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51. The ‘wait for symptoms’ strategy in asymptomatic severe aortic stenosis

Author: Manuel J. Antunes, Isidre Vilacosta, Javier Lopez, José Alberto San Román, Hans-Joachim Schäfers, and Bernard Iung
Subjects: Heart Valve Prosthesis Implantation, medicine.medical_specialty, Percutaneous, business.industry, medicine.medical_treatment, Aortic Valve Stenosis, Disease, Prognosis, medicine.disease, Severity of Illness Index, Asymptomatic, Time-to-Treatment, Surgery, Natural history, Stenosis, Therapeutic approach, Valve replacement, Asymptomatic Diseases, Humans, Medicine, In patient, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Randomized Controlled Trials as Topic
Abstract: Calcific aortic stenosis is a prevalent and worrisome healthcare problem. The therapeutic approach in asymptomatic aortic stenosis is not well established. We argue that the natural history of this disease is based on old incomplete studies with many limitations. Likewise, studies suggesting that replacement, either surgical or percutaneous, improves prognosis in asymptomatic patients with severe aortic stenosis have important drawbacks and do not support this strategy as the treatment of choice. Despite the lack of evidence, some groups recommend early valve replacement in patients with severe asymptomatic aortic stenosis. There are five ongoing randomised trials which will shed light on this topic. Our conclusion is that unless a randomised study changes the evidence, valve replacement cannot be recommended in asymptomatic patients with severe aortic stenosis.
Published: 2020

52. Infective endocarditis in French Polynesia: Epidemiology, treatments and outcomes

Author: Bruno Pagis, Florence Ah-Kang, Renaud Lutinier, Fréderic Moronval, Sylvain Girardot, Olivier Atger, Anthony Fontan, Bernard Iung, Yoan Lavie-Badie, Katell Gallais, Virginie Blanchard, Rainui Richaud, and Christophe Le Goanvic
Subjects: Adult, Male, medicine.medical_specialty, Prosthesis-Related Infections, Time Factors, 030204 cardiovascular system & hematology, Health Services Accessibility, Polynesia, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Interquartile range, Internal medicine, Epidemiology, medicine, Humans, Endocarditis, 030212 general & internal medicine, Aged, Retrospective Studies, Heart Valve Prosthesis Implantation, Septic shock, business.industry, Cardiogenic shock, Hazard ratio, Rheumatic Heart Disease, General Medicine, Middle Aged, medicine.disease, Anti-Bacterial Agents, Cardiac surgery, Treatment Outcome, Heart Valve Prosthesis, Infective endocarditis, Female, Cardiology and Cardiovascular Medicine, business
Abstract: French Polynesia is a French overseas collectivity in the South Pacific Ocean, where data on infective endocarditis (IE) are lacking.To investigate the epidemiology and outcomes of IE in French Polynesia.All hospital records from consecutive patients hospitalized in Taaone Hospital, Tahiti, from 2015 to 2018, with an International Classification of Diseases, 10th revision, separation diagnosis of IE (I330), were reviewed retrospectively.From 190 hospital charts reviewed, 105 patients with a final diagnosis of IE, confirmed according to the modified Duke criteria, were included. The median duration of follow-up was 71 days (interquartile range 18-163 days). The mean age was 55±17 years, and there were 68 men (65%). Thirty-five patients (33%) had a history of rheumatic carditis and 43 (41%) had a prosthetic valve. There were 40 (38%) cases of staphylococcal IE, 32 (30%) of streptococcal IE and six (6%) of enterococcal IE. Cardiogenic shock, septic shock and clinically relevant cerebral complications were strongly associated with death from any cause (hazard ratio [HR] 16.85, 95% confidence interval [CI] 5.45-52.05 [P0.001]; HR 2.62, 95% CI 1.23-5.56 [P=0.01]; and HR 4.14, 95% CI 1.92-8.92 [P0.001], respectively). Seventy-three patients (69%) had a theoretical indication for surgery, which was performed in 38 patients (36%). Lack of surgery when there was a theoretical indication was significantly associated with death (HR 6.93, 95% CI 3.47-13.83; P0.0001).The pattern of IE in French Polynesia differs from Western countries in many ways. Postrheumatic valvular disease remains the main underlying disease, and access to emergency heart surgery is still a challenge.
Published: 2020

53. Imagerie et cathétérisme interventionnel valvulaire

Author: Marina Urena, G. Steg, J.-M. Juliard, Eric Brochet, Bernard Iung, C. Chong-Nguyen, G. Ducrocq, and D. Himbert
Subjects: Cardiology and Cardiovascular Medicine
Published: 2020

54. Antibiotic prophylaxis of infective endocarditis in patients with predisposing cardiac conditions: French cardiologists' implementation of current guidelines

Author: Xavier Duval, Philippe Lesclous, T. Le Tourneau, Christine Selton-Suty, Bernard Iung, François Delahaye, Jean-Noël Trochu, Alexis Gaudin, Daniel Thomas, Alexandra Cloitre, Q. Trochu, David Boutoille, CCSD, Accord Elsevier, Regenerative Medicine and Skeleton (RMeS), École nationale vétérinaire, agroalimentaire et de l'alimentation Nantes-Atlantique (ONIRIS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy], Service des maladies infectieuses et tropicales [CHU Nantes], Centre hospitalier universitaire de Nantes (CHU Nantes), Institut du thorax, Université de Nantes (UN)-IFR26-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Louis Pradel [CHU - HCL], Hospices Civils de Lyon (HCL), Institut de cardiologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148)), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de cardiologie [CHU Bichat], AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot, Sorbonne Paris Cité, Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Regenerative Medicine and Skeleton research lab (RMeS), Ecole Nationale Vétérinaire, Agroalimentaire et de l'alimentation Nantes-Atlantique (ONIRIS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)
Subjects: Adult, Male, medicine.medical_specialty, 030204 cardiovascular system & hematology, 03 medical and health sciences, Cardiologists, 0302 clinical medicine, Surveys and Questionnaires, medicine, Humans, In patient, Prospective Studies, 030212 general & internal medicine, Antibiotic prophylaxis, Intensive care medicine, [SDV.MHEP.RSOA] Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system, [SDV.MHEP.GEG] Life Sciences [q-bio]/Human health and pathology/Geriatry and gerontology, Endocarditis, business.industry, [SDV.MHEP.GEG]Life Sciences [q-bio]/Human health and pathology/Geriatry and gerontology, Incidence (epidemiology), Dental procedures, Clindamycin, Endocarditis, Bacterial, Guideline, Antibiotic Prophylaxis, Middle Aged, Amoxicillin, medicine.disease, 3. Good health, [SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system, Infective endocarditis, Practice Guidelines as Topic, Female, France, Cardiology and Cardiovascular Medicine, business, medicine.drug
Abstract: Background To prevent infective endocarditis (IE), with the exception of the United Kingdom, antibiotic prophylaxis (AP) is recommended in patients with predisposing cardiac conditions (PCCs) worldwide. To conclude on the relevance of this strategy, how the current guidelines are applied is a crucial point to investigate. The first aim of this study was to assess cardiologists' implementation of the current guidelines. The secondary objective was to identify specific areas where the training and knowledge of French cardiologists could be improved. Methods A national online survey was carried out among the 2228 cardiologist members of the French Society of Cardiology. Results The high risk PCCs for which IE AP is recommended were correctly identified by the vast majority of the respondents so that IE AP is mostly prescribed correctly in such patients. But only 12% identified all the right indications for IE AP according to 13 predefined PCCs (3 at high-risk, 6 at moderate-risk and 4 at low-risk of IE) so that some IE AP misuses are recorded, overprescription in particular. Only 47% prescribed the proper amoxicillin schedule and only 15% prescribed the appropriate clindamycin schedule in cases with penicillin allergy. Conclusion This study evidenced relevant areas where the training of cardiologists could be improved such as knowledge of the risk of IE for certain PCCs and some common invasive dental procedures. Cardiologists' knowledge should be improved before any conclusion can be drawn on the relevance of this AP strategy and its influence on IE incidence.
Published: 2020

55. Correction to: Aortic Valve Replacement Versus Conservative Treatment in Asymptomatic Severe Aortic Stenosis: The AVATAR Trial

Author: Bernard Iung and Sigita Glaveckaite
Subjects: Physiology (medical), Cardiology and Cardiovascular Medicine
Published: 2022

56. Global threat of rheumatic heart disease: do not forget children!

Author: Bernard Iung
Subjects: Heart Valve Diseases, Rheumatic Heart Disease, Humans, Mitral Valve, Mitral Valve Insufficiency, Cardiology and Cardiovascular Medicine, Child
Published: 2022

57. Mitral valve-in-valve and valve-in-ring procedures: Midterm outcomes in a French nationwide registry

Author: Robin Le Ruz, Patrice Guérin, Guillaume Leurent, Lionel Leroux, Thierry Lefevre, Mohammed Nejjari, Didier Champagnac, Didier Tchétché, Thibault Lhermusier, Thomas Senage, Pierre‐Guillaume Piriou, Christophe Caussin, Maxence Delomez, Guillaume Bonnet, Xavier Favereau, Nicole Karam, Antoine Gerbay, Francis Juthier, Martine Gilard, Jean‐Francois Obadia, Bernard Iung, Thibaut Manigold, Hôpital Guillaume-et-René-Laennec [Saint-Herblain], Institut du Thorax [Nantes], Université de Rennes (UR), Médico-Chirurgical de Valvulopathies et Cardiomyopathies, Chirurgie Cardiaque Adulte, Cardiologie Interventionnelle Structurelle Adulte [CHU Bordeaux], CHU Bordeaux [Bordeaux], Institut Cardiovasculaire Paris Sud [Massy] (ICPS), Centre cardiologique du Nord (CCN), Clinique du Tonkin [Villeurbanne] (CT), Clinique Pasteur [Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), PHU 2 - Institut du Thorax et du Sytème Nerveux [CHU Nantes] (ITSN), Centre hospitalier universitaire de Nantes (CHU Nantes), Institut Mutualiste de Montsouris (IMM), Hôpital Privé Le Bois Ramsay Santé [Lille], Hôpital de la Timone [CHU - APHM] (TIMONE), Hôpital privé de Parly 2 - Ramsay Santé [Le Chesnay-Rocquencourt], Paris-Centre de Recherche Cardiovasculaire (PARCC (UMR_S 970/ U970)), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Université Jean Monnet - Saint-Étienne (UJM), CHU Lille, Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Hôpital Louis Pradel [CHU - HCL], Hospices Civils de Lyon (HCL), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Service de cardiologie [CHU Bichat], AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot, Sorbonne Paris Cité, and CarMeN, laboratoire
Subjects: Male, Cardiac Catheterization, [SDV]Life Sciences [q-bio], heart failure, Ventricular Function, Left, paravalvular leak, percutaneous intervention, percutaneous valve therapy, Humans, Radiology, Nuclear Medicine and imaging, Registries, mitral valve disease, Aged, 80 and over, Bioprosthesis, Heart Valve Prosthesis Implantation, Mitral Valve Insufficiency, Stroke Volume, General Medicine, Prosthesis Failure, [SDV] Life Sciences [q-bio], structural heart disease intervention, Treatment Outcome, Heart Valve Prosthesis, Mitral Valve, Female, Cardiology and Cardiovascular Medicine
Abstract: International audience; OBJECTIVES: Report contemporary outcomes in patients included in the Mitragister registry and treated with transcatheter mitral valve implantation for failed surgical annuloplasty rings or deteriorated bioprosthesis. BACKGROUND: Midterm survival rates have been reported, but little is known about contemporary morbimortality endpoints. METHODS: The primary safety outcome was the technical success rate. The primary efficacy composite endpoint was a composite of cardiovascular mortality and heart failure hospitalizations. RESULTS: From 2016 to 2021, 102 patients (median age: 81 [74;84] years, 61% female, Euroscore II 11.0% [7.8;16.0]) undergoing valve-in-valve (ViV; n = 89) or valve-in-ring (ViR; n = 13) procedures were consecutively included. At baseline, ViR group patients had worse left ventricular ejection fraction (50% vs. 60%; p = 0.004) and more frequently severe regurgitation (46% vs. 15%; p = 0.014). The primary safety outcome was 95%: 77% and 98% in the ViR and ViV populations, respectively, (p = 0.014). At intermediate follow-up (6-12 months) clinical improvement was notable, 88% of the patients were in NYHA class ≤ II (vs. 25% at baseline; p \textless 0.001). At a mean follow-up of 17.1 ± 11.0 months, the primary efficacy composite reached 27%. By multivariate analysis, paravalvular leak (PVL) was the only independent predictor (hazard ratio: 2.39, 95% confidence interval: 1.08-5.29; p = 0.031) while ViR was not found statistically associated (p = 0.456). CONCLUSIONS: This study confirms the safety and efficacy of the mitral ViV procedure. ViR patients appear at higher risk of procedural complications. The presence of PVL could be associated with markedly worse midterm prognosis. Whatever the intervention, procedural strategies to reduce PVL incidence remain to be assessed to prevent latter adverse outcomes.
Published: 2022

58. Les auteurs

Author: Alexandra Benachi, Dominique Luton, Laurent Mandelbrot, Olivier Picone, Hélène Affres, Nadine Ajzenberg, Laurence Amar, Pascale Amate, Djillali Annane, Rana Aoun, Elie Azria, Rakiba Belkhir, Ivan Berlin, Jacques Bernuau, Emmanuel Boleslawski, Claire Bonneau, Marie Bornes, Yoram Bouhnik, Corinne Bouteloup, Elisabeth Bouvet, Dominique Brémond-Gignac, Arnaud Bresset, Florence Bretelle, Léopoldine Bricaire, Marie Bruyère, Julie Carrara, Pierre-François Ceccaldi, Philippe Chanson, Sophie Chauvet, Bernard Clair, Élodie Clouqueur, Sarah Cohen, Chloé Comarmond-Ortoli, Jacqueline Conard, Sophie Conquy, Henri Copin, Anne-Gaël Cordier, Sophie Cordiez, Sarah Coscas, Nathalie Costedoat-Chalumeau, Emile Daraï, Amélie Delabaere, Philippe Deruelle, Marc Dommergues, Anne-Sophie Ducloy-Bouthors, Caroline Dubertret, Hubert Ducou Le Pointe, Bénédicte Dumont, Lise Duranteau, Elisabeth Elefant, Nejla Essafi, Hervé Fernandez, Julia Filippova, Renato Fior, Michael Frank, Jean-Baptiste de Fréminville, Diane Friedman, Frédéric Galacteros, Denis Gallot, Gilles Garcia, Jean-Yves Gauvrit, Anne Gervais, Robert Girot, Bertrand Godeau, Gilles Grangé, Dominique Grenet, Lionel Groussin-Rouiller, Gaëlle Guettrot-Imbert, Stéphanie Guillet, Anoosha Habibi, Smail Hadj-Rabia, Olivier Hermine, Véronique Houfflin-Debarge, Marie Houllier, Lucile Houyel, Marc Humbert, Laurence Iserin, Bernard Iung, Xavier Jaïs, Bérangère Joly, Guillaume Jondeau, Jean-Emmanuel Kahn, Gilles Kayem, Hawa Keita, Valentin Keller, Magalie Ladouceur, Cécile Lavenu-Bombled, Hélène Legardeur, Véronique Le Guern, Claude Lejeune, Claire Le Jeunne, null Lous, null Ray, Aurélien Lorthioir, Lynda Manamani-Bererhi, Isabelle Marie, Grégoire Martin de Frémont, Sophie Matheron, Amandine Maulard, Nadia Merbai, Emmanuel Messas, Sandra de Miranda, Anna Molto, Stéphanie Morgant, Simon Msika, Sophie Nebout, Jacky Nizard, Roseline d'Oiron, Violaine Ozenne, Gabriel Perlemuter, Sandrine Perol, Franck Perrotin, Brigitte Perrouin-Verbe, Edith Peynaud-Debayle, Violaine Peyronnet, Henri-Jean Philippe, Clément Picard, Geneviève Plu-Bureau, Laura Polivka, Brigitte Raccah-Tebeka, Emmanuelle de Raucourt, Jean-Antoine Ribeil, Thomas Ronzière, Valérie Roussel-Robert, Aude Rossi, Lucia Rugeri, David Saadoun, Lise Selleret, Pierre Sellier, Marie-Victoire Sénat, Raphaèle Seror, Damien Subtil, Camille Taillé, Sarah Tebeka, Denis Therby, Ngoc-Tram Tô, Bertrand de Toffol, Nathalie Trillot, Vassilis Tsatsaris, Géraud Tuyeras, Mathieu Uzzan, Morgane Valentin, David Vandendriessche, Roxane Vanspranghels-Gibert, Eric Verspyck, Aurélie Vincent-Rohfritsch, Sandra Vukusic, Bernard Wechsler, Norbert Winer, and Jacques-François Young
Published: 2022

59. Correction to: Surgery and outcome of infective endocarditis in octogenarians: prospective data from the ESC EORP EURO-ENDO registry

Author: Marta Hernández-Meneses, Lilia Zakhama, Antoni Bayes-Genis, Eduard Quintana, Aldo Pietro Maggioni, Eustachio Agricola, Abdallah Almaghraby, Bernard Iung, Mouaz Al-Mallah, Lucia Soriente, Carmen Olmos, Daniel Lovric, Elena Raevschi, Kevin Bouiller, Patrick Assayag, and Ugur Canpolat
Subjects: Microbiology (medical), Infectious Diseases, General Medicine
Published: 2022

60. Erratum to 'Evolution of TAVI patients and techniques over the past decade: The French TAVI registries' [Arch. Cardiovasc. Dis. 115 (4) (2022) 206–13]

