François Roubertie

Université Victor Segalen Bordeaux 2, Burdeos, Aquitaine, France

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Publications (43)92.73 Total impact

  • Xavier Iriart · François Roubertie · Zakaria Jalal · Jean-Benoit Thambo
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    ABSTRACT: Improvements in cardiac imaging have recently focused a great interest on the right ventricle (RV). In patients with congenital heart disease, the right ventricle (RV) may support the systemic circulation (systemic RV). There are 2 different anatomic conditions providing such physiology: the congenitally corrected transposition of the great arteries (ccTGA) and the TGA surgically corrected by atrial switch. During the last decades, evidence is accumulating that progressive systemic RV failure develops leading to considerable morbidity and mortality. Various imaging modalities have been used to evaluate the systemic RV, but echocardiography is still predominantly used in clinical practice, allowing an anatomic and functional approach of the systemic RV function and the potential associated anomalies. The goal of this review is to offer a clinical perspective of the non-invasive evaluation of the systemic RV by echocardiography.
    No preview · Article · Feb 2016 · Archives of cardiovascular diseases

  • No preview · Article · Feb 2016
  • Pierre-Emmanuel Séguéla · François Roubertie · Jean-Benoit Thambo
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    ABSTRACT: Injury of the left main coronary artery may sometimes complicate a pulmonary valve replacement (PVR). We present the case of a 39-year-old man, with post-operative distortion of the left anterior descending coronary artery, which caused onset of ventricular arrhythmia associated with electrocardiographic signs of myocardial ischemia. A coronary angiogram revealed the cause of the lesion. Stenting the coronary artery restored normal coronary blood flow and improved the patient's condition. Through this case, we describe a new life-threatening complication after PVR.
    No preview · Article · Nov 2015 · Catheterization and Cardiovascular Interventions
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    ABSTRACT: Surgical repair of Tetralogy of Fallot (TOF) is highly successful but may be complicated in adulthood by arrhythmias, sudden death, and right ventricular or biventricular dysfunction. To better understand the molecular and cellular mechanisms of these delayed cardiac events, a chronic animal model of postoperative TOF was studied using microarrays to perform cardiac transcriptomic studies. The experimental study included 12 piglets (7 rTOF and 5 controls) that underwent surgery at age 2 months and were further studied after 23 (+/- 1) weeks of postoperative recovery. Two distinct regions (endocardium and epicardium) from both ventricles were analyzed. Expression levels from each localization were compared in order to decipher mechanisms and signaling pathways leading to ventricular dysfunction and arrhythmias in surgically repaired TOF. Several genes were confirmed to participate in ventricular remodeling and cardiac failure and some new candidate genes were described. In particular, these data pointed out FRZB as a heart failure marker. Moreover, calcium handling and contractile function genes (SLN, ACTC1, PLCD4, PLCZ), potential arrhythmia-related genes (MYO5B, KCNA5), and cytoskeleton and cellular organization-related genes (XIRP2, COL8A1, KCNA6) were among the most deregulated genes in rTOF ventricles. To our knowledge, this is the first comprehensive report on global gene expression profiling in the heart of a long-term swine model of repaired TOF.
    Full-text · Article · Aug 2015 · PLoS ONE
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    ABSTRACT: We used the Medtronic Freestyle valve (Medtronic, Minneapolis, MN) as an orthotopic conduit in pulmonary valve replacement in repaired tetralogy of Fallot and as part of the Ross procedure. Midterm outcomes and hemodynamic status of this conduit were analyzed and performances in both subgroups were compared. From February 2002 to July 2012, 115 Freestyle valves were implanted in 52 patients with tetralogy of Fallot and 63 patients within the Ross procedure. Preoperative and perioperative data were reviewed retrospectively in this bicentric study. Mean age at valve surgery was 37 ± 13 years. Median implanted valve size was 27 mm (21 to 29). Early postoperative mortality was 3.48%. There was 100% follow-up for the survivors at a mean of 4.38 ± 2.52 years. There was 1 case of thromboembolism (0.89%), 6 endocarditis (5.4%), and 9 (7.8%) conduit re-interventions. Echocardiography at discharge and last follow-up showed average peak systolic transvalvular gradients of 12.4 ± 5.1 and 18.7 ± 8.8 mm Hg, respectively. Ten patients had significant proximal anastomotic gradients of greater than 50 mm Hg and 4 moderate conduit regurgitations. Survival was 96.52%. No valve degeneration was seen in 87.82% at 5 years. The only risk factor identified for valve re-intervention was conduit implantation without infundibular hood (p = 0.01 in multivariate analysis). Mid-term data show that Freestyle valves are well suited for pulmonary valve replacement in adults in both categories. The surgical technique used in valve implantation is important to ensure conduit durability. These results and accessibility to the Freestyle valve make this an acceptable alternative to homografts. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
    No preview · Article · Jul 2015 · The Annals of thoracic surgery

