Papers by Jean-Michel Maury
Revue Des Maladies Respiratoires, 2012
Lung Cancer, 2017
Background: Pleural recurrences are a hallmark of thymomas, and represent a challenge for multidi... more Background: Pleural recurrences are a hallmark of thymomas, and represent a challenge for multidisciplinary management. The purpose of this study was to assess the feasibility and the results in terms of morbidity, mortality and survival rates, of Intra-Thoracic Chemo-Hyperthermia (ITCH) for the treatment of pleural recurrences of thymomas. Methods: Retrospective analysis of 19 consecutives patients between 1997 and 2015 treated by surgical cytoreduction (pleurectomy) followed by ITCH with 25 mg/m 2 of mitomycin, and 50 mg/m 2 of Cisplatin. Results: There were 8 men and 11 women with a median age of 44 years. ITCH was combined with pleurectomy alone in 4 (22%) patients, pleurectomy and wedge resections in 14 (74%) patients; 1 (5%) patient had a pleuropneumonectomy. There were no perioperative deaths, and 5 patients (26%) presented with postoperative complication, including 3 (16%) cases related to chemotherapy (one case of reversible grade 2 bone marrow aplasia, and 2 cases of reversible, acute kidney failure). The median length of stay in intensive care unit and hospital were 1 day and 10 days, respectively. After a median follow-up period of 39 months (range 10-127 months), median disease-free survival was 42 months. Five patients (26%) died during follow-up. Conclusions: Our data indicate that ITCH is a feasible option for selected patients with pleural recurrence of thymomas. ITCH clearly provides long local control, without major safety issues, and prolonged survival may be achieved in selected patients. This therapeutic option should be discussed at a multidisciplinary tumor board.
Intensive Care Medicine, 2015
ABSTRACT L'infection de pontage périphérique est une complication redoutable associée à u... more ABSTRACT L'infection de pontage périphérique est une complication redoutable associée à un taux élevé de morbi-mortalité. Le but de cette étude a été d'évaluer de façon prospective les performances des allogreffes artérielles cryopréservées (AAC) dans la prise en charge de cette complication. Entre Avril 1996 et Juin 2008 nous avons recueilli prospectivement les données des patients qui présentaient des infections majeures de pontages périphériques et qui ont bénéficié d'une reconstruction par AAC associée à l'excision du pontage infecté. Les AAC ont été prélevées chez des donneurs multi-organes et congelées à – 80°C. La durée moyenne de conservation des AAC a été de 115 jours (±132). Durant les douze années de l'étude, 36 patients (31 hommes, 5 femmes, âge moyen = 68 ans) ont bénéficié d'une reconstruction par AAC pour infections majeures de pontages périphériques. Dix huit patients (50%) avaient un syndrome septique, 5 patients (14%) avaient une ischémie aigüe au moment de la reconstruction et 12 patients (33%) avaient eu une rupture anastomotique. La reconstruction avec l'AAC a été réalisée en urgence chez 7 patients (19%). Il n'y a pas eu de décès périopératoire, ni d'amputation précoce. Le suivi des patients a été complet, en moyenne de 42 mois (3–116). Il n'y a pas eu d'infection persistante, ni de récidive d'infection. Dix patients ont bénéficié de révision, d'excision ou de remplacement de l'AAC au cours du suivi. Quinze patients sont décédés au cours du suivi de cause sans rapport avec l'infection initiale. Le taux cumulé de conservation de membre a été de 87% à 3 ans. Les taux cumulés de perméabilité primaire et secondaire ont été respectivement de 57% et de 78% à 3 ans. La reconstruction avec des AAC associée à l'excision du pontage infecté est un traitement efficace des infections majeures des pontages périphériques. Nos résultats nous encouragent à poursuivre les reconstructions avec des AAC dans cette indication.