Author: Romain Didier, Herve Le Breton, Hélène Eltchaninoff, Guillaume Cayla, Philippe Commeau, Jean-Philippe Collet, Thomas Cuisset, Nicolas Dumonteil, Jean-Philippe Verhoye, Sylvain Beurtheret, Thierry Lefèvre, Bernard Iung, and Martine Gilard
Subjects: General Medicine, Cardiology and Cardiovascular Medicine
Published: 2022

61. Contemporary Management of Severe Symptomatic Aortic Stenosis

Author: Marc Eugène, Piotr Duchnowski, Bernard Prendergast, Olaf Wendler, Cécile Laroche, Jean-Luc Monin, Yannick Jobic, Bogdan A. Popescu, Jeroen J. Bax, Alec Vahanian, Bernard Iung, Jeroen Bax, Michele De Bonis, Victoria Delgado, Michael Haude, Gerhard Hindricks, Aldo P. Maggioni, Luc Pierard, Susanna Price, Raphael Rosenhek, Frank Ruschitzka, Stephan Windecker, Souad Mekhaldi, Katell Lemaitre, Sébastien Authier, Magdy Abdelhamid, Astrid Apor, Gani Bajraktari, Branko Beleslin, Alexander Bogachev-Prokophiev, Daniela Cassar Demarco, Agnes Pasquet, Sait Mesut Dogan, Andrejs Erglis, Arturo Evangelista, Artan Goda, Nikolaj Ihlemann, Huseyin Ince, Andreas Katsaros, Katerina Linhartova, Julia Mascherbauer, Erkin Mirrakhimov, Vaida Mizariene, Shelley Rahman-Haley, Regina Ribeiras, Fuad Samadov, Antti Saraste, Iveta Simkova, Elizabeta Srbinovska Kostovska, Lidia Tomkiewicz-Pajak, Christophe Tribouilloy, Eliverta Zera, Mimoza Metalla, Ervina Shirka, Elona Dado, Loreta Bica, Jorida Aleksi, Gerti Knuti, Lidra Gjyli, Rudina Pjeci, Eritinka Shuperka, Erviola Lleshi, Joana Rustemaj, Marsjon Qordja, Mirald Gina, Senada Husi, Daniel Basic, Regina Steringer-Mascherbauer, Charlotte Huber, Christian Ebner, Elisabeth Sigmund, Andrea Ploechl, Thomas Sturmberger, Veronica Eder, Tanja Koppler, Maria Heger, Andreas Kammerlander, Franz Duca, Christina Binder, Matthias Koschutnik, Leonard Perschy, Lisa Puskas, Chen-Yu Ho, Farid Aliyev, Vugar Guluzada, Galib Imanov, Firdovsi Ibrahimov, Abbasali Abbasaliyev, Tahir Ahmedov, Fargana Muslumova, Jamil Babayev, Yasmin Rustamova, Tofig Jahangirov, Rauf Samadov, Muxtar Museyibov, Elnur Isayev, Oktay Musayev, Shahin Xalilov, Saleh Huseynov, Madina Yuzbashova, Vuqar Zamanov, Vusal Mammadov, Gery Van Camp, Martin Penicka, Hedwig Batjoens, Philippe Debonnaire, Daniel Dendooven, Sebastien Knecht, Mattias Duytschaever, Yves Vandekerckhove, Luc Missault, Luc Muyldermans, René Tavernier, Tineke De Grande, Patrick Coussement, Joyce DeTroyer, Katrien Derycker, Kelly De Jaegher, Antoine Bondue, Christophe Beauloye, Céline Goffinet, Daniela Corina Mirica, Frédéric Vanden Eynden, Philippe Van de Borne, Béatrice Van Frachen, David Vancraeynest, Jean Louis Vanoverschelde, Sophie Pierard, Mihaela Malanca, Florence Sinnaeve, Séverine Tahon, Marie De Clippel, Frederic Gayet, Jacques Loiseau, Nico Van de Veire, Veronique Moerman, Anne-Marie Willems, Bernard Cosyns, Steven Droogmans, Andreea Motoc, Dirk Kerkhove, Daniele Plein, Bram Roosens, Caroline Weytjens, Patrizio Lancellotti, Elena Raluca Dulgheru, Ilona Parenicova, Helena Bedanova, Frantisek Tousek, Stepanka Sindelarova, Julia Canadyova, Milos Taborsky, Jiri Ostransky, null Ivona simkova, Marek Vicha, Libor Jelinek, Irena Opavska, Miroslav Homza, Miriam Kvrayola, Radim Brat, Dan Mrozek, Eva Lichnerova, Iveta Docekalova, Marta Zarybnicka, Marketa Peskova, Patrik Roucka, Vlasta Stastna, Dagmar Jungwirtova Vondrackova, Alfred Hornig, Matus Niznansky, Marian Branny, Alexandra Vodzinska, Miloslav Dorda, Libor Snkouril, Krystyna Kluz, Jana Kypusova, Radka Nezvalova, Niels Thue Olsen, Hosam Hasan Ali, Salma Taha, Mohamed Hassan, Ahmed Afifi, Hamza Kabil, Amr Mady, Hany Ebaid, Yasser Ahmed, Mohammad Nour, Islam Talaat, CairoMaiy El Sayed, Ahmad Elsayed Mostafa, CairoYasser Sadek, CairoSherif Eltobgi, Sameh Bakhoum, Ramy Doss, Mahmoud Sheashea, Abd Allah Elasry, Ahmed Fouad, Mahmoud Baraka, Sameh Samir, Alaa Roshdy, Yasmin AbdelRazek, Mostafa M. Abd Rabou, Ahmed Abobakr, Moemen Moaaz, Mohamed Mokhtar, Mohamed Ashry, Khaled Elkhashab, Haytham Soliman Ghareeb, Mostafa Kamal, Gomaa AbdelRazek, GizaNabil Farag, Giza:Ahmed Elbarbary, Evette Wahib, Ghada Kazamel, Diaa Kamal, Mahmoud Tantawy, Adel Alansary, Mohammed Yahia, Raouf Mahmoud, Tamer El Banna, Mohamed Atef, Gamela Nasr, Salah Ahmed, Ehab E. El Hefny, Islam Saifelyazal, Mostafa Abd El Ghany, Abd El Rahman El Hadary, Ahmed Khairy, Jyri Lommi, Mika Laine, Minna Kylmala, Katja Kankanen, Anu Turpeinen, Juha Hartikainen, Lari Kujanen, Juhani Airaksinen, Tuija Vasankari, Catherine Szymanski, Yohann Bohbot, Mesut Gun, Justine Rousseaux, Loic Biere, Victor Mateus, Martin Audonnet, Jérémy Rautureau, Charles Cornet, Emmanuel Sorbets, BourgesKarine Mear, Adi Issa, Florent Le Ven, Marie-Claire Pouliquen, Martine Gilard, Alice Ohanessian, Ali Farhat, Alina Vlase, Fkhar Said, Caroline Lasgi, Carlos Sanchez, Romain Breil, Marc Peignon, Jean-Philippe Elkaim, Virginie Jan-Blin, Sylvain Ropars BertrandM'Ban, Hélène Bardet, Samuel Sawadogo, Aurélie Muschoot, Dieudonné Tchatchoua, Simon Elhadad, Aline Maubert, Tahar Lazizi, Kais Ourghi, Philippe Bonnet, Clarisse Menager-Gangloff, Sofiene Gafsi, Djidjiga Mansouri, Victor Aboyans, Julien Magne, Elie Martins, Sarah Karm, Dania Mohty, Guillaume Briday, Amandine David, Sylvestre Marechaux, Caroline Le Goffic, Camille Binda, Aymeric Menet, Francois Delelis, Anne Ringlé, Anne-Laure Castel, Ludovic Appert, Domitille Tristram, Camille Trouillet, Yasmine Nacer, Lucas Ngoy, MarseilleGilbert Habib, Franck Thuny, Julie Haentjens, Jennifer Cautela, Cécile Lavoute, Floriane Robin, Pauline Armangau, Ugo Vergeylen, Khalil Sanhadji, Nessim Hamed Abdallah, Hassan Kerzazi, Mariana Perianu, François Plurien, Chaker Oueslati, Mathieu Debauchez, Zannis Konstantinos, Alain Berrebi, Alain Dibie, Emmanuel Lansac, Aurélie Veugeois, Christelle Diakov, Christophe Caussin, Daniel Czitrom, Suzanna Salvi, Nicolas Amabile, Patrice Dervanian, Stéphanie Lejeune, Imane Bagdadi, Yemmi Mokrane, Gilles Rouault, Jerome Abalea, Marion Leledy, Patrice Horen, Erwan Donal, Christian Bosseau, Elise Paven, Elena Galli, Edouard Collette, Jean-Marie Urien, Valentin Bridonneau, Renaud Gervais, Fabrice Bauer, Houzefa Chopra, Arthur Charbonnier, David Attias, Nesrine Dahouathi, Moukda Khounlaboud, Magalie Daudin, Christophe Thebault, Cécile Hamon, Philippe Couffon, Catherine Bellot, Maelle Vomscheid, Anne Bernard, Fanny Dion, Djedjiga Naudin, Mohammed Mouzouri, Mathilde Rudelin, Alain Berenfeld, Thibault Vanzwaelmen, Tarik Alloui, Marija Gjerakaroska Radovikj, Slavica Jordanova, Werner Scholtz, Eva Liberda-Knoke, Melanie Wiemer, Andreas Mugge, Georg Nickenig, Jan-Malte Sinning, Alexander Sedaghat, Matthias Heintzen, Jan Ballof, Daniel Frenk, Rainer Hambrecht, Harm Wienbergen, Annemarie Seidel, Rico Osteresch, Kirsten Kramer, Janna Ziemann, Ramona Schulze, Wolfgang Fehske, Clarissa Eifler, Bahram Wafaisade, Andreas Kuhn, Sören Fischer, Lutz Lichtenberg, Mareike Brunold, Judith Simons, Doris Balling, Thomas Buck, Bjoern Plicht, Wolfgang Schols, Henning Ebelt, Marwan Chamieh, Jelena Anacker, Tienush Rassaf, Alexander Janosi, Alexander Lind, Julia Lortz, Peter Lüdike, Philipp Kahlert, Harald Rittger, Gabriele Eichinger, Britta Kuhls, Stephan B. Felix, Kristin Lehnert, Ann-Louise Pedersen, Marcus Dorr, Klaus Empen, Sabine Kaczmarek, Mathias Busch, Mohammed Baly, Fikret Er, Erkan Duman, Linda Gabriel, Christof Weinbrenner, Johann Bauersachs, Julian Wider, Tibor Kempf, Michael Bohm, Paul-Christian Schulze, C. Tudor Poerner, Sven Möbius-Winkler, Karsten Lenk, Kerstin Heitkamp, Marcus Franz, Sabine Krauspe, Burghard Schumacher, Volker Windmuller, Sarah Kurwitz, Holger Thiele, Thomas Kurz, Roza Meyer-Saraei, Ibrahim Akin, Christian Fastner, Dirk Lossnitzer, Ursula Hoffmann, Martin Borggrefe, Stefan Baumann, Brigitte Kircher, Claudia Foellinger, Heike Dietz, Bernhard Schieffer, Feraydoon Niroomand, Harald Mudra, Lars Maier, Daniele Camboni, Christoph Birner, Kurt Debl, Michael Paulus, Benedikt Seither, Nour Eddine El Mokhtari, Alper Oner, Evren Caglayan, Mohammed Sherif, Seyrani Yucel, Florian Custodis, Robert Schwinger, Marc Vorpahl, Melchior Seyfarth, Ina Nover, Till Koehler, Sarah Christiani, David Calvo Sanchez, Barbel Schanze, Holger Sigusch, Athir Salman, Jane Hancock, John Chambers, Camelia Demetrescue, Claire Prendergast, Miles Dalby, Robert Smith, Paula Rogers, Cheryl Riley, Dimitris Tousoulis, Ioannis Kanakakis, Konstantinos Spargias, Konstantinos Lampropoulos, Tolis Panagiotis, Athanasios Koutsoukis, Lampros Michalis, Ioannis Goudevenos, Vasileios Bellos, Michail Papafaklis, Lampros Lakkas, George Hahalis, Athanasios Makris, Haralampos Karvounis, Vasileios Kamperidis, Vlasis Ninios, Vasileios Sachpekidis, Pavlos Rouskas, Leonidas Poulimenos, Georgios Charalampidis, Eftihia Hamodraka, Athanasios Manolis, Robert Gabor Kiss, Tunde Borsanyi, Zoltan Jarai, Andras Zsary, Elektra Bartha, Annamaria Kosztin, Alexandra Doronina, Attila Kovacs, Barabas Janos Imre, Chun Chao, Kalman Benke, Istvan Karoczkai, Kati Keltai, Zsolt Förchécz, Zoltán Pozsonyi, Zsigmond Jenei, Adam Patthy, Laszlo Sallai, Zsuzsanna Majoros, Tamás Pál, Jusztina Bencze, Ildiko Sagi, Andrea Molnar, Anita Kurczina, Gabor Kolodzey, Istvan Edes, Valeria Szatmari, Zsuzsanna Zajacz, Attila Cziraki, Adam Nemeth, Reka Faludi, Laszlone Vegh, Eva Jebelovszki, Geza Karoly Lupkovics, Zsofia Kovacs, Andras Horvath, Gezim Berisha, Pranvera Ibrahimi, Luan Percuku, Rano Arapova, Elmira Laahunova, Kseniia Neronova, Zarema Zhakypova, Gulira Naizabekova, Gulnazik Muratova, Iveta Sime, Nikolajs Sorokins, Ginta Kamzola, Irina Cgojeva-Sproge, Gita Rancane, Ramune Valentinaviciene, Laima Rudiene, Rasa Raugaliene, Aiste Bardzilauske, Regina Jonkaitiene, Jurate Petrauskaite, Monika Bieseviciene, Raimonda Verseckaite, Ruta Zvirblyte, Danute Kalibatiene, Greta Radauskaite, Gabija Janaviciute-Matuzeviciene, Dovile Jancauskaite, Deimile Balkute, Juste Maneikyte, Ingrida Mileryte, Monika Vaisvilaite, Lina Gedvilaite, Mykolas Biliukas, Vaiva Karpaviciene, Robert George Xuereb, Elton Pllaha, Roxana Djaberi, Klaudiusz Komor, Agnieszka Gorgon-Komor, Beata Loranc, Jaroslaw Myszor, Katarzyna Mizia-Stec, Adrianna Berger-Kucza, Magdalena Mizia, Mateusz Polak, Piotr Bogacki, Piotr Podolec, Monika Komar, Ewa Sedziwy, Dorota Sliwiak, Bartosz Sobien, Beata Rog, Marta Hlawaty, Urszula Gancarczyk, Natasza Libiszewska, Danuta Sorysz, Andrzej Gackowski, Malgorzata Cieply, Agnieszka Misiuda, Franciszek Racibor, Anna Nytko, Kazimierz Widenka, Maciej Kolowca, Janusz Bak, Andrzej Curzytek, Mateusz Regulski, Malgorzata Kamela, Mateusz Wisniowski, Tomasz Hryniewiecki, Piotr Szymanski, Monika Rozewicz, Maciej Grabowski, Andrzej Budaj, Beata Zaborska, Ewa Pilichowska-Paskiet, Malgorzata Sikora-Frac, Tomasz Slomski, Isabel Joao, Ines Cruz, Hélder Pereira, Rita Cale, Ana Marques, Ana Rita Pereira, Carlos Morais, Antonio Freitas, David Roque, Nuno Antunes, Antonio Costeira Pereira, Catarina Vieira, Nuno Salome, Juliana Martins, Isabel Campos, Goncalo Cardoso, Claudia Silva, Afonso Oliveira, Mariana Goncalves, Rui Martins, Nuno Quintal, Bruno Mendes, Joseline Silva, Joao Ferreira, James Milner, Patricia Alves, Vera Marinho, Paula Gago, Jose Amado, Joao Bispo, Dina Bento, Inocencia Machado, Margarida Oliveira, Lucy Calvo, Pedro von Hate, Bebiana Faria, Ana Galrinho, Luisa Branco, Antonio Goncalves, Tiago Mendonca, Mafalda Selas, Filipe Macedo, Carla Sousa, Sofia Cabral, Filomena Oliveira, Maria Trepa, Marta Fontes-Oliveira, Alzira Nunes, Paulo Araújo, Vasco Gama Ribeiro, Joao Almeida, Alberto Rodrigues, Pedro Braga, Sonia Dias, Sofia Carvalho, Catarina Ferreira, Alberto Ferreira, Pedro Mateus, Miguel Moz, Silvia Leao, Renato Margato, Ilidio Moreira, Jose Guimanaes, Joana Ribeiro, Fernando Goncalves, Jose Cabral, Ines Almeida, Luisa Goncalves, Mariana Tarusi, Calin Pop, Claudia Matei, Diana Tint, Sanziana Barbulescu, Sorin Micu, Ioana Pop, Costica Baba, Doina Dimulescu, Maria Dorobantu, Carmen Ginghina, Roxana Onut, Andreea Popescu, Brandusa Zamfirescu, Raluca Aflorii, Mihaela Popescu, Liviu Ghilencea, Andreeea Rachieru, Monica Stoian, Nicoleta Oprescu, Silvia Iancovici, Iona Petre, Anca Doina Mateescu, Andreea Calin, Simona Botezatu, Roxana Enache, Monica Rosca, Daniela Ciuperca, Evelyn Babalac, Ruxandra Beyer, Laura Cadis, Raluca Rancea, Raluca Tomoaia, Adela Rosianu, Emese Kovacs, Constantin Militaru, Alina Craciun, Oana Mirea, Mihaela Florescu, Lucica Grigorica, Daniela Dragusin, Luiza Nechita, Mihai Marinescu, Teodor Chiscaneanu, Lucia Botezatu, Costela Corciova, Antoniu Octavian Petris, Catalina Arsenescu-Georgescu, Delia Salaru, Dan Mihai Alexandrescu, Carmjen Plesoianu, Ana Tanasa, Ovidiu Mitu, Irina Iuliana Costache, Ionut Tudorancea, Catalin Usurelu, Gabriela Eminovici, Ioan Manitiu, Oana Stoia, Adriana Mitre, Dan-Octavian Nistor, Anca Maier, Silvia Lupu, Mihaela Opris, Adina Ionac, Irina Popescu, Simina Crisan, Cristian Mornos, Flavia Goanta, Liana Gruescu, Oana Voinescu, Madalina Petcu, Ramona Cozlac, Elena Damrina, Liliya Khilova, Irina Ryazantseva, Dmitry Kozmin, Maria Kiseleva, Marina Goncharova, Kamila Kitalaeva, Victoria Demetskay, Artem Verevetinov, Mikhail Fomenko, Elena Skripkina, Viktor Tsoi, Georgii Antipov, Yuri Schneider, Denis Yazikov, Marina Makarova, Aleksei Cherkes, Natalya Ermakova, Aleksandr Medvedev, Anastasia Sarosek, Mikhail Isayan, Tatyana Voronova, Oleg Kulumbegov, Alina Tuchina, Sergei Stefanov, Margarita Klimova, Konstantin Smolyaninov, Zhargalma Dandarova, Victoriya Magamet, Natalia Spiropulos, Sergey Boldyrev, Kirill Barbukhatty, Dmitrii Buyankov, Vladimir Yurin, Yuriy Gross, Maksim Boronin, Mariya Mikhaleva, Mariya Shablovskaya, Alex Zotov, Daniil Borisov, Vasily Tereshchenko, Ekaterina Zubova, A. Kuzmin, Ivan Tarasenko, Alishir Gamzaev, Natalya Borovkova, Tatyana Koroleva, Svetlana Botova, Ilya Pochinka, Vera Dunaeva, Victoria Teplitskaya, Elena I. Semenova, Olga V. Korabel'Nikova, Denis S. Simonov, Elena Denisenko, Natalia Harina, Natalia Yarohno, Svetlana Alekseeva, Julia Abydenkova, Lyubov Shabalkina, Olga Mayorova, Valeriy Tsechanovich, Igor Medvedev, Michail Lepilin, PenzaEvgenii Nemchenko, Vadim Karnahin, Vasilya Safina, Yaroslav Slastin, Venera Gilfanova, Roman Gorbunov, Ramis Jakubov, Aigul Fazylova, Mansur Poteev, Laysan Vazetdinova, Indira Tarasova, Rishat Irgaliyev, Olga Moiseeva, Mikhail Gordeev, Olga Irtyuga, Raisa Moiseeva, Nina Ostanina, Dmitry Zverev, Patimat Murtazalieva, Dmitry Kuznetsov, Mariya Skurativa, Larisa Polyaeva, Kirill Mihaiilov, Biljana Obrenovic-Kircanski, Svetozar Putnik, Dragan Simic, Milan Petrovic, Natasa Markovic Nikolic, Ljiljana Jovovic, Dimitra Kalimanovska Ostric, Milan Brajovic, Milica Dekleva Manojlovic, Vladimir Novakovic, Danijela Zamaklar-Trifunovic, Bojana Orbovic, Olga Petrovic, Marija Boricic-Kostic, Kristina Andjelkovic, Marko Milanov, Maja Despotovic-Nikolic, Sreten Budisavljevic, Sanja Veljkovic, Nataša Cvetinovic, Daniijela Lepojevic, Aleksandra Todorovic, Aleksandra Nikolic, Branislava Borzanovic, Ljiljana Trkulja, Slobodan Tomic, Milan Vukovic, Jelica Milosavljevic, Mirjana Milanovic, Vladan Stakic, Aleksandra Cvetkovic, Suzana Milutinovic, Olivera Bozic, Miodrag Miladinovic, Zoran Nikolic, Dinka Despotovic, Dimitrije Jovanovic, Anastazija Stojsic-Milosavljevic, Aleksandra Ilic, Mirjana Sladojevic, Stamenko Susak, Srdjan Maletin, Salvo Pavlovic, Vladimir Kuzmanovic, Nikola Ivanovic, Jovana Dejanovic, Dusan Ruzicic, Dragana Drajic, Danijel Cvetanovic, Marija Mirkovic, Jon Omoran, Roman Margoczy, Katarina Sedminova, Adriana Reptova, Eva Baranova, Tatiana Valkovicova, Gabriel Valocik, Marian Kurecko, Marianna Vachalcova, Alzbeta Kollarova, Martin Studencan, Daniel Alusik, Marek Kozlej, Jana Macakova, Sergio Moral, Merce Cladellas, Daniele Luiso, Alicia Calvo, Jordi Palet, Juli Carballo, Gisela Teixido Tura, Giuliana Maldonado, Laura Gutierrez, Teresa Gonzalez-Alujas, Rodriguez Palomares Jose Fernando, Nicolas Villalva, Ma Jose Molina-Mora, Ramon Rubio Paton, Juan Jose Martinez Diaz, Pablo Ramos Ruiz, Alfonso Valle, Ana Rodriguez, Edgardo Alania, Emilio Galcera, Julia Seller, Gonzalo de la Morena Valenzuela, Daniel Saura Espin, Dolores Espinosa Garcia, Maria Jose Oliva Sandoval, Josefa Gonzalez, Miguel Garcia Navarro, Maria Teresa Perez-Martinez, Jose Ramon Ortega Trujillo, Irene Menduina Gallego, Daniel San Roman, Eliu David Perez Nogales, Olga Medina, Rodolfo Antonio Montiel Quintero, Pablo Felipe Bujanda Morun, Marta Lopez Perez, Jimmy Plasencia Huaripata, Juan Jose Morales Gonzalez, Veronica Quevedo Nelson, Jose Luis Zamorano, Ariana Gonzalez Gomez, Alfonso Fraile, Maria Teresa Alberca, Joaquin Alonso Martin, Covadonga Fernandez-Golfin, Javier Ramos, Sergio Hernandez Jimenez, Cristina Mitroi, Pedro L. Sanchez Fernandez, Elena Diaz-Pelaez, Beatriz Garde, Luis Caballero, Fermin Martinez Garcia, Francisco Cambronero, Noelia Castro, Antonio Castro, Alejandro De La Rosa, Pastora Gallego, Irene Mendez, David Villagomez Villegas, Manuel Gonzalez Correa, Roman Calvo, Francisco Florian, Rafael Paya, Esther Esteban, Francisco Buendia, Andrés Cubillos, Carmen Fernandez, Juan Pablo Cárdenas, José Leandro Pérez-Boscá, Joan Vano, Joaquina Belchi, Cristina Iglesia-Carreno, Francisco Calvo Iglesias, Aida Escudero-Gonzalez, Sergio Zapateria-Lucea, Juan Sterling Duarte, Lara Perez-Davila, Rafael Cobas-Paz, Rosario Besada-Montenegro, Maribel Fontao-Romeo, Elena Lopez-Rodriguez, Emilio Paredes-Galan, Berenice Caneiro-Queija, Alba Guitian Gonzalez, Abdi Bozkurt, Serafettin Demir, Durmus Unlu, Caglar Emre Cagliyan, Muslum Firat Ikikardes, Mustafa Tangalay, Osman Kuloglu, Necla Ozer, Ugur Canpolat, Melek Didem Kemaloglu, Abdullah Orhan Demirtas, Didar Elif Akgün, Eyup Avci, Gokay Taylan, Mustafa Adem Yilmaztepe, Fatih Mehmet Ucar, Servet Altay, Muhammet Gurdogan, Naile Eris Gudul, Mujdat Aktas, Mutlu Buyuklu, Husnu Degirmenci, Mehmet Salih Turan, Kadir Ugur Mert, Gurbet Ozge Mert, Muhammet Dural, Sukru Arslan, Nurten Sayar, Batur Kanar, Beste Ozben Sadic, Ahmet Anil Sahin, Ahmet Buyuk, Onur Kilicarslan, Cem Bostan, Tarik Yildirim, Seda Elcim Yildirim, Kahraman Cosansu, Perihan Varim, Ersin Ilguz, Recep Demirbag, Asuman Yesilay, Abdullah Cirit, Eyyup Tusun, Emre Erkus, Muhammet Rasit Sayin, Zeynep Kazaz, Selim Kul, Turgut Karabag, Belma Kalayci, Clinical sciences, Cardio-vascular diseases, and Cardiology
Subjects: Male, medicine.medical_specialty, Multivariate analysis, Clinical Decision-Making, Risk Assessment, Severity of Illness Index, decision making, surgery, Risk Factors, Internal medicine, Intervention (counseling), medicine, Clinical endpoint, Humans, 03.02. Klinikai orvostan, guidelines, Symptomatic aortic stenosis, Aged, Retrospective Studies, Aged, 80 and over, business.industry, valvular heart disease, Disease Management, aortic stenosis, Aortic Valve Stenosis, Odds ratio, medicine.disease, Europe, Stenosis, Treatment Outcome, Echocardiography, Aortic Valve, Charlson comorbidity index, transcatheter aortic valve replacement, Female, Morbidity, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies, surgical aortic valve replacement
Abstract: BACKGROUND There were gaps between guidelines and practice when surgery was the only treatment for aortic stenosis (AS). OBJECTIVES This study analyzed the decision to intervene in patients with severe AS in the EORP VHD (EURObservational Research Programme Valvular Heart Disease) II survey. METHODS Among 2,152 patients with severe AS, 1,271 patients with high-gradient AS who were symptomatic fulfilled a Class I recommendation for intervention according to the 2012 European Society of Cardiology guidelines; the primary end point was the decision for intervention. RESULTS A decision not to intervene was taken in 262 patients (20.6%). In multivariate analysis, the decision not to intervene was associated with older age (odds ratio [OR]: 1.34 per 10-year increase; 95% CI: 1.11 to 1.61; P = 0.002), New York Heart Association functional classes I and II versus III (OR: 1.63; 95% CI: 1.16 to 2.30; P = 0.005), higher age adjusted Charlson comorbidity index (OR: 1.09 per 1-point increase; 95% CI: 1.01 to 1.17; P = 0.03), and a lower transaortic mean gradient (OR: 0.81 per 10-mm Hg decrease; 95% CI: 0.71 to 0.92; P < 0.001). During the study period, 346 patients (40.2%, median age 84 years, median EuroSCORE II [European System for Cardiac Operative Risk Evaluation II] 3.1%) underwent transcatheter intervention and 515 (59.8%, median age 69 years, median EuroSCORE II 1.5%) underwent surgery. A decision not to intervene versus intervention was associated with lower 6-month survival (87.4%; 95% CI: 82.0 to 91.3 vs 94.6%; 95% CI: 92.8 to 95.9; P < 0.001). CONCLUSIONS A decision not to intervene was taken in 1 in 5 patients with severe symptomatic AS despite a Class I recommendation for intervention and the decision was particularly associated with older age and combined comorbidities. Transcatheter intervention was extensively used in octogenarians. (J Am Coll Cardiol 2021;78:2131-2143) (c) 2021 by the American College of Cardiology Foundation.
Published: 2021

