. 80.0 ± 7.7% respectively; P = 0.12). In multivariate analysis, CABG was not associated with an excess mid-term mortality after TAVI. Previous CABG does not adversely affect outcome in patients undergoing TAVI. If confirmed by larger prospective series and ideally by a randomized trial comparing CABG vs. redo surgery, this observation might lead the heart team to consider TAVI as an attractive option in the population of high risk patients with aortic stenosis and previous CABG.
  European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 03/2012; 41(3):499-504. · 2.40 Impact Factor
• Article: Wrapping of the ascending aorta in acute type A retrograde aortic dissection.

  Ramzi Ramadan, Alexandre Azmoun, Nawwar Al-Attar, Remi Nottin
  [show abstract] [hide abstract]
  ABSTRACT: We describe off-pump wrapping of the ascending aorta in 3 high-risk patients with acute type A aortic dissection when the primary intimal tear was not located in the ascending aorta and in the absence of aortic insufficiency. A Teflon plaque (Bard Inc, Murray Hill, NJ) was tailored to tightly wrap the aorta from the coronary ostia to the innominate artery. The mean age of the patients was 80.3 years. All patients were at high risk for conventional surgery. A postoperative computed tomographic scan showed a reapplication of the intimal flap and containment of the false lumen in the reinforced ascending aorta in all patients.
  The Annals of thoracic surgery 09/2011; 92(3):e49-50. · 3.74 Impact Factor
• Article: ESC Guidelines on the management of cardiovascular diseases during pregnancy: the Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC).

  Vera Regitz-Zagrosek, Carina Blomstrom Lundqvist, Claudio Borghi, Renata Cifkova, Rafael Ferreira, Jean-Michel Foidart, J Simon R Gibbs, Christa Gohlke-Baerwolf, Bulent Gorenek, Bernard Iung, [......], Silvia G Priori, Maria J Salvador, Avraham Shotan, Candice K Silversides, Sven O Skouby, Jörg-Ingolf Stein, Pilar Tornos, Niels Vejlstrup, Fiona Walker, Carole Warnes
  European Heart Journal 08/2011; 32(24):3147-97. · 10.48 Impact Factor
• Article: Extracorporeal membrane oxygenation in 5 patients with bronchial fistula with severe acute lung injury.

  Omar Daoud, Pascal Augustin, Pierre Mordant, Sigismond Lasocki, Nawwar Al-Attar, Jean-Michel Maury, Mathieu Desmard, Dan Longrois, Philippe Montravers
  [show abstract] [hide abstract]
  ABSTRACT: The management of bronchial fistula associated with acute lung injury raises two major concerns: (1) high ventilation pressures are necessary for lung recruitment but detrimental for fistula healing, and (2) adequate lung recruitment is prevented by large air leak. Primary surgical closure of bronchial fistula should be attempted but is rarely successful during mechanical ventilation. We sought to evaluate the efficacy of extracorporeal membrane oxygenation associated with lung-protective ventilation in case of failure of conventional management. Arteriovenous extracorporeal membrane oxygenation was initiated by femorofemoral cannulation. A stepwise increase of extracorporeal membrane oxygenation output and a decrease of mechanical ventilation settings were simultaneously performed, aiming at lung-protective ventilation. During a 1-year period, this protocol management was used in 5 patients with refractory respiratory failure associated with bronchial fistula after thoracic operations. This strategy allowed fistula healing in 3 patients. If correctly timed, extracorporeal membrane oxygenation can provide a therapeutic bridge to lung-protective ventilation and allow bronchial fistula healing in case of refractory respiratory failure.
  The Annals of thoracic surgery 07/2011; 92(1):327-30. · 3.74 Impact Factor
• Article: Severe intraprosthetic regurgitation by immobile leaflet after trans-catheter aortic valve implantation.

  Nawwar Al-Attar, Dominique Himbert, Alec Vahanian, Patrick Nataf
  [show abstract] [hide abstract]
  ABSTRACT: Aortic regurgitation mainly in the form of paravalvular leaks is a frequent complication of trans-catheter aortic valve implantation (TAVI). We describe a case of an 86-year-old woman with severe aortic stenosis, who underwent trans-apical TAVI with a 23-mm Edwards-SAPIEN valve. Immediately post-implantation, severe intravalvular leak was observed on trans-esophageal echocardiogram (TEE) due to an immobile cusp associated with left-ventricular distension and cardiovascular collapse. Despite successfully treating the leak with the implantation of a second valve of the same diameter within the first one, the hemodynamic status remained unstable. Peripheral extracorporeal membrane oxygenation (ECMO) was established but resulted in a fatal outcome due to intractable heart failure.
  European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 04/2011; 39(4):591-2. · 2.40 Impact Factor
• Article: Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC).

