Mehul Patel

Publications (7)22.66 Total impact

• Article: Patent Ductus Arteriosus Stenting (Transcatheter Potts Shunt) for Palliation of Suprasystemic Pulmonary Arterial Hypertension: A Case Series.

  Younes Boudjemline, Mehul Patel, Sophie Malekzadeh-Milani, Isabelle Szezepanski, Marilyne Lévy, Damien Bonnet
  Circulation Cardiovascular Interventions 04/2013; 6(2):e18-e20. · 6.06 Impact Factor
• Article: Impact of right ventricular outflow tract size and substrate on outcomes of percutaneous pulmonary valve implantation.

  Younes Boudjemline, Georgia Sarquella-Brugada, Issam Kamache, Mehul Patel, Magalie Ladouceur, Damien Bonnet, Fazia-Marie Boughenou, Alain Fraisse, Laurence Iserin
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  ABSTRACT: BACKGROUND: Owing to the wide variety of surgical substrates used for right ventricular outflow tract (RVOT) reconstruction, the predictors of successful outcomes in such patients are unclear. AIMS: To compare haemodynamic outcomes of percutaneous pulmonary valve implantation (PPVI) in patients with dysfunctional RVOT. METHODS: This was a multicentre prospective study on all consecutive patients who underwent PPVI from May 2008 to December 2009. All patients underwent prestenting using a bare-metal stent. The patients were divided into two groups based on the surgical substrate used for RVOT reconstruction. RESULTS: Baseline demographics, including right ventricle to pulmonary artery (RV-PA) pressure gradient and RV/aortic (Ao) pressure ratio, were similar in both groups. The mean RV-PA gradient and RV/Ao pressure ratio showed immediate and significant improvement after PPVI. At last follow-up, the RV-PA gradient and RV/Ao pressure ratio were significantly higher in patients with non-expandable conduits (P=0.002 and P=0.008, respectively). Patients with conduits greater than 20mm showed better immediate and midterm outcomes compared with other patients. Patients with non-expandable conduits less or equal to 20mm diameter showed good immediate outcomes but poor midterm haemodynamic outcomes compared with those with expandable conduits less or equal to 20mm diameter (P=0.03). CONCLUSIONS: PPVI is successful with a wide variety of surgical substrates used for RVOT reconstruction; there was immediate haemodynamic improvement in all patients. However, patients with non-expandable conduits less or equal to 20mm had the worst outcomes. This information should be integrated into the decision-making process before selecting patients for PPVI.
  Archives of cardiovascular diseases 01/2013; 106(1):19-26. · 0.66 Impact Factor
• Article: Feasibility of creating a novel animal heart model to test transcatheter techniques for a cavocaval connection that mimics a Fontan completion.

  Sébastien Gerelli, Mathieu Van Steenberghe, Mehul Patel, Isabelle Van Aerschot, Younes Boudjemline
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  ABSTRACT: OBJECTIVE: The objective of this study was to create a novel animal model to foster the future development of interventional techniques for a cavocaval connection that mimics a Fontan completion. METHODS: Ten sheep were studied. All had the superior vena cava-right atrium junction closed using a polytetrafluoroethylene membrane. A valveless Gore-Tex conduit connecting the terminal portion of the superior vena cava to the right atrium was used to bypass the polytetrafluoroethylene occlusion and to allow normal venous drainage through the right atrium. Radio-opaque nitinol rings were placed around the inferior vena cava near its entry in the right atrium to allow better fluoroscopic visualization and to enhance stent stability during transcatheter cavocaval connection. RESULTS: The first 3 animals died during the learning curve as a result of technical issues. The subsequent 7 surviving sheep showed good flow dynamics on cardiac catheterization. Transcatheter cavocaval connection was performed successfully performed in 6 sheep at 0 to 9 months after the initial surgery. Sacrifice was done electively in all animals at 1 to 9 months per protocol. One animal was euthanized early because of an untreatable infection. One sheep was observed as a control without a transcatheter cavocaval connection and was sacrificed at 12 months. CONCLUSIONS: A novel, chronic ovine model to foster development of transcatheter techniques for cavocaval connection to mimic a Fontan completion was created. The successful model is easily reproducible after a short learning curve and shows good survival.
  The Journal of thoracic and cardiovascular surgery 10/2012; · 3.41 Impact Factor
• Article: Feasibility of transcatheter techniques for intracardiac and extracardiac cavocaval connection in principle for Fontan completion in chronic animal models.