62. Are We Right to Believe in the Value of Transcatheter Treatment of Secondary Tricuspid Regurgitation?

Author: Erwan Donal, Bernard Iung, Guillaume Leurent, Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: medicine.medical_specialty, 030204 cardiovascular system & hematology, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Internal medicine, randomized trial, medicine, Humans, clip, 030212 general & internal medicine, tricuspid regurgitation, ComputingMilieux_MISCELLANEOUS, Heart Valve Prosthesis Implantation, business.industry, Tricuspid Valve Insufficiency, 3. Good health, Regurgitation (digestion), Cardiology, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Tricuspid Valve, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Value (mathematics)
Abstract: International audience
Published: 2021

63. Characteristics and Outcome of COAPT-Eligible Patients in the MITRA-FR Trial

Author: Jean-François Obadia, Delphine Maucort-Boulch, Alec Vahanian, Jean-Noël Trochu, Bernard Iung, Florent Boutitie, Xavier Armoiry, David Messika-Zeitoun, Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Université Sorbonne Paris Nord, University of Ottawa [Ottawa], Hospices Civils de Lyon (HCL), Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Université de Lyon, Université de Nantes (UN), Centre d’Investigation Clinique de Nantes (CIC Nantes), Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre hospitalier universitaire de Nantes (CHU Nantes), Matériaux, ingénierie et science [Villeurbanne] (MATEIS), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Centre National de la Recherche Scientifique (CNRS), Hôpital Louis Pradel [CHU - HCL], AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, and CarMeN, laboratoire
Subjects: Male, Cardiac Catheterization, medicine.medical_specialty, Time Factors, [SDV]Life Sciences [q-bio], Clinical Decision-Making, MEDLINE, heart failure, Eligibility Determination, 030204 cardiovascular system & hematology, Prosthesis Design, heart valve diseases, Risk Assessment, Severity of Illness Index, Outcome (game theory), 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Physiology (medical), Internal medicine, medicine, Humans, 030212 general & internal medicine, ComputingMilieux_MISCELLANEOUS, Aged, Heart Valve Prosthesis Implantation, Clinical Trials as Topic, business.industry, Patient Selection, Mitral Valve Insufficiency, Recovery of Function, Middle Aged, medicine.disease, 3. Good health, [SDV] Life Sciences [q-bio], Treatment Outcome, Heart Valve Prosthesis, Heart failure, Disease Progression, Mitral Valve, Female, Cardiology and Cardiovascular Medicine, business
Abstract: International audience; No abstract available
Published: 2020

64. Impact of systematic whole-body 18F-fluorodeoxyglucose PET/CT on the management of patients suspected of infective endocarditis: the prospective multicenter TEPvENDO study

Author: Xavier, Duval, Vincent, Le Moing, Sarah, Tubiana, Marina, Esposito-Farèse, Emila, Ilic-Habensus, Florence, Leclercq, Aurélie, Bourdon, François, Goehringer, Christine, Selton-Suty, Elodie, Chevalier, David, Boutoille, Nicolas, Piriou, Thierry, Le Tourneau, Catherine, Chirouze, Marie-France, Seronde, Olivier, Morel, Lionel, Piroth, Jean-Christophe, Eicher, Olivier, Humbert, Matthieu, Revest, Elise, Thébault, Anne, Devillers, François, Delahaye, André, Boibieux, Bastien, Grégoire, Bruno, Hoen, Cédric, Laouenan, Bernard, Iung, François, Rouzet, Ophélie, Rogier, CIC - CHU Bichat, Institut National de la Santé et de la Recherche Médicale (INSERM), Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Université Sorbonne Paris Nord, Université de Montpellier (UM), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service de Cardiologie [CHRU Nancy], Centre hospitalier universitaire de Nantes (CHU Nantes), Centre d’Investigation Clinique de Nantes (CIC Nantes), Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre hospitalier universitaire de Nantes (CHU Nantes), unité de recherche de l'institut du thorax UMR1087 UMR6291 (ITX), Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( EA 3920) (PCVP / CARDIO), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Centre d'Investigation Clinique 1432 (Dijon) - Module Plurithématique : Périnatalité Cancérologie Handicap et Ophtalmologie (CIC-P803), Institut National de la Santé et de la Recherche Médicale (INSERM)-Direction Générale de l'Organisation des Soins (DGOS)-Université de Bourgogne (UB), Centre de génétique - Centre de référence des maladies rares, anomalies du développement et syndromes malformatifs (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), CHU Dijon, CHU Pontchaillou [Rennes], ARN régulateurs bactériens et médecine (BRM), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Eugène Marquis (CRLCC), Hospices Civils de Lyon (HCL), Service de Maladies Infectieuses et Tropicales [Hôpital de la Croix-Rousse - HCL], Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), 13549-P130938, French Ministry of Health, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Unité de recherche de l'institut du thorax (ITX-lab), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Laboratoire Chrono-environnement (UMR 6249) (LCE), Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( UR 3920) (PCVP / CARDIO), Université de Bourgogne (UB)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), and Jonchère, Laurent
Subjects: Microbiology (medical), medicine.medical_specialty, [SDV.IB.IMA]Life Sciences [q-bio]/Bioengineering/Imaging, 18F-FDG-PET/CT, 030204 cardiovascular system & hematology, Tertiary care, Duke criteria, Fluorodeoxyglucose PET, 03 medical and health sciences, 0302 clinical medicine, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Fluorodeoxyglucose F18, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Positron Emission Tomography Computed Tomography, diagnostic impact, medicine, Humans, 030212 general & internal medicine, Prospective Studies, patient management, Prosthetic valve, Endocarditis, business.industry, infective endocarditis, medicine.disease, Diagnostic classification, 3. Good health, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Infectious Diseases, [SDV.IB.IMA] Life Sciences [q-bio]/Bioengineering/Imaging, Native valve, Infective endocarditis, Heart Valve Prosthesis, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Radiology, Radiopharmaceuticals, Whole body, business
Abstract: BackgroundDiagnostic and patients’ management modifications induced by whole-body 18F-FDG-PET/CT had not been evaluated so far in prosthetic valve (PV) or native valve (NV) infective endocarditis (IE)-suspected patients.MethodsIn sum, 140 consecutive patients in 8 tertiary care hospitals underwent 18F-FDG-PET/CT. ESC-2015-modified Duke criteria and patients’ management plan were established jointly by 2 experts before 18F-FDG-PET/CT. The same experts reestablished Duke classification and patients’ management plan immediately after qualitative interpretation of 18F-FDG-PET/CT. A 6-month final Duke classification was established.ResultsAmong the 70 PV and 70 NV patients, 34 and 46 were classified as definite IE before 18F-FDG-PET/CT. Abnormal perivalvular 18F-FDG uptake was recorded in 67.2% PV and 24.3% NV patients respectively (P < .001) and extracardiac uptake in 44.3% PV and 51.4% NV patients. IE classification was modified in 24.3% and 5.7% patients (P = .005) (net reclassification index 20% and 4.3%). Patients’ managements were modified in 21.4% PV and 31.4% NV patients (P = .25). It was mainly due to perivalvular uptake in PV patients and to extra-cardiac uptake in NV patients and consisted in surgery plan modifications in 7 patients, antibiotic plan modifications in 22 patients and both in 5 patients. Altogether, 18F-FDG-PET/CT modified classification and/or care in 40% of the patients (95% confidence interval: 32–48), which was most likely to occur in those with a noncontributing echocardiography (P < .001) or IE classified as possible at baseline (P = .04), while there was no difference between NV and PV.ConclusionsSystematic 18F-FDG-PET/CT did significantly and appropriately impact diagnostic classification and/or IE management in PV and NV-IE suspected patients.Clinical Trials RegistrationNCT02287792.
Published: 2021

