J R Monties

Aix-Marseille Université, Marsiglia, Provence-Alpes-Côte d'Azur, France

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Publications (197)183.88 Total impact

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    ABSTRACT: Giant cerebral aneurysms may be untreatable by conventional neurosurgical techniques. Early attempts to use circulatory assistance and deep hypothermia were abandoned due to hemorrhagic complications. More recently, interest in circulatory support for complex neurosurgical procedures has been renewed. A consecutive series of 8 patients were operated on for giant cerebral aneurysms with the combined use of deep hypothermia. The protocol included careful preoperative cardiovascular assessment, perfect intraoperative synergy between neurosurgical and cardiac teams, minimally invasive peripheral vascular access including two femoral vein (21 F) and single arterial (17 F) femoral cannulation, use of total Carmeda coating on BioMedicus pumps in closed circuits, and reduced heparinization without Protamine reversal. All cerebral aneurysms were successfully treated through deep hypothermia (15–18°C) as assessed by intraoperative fluoroscopic controls and Doppler vascular assessment. Mean circulatory support time was 174.2 ± 29.6 min. Circulatory arrest period was 20 ± 12 min. All patients survived and were extubated within 48 h. No major deficit was observed clinically or on postoperative CT scan. No hemorrhagic complications occurred (mean transfusions was 2.2 blood units). This work supports an extensive use of heparin-coated surfaces for complex circulatory assist techniques, either for cardiac or extra cardiac complex procedures.
    No preview · Article · Dec 2001 · Artificial Organs
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    ABSTRACT: We previously showed that the risk of reoperation for structural degeneration of bioprostheses was higher in cases involving patients older than 65 years (p = 0.003) and double-valve replacement (p = 0.02). The purpose of this study was to compare late outcome of mitral-aortic valve replacement using bioprostheses or mechanical valves. The bioprosthesis group included all mainland France residents (n = 48) between 55 and 65 years old operated on between 1980 and 1995 for mitral-aortic valve replacement using bioprostheses. The mechanical valve group was obtained by matching each of these patients with a patient operated on using mechanical valves at approximately the same time during the study. In the bioprosthesis group, 10-year survival was 45%+/-8% versus 62%+/-7% in the mechanical valve group (not significant). The linearized reoperation rate was 6.8 per patient-year versus 1.1 per patient-year (p = 0.001), and the linearized reoperative mortality rate was 1.8 per patient-year and 0.7 per patient-year (not significant), respectively. The reoperative mortality risk after mitral-aortic valve replacement using two bioprostheses does not significantly decrease overall survival after age 65 years.
    No preview · Article · Jun 2001 · The Annals of Thoracic Surgery
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    ABSTRACT: The aim of this study was to demonstrate the clinical and biological benefits of heparin-coated circuits in routine coronary artery bypass grafting (CABG). A prospective, randomized study was conducted in 80 patients undergoing routine CABG. Patients were randomized to either noncoated circuits (Group 1) or heparin-coated circuits (Group 2). A complete clinical evaluation was performed preoperatively at Days 0, 1, 2, and 3 and at discharge day and combined with extensive laboratory tests for hemostasis and inflammatory response. This study did not prove any major statistically significant clinical benefit of heparin-coated circuits in low risk patients. Postoperative bleeding, significantly less in the heparin-coated group, did not decrease significantly the number of transfused patients. Biological values were not changed significantly except for factor II and monocytes, which were higher in Group 2. Heparin-coated circuits offer minimal clinical and biological benefits for routine CABG surgery. However, they may prove beneficial for complex procedures or at-risk patients.