  • No preview · Article · Jan 2015 · Archives of Cardiovascular Diseases Supplements

  • No preview · Article · Jan 2015 · Archives of Cardiovascular Diseases Supplements
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    ABSTRACT: Uncommonly, adults with functionally univentricular hearts are becoming candidates for a Fontan procedure. The purpose of this study was to evaluate the course of patients undergoing the modified Fontan procedure with an extracardiac conduit in recent years. Between January 2003 and December 2013, 32 adult patients (17 female and 15 male) underwent total cavopulmonary connection (TCPC) with extracardiac conduit. The median age at procedure was 24.5 years (interquartile range [IQR] 20 to 33 years). The diagnoses included double-inlet left ventricle (DILV) in 10 patients (31.2%), tricuspid atresia in 8 patients (25%), double-outlet right ventricle in 4 patients (12.5%), heterotaxia in 4 patients (12.5%), and mitral atresia in 2 patients (6.2%). Seventy-eight percent of patients had undergone at least one prior palliative procedure; the most common procedures were Blalock-Taussig shunt (16 patients), superior cavopulmonary shunt (12 patients), and pulmonary artery banding (6 patients). All patients underwent cardiac catheterization preoperatively. Aortic cross-clamping was necessary in 15 patients for intracardiac procedures. Fenestration was required in 9 patients (28%). Four concomitant intraoperative cryoablation procedures were performed. There was no hospital mortality. One patient (3.1%) died 6 months after undergoing TCPC. Morbidities included prolonged pleural effusion lasting more than 7 days in 20 patients (62.5%), atrial arrhythmias in 4 patients (12.5%), and permanent pacemakers in 3 patients (9.3%). The median follow-up time was 33 months (interquartile range [IQR], 10.5 to 50 months). Actuarial survival was 91.83% (95% confidence limits, 71.07 to 97.89) at 1 year and 5 years. Ninety-two percent of patients were in New York Heart Association class I or II at follow-up. The median postoperative oxygen saturation was 95% (IQR, 93% to 95.5%). Cardiac arrhythmia occurred in 4 patients. Systolic ventricular function improved during follow-up for all patients except 1 patient, who underwent cardiac transplantation 7 months after the TCPC. The modified Fontan procedure with use of an extracardiac conduit can be performed in adults with encouraging early and midterm results. The majority of late survivors had improved quality of life. The incidence of late death, reoperation, arrhythmias, and thromboembolic events was low during follow-up. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
    No preview · Article · Dec 2014 · The Annals of Thoracic Surgery
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    ABSTRACT: An aortopulmonary window (APW) associated with an interrupted aortic arch (IAA) can be associated with significant rates of perioperative mortality and recurrent arch obstruction. We assessed the outcomes associated with the use of a single pericardial patch technique for primary repair. Between 2002 and 2011, 9 neonates and 2 infants with APW and IAA underwent single-stage repair, under a hypothermic (28°C) continuous cardiopulmonary bypass with antegrade selective cerebral perfusion. A single autologous pericardial patch (glutaraldehyde-fixed) was used both to augment the IAA end-to-side anastomosis and to close the APW by use of the "sandwich" technique. The IAA was type A in 6 patients and type B in 5 patients. The APW morphology was type I in 6 patients, type II in 4 patients, and type III in 1 patient. The median age and weight at operation were 11 days (range, 6 to 180 days) and 2.6 kg (range, 2.2 to 6.5 kg), respectively. The mean cardiopulmonary bypass and aortic cross-clamp times were 108.6 ± 27.5 minutes and 49.3 ± 13.4 minutes, respectively. One patient required additional closure of a ventricular septal defect. Delayed sternal closure was performed in 8 patients. The mean follow-up time was 6 ± 3 years. There were no early and no late deaths. Postoperative morbidity consisted of one postoperative stroke with no late sequelae. There were no reoperations. The last follow-up visits confirmed the absence of recurrent aortic arch obstruction and pulmonary artery branch stenosis in all patients. Primary anatomic repair of APW associated with IAA can be safely performed. The efficiency of the single-patch technique was confirmed by the restoration of normal functional anatomy of the great arteries and aortic arch during follow-up. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