65. High Post-Procedural Transvalvular Gradient or Delayed Mean Gradient Increase after Transcatheter Aortic Valve Implantation: Incidence, Prognosis and Associated Variables. The FRANCE-2 Registry

Author: Jean Fajadet, Michel Lievre, Thierry Lefèvre, Clément Bénic, Romain Didier, Bahaa Nasr, Martine Gilard, Edward Koifman, Alain Leguerrier, Alain Prat, Hervé Le Breton, Emmanuel Teiger, Thomas Cuisset, Sinda Hannachi, Florent Le Ven, Patrick Donzeau-Gouge, Vincent Auffret, Bernard Iung, Hélène Eltchaninoff, Pascal Leprince, Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Hôpital Charles Nicolle [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU), Pharmacologie des Dysfonctionnements Endotheliaux et Myocardiques, Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Soroka University Medical Center [Beer Sheva, Israel], Institut Cardiovasculaire Paris Sud (ICPS), Clinique Pasteur [Toulouse], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Pontchaillou [Rennes], Université Claude Bernard Lyon 1 (UCBL), Université de Lyon, Hôpital cardiologique, Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Hôpital Henri Mondor, Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Hôpital de la Timone [CHU - APHM] (TIMONE), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Paris Diderot - Paris 7 (UPD7), and RANCHON, GUILLAUME
Subjects: medicine.medical_specialty, Transcatheter aortic, [SDV]Life Sciences [q-bio], Population, 030204 cardiovascular system & hematology, Article, TAVI, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, 030212 general & internal medicine, education, education.field_of_study, business.industry, Incidence (epidemiology), General Medicine, Gradient Increase, post-procedural mean gradient, medicine.disease, structural valve degeneration, [SDV] Life Sciences [q-bio], Stenosis, Cardiology, Medicine, mean gradient, business
Abstract: Mean Gradient (MG) elevation can be detected immediately after transcatheter aortic valve implantation (TAVI) or secondarily during follow-up. Comparisons and interactions between these two parameters and their impact on outcomes have not previously been investigated. This study aimed to identify incidence, influence on prognosis, and parameters associated with immediate high post-procedural mean transvalvular gradient (PPMG) and delayed mean gradient increase (6 to 12 months after TAVI, DMGI) in the FRANCE 2 (French Aortic National CoreValve and Edwards 2) registry. The registry includes all consecutive symptomatic patients with severe aortic stenosis who have undergone TAVI. Three groups were analyzed: (1) PPMG &lt, 20 mmHg without DMGI &gt, 10 mmHg (control), (2) PPMG &lt, 20 mmHg with DMGI &gt, 10 mmHg (Group 1), and (3) PPMG ≥ 20 mmHg (Group 2). From January 2010 to January 2012, 4201 consecutive patients were prospectively enrolled in the registry. Controls comprised 2078 patients. In Group 1(n = 131 patients), DMGI exceeded 10 mmHg in 5.6%, and was not associated with greater 4-years mortality than in controls (32.6% vs. 40.1%, p = 0.27). In Group 2 (n = 144 patients), PPMG was at least 20 mmHg in 6.1% and was associated with higher 4-year mortality (48.7% versus 40.1%, p = 0.005). A total of two-thirds of the patients with PPMG ≥ 20 mmHg had MG &lt, 20 mmHg at 1 year, with mortality similar to the controls (39.2% vs. 40.1%, p = 0.73). Patients with PPMG &gt, 20 mmHg 1 year post-TAVI had higher 4-years mortality than the general population of the registry, unlike patients with MG normalization.
Published: 2021

66. Community burden of aortic valve disease

Author: Bernard Iung and Dimitri Arangalage
Subjects: Aortic valve disease, medicine.medical_specialty, Pediatrics, Cardiovascular health, media_common.quotation_subject, Population, 030204 cardiovascular system & hematology, Article, 03 medical and health sciences, 0302 clinical medicine, Epidemiology, medicine, Humans, 030212 general & internal medicine, education, media_common, Selection bias, education.field_of_study, business.industry, Aortic Valve Stenosis, medicine.disease, Aortic Valve Disease, Stenosis, Aortic valve stenosis, Aortic Valve, Cohort, Cardiology and Cardiovascular Medicine, business
Abstract: OBJECTIVES: Current estimates of aortic stenosis (AS) frequency have mostly relied on cross-sectional echocardiographic or longitudinal administrative data, making understanding of AS burden incomplete. We performed case adjudications to evaluate the frequency of AS and assess differences by age, sex and race in an older cohort with long-term follow-up. METHODS: We developed case-capture methods using study echocardiograms, procedure and diagnosis codes, heart failure events and deaths for targeted review of medical records in the Cardiovascular Health Study to identify moderate or severe AS and related procedures or hospitalizations. The primary outcome was clinically significant AS (severe AS or procedure). Assessment of incident AS burden was based on subdistribution survival methods, while associations with age, sex and race relied on cause-specific survival methods. RESULTS: The cohort comprised 5,795 participants (age 73±6, 42.2% male,14.3% Black). Cumulative frequency of clinically significant AS at maximal 25-year follow-up was 3.69% (probable/definite) to 4.67% (possible/probable/definite), while the corresponding 20-year cumulative incidence was 2.88 to 3.71%. Of incident cases, about 85% had a hospitalization for severe AS, but roughly half did not undergo valve intervention. The adjusted incidence of clinically significant AS was higher in men (HR=1.62 [95% CI=1.21-2.17]) and increased with age (HR=1.08 [95% CI=1.04-1.11]), but was lower in Blacks (HR=0.43 [95% CI=0.23-0.81]). CONCLUSIONS: In this community-based study, we identified a higher burden of clinically significant AS than reported previously, with differences by age, sex, and race. These findings have important implications for public health resource planning, although the lower burden in Blacks merits further study.
Published: 2021

67. Causes and predictors of mortality after transcatheter mitral valve implantation in patients with severe mitral annulus calcification

Author: Alec Vahanian, Jose-Luis Carrasco, Marina Urena, Bernard Iung, Eric Brochet, Gregory Ducrocq, Thomas Lemann, Dominique Himbert, and Caroline Chong-Nguyen
Subjects: medicine.medical_specialty, Cardiac Catheterization, medicine.medical_treatment, Population, Internal medicine, Mitral valve, Medicine, Humans, Radiology, Nuclear Medicine and imaging, education, Aged, Aged, 80 and over, Heart Valve Prosthesis Implantation, Mitral regurgitation, education.field_of_study, business.industry, Mortality rate, Mitral valve replacement, Mitral Valve Insufficiency, EuroSCORE, General Medicine, medicine.disease, medicine.anatomical_structure, Treatment Outcome, Heart failure, Infective endocarditis, Heart Valve Prosthesis, Cardiology, Mitral Valve, Female, Cardiology and Cardiovascular Medicine, business
Abstract: Objectives To evaluate the causes and predictors of mortality after valve-in-mitral annulus calcification (MAC) transcatheter mitral valve implantation (TMVI). Background Conventional surgical mitral valve replacement is associated with a high risk in patients with mitral valve disease associated with severe MAC. In this population, TMVI may be an attractive alternative option. However, its prognostic factors are poorly understood. Methods All patients undergoing valve-in-MAC TMVI from 2013 to 2018 in our center were included. Indication for TMVI relied on the judgment of the local heart team. Patients were followed at 30 days and 1 year. Results A total of 34 patients underwent valve-in-MAC TMVI. The mean age was 79 ± 11 years and 73% of patients were women. Their mean EuroSCORE 2 was 8 ± 7%. The transseptal approach was used in 79% of patients and a hybrid transatrial in 29%. Balloon expandable transcatheter heart valves were used in all the patients. Technical success was achieved in 76% of the patients. Thirty-day and 1-year all-cause mortality rates were 14.7% and 32.4%, respectively. The main two causes of 1-year mortality were congestive heart failure (8.8%) and infective endocarditis (5.9%). In multivariate analysis, the only predictor of 1-year mortality was the presence of periprothetic mitral regurgitation grade 2 (HR, 5.69; 95%CI, 1.59-27.88, p = 0.032). Conclusion Early and mid-term mortality remains high after valve-in-MAC TMVI and seems to be associated with the presence of paravalvular mitral regurgitation. However, whether the latter is a prognostic factor or marker remains to be determined to improve clinical outcomes in this high-risk population.
Published: 2021

68. Atrial Fibrillation and Aortic Stenosis

Author: Vincent Algalarrondo and Bernard Iung
Subjects: medicine.medical_specialty, Stenosis, Valvular disease, business.industry, Internal medicine, Heart failure, medicine, Cardiology, Atrial fibrillation, Cardiology and Cardiovascular Medicine, medicine.disease, business
Published: 2020

69. Valve-in-valve vs. repeat surgical aortic valve replacement: a new match but the game is not over!

Author: Olaf Wendler and Bernard Iung
Subjects: 03 medical and health sciences, medicine.medical_specialty, 0302 clinical medicine, 030228 respiratory system, Aortic valve replacement, business.industry, medicine, 030204 cardiovascular system & hematology, Cardiology and Cardiovascular Medicine, medicine.disease, business, Valve in valve, Surgery
Published: 2020

70. Corrigendum to '2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk' [Atherosclerosis 290 (2019) 140–205]

Author: Francois Mach, Colin Baigent, Alberico L. Catapano, Konstantinos C. Koskinas, Manuela Casula, Lina Badimon, M. John Chapman, Guy G. De Backer, Victoria Delgado, Brian A. Ference, Ian M. Graham, Alison Halliday, Ulf Landmesser, Borislava Mihaylova, Terje R. Pedersen, Gabriele Riccardi, Dimitrios J. Richter, Marc S. Sabatine, Marja-Riitta Taskinen, Lale Tokgozoglu, Olov Wiklund, Djamaleddine Nibouche, Parounak H. Zelveian, Peter Siostrzonek, Ruslan Najafov, Philippe van de Borne, Belma Pojskic, Arman Postadzhiyan, Lambros Kypris, Jindřich Špinar, Mogens Lytken Larsen, Hesham Salah Eldin, Margus Viigimaa, Timo E. Strandberg, Jean Ferrieres, Rusudan Agladze, Ulrich Laufs, Loukianos Rallidis, Laszlo Bajnok, Thorbjorn Gudjonsson, Vincent Maher, Yaakov Henkin, Michele Massimo Gulizia, Aisulu Mussagaliyeva, Gani Bajraktari, Alina Kerimkulova, Gustavs Latkovskis, Omar Hamoui, Rimvydas Slapikas, Laurent Visser, Philip Dingli, Victoria Ivanov, Aneta Boskovic, Mbarek Nazzi, Frank Visseren, Irena Mitevska, Kjetil Retterstol, Piotr Jankowski, Ricardo Fontes-Carvalho, Dan Gaita, Marat Ezhov, Marina Foscoli, Vojislav Giga, Daniel Pella, Zlatko Fras, Leopoldo Perez de Isla, Emil Hagstrom, Roger Lehmann, Leila Abid, Oner Ozdogan, Olena Mitchenko, Riyaz S. Patel, Stephan Windecker, Victor Aboyans, Jean-Philippe Collet, Veronica Dean, Donna Fitzsimons, Chris P. Gale, Diederick Grobbee, Sigrun Halvorsen, Gerhard Hindricks, Bernard Iung, Peter Juni, Hugo A. Katus, Christophe Leclercq, Maddalena Lettino, Basil S. Lewis, Bela Merkely, Christian Mueller, Steffen Petersen, Anna Sonia Petronio, Marco Roffi, Evgeny Shlyakhto, Iain A. Simpson, Miguel Sousa-Uva, and Rhian M. Touyz
Subjects: Cardiology and Cardiovascular Medicine
Published: 2020

71. Erratum to '2019 ESC/EAS guidelines for the management of dyslipidemias: Lipid modification to reduce cardiovascular risk' [Atherosclerosis 290 (2019) 140–205]

Author: Francois Mach, Colin Baigent, Alberico L. Catapano, Konstantinos C. Koskinas, Manuela Casula, Lina Badimon, M. John Chapman, Guy G. De Backer, Victoria Delgado, Brian A. Ference, Ian M. Graham, Alison Halliday, Ulf Landmesser, Borislava Mihaylova, Terje R. Pedersen, Gabriele Riccardi, Dimitrios J. Richter, Marc S. Sabatine, Marja-Riitta Taskinen, Lale Tokgozoglu, Olov Wiklund, Djamaleddine Nibouche, Parounak H. Zelveian, Peter Siostrzonek, Ruslan Najafov, Philippe van de Borne, Belma Pojskic, Arman Postadzhiyan, Lambros Kypris, Jindřich Špinar, Mogens Lytken Larsen, Hesham Salah Eldin, Margus Viigimaa, Timo E. Strandberg, Jean Ferrieres, Rusudan Agladze, Ulrich Laufs, Loukianos Rallidis, Laszlo Bajnok, Thorbjorn Gudjonsson, Vincent Maher, Yaakov Henkin, Michele Massimo Gulizia, Aisulu Mussagaliyeva, Gani Bajraktari, Alina Kerimkulova, Gustavs Latkovskis, Omar Hamoui, Rimvydas Slapikas, Laurent Visser, Philip Dingli, Victoria Ivanov, Aneta Boskovic, Mbarek Nazzi, Frank Visseren, Irena Mitevska, Kjetil Retterstol, Piotr Jankowski, Ricardo Fontes-Carvalho, Dan Gaita, Marat Ezhov, Marina Foscoli, Vojislav Giga, Daniel Pella, Zlatko Fras, Leopoldo Perez de Isla, Emil Hagstrom, Roger Lehmann, Leila Abid, Oner Ozdogan, Olena Mitchenko, Riyaz S. Patel, Stephan Windecker, Victor Aboyans, Jean-Philippe Collet, Veronica Dean, Donna Fitzsimons, Chris P. Gale, Diederick Grobbee, Sigrun Halvorsen, Gerhard Hindricks, Bernard Iung, Peter Juni, Hugo A. Katus, Christophe Leclercq, Maddalena Lettino, Basil S. Lewis, Bela Merkely, Christian Mueller, Steffen Petersen, Anna Sonia Petronio, Marco Roffi, Evgeny Shlyakhto, Iain A. Simpson, Miguel Sousa-Uva, and Rhian M. Touyz
Subjects: 03 medical and health sciences, 0302 clinical medicine, business.industry, Medicine, 030209 endocrinology & metabolism, 030204 cardiovascular system & hematology, Lipid modification, Cardiology and Cardiovascular Medicine, Bioinformatics, business
Published: 2020

