Author: "Hervé Le Breton" - Searchworks@Jio Institute Digital Library Search Results

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152 results on '"Hervé Le Breton"'

1. Similarity measures and attribute selection for case-based reasoning in transcatheter aortic valve implantation.

Author: Hélène Feuillâtre, Vincent Auffret, Miguel Castro, Florent Lalys, Hervé Le Breton, Mireille Garreau, and Pascal Haigron
Subjects: Medicine, Science
Abstract: In a clinical decision support system, the purpose of case-based reasoning is to help clinicians make convenient decisions for diagnoses or interventional gestures. Past experience, which is represented by a case-base of previous patients, is exploited to solve similar current problems using four steps-retrieve, reuse, revise, and retain. The proposed case-based reasoning has been focused on transcatheter aortic valve implantation to respond to clinical issues pertaining vascular access and prosthesis choices. The computation of a relevant similarity measure is an essential processing step employed to obtain a set of retrieved cases from a case-base. A hierarchical similarity measure that is based on a clinical decision tree is proposed to better integrate the clinical knowledge, especially in terms of case representation, case selection and attributes weighting. A case-base of 138 patients is used to evaluate the case-based reasoning performance, and retrieve- and reuse-based criteria have been considered. The sensitivity for the vascular access and the prosthesis choice is found to 0.88 and 0.94, respectively, with the use of the hierarchical similarity measure as opposed to 0.53 and 0.79 for the standard similarity measure. Ninety percent of the suggested solutions are correctly classified for the proposed metric when four cases are retrieved. Using a dedicated similarity measure, with relevant and weighted attributes selected through a clinical decision tree, the set of retrieved cases, and consequently, the decision suggested by the case-based reasoning are substantially improved over state-of-the-art similarity measures.
Published: 2020
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2. Assessment of Left Ventricular Function in Cardiac MSCT Imaging by a 4D Hierarchical Surface-Volume Matching Process

Author: Mireille Garreau, Antoine Simon, Dominique Boulmier, Jean-Louis Coatrieux, and Hervé Le Breton
Subjects: Medical physics. Medical radiology. Nuclear medicine, R895-920, Medical technology, R855-855.5
Abstract: Multislice computed tomography (MSCT) scanners offer new perspectives for cardiac kinetics evaluation with 4D dynamic sequences of high contrast and spatiotemporal resolutions. A new method is proposed for cardiac motion extraction in multislice CT. Based on a 4D hierarchical surface-volume matching process, it provides the detection of the heart left cavities along the acquired sequence and the estimation of their 3D surface velocity fields. A Markov random field model is defined to find, according to topological descriptors, the best correspondences between a 3D mesh describing the left endocardium at one time and the 3D acquired volume at the following time. The global optimization of the correspondences is realized with a multiresolution process. Results obtained on simulated and real data show the capabilities to extract clinically relevant global and local motion parameters and highlight new perspectives in cardiac computed tomography imaging.
Published: 2006
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3. Evolution of non-invasive myocardial work variables after transcatheter aortic valve implantation in patients with severe aortic stenosis

Author: Louis Quinio, Marion Taconne, Virginie Le Rolle, Libby Curtis, Vincent Auffret, Dominique Boulmier, Guillaume Leurent, Hervé Le Breton, Elena Galli, Emmanuel Oger, Erwan Donal, CHU Pontchaillou [Rennes], Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), and None
Subjects: Transcatheter aortic valve implantation, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Speckle tracking analysis, Aortic stenosis, [SDV.IB]Life Sciences [q-bio]/Bioengineering, General Medicine, Myocardial work, Cardiology and Cardiovascular Medicine
Abstract: International audience; INTRODUCTION: Guidelines recommend aortic valve replacement in patients with severe aortic stenosis who present with symptoms or left ventricular ejection fraction
Published: 2023

4. Study of the Behavior of Different Guidewire Shapes in a Patient-Specific Numerical Model for Transcatheter Aortic Valve Implantation.

Author: Phuoc Vy, Vincent Auffret, Miguel Castro 0002, Pierre Badel, Michel Rochette, Pascal Haigron, Stéphane Avril, and Hervé Le Breton
Published: 2017
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5. Study of Similarity Measures for Case-Based Reasoning in Transcatheter Aortic Valve Implantation.