  Younes Boudjemline, Sébastien Gerelli, Mathieu Van Steenberghe, Mehul Patel, Sophie Malekzadeh-Milani, Damien Bonnet
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  ABSTRACT: OBJECTIVES: We report the safety and feasibility of various transcatheter techniques of cavocaval connection in principle for the completion of Fontan circulation in viable, chronic and ovine heart models. Surgically simulated preparations of both intracardiac and extracardiac cavocaval connections were studied. METHODS: Sixteen sheep were divided into two groups per the type of surgical preparation. All animals underwent standard right thoracotomy with interposition of a 20-mm Gore-tex(®) conduit between the superior vena cava (SVC) and the right atrium (RA). Nitinol rings were placed around the SVC and the inferior vena cava (IVC). In Group I (intracardiac, n = 10), the SVC-RA junction was closed using a polytetrafluoroethylene (PTFE) membrane 1 cm below the SVC-Gore-tex(®) anastomosis. In Group II (extracardiac, n = 6), a 20-mm Gore-tex conduit de-aired and filled with heparinized saline was anastomosed to connect the SVC and the IVC. The IVC end was anastomosed in a termino-lateral fashion and the SVC end in a termino-terminal fashion; both the ends were occluded with a PTFE membrane. Animals were scheduled for transcatheter cavocaval connection after a variable healing period. RESULTS: Four animals in Group I died; three early and one late after surgical preparation. After a median interim period of 1 month (0-9 months), five sheep from Group I and six from Group II underwent successful transcatheter cavocaval connection. Perforation of the PTFE membrane was successful in all animals. Covered stents were deployed precisely and with good stability ensured by the nitinol rings. All animals survived transcatheter completion and were sacrificed after a median follow-up of 4 months (0-8 months) per protocol. No stent migration, thromboembolic events, residual shunts or paraprosthetic leak was noticed on angiographic evaluation or at autopsy in any animal. CONCLUSIONS: Transcatheter techniques for completion of cavocaval connection in surgically simulated, chronic animal models is safe and feasible. Both techniques were equally successful with no failures or short-term complications. Such techniques should work in principle for completion of intracardiac and extracardiac Fontan circulation.
  European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 08/2012; · 2.40 Impact Factor
• Article: Outcomes and safety of transcatheter pulmonary valve replacement in patients with large patched right ventricular outflow tracts.

  Younes Boudjemline, Georgia Brugada, Isabelle Van-Aerschot, Mehul Patel, Adeline Basquin, Caroline Bonnet, Antoine Legendre, Damien Bonnet, Laurence Iserin
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  ABSTRACT: Although globally accepted, the indication for implantation of the Melody(®) (Medtronic Inc., Minneapolis, MN, USA) transcatheter pulmonary valve is limited to the treatment of haemodynamically dysfunctional right ventricular outflow tract (RVOT) with right ventricle to pulmonary artery (PA) obstruction. The use of the Melody valve for haemodynamically significant isolated pulmonary regurgitation has not been evaluated. We evaluated the outcomes of Melody valve insertion in patients with a large patched RVOT. We analysed procedural and short-term outcomes data from 13 patients who underwent Melody valve implantation for a large RVOT with significant pulmonary regurgitation as the primary lesion. RVOT preparation was done in all patients using the Russian dolls technique and/or the PA jailing technique. Melody valve insertion was performed concomitantly in 10 patients and after 1 to 3 months in three patients. All procedures were successful. The mean follow-up period was 30±4 months after the procedure. There was no incidence of stent fracture, migration or embolization. Only one patient who underwent the jailing technique developed a significant paraprosthetic leak and is scheduled for redilatation of the Melody valve. Careful patient selection, balloon sizing and RVOT preparation with prestenting using the Russian dolls technique and/or the PA jailing technique are required to modify the RVOT for transcatheter valve implantation. Short-term follow-up showed competent valves with no stent fracture or migration and appears promising. Wider experience with long-term outcomes may be required to standardize the procedure in such a subset of patients.
  Archives of cardiovascular diseases 08/2012; 105(8-9):404-13. · 0.66 Impact Factor
• Article: Branch pulmonary artery jailing with a bare metal stent to anchor a transcatheter pulmonary valve in patients with patched large right ventricular outflow tract.

  Younes Boudjemline, Antoine Legendre, Magalie Ladouceur, Marie-Fazhia Boughenou, Mehul Patel, Damien Bonnet, Laurence Iserin
  Circulation Cardiovascular Interventions 04/2012; 5(2):e22-5. · 6.06 Impact Factor
• Article: Atypical malignant late infective endocarditis of Melody valve.

  Mehul Patel, Laurence Iserin, Damien Bonnet, Younes Boudjemline
  The Journal of thoracic and cardiovascular surgery 01/2012; 143(4):e32-5. · 3.41 Impact Factor