    No preview · Article · Nov 2014 · The Annals of Thoracic Surgery
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    ABSTRACT: Evaluation of the right ventricle (RV) using transthoracic echocardiography is challenging in patients with repaired tetralogy of Fallot (rTOF). To evaluate the accuracy of conventional echocardiographic variables and real-time three-dimensional echocardiography (RT3DE) in assessing right ventricular (RV) volumes and function compared with magnetic resonance imaging (MRI), in adult patients with rTOF and referred for pulmonary valve replacement (PVR). Complete echocardiography was performed on 26 consecutive patients referred for PVR, before and 1 year after surgery. All variables were compared with MRI. Correlations between conventional variables and MRI were absent or poor when assessing RV ejection fraction (RVEF), except for fractional area of change (FAC; r=0.70, P<0.01 before PVR; r=0.68, P<0.01 after PVR) and RT3DE (r=0.96, P<0.01 before PVR; r=0.98, P<0.01 after PVR). The RV volume correlation between RT3DE and MRI was excellent before and after surgery for RV end-diastolic volume (r=0.88, P<0.01 and r=0.91, P<0.01, respectively) and RV end-systolic volume (r=0.92, P<0.01 and r=0.95, P<0.01, respectively). The accuracy of these indices, as a diagnostic test for impaired RV (<45%), was good: Youden's indexes varied from 0.47 to 0.89; areas under the receiver operating characteristic curve before and after PVR were 0.86 and 0.81 for FAC and 0.98 and 0.97 for RT3DE, respectively. Commonly used echocardiography variables, such as tricuspid annular plane systolic excursion and tricuspid annular peak systolic velocity, did not sensitively evaluate global RVEF. A global approach, that includes the whole RV and integration of its different components, was more reliable in patients with rTOF. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
    Preview · Article · Nov 2014 · Archives of Cardiovascular Diseases
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    ABSTRACT: Background Aortic valve replacement and management of complex left ventricular outflow tract obstruction in early life remains a surgical challenge. We assessed our experience with the Ross-Konno procedure. Methods Since 2000, 49 consecutive patients (24 neonates and infants) underwent the Ross-Konno procedure. Anatomic and clinical risk factors were analyzed. Results Median age was 12.2 months (0.0 to 194.4); 82% had previous valvotomy (surgical, n = 26; balloon, n = 7; balloon then surgical, n = 7) and 35% preceding arch repair (n = 17). Fifteen patients (31%) required concomitant procedures: mitral valve repair (n = 11), replacement (n = 1), endocardial fibroelastosis resection (n = 4), and aortic arch repair (n = 2). There were 5 hospital deaths (10.2%). Median follow-up was 63 ± 47 months. There were 4 late deaths (8.1%), all because of persistent pulmonary hypertension despite subsequent mitral procedures. Five-year actuarial survival and freedom from reoperation were 79.7% ± 6.1% and 68.6% ± 9.3%, respectively. Preoperative lower shortening fraction (p = 0.005) was associated with early mortality, while concomitant mitral surgery and pulmonary hypertension (p = 0.002) were associated with late mortality. Sixteen patients underwent 26 reoperations. Autograft function was normal in 30 of the 37 late survivors (81.1%), 4 (10.8%) had grade 2 regurgitation, and 3 (8.1%) required valve replacement. Conclusions Ross-Konno in children remains a high-risk procedure. Preoperative ventricular dysfunction is associated with significant early mortality and should favor conservative options. Mitral involvement substantially affects late outcome, survival for these patients relies on the efficacy in relieving mitral disease. Efforts to improve mitral repair in these infants are critically required as an alternative to univentricular pathways.
    No preview · Article · Oct 2014 · The Annals of Thoracic Surgery