Revue des Maladies Respiratoires, 2014
Journal of Vascular Surgery, 2005
Objective: This prospective, observational study evaluated the safety and efficacy of cryopreserv... more Objective: This prospective, observational study evaluated the safety and efficacy of cryopreserved arterial allograft reconstruction in the management of major peripheral arterial graft infections. Methods: From April 1996 to May 2003, data from patients with major peripheral arterial graft infection who underwent graft excision and cryopreserved arterial allograft reconstruction were prospectively collected. Arterial allografts were harvested from multiple organ donors and cryopreserved at ؊80°C. The patients were observed for survival, limb salvage, persistence or recurrence of infection, and allograft patency. The results were calculated with the Kaplan-Meier method. Results: During the 7-year study period, 17 patients (14 men, 3 women; mean age, 68 years) with major peripheral graft infection underwent graft excision and cryopreserved arterial allograft reconstruction. Eight patients (47%) had systemic sepsis, 5 (29%) had acute ischemia at the time of the allograft reconstruction, and 9 (53%) had experienced anastomotic rupture. Allograft reconstruction was performed as an emergency procedure in 7 patients (41%). There were no perioperative deaths or early amputations. Two patients had allograft ruptures in the groin during the early postoperative period. The mean follow-up period was 34 months (range, 8 to 80 months). There was no persistent or recurrent infection, and none of the patients received long-term (>3 months) antibiotic therapy. Reoperation for allograft revision, excision, or replacement was performed in 2 patients. The 18-month primary and secondary allograft patency rates were 68% and 86%; the overall limb salvage rate was 82% at 2 years. Conclusion: Our experience with cryopreserved arterial allograft in the management of major peripheral bypass graft infection suggests that this technique seems to be a useful option for treating one of the most dreaded vascular complications. ( J Vasc Surg 2005;41:30-7.) From the Service de Chirurgie Vasculaire et Thoracique, a and Service d'anesthésie-réanimation, b Hôpital Beaujon, Assistance Publique Hopitaux de Paris (AP-HP). Competition of interest: none.
Anesthésie & Réanimation, 2015
Revue des Maladies Respiratoires, 2014
Revue de pneumologie clinique, Jan 26, 2015
Lung transplantation (LT) is now considered as an excellent treatment option for selected patient... more Lung transplantation (LT) is now considered as an excellent treatment option for selected patients with end-stage pulmonary diseases, such as COPD, cystic fibrosis, idiopathic pulmonary fibrosis, and pulmonary arterial hypertension. The 2 goals of LT are to provide a survival benefit and to improve quality of life. The 3-step decision process leading to LT is discussed in this review. The first step is the selection of candidates, which requires a careful examination in order to check absolute and relative contraindications. The second step is the timing of listing for LT; it requires the knowledge of disease-specific prognostic factors available in international guidelines, and discussed in this paper. The third step is the choice of procedure: indications of heart-lung, single-lung, and bilateral-lung transplantation are described. In conclusion, this document provides guidelines to help pulmonologists in the referral and selection processes of candidates for transplantation in or...
Annales de Chirurgie Vasculaire, 2010
ABSTRACT L'infection de pontage périphérique est une complication redoutable associée à u... more ABSTRACT L'infection de pontage périphérique est une complication redoutable associée à un taux élevé de morbi-mortalité. Le but de cette étude a été d'évaluer de façon prospective les performances des allogreffes artérielles cryopréservées (AAC) dans la prise en charge de cette complication. Entre Avril 1996 et Juin 2008 nous avons recueilli prospectivement les données des patients qui présentaient des infections majeures de pontages périphériques et qui ont bénéficié d'une reconstruction par AAC associée à l'excision du pontage infecté. Les AAC ont été prélevées chez des donneurs multi-organes et congelées à – 80°C. La durée moyenne de conservation des AAC a été de 115 jours (±132). Durant les douze années de l'étude, 36 patients (31 hommes, 5 femmes, âge moyen = 68 ans) ont bénéficié d'une reconstruction par AAC pour infections majeures de pontages périphériques. Dix huit patients (50%) avaient un syndrome septique, 5 patients (14%) avaient une ischémie aigüe au moment de la reconstruction et 12 patients (33%) avaient eu une rupture anastomotique. La reconstruction avec l'AAC a été réalisée en urgence chez 7 patients (19%). Il n'y a pas eu de décès périopératoire, ni d'amputation précoce. Le suivi des patients a été complet, en moyenne de 42 mois (3–116). Il n'y a pas eu d'infection persistante, ni de récidive d'infection. Dix patients ont bénéficié de révision, d'excision ou de remplacement de l'AAC au cours du suivi. Quinze patients sont décédés au cours du suivi de cause sans rapport avec l'infection initiale. Le taux cumulé de conservation de membre a été de 87% à 3 ans. Les taux cumulés de perméabilité primaire et secondaire ont été respectivement de 57% et de 78% à 3 ans. La reconstruction avec des AAC associée à l'excision du pontage infecté est un traitement efficace des infections majeures des pontages périphériques. Nos résultats nous encouragent à poursuivre les reconstructions avec des AAC dans cette indication.
