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International audience; Background : France has a long history of successful cardiovascular research and scientific innovations, but its continued success cannot be taken for granted.Aims : To identify current obstacles to cardiovascular research in France and to crystallize the analysis into recommendations for maintained and enhanced research excellence in the future.Methods : The French Society of Cardiology set up seven Working Groups, each comprising four to eight cardiologists, covering a spectrum of research institutes, hospitals, specialties, ages and research experience. The Working Groups met regularly in person or by conference call to analyse experiences, refine situation assessments and formulate recommendations for improvements. Results and suggestions were presented to a Core Team, which worked to synthesize, prioritize and organize the findings into a consolidated situation assessment and generate a set of action-orientated recommendations.Results : Four key areas of action were identified: stronger focus on the generation of high-quality data; facilitation of future cardiovascular research; greater promotion and support for research among young cardiologists; and increased focus and support for communications. Most recommendations targeted structural shortcomings and may be implemented at low additional financial cost.Conclusions : It is possible to maintain, and even increase, the quality of cardiovascular research in France and to boost the conversion of successful projects into high-impact publications, without major increases in funding. Intense collaboration between specialties and organizations is necessary to achieve sustainable results.

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.

Background Since the first-in-man transcatheter aortic valve implantation (TAVI) performed in 2002, the number of procedures has dramatically increased. However, long-term data regarding outcome and valve durability remain poor. Purpose We aimed to evaluate the evolution of 30-day outcomes over years and long-term mortality and valve durability after TAVI. Methods All consecutive patients presenting with severe symptomatic aortic stenosis treated by TAVI in our center were included prospectively. Clinical and echocardiographic follow-up was performed at 30 days and annually thereafter. Survival curves were constructed using Kaplan-Meier analysis. We also evaluated valve durability according to the European standardized definition of structural valve deterioration. Results Between 2002 and 2018, 1530 consecutive patients underwent TAVI including 1285 (84.0%) patients via a femoral approach. A balloon-expandable transcatheter heart valve was predominantly used (1421 patients; 92.9%). The annual transfemoral approach rate increased progressively to reach 93.3%. Age of patients remained stable over time with a global mean age of 83.7±6.5 years old. Logistic EuroSCORE decreased from 49.2±8.2% to 14.3±8.6% (p TEE mean transaortic gradient Conclusions Long-term (up to 10 years) follow-up of our large pioneer series of patients treated by TAVI shows a dramatic improvement of outcomes and no warning signs of valve deterioration suggesting very encouraging valve durability, using predominantly, a balloon expandable prosthesis. Further studies are warranted to study valve durability after TAVI before extension to lower risk patients.

Background Infective endocarditis is rare but serious. Epidemiology is well known in standard population and surgical valve patients (Pts). The recent development of Transcatheter Aortic Valve Implantation (TAVI) raises new questions about endocarditis in this population. Purpose The aim of this study was to assess outcomes of endocarditis in TAVI Pts and to compare the results to surgical aortic valve (SV) owners and native aortic valve (NV) patients. Methods We included all patients hospitalized in our institution and presenting with endocarditis after TAVI between 2012 and 2018. We compared these patients to those discussed within the “endocarditis team” and presenting with endocarditis located on SV or on NV. Results A total of 34 TAVI Pts were included and compared to a population of 45 SV and 68 NV Pts. TAVI Pts were older (83.1±1.1 yrs, vs 73.3±1.7 and 66.0±1.7, respectively; p Conclusion Despite more frequent comorbidities, TAVI patients affected by infective endocarditis have the same mortality during the first year after diagnosis compared to SV and NV patients but are more often rehospitalized.