  • No preview · Article · Jul 2014 · European Heart Journal – Cardiovascular Imaging
  • François Roubertie · Roland Henaine · Xavier Roques · Jean-Benoît Thambo
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    ABSTRACT: Pulmonary valve replacement in adults who have a repaired tetralogy of Fallot is realized through a redo median sternotomy. A dilated ascending aorta is often present and adherent to the sternum and can be injured during sternum reentry, with dramatic consequences. We report on an adult patient with a corrected tetralogy of Fallot who underwent pulmonary valve replacement, thick transannular patch excision, and left pulmonary artery enlargement. Surgery was performed through a left posterolateral thoracotomy. This surgical approach was safe and efficient and, compared with the left anterior thoracotomy approach, offered many more possibilities.
    No preview · Article · Feb 2014 · The Annals of thoracic surgery
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    Arnaud Rodriguez · François Roubertie · Matthieu Thumerel · Jacques Jougon
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    ABSTRACT: We report a case of metastatic chondrosarcoma to the lung that invaded the right inferior pulmonary vein with massive cardiac extension and presented with an acute heart failure. CT scan showed a large mass of the right lower lobe which invaded and filled almost all the left atrium with an extension into left ventricle through the mitral valve. Surgical resection was performed in emergency. The patient is still alive 4 months after development of cardiac symptoms and surgery.
    Full-text · Article · Sep 2013 · European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery
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    ABSTRACT: Open-heart surgery can result in adhesions, which can complicate resternotomy. To document the occurrence of adhesions after the use of a new collagen membrane; to evaluate its tolerability; and to compare surgical parameters with control patients. Paediatric patients who underwent cardiac surgery with the collagen membrane (Cova™ CARD; Biom'up, Saint Priest, France) were analysed retrospectively for levels of adhesion and tolerability. The times of dissection and intervention and the transfusion of packed red blood cells and haemostatic products were compared to a historic cohort who did not receive an anti-adhesion device. From January 2010 to December 2011, 36 patients received a collagen membrane. Nineteen re-interventions were performed, after a mean of 169days. No grade 3 adhesions were observed and no tolerability problems were reported. During re-interventions after more than 30days, the propensity score-adjusted durations of dissection and the total process for patients with and without a collagen membrane were 32 vs 41minutes and 151 vs 182minutes, respectively (not significant). The mean quantities of red blood cells and biological glue administered in the two groups were 98 vs 139mL and 1.2 vs 0.5mL, respectively (not significant). This feasibility study shows the potential use of the new membrane in paediatric patients, both in terms of prevention from severe adherence and tolerability. This is the first study of this membrane in humans. A prospective, controlled study is necessary to provide strong evidence of its efficiency.
    Full-text · Article · Jul 2013 · Archives of cardiovascular diseases