Author: Hélène Feuillâtre, Vincent Auffret, Miguel Castro 0002, Hervé Le Breton, Mireille Garreau, and Pascal Haigron
Published: 2017
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6. Clinical outcomes after unprotected left main coronary artery occlusion: A retrospective multicentre cohort analysis

Author: Marco Dürig, Diego Arroyo, Marc Bedossa, Philippe Commeau, Stephane Fournier, Olivier Müller, Paul Barragan, Hervé Le Breton, Serban Puricel, Stéphane Cook, Université de Fribourg = University of Fribourg (UNIFR), Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), 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], Lausanne University Hospital, and Université de Fribourg
Subjects: [SDV]Life Sciences [q-bio], cardiogenic shock, percutaneous coronary intervention, acute myocardial infarction, Radiology, Nuclear Medicine and imaging, General Medicine, Cardiology and Cardiovascular Medicine, left main coronary artery occlusion
Abstract: International audience; Aims: Unprotected left main coronary artery (ULMCA) occlusion is a rare and disastrous condition with scarce data on presentation and outcomes. Herein, we report data on patients presenting with acute coronary syndrome due to ULMCA occlusion at four different institutions. Methods: This is an international multicentre observational study. Baseline characteristics were retro- and prospectively collected. Clinical follow-up was prospective. The primary outcome was in-hospital death. Patients surviving the index hospitalization were compared with nonsurvivors to find predictors of survival. Results: The study population consisted of 55 patients. Eight patients (15%) died in the cath lab, and 23 (42%) died in hospital. Three (6%) deaths were noncardiac and due to major bleeding. Thirty-two (58%) patients survived the index hospitalization and were discharged. These patients were followed for a median of 17.5 months during which three cardiac deaths occurred. Repeat revascularization was performed in 25% (n = 8). Overall mortality at maximum follow-up was 47% (n = 26). The only significant predictor for hospital survival was left ventricular ejection fraction (odds ratio [OR]: 1.10 (per 1 point increase); 95% confidence interval [CI]: 1.02–1.19; p = 0.02). Conclusion: ULMCA occlusion carries a high short-term mortality. Patients who survive index hospitalization have similar mortality rates as compared with other st elevation myocardial infarction patients. © 2023 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.
Published: 2023

7. Intraoperative tracking of aortic valve plane.

Author: D. L. H. Nguyen, Mireille Garreau, Vincent Auffret, Hervé Le Breton, Jean-Philippe Verhoye, and Pascal Haigron
Published: 2013
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8. ACTIVATION (PercutAneous Coronary inTervention prIor to transcatheter aortic VAlve implantaTION)

Author: Duolao Wang, Simon Redwood, Anthony H. Gershlick, Tim Clayton, Florian Irague, Doug Fraser, Derk Frank, Won-Keun Kim, Mark A. de Belder, Zeeshan Khawaja, Karen Wilson, David H. Roberts, Hervé Le Breton, Adrian P. Banning, Didier Carrié, Rainer Hambrecht, Bernard Prendergast, Martyn Thomas, Jonathan Byrne, Marie Claude Morice, Tiffany Patterson, Ian Cox, Stuart J. Pocock, David Hildick-Smith, Hélène Eltchaninoff, Azfar Zaman, David Smith, Nicolas Meneveau, Sagar N. Doshi, and Matthew Dodd
Subjects: medicine.medical_specialty, education.field_of_study, business.industry, medicine.medical_treatment, Population, Percutaneous coronary intervention, Canadian Cardiovascular Society, medicine.disease, Coronary artery disease, Angina, surgical procedures, operative, Valve replacement, Internal medicine, Conventional PCI, medicine, Cardiology, cardiovascular diseases, Myocardial infarction, Cardiology and Cardiovascular Medicine, education, business
Abstract: Objectives This study sought to determine if percutaneous coronary intervention (PCI) prior to transcatheter aortic valve replacement (TAVR) in patients with significant coronary artery disease would produce noninferior clinical results when compared with no PCI (control arm). Background PCI in patients undergoing TAVR is not without risk, and there are no randomized data to inform clinical practice. Methods Patients with severe symptomatic aortic stenosis and significant coronary artery disease with Canadian Cardiovascular Society class ≤2 angina were randomly assigned to receive PCI or no PCI prior to TAVR. The primary endpoint was a composite of all-cause death or rehospitalization at 1 year. Noninferiority testing (prespecified margin of 7.5%) was performed in the intention-to-treat population. Results At 17 centers, 235 patients underwent randomization. At 1 year, the primary composite endpoint occurred in 48 (41.5%) of the PCI arm and 47 (44.0%) of the no-PCI arm. The requirement for noninferiority was not met (difference: -2.5%; 1-sided upper 95% confidence limit: 8.5%; 1-sided noninferiority test P = 0.067). On analysis of the as-treated population, the difference was -3.7% (1-sided upper 95% confidence limit: 7.5%; P = 0.050). Mortality was 16 (13.4%) in the PCI arm and 14 (12.1%) in the no-PCI arm. At 1 year, there was no evidence of a difference in the rates of stroke, myocardial infarction, or acute kidney injury, with higher rates of any bleed in the PCI arm (P = 0.021). Conclusions Observed rates of death and rehospitalization at 1 year were similar between PCI and no PCI prior to TAVR; however, the noninferiority margin was not met, and PCI resulted in a higher incidence of bleeding. (Assessing the Effects of Stenting in Significant Coronary Artery Disease Prior to Transcatheter Aortic Valve Implantation; ISRCTN75836930 )
Published: 2021

