Publications by authors named "Charles-Henri David"

14 Publications

  • Page 1 of 1

Success of Thrombectomy in Management of Ischemic Stroke in Two Patients with SynCardia Total Artificial Heart in Bridge-to-Transplantation.

Bioengineering (Basel) 2021 Sep 19;8(9). Epub 2021 Sep 19.

Department of Cardiothoracic Surgery, Nantes University Hospital, 44093 Nantes, France.

Introduction: Circulatory assistance from a SynCardia Total Artificial Heart (SynCardia-TAH) is a reliable bridge-to-transplant solution for patients with end-stage biventricular heart failure. Ischemic strokes affect about 10% of patients with a SynCardia-TAH. We report for the first time in the literature two successful thrombectomies to treat the acute phase of ischemic stroke in two patients treated with a SynCardia-TAH in the bridge-to-transplant (BTT).

Case Report: We follow two patients with circulatory support from a SynCardia-TAH in the bridge-to-transplant for terminal biventricular cardiac failure with ischemic stroke during the support period. An early in-hospital diagnosis enables the completion of a mechanical thrombectomy within the first 6 h of the onset of symptoms. There was no intracranial hemorrhagic complication during or after the procedure and the patients fully recovered from neurological deficits, allowing a successful heart transplant.

Conclusion: This case report describes the possibility of treating ischemic strokes under a SynCardia-TAH by mechanical thrombectomy following the same recommendations as for the general population with excellent results and without any hemorrhagic complication during or after the procedure.
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http://dx.doi.org/10.3390/bioengineering8090126DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8469750PMC
September 2021

Electrical Storm Ablation in a Patient in Cardiogenic Shock Supported by Impella 5.0.

JACC Case Rep 2021 Mar 17;3(3):486-490. Epub 2021 Mar 17.

Department of Cardiology, Nantes University Hospital Center, Saint-Herblain, France.

Intra-axial pumps are increasingly used to support cardiogenic shock. The occurrence of electrical storms in this setting is a rising issue, and data remain scarce about optimal management. We report the feasibility of ventricular tachycardia ablation in the presence of a recent surgically inserted Impella 5.0 device (Abiomed, Danvers, Massachusetts). ().
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http://dx.doi.org/10.1016/j.jaccas.2020.12.032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8311017PMC
March 2021

A simplified delivery frozen elephant trunk technique to reduce circulatory arrest time in hybrid aortic arch surgery.

J Card Surg 2021 Sep 2;36(9):3371-3373. Epub 2021 Jun 2.

CHU Félix Guyon, Saint-Denis, La Réunion, France.

A simplified delivery technique for the frozen elephant trunk procedure allows the distal suture to be performed on a perfused and loaded aorta in moderate hypothermia-or even normothermia-reducing circulatory arrest time to just a few minutes. Two surgical sealing tourniquets are placed around the aortic arch, usually between the brachiocephalic trunk (BCT) and the left common carotid artery and the aorta is cross-clamped and cardioplegia started. Once in mild hypothermia, the BCT is disconnected and circulatory arrest is initiated while cerebral perfusion is maintained. This modified technique can be used in all pathologies, including dissections.
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http://dx.doi.org/10.1111/jocs.15708DOI Listing
September 2021

Utilization of a training portfolio in thoracic and cardiovascular surgery: the example of the French platform-EPIFORM.

J Thorac Dis 2021 Mar;13(3):2054-2057

Department of Thoracic Surgery, Strasbourg University Hospital, Strasbourg, France.

Thoracic and cardiovascular surgery requires learning both theoretical knowledge and technical skills. In this surgical field, several disparities exist between the different training programs around the world. This report describes the implementation of a portfolio in the teaching and assessment of French trainees in Thoracic and Cardiovascular surgery, following an electronic logbook model, aiming to improve the training program. The French surgical course is a twelve semesters' curriculum divided in 3 parts, each part containing knowledge, technical skills and behaviors objectives to be validated, defined by the French College of Thoracic and Cardiovascular surgery. The competencies are marked in the logbook, following a declarative model where the surgical trainee fills every surgical procedure attended (all or part) if he/she has observed, partially or fully performed, or supervised another trainee. All the surgical procedures are linked to theoretical e-learning lessons and each e-learning lesson includes a self-evaluation. This constitutes a competency-based assessment model with milestones both for surgeon trainees and their mentors. This portfolio also contains complementary tools such as an automated publication point calculation, a formatted curriculum vitae generator, and several contact tools between trainees. Implementation of a dedicated portfolio following an electronic logbook model appears to be a relevant pedagogic tool and survey element in the thoracic and cardiovascular surgery training program. Its use may lead to potential educational benefits for the trainee, reliable competency assessment for the supervising surgeon and for scientific society or national college.
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http://dx.doi.org/10.21037/jtd.2018.08.104DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8024805PMC
March 2021

Carotid versus femoral access for transcatheter aortic valve replacement: comparable results in the current era.

