Patrick Nataf

Paris Diderot University, Lutetia Parisorum, Île-de-France, France

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Publications (108)422.5 Total impact

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    ABSTRACT: Tricuspid valve disease is mainly represented by tricuspid regurgitation (TR), which is a predictor of poor outcome. TR is usually secondary, caused by right ventricle pressure or volume overload, the leading cause being left-sided heart valve diseases. Tricuspid surgery for severe TR is recommended during left valve surgery, and consists of either a valve replacement or, most often, a tricuspid repair with or without prosthetic annuloplasty. When TR persists or worsens after left valvular surgery, redo isolated tricuspid surgery is associated with high mortality. In addition, a sizeable proportion of patients present with tricuspid surgery deterioration over time, and need a reintervention, which is associated with high morbi-mortality rates. In this context, and given the recent major breakthrough in the percutaneous treatment of aortic and mitral valve diseases, the tricuspid valve appears an appealing challenge, although it raises specific issues. The first applications of transcatheter techniques for tricuspid valve disease were valve-in-valve and valve-in-ring implantation for degenerated bioprosthesis or ring annuloplasty. Some concerns remain regarding prosthesis sizing, rapid ventricular pacing and the best approach, but these procedures appear to be safe and effective. More recently, bicuspidization using a transcatheter approach for the treatment of native tricuspid valve has been published, in two patients. Finally, other devices are in preclinical development.
    No preview · Article · Oct 2015 · Archives of cardiovascular diseases
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    ABSTRACT: Background Sternal Wound Infection (SWI) is a severe complication after cardiac surgery. Debridement associated with primary closure using Redon drains (RD) is an effective treatment, but data on RD management and antibiotic treatment are scarce. Methods We performed a single-center analysis of consecutive patients who were re-operated for SWI between 01/2009 and 12/2012. All patients underwent a closed drainage with RD (CDRD). Patients with endocarditis or those who died within the first 45 days were excluded from management analysis. RD fluid was cultured twice weekly. Variables recorded were clinical and biological data at SWI diagnosis, severity of SWI based on criteria for mediastinitis as defined by the Centers for Disease Control (CDC), antibiotic therapy, RD management and patient’s outcome. Results 160 patients developed SWI, 102 (64%) fulfilled CDC criteria (CDC+) and 58 (36%) did not (CDC- SWI). Initial antibiotic treatment and surgical management were similar in CDC+ and CDC- SWI. Patients with CDC+ SWI had a longer duration of antibiotic therapy and a mortality rate of 17% as compared to 3% in patients with CDC- SWI (p = 0.025). Rates of superinfection (10% and 9%) and need for second reoperation (12% and 17%) were similar. Failure (death or need for another reoperation) was associated with female gender, higher EuroScore for prediction of operative mortality, and stay in the ICU. Conclusion In patients with SWI, initial one-stage surgical debridement with CDRD is associated with favorable outcomes. CDC+ and CDC- SWI received essentially the same management, but CDC+ SWI has a more severe outcome.