    No preview · Article · Sep 2000 · Artificial Organs
  • T Mesana · F Collart · T Caus · C Pomane · N Graziani · N Bruder · H Dufour · F Grisoli · J R Montiès
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    ABSTRACT: Giant cerebral aneurysms may be untreatable by conventional neurosurgical techniques. Early attempts to use circulatory assistance and deep hypothermia were abandoned due to hemorrhagic complications. More recently, interest in circulatory support for complex neurosurgical procedures has been renewed. A consecutive series of 8 patients were operated on for giant cerebral aneurysms with the combined use of deep hypothermia. The protocol included careful preoperative cardiovascular assessment, perfect intraoperative synergy between neurosurgical and cardiac teams, minimally invasive peripheral vascular access including two femoral vein (21 F) and single arterial (17 F) femoral cannulation, use of total Carmeda coating on BioMedicus pumps in closed circuits, and reduced heparinization without Protamine reversal. All cerebral aneurysms were successfully treated through deep hypothermia (15-18 degrees C) as assessed by intraoperative fluoroscopic controls and Doppler vascular assessment. Mean circulatory support time was 174.2 +/- 29.6 min. Circulatory arrest period was 20 +/- 12 min. All patients survived and were extubated within 48 h. No major deficit was observed clinically or on postoperative CT scan. No hemorrhagic complications occurred (mean transfusions was 2.2 blood units). This work supports an extensive use of heparin-coated surfaces for complex circulatory assist techniques, either for cardiac or extra cardiac complex procedures.
    No preview · Article · Jul 2000 · Artificial Organs
  • T Caus · J N Albertini · Y Chi · F Collart · J R Monties · T Mesana
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    ABSTRACT: The study aim was to analyze the results of reoperations for structural degeneration of bioprostheses, and to define a high-risk population for reoperative procedures. A series of 524 consecutive patients who had undergone a first reoperative replacement for a failed bioprosthesis between 1978 and 1998 was reviewed retrospectively. The reoperative procedure comprised 363 single valve replacements, and 161 multiple valve replacements. During the original procedure, 648 bioprostheses had been implanted in the mitral (n = 403), aortic (n = 220) and tricuspid (n = 25) positions. The mean interval between the original procedure and reoperation was 8.8 +/- 3.3 years. Tissue valve failure was revealed by recurrence of cardiac insufficiency in 70% of cases. The overall early mortality rate was 8%, but early mortality rates for elective single mitral and aortic reoperative valve replacements were only 3.9% and 4%, respectively. Early mortality following reoperation for single and multiple valve replacement was 6.0% and 12.4% respectively (p = 0.02). Other significant multivariable predictors for early mortality were old age (p = 0.003), NYHA functional class (p = 0.007), presence of ascites (p = 0.02) and reoperation performed before 1988 (p = 0.013). The risk of reoperation for structural degeneration of bioprostheses is acceptable for elective single reoperative valve replacement as opposed to multiple reoperative valve replacement. This may limit the use of bioprostheses during the original procedure when multiple valve replacement is required.
    No preview · Article · Aug 1999 · The Journal of heart valve disease
  • J R Montiès · T Mesana