Eur J Cardiothorac Surg 2021 Mar 16. Epub 2021 Mar 16.

Department of Thoracic and Cardio-Vascular Surgery, Thorax Institute, Nantes Hospital University, Nantes, France.

Objectives: The carotid approach for transcatheter aortic valve replacement (TAVR) has been shown to be feasible and safe. The goal of this study was to compare the 30-day outcomes of trans-carotid (TC) and transfemoral (TF) TAVR.

Methods: This retrospective study enrolled 500 consecutive patients treated by TC-TAVR (n = 100) or TF-TAVR (n = 400) with percutaneous closure between January 2018 and January 2020 at the Nantes University Hospital. The primary end-point was the occurrence of cardiovascular death and cerebrovascular events at 30 days.

Results: The mean age was 79.9 ± 8.1 in the TC group and 81.3 ± 6.9 (P = 0.069) in the TF group. The TC group had more men (69% vs 50.5%; P = 0.001) and more patients with peripheral vascular disease (86% vs 14.8%; P < 0.0001). Cardiac characteristics were similar between the groups, and the EuroSCORE II was 3.8 ± 2.6% vs 4.6 ± 6.0%, respectively (P = 0.443). The 30-day mortality was 2% in the TC group versus 1% in the TF group (P = 0.345). TC-TAVR was not associated with an increased risk of stroke (2% vs 2.5%; P = 0.999) or major vascular complications (2% vs 4%; P = 0.548). More permanent pacemakers were implanted in the TF group (14.9% vs 5.6%; P = 0.015), and no moderate or severe aortic regurgitation was observed in the TC group (0 vs 3.3%; P = 0.08). TC-TAVR was not associated with an increased risk of mortality or stroke at 30 days (odds ratio 1.32; 95% confidence interval 0.42-4.21; P = 0.63) in the multivariable analysis.

Conclusions: No statistically significant differences between TC-TAVR and TF-TAVR were observed; therefore, TC-TAVR should be the first alternative in patients with anatomical contraindications to the femoral route.
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http://dx.doi.org/10.1093/ejcts/ezab109DOI Listing
March 2021

Celsior crystalloid cardioplegia versus standard hyperkalemic normothermic blood cardioplegia: Analysis of myocardial protection in elective mitral valve repair.

Perfusion 2021 Jul 2;36(5):455-462. Epub 2021 Feb 2.

Department of Thoracic and Cardiovascular Surgery, Thorax Institute, Nantes Hospital University, Nantes, France.

Introduction: With the increase and refinement of video assisted mitral valve surgery, cristalloïd cardioplegia started regaining popularity. The aim of our study was to evaluate the effectiveness of Celsior, a crystalloid cardioplegic solution, on myocardial protection in elective surgical mitral valve repair in comparison to blood based hyperkalemic cardioplegia.

Methods: In this observational retrospective study, all consecutive elective isolated surgical mitral valve repair where Celsior or normothermic hyperkalemic blood cardioplegia were used were included. Primary endpoint was any sign of myocardial protection failure (troponin levels, need for inotropic or mechanical support, rhythm disturbances, mortality). Secondary endpoint was Celsior safety (allergic reactions, bleeding, organ toxicities).

Results: From January 2009 to August 2016, 382 patients underwent elective isolated mitral valve repair in whom normothermic hyperkalemic blood cardioplegia ( = 181) or Celsior ( = 201) were used. There were no statistically significant differences in baseline characteristics including Euroscore 2. Peak troponin (pg/ml) release and 30-days mortality were not statistically different. Need for cardioversion was significantly more frequent in the Celsior group (47% vs 13%,  < 0.001). There was no statistical difference in post-operative atrial fibrillation, permanent pacemaker implantation, reoperation for bleeding, transfusion, acute kidney injury, haemoglobin at discharge or length of stay. No allergic reaction to Celsior occurred.

Conclusion: Effective myocardial protection was achieved with the Celsior cardioplegic solution with no unexpected toxicity. Celsior may be an efficacious and safe cardioprotective strategy in mitral valve repair.
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http://dx.doi.org/10.1177/0267659121991760DOI Listing
July 2021

A heart transplant after total artificial heart support: initial and long-term results.

Eur J Cardiothorac Surg 2020 12;58(6):1175-1181

Department of Thoracic and Cardiovascular Surgery, Nantes Hospital University, Nantes, France.

Objectives: At our centre, the SynCardia temporary Total Artificial Heart (TAH-t) (SynCardia Systems, LLC, Tucson, AZ, USA) is used to provide long-term support for patients with biventricular failure as a bridge to a transplant. However, a heart transplant (HT) after such support remains challenging. The aim of this retrospective study was to assess the immediate and long-term results following an HT in the cohort of patients who had a TAH-t implant.