    Preview · Article · Sep 2015 · PLoS ONE
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    ABSTRACT: Associated tricuspid annuloplasty is recommended during left-heart valve surgery when the tricuspid annulus (TA) is dilated but methodology for the measurement of TA size and thresholds for TA enlargement are not clearly defined. Measurement of the TA diameter (TAD) was prospectively performed using 2-dimensional transthoracic echocardiography (2D-TTE) in 282 patients in 4 different views (parasternal long axis, parasternal short axis, apical 4-chamber [A4C], and subcostal). TAD was also measured using 3D-transesophageal echocardiography in 183 patients (long axis), peroperatively in 120 patients who underwent a tricuspid valve surgery and using TTE (A4C) in 66 healthy volunteers. TAD was significantly different between the 4 2D-TTE views (3.85±0.58, 3.87±0.61, 4.02±0.69, and 3.92±0.65 cm, respectively; P<0.0001) but differences were small and the A4C was the most feasible (76%, 65%, 92%, and 73%, respectively; P<0.0001) and offered the highest reproducibility. TAD measured in A4C view was smaller than when measured by 3D-transesophageal echocardiography (3.90±0.63 versus 4.33±0.62 cm; P<0.0001) but correlation was excellent (r=0.84; P<0.0001) with a systematic 4-mm underestimation. In contrast, 2D-TTE measurements were significantly smaller and only modestly correlated to surgical measurements (4.11±0.61 versus 4.37±0.75 cm; P<0.0001; r=0.57; P<0.0001) which were poorly reproducible. In healthy volunteers, we suggested 42 mm or 23 mm/m(2) as pathological values for the TAD in A4C. Measurements of the TAD using 2D-TTE in A4C were highly feasible and reproducible and despite being systematically smaller than 3D measurements, accurately reflected the degree of TA enlargement as assessed using 3D transesophageal echocardiography. We proposed the thresholds that may be used in future prospective studies to demonstrate whether a preventive strategy would improve the outcome. © 2015 American Heart Association, Inc.
    No preview · Article · Jul 2015 · Circulation Cardiovascular Imaging
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    ABSTRACT: The incidence of surgical site infection (SSI) after cardiac surgery depends on the definition used. A distinction is generally made between mediastinitis, as defined by the Centers for Disease Control (CDC), and superficial SSI. Our objective was to decipher these entities in terms of presentation and risk factors. We performed a 7-year single center analysis of prospective surveillance of patients with cardiac surgery via median sternotomy. SSI was defined as the need for reoperation due to infection. Among 7,170 patients, 292 (4.1%) developed SSI, including 145 CDC-defined mediastinitis (CDC+ SSI, 2.0%) and 147 superficial SSI without associated bloodstream infection (CDC- SSI, 2.1%). Median time to reoperation for CDC- SSI was 18 days (IQR, 14-26) and 16 (IQR, 11-24) for CDC+ SSI (p= 0.02). Microorganisms associated with CDC- SSI were mainly skin commensals (62/147, 41%) or originated in the digestive tract (62/147, 42%) and only 6 Staphylococcus aureus (4%), while CDC+ SSI were mostly due to S.aureus (52/145, 36%) and germs from the digestive tract (52/145: 36%). Risk factors for SSI were older age, obesity, chronic obstructive bronchopneumonia, diabetes mellitus, critical pre-operative state, post-operative vasopressive support, transfusion or prolonged ventilation and coronary artery bypass grafting, especially if using both internal thoracic arteries (ITA) in female patients. The number of ITA used and factors affecting wound healing were primarily associated with CDC- SSI, whereas co-morbidities and peri-operative complications were mainly associated with CDC+ SSI. These 2 entities differed in time to revision surgery, bacteriology and risk factors, suggesting a differing pathophysiology. Copyright © 2015. Published by Elsevier Ltd.
    Full-text · Article · Apr 2015 · Clinical Microbiology and Infection
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    ABSTRACT: Purpose: Concerns have been raised regarding the reliability of the logistic Euroscore (Euroscore I). The Euroscore II has been recently described to achieve a more accurate prediction of operative mortality. However its performance has not been specifically studied in valvular surgery. Methods: The predictive performance of the Euroscore I and II was compared in 2859 consecutive patients who underwent valvular surgery in our institution between 2006 and 2010. Discrimination was assessed using the c-index and calibration by comparing predicted and observed mortality. Results: Mean age was 64±16 years, mean Euroscore I 8.6±9.6% and mean Euroscore II 5.8±7.7%. Half of the patients underwent more than a single valve procedure. Mortality at 30 days was 5.4% (154 patients). C-index was 0.77 (95% CI 0.74-0.81) for the Euroscore I and 0.81 (95% CI 0.77-0.84) for the Euroscore II. The overall comparison between predicted and observed mortality showed a significant difference for the Euroscore I (p<0.0001), whereas no difference was found for the Euroscore II (p=0.97). The Euroscore I overestimated operative mortality, in particular in patients at intermediate and high risk for surgery (Figure 1).