9. TAVR Patients Requiring Anticoagulation

Author: Jean Philippe Verhoye, Thibaut Manigold, Alain Cribier, Nicolas Dumonteil, Patrick Ohlmann, Dominique Himbert, Hervé Le Breton, Frederic Collet, Philippe Guyon, Nicolas Meneveau, Xavier Favereau, Didier Carrié, Stéphane Delépine, Thomas Cuisset, Francois Bourlon, Emmanuel Teiger, Farzin Beygui, Olivier Bar, Bernard Albat, Bernard Bertrand, Martine Gilard, Géraud Souteyrand, Bernard Iung, France-TAVI, Arnaud Sudre, Remi Houel, Vincent Auffret, Philippe Commeau, Romain Didier, Louis Labrousse, Antoine Gommeaux, Guillaume Cayla, Thierry Lefèvre, Jean-Philippe Collet, Hélène Eltchaninoff, Didier Blanchard, Sylvain Beurtheret, Jean-Philippe Claudel, Vincent Doisy, Thibault Lhermusier, Gilles Rioufol, Stop-As, and Said Ghostine
Subjects: medicine.medical_specialty, business.industry, medicine.drug_class, medicine.medical_treatment, Anticoagulant, Hazard ratio, 030204 cardiovascular system & hematology, Vitamin K antagonist, Confidence interval, 3. Good health, 03 medical and health sciences, 0302 clinical medicine, Valve replacement, Internal medicine, Propensity score matching, Oral anticoagulant, Medicine, 030212 general & internal medicine, Cardiology and Cardiovascular Medicine, business, Major bleeding
Abstract: Objectives Using French transcatheter aortic valve replacement (TAVR) registries linked with the nationwide administrative databases, the study compared the rates of long-term mortality, bleeding, and ischemic events after TAVR in patients requiring oral anticoagulation with direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs). Background The choice of optimal drug for anticoagulation after TAVR remains debated. Methods Data from the France-TAVI and FRANCE-2 registries were linked to the French national health single-payer claims database, from 2010 to 2017. Propensity score matching was used to reduce treatment-selection bias. Two primary endpoints were death from any cause (efficacy) and major bleeding (safety). Results A total of 24,581 patients who underwent TAVR were included and 8,962 (36.4%) were treated with OAC. Among anticoagulated patients, 2,180 (24.3%) were on DOACs. After propensity matching, at 3 years, mortality (hazard ratio [HR]: 1.37; 95% confidence interval [CI]: 1.12-1.67; P Conclusions In these large multicenter French TAVR registries with an exhaustive clinical follow-up, the long-term mortality and major bleeding were lower with DOACs than VKAs at discharge. The present study supports preferential use of DOACs rather than VKAs in patients requiring oral anticoagulation therapy after TAVR.
Published: 2021

10. Incidence, Clinical Characteristics, and Impact of Absent Echocardiographic Signs in Patients with Infective Endocarditis after Transcatheter Aortic Valve Implantation