72. Percutaneous repair or medical treatment for secondary mitral regurgitation: outcomes at 2 years

Author: Lionel Leroux, Nicolas Piriou, Frédéric Rouleau, Xavier Armoiry, David Messika-Zeitoun, Gilles Rioufol, Sophie Thivolet, Nathan Mewton, Guillaume Bonnet, Bertrand Cormier, Thierry Lefèvre, Florent Boutitie, Guillaume Leurent, Martine Gilard, Delphine Maucort-Boulch, Jean-François Obadia, Gilbert Habib, Mitra-Fr Investigators, Christophe Piot, Didier Carrié, Patrick Ohlmann, Dominique Himbert, Bernard Iung, Patrice Guerin, Mohammed Nejjari, Alec Vahanian, Jean-Noël Trochu, Géraldine Samson, Hélène Thibault, Eric Brochet, Erwan Donal, and Christophe Saint Etienne
Subjects: Male, Cardiac Catheterization, medicine.medical_specialty, Time Factors, Percutaneous, 030204 cardiovascular system & hematology, Effective Regurgitant Orifice Area, Ventricular Function, Left, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Aged, Retrospective Studies, Heart Failure, Heart Valve Prosthesis Implantation, Mitral regurgitation, Ejection fraction, business.industry, Hazard ratio, Mitral Valve Insufficiency, Stroke Volume, Middle Aged, medicine.disease, Confidence interval, 3. Good health, Surgery, Treatment Outcome, Heart failure, Mitral Valve, Female, Cardiology and Cardiovascular Medicine, business, Echocardiography, Transesophageal, Percutaneous Mitral Valve Repair, Follow-Up Studies
Abstract: Aims The MITRA-FR trial showed that among symptomatic patients with severe secondary mitral regurgitation, percutaneous repair did not reduce the risk of death or hospitalization for heart failure at 12 months compared with guideline-directed medical treatment alone. We report the 24-month outcome from this trial. Methods and results At 37 centres, we randomly assigned 304 symptomatic heart failure patients with severe secondary mitral regurgitation (effective regurgitant orifice area >20 mm2 or regurgitant volume >30 mL), and left ventricular ejection fraction between 15% and 40% to undergo percutaneous valve repair plus medical treatment (intervention group, n = 152) or medical treatment alone (control group, n = 152). The primary efficacy outcome was the composite of all-cause death and unplanned hospitalization for heart failure at 12 months. At 24 months, all-cause death and unplanned hospitalization for heart failure occurred in 63.8% of patients (97/152) in the intervention group and 67.1% (102/152) in the control group [hazard ratio (HR) 1.01, 95% confidence interval (CI) 0.77-1.34]. All-cause mortality occurred in 34.9% of patients (53/152) in the intervention group and 34.2% (52/152) in the control group (HR 1.02, 95% CI 0.70-1.50). Unplanned hospitalization for heart failure occurred in 55.9% of patients (85/152) in the intervention group and 61.8% (94/152) in the control group (HR 0.97, 95% CI 0.72-1.30). Conclusions In patients with severe secondary mitral regurgitation, percutaneous repair added to medical treatment did not significantly reduce the risk of death or hospitalization for heart failure at 2 years compared with medical treatment alone.
Published: 2019

73. Risk Stratification in Patients With Aortic Stenosis

Author: Philippe Pibarot, João L. Cavalcante, and Bernard Iung
Subjects: medicine.medical_specialty, business.industry, medicine.disease, Pulmonary hypertension, Right ventricular dysfunction, Stenosis, Aortic valve replacement, Internal medicine, Risk stratification, medicine, Cardiology, In patient, Cardiology and Cardiovascular Medicine, business
Published: 2019

74. Neurologic Complications of Infective Endocarditis

Author: Mikael Mazighi, Jean-Marc Olivot, Françoise Chau, Clément Journé, Marie Cantier, Benoît Ho-Tin-Noé, Homa Adle-Biassette, Jean-Philippe Desilles, Candice Sabben, Isabelle F. Klein, Devy Diallo, Phalla Ou, Agnès Lefort, Xavier Duval, Bernard Iung, Liliane Louedec, Sandrine Delbosc, Jean-Baptiste Michel, and Romain Sonneville
Subjects: Male, Staphylococcus aureus, medicine.medical_specialty, Disease, Critical Care and Intensive Care Medicine, medicine.disease_cause, 03 medical and health sciences, 0302 clinical medicine, Cerebral lesion, Thromboembolism, medicine, Animals, Rats, Wistar, Endocarditis, business.industry, Brain, 030208 emergency & critical care medicine, medicine.disease, Immunohistochemistry, Magnetic Resonance Imaging, Pathophysiology, Rats, Surgery, Disease Models, Animal, Streptococcus pneumoniae, 030228 respiratory system, Cerebral Small Vessel Diseases, Infective endocarditis, Small vessel, Vasculitis, business
Abstract: Embolic events from vegetations are commonly accepted as the main mechanism involved in neurologic complications of infective endocarditis. The pathophysiology may imply other phenomena, including vasculitis. We aimed to define the cerebral lesion spectrum in an infective endocarditis rat model.Experimental model of Staphylococcus aureus or Enterococcus faecalis infective endocarditis. Neurologic lesions observed in the infective endocarditis model were compared with three other conditions, namely bacteremia, nonbacterial thrombotic endocarditis, and healthy controls.Research laboratory of a university hospital.Male Wistar rats.Brain MRI, neuropathology, immunohistochemistry for astrocyte and microglia, and bacterial studies on brain tissue were used to characterize neurologic lesions.In the infective endocarditis group, MRI revealed at least one cerebral lesion in 12 of 23 rats (52%), including brain infarctions (n = 9/23, 39%) and cerebral microbleeds (n = 8/23, 35%). In the infective endocarditis group, neuropathology revealed brain infarctions (n = 12/23, 52%), microhemorrhages (n = 10/23, 44%), and inflammatory processes (i.e., cell infiltrates including abscesses, vasculitis, meningoencephalitis, and/or ependymitis; n = 11/23, 48%). In the bacteremia group, MRI studies were normal and neuropathology revealed only hemorrhages (n = 2/11, 18%). Neuropathologic patterns observed in the nonbacterial thrombotic endocarditis group were similar to those observed in the infective endocarditis group. Immunochemistry revealed higher microglial activation in the infective endocarditis group (n = 11/23, 48%), when compared with the bacteremia (n = 1/11, 9%; p = 0.03) and nonbacterial thrombotic endocarditis groups (n = 0/7, 0%; p = 0.02).This original model of infective endocarditis recapitulates the neurologic lesion spectrum observed in humans and suggests synergistic mechanisms involved, including thromboembolism and cerebral vasculitis, promoted by a systemic bacteremia-mediated inflammation.
Published: 2019

75. Performing optimal transcatheter aortic valve implantation: The need for tailored use of transcatheter valves

Author: Eric Brochet, Dominique Himbert, Marina Urena, Bernard Iung, Quentin Fischer, Jose-Luis Carrasco, Jérémie Abtan, Alec Vahanian, and Claire Bouleti
Subjects: Balloon Valvuloplasty, Male, medicine.medical_specialty, Time Factors, Transcatheter aortic, Aortic root, Clinical Decision-Making, Patient characteristics, 030204 cardiovascular system & hematology, Prosthesis Design, Transcatheter Aortic Valve Replacement, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, medicine, Humans, 030212 general & internal medicine, Major complication, Heart valve, Adverse effect, Stroke, Aged, Aged, 80 and over, business.industry, Patient Selection, Aortic Valve Stenosis, Recovery of Function, General Medicine, medicine.disease, Surgery, Treatment Outcome, medicine.anatomical_structure, Aortic Valve, Heart Valve Prosthesis, Female, Cardiology and Cardiovascular Medicine, business, Major bleeding
Abstract: Summary Background Despite the worldwide development of transcatheter aortic valve implantation (TAVI) over the last decade, strategies that take patient characteristics into account to guide the choice of transcatheter heart valve have not been evaluated. Aim To evaluate the immediate results of TAVI using a tailored choice of balloon-expandable or self-expanding transcatheter heart valve, according to each patient's clinical and anatomical characteristics. Methods This single-centre observational study included all patients treated with TAVI from 2012 to 2017. The 30-day results were reported according to Valve Academic Research Consortium-2 criteria. A total of 502 patients were included (mean age, 81 ± 9 years; 52% men; mean EuroSCORE II, 7.0 ± 6.5%). Three main variables guided the choice of transcatheter heart valve: the anatomy of the iliofemoral arteries and of the aortic root, and the general condition of the patient. Results A SAPIEN™ balloon-expandable transcatheter heart valve was used in 275 patients (55%) and a CoreValve™ self-expanding transcatheter heart valve in 227 patients (45%). The approach was transfemoral in 427 patients (85%), and only 29 patients (6%) required transthoracic access. At 30-day follow-up, the rates of adverse events were as follows: mortality, 3.2%; stroke, 3.0%; major bleeding, 5.9%; and major vascular complications, 6.0%. Rates of complications at 30 days were similar in the SAPIEN™ and CoreValve™ groups, except for a higher rate of pacemaker implantation in the latter group (29.5% vs. 14.5%; P Conclusion The choice of balloon-expandable or self-expanding transcatheter heart valve tailored to the patient's clinical and anatomical characteristics allows for maximal use of the transfemoral approach, and is associated with low 30-day rates of major complications and mortality.
Published: 2019

76. Infective endocarditis: innovations in the management of an old disease

Author: Bernard Iung and Xavier Duval
Subjects: 0301 basic medicine, medicine.medical_specialty, Population, Disease, 030204 cardiovascular system & hematology, Preoperative care, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Positron Emission Tomography Computed Tomography, Preoperative Care, Epidemiology, Humans, Medicine, Cardiac Surgical Procedures, Antibiotic prophylaxis, Intensive care medicine, education, education.field_of_study, Endocarditis, business.industry, Incidence (epidemiology), Antibiotic Prophylaxis, medicine.disease, Heart Valves, Anti-Bacterial Agents, 030104 developmental biology, Echocardiography, Heart failure, Infective endocarditis, Practice Guidelines as Topic, Cardiology and Cardiovascular Medicine, business
Abstract: The annual incidence of infective endocarditis (IE) is estimated to be between 15 and 80 cases per million persons in population-based studies. The incidence of IE is markedly increased in patients with valve prostheses (>4 per 1,000) or with prior IE (>10 per 1,000). The interaction between platelets, microorganisms and diseased valvular endothelium is the cause of vegetations and valvular or perivalvular tissue destruction. Owing to its complexity, the diagnosis of IE is facilitated by the use of the standardized Duke–Li classification, which combines two major criteria (microbiology and imaging) with five minor criteria. However, the sensitivity of the Duke–Li classification is suboptimal, particularly in prosthetic IE, and can be improved by the use of PET or radiolabelled leukocyte scintigraphy. Prolonged antibiotic therapy is mandatory. Indications for surgery during acute IE depend on the presence of haemodynamic, septic and embolic complications. The most urgent indications for surgery are related to heart failure. In the past decade, the prevention of IE has been reoriented, with indications for antibiotic prophylaxis now limited to patients at high risk of IE undergoing dental procedures. Guidelines now emphasize the importance of nonspecific oral and cutaneous hygiene in individual patients and during health-care procedures. Infective endocarditis (IE) is not a common disease, but it has a poor prognosis. In this Review, contemporary findings concerning the epidemiology, diagnosis, therapeutic management and prevention of IE are highlighted, with a particular emphasis on innovations and changes in guidelines.
Published: 2019

77. Prévention de l’endocardite infectieuse

Author: Bernard Iung, Sarah Millot, Sarah Tubiana, Xavier Duval, Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Université Sorbonne Paris Nord, and Université Paris Diderot - Paris 7 (UPD7)
Subjects: medicine.medical_specialty, business.industry, [SDV]Life Sciences [q-bio], media_common.quotation_subject, Dental procedures, MEDLINE, Implant failure, General Medicine, 030204 cardiovascular system & hematology, medicine.disease, 3. Good health, 03 medical and health sciences, 0302 clinical medicine, Hygiene, Infective endocarditis, medicine, Endocarditis, 030212 general & internal medicine, Antibiotic prophylaxis, Intensive care medicine, business, Restorative dentistry, media_common
Abstract: Indications of antibiotic prophylaxis are restricted to the patients at highest risk of infective endocarditis undergoing at-risk dental procedures. Guidelines emphasize the importance of daily non-specific oral and cutaneous hygiene. Restorative dentistry, endodontic and periodontal therapy can be performed in patients at high risk of endocarditis, provided careful follow-up is effective. The use of dental implants is no longer contra-indicated in patients at high risk of endocarditis, but the decision be based on an individual analysis of risk factors of implant failure. Evaluations of practices show that prevention of endocarditis is not sufficiently implemented. All health professionals should be aware of the importance of prevention measures of heathcare-associated infective endocarditis. Endocarditis prophylaxis cards are made available to patients and health professionals to make them aware of the endocarditis prophylaxis.
Published: 2019

78. Endocardite infectieuse. Épidémiologie, physiopathologie et anatomopathologie

Author: Bernard Iung
Subjects: Gynecology, 03 medical and health sciences, medicine.medical_specialty, 0302 clinical medicine, business.industry, medicine, 030212 general & internal medicine, General Medicine, 030204 cardiovascular system & hematology, business
Abstract: Points essentiels L’incidence de l’endocardite infectieuse est estimee autour de 30 cas par million d’habitants et par an dans les etudes en population generale conduites dans les pays occidentaux. L’incidence de l’endocardite infectieuse est nettement accrue chez les patients ayant une prothese valvulaire et plus encore en cas d’antecedent d’endocardite. L’epidemiologie de l’endocardite infectieuse a evolue. Elle survient chez des patients âges et elle est le plus souvent due au staphylocoque. La physiopathologie de l’endocardite infectieuse fait intervenir des interactions complexes entre les micro-organismes circulants, l’endothelium valvulaire lese et les defenses immunitaires de l’hote. Les principales lesions de l’endocardite infectieuse sont les vegetations qui sont causes d’embolies et les destructions du tissu valvulaire ou peri-valvulaire a l’origine de regurgitations aigues.
Published: 2019

79. Time to blood culture positivity: An independent predictor of infective endocarditis and mortality in patients with Staphylococcus aureus bacteraemia

Author: V. Le Moing, Sandrine Barbas, Elodie Curlier, Hélène Jean-Pierre, Willem Vanwamel, Damien Fournier, Isabelle Patry, Eric Bellissant, Jacques Reynes, Sandrine Gohier-Treuvelot, François Alla, Catherine Chirouze, Fabienne Le Gac, Catherine Neuwirth, Philippe Géraud, François Goehringer, Christine Selton-Suty, Bruno Hoen, Virginie Sussmuth, Christine Delonca, Nathalie Keil, Catherine Sportouch, Thanh Doco-Lecompte, S. Tubiana, F. Vandenesch, Laetitia Minary, S. Desage, Catherine Leport, Hepher Malela, Cécile Descottes-Genon, Lionel Piroth, Christian Michelet, Pascale Rausch, Matthieu Revest, Bernard Iung, Jerome Etienne, Albert Sotto, Vincent Le Moing, J.-P. Lavigne, Catherine Cornu, Fernando Rivadeneira, Elise Thebault, Nathalie Bedos, Pierre-Yves Donnio, Lucie Vettoretti, Michèle Bes, S. Siméon, Jean-Christophe Eicher, Catherine Lechiche, X. Duval, François Vandenesch, Marie Célard, Pascal Chavanet, Sarah Tubiana, Raymond Ruimy, M.-L. Erpelding, Thierry May, André Pechinot, Nejla Aissa, Emila Ilic Habensus, François Delahaye, C.-A. Gustave, Lorraine Letranchant, Taissia Lelekov-Boissard, C. Chirouze, Anne Tristan, Audrey Coma, Jean-Philippe Lavigne, Xavier Duval, Pierre Tattevin, Alex van Belkum, Pierre Braquet, Marie-Line Erpelding, Pascale Longuet, Malika Hadid, Marie-Christine Greusard, Florence Galtier, Anne Verchère, P. Tattevin, Service des maladies infectieuses et réanimation médicale [Rennes] = Infectious Disease and Intensive Care [Rennes], CHU Pontchaillou [Rennes], Maladies Infectieuses [CHU de Montpellier], Centre Hospitalier Universitaire de Montpellier (CHU Montpellier ), Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), CIC1425 Bichat [AP-HP Hôpital Bichat - Claude Bernard] (INSERM), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire de Bactériologie [CHRU Besançon], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Virulence bactérienne et maladies infectieuses (VBMI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Service de Microbiologie [CHU Caremeau, Nîmes], Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)-Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Centre d'investigation clinique [Nancy] (CIC), Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de référence des Staphylocoques [HCL, Lyon] (Institut des Agents Infectieux), Hospices Civils de Lyon (HCL), Laboratoire de Bactériologie [HCL, Lyon] (Institut des Agents Infectieux), Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), ARN régulateurs bactériens et médecine (BRM), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), VIRSTA/AEPEI Study Group. Chirouze C, Curlier E, Descottes-Genon C, Hoen B, Patry I, Vettoretti L, Chavanet P, Eicher JC, Gohier-Treuvelot S, Greusard MC, Neuwirth C, Péchinot A, Piroth L, Célard M, Cornu C, Delahaye F, Hadid M, Rausch P, Coma A, Galtier F, Géraud P, Jean-Pierre H, Le Moing V, Sportouch C, Reynes J, Aissa N, Doco-Lecompte T, Goehringer F, Keil N, Letranchant L, Malela H, May T, Selton-Suty C, Bedos N, Lavigne JP, Lechiche C, Sotto A, Duval X, Habensus EI, Iung B, Leport C, Longuet P, Ruimy R, Bellissant E, Donnio PY, Le Gac F, Michelet C, Revest M, Tattevin P, Thebault E, Alla F, Braquet P, Erpelding ML, Minary L, Tubiana S, Bès M, Etienne J, Lelekov-Boissard T, Tristan A, Vandenesch F, Van Belkum A, Rivadeneira F, Vanwamel W, Barbas S, Delonca C, Sussmuth V, Verchère A., Service des maladies infectieuses et réanimation médicale, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC), AP-HP - Hôpital Bichat - Claude Bernard [Paris]-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon), CHU Caremeau, Nîmes, CIC-Nancy, Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy]-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire Chrono-environnement - UFC (UMR 6249) (LCE), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Recherches Translationnelles sur le VIH et les maladies infectieuses (TransVIHMI), Université Montpellier 1 (UM1)-Institut de Recherche pour le Développement (IRD)-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Universtié Yaoundé 1 [Cameroun]-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), CIC Hôpital Bichat, Institut National de la Santé et de la Recherche Médicale (INSERM)-UFR de Médecine-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Modèles et méthodes de l'évaluation thérapeutique des maladies chroniques (U738 / UMR_S738), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Diderot - Paris 7 (UPD7), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), service de maladies infectieuses CHU J Minjoz Besancon, Hôpital Jean Minjoz, Centre National de référence des Staphylocoques, Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL), Service des Maladies Infectieuses et Tropicales [Point-à-Pitre, Guadeloupe], CHU Pointe-à-Pitre/Abymes [Guadeloupe], Centre d'Investigation Clinique Antilles-Guyane (CIC - Antilles Guyane), Université des Antilles et de la Guyane (UAG)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pointe-à-Pitre/Abymes [Guadeloupe] -CHU de Fort de France-Centre Hospitalier Andrée Rosemon [Cayenne, Guyane Française], Service de Cardiologie [CHU de Dijon], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Biologie Laboratoire de Bacteriologie, Laboratoire de Microbiologie Médicale et Moléculaire, Université de Bourgogne (UB), Département d'infectiologie (CHU de Dijon), Evaluation et modélisation des effets thérapeutiques, Département biostatistiques et modélisation pour la santé et l'environnement [LBBE], Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-Centre National de la Recherche Scientifique (CNRS)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-Centre National de la Recherche Scientifique (CNRS)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-Centre National de la Recherche Scientifique (CNRS)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS), REseau national d'Investigation clinique en VACcinologie (REIVAC), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Cochin [AP-HP]-Hôtel-Dieu-Groupe hospitalier Broca-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de Gestion des Essais de Produits de Santé (CeNGEPS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Département Maladies Infectieuses et Tropicales, Hôpital Universitaire, Montpellier, France, Service de Bactériologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service des Maladies Infectieuses et Tropicales [CHRU Nancy], Service de Cardiologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nîmes (CHRU Nîmes), Laboratoire universitaire d'antibiologie, Université Montpellier 1 (UM1), CIC - CHU Bichat, Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Bichat - Claude Bernard, Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Microbiologie : Risques Infectieux, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-CHU Pontchaillou [Rennes]-Faculté de Chirurgie Dentaire de Rennes-Faculté d'Odontologie-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Service des maladies infectieuses, Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université de Lorraine (UL), CHU Montpellier, Service d'Epidémiologie et Evaluations Cliniques [CHRU Nancy] (Pôle S2R), Centre National de Reference des Staphylocoques, Université de Lyon, Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Laboratoire Chrono-environnement (UMR 6249) (LCE), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), and Jonchère, Laurent
Subjects: Male, Methicillin-Resistant Staphylococcus aureus, 0301 basic medicine, Microbiology (medical), Staphylococcus aureus, bacteraemia, medicine.medical_specialty, Time Factors, Multivariate analysis, 030106 microbiology, Bacteremia, Independent predictor, medicine.disease_cause, 03 medical and health sciences, 0302 clinical medicine, Interquartile range, hemic and lymphatic diseases, Internal medicine, medicine, Humans, Blood culture, Prospective Studies, 030212 general & internal medicine, time to blood culture positivity, Prospective cohort study, [SDV.MP] Life Sciences [q-bio]/Microbiology and Parasitology, Aged, medicine.diagnostic_test, infective endocarditis, business.industry, Endocarditis, Bacterial, General Medicine, Middle Aged, Staphylococcal Infections, respiratory system, medicine.disease, mortality, 3. Good health, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, Infectious Diseases, Quartile, Blood Culture, Infective endocarditis, Female, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; Objectives - Time to blood culture positivity (TTP), a routinely available parameter in automated blood culture systems, may be a proxy for infectious burden in patients with bloodstream infections. We aimed to study the association between TTP and infective endocarditis (IE), or death, in patients with Staphylococcus aureus bacteraemia. Methods - VIRSTA is a multicenter prospective cohort study that included all adult patients with S. aureus bacteraemia in eight university hospitals in France (2009-2011). We analyzed data from four centers which collected data on TTP. Regression models were used to study the association between TTP and definite IE (Duke-Li criteria), and 30 day-mortality. Results - We included 587 patients with S. aureus bacteraemia: mean age was 65.3±16.3 years, 420/587 patients (71.6%) were male, 121/587 (20.6%) died, and 42/587 (7.2%) had definite IE. Median TTP of first positive blood culture was 13.7 h (interquartile range, 9.9-18). On multivariate analysis, 30-day mortality was associated with TTP≤13.7 h (74/295 (25.1%) vs 47/292 (16.1%), P=0.02), as well as old age, McCabe score, methicillin resistance, stroke, pneumonia, and C-Reactive Protein. TTP was also independently associated with IE, but with a U-shape curve: IE was more common in the first (TTP18 h, 8/146, 5.5%) quartiles of TTP, P=0.002. Conclusions - TTP provides reliable information in patients with S. aureus bacteraemia, on the risk of IE, and prognosis, with short TTP being an independent predictor of death. This data readily available at no cost may be used to identify patients who require specific attention.
Published: 2019