EuroIntervention, 2010
Vascular complications remain the main limitation of transfemoral aortic valve implantation. Base... more Vascular complications remain the main limitation of transfemoral aortic valve implantation. Based on a single-centre experience, we aim to detail the type, management and impact of those vascular complications. From October 2006 to January 2009, 54 transfemoral aortic valve implantations were performed using the Edwards SAPIEN prosthesis. Nine patients (16.7%) developed vascular complications. Five patients (9.3%) had ruptures which necessitated a surgical bypass. Four patients (7.4%) had dissection necessitating repair using stenting in all four patients and associated bypass in two of them. Vascular complications led to death in one patient (1.9%), reintervention in one (1.9%), and transfusions in seven (13%). Five vascular complications occurred in the first 20 patients (25%), and only four in the last 34 (12%). Vascular complications of transfemoral aortic valve implantation are frequent and seem to be influenced by experience. They are associated with a high need for transfusion and could lead to major events such as death or reintervention. These findings highlight the importance of a multidisciplinary approach for patient selection and management of the procedure.
Intensive Care Medicine, 2014
ABSTRACT
Intensive Care Medicine, 2015
ABSTRACT
Journal of Thoracic Oncology, 2015
Solitary fibrous tumors of the pleura (SFTP) refer as to a heterogeneous group of mesenchymal mal... more Solitary fibrous tumors of the pleura (SFTP) refer as to a heterogeneous group of mesenchymal malignancies with various anatomic and histology features. Upfront surgical resection is the standard approach, but recurrences may be aggressive and difficult to treat. The most widely accepted staging system has been proposed by De Perrot et al. Because SFTPs are rare, evidence to support a role for perioperative chemotherapy is scarce. Likewise, the predictive or prognostic relevance of the De Perrot system may be questioned. Multicenter retrospective study of patients with histologically proven SFTP with complete follow-up from surgical diagnostic to tumor recurrence and death. Sixty-eight patients were included. Tumor stage was 0/I for 29 (43%) patients, II for 23 (34%) patients, III for seven (10%) patients, and IV for nine (13%) patients. Postoperative chemotherapy was given to seven patients, mostly with stage III/IV SFTP, mostly consisting of doxorubicin-based regimen. Recurrence rate and median relapse-free survival after surgery were 3%, 52%, 71%, and 80% (p < 0.001), and 107, 70, 29, 11 months (p < 0.001) for stage 0/I, II, III, and IV tumors, respectively. At time of tumor recurrence, 14 patients received exclusive chemotherapy. Highest disease control rates were observed with trabectedin, and gemcitabine-dacarbazine combination. Our study confirms the prognostic value of the De Perrot staging system, as well as its possible predictive value for perioperative chemotherapy decision-making, whereas the efficacy of currently available regimens to significantly reduce the risk of tumor recurrence remains questionable. Trabectedin may be of interest for recurrent tumors.
Journal of Vascular Surgery, 2006
Symptomatic suprarenal coral reef aortic lesions have a poor natural history and threaten viscera... more Symptomatic suprarenal coral reef aortic lesions have a poor natural history and threaten visceral and lower extremity perfusion. We report our experience with total laparoscopic suprarenal aortic coral reef removal in three patients, aged 46, 48, and 52 years. Coral reef lesions were associated with aortoiliac occlusive lesions in two cases. One patient had an associated thoracic coral reef lesion. Patients underwent total laparoscopic coral reef removal combined with laparoscopic aortobifemoral bypass in two cases and open thoracic coral reef removal in one case. Postoperative courses were uneventful. All patients were alive with patent revascularization after a mean follow-up of 38 months, 29 months, and 1 month. ( J Vasc Surg 2006;44:194-7.) Suprarenal coral reef aorta lesions are uncommon. Surgical treatment is recommended because of the poor natural history of symptomatic lesions, which threaten digestive, renal, or lower extremity perfusion. Transaortic endarterectomy is accepted as a standard repair that is usually performed through an extensive thoracoabdominal approach. 1-7 Removal of the coral reef lesion often necessitates a simple atherectomy. Endarterectomy is in fact performed for extensive lesions, especially when they extend into visceral arteries. Taking advantage of our experience with videoscopic aortic surgery, 8-10 we performed a total laparoscopic removal (TLR) for suprarenal coral reef lesions in three patients. We discuss the technical points and main advantages of this new surgical approach.