    Full-text · Article · Apr 2015 · Archives of Cardiovascular Diseases Supplements
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    ABSTRACT: Purpose: The logistic Euroscore (Euroscore I) has been shown to lack accuracy when applied to contemporary patients. The Euroscore II has therefore been recently proposed to improve the prediction of operative mortality, but external validations are scarce. We compared the predictive performances of the Euroscore I and II in our institution. Methods: The Euroscore I and II were was computed in 5118 consecutive patients who underwent cardiac surgery over a 5-year period. Discrimination was assessed using the c-index and calibration by comparing predicted and observed mortality. Besides the overall population we also specifically studied elderly patients (age ≥80) and patients with a body mass index (BMI) <25. Results: Mean age was 63±14 years. Mean Euroscore I was 6.8±8.7%, mean Euroscore II 4.6±6.7% and 30-day mortality 4.8% (245 patients). C-index and comparisons between predicted and observed mortality are detailed in Table 1 for the overall population and for subgroups according to age and BMI. View this table:Enlarge table
    Full-text · Article · Apr 2015 · Archives of Cardiovascular Diseases Supplements
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    ABSTRACT: To assess late outcome after transcatheter aortic valve implantation (TAVI) up to 6 years and to analyse its predictive factors with a particular emphasis on functional status. Very few data exist on the long-term results of TAVI, and these data are crucial for decision making. Between October 2006 and December 2009, 123 consecutive patients were discharged alive after TAVI in our institution. Mean age was 82±8 years, and 88% of patients were highly symptomatic in New York Heart Association (NYHA) class III-IV. Follow-up was complete in 122 patients (99%). The overall 6-year survival rate was 31%±5%, the majority of deaths being non-cardiac. Predictive factors of late mortality were the presence of lower limb arteritis (p=0.009), a higher Charlson comorbidity index (p=0.03) and post-TAVI paraprosthetic aortic regurgitation ≥2/4 (p=0.01). Late outcomes according to Valve Academic Research Consortium-2 criteria were analysed, and the 5-year event-free survival rate was 28%±4%. Finally, the rate of good functional results, defined as survival in NYHA class I or II, was 32%±5% at 5-year follow-up. In the survivors, the EQ-5D questionnaire further confirmed the benefit in terms of quality of life. About one-third of patients discharged alive after TAVI were alive at 6-year follow-up, and the survivors exhibited good functional results assessed by NYHA class and quality-of-life standardised evaluation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
    Full-text · Article · Feb 2015 · Heart (British Cardiac Society)

  • No preview · Article · Feb 2015 · EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
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    ABSTRACT: Aims The presence of intravalve hemorrhage close to calcium crystals has recently been described in calcified aortic valves histologic slides. Those hemorrhages can play a pathogenic and initiating role in calcification process but they could also be a mere consequence of the mechanical damage due to calcifications. We aimed at assessing whether iron deposits are present both in calcified valves and non calcified valves. Methods and results Aortic valves deriving from patients operated at the Bichat Hospital were consecutively (February-April 2014) included in our study (Table 1). We have developed a morphologic analysis technique in 3D whole mounts, using Perls’ blue staining for ferric iron and Alizarin red staining for calcium crystals, in situ. The valves are optically claryfied using benzyl benzoate prior to analysis. Results Ferric iron staining was positive in 18/20 (90%) non-calcified valves. Ferric iron deposits were present in 93% of calcified valves (78% in the group « severe aortic stenosis » and 100% in the group « moderate aortic stenosis »). Ferric iron deposits displayed two types of pattern: either in « close contact » with calcium crystals (74%), or located within the healthy tissue, « distant » from the calcium