80. Corrigendum to: Characteristics, management, and outcomes of patients with multiple native valvular heart disease: a substudy of the EURObservational Research Programme Valvular Heart Disease II Survey

Author: Bernard Iung
Subjects: Cardiology and Cardiovascular Medicine
Published: 2022

81. Trends in aortic valve replacement for aortic stenosis: a French nationwide study

Author: Alain Cribier, Ian G. Burwash, Virginia Nguyen, Christel Dindorf, Hélène Eltchaninoff, Karine Chevreul, Bernard Iung, Eric Durand, Nadav Willner, Martine Gilard, Alec Vahanian, David Messika-Zeitoun, and Morgane Michel
Subjects: Aortic valve, Heart Valve Prosthesis Implantation, medicine.medical_specialty, business.industry, Mortality rate, medicine.medical_treatment, Charlson index, Aortic Valve Stenosis, medicine.disease, Transcatheter Aortic Valve Replacement, Stenosis, medicine.anatomical_structure, Treatment Outcome, Valve replacement, Aortic valve replacement, Risk Factors, Internal medicine, Aortic valve stenosis, Aortic Valve, medicine, Cardiology, Humans, Cardiology and Cardiovascular Medicine, business, Complication
Abstract: Aims Transcatheter aortic valve replacement (TAVR) as an alternative to surgical aortic valve replacement (SAVR) has profoundly changed the management of patients with aortic valve stenosis (AS). Large unbiased nationwide data regarding TAVR implementation, impact on SAVR and their respective outcomes are scarce. Methods and results Based on a French administrative hospital-discharge database, we collected data on all consecutive aortic valve replacements (AVRs) performed in France for AS between 2007 and 2019 [106 253 isolated SAVR (49%), 46 514 combined SAVR (21%), and 65 651 TAVR (30%)]. The number of AVR linearly increased between 2007 and 2019 (from 10 892 to 23 109, P for trend < 0.0001) due to a marked increase in TAVR (from 253 to 13 030, P for trend < 0.0001), while SAVR increased up to 2013 and then declined (10 892 in 2007, 12 699 in 2013, and 10 079 in 2019). The Charlson index decreased linearly for TAVR, but in two steps for SAVR (2011 and 2017). In-hospital mortality rates of both SAVR and TAVR declined (both P for trend < 0.0001) and were similar or lower for TAVR than for isolated SAVR in patients 75 years or above in the last 3 years (2017–19). Complication rates of TAVR also declined but permanent pacemaker rates remained high and length of stay substantial (16.7% and median 6 days, respectively, in 2017–19). Conclusion The number of AVR has doubled in a decade and TAVR has become the dominant form of AVR in 2018. The improvement in patient profiles seems to have anticipated the demonstrated benefit of TAVR in intermediate and low-risk patients. In patients 75 years or older, TAVR should be considered as the first option. We also highlight two important areas for improvement, the high permanent pacemaker rates, and the long length of stay even in the contemporary era. Our results may have major implications for clinical practice and policymakers.
Published: 2021

82. Transcatheter mitral valve repair for primary and secondary mitral regurgitation: new insights from a nationwide registry

Author: Bernard Iung and Marina Urena
Subjects: Heart Failure, medicine.medical_specialty, Mitral regurgitation, Mitral Valve Annuloplasty, business.industry, Mitral Valve Insufficiency, medicine.disease, Internal medicine, Heart failure, Cardiology, Medicine, Humans, Mitral Valve, Transcatheter mitral valve repair, Registries, Cardiology and Cardiovascular Medicine, business
Published: 2021

83. Impact of Mitral Annular Calcium and Mitral Stenosis on Outcomes After Transcatheter Aortic Valve Implantation

Author: Zaven Terzian, Quentin Fischer, Caroline Chong-Nguyen, Marina Urena, John Kikoïne, Bernard Iung, Eric Brochet, Dominique Himbert, Jules Mesnier, and Jose Luis Carrasco
Subjects: Male, medicine.medical_specialty, Transcatheter aortic, Computed tomography, Independent predictor, Severity of Illness Index, Pacemaker implantation, Transcatheter Aortic Valve Replacement, Risk Factors, Internal medicine, medicine, Humans, Mitral Valve Stenosis, In patient, Retrospective Studies, Aged, 80 and over, medicine.diagnostic_test, business.industry, Aortic Valve Stenosis, medicine.disease, Prognosis, Stenosis, Echocardiography, Cardiology, Mitral Valve, Calcium, Female, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract: Mitral annular calcium (MAC) is a common finding in patients undergoing transcatheter aortic valve implantation (TAVI) and may be associated with mitral stenosis (MAC-MS). Their impact on post-TAVI outcomes remains controversial. We sought to assess the impact of MAC and MAC-MS on clinical outcomes following TAVI. We included 1,177 patients who consecutively underwent TAVI in our institution between January 2008 and May 2018. MAC diagnosis reposed on echocardiogram and computed tomography. The combination of MAC and a mean transmitral gradient ≥ 5 mmHg defined MAC-MS. The study included 1,177 patients, of whom 504 (42.8%) had MAC and 85 (7.2%) had MAC-MS. Patients with and without MAC had similar outcomes except for a higher rate of pacemaker implantation in MAC patients (adjusted HR: 1.32, 95% CI: 1.03-1.69, p = 0.03). The subgroup of patients with severe MAC had similar outcomes. However, MAC-MS was an independent predictor of all-cause mortality at 30 days (adjusted HR: 2.30, 95% CI: 1.08-4.86, p = 0.03) and 1 year (adjusted HR: 1.73, 95% CI: 1.04-2.89, p = 0.04). In conclusion, MAC is present in nearly half of the patients treated with TAVI but MAC-MS is far less frequent. In itself, even severe, MAC does not influence outcomes while MAC-MS is an independent predictor of all-cause 1-year mortality. Measurement of mean transmitral gradient identifies patients with MAC at high risk after TAVI.
Published: 2021

84. Current treatment of symptomatic aortic stenosis in elderly patients: Do risk scores really matter after 80 years of age?

Author: Claire Bouleti, Emmanuel Lansac, C. Delon, Bernard Iung, Nicole Naccache, Maxence Delomez, Martine Gilard, Alain Dibie, Oualid Zouaghi, Morgane Michel, Antoine Jobbe Duval, Karine Chevreul, Hervé Le Breton, Jean-François Obadia, Pierre-Philippe Nicol, Bertrand Cormier, Christophe Tribouilloy, T. Hémery, David Attias, Didier Tchetche, Hélène Eltchaninoff, Romain Didier, Floriane Zeyons, Centre hospitalier universitaire de Poitiers (CHU Poitiers), Université de Poitiers - Faculté de Médecine et de Pharmacie, Université de Poitiers, CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables (ECEVE (U1123 / UMR_S_1123)), Institut National de la Santé et de la Recherche Médicale (INSERM)-AP-HP Hôpital universitaire Robert-Debré [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPC), Endothélium, valvulopathies et insuffisance cardiaque (EnVI), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Rouen, Normandie Université (NU), Hôpital de la Cavale Blanche, Service de cardiologie [Brest], Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Les Hôpitaux Universitaires de Strasbourg (HUS), Clinique Pasteur [Toulouse], Institut Mutualiste de Montsouris (IMM), Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Privé Jacques Cartier [Massy], Hospices Civils de Lyon (HCL), Université de Picardie Jules Verne (UPJV), Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, Département de la Recherche Clinique et du Développement [AP-HP Hôtel Dieu] (DRCD-URC Eco), Unité de Recherche Clinique en Economie de la Santé d'Ile-de-France, Hôpital Hôtel-Dieu [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Hôtel-Dieu [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Optimisation des régulations physiologiques (ORPHY (EA 4324)), Université de Brest (UBO)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPC)-Université Sorbonne Paris Nord, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, and ANR-16-RHUS-0003,STOP-AS,STOP-AS(2016)
Subjects: Male, medicine.medical_specialty, [SDV]Life Sciences [q-bio], Risk Assessment, Severity of Illness Index, Euroscore ii, Aortic valve replacement, Risque opératoire, Risk Factors, medicine, Clinical endpoint, Humans, In patient, Prospective Studies, Symptomatic aortic stenosis, Remplacement valvulaire aortique percutané, Aged, Aged, 80 and over, Heart Valve Prosthesis Implantation, Transcatheter aortic valve implantation, Medical treatment, business.industry, Aortic stenosis, Surgical aortic valve replacement, EuroSCORE, General Medicine, Therapeutic decision making, Aortic Valve Stenosis, Rétrécissement aortique, medicine.disease, Surgery, Remplacement valvulaire aortique chirurgical, Female, Cardiology and Cardiovascular Medicine, business
Abstract: International audience; Background. - According to the guidelines, surgical aortic valve replacement (SAVR) is recommended in patients at low surgical risk (EuroSCORE II < 4%), whereas for other patients, the decision between transcatheter aortic valve implantation (TAVI) and surgery should be made by the Heart Team, with TAVI being favoured in elderly patients. Aim. - The RAC prospective multicentre survey assessed the respective contributions of age and surgical risk scores in therapeutic decision making in elderly patients with severe symptomatic aortic stenosis. Methods. - In September and October 2016, 1049 consecutive patients aged >= 75 years were included in 32 centres with on-site TAVI and surgical facilities. The primary endpoint was the decision between medical management, TAVI or SAVR. Results. - Mean age was 84 +/- 5 years and 53% of patients were female. The surgical risk was classified as high (EuroSCORE II > 8%) in 18% of patients, intermediate (EuroSCORE II 4-8%) in 34% and low (EuroSCORE II = 80 years were referred for TAVI, despite a low estimated surgical risk. Conclusions. - The impact of risk scores depends strongly on age, and decreases considerably after 80 years, most patients being referred for TAVI, independent of their estimated surgical risk. Despite medical advancements, 10% of patients were still denied any intervention. (C) 2021 Elsevier Masson SAS. All rights reserved.
Published: 2021

85. Acute valve disease and endocarditis

Author: Franck Thuny, Gregory Ducrocq, Bernard Iung, and Alec Vahanian
Subjects: medicine.medical_specialty, business.industry, medicine, Endocarditis, medicine.disease, business, Valve disease, Surgery
Abstract: The management of patients with acute valve disease is now a rare, but challenging, event, as valvular patients are often elderly with severe comorbidities. Furthermore, a proportion of previously operated patients present with acute valve dysfunction. The aim, in this situation, is to establish a rapid diagnosis, based on clinical examination and echocardiography, followed by early intervention. The primary treatment remains surgical valve replacement but more conservative surgical approaches have been developed More recently, percutaneous interventional techniques have been introduced. However, every effort should be made to avoid performing interventions in an acute situation, as it is always at high risk.
Published: 2021

86. Analysis of length of stay after transfemoral transcatheter aortic valve replacement: results from the FRANCE TAVI registry

Author: André Gillibert, Hervé Le Breton, Martine Gilard, Hélène Eltchaninoff, Christophe Tron, Thierry Lefèvre, G. Avinee, N. Bouhzam, René Koning, Pascal Leprince, Jean Philippe Verhoye, Eric Van Belle, Eric Durand, Bernard Iung, N. Bettinger, Endothélium, valvulopathies et insuffisance cardiaque (EnVI), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Rouen, Normandie Université (NU), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), CHU Pontchaillou [Rennes], Laboratoire Traitement du Signal et de l'Image (LTSI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Clinique Saint-Hilaire [Rouen], Hôpital Privé Jacques Cartier [Massy], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Université Sorbonne Paris Nord, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord
Subjects: Male, medicine.medical_specialty, Time Factors, Transcatheter aortic, medicine.medical_treatment, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, 030204 cardiovascular system & hematology, TAVR, Prosthesis, Transcatheter Aortic Valve Replacement, 03 medical and health sciences, 0302 clinical medicine, Valve replacement, length of stay, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Risk Factors, Internal medicine, Catheterization, Peripheral, medicine, Humans, 030212 general & internal medicine, Major complication, Registries, Early discharge, Aged, 80 and over, business.industry, Female sex, aortic stenosis, General Medicine, Aortic Valve Stenosis, Surgery, Center effect, Femoral Artery, Treatment Outcome, Aortic Valve, Cardiology, Population study, Female, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract: International audience; BACKGROUND:Currently, there are no recommendations regarding the minimum duration of in-hospital monitoring after transfemoral (TF) transcatheter aortic valve replacement (TAVR) and practices are extremely heterogeneous. We, therefore, aimed to evaluate length of stay (LOS) and predictive factors for late discharge after TF TAVR using data from the FRANCE TAVI registry.METHODS:TAVR was performed in 12,804 patients in 48 French centers between 2013 and 2015. LOS was evaluated in 5857 TF patients discharged home. LOS was calculated from TAVR procedure (day 0) to discharge. The study population was divided into three groups based on LOS values. Patients discharged within 3 days constituted the "very early" discharge group, patients with a LOS between 3 and 6 days constituted the "early" discharge group, and patients with a length of stay > 6 days constituted the "late" discharge group.RESULTS:The median LOS was 7 (5-9) days and was extremely variable among centers. The proportion of patients discharged very early, early, and late was 4.4% (n = 256), 33.7% (n = 1997), and 61.9% (n = 3624) respectively. Variables associated with late discharge were female sex, co-morbidities, major complications, self-expandable valve, general anesthesia, and a significant center effect. In contrast, history of previous pacemaker was a protective factor. The composite of death and re-admission in the very early and early versus late discharge groups was similar at 30 days (3.3% vs. 3.5%, p = 0.66).CONCLUSIONS:LOS is extremely variable after TF TAVR in France. Co-morbidities and complications were predictive factors of late discharge after TAVI. Interestingly, the use of self-expandable prosthesis and general anesthesia may also contribute to late discharge. Our results confirm that early discharge is safe.
Published: 2021