Author: Norman Mangner, Vassili Panagides, David del Val, Mohamed Abdel-Wahab, Lisa Crusius, Eric Durand, Nikolaj Ihlemann, Marina Urena, Costanza Pellegrini, Francesco Giannini, Tomasz Gasior, Wojtek Wojakowski, Martin Landt, Vincent Auffret, Jan-Malte Sinning, Asim N Cheema, Luis Nombela-Franco, Chekrallah Chamandi, Francisco Campelo-Parada, Erika Munoz-Garcia, Howard C Herrmann, Luca Testa, Won-Keun Kim, Helene Eltchaninoff, Lars Søndergaard, Dominique Himbert, Oliver Husser, Azeem Latib, Hervé Le Breton, Clement Servoz, Philippe Gervais, Mélanie Côté, Holger Thiele, David Holzhey, Axel Linke, Josep Rodés-Cabau, Technische Universität Dresden = Dresden University of Technology (TU Dresden), Université Laval [Québec] (ULaval), Leipzig University, 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), Rigshospitalet [Copenhagen], Copenhagen University Hospital, AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Ospedale San Raffaele, Service de cardiologie et maladies vasculaires [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes], CHU Pontchaillou [Rennes], Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), University Hospital Bonn, St. Michael's Hospital, 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), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Hospital Universitario Virgen de la Victoria [Malaga, Espagne], IRCCS Ospedale San Raffaele [Milan, Italy], and None
Subjects: Microbiology (medical), TAVI, Infectious Diseases, infective endocarditis, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, imaging, Duke criteria, TEE
Abstract: Background Echocardiography is the primary imaging modality for diagnosis of infective endocarditis (IE) in prosthetic valve endocarditis (PVE) including IE after transcatheter aortic valve implantation (TAVI). This study aimed to evaluate the characteristics and clinical outcomes of patients with absent compared with evident echocardiographic signs of TAVI-IE. Methods Patients with definite TAVI-IE derived from the Infectious Endocarditis after TAVI International Registry were investigated comparing those with absent and evident echocardiographic signs of IE defined as vegetation, abscess, pseudo-aneurysm, intracardiac fistula, or valvular perforation or aneurysm. Results Among 578 patients, 87 (15.1%) and 491 (84.9%) had absent (IE-neg) and evident (IE-pos) echocardiographic signs of IE, respectively. IE-neg were more often treated via a transfemoral access with a self-expanding device and had higher rates of peri-interventional complications (eg, stroke, major vascular complications) during the TAVI procedure (P < .05 for all). IE-neg had higher rates of IE caused by Staphylococcus aureus (33.7% vs 23.2%; P = .038) and enterococci (37.2% vs 23.8%; P = .009) but lower rates of coagulase-negative staphylococci (4.7% vs 20.0%, P = .001). IE-neg was associated with the same dismal prognosis for in-hospital mortality in a multivariate binary regression analysis (odds ratio: 1.51; 95% confidence interval [CI]: .55–4.12) as well as a for 1-year mortality in Cox regression analysis (hazard ratio: 1.10; 95% CI: .67–1.80). Conclusions Even with negative echocardiographic imaging, patients who have undergone TAVI and presenting with positive blood cultures and symptoms of infection are a high-risk patient group having a reasonable suspicion of IE and the need for an early treatment initiation.
Published: 2022

11. Sex Differences in Infective Endocarditis After Transcatheter Aortic Valve Replacement

Author: Vassili Panagides, Mohamed Abdel-Wahab, Norman Mangner, Eric Durand, Nikolaj Ihlemann, Marina Urena, Costanza Pellegrini, Francesco Giannini, Piotr Scislo, Zenon Huczek, Martin Landt, Vincent Auffret, Jan Malte Sinning, Asim N. Cheema, Luis Nombela-Franco, Chekrallah Chamandi, Francisco Campelo-Parada, Erika Munoz-Garcia, Howard C. Herrmann, Luca Testa, Won-Keun Kim, Helene Eltchaninoff, Lars Sondergaard, Dominique Himbert, Oliver Husser, Azeem Latib, Hervé le Breton, Clement Servoz, Philippe Gervais, David del Val, Axel Linke, Lisa Crusius, Holger Thiele, David Holzhey, Josep Rodés-Cabau, Université Laval [Québec] (ULaval), Universität Leipzig, 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), Rigshospitalet [Copenhagen], Copenhagen University Hospital, AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Deutsches Herzzentrum München (DHM), Maria Cecilia Hospital [Cotignola], Medical University of Warsaw - Poland, CHU Pontchaillou [Rennes], Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Heart Center Bonn [Bonn, Germany] (HCB), University Hospital Bonn, St. Michael's Hospital, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos [Madrid, Spain] (IdISSC), 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), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Hospital Universitario Virgen de la Victoria [Malaga, Espagne], Hospital of the University of Pennsylvania (HUP), Perelman School of Medicine, University of Pennsylvania-University of Pennsylvania, Università degli Studi di Milano, IRCCS Policlinico San Donato, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany, Montefiore Medical Center [Bronx, New York], Albert Einstein College of Medicine [New York], Technische Universität Dresden = Dresden University of Technology (TU Dresden), Leipzig University, and None
Subjects: Male, Sex Characteristics, Endocarditis, Aortic Valve Stenosis, Endocarditis, Bacterial, Transcatheter Aortic Valve Replacement, Treatment Outcome, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Risk Factors, Aortic Valve, Humans, Female, Cardiology and Cardiovascular Medicine, Retrospective Studies
Abstract: International audience; Background: Outcomes after transcatheter aortic valve replacement (TAVR) and infectious diseases may vary according to sex.Methods: This multicentre study aimed to determine the sex differences in clinical characteristics, management, and outcomes of infective endocarditis (IE) after TAVR. A total of 579 patients (217 women, 37.5%) who had the diagnosis of definite IE following TAVR were included retrospectively from the Infectious Endocarditis After TAVR International Registry.Results: Women were older (80 ± 8 vs 78 ± 8 years; P = 0.001) and exhibited a lower comorbidity burden. Clinical characteristics and microbiological profiles were similar between men and women, but culture-negative IE was more frequent in women (9.9% vs 4.3%; P = 0.009). A high proportion of patients had a clinical indication for surgery (54.4% in both groups; P = 0.99), but a surgical intervention was performed in a minority of patients (women 15.2%, men 20.3%; P = 0.13). The mortality rate at index IE hospitalisation was similar in both groups (women 35.4%, men 31.7%; P = 0.37), but women exhibited a higher mortality rate at 2-year follow-up (63% vs 52.1%; P = 0.021). Female sex remained an independent risk factor for cumulative mortality in the multivariable analysis (adjusted HR 1.28, 95% CI 1.02-1.62; P = 0.035). After adjustment for in-hospital events, surgery was not associated with better outcomes in women.Conclusions: There were no significant sex-related differences in the clinical characteristics and management of IE after TAVR. However, female sex was associated with increased 2-year mortality risk.
Published: 2022