crystals (42,5%). Both types of pattern were concomitanly present in 30% of all calcified valves. Conclusion Our study shows that ferric iron deposits can be found in non-calcified valves, suggesting that hemorrhage are not necessarily a consequence of valve calcification. The iron deposits that are not spatially associated with calcium crystals may precede the development of calcifications, possibly playing an active role. Abstract 0428 – Table: Baseline characteristicsType of procedureNb (men)Mean age, yearsMean gradient,mmHgMacroscopically calcified valvesAortic valve replacement45 (22)72,546,745Severe aortic stenosis40 (18)7349,540Moderate aortic stenosis5(4)71,5255Bentall procedure16 (14)53–2Explanted heart4 (4)62–0
    No preview · Article · Jan 2015 · Archives of Cardiovascular Diseases Supplements
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    ABSTRACT: This study sought to evaluate the feasibility of transfemoral transcatheter heart valve (THV) implantation in failed mitral bioprostheses and ring annuloplasties. Redo mitral surgery may be high risk or contraindicated due to comorbidity. THV implantation has been recently reported in this setting. Transfemoral implantation of Edwards Sapien prosthesis was performed in 17 patients for degenerated mitral bioprosthesis or previous ring annuloplasty (6 bioprostheses, 11 ring annuloplasties). The procedure was elective for 14 patients and attempted as a rescue in 3 patients. Mean age was 61 ± 24 years. All patients were in New York Heart Association class ≥III, and the surgical risk was high (EuroSCORE [European System for Cardiac Operative Risk Evaluation]: 37 ± 29%, Society of Thoracic Surgeons score: 18 ± 22%). Procedure was successful in 14 patients (82%). Two complications occurred during rescue procedures: 1 procedural death and 1 THV migration. One patient had moderate paraprosthetic regurgitation following the procedure, whereas residual regurgitation was trace or less in 11 patients (69%) and mild in 4 patients (25%). Mean gradient decreased from 12 ± 6 mm Hg to 8 ± 3 mm Hg. During a mean follow-up of 22 months, 4 patients died, 3 from cardiac cause. The 18-month survival was 68 ± 14% in the overall population and 78 ± 14% for patients with elective procedure. One patient underwent mitral valve replacement due to periprosthetic mitral regurgitation. At last follow-up, 12 patients were in New York Heart Association class ≤II (75%) and 4 in class III (25%). This single-center series suggests that transfemoral THV implantation for deterioration of mitral bioprosthesis or surgical repair is feasible in selected patients and improves early hemodynamic and midterm functional status. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
    Full-text · Article · Jan 2015 · JACC Cardiovascular Interventions
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    Full-text · Article · Dec 2014 · Journal of the American College of Cardiology
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    ABSTRACT: BACKGROUND: An 83-year-old woman was refferred to our dedicated out-patient clinic for evaluation fo the feasibility of trancather mital valve-in-valve implantation. She wa heavily symptomatic for dyspnoea, and was not a candidate for conventional surgeyr (logistic EuroScore 54.27%). The pre-porocedural evluation confirmed the presence of a severrly degenerated 27 mm Carpentier-Edwards porcine mitral bioprosthesis, and revealed the presence of a severely degenerated, malfunctioning 21 mm Sorin Mitroflow aortic bioprosthesis. INVESTIGATION: Clinical assessment, echocardiography cardiac catheterisation including coronary angiogram and aortography during balloon aortic valvulopathy (BAV), cardiac CT. DIAGNOSIS: Structural valve degeneration of the mitral bioprosthesis causing severe mitral stenosis and moderate to severe mitral regurgitation. Structural valve degeneration of the aortic bioprosthesis casuing severe aortic stenosis and severe aortic regurgitation. Tricuspid regurgitation. Pulmonary hypertension. Chronic renal failure. Patency of the coronary arteries during BAV. TREATMENT: Staged transapical mitral valve-in-valve implantation with a 26 mm Edwards SAPIEN valve and percutaneous aortic valve-in-valve implantation with a 23 mm Medtronic CoreValve.