  A John Camm, Paulus Kirchhof, Gregory Y H Lip, Ulrich Schotten, Irene Savelieva, Sabine Ernst, Isabelle C Van Gelder, Nawwar Al-Attar, Gerhard Hindricks, Bernard Prendergast, [......], Raffaele De Caterina, Johan De Sutter, Andreas Goette, Bulent Gorenek, Magnus Heldal, Stefan H Hohloser, Philippe Kolh, Jean-Yves Le Heuzey, Piotr Ponikowski, Frans H Rutten
  Europace 10/2010; 12(10):1360-420. · 1.98 Impact Factor
• Article: Abdominal compartment syndrome due to extracorporeal membrane oxygenation in adults.

  Pascal Augustin, Sigismond Lasocki, Guillaume Dufour, Julie Rode, Alexandre Karsenti, Nawwar Al-Attar, Romain Bazeli, Philippe Montravers
  [show abstract] [hide abstract]
  ABSTRACT: Extracorporeal membrane oxygenation (ECMO) improves the outcome of refractory cardiogenic shock. Few studies in adult populations have specifically addressed the complications of ECMO. Abdominal compartment syndrome (ACS) has been previously described in the pediatric literature, but it has never been directly attributed to ECMO alone. The authors describe two cases of ACS directly induced by venoarterial ECMO. In one case, decompressive laparotomy restored an adequate hemodynamic status. The authors hypothesize that ECMO contributed to ACS by inducing massive fluid overload and subsequent tense ascites. In conclusion, when ECMO dysfunction or hemodynamic impairment occurs, ACS should be considered and a decompressive laparotomy should be performed.
  The Annals of thoracic surgery 09/2010; 90(3):e40-1. · 3.74 Impact Factor
• Article: Reply.

  Nawwar Al-Attar, Patrick Nataf
  The Annals of thoracic surgery 04/2010; 89(4):1343-4. · 3.74 Impact Factor
• Article: Immediate and mid-term results of transfemoral aortic valve implantation using either the Edwards Sapien transcatheter heart valve or the Medtronic CoreValve System in high-risk patients with aortic stenosis.

  David Attias, Dominique Himbert, Gregory Ducrocq, Delphine Détaint, Nawwar Al-Attar, Bernard Iung, Fady Francis, Jean-Michel Maury, Eric Brochet, Daniel Enguerrand, Patrick Nataf, Alec Vahanian
  [show abstract] [hide abstract]
  ABSTRACT: We sought to describe the results of transfemoral aortic valve implantation using either the Sapien prosthesis or the CoreValve System. Results of transfemoral aortic valve implantation using both commercially available prostheses have rarely been studied. Of 236 patients at high-risk or with contraindications to surgery, consecutively referred for transcatheter aortic valve implantation between October 2006 and June 2009, 83 were treated with transfemoral aortic valve implantation. The Sapien was the only prosthesis available until May 2008 and, since then, was used as the first option, while the CoreValve System was used when contraindications to the Sapien prosthesis were present. Patients were aged 81+/-9 years, 98% in New York Heart Association classes III/IV, with predicted surgical mortalities of 26+/-14% using the EuroSCORE and 15+/-8% using the Society of Thoracic Surgeons Predicted Risk of Mortality score. Seventy-two patients were treated with the Sapien prosthesis and 11 with the CoreValve System. The valve was implanted in 94% of the cases. Thirty-day mortality was 7%. Overall, 1- and 2-year survival rates were 78+/-5% and 71+/-7%, respectively. Among patients treated with the Sapien, the 1-year survival rate was 67+/-12% in the first 20% of patients versus 86+/-5% in the last 80% of patients (p=0.02). In univariate analysis, early experience was the only significant predictor of 1-year mortality. Combining the use of the Sapien and the CoreValve prostheses increases the number of patients who can be treated by transfemoral aortic valve implantation and provides satisfactory results at 2 years in this high-risk population. The results are strongly influenced by experience.
  Archives of cardiovascular diseases 04/2010; 103(4):236-45. · 0.66 Impact Factor
• Article: Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery: the Task Force for Preoperative Cardiac Risk Assessment and Perioperative Cardiac Management in Non-cardiac Surgery of the European Society of Cardiology (ESC) and endorsed by the European Society of Anaesthesiology (ESA).

  Don Poldermans, Jeroen J Bax, Eric Boersma, Stefan De Hert, Erik Eeckhout, Gerry Fowkes, Bulent Gorenek, Michael G Hennerici, Bernard Iung, Malte Kelm, [......], Carsten W Israel, Ran Kornowski, Nekane Murga Eizagaechevarria, Mauro Pepi, Massimo Piepoli, Hans Joachim Priebe, Martin Scherer, Janina Stepinska, David Taggart, Marco Tubaro
  European Journal of Anaesthesiology 02/2010; 27(2):92-137. · 2.23 Impact Factor
• Article: Development of aortic valve implantation.