12. A Surface-Volume Matching Process Using a Markov Random Field Model for Cardiac Motion Extraction in MSCT Imaging.

Author: Antoine Simon, Mireille Garreau, Dominique Boulmier, Jean-Louis Coatrieux, and Hervé Le Breton
Published: 2005
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13. Oral Anticoagulation Continuation Throughout TAVR

Author: Hervé Le Breton, Vincent Auffret, and Guillaume Leurent
Subjects: medicine.medical_specialty, business.industry, Atrial fibrillation, 030204 cardiovascular system & hematology, medicine.disease, 03 medical and health sciences, Continuation, 0302 clinical medicine, Oral anticoagulant, Medicine, 030212 general & internal medicine, Cardiology and Cardiovascular Medicine, business, Intensive care medicine, Stroke, Oral anticoagulation
Published: 2021

14. Very early infective endocarditis after transcatheter aortic valve replacement

Author: Vassili Panagides, Mohamed Abdel-Wahab, Norman Mangner, Eric Durand, Nikolaj Ihlemann, Marina Urena, Costanza Pellegrini, Francesco Giannini, Piotr Scislo, Zenon Huczek, Martin Landt, Vincent Auffret, Jan Malte Sinning, Asim N. Cheema, Luis Nombela-Franco, Chekrallah Chamandi, Francisco Campelo-Parada, Erika Munoz-Garcia, Howard C. Herrmann, Luca Testa, Won-Keun Kim, Helene Eltchaninoff, Lars Søndergaard, Dominique Himbert, Oliver Husser, Azeem Latib, Hervé Le Breton, Clement Servoz, Philippe Gervais, David del Val, Axel Linke, Lisa Crusius, Holger Thiele, David Holzhey, Josep Rodés-Cabau, Université Laval [Québec] (ULaval), Universität Leipzig, Technische Universität Dresden = Dresden University of Technology (TU Dresden), 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), Rigshospitalet [Copenhagen], Copenhagen University Hospital, AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Deutsches Herzzentrum München (DHM), Ospedale San Raffaele, Medical University of Warsaw - Poland, 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], 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), Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany, Mediterranean Academic Research and Studies in Cardiology association (MARS Cardio), Universität Leipzig [Leipzig], 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: Male, Endocarditis, General Medicine, Aortic Valve Stenosis, Endocarditis, Bacterial, Staphylococcal Infections, TAVR, Anti-Bacterial Agents, Heart surgery, Transcatheter Aortic Valve Replacement, Risk Factors, Aortic Valve, Heart Valve Prosthesis, Humans, Female, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Anti-bio-prophylaxis, Infective endocarditis, Healthcare-associated infection, Cardiology and Cardiovascular Medicine
Abstract: International audience; Background - Scarce data exist about early infective endocarditis (IE) after trans-catheter aortic valve replacement (TAVR). Objective - The objective was to evaluate the characteristics, management, and outcomes of very early (VE) IE (≤ 30 days) after TAVR. Methods - This multicenter study included a total of 579 patients from the Infectious Endocarditis after TAVR International Registry who had the diagnosis of definite IE following TAVR. Results - Ninety-one patients (15.7%) had VE-IE. Factors associated with VE-IE (vs. delayed IE (D-IE)) were female gender (p = 0.047), the use of self-expanding valves (p
Published: 2022

15. An Optimized Approach for Transfemoral Transcatheter Aortic Valve Implantation: A Comprehensive Review and Current Evidence