    No preview · Article · Sep 2014 · EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
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    ABSTRACT: Background Bleeding originating in the gastrointestinal (GI) tract is one of the most common adverse events after left ventricular assist device (LVAD) implantation. In these patients, GI bleeding appears to be the consequence of altered hemostasis on the one hand and alterations of the GI microvasculature on the other.Case ReportWe report the case of a patient who suffered repeated, severe GI bleeding early after implantation of a HeartMate II continuous-flow LVAD.ResultsAfter failure of conventional treatment strategies, GI bleeding was controlled using repeated transfusions of a purified von Willebrand factor (VWF) concentrate, almost devoid of Factor VIII (Wilfactin, LFB). No episodes of pump thrombosis were noted. Subsequent to VWF transfusions, we observed a progressive normalization of circulating vascular endothelial growth factor levels.Conclusions Our data raise the possibility that, in addition to its hemostatic properties, transfusions of VWF might have acted as an antiangiogenic factor.
    No preview · Article · Aug 2014 · Transfusion
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    ABSTRACT: BACKGROUND: The Logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) and the Society of Thoracic Surgeons (STS) score are routinely used to identify patients at high surgical risk as potential candidates for transcatheter aortic valve implantation (TAVI). AIMS: To compare the new EuroSCORE II with the Logistic EuroSCORE and the STS score. METHODS: From October 2006 to June 2011, patients with severe symptomatic aortic stenosis who underwent a TAVI were enrolled prospectively. RESULTS: Among 272 patients, the EuroSCORE II was significantly lower and moderately correlated with the Logistic EuroSCORE (9±8% vs. 23±14%, P<0.01; r=0.61, P<0.001), but similar to and poorly correlated with the STS (10±9%, P=0.10; r=0.25, P<0.001). Based on recommended high-risk thresholds (Logistic EuroSCORE≥20%; STS≥10%), a EuroSCORE II≥7% provided the best diagnostic value. However, using the EuroSCORE II, Logistic EuroSCORE or STS score, only 51%, 58% and 37% of patients, respectively, reached these thresholds. Contingency analyses showed that agreements between the EuroSCORE II and the Logistic EuroSCORE or the STS score were modest or poor, respectively, with a risk assessment different in 28% and 36% of patients, respectively. CONCLUSIONS: A EuroSCORE II≥7% corresponded to a Logistic EuroSCORE≥20% or STS score≥10%, but correlations and agreements were at best modest and only approximately half of the patients reached these thresholds. Our results highlight the limits of current scoring systems and reinforce the European guidelines stressing the importance of clinical judgment in addition to risk scores.
    No preview · Article · Jul 2014 · Archives of cardiovascular diseases
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    ABSTRACT: Mitral insufficiency is a frequently occurring valvular disease for which surgery is the reference treatment. A large number of patients are at high risk or even contraindicated for surgery due to comorbidities. The MitraClip procedure reproduces a surgical technique for mitral valve repair. Global experience includes over 12,000 patients and has been mainly reported in registries with limited follow-up. The degree of reduction of mitral insufficiency is less with the MitraClip than with surgery. Safety of the procedure is good in experienced centres. Most patients have functional improvement in the mid-term. The procedure may be considered in patients who are at high risk for surgery and remain symptomatic despite optimal medical treatment. In the future, more data are needed from longer follow-up and randomised trials. Both the technique and the equipment used in the procedure need to improve. In addition, it is hoped that combined percutaneous procedures will be available in the near future.
    No preview · Article · May 2014 · La Presse Médicale
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    Full-text · Article · May 2014 · JACC Cardiovascular Interventions
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    ABSTRACT: Mitral insufficiency is a frequently occurring valvular disease for which surgery is the reference treatment. A large number of patients are at high risk or even contraindicated for surgery due to comorbidities. The MitraClip procedure reproduces a surgical technique for mitral valve repair. Global experience includes over 12,000 patients and has been mainly reported in registries with limited follow-up. The degree of reduction of mitral insufficiency is less with the MitraClip than with surgery. Safety of the procedure is good in experienced centres. Most patients have functional improvement in the mid-term. The procedure may be considered in patients who are at high risk for surgery and remain symptomatic despite optimal medical treatment. In the future, more data are needed from longer follow-up and randomised trials. Both the technique and the equipment used in the procedure need to improve. In addition, it is hoped that combined percutaneous procedures will be available in the near future.