  Nawwar Al-Attar, Patrick Nataf
  [show abstract] [hide abstract]
  ABSTRACT: Aortic valve stenosis is an important public-health problem in Europe and is predicted to increase with the aging population. Management of severe symptomatic aortic stenosis is by surgical replacement of the aortic valve whenever feasible. Improvement in the perioperative management has permitted surgical intervention in high-risk patients. However, patients refused surgery can now be managed by transcatheter techniques. These have opened new horizons for patients for whom conventional surgery is contraindicated or the technical complexity of the procedure is associated with considerable operative risk. The development of transcatheter aortic valve implantation, available technology, choice of approach, and future perspectives are discussed.
  Herz 09/2009; 34(5):367-73. · 0.92 Impact Factor
• Source

  Available from: onlinejacc.org

  Article: Results of transfemoral or transapical aortic valve implantation following a uniform assessment in high-risk patients with aortic stenosis.

  Dominique Himbert, Fleur Descoutures, Nawwar Al-Attar, Bernard Iung, Gregory Ducrocq, Delphine Détaint, Eric Brochet, David Messika-Zeitoun, Fady Francis, Hassan Ibrahim, Patrick Nataf, Alec Vahanian
  [show abstract] [hide abstract]
  ABSTRACT: We sought to describe the results of a strategy offering either transfemoral or transapical aortic valve implantation in high-risk patients with severe aortic stenosis. Results of transfemoral and transapical approaches have been reported separately, but rarely following a uniform assessment to select the procedure. Of 160 consecutive patients at high risk or with contraindications to surgery, referred between October 2006 and November 2008, 75 were treated with transcatheter aortic valve implantation. The transfemoral approach was used as the first option and the transapical approach was chosen when contraindications to the former were present. The valve used was the Edwards Lifesciences SAPIEN prosthesis. Patients were age 82 +/- 8 years (mean +/- SD), in New York Heart Association functional classes III/IV, with predicted mean surgical mortalities of 26 +/- 13% using the European System for Cardiac Operative Risk Evaluation and 16 +/- 7% using the Society of Thoracic Surgeons Predicted Risk of Mortality. Fifty-one patients were treated via the transfemoral approach, and 24 via the transapical approach. The valve was implanted in 93% of the patients. Hospital mortality was 10%. Mean (+/- SD) 1-year survivals were 78 +/- 6% in the whole cohort, 81 +/- 7% in the transfemoral group, 74 +/- 9% in the transapical group (p = 0.22), and 60 +/- 10% in the first 25 patients versus 93 +/- 4% in the last 50 patients treated (p = 0.001). In multivariate analysis, early experience was the only significant predictor of late mortality. Being able to offer either transfemoral or transapical aortic valve implantation, within a uniform assessment, expands the scope of the treatment of aortic stenosis in high-risk patients and provides satisfactory results at 1 year in this population. The results are strongly influenced by experience.
  Journal of the American College of Cardiology 08/2009; 54(4):303-11. · 14.16 Impact Factor
• Article: Unexpected complications of transapical aortic valve implantation.

  Nawwar Al-Attar, Walid Ghodbane, Dominique Himbert, Céderic Rau, Richard Raffoul, David Messika-Zeitoun, Eric Brochet, Alec Vahanian, Patrick Nataf
  [show abstract] [hide abstract]
  ABSTRACT: Recent series have reviewed the results of transapical aortic valve implantation (TAVI). However, specific problems of this new procedure are not well-described. Unexpected complications due to the procedure and their management are reported. Eighteen patients underwent TAVI using the Edwards Sapien bioprosthesis (Edwards Lifesciences Inc, CA) between September 2007 and June 2008 due to contraindications of conventional surgery (n = 5) or high operative risk (n = 13). The system was introduced through 2 purse string sutures in the apex under echocardiographic and fluoroscopic control. The implantation success rate and initial procedural success were 100%. There was no intraoperative death and no stroke. During the procedure, two cases of ventricular fibrillation consequent to rapid pacing were treated by cardioversion. Acute mitral regurgitation due to traction of the subvalvular apparatus by the guidewire and acute aortic regurgitation from pressure on a bioprosthesis cusp by the guidewire were diagnosed by transesophageal echocardiography and reversed by the removal of the guidewire. Another case of aortic regurgitation was due to incomplete deployment of the bioprosthesis and was managed by a "valve after valve" procedure. Two patients died on postoperative day 2 from left ventricular failure. In one patient the postmortem study showed, despite correct implantation of the bioprosthesis, a hematoma of the septum with a small ventricular septal defect. The total in-hospital death was 27.7% (5 patients). There was no periprocedural bleeding but in one patient delayed rupture of the apex (36 hours after the procedure) necessitated emergency surgery. A false aneurysm of the apex appeared 3 months after surgery in another patient. Closure of the apex was performed through sternotomy and cardiopulmonary bypass with an uneventful follow-up. The TAVI is associated with incidents and complications different to those encountered in conventional aortic valve surgery. Recognizing their existence contributes to elucidating their mechanisms and to propose solutions to avoid or treat them.
  The Annals of thoracic surgery 08/2009; 88(1):90-4. · 3.74 Impact Factor