    No preview · Article · Jul 1998 · Artificial Organs
  • Jean‐Raoul Montiès

    No preview · Article · Jun 1998 · Artificial Organs
  • A Riberi · Th Caus · Th Mesana · A Goudard · A Mouly · G Habib · J R Monties
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    ABSTRACT: Active aortic endocarditis is a serious condition that carries a high mortality and morbidity. The aim of this study was to analyse results obtained from 24 patients who underwent aortic valve or root replacement with cryopreserved homograft for aortic endocarditis. Eleven patients had native valve endocarditis, and 13 had prosthetic valve endocarditis. The mean age was 47.7 years: there were seven women and 17 men. Causative organisms were staphylococci (12), streptococci (four), serratia (one), candida (one), pneumococci (one), while no organisms were isolated in the remaining five patients. Complete reconstruction of the aortic annulus with homograft conduits was necessary in 20 patients (six total root and 14 mini-root). Infracoronary homograft aortic valve replacement was performed in the remaining patients. One patient died 1 day after the operation from ventricular failure, and two others died after 4 and 6 months as a result of arrhythmia. One patient died of recurrent endocarditis 1 year after surgery. The actuarial survival rate at 3 years was 83.4%. All survivors are symptom-free, with no evidence of recurrent endocarditis. Doppler echocardiography showed minimal aortic regurgitation in four patients.
    No preview · Article · Jan 1998 · Cardiovascular Surgery
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    ABSTRACT: Previous studies in heart transplant patients have shown that administration of Neoral results in an increased and more consistent cyclosporin A absorption than Sandimmun.1,2,3 A consequence of this improved bioavailability is a reduction in intrapatient and interpatient variability. With Neoral there is a better correlation between trough levels and areas under the curve (AUC) therefore that trough levels reflect better exposure to cyclosporin A.4,5However Neoral is not bioequivalent to Sandimmun. The pharmacokinetic characteristics of the two formulations are different. After Neoral conversion, the modification in AUC values is higher than the change in trough level values.The aim of this study was to assess the efficacy and the safety of the switch from Sandimmun to Neoral as the doses of cyclosporin A were adjusted to achieve the same trough levels, in stable heart transplant recipients for more than one year.
    No preview · Article · Sep 1997 · Transplantation Proceedings
  • J.R. Montiès · I Dion · P Havlik · F Rouais · J Trinkl · C Baquey
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    ABSTRACT: Our group is developing a left ventricular assist device based on the principle of the Maillard-Wankel rotative compressor: it is a rotary, not centrifugal, pump that produces a pulsatile flow. Stringent requirements have been defined for construction materials. They must be light, yet sufficiently hard and rigid, and able to be machined with high precision. The friction coefficient must be low and the wear resistance high. The materials must be chemically inert and not deformable. Also, the materials must be biocompatible, and the blood contacting surface must be hemocompatible. We assessed the materials in terms of physiochemistry, mechanics, and tribology to select the best for hemocompatibility (determined by studies of protein adsorption; platelet, leukocyte, and red cell retention; and hemolysis, among other measurements) and biocompatibility (determined by measurement of complement activation and toxicity, among other criteria). Of the materials tested, for short- and middle-term assistance, we chose titanium alloy (Ti6Al4V) and alumina ceramic (Al2O3) and for long-term and permanent use, composite materials (TiN coating on graphite). We saw that the polishing process of the substrate must be improved. For the future, the best coating material would be diamond-like carbon (DLC) or crystalline diamond coating.
    No preview · Article · Aug 1997 · Artificial Organs
  • I Dion · F Rouais · Ch BAQUEY · M Lahaye · R Salmon · L Trut · J P Cazorla · P V Huong · J R Monties · P Havlik
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    ABSTRACT: The morphology of Al2O3, ZrO2/Y2O3, AIN, B4C, BN, SiC, Si3N4, TiB2, TiC, TiN ceramic, graphite and diamond powders has been studied by scanning electron microscopy (SEM) and the specific area of each powder was determined with the BET method. X-ray diffraction (XRD) investigations have been carried out in order to evaluate the crystallinity and determine the constitutive phases. The chemical composition was assessed by classical chemical analyses and by X-ray microprobe; some powders were studied by the laser micro-Raman technique. Correlations have been established between all these results.
    No preview · Article · Jun 1997 · Journal of Materials Science Materials in Medicine
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    ABSTRACT: Data from animal experiments with mechanical circulatory support systems (MCSS) performed in Groningen and Marseille over the past years were used to obtain normal values of hematological, coagulation, rheological and blood chemistry parameters in calves. These parameters were divided between two groups: a limited number of parameters necessary to assess biocompatibility properties of MCSS quickly and a more extensive number of parameters suitable for more detailed biological evaluation of blood pumps. All applied tests can be examined in calf blood as well as in human blood. Parameters were selected on clinical relevance and usefulness for standardization procedures. The obtained data were compared with normal values in human beings derived from the literature.
    No preview · Article · Sep 1996 · The International journal of artificial organs
  • J. R. Montiès · I. Dion · P. Havlik · F. Rouais · J. Trinkl · C. Baquey

    No preview · Article · Mar 1996 · ASAIO Journal
  • T Caus · M Bernard · M Sciaky · J R Monties · P J Cozzone

    No preview · Article · Mar 1996 · Transplantation Proceedings
  • M Bernard · T Caus · M Sciaky · J R Monties · P J Cozzone