Methods: A total of 73 patients were implanted with the TAH-t between 1988 and 2019 in our centre. Of these 73 consecutive patients, 50 (68%) received an HT and are included in this retrospective analysis of prospectively collected data.

Results: In the selected cohort, in-hospital mortality after an HT was 10% (n = 5). The median intensive care unit stay was 33 days (range 5-278). The median hospital stay was 41 days (range 28-650). A partial or total pericardiectomy was performed during the HT procedure in 21 patients (42%) due to a severe pericardial reaction. Long-term survival rates after an HT at 5, 10 and 12 years were 79.1 ± 5.9% (n = 32), 76.5 ± 6.3% (n = 22) and 72.4 ± 7.1% (n = 12), respectively, which was similar to the long-term survival for a primary HT without TAH-t during the same period (n = 686). An HT performed within 3-6 months post-TAH-t implantation appeared to provide the best survival (P = 0.007). Eight (16%) patients required chronic dialysis during the subsequent follow-up period, with 3 patients requiring a kidney transplant.

Conclusions: The long-term outcomes with the SynCardia TAH-t as a bridge to transplant in patients with severe biventricular failure are very encouraging. Our review noted that an HT following TAH-t can be technically challenging, especially in the case of a severe pericardial reaction, with potential pitfalls that should be recognized preoperatively.
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http://dx.doi.org/10.1093/ejcts/ezaa261DOI Listing
December 2020

Total artificial heart: patient selection and risk factors.

Ann Cardiothorac Surg 2020 Mar;9(2):118-120

Department of Thoracic and CardioVascular Surgery, Thorax Institut, University of Nantes, Nantes, France.

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http://dx.doi.org/10.21037/acs.2020.02.10DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7160622PMC
March 2020

Mechanical circulatory support with the Impella 5.0 and the Impella Left Direct pumps for postcardiotomy cardiogenic shock at La Pitié-Salpêtrière Hospital.

Eur J Cardiothorac Surg 2020 01;57(1):183-188

Department of Cardiac Surgery, Institute of Cardiology, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie-Paris 6, Paris, France.

Objectives: Postcardiotomy cardiogenic shock (PCCS) is associated with high mortality rates of 50-80%. Although veno-arterial extracorporeal membrane oxygenation has been used as mechanical circulatory support in patients with PCCS, it is associated with a high rate of complications and poor quality of life. The Impella 5.0 and Impella Left Direct (LD) (Impella 5.0/LD) are minimally invasive left ventricular assist devices that provide effective haemodynamic support resulting in left ventricular unloading and systemic perfusion. Our goal was to describe the outcome of patients with PCCS supported with the Impella 5.0/LD at La Pitié-Salpêtrière Hospital.

Methods: We retrospectively reviewed consecutive patients supported with the Impella 5.0/LD for PCCS between December 2010 and June 2015. Survival outcome and in-hospital complications were assessed.

Results: A total of 29 patients (63 ± 14 years, 17% women) with PCCS were supported with the Impella 5.0/LD. At baseline, 69% experienced chronic heart failure, 66% had dilated cardiomyopathy and 57% had valvular disease. The mean EuroSCORE II was 22 ± 17 and the ejection fraction was 28 ± 11%. Most of the patients underwent isolated valve surgery (45%) or isolated coronary artery bypass grafting (38%). The mean duration of Impella support was 9 ± 7 days. Weaning from the Impella was successful in 72.4%, and 58.6% survived to discharge. Recovery of native heart function was observed in 100% of discharged patients. Survival to 30 days and to 1 year from Impella implant was 58.6% and 51.7%, respectively.

Conclusions: The Impella 5.0 and the Impella LD represent an excellent treatment option for critically ill patients with PCCS and are associated with favourable survival outcome and native heart recovery.
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http://dx.doi.org/10.1093/ejcts/ezz179DOI Listing
January 2020

Transdiaphragmatic plombage omentoplasty without thoracotomy for post-lobectomy bronchial fistula.

J Thorac Cardiovasc Surg 2019 06 19;157(6):e413-e415. Epub 2019 Feb 19.

Department of Thoracic Surgery, North Hospital, Aix-Marseille University & Assistance Publique-Hôpitaux de Marseille, Marseille, France; Predictive Oncology Laboratory, Centre de Recherche en Cancérologie de Marseille, Inserm UMR1068, Aix-Marseille University, Marseille, France. Electronic address:

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http://dx.doi.org/10.1016/j.jtcvs.2019.02.013DOI Listing
June 2019

Endovascular Treatment of Atherosclerotic Iliac Stenosis: Local and Systemic Complications of the Open Brachial Access.

Ann Vasc Surg 2016 May 21;33:45-54. Epub 2016 Jan 21.

CHU de Brest, Service de Chirurgie Vasculaire, Brest, France.