Journal of Vascular Surgery, 2005
Objective: This prospective, observational study evaluated the safety and efficacy of cryopreserv... more Objective: This prospective, observational study evaluated the safety and efficacy of cryopreserved arterial allograft reconstruction in the management of major peripheral arterial graft infections. Methods: From April 1996 to May 2003, data from patients with major peripheral arterial graft infection who underwent graft excision and cryopreserved arterial allograft reconstruction were prospectively collected. Arterial allografts were harvested from multiple organ donors and cryopreserved at ؊80°C. The patients were observed for survival, limb salvage, persistence or recurrence of infection, and allograft patency. The results were calculated with the Kaplan-Meier method. Results: During the 7-year study period, 17 patients (14 men, 3 women; mean age, 68 years) with major peripheral graft infection underwent graft excision and cryopreserved arterial allograft reconstruction. Eight patients (47%) had systemic sepsis, 5 (29%) had acute ischemia at the time of the allograft reconstruction, and 9 (53%) had experienced anastomotic rupture. Allograft reconstruction was performed as an emergency procedure in 7 patients (41%). There were no perioperative deaths or early amputations. Two patients had allograft ruptures in the groin during the early postoperative period. The mean follow-up period was 34 months (range, 8 to 80 months). There was no persistent or recurrent infection, and none of the patients received long-term (>3 months) antibiotic therapy. Reoperation for allograft revision, excision, or replacement was performed in 2 patients. The 18-month primary and secondary allograft patency rates were 68% and 86%; the overall limb salvage rate was 82% at 2 years. Conclusion: Our experience with cryopreserved arterial allograft in the management of major peripheral bypass graft infection suggests that this technique seems to be a useful option for treating one of the most dreaded vascular complications. ( J Vasc Surg 2005;41:30-7.) From the Service de Chirurgie Vasculaire et Thoracique, a and Service d'anesthésie-réanimation, b Hôpital Beaujon, Assistance Publique Hopitaux de Paris (AP-HP). Competition of interest: none.
The Journal of Heart and Lung Transplantation, 2013
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is increasingly used as a bridge to lung t... more BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is increasingly used as a bridge to lung transplantation (LTx). However, data concerning this approach remain limited. METHODS: We retrospectively reviewed the medical records of all patients in France who received ECMO as a bridge to LTx from 2007 to 2011. Post-transplant survival and associated factors were assessed by the Kaplan-Meier method and the Cox model. RESULTS: Included were 36 patients from 11 centers. Indications for LTx were cystic fibrosis (CF) in 20 (56%), pulmonary fibrosis (PF) in 11 (30%), and other diagnoses in 5 (14%). ECMO was venovenous for 27 patients (75%) and venoarterial for 9 (25%). Mean follow-up was 17 months. Bridging to LTx was achieved in 30 patients (83%); however, only 27 patients (75%) survived the LTx procedure, and 20 (56%) were discharged from hospital. From ECMO initiation, 2-year survival rates were 50.4% overall, 71.0% for CF patients, 27.3% for PF patients, and 20.0% for other patients (p o 0.001). From LTx, 2-year survival rates were 60.5% overall, 71.0% for CF patients, 42.9% for PF patients, and 33.0% for other patients (p ¼ 0.04). CONCLUSIONS: Our study confirms that the use of ECMO as a bridge to LTx in France could provide a medium-term survival benefit for LTx recipients with critical conditions. Survival differed by underlying respiratory disease. Larger studies are needed to further define the optimal use of ECMO. J Heart Lung Transplant 2013;32:905-913 r
Archives of Cardiovascular Diseases, 2010
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Papers by Jean-Michel Maury