    No preview · Article · Jan 2014
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    ABSTRACT: Aims: We report a case of emergency transcatheter heart valve implantation in a failing mitral bioprosthesis via a transseptal access complicated by the atrial migration of a prosthesis. Methods and results: A 42-year-old woman was referred for stenotic failure of a mitral bioprosthesis. A transapical valve-in-valve implantation was initially planned. However, due to sudden haemodynamic deterioration, an emergency transseptal implantation via a femoral venous access was undertaken. Following cardiac arrest, the procedure was performed with extracorporeal membrane oxygenation (ECMO), and was complicated by the migration of a valve, which was left moving freely in the left atrium. A second valve was successfully implanted in the mitral bioprosthesis. Following initial clinical recovery, there was a sudden recurrence of heart failure due to entrapment of the migrated valve in the implanted valve in a "reverse position", which was dislodged percutaneously in an emergency procedure. The valve later migrated into the left atrial appendage. Immediate outcome was uneventful, but the patient suddenly died six months later. Conclusions: Transseptal transcatheter mitral valve-in-valve implantation is feasible, even in an emergency setting with ECMO. Valve migration in the left atrium may occur and lead to late entrapment in a "reverse position", with significant haemodynamic consequences.
    Full-text · Article · Sep 2013 · EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
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    ABSTRACT: In selected high-risk patients with aortic stenosis, transcatheter aortic valve implantation (TAVI) can provide comparable functional improvement and early survival after surgical aortic valve replacement. However, the long-term outcome after TAVI is still to be determined and the occurrence of aortic dissection has not been systematically reported. Herein, a case is presented of delayed aortic dissection and rupture several months after an uneventful TAVI in a patient with bicuspid aortic valve stenosis.
    No preview · Article · Sep 2013 · The Journal of heart valve disease
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    ABSTRACT: Peripheral venoarterial extracorporeal membrane oxygenation support provides prolonged support in the event of acute or acute-on-chronic cardiac and/or respiratory failure. This support serves as a bridge to recovery, decision-making, heart transplantation or ventricular-assist device implantation. It can be implanted either through a percutaneous approach using Seldinger's technique or via an open approach via the common femoral artery or the axillary artery. Early and late arterial vascular complications remain an important issue, with rates of up to 28% with femoral and axillary cannulation sites. Among them, limb ischemia requires prompt diagnosis and management to avoid limb amputation. In the case of peripheral artery cannulation, ipsilateral distal limb perfusion to prevent acute limb ischemia can be performed via a single lumen catheter through the artery or via the 'chimney graft' technique during extracorporeal membrane oxygenation implantation.
    No preview · Article · Jul 2013 · Future Cardiology

Publication Stats

4k Citations
422.50 Total Impact Points

Institutions

  • 2008-2015
    • Paris Diderot University
      Lutetia Parisorum, Île-de-France, France
    • Assistance Publique – Hôpitaux de Paris
      • Department of Cardiology
      Lutetia Parisorum, Île-de-France, France
  • 2010-2014
    • University of Paris-Est
      La Haye-Descartes, Centre, France
  • 2007-2013
    • Hôpital Bichat - Claude-Bernard (Hôpitaux Universitaires Paris Nord Val de Seine)
      • Service de Cardiologie
      Lutetia Parisorum, Île-de-France, France
  • 1992-2012
    • Hôpitaux Universitaires La Pitié salpêtrière - Charles Foix
      Lutetia Parisorum, Île-de-France, France
  • 2011
    • Centre Hospitalier Universitaire de Dijon
      Dijon, Bourgogne, France
  • 2006
    • Claude Bernard University Lyon 1
      Villeurbanne, Rhône-Alpes, France
  • 1998
    • Loma Linda University
      • Department of Cardiovascular and Thoracic Surgery
      Loma Linda, California, United States