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Briand, Martin.

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Briand

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Martin.

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Faculté de médecine, Université Laval

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  • PublicationRestreint
    Hemodynamic performance at rest and during exercise after aortic valve replacement : comparison of pulmonary autografts versus aortic homografts.
    (American Heart Association, 2002-09-24) Briand, Martin.; Laforest, Isabelle; Cartier, Paul C.; Pibarot, Philippe; Dumesnil, Jean G.
    Background : The Ross procedure and aortic homografts have both been shown to have superior hemodynamic performance after valve replacement, but there have been few comparisons. Methods : Sequential Doppler echocardiograms were performed up to 5 years after aortic valve replacement in 132 patients with the Ross procedure and 111 patients with an aortic homograft (AH). Measurements included assessment of valvular regurgitation and calculations of valve effective orifice area (EOA) and mean transvalvular gradients; the same measurements were also performed at the level of the pulmonary homograft in the Ross patients as well as during maximum exercise in 20 Ross patients and 14 AH patients. Results : Aortic valve hemodynamics were stable during follow-up for both procedures and values at 1 year showed larger indexed EOAs (1.77±0.45 versus 1.42±0.35 cm2/m2, P<0.001) and lower gradients (2±3 versus 4±3 mm Hg) for the Ross procedure; similar findings were also observed during exercise (1.99±0.44 versus 1.36±0.39 cm2/m2, P<0.001 and 7±3 versus 17±11 mm Hg). Prevalence and severity of aortic regurgitation were low in both groups, although 4 patients (1 Ross, 3 AH) underwent a second operation for this reason. Also, various degrees of pulmonary homograft stenosis were found in 20% of Ross patients, 4 of which underwent a second operation. Conclusion : Both procedures provide continued excellent hemodynamics of the aortic valve. The Ross procedure has a slight advantage, but this is somewhat counterbalanced by the deterioration of the pulmonary homograft in up to 20% of patients. Further studies aimed at clarifying longer-term outcomes as well as preventing pulmonary homograft stenosis with the Ross operation are clearly needed.
  • PublicationRestreint
    Hemodynamic performance during maximum exercise in adult patients with the ross operation and comparison with normal controls and patients with aortic bioprostheses
    (Elsevier, 2000-10-24) Briand, Martin.; Laforest, Isabelle; Cartier, Paul C.; Pibarot, Philippe; Dumesnil, Jean G.
    This study examines the resting and exercise hemodynamic performance of the pulmonary autografts in the aortic position as well as of the homografts used for right ventricular outflow reconstruction in patients undergoing the Ross operation. Previous studies have reported excellent resting hemodynamics in patients who underwent aortic valve replacement with a pulmonary autograft. However, there are very few studies of their hemodynamic performance during exercise. Twenty adult subjects who underwent the Ross operation and 12 normal control subjects were submitted to maximum ramp bicycle exercise. The valve effective orifice areas and transvalvular gradients of both aortic (autograft) and pulmonary (homograft) valves were measured at rest and at peak of maximum exercise using Doppler echocardiography. Valve areas were indexed for body surface area. The hemodynamics of the aortic valve were very similar in Ross subjects and in control subjects at rest and during exercise. However, the indexed valve area of the pulmonary valve at rest was significantly (p <0.001) lower in the Ross subjects (1.10 ± 0.46 cm 2 /m 2 ) than in the control subjects (1.95 ± 0.41 cm 2 /m 2 ), resulting in higher (p = 0.004) mean gradients at rest (Ross: 9 ± 7 mm Hg vs control: 2 ± 1 mm Hg) and at peak exercise (Ross: 21 ± 14 mm Hg vs control: 7 ± 2 mm Hg). The pulmonary autograft provided excellent hemodynamics in the aortic position either at rest or during maximum exercise, whereas moderately high gradients were found during exercise across the homograft implanted in the pulmonary valve position. Future improvement of the Ross procedure should be oriented toward the search of new methods to prevent the deterioration of the homografts
  • PublicationRestreint
    Midterm echocardiographic follow-up after Ross operation
    (American Heart Association, 2000-11-07) Briand, Martin.; Cartier, Paul C.; Pibarot, Philippe; Dumesnil, Jean G.
    Background— The pulmonary autograft (Ross) operation is an attractive treatment for aortic valve disease, but hemodynamic follow-up is not well defined. Methods and Results— One hundred thirty-two consecutive patients (62% male, mean age 40±11 years) were followed up to 5 years after the Ross operation. Echocardiography was performed early (within 30 days), 3 to 6 months, and yearly after surgery. The valve effective orifice area (EOA) and mean transvalvular gradient of both aortic and pulmonary valves were measured, and transvalvular regurgitation was assessed by using color Doppler echocardiography. EOA was indexed for body surface area. The hemodynamic performance was excellent for both the aortic and pulmonary valves early after surgery (gradient, 3±4 and 3±4 mm Hg, respectively). It remained stable thereafter for the aortic valve, whereas there was a significant deterioration of the EOA (-0.74±0.82 cm2) and gradient (+6±8 mm Hg) for the pulmonary valve, which occurred mostly during the first 6 months after surgery. This hemodynamic deterioration resulted in suboptimal (defined as an EOA index <0.85 cm2/m2) hemodynamics in 19.3% of the patients, to the extent that 3 (2%) of the 132 patients eventually had to be subjected to further surgery for severe pulmonary valve stenosis. Conclusions— The pulmonary autograft provides continued excellent hemodynamics in the aortic position, whereas moderately high gradients can be found across the pulmonary homograft in some patients. Further studies are necessary to identify the factors responsible for the deterioration of the hemodynamic performance of the homograft in the pulmonary position and to determine its impact on right ventricular function and clinical status.