87. Valve-in-Valve and Valve-in-Ring Transcatheter Mitral Valve Implantation in Young Women Contemplating Pregnancy

Author: John Kikoïne, Adeline Fuchs, Jérémie Abtan, Caroline Chong-Nguyen, Quentin Fischer, Alec Vahanian, Gregory Ducrocq, Bernard Iung, Dominique Himbert, Marina Urena, and Eric Brochet
Subjects: Adult, Cardiac Catheterization, medicine.medical_specialty, Mitral Valve Annuloplasty, medicine.medical_treatment, Valve in ring, Prosthesis Design, Young Adult, Pregnancy, Internal medicine, medicine.artery, Mitral valve, medicine, Humans, Bioprosthesis, Heart Valve Prosthesis Implantation, business.industry, Infant, Newborn, Mitral valve replacement, Mitral Valve Insufficiency, medicine.disease, Valve in valve, Treatment Outcome, medicine.anatomical_structure, Heart Valve Prosthesis, Pulmonary artery, Cardiology, Mitral Valve, Female, Cardiology and Cardiovascular Medicine, business
Abstract: Background: Transcatheter mitral valve implantation (TMVI) is emerging as an alternative to surgical mitral valve replacement in selected high-risk patients. Delaying definitive mechanical mitral valve replacement and the constraints of anticoagulation thanks to TMVI may be an attractive option in young women contemplating pregnancy and suffering from failure of mitral bioprosthesis or annuloplasty. The aim of the study was to evaluate the possibility, safety, and outcomes of pregnancy after TMVI in this population. Methods: From 2013 to 2019, 12 young women contemplating pregnancy underwent transseptal valve-in-valve or valve-in-ring TMVI using the Edwards SAPIEN XT/3 valves and were prospectively followed up at 1 month, 6 months, 1 year, and yearly thereafter. Results: Mean age of the patients was 30±6 years. Bioprosthesis degeneration was observed in 7 cases and annuloplasty failure in 5. Three valve-in-ring patients required the implantation of a second valve, which led to an overall procedural success rate of 75%. One delayed left ventricular outflow tract obstruction required elective surgical mitral valve replacement. At 6 months/1 year, 83% of the patients were in New York Heart Association classes I/II. Mitral regurgitation was ≤2+ in all the cases and mean gradient was 7±2 mm Hg. Four patients could complete 6 full-term pregnancies. One symptomatic thrombosis occurred and resolved under aspirin and anticoagulation therapy. All others pregnancies were uneventful. Predelivery mean gradient was 11 mm Hg, and systolic pulmonary artery pressure was 32 mm Hg. There were 4 vaginal deliveries and 2 cesarians. Newborns were alive and healthy. At last follow-up, there was no death, and 3 patients required elective surgical mitral valve replacement at 6- to 54-month follow-up. Conclusions: Our study suggests that, in young women, transseptal TMVI to treat failing bioprostheses may result in good short-term outcomes that allow uneventful pregnancies. The results are less favorable in women with failed annuloplasty rings.
Published: 2020

88. Management and Outcome of Patients Admitted With Tricuspid Regurgitation in France

Author: Jean-François Obadia, Pascal Candolfi, David Messika-Zeitoun, Ian G. Burwash, Jean-Manuel Toussaint, Maurice Enriquez-Sarano, Bernard Iung, Alec Vahanian, Ted Feldman, Patrick Verta, Jean-François Philippon, J. Dreyfus, Thierry G. Mesana, CarMeN, laboratoire, University of Ottawa [Ottawa], Edwards Lifesciences [Nyon, Switzerland], Centre cardiologique du Nord (CCN), Université d'Ottawa [Ontario] (uOttawa), Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, École des Hautes Études en Santé Publique [EHESP] (EHESP), International Health Market Trends [Paris] (IHMT), Edwards Lifesciences [Irvine, CA, USA], Université Claude Bernard Lyon 1 (UCBL), Université de Lyon, Hôpital Louis Pradel [CHU - HCL], Hospices Civils de Lyon (HCL), Mayo Clinic [Rochester], and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Université Sorbonne Paris Nord
Subjects: Male, medicine.medical_specialty, Pediatrics, [SDV]Life Sciences [q-bio], Population, Heart Valve Diseases, Long Term Adverse Effects, 030204 cardiovascular system & hematology, outcomes, Health Services Misuse, Patient Readmission, 03 medical and health sciences, 0302 clinical medicine, Aortic valve replacement, Mitral valve, medicine, Humans, 030212 general & internal medicine, Hospital Mortality, education, Heart Failure, Heart Valve Prosthesis Implantation, Mitral regurgitation, education.field_of_study, Tricuspid valve, business.industry, medicine.disease, Prognosis, Quality Improvement, Tricuspid Valve Insufficiency, 3. Good health, Cardiac surgery, [SDV] Life Sciences [q-bio], Hospitalization, medicine.anatomical_structure, Outcome and Process Assessment, Health Care, Cohort, Female, France, Tricuspid Valve, Tricuspid Valve Regurgitation, Tricuspid valve regurgitation, Cardiology and Cardiovascular Medicine, business, Cardiomyopathies, management
Abstract: International audience; BACKGROUND: Growing evidence shows a major outcome impact and under-treatment of tricuspid regurgitation (TR) but large and comprehensive contemporary reports of management and outcome at the nationwide level are lacking. METHODS: We gathered all consecutive patients admitted with a diagnosis of likely functional TR in 2014-2015 in France from the "Programme de Médicalisation des Systèmes d'Information" (PMSI) national database and collected rate of surgery, in-hospital mortality, one-year mortality or heart failure (HF) readmission rates. RESULTS: In 2014-2015, 17,676 consecutive patients (75±14 years, 51% female) were admitted with a TR diagnosis. Charlson index was ≥2 in 56% of the population and 46% presented with heart failure. TR was associated with prior cardiac surgery, ischemic/dilated cardiomyopathy or mitral regurgitation in 73% of patients. Only 10% of TR patients overall and 67% of those undergoing a mitral valve surgery received a tricuspid valve intervention. Among the 13,654(77%) conservatively managed patients, in-hospital mortality, one-year mortality and one-year mortality or HF readmission rates were 5.1%,17.8% and 41% respectively overall and 5.3%,17.2% and 37% respectively in those no underlying medical conditions (8-times higher than predicted for age and gender). CONCLUSION: This nationwide cohort of patients admitted with TR included elderly patients with frequent comorbidities/underlying cardiac diseases. In patients conservatively managed, mortality and morbidity were considerably high over a short time-span. Despite this poor prognosis only 10% of patients underwent a tricuspid valve intervention. These nationwide data showing a considerable risk and potential underuse of treatment highlight the critical need to develop strategies to improve the management and outcomes of TR patients.
Published: 2020

89. Incidence, clinical impact and treatment outcomes of valve thrombosis after transcatheter mitral valve implantation

Author: Caroline Nguyen, Dominique Himbert, A. Fuchs, Bernard Iung, Marina Urena, J. Kikoïne, Jose Luis Carrasco, Gregory Ducrocq, A. Vahanian, and Eric Brochet
Subjects: Patient discharge, medicine.medical_specialty, Valve thrombosis, business.industry, Incidence (epidemiology), Mitral valve annular calcification, Treatment outcome, medicine.disease, Thrombosis, Surgery, medicine.anatomical_structure, Mitral valve, Medicine, Thrombus, Cardiology and Cardiovascular Medicine, business
Abstract: Background Transcatheter mitral valve implantation (TMVI) is a new treatment option for high-risk surgical patients with degenerated bioprosthesis (ViV), failed annuloplasty rings (ViR) and severe mitral annular calcification (ViMAC). However, limited data exist on transcatheter heart valve thrombosis. Purpose The aim of this study was to report the incidence, clinical impact and treatment outcomes of transcatheter heart valve (THV) thrombosis in patients undergoing TMVI. Methods All consecutive patients undergoing TMVI in our center between July 2010 and September 2019 were included. A transoesophageal echocardiography and a computed tomography (CT) were performed before hospital discharge and at each clinical visit, at 3 months, at 1 year and yearly after. THV thrombosis was defined as the presence of at least one thickened leaflet with restricted motion suggestive of thrombus confirmed by TOE and/or contrast CT. All patients received anticoagulation therapy with vitamin K antagonists (VKA) and a low dose of aspirin for the first 3 months. Results A total of 132 patients underwent TMVI (62 ViV, 36 ViR and 34 ViMAC). Among them, 16 (12.1%) patients had a THV thrombosis. Median age was 67 years old and 56.2% of patients were women. Median time to diagnosis of THV thrombosis was 78 days. Early THV thrombosis was observed in 7 (43.7%) and in 13 (81.2%) patients THV thrombosis occurred within the first 6 months after the procedure. 8 out 9 patients with subacute or late THV thrombosis were not anticoagulated or with subtherapeutic anticoagulation. No stroke or thromboembolic events occurred in these patients. No change in mitral gradient was observed in 14 out 16 patients. VKA were indicated in all patients. THV thrombosis resolved in all but one patient. Conclusion THV thrombosis is frequent after TMVI, occurs mainly within the first 6-months after the procedure, are mostly subclinical and resolves after optimization of anticoagulation treatment. An anticoagulation therapy for at least 6 months may be necessary. Timing of THV thrombosis Funding Acknowledgement Type of funding source: None
Published: 2020

90. Transseptal transcatheter mitral valve implantation versus redo surgical mitral valve replacement for degenerated mitral bioprostheses

Author: C. Cimadevilla, Dominique Himbert, Gregory Ducrocq, Sophie Provenchère, M. Urena-Alcazar, Bernard Iung, M. Eugène, A. Vahanian, Eric Brochet, Caroline Kerneis, W Ghodhbane, Caroline Nguyen, Jose Luis Carrasco, and A. Fuchs
Subjects: medicine.medical_specialty, medicine.anatomical_structure, business.industry, Mitral valve, medicine.medical_treatment, Mitral valve replacement, Medicine, Cardiology and Cardiovascular Medicine, business, Surgery
Abstract: Background The growing use of surgical bioprostheses raises concerns about a future reoperation for bioprosthesis degeneration. There are few data on outcome after transcatheter mitral valve-in-valve implantation (TMVI) compared with redo surgical mitral valve replacement (SMVR). Purpose To compare the feasibility, safety and outcomes of TMVI versus SMVR for degenerated mitral bioprosthesis in high-risk patients. Methods In our institution, 52 patients underwent TMVI by transseptal approach and 33 SMVR for degenerated mitral bioprosthesis. The composite endpoint of event-free survival included cardiovascular mortality, stroke, major bleeding, hospitalization for heart failure or mitral valve reintervention. Results Mean age and EuroSCORE II were higher in TMVI group vs. SMVR group (age 63±21 years vs. 51±15 years, p=0.002; EuroSCORE II 12.5±12.2% vs. 6.2±3.3%, p=0.001) (Table). In-hospital mortality was 3.8% after TMVI vs. 3.0% after SMVR (p=1.0). Median follow-up was 2.2 years. At 5 years, survival was 69.7±9.4% after TMVI vs. 86.6±7.6% after SMVR (p=0.10) and event-free survival was lower after TMVI (40.1±9.9% vs 78.7±8.8% respectively, p=0.003) (Figure). In multivariate analysis, older age (p=0.02), neurologic history (p=0.05) and non-elective procedure (p Conclusion TMVI is an alternative to SMVR in high-risk patients with degenerated mitral bioprosthesis. Comparison of mid-term results of the two techniques must take into account the differences in patient characteristics. Event-free survival Funding Acknowledgement Type of funding source: None
Published: 2020

91. Gender specific differences in functional capacity in asymptomatic patients with isolated severe aortic stenosis

Author: J. Bartunek, Bernard Iung, Dejana Popovic, Milika Asanin, V. Brkovic, M. Jaukovic, Predrag Mitrovic, Marko Banovic, Ivana Nedeljkovic, Martin Penicka, and Srdjan Aleksandric
Subjects: medicine.medical_specialty, Supine position, Ejection fraction, business.industry, Ischemia, medicine.disease, Brain natriuretic peptide, Asymptomatic, Stenosis, Internal medicine, Aortic valve stenosis, medicine, Cardiology, medicine.symptom, Cardiology and Cardiovascular Medicine, Adverse effect, business
Abstract: Risk stratification as well as treatment decision in asymptomatic patients with isolated severe aortic stenosis (AS) is matter of ongoing debate. It has been known that gender-specific difference in left ventricular reaction to AS exists. Female gender has also been linked to increased risk of adverse events after surgical AVR but with better outcome after TAVI. We investigated whether there is a gender difference in functional capacity in asymptomatic patients with isolated severe AS. Asymptomatic patients with severe AS were prospectively enrolled and underwent cardiopulmonary stress-echocardiography exercise testing (ESE-CPET) on supine ergobicycle, ramp protocol, 15 W/min. Patients with ischemia positive test were excluded (ECG and/or echo) There were 139 patients, 61 women. There were no gender differences in age (66.36 vs 67.37, p=ns), echo parameters (Vmax 4.54 vs 4.48m/s, AVA 0.62 vs 0.68cm2, and Pmean 52.6 vs 53.8mmHg, all p=ns), LVEF (68.56 vs 70.90%, p=ns), e/E' (12.74 vs 14.45, p=ns), BNP (112.51 vs 110.55 pg/ml, p=ns) and valvulo-arterial impedance (4.65 vs 5.14mm Hg·ml–1·m2, p=0.07). Women had higher body mass index (29.05 vs 26.95, p=0.022), lower VO2max (12.96 vs 17.93 ml/kg/m2, p=0.001) and higher VE/VCO2 slope (33.69 vs 29.01, p=0.003). Univariable and multivariable linear regression analysis were used to test the relation between various clinical and echocardiographic parameters and VO2max. The variables independently associated with the VO2max are shown in table 1, with female gender being the strongest independent predictor of VO2max Conclusion Female gender is independent predictor of decreased functional capacity, even when adjusting for other variables, including BMI and echo markers of AS severity. Further studies are needed to determine whether this finding affects the course and outcome of the disease Funding Acknowledgement Type of funding source: None
Published: 2020

92. Cancer and Infective endocarditis: diagnosis and prognostic impact. Results of the ESC-EORP EURO-ENDO (European infective endocarditis) registry: a prospective cohort study

Author: Essam M. Mahfouz, J.D. Kasprzak, Agnes Pasquet, Patrizio Lancellotti, Bernard Iung, Isidre Vilacosta, Cornelia Piper, L Piroth, V Scheggi, Bernard Cosyns, B Roosens, Gilbert Habib, Stella Marchetta, Zh. D. Kobalava, and G Reyes
Subjects: medicine.medical_specialty, business.industry, Infective endocarditis, Internal medicine, medicine, Cancer, Cardiology and Cardiovascular Medicine, medicine.disease, business, Prospective cohort study
Abstract: Background Little is known about the characteristics of infectious endocarditis (IE) in cancer patients, although their risk may be higher and their presentation non-specific. Purpose This study sought to assess the prevalence of cancer in patients with IE in the EURO-ENDO registry and to determine their baseline characteristics, management, outcomes in comparison to cancer-free patients with IE. Methods Data were collected from a prospective cohort of 3085 adult patients enrolled in 40 countries between January 2016 and March 2018 with a diagnosis of IE based on the ESC 2015 diagnostic criteria. Clinical, biological, microbiological and echocardiographic findings, use of other imaging techniques, medical therapy, complications, theoretical indications for surgery, in-hospital mortality, and 1-year mortality were analysed in IE patients with and without cancer. Results 359 (11.6%) cancer patients with IE were identified and compared with 2726 IE patients without cancer. IE was community-acquired in 225/361 (74.8%), and more often nosocomial (18.6%) in healthcare associated cases. IE was native in 209 (60.4%), prosthetic in 97 (28%) and device-related in 30 (8.7%) patients. Microorganisms involved were Enterococci in 72/303 (23.8%), methicillin-sensitive Staphylococci in 63/303 (20.8%), and Streptococcus gallolyticus in 33/303 (10.9%) patients. IE cancer patients received more long-term cortico-therapy and immunosuppressive treatment compared to cancer free IE patients (9.1% vs. 3.9%, P Cancer IE patients were more frequently treated with amoxicillin (35.8% vs. 26.3%; P=0.0002) and daptomycin (15.2% vs. 10.6%; P=0.0096), but less frequently treated with vancomycin (34.6% vs. 44.9%, P=0.0003). According to the ESC guidelines, theoretical indication for cardiac surgery was not significantly different between groups (65.5% vs. 69.8%, P=0.091), but was effectively less performed when indicated in cancer IE patients during hospitalisation (65.5% vs. 75.0%, P=0.0018). Compared to cancer-free IE patients, in-hospital and 1-year death occurred in 23.4% vs. 16.1%, P=0.006, and 35.7% vs. 23.1%, P2 mg/dL, congestive heart failure and unperformed cardiac surgery (when indicated). Conclusion We report the largest contemporary series of patients with IE and cancer. The prevalence of cancer in IE patients is common and associated with a worse outcome. Patients with IE and cancer have different clinical characteristics than the general population and should require a specific management. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Pharmacological.
Published: 2020