International audience; Objective: The use of animal models of aortic stenosis (AS) remains essential to further elucidate its patho-physiology and to evaluate new therapeutic strategies. The waved-2 mouse AS model has been proposed; data have indicated that while aortic regurgitation (AR) is effectively induced, development of AS is rare. We aimed to evaluate the effect of high-fat diet (HFD) and vitamin D 3 supplementation in this model. Methods: HFD and subcutaneous vitamin D 3 injections were initiated at the age of 6 weeks until the age of 6 (n = 16, 6-month treatment group) and 9 (n = 11, 9-month treatment group) months. Twelve waved-2 mice without supplementation were used as control. Echocardiography was performed at 3, 6 and 9 months. Blood serum analysis (calcium, 1,25(OH) 2 D 3 and cholesterol), histology and immunohistochem-istry (CD-31, CD-68 and osteopontin) were evaluated at the end of the experiment (6 or 9 months). Results: Total cholesterol and 1,25(OH) 2 D 3 were significantly increased relative to the control group. HFD and vitamin D 3 supplementation did result in improvements to the model, since AS was only detected in 6 (15.3%) mice (2 in the 3 groups) and AR was developed in the remaining animals. Echocardiographic parameters, fibrosis, thickness, inflammation and valvular calcification, were not significantly different between the 6-month treatment and control groups. Similar results were also observed in the 9-month treatment group. Conclusion: These results suggest that HFD and vitamin D 3 supplementation have no effect in the waved-2 mouse model. This model essentially mimics AR and rarely AS. Further studies are needed to find a reliable animal model of AS. Please cite this article as: Colleville B, Perzo N, Avinée G, Dumesnil A, Ziegler F, Billoir P, Eltchaninoff H, Richard V, Durand E. Impact of high-fat diet and vitamin D 3 supplementation on aortic stenosis establishment in waved-2 epidermal growth factor receptor mutant mice.

Aims Durability of transcatheter aortic bioprosthetic valves remains a major issue. Standardised definitions of deterioration and failure of bioprosthetic valves have recently been proposed. The aim of this study was to assess structural transcatheter valve deterioration (SVD) and bioprosthetic valve failure (BVF) using these new definitions. Methods and results All TAVI patients implanted up to September 2012 with a minimal theoretical five-year follow-up were included. Systematic clinical and echocardiographic follow-up was performed annually. New standardised definitions were used to assess durability of transcatheter aortic bioprosthetic valves. From 2002 to 2012, 378 patients were included. Mean age and logistic EuroSCORE were 83.3±6.8 years and 22.8±13.1%. Thirty-day mortality was 13.2%. Nine patients had SVD including two severe forms and two patients had definite late BVF. The incidence of SVD and BVF at eight years was 3.2% (95% CI: 1.45-6.11) and 0.58% (95% CI: 0.15-2.75), respectively. Conclusions Even though limited by the poor survival of the very high-risk/compassionate early population, our data do not demonstrate any alarm concerning transcatheter aortic valve durability. Careful prospective assessment in younger and lower-risk patients and comparison with surgical bioprosthetic valves are required for further assessment of the long-term durability of transcatheter valves.

Introduction Transcatheter aortic valve implantation (TAVI) is playing a growing role in the management of patients with symptomatic severe aortic stenosis. However, length of hospital stay (LOS) after transfemoral (TF) TAVI remains widely variable. Objective We aimed to evaluate LOS after TF TAVI and the variability of LOS among French centers using data from the FRANCE TAVI registry. Methods TAVI was performed in 12,804 patients in 48 French centers between January 2013 and December 2015. LOS was evaluated in 5,857 (45.7%) patients treated via a TF approach and discharged directly at home. LOS was calculated from TAVI procedure (day 0) to discharge. The study population was divided into 2 groups based on tertile LOS values. Results The median LOS in the studied population was 7 (5–9) days and was extremely variable among centers. Patients in the lowest tertile (LOS 6 days (n = 3,624) constituted the “Late Discharge group”. Variables independently associated with late discharge were comorbidities (history of mitral valve prosthesis, respiratory failure, atrial fibrillation, and severe pulmonary hypertension), complications occurring during or after TAVI (need for a new pacemaker, tamponade, stroke, vascular complications and acute kidney injury), the use of self-expandable valve and general anesthesia with a significant center effect. In contrast, the history of previous pacemaker before TAVI was a protective factor. Finally, we did not observe any significant difference in the rate of death and re-admission in the early versus late discharge groups. Conclusion LOS remain high after TF TAVI in France and extremely variable. As expected, co-morbidities and complications were predictive factors of late discharge after TAVI. Furthermore, our results suggest that the use of self-expandable prosthesis and general anesthesia also contributes to late discharge.