    No preview · Article · Mar 1996 · Transplantation Proceedings
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    ABSTRACT: Abstract Modifications of the dias-tolic parameters pressure half-time (PHT) and isovolumic relaxation time (IVRT), recorded using cardiac Doppler echocardiography (CDE), were studied in 23 heart transplant recipients and compared to the results of 345 endomyocardial biopsies (EMB) performed on the same day. Two different protocols, analyzing respectively (1) a decrease of 20% or more in IVRT and/or PHT with respect to the mean and (2) a decrease of 20% or more in IVRT and/or PHT with respect to its preceding value, were used to evaluate the efficiency of CDE in diagnosing mild and moderate rejections. When a mild rejection was detected by EMB, a statistically significant decrease was found in the average CDE parameter values of the patient population. However, these variations were weak and did not differ from the spontaneous variations observed in each patient in the absence of rejection. Thus, it is not surprising that the sensitivity of CDE in the detection of mild rejections was very low (45 %) using the most sensitive protocol (variations of the parameters from their preceding value). We conclude that CDE alone does not seem to be sufficient to perform the noninvasive diagnosis of low-grade rejections and must be complemented by other noninvasive methods.
    No preview · Article · Feb 1996 · Transplant International
  • [Show abstract] [Hide abstract]
    ABSTRACT: Modifications of the diastolic parameters pressure half-time (PHT) and isovolumic relaxation time (IVRT), recorded using cardiac Doppler echocardiography (CDE), were studied in 23 heart transplant recipients and compared to the results of 345 endomyocardial biopsies (EMB) performed on the same day. Two different protocols, analyzing respectively (1) a decrease of 20% or more in IVRT and/or PHT with respect to the mean and (2) a decrease of 20% or more in IVRT and/ or PHT with respect to its preceding value, were used to evaluate the efficiency of CDE in diagnosing mild and moderate rejections. When a mild rejection was detected by EMB, a statistically significant decrease was found in the average CDE parameter values of the patient population. However, these variations were weak and did not differ from the spontaneous variations observed in each patient in the absence of rejection. Thus, it is not surprising that the sensitivity of CDE in the detection of mild rejections was very low (45%) using the most sensitive protocol (variations of the parameters from their preceding value). We conclude that CDE alone does not seem to be sufficient to perform the noninvasive diagnosis of low-grade rejections and must be complemented by other noninvasive methods.
    No preview · Article · Feb 1996 · Transplant International
  • A Mouly-Bandini · M Badier · C Guillot · T Caus · T Mesana · D Metras · J R Monties

    No preview · Article · Sep 1995 · Transplantation Proceedings
  • T Mesana · S Morita · J Trinkl · J.L. Demunck · T Gauthier · F Aucomte · P Havlik · J.R. Montiès
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    ABSTRACT: We tested our valveless pulsatile rotary blood pump (CORA) extensively in animals, but only as a temporary implantable left ventricular assist device. To expand the scope of future clinical applications, we recently undertook experiments to assess the feasibility of our pump for use in a standard cardiopulmonary bypass circuit. We conducted 4 experiments in adult sheep (body weight, 40 kg): 2 with CORA and 2 with the BioMedicus pump (BP) for comparison. In all experiments, a currently used extracorporeal circuit with reservoir, filter, and membrane oxygenator (Sorin monolith) was installed, and open chest extracorporeal circulation (ECC) was performed for 6 h. Hemodynamic performance and hemolysis were evaluated. CORA provided semipulsatile systemic flow at a level comparable to that of the BP. Free plasma hemoglobin levels were slightly higher with CORA, but the decrease in platelet count was the same for both devices. There was no significant difference in the extent of blood trauma. We conclude that CORA could be successfully used for ECC with an oxygenator. Negative pressure can be prevented by our specially designed control system.
    No preview · Article · Aug 1995 · Artificial Organs
  • J R Montiès · T Caus · T Mesana · C Pomane · A Mouly-Bandini · P Guez
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    ABSTRACT: Use of cardiopulmonary support (CPS) by peripheral access with a membrane oxygenator has made considerable progress as a result of the development of centrifugal pumps, percutaneous cannulation, and preheparinized circuits. We have used CPS for resuscitation in 3 cases, for recovery after cardiotomy in 6 cases (myocardial insufficiency, 4; pulmonary arterial hypertension, 1; respiratory insufficiency, 1), and after heart transplantation in 1 case. Of these 10 patients, 3 died during CPS, 5 were successfully weaned, and 2 underwent heart transplantation. Use of CPS is expanding for emergency cardiac assistance. Installation is simple and rapid. It allows recovery of organs pending more invasive and costly techniques.
    No preview · Article · Aug 1995 · Artificial Organs

Publication Stats

601 Citations
183.88 Total Impact Points

Institutions

  • 1986-2000
    • Aix-Marseille Université
      • Faculté de Médecine
      Marsiglia, Provence-Alpes-Côte d'Azur, France
  • 1996
    • Institut Hospitalo-Universitaire
      Pessac, Aquitaine, France
  • 1993
    • Université Jean Moulin Lyon 3
      Lyons, Rhône-Alpes, France
    • University of Bordeaux
      Burdeos, Aquitaine, France