Author: Vincent Auffret, Guilherme F. Attizzani, Rishi Puri, Maurizio Taramasso, Bernhard Meier, Yasuhiro Ichibori, Samir R. Kapadia, Deepak L. Bhatt, Rajiv Das, João L. Cavalcante, Fabian Nietlispach, Hervé Le Breton, and Ankur Kalra
Subjects: medicine.medical_specialty, Transcatheter aortic, Heart Valve Diseases, Punctures, 030204 cardiovascular system & hematology, Risk Assessment, Transcatheter Aortic Valve Replacement, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Risk Factors, Catheterization, Peripheral, Humans, Medicine, 030212 general & internal medicine, Intensive care medicine, Evidence-Based Medicine, business.industry, Early recovery, General Medicine, Perioperative, Femoral Artery, Treatment Outcome, Aortic Valve, Patient Safety, Cardiology and Cardiovascular Medicine, business, Hospital stay, Resource utilization
Abstract: Device iterations and technical refinements have enabled transcatheter aortic valve implantation (TAVI) to be offered as a routine interventional procedure in many centers with high reproducibility and success. The concept of a streamlined procedure with appropriate procedural optimization, namely "optimized approach," has become increasingly relevant, aimed at minimizing perioperative burden and promoting early recovery. Relatively high device costs may be mitigated by reducing length of hospital stay and resource utilization. This review summarizes current evidence of components related to the optimization process during transfemoral TAVI. It is important to customize the procedure specific to each patient for its optimization.
Published: 2020

16. Routine CYP2C19 Genotyping to Adjust Thienopyridine Treatment After Primary PCI for STEMI

Author: Jean-Sébastien Hulot, Bernard Chevalier, Loic Belle, Guillaume Cayla, Khalife Khalife, François Funck, Romain Berthier, Christophe Piot, Muriel Tafflet, Gilles Montalescot, Loïc Belle, Hervé Le Breton, Emmanuel Teiger, Grégoire Dambrin, K. Khalife, L. Schmutz, F. Funck, R. Berthier, C. Piot, G. Hannebicque, G. Montalescot, T. Lognone, F. De Poli, B. Chevalier, N. Lhoest, M. Schneeberger, N. Delarche, A. Faure, H. Aelion, M. Godin, M. Gilard, B. Ritz, P. Barraud, P. Barnay, L.N. Saïdi, O. Le Dref, P. Garot, G. Range, J. Georges, C. Robin, Y. Cottin, L. Belle, G. Souteyrand, A. Lafont, A. Fournier, P. Dupouy, J. Shayne, P. Chapon, C. Boureux, J.P. Faure, H. Ben Amer, A. Furber, O. Ormezzano, G. Bayet, G. Karrillon, L. Maillard, A. Grenzinger, A. Avran, R. Koning, D. Dumant, X. Lamit, R. Dauphin, L. Drogoul, T. Cuisset, O. Wittenberg, J.P. Peyre, P. Laury, and R. Robert
Subjects: medicine.medical_specialty, Thienopyridine, business.industry, Cyp2c19 genotype, CYP2C19, 030204 cardiovascular system & hematology, medicine.disease, Clopidogrel, Real life setting, 3. Good health, 03 medical and health sciences, surgical procedures, operative, 0302 clinical medicine, Internal medicine, Conventional PCI, medicine, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, Cardiology and Cardiovascular Medicine, business, Genotyping, medicine.drug
Abstract: @DrHulot_PARCC Anti-platelet therapy adjustment guided by CYP2C19 genotyping can be done in
Published: 2020