Introduction Infective endocarditis is rare but serious. Epidemiology is well known in standard population and surgical valve patients (Pts). The recent development of Transcatheter Aortic Valve Implantation (TAVI) raise new questions about endocarditis in this population. Objective To assess the epidemiology and mortality of endocarditis in TAVI Pts and to compare the results to surgical valve owners and native patients. Method We included all patients presenting with endocarditis after TAVI between 2010 and 2018 hospitalized in our institution. We compared these patients to those discussed within the “endocarditis team staff” and presenting with endocarditis located on surgical aortic prosthetic valve or on native aortic valve. Results A total of 34 TAVI Pts were included, and compared to a population of 45 surgical aortic prosthetic valve and 68 native Pts. TAVI Pts were older (83.1 ± 1.1 yrs, vs 73.3 ± 1.7 and 66.0 ± 1.7, respectively; P Conclusion TAVI patients affected by infective endocarditis, despite more comorbidities, have the same mortality at 1 year compared to prosthetic valve owners and patients with aortic endocarditis on native valve but are more often rehospitalized.

Introduction Recommendations have upgraded transcatheter aortic valve implantation (TAVI) indications. It is currently an alternative to conventional surgery in intermediate risk patients. As the indications extended to patients with potentially longer life expectancy, the topic of durability of percutaneous aortic bioprostheses becomes crucial. Objective We evaluated the durability of these bioprostheses through this French multicentric study offering the longest follow-up in Europe. Method All patients treated with TAVI in 5 French centers from 2002 to 2011 were included. Bioprosthetic valve failure (BVF) was defined as repeated intervention or severe structural valve deterioration (SVD). Patients selected for the durability analysis were those who had an echocardiography at least one year before the last follow-up. SVD was evaluated according to the recent definition: moderate when mean transprosthetic gradient was > 20 mmHg and 10 and 40 mmHg with an increase of > 20 mmHg and/or with a severe intra-prosthetic AR. Results During this period 1403 patients were included. Mean duration follow-up was 3.6 ± 2.1 years, maximum duration was 10.2 years. Survival rates were 39.1% (95% CI: 36.3–41.8) and 13.4% (95% CI: 9.7–17.0) at respectively 5 and 8 years. In total, 589 patients were eligible for the durability analysis (46.6%). BVF occurred in 18 patients (1.4%). Among them, 5 patients required re-intervention. Risk of BVF at 10 years was 3.4% (95% CI: 1.7–5.9). Moderate SVD occurred in 41 patients (7.0%), risk of moderate SVD was 17.0% (95% CI: 9.1–26.0) at 10 years. Severe SVD occurred in 15 patients (2.5%), risk of severe SVD was 8.0% (95% CI: 3.3–15.2) at 10 years. Conclusion Our study does not highlight any alarm signal concerning percutaneous aortic bioprostheses durability.

Introduction Radial artery occlusion is the most common complication after coronary angiography performed by transradial access. It has been shown that heparin administration decreases the rate of radial artery occlusion but most of these studies were performed using 6 F arterial sheaths. There are few data regarding the radial artery occlusion rate after 4 French coronary angiography performed without heparin and with a reduced compression time. Objective To assess radial artery patency after diagnostic coronary angiography performed through a 4F sheath without heparin administration and with a short hemostasis time by manual compression. Methods In this observational study, patients referred for diagnostic coronary angiography from February 2017 to May 2017 underwent the procedure either using a 4 French arterial sheath, no heparin administration and a short manual compression time (Group 1) or using a 5 French arterial sheath, heparin administration and prolonged hemostasis by a compression wristband (Group 2). We assessed radial artery patency by continuous Doppler ultrasound after removal of the radial compression band, if any. Results Three thousand and eight patients were included, 51 (16.5%) in Group 1. Eleven cases of radial artery occlusion (3.57% of the study population) were diagnosed by Doppler, asymptomatic in all. Radial artery occlusion was more frequent in Group 1 (9.8% vs. 2.3%, P = 0.006). Lower weight (P = 0.04) and lower heparin dose (P = 0.005) were associated with an increased risk of radial occlusion. Conclusion Four French transradial coronary angiography without heparin led to an increased risk of radial artery occlusion compared to a strategy of 5 French coronary angiography with heparin administration.