93. Diagnostic performance of White Blood Cell SPECT imaging against intra-operative findings in patients with a suspicion of prosthetic valve endocarditis

Author: K. Benali, Claire Cimadevilla, François Rouzet, Bernard Iung, Angelo Pisani, Richard Raffoul, Besma Mahida, Navid Kooshki, Caroline Nguyen, Julia Grambow-Velilla, Fabien Hyafil, and Wael Braham
Subjects: medicine.medical_specialty, Intra operative, Prosthesis-Related Infections, 030204 cardiovascular system & hematology, Scintigraphy, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, hemic and lymphatic diseases, Spect imaging, White blood cell, Leukocytes, Medicine, Humans, Radiology, Nuclear Medicine and imaging, In patient, Abscess, Prosthetic valve endocarditis, Retrospective Studies, Tomography, Emission-Computed, Single-Photon, medicine.diagnostic_test, Endocarditis, business.industry, Endocarditis, Bacterial, medicine.disease, Cardiac surgery, medicine.anatomical_structure, Heart Valve Prosthesis, Radiology, Cardiology and Cardiovascular Medicine, business, circulatory and respiratory physiology
Abstract: The objective of this study was to evaluate the diagnostic performance of white blood cells (WBC)-SPECT imaging in patients with suspicion of prosthetic valve endocarditis (PVE) against intra-operative findings. 36 consecutive patients who underwent cardiac surgery 30 days after WBC-SPECT imaging were identified retrospectively. Clinical, imaging, and biological results were collected from reports. WBC-SPECT results were classified as positive or negative and, if positive, the intensity of signal graded as intense or mild. Lesions observed during cardiac surgery were collected from surgeons’ reports. The 20 patients with positive WBC-SPECT study had confirmed PVE intra-operatively. Patients with intense signal on WBC-SPECT had high prevalence of abscesses (83%) compared to patients with only mild signal (12%). The three patients with negative WBC-SPECT but confirmed PVE had longer duration of antibiotic treatment before imaging and had no perivalvular abscess. Sensitivity, specificity, positive predictive and negative values, and accuracy of WBC-SPECT were measured at 87%, 100%, 100%, 81%, and 92%, respectively. Addition of WBC-SPECT results to the modified Duke score helped re-classify correctly 25% of patients from possible to definite PVE. In patients with suspicion of PVE, WBC-SPECT imaging provides excellent diagnostic performance against intra-operative findings.
Published: 2020

94. Isolated tricuspid valve surgery: impact of aetiology and clinical presentation on outcomes

Author: Jean-François Obadia, Martin Nicol, Richard Raffoul, Christine Selton-Suty, Augustin Coisne, Thierry Le Tourneau, Erwan Donal, David Messika-Zeitoun, Michele Flagiello, Henri Dubrulle, D. Eyharts, J. Dreyfus, Yannick Mbaki, Florence Viau, Elisabeth Riant, Yohann Bohbot, Christophe Tribouilloy, Gilbert Habib, Florian Eggenspieler, Bernard Iung, Baptiste Bazire, Jacques Tomasi, Thomas Senage, Fabien Doguet, Virginia Nguyen, Yoan Lavie-Badie, Centre cardiologique du Nord (CCN), Hôpital Louis Pradel [CHU - HCL], Hospices Civils de Lyon (HCL), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Assistance Publique - Hôpitaux de Marseille (APHM), CHU Henri Mondor [Créteil], Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Picardie Jules Verne (UPJV), CHU Amiens-Picardie, Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Centre hospitalier universitaire de Nantes (CHU Nantes), MethodS in Patients-centered outcomes and HEalth ResEarch (SPHERE), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, Université de Nantes (UN)-Université de Nantes (UN), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), CHU Rouen, Normandie Université (NU), Endothélium, valvulopathies et insuffisance cardiaque (EnVI), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Récepteurs nucléaires, maladies cardiovasculaires et diabète - U 1011 (RNMCD), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Unité de recherche de l'institut du thorax (ITX-lab), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, CHU Pontchaillou [Rennes], Microbes évolution phylogénie et infections (MEPHI), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Service de Cardiologie [CHRU Nancy], University of Ottawa [Ottawa], CHU Henri Mondor, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital de Rangueil, CHU Toulouse [Toulouse], Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Institut National de la Santé et de la Recherche Médicale (INSERM), unité de recherche de l'institut du thorax UMR1087 UMR6291 (ITX), Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU), and Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques
Subjects: Adult, medicine.medical_specialty, Ventricular Dysfunction, Right, Regurgitation (circulation), Tricuspid regurgitation, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Tricuspid Valve Insufficiency, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Statistical significance, Medicine, Humans, 030212 general & internal medicine, Retrospective Studies, Outcome, Prothrombin time, Heart Valve Prosthesis Implantation, Tricuspid valve, medicine.diagnostic_test, business.industry, medicine.disease, 3. Good health, Surgery, medicine.anatomical_structure, Treatment Outcome, Heart failure, Infective endocarditis, Etiology, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Tricuspid Valve, Cardiology and Cardiovascular Medicine, business
Abstract: Aims The aim of this study was to identify determinants of in-hospital and mid-term outcomes after isolated tricuspid valve surgery (ITVS) and more specifically the impact of tricuspid regurgitation (TR) mechanism and clinical presentation. Methods and results Among 5661 consecutive adult patients who underwent a tricuspid valve (TV) surgery at 12 French tertiary centres in 2007–2017 collected from a mandatory administrative database, we identified 466 patients (8% of all tricuspid surgeries) who underwent an ITVS. Most patients presented with advanced disease [47% in New York Heart Association (NYHA) III/IV, 57% with right-sided heart failure (HF) signs]. Tricuspid regurgitation was functional in 49% (22% with prior left-sided heart valve surgery and 27% isolated) and organic in 51% (infective endocarditis in 31% and other causes in 20%). In-hospital mortality and major complications rates were 10% and 31%, respectively. Rates of survival and survival free of HF readmission were 75% and 62% at 5 years. Patients with functional TR incurred a worse in-hospital mortality than those with organic TR (14% vs. 6%, P = 0.004), but presentation was more severe. Independent determinants of outcomes were NYHA Class III/IV [odd ratios (OR) = 2.7 (1.2–6.1), P = 0.01], moderate/severe right ventricular dysfunction [OR = 2.6 (1.2–5.8), P = 0.02], lower prothrombin time [OR = 0.98 (0.96–0.99), P = 0.008], and with borderline statistical significance, right-sided HF signs [OR = 2.4 (0.9–6.5), P = 0.06] while TR mechanism was not [OR = 0.7 (0.3–1.8), P = 0.88]. Conclusion Isolated TV surgery was associated with high mortality and morbidity, both in hospital and during follow-up, predicted by the severity of the presentation but not by TR mechanism. Our results suggest that TV intervention should be performed earlier in the course of the disease.
Published: 2020

95. Outcomes of Transcatheter Aortic Valve Implantation in Patients Receiving Chronic Systemic Corticosteroid Treatment

Author: Quentin Fischer, Caroline Chong-Nguyen, Bernard Iung, Marina Urena, Eric Brochet, Jérémie Abtan, Dominique Himbert, Alexandre Gautier, Jose Luis Carrasco, Université de Paris (UP), Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148)), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Université Sorbonne Paris Nord
Subjects: Male, medicine.medical_specialty, Time Factors, Transcatheter aortic, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Treatment outcome, Corticosteroid treatment, 030204 cardiovascular system & hematology, Transcatheter Aortic Valve Replacement, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Humans, In patient, 030212 general & internal medicine, Glucocorticoids, Dialysis, Aged, Aged, 80 and over, business.industry, Hazard ratio, Aortic Valve Stenosis, Confidence interval, 3. Good health, Surgery, Treatment Outcome, Baseline characteristics, Cardiology, Prednisone, Female, Cardiology and Cardiovascular Medicine, business
Abstract: The aim of this study was to describe the effects of chronic systemic corticosteroid treatment (SCT) on early and late outcomes after transcatheter aortic valve implantation (TAVI). From October 2006 to November 2018, 1,299 patients underwent TAVI in our institution. Among them, 48 (3.7%) received chronic SCT at the time of procedure (SCT group). They were more frequently women (p = 0.08) and needed more often dialysis (p = 0.002). All other baseline characteristics were similar between both groups. At 30 days, there was no difference on mortality. However, after adjustment, the SCT group had more major vascular complications: 16.7% versus 7.4%, hazard ratio (HR) 2.52 (95% confidence interval [CI] 1.14 to 5.9, p = 0.023), major or life-threatening bleedings: 22.9% versus 12.4%, HR 2.02 (95% CI 1.00 to 4.08, p = 0.05), and tamponades: 8.3% versus 2.4%, HR 4.05 (95% CI 1.35 to 12.15, p0.001) than the non-SCT group. One-year all-cause mortality was significantly higher in the SCT than in the non-SCT group (37.5% vs 12.5%, p0.0001). Multivariate analysis confirmed that SCT use was an independent predictor of 1-year mortality (HR 2.29, 95% CI 1.16 to 4.50, p = 0.017). In conclusion, chronic use of SCT significantly increases the rates of early vascular complications, major or life-threatening bleedings and tamponade and is an independent predictor of 1-year all-cause mortality after TAVI.
Published: 2020

96. Dismal Outcomes and High Societal Burden of Mitral Valve Regurgitation in France in the Recent Era: A Nationwide Perspective

Author: Thierry G. Mesana, Bernard Iung, Ian G. Burwash, Alec Vahanian, Ted Feldman, David Messika-Zeitoun, Vincent Chan, Jean Manuel Toussaint, Pascal Candolfi, David Glineur, Maurice Enriquez-Sarano, Patrick Verta, and Jean Francois Philippon
Subjects: Male, medicine.medical_specialty, Population, Datasets as Topic, 030204 cardiovascular system & hematology, outcomes, Patient Readmission, 03 medical and health sciences, 0302 clinical medicine, Cost of Illness, cost, medicine, Humans, 030212 general & internal medicine, Intensive care medicine, education, Aged, Original Research, Aged, 80 and over, Mitral regurgitation, education.field_of_study, business.industry, mitral valve regurgitation, Perspective (graphical), Mitral Valve Insufficiency, Middle Aged, medicine.disease, Valvular Heart Disease, Female, France, Cardiology and Cardiovascular Medicine, Mitral valve regurgitation, business, management
Abstract: Background Although US recent data suggest that mitral regurgitation (MR) is severely undertreated and carries a poor outcome, population‐based views on outcome and management are limited. We aimed to define the current treatment standards, clinical outcomes, and costs related to MR at the nationwide level. Methods and Results In total, 107 412 patients with MR were admitted in France in 2014 to 2015. Within 1 year, 8% were operated and 92% were conservatively managed and constituted our study population (68% primary MR and 32% secondary MR). The mean age was 77±15 years; most patients presented with comorbidities. In‐hospital and 1‐year mortality rates were 4.1% and 14.3%, respectively. Readmissions were common (63% at least once and 37% readmitted ≥2 times). Rates of 1‐year mortality or all‐cause readmission and 1‐year mortality or heart failure readmission were 67% and 34%, respectively, and increased with age, Charlson index, heart failure at admission, and secondary MR etiology; however, the event rate remained notably high in the primary MR subset (64% and 28%, respectively). The mean costs of hospital admissions and of readmissions were 5345±6432 and 10 080±10 847 euros, respectively. Conclusions At the nationwide level, MR was a common reason for admission and affected an elderly population with frequent comorbidities. Less than 10% of patients underwent a valve intervention. All subsets of patients who were conservatively managed incurred high mortality and readmissions rates, and MR represented a major societal burden with an extrapolated annual cost of 350 to 550 million euros (390–615 million US dollars). New strategies to improve the management and outcomes of patients with both primary and secondary MR are critical and warranted.
Published: 2020

97. Successful linkage of French large-scale national registry populations to national reimbursement data: Improved data completeness and minimized loss to follow-up

Author: Laura Liepchitz, Bernard Glatt, Guillaume Cayla, Mehdi Gabbas, Hervé Le Breton, Martine Gilard, Margaux Gouysse, Philippe Tuppin, Bernard Iung, Romain Didier, Philippe Commeau, Marjorie Boussac, Nicolas Glatt, Hélène Eltchaninoff, Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Clinityx, Anesthésie et réanimation en chirurgie cardiaque [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU), Service de cardiologie et maladies vasculaires [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes], CHU Pontchaillou [Rennes], Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Caisse Nationale de l'Assurance Maladie [Paris] (CNAM), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and CCSD, Accord Elsevier
Subjects: Time Factors, SNIIRAM, Databases, Factual, Pilot Projects, 030204 cardiovascular system & hematology, SNDS, 0302 clinical medicine, Documentation, Data Mining, Electronic Health Records, Medicine, 030212 general & internal medicine, Claims database, Registries, Case report form, Reimbursement, MESH: Electronic Health Records, education.field_of_study, Data Collection, General Medicine, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Data Accuracy, 3. Good health, Insurance, Health, Reimbursement, MESH: Administrative Claims, Healthcare, France, Medical Record Linkage, Medical emergency, Cardiology and Cardiovascular Medicine, Completeness (statistics), Algorithms, MESH: Medical Record Linkage, Registry, Population, MESH: Algorithms, TAVI, 03 medical and health sciences, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Humans, education, business.industry, MESH: Data Mining, Patient data, PMSI, medicine.disease, MESH: Pilot Projects, MESH: Insurance, Health, Reimbursement, National registry, business, Administrative Claims, Healthcare
Abstract: Summary Background Registries, a cornerstone of contemporary medicine, frequently suffer from incomplete documentation and losses to follow-up. By linking data to a single-payer national claims database, national registries may be enriched and the quality enhanced. Aims To explore the value of data from the French Systeme National des Donnees de Sante (SNDS) as a resource to enhance the quality of registries when combined with data from electronic case report forms, and to assess the power to minimize data gaps and losses to follow-up. Methods A probabilistic algorithm was developed to link and match records in the SNDS with patient data from the electronic case report forms of two registries on transcatheter aortic valve implantation: FRANCE-2 and FRANCE-TAVI. The algorithm created patient profiles from transcatheter aortic valve implantation procedures in the SNDS, matching them as closely as possible to the profiles in the registry databases. The objective was to achieve 90% linkage of the populations. The linked database was analysed for completeness and loss to follow-up. For validation, mortality curves for the linked registry cohorts were compared with those for the original populations. Results A total of 34,397 unique registries entries were identified, and 89.9% of patients in the SNDS could be linked. Rates of losses to follow-up over 2 years were 1.0% in the linked FRANCE-TAVI population compared with 40.3% based on electronic case report form documentation. For FRANCE-2, 3-year rates of losses to follow-up were 1.7% and 6.1%, respectively. Mortality curves for populations based on SNDS and electronic case report form data were practically superimposable. Conclusions Linking data from a single-payer national claims database to national registries using a probabilistic approach is feasible and can close data gaps and practically abolish losses to follow-up in the registry population.
Published: 2020

98. NYHA Functional Class in Secondary Mitral Regurgitation: An Old Classification to Evaluate an Innovative Technique

Author: Bernard, Iung
Subjects: Heart Failure, Heart Valve Prosthesis Implantation, Treatment Outcome, Humans, Mitral Valve, Mitral Valve Insufficiency
Published: 2020

99. Atrial Fibrillation and Aortic Stenosis: Complex Interactions Between 2 Diseases

Author: Bernard, Iung and Vincent, Algalarrondo
Subjects: Heart Valve Prosthesis Implantation, Transcatheter Aortic Valve Replacement, Treatment Outcome, Atrial Fibrillation, Humans, Aortic Valve Stenosis
Published: 2020

100. Ann Epidemiol

Author: Magali Collonnaz, Vincent Le Moing, Nelly Agrinier, François Delahaye, B. Hoen, Marie-Line Erpelding, François Alla, Christine Selton-Suty, François Goehringer, Bernard Iung, Bordeaux population health (BPH), and Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Male, medicine.medical_specialty, Referral, Epidemiology, media_common.quotation_subject, Population, 01 natural sciences, Cohort Studies, 03 medical and health sciences, Population based cohort, 0302 clinical medicine, Bias, Internal medicine, medicine, Humans, 030212 general & internal medicine, 0101 mathematics, education, Referral and Consultation, media_common, Selection bias, education.field_of_study, Endocarditis, business.industry, 010102 general mathematics, Hazard ratio, medicine.disease, Prognosis, 3. Good health, Infective endocarditis, Cohort, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Female, France, business
Abstract: PURPOSE: Prognostic studies derived from samples of patients managed in tertiary hospitals are subject to referral bias. We aimed to characterise this bias using the example of infective endocarditis (IE). METHODS: We analysed data from a French population-based cohort which included 497 patients with IE in 2008. Patients were admitted directly to a tertiary hospital (group T), or admitted to a non-tertiary hospital and referred to a tertiary hospital (group NTT) or not (group NT). We compared patients' characteristics and survival rates and prognostic factors between groups. RESULTS: Compared to group T (N=291), NTT patients (N=144) were more often males (81.3% vs 72.5%, p=0.046), injection drug users (9.7% vs 4.5%, p=0.033), had more frequent surgical indications (78.5% vs 64.3%, p=0.003). Compared to group NT (N=62), NTT patients were more often males (81.3% vs 67.7%, p=0.034) and had surgical indications more often (78.5% vs 19.4%, p
Published: 2020

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