Background: The femoral access is the approach of reference for iliac angioplasty. In the current context of an early ambulation and a minimization of in-hospital stay period, the brachial access seems to be an appropriate approach, especially that long and small diameter equipments are available. Furthermore, it is extremely useful in case of inappropriate or unavailable femoral access. The aim of this study was to evaluate the complication risk factors of the brachial approach in the treatment of iliac stenosis.

Methods: Between January 2012 and December 2013, we performed 281 iliac transluminal angioplasties of which 57 (20%) consecutive left brachial artery accesses were performed in 54 patients. The choice of brachial access was justified in 68% of the cases by an unavailable femoral access, in 29% of the cases by the presence of bilateral iliac lesions, and in 3% of the cases after failure of retrograde femoral approach.

Results: The patients were of a male majority (81%) with a mean age of 66 ± 9 years. The procedure was performed under local anesthesia in 65% of the cases. No upper limb ischemia or nervous complications had been reported. No cerebrovascular stroke has been identified. One patient presented with dysarthria associated with disorientation without the presence of cerebrovascular ischemia on the computed tomography scan and on the magnetic resonance imaging. There were 3 major hematomas at the brachial access site, which required reoperation; these 3 patients were on dialysis. There was no statistically significant relationship between a complication occurrence and the diameter or length of the introducer. The mean in-hospital stay period was 2 days. The procedure was considered successful in 91% of the cases. We reported 5 cases of failure: 4 of which was due to a difficulty in crossing the lesion and 1 due to a very short material. The only significant risk factor of failure was the thrombosis of the iliac axis (odds ratio 23.3, 95% confidence interval 2.5-264.6, P = 0.003).

Conclusions: The femoral access remains the recommended approach for the treatment of iliac occlusive lesions. However, brachial artery access seems to provide a safe and secure alternative approach for patients when femoral artery access is unavailable. It allows a rapid ambulation and an ambulatory care.
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http://dx.doi.org/10.1016/j.avsg.2015.10.027DOI Listing
May 2016

Giant aneurysmal evolution of a spontaneous coronary artery dissection in the postpartum.

Int J Cardiol 2016 Jan 14;202:362-5. Epub 2015 Sep 14.

Department of Cardiology, CHU Brest, Hôpital La Cavale Blanche, Boulevard Tanguy Prigent, 29609 Brest Cedex, France. Electronic address:

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http://dx.doi.org/10.1016/j.ijcard.2015.08.147DOI Listing
January 2016

Finegoldia magna, not a well-known infectious agent of bacteriemic post-sternotomy mediastinitis.

Anaerobe 2015 Apr 28;32:32-33. Epub 2014 Nov 28.

Département de Médecine Interne et Pneumologie, CHRU de Brest, France; EA3882-LUBEM, Université de Brest, France. Electronic address:

Post-sternotomy mediastinitis, a nosocomial infection mostly caused by staphylococci, can be life-threatening. A case of mediastinitis due to Finegoldia magna after a coronary artery bypass graft surgery was reviewed. Although this bacterium is difficult to be isolated from routine blood cultures, a F. magna bacteriemia associated with mediastinitis was diagnosed.
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http://dx.doi.org/10.1016/j.anaerobe.2014.11.012DOI Listing
April 2015

Medium-term survival of diffuse coronary artery disease patients following coronary artery reconstruction with the internal thoracic artery.

Cardiology 2011 20;120(4):192-9. Epub 2012 Jan 20.

Department of Cardiovascular and Thoracic Surgery, Brest University Hospital, Brest, France.

Objective: Diffuse coronary artery disease makes cardiac surgeons hesitant regarding whether coronary artery bypass grafting (CABG) surgery is feasible or not. Coronary artery reconstruction using the internal thoracic artery (ITA) allows bypassing of coronary arteries with diffuse atheromatous plaques without systematically resorting to endarterectomy. The aim of the present study was to evaluate the medium-term results of coronary artery reconstruction.

Methods: All patients undergoing coronary artery reconstruction using the ITA between 1999 and 2002 (233 patients) were included in the study. The mean age was 61.9 ± 9.8 years. Two hundred and eighty-one coronary artery reconstructions using the ITA were performed (mean length 3.6 ± 2 cm) for 514 CABGs. Coronary artery reconstruction using the ITA was associated with endarterectomy in 48 cases (17%).

Results: In-hospital mortality was 2.6%. Follow-up data were compiled in December 2008. Mean follow-up was 73.4 ± 16.7 months. The actuarial survival rate at 7 years was 89.3 ± 2.1%, and 88% of patients were free of major cardiac events at 7 years.

Conclusions: Coronary artery reconstruction gives comparable medium-term results to conventional coronary surgery, even though it is indicated for patients with more severe lesions.
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http://dx.doi.org/10.1159/000335068DOI Listing
May 2012
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