Introduction The pathophysiology of aortic stenosis (AS), the most common acquired valvulopathy, is not fully understood and there is to date no treatment to slow or stop the progression of the disease. To define new therapeutic strategies, reproductible and adequate animal models of AS remain essentials and is lacking. A new mouse model has been proposed consisting of a single-nucleotide homozygous substitution mutation in the gene encoding EGFr, known as C57BL6 EgfrWa2/Wa2. However, it has been recently shown that aortic regurgitation (AR) remained prevalent, and that AS was rare or absent. Objective The aim of this study was to evaluate the effect of a high fat diet (HFD) and vitamin D3 supplementation in this model. Methods C57BL6 EgfrWa2/Wa2 mice were fed with HFD and were subcutaneous injected with vitamin D3 (16 UI/kg UI, 3 times a week, n = 16) during eighteen weeks. We used as control C57BL6 EgfrWa2/Wa2 mice fed without HFD and vitamin D3 (n = 12). Echocardiography was performed 3 and 6 months later. Blood serum 25(OH)2D3, 1,25(OH)2D3, calcium, total cholesterol, phosphates and creatinine were analyzed, and histology/IHC were performed at 6 months to assess valvular fibrosis, calcification and inflammation. Results Echocardiographic analysis did not show any improvement of the model with HFD and vitamin D3 supplementation. We observed pure severe AS in only two animals in each group and predominant AR in remaining animals. The different variables studied by echocardiography are represented in Table 1 . Vitamin D3 supplementation and HFD did not affect inflammation and calcification, although total cholesterol level was increased. Conclusion These results suggest that HFD and vitamin D3 supplementation had no effect on the C57BL6 EgfrWa2/Wa2 mice model. This model essentially mimics AR and no AS. Further studies are needed to find a reliable animal model of AS.

Since the first in man transcatheter aortic valve implantation (TAVI) in 2002, TAVI has been spreading worldwide. While indications of TAVI are expanding, our cohort represents the longest follow-up available. We aimed to analyze short- and long-term survival, complications and valve durability

Background As the pioneer center in the transcatheter aortic valve implantation (TAVI) our experience provides the longest follow-up. The number of nonagenarians is rising dramatically. These patients often develop aortic stenosis. Purpose We aimed to assess the safety and long-term outcomes after TAVI in this population in our center from 2002 to 2016. Methods All patients treated by TAVI in our center were included prospectively. Clinical and echocardiographic follow-up was performed at 30 days and yearly. Two groups were defined according to age: “ Results A total of 1071 patients underwent TAVI during the period. One hundred and fifty-four were age “≥ 90”. Mean logistic EuroSCORE was lower in “≥ 90” (18.3 ± 11.8% vs. 20.8 ± 11.7%, P = 0.01). “≥ 90” had less diabetes mellitus (17.1 vs. 29.9%, P = 0.001), less peripheral arterial disease (10.4% vs. 16.6%, P = 0.05), less chronic obstructive pulmonary disease (8.5% vs. 20.1%, P = 0.001), and less severe pulmonary hypertension (4.5% vs. 12.2% vs. 4.5%, P = 0.01). “≥ 90” also had less prevalence of cancer (11.8% vs. 20.7%, P = 0.03), less coronary artery bypass surgery (0.6% vs.12.6%, P Fig. 1 ). The life expectancy of these patients was comparable a population of the same age without aortic stenosis. Conclusion Nonagenarians have less comorbidities. They benefit most from transfemoral approach. Outcomes are comparable to the overall population. TAVI is a safe and life-saving treatment in well-selected nonagenarian population.

Major vascular complications (VC) remain an important issue after transfemoral transcatheter aortic valve implantation (TF-TAVI). Previous studies demonstrated that major VC were frequent with first-generation of transcatheter heart valves (THV) and were associated with higher 30-day mortality using

There is currently no consensus on the duration of hospitalization required after TAVI. We report the feasibility and safety of early discharge after transfemoral transcatheter aortic valve implantation (TAVI) with the Edwards SAPIEN-XT prosthesis. Between 2009 and 2013, 337 patients underwent

Background In the context of extension of transcatheter aortic valve implantation (TAVI) indications, transcatheter heart valve durability is a pivotal concern. Being the pioneer center since Fist-In-Man TAVI provides us the longest worldwide follow-up. Purpose We aimed to report long-term outcomes and assess valve durability by evaluating structural valve deterioration (SVD) in patients treated with balloon-expandable TAVI prior to 2011. Methods From 2002 to 2011, 242 patients underwent balloon-expandable TAVI in our center. On site clinical and echocardiographic follow-up were scheduled at one month, one year and yearly thereafter. In the absence of universal definition of SVD, we used the surgical definition, survival without reintervention, and proposed a definition using echocardiographic criteria. SVD was considered moderate when mean aortic gradient was ≥ 20 mmHg and Results Mean age was 82.2 years. Patients were highly symptomatic (79.1% in NYHA III/IV), mean logistic Euroscore was 25.5 ± 14.2%. 30-day mortality was 12.1%. Survival rate was 68.3 ± 3.0%, 26.9 ± 2.9%, and 5.3 ± 2.0% at one-, 5- and 10-years, respectively. Using surgical definition, only one patient required reintervention for symptomatic SVD and freedom from SVD at 10y was 93.8 ± 6.1%. According to our definition, 1 patient had probable severe SVD, 2 had probable moderate SVD, 1 had possible moderate SVD and freedom from SVD at 10 y was 87.7 ± 6.6% ( Fig. 1 ). Conclusions Our data do not demonstrate an alarm on durability. Long-term assessment of transcatheter aortic valve is difficult given the high mortality of the studies population. Further studies are required to estimate accurately TAVI durability. When assessing SVD and comparing TAVI to surgery, SVD definition should be universal.

Introduction Since the first-in-man transcatheter aortic valve implantation (TAVI) performed by our group in 2002, the number of procedures has dramatically increased. Currently restricted to inoperable and high-risk patients TAVI is likely to be extended to lower risk patients. However, long-term data regarding valve durability are missing. We aimed to report our experience with long-term follow-up to assess long-term mortality and valve durability. Methods All consecutive patients presenting with severe symptomatic aortic stenosis treated by TAVI were included prospectively. Clinical and echocardiographic follow-up was performed at 30 days and annually thereafter. Survival curves were constructed using Kaplan-Meier analysis. We also evaluated valve durability and the incidence of infective endocarditis. Results Between 2002 and 2015, 784 consecutive patients (age: 83.3±9.4 years, logistic EuroSCORE of 19.6±12.1%) underwent TAVI including 634 (80.9%) patients via a femoral approach. A balloon-expandable transcatheter heart valve (THV) was predominantly used (747 Pts; 95.3%): 68 Cribier- Edwards, 114 Sapien, 482 Sapien XT, and 83 Sapien 3 since July 2014. Thirty-day mortality dramatically decreased from 22.1% using the Cribier- Edwards in compassionate patients to 1.3% with the Sapien 3 (p Conclusions Long-term (up to 9 years) follow-up of our large series of patients treated by TAVI demonstrates no warning signs of valve deterioration suggesting very encouraging valve durability, using predominantly, a balloon expandable prosthesis The author declares a conflict of interest: Helene Eltchaninoff, Pierre-Yves Litzler and Alain Cribier are consultants for Edwards Lifesciences. Other authors have no disclosure. Download : Download full-size image Figure . Survival analysis by Kaplan-Meier