  • No preview · Article · Jul 2013 · The Journal of thoracic and cardiovascular surgery
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    Preview · Article · Jan 2013 · Archives of Cardiovascular Diseases Supplements
  • Z. Jalal · F. Camou · F. Roubertie · X. Iriart · J.-B. Thambo
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    ABSTRACT: We report a case of a 12 year old child with a ventricular septal defect (VSD) and right-sided MRSA endocarditis complicated by pulmonary septic emboli. The patients was treated successfully with daptomycin in combination with gentamicin and rifampin, followed by surgery to excise the vegetation and close the VSD.
    No preview · Article · Jan 2013
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    ABSTRACT: Background: Total cavopulmonary connection (TCPC) has not been studied in adults. We investigated early and midterm morbidity and mortality in adults undergoing TCPC and assessed risk factors for mortality. Methods: Between June 1994 and October 2010, 30 adults (21.3 ± 5.5 years) underwent TCPC (extracardiac conduit). Twenty-two patients who had palliated single ventricles underwent TCPC completions and 8 patients underwent TCPC conversions. Preoperative and perioperative data were reviewed retrospectively. Results: Six of 9 patients with preoperative atrial flutter or fibrillation or intraatrial reentry tachycardia were treated in the catheterization room. An aortic cross-clamp was necessary in 12 patients, and 16 TCPCs were fenestrated. Mean follow-up was 51 months (range, 4-198 months). Early mortality was 10%: 2 of 8 conversions and 1 of 22 completions. There was 1 late conversion death (at 56 months postoperatively). Postoperatively, 4 patients required pacemakers and 1 patient required long-term antiarrhythmic medication, but no heart transplantations were necessary. Risk factors for early mortality were arrhythmia (p = 0.02), aortic cross-clamp (p = 0.054), and extracorporeal circulation in hypothermia (p = 0.03). Risk factors for overall mortality were conversion (p = 0.047), absence of fenestration (p = 0.036), surgery before January 2006 (p = 0.036), aortic cross-clamp (p = 0.018), extracorporeal circulation in hypothermia (p = 0.008), and arrhythmia (p = 0.005). New York Heart Association functional class had improved at the last follow-up: preoperatively, 17 patients were in class II and 12 patients were in class III versus 18 patients in class I and 9 patients in class II postoperatively (p < 0.001). At the last clinical visit, systemic ventricular function was maintained, and no late supraventricular arrhythmia was found. Conclusions: Early and midterm TCPC results for adults are encouraging for completion but are disappointing for conversion. Identified risk factors for mortality should improve patient selection for TCPC.
    No preview · Article · Dec 2012 · The Annals of thoracic surgery
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    Roland Henaine · François Roubertie · Mathieu Vergnat · Jean Ninet
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    ABSTRACT: Valvular pathology in infants and children poses numerous challenges to the paediatric cardiac surgeon. Without question, valvular repair is the goal of intervention because restoration of valvular anatomy and physiology using native tissue allows for growth and a potentially better long-term outcome. When reconstruction fails or is not feasible, valve replacement becomes inevitable. Which valve for which position is controversial. Homograft and bioprosthetic valves achieve superior haemodynamic results initially but at the cost of accelerated degeneration. Small patient size and the risk of thromboembolism limit the usefulness of mechanical valves, and somatic outgrowth is an universal problem with all available prostheses. The goal of this article is to address valve replacement options for all four valve positions within the paediatric population. We review current literature and our practice to support our preferences. To summarize, a multitude of opinions and surgical experiences exist. Today, the valve choices that seem without controversy are bioprosthetic replacement of the tricuspid valve and Ross or Ross-Konno procedures when necessary for the aortic valve. On the other hand, bioprostheses may be implanted when annular pulmonary diameter is adequate; if not or in case of right ventricular outflow tract discontinuity, it is better to use a pulmonary homograft with the Ross procedure. Otherwise, a valved conduit. Mitral valve replacement remains the most problematic; the mechanical prosthesis must be placed in the annular position, avoiding oversizing. Future advances with tissue-engineered heart valves for all positions and new anticoagulants may change the landscape for valve replacement in the paediatric population.
    Preview · Article · Oct 2012 · Archives of cardiovascular diseases

Publication Stats

234 Citations
92.73 Total Impact Points

Institutions

  • 2015
    • Université Victor Segalen Bordeaux 2
      Burdeos, Aquitaine, France
  • 2009-2015
    • University of Bordeaux
      Burdeos, Aquitaine, France
  • 2010-2014
    • Université Paris-Sud 11
      Orsay, Île-de-France, France
  • 2009-2014
    • Centre Chirurgical Marie Lannelongue
      Plessis-Robinson, Île-de-France, France
  • 2013
    • Hospices Civils de Lyon
      Lyons, Rhône-Alpes, France
  • 2012
    • Maastricht University
      Maestricht, Limburg, Netherlands
  • 2008-2009
    • Université René Descartes - Paris 5
      • Faculté de Médecine
      Lutetia Parisorum, Île-de-France, France