17. Association of estimated plasma volume status with hemodynamic and echocardiographic parameters

Author: Patrick Rossignol, Elena Galli, Nicolas Girerd, Frédéric Schnell, Arnaud Hubert, Maxime Fournet, Olivier Huttin, Hervé Le Breton, Philippe Mabo, Kevin Duarte, Christophe Leclercq, Erwan Donal, Masatake Kobayashi, Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy] (INI-CRCT), Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy], French-Clinical Research Infrastructure Network - F-CRIN [Paris] (Cardiovascular & Renal Clinical Trialists - CRCT ), Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), 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], Contrat de Plan Etat Lorraine IT2MP and FEDER Lorraine, ANR-15-IDEX-0004,LUE,Isite LUE(2015), ANR-15-RHUS-0004,FIGHT-HF,Combattre l'insuffisance cardiaque(2015), ANR-15-CE14-0032,MR-focus,Régulation, Diagnostique et Thérapeutique ciblée du récepteur minéralocorticoïde dans le remodelage cardiaque(2015), ANR-16-ECVD-0002,EXPERT,Exploring new pathways in age-related heart diseases(2016), Université de Lorraine (UL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), 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), Jonchère, Laurent, ISITE - Isite LUE - - LUE2015 - ANR-15-IDEX-0004 - IDEX - VALID, Combattre l'insuffisance cardiaque - - FIGHT-HF2015 - ANR-15-RHUS-0004 - RHUS - VALID, Régulation, Diagnostique et Thérapeutique ciblée du récepteur minéralocorticoïde dans le remodelage cardiaque - - MR-focus2015 - ANR-15-CE14-0032 - AAPG2015 - VALID, and Exploring new pathways in age-related heart diseases - - EXPERT2016 - ANR-16-ECVD-0002 - ERA-CVD - VALID
Subjects: Male, Plasma volume, medicine.medical_specialty, sex difference, medicine.medical_treatment, Hemodynamics, 030204 cardiovascular system & hematology, Hematocrit, left ventricular filling pressure, 03 medical and health sciences, 0302 clinical medicine, Left atrial, Internal medicine, medicine, Humans, Prospective Studies, 030212 general & internal medicine, Aged, Cardiac catheterization, [SDV.IB] Life Sciences [q-bio]/Bioengineering, Aged, 80 and over, Heart Failure, medicine.diagnostic_test, business.industry, congestion, Stroke Volume, General Medicine, Prognosis, medicine.disease, Myocardial Contraction, 3. Good health, Blood pressure, Echocardiography, Heart failure, Left-ventricular filling pressure, Cardiology, Female, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Hemoglobin, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract: International audience; Background: Estimated plasma volume status (ePVS) has diagnostic and prognostic value in patients with heart failure (HF). However, it remains unclear which congestion markers (i.e., biological, imaging and hemodynamic markers) are preferentially associated with ePVS. In addition, there is evidence of sex differences in both the hematopoietic process and myocardial structure/function.Method and results: Patients with significant dyspnea (NYHA≥2) underwent echocardiography and lung ultrasound within four hours prior to cardiac catheterization. Patients were divided according to tertiles based on sex-specific ePVS thresholds calculated from hemoglobin and hematocrit measurements using Duarte’s formula.Among the 78 included patients (median age 74.5 years; males 69.2%; HF 48.7%), median ePVS was 4.1 (percentile25-75=3.7-4.9) ml/g in males (N=54) and 4.8 (4.4-5.3) ml/g in females (N=24). Patients with the highest ePVS had more frequently HF, higher NT-proBNP, larger left atrial volume and higher E/e’ (all p-values0.10). In multivariable analysis, higher E/e’ and lower diastolic blood pressure were significantly associated with increased ePVS. The association between ePVS and congestion variables was not sex-dependent except for left ventricular end-diastolic pressure, which was only correlated with ePVS in females (Spearman Rho=0.53, p
Published: 2020

18. Prognostic impact of permanent pacemaker implantation after transcatheter aortic valve replacement

Author: Sam Sharobeem, Dominique Boulmier, Guillaume Leurent, Marc Bedossa, Christophe Leclercq, Philippe Mabo, Raphael P. Martins, Jacques Tomasi, Jean-Philippe Verhoye, Erwan Donal, Gwenaelle Sost, Marielle Le Guellec, Hervé Le Breton, Vincent Auffret, CHU Pontchaillou [Rennes], Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Jonchère, Laurent
Subjects: [SDV.IB] Life Sciences [q-bio]/Bioengineering, Aged, 80 and over, Heart Failure, Male, Pacemaker, Artificial, Conduction disturbances, Aortic stenosis, Aortic Valve Stenosis, TAVR, Prognosis, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Transcatheter Aortic Valve Replacement, Treatment Outcome, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Risk Factors, Physiology (medical), Aortic Valve, Humans, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Female, Cardiology and Cardiovascular Medicine, Permanent pacemaker implantation, Aged
Abstract: International audience; BACKGROUND: Conduction disturbances requiring permanent pacemaker implantation (PPI) remain a common complication of transcatheter aortic valve replacement (TAVR). OBJECTIVE: The purpose of this study was to determine the prognostic impact of PPI after TAVR according to the timing of implantation relative to TAVR. METHODS: A total of 1199 patients (median age 83 years; interquartile range 78-86 years; 45.8% female) were included in the analysis, of whom 894 had not undergone PPI, 130 had undergone previous PPI, 116 had undergone in-hospital PPI, and 59 had undergone PPI during follow-up. Median follow-up was 2.94 years (1.42-4.32 years). The primary outcome was the composite of all-cause mortality and hospitalization for heart failure. RESULTS: PPI during follow-up was associated with a higher occurrence of the primary outcome (hazard ratio [HR] 2.11; 95% confidence interval [CI] 1.39-3.20) whereas previous PPI and in-hospital PPI were not (HR 0.96; 95% CI 0.71-1.29 and HR 1.26; 95% CI 0.88-1.81, respectively). PPI during follow-up was associated with a higher risk of hospitalization for heart failure (sub-HR 3.21; 95% CI 2.02-5.11), while this relationship was only borderline significant for previous PPI (sub-HR 1.51; 95% CI 0.99-2.29). In contrast, there was no relationship between in-hospital PPI and the subsequent risk of hospitalization for heart failure. CONCLUSION: Previous PPI and in-hospital PPI had no long-term prognostic impact on the risk of all-cause mortality and hospitalization for heart failure, whereas PPI during follow-up was associated with a higher risk of hospitalization for heart failure. The present study questions the deleterious influence of periprocedural post-TAVR PPI, which has previously been suggested by certain studies.
Published: 2022

19. Infective Endocarditis Caused by Staphylococcus Aureus after Transcatheter Aortic Valve Replacement

Author: Fernando Alfonso, Marco Barbanti, Oliver Husser, Harindra C. Wijeysundera, Jean-Bernard Masson, Ignacio J. Amat-Santos, Samir R. Kapadia, Marina Urena, Francisco Campelo-Parada, Vinicius Esteves, Roger R. Godinho, Tarun Chakravarty, Marcos Antonio Marino, Stamatios Lerakis, Alexandre Siciliano Colafranceschi, Marouane Boukhris, Chekrallah Chamandi, Lisa Crusius, Tomasz Gasior, Azeem Latib, Norman Mangner, Utz Kappert, Josep Rodés-Cabau, José Armando Mangione, Francesco Rosato, Axel Linke, Sandro Sponga, Erika Muñoz-García, Valter Corriea de Lima, Susheel Kodali, Asim N. Cheema, Lars Søndergaard, Igor Vendramin, Alexandre Abizaid, Antonio L. Bartorelli, Annapoorna Kini, Rosana Hernández-Antolín, John G. Webb, Costanza Pellegrini, Didier Tchetche, Howard C. Herrmann, John Lisko, Claudia Fiorina, Mohamed Abdel-Wahab, Kim Won-Keun, Hélène Eltchaninoff, Alberto Alperi, Martin Landt, Dominique Himbert, Frédéric Maes, Victoria Vilalta, Luca Testa, Isaac Pascual, Luisa Salido, Jan Malte Sinning, Vicenç Serra, Guglielmo Mario Actis Dato, Antonio Miceli, Clement Servoz, David del Val, Rafael Romaguera, Maria-Cristina Ferreira, Eric Durand, Julio Andrea, Fabio Sandoli de Brito, Vincent Auffret, Philippe Gervais, Stefan Stortecky, Paolo Olivares, Francesco Giannini, Enrique Gutiérrez-Ibañes, Raj Makkar, Nikolaj Ihlemann, Wojtek Wojakowski, Hervé Le Breton, Abdullah Alkhodair, Juan C. Castillo, Ander Regueiro, David Holzhey, Luis Nombela-Franco, Henrique Barbosa Ribeiro, Saif Siddiqui, Université Laval [Québec] (ULaval), Universität Leipzig [Leipzig], 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), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), 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), CHU Pontchaillou [Rennes], 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), CHU Toulouse [Toulouse], Clinique Pasteur, Clinique Pasteur [Toulouse], Mount Sinai Hospital [Toronto, Canada] (MSH), Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal (UdeM), University Hospital Leipzig, Edwards Lifesciences, Fundación Alfonso Martín Escudero, Abbott Laboratories, Medtronic, Boston Scientific Corporation, UCL - (SLuc) Département cardiovasculaire, UCL - SSS/IREC/SLUC - Pôle St.-Luc, Hôpital de Rangueil, Universität Leipzig, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)
Subjects: Male, medicine.medical_specialty, Staphylococcus aureus, Prosthesis-Related Infections, Transcatheter aortic, medicine.medical_treatment, [SDV]Life Sciences [q-bio], 030204 cardiovascular system & hematology, medicine.disease_cause, Global Health, Prosthesis, Sepsis, Transcatheter Aortic Valve Replacement, 03 medical and health sciences, 0302 clinical medicine, Valve replacement, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Risk Factors, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, medicine, Endocarditis, Humans, 030212 general & internal medicine, Hospital Mortality, Registries, 610 Medicine & health, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Incidence, Aortic Valve Stenosis, Endocarditis, Bacterial, Staphylococcal Infections, medicine.disease, 3. Good health, Surgery, Survival Rate, Infective endocarditis, Aortic Valve, Heart Valve Prosthesis, Etiology, Female, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract: International audience; Background - Staphylococcus aureus (SA) has been extensively studied as causative microorganism of surgical prosthetic-valve infective endocarditis (IE). However, scarce evidence exists on SA IE after transcatheter aortic valve replacement (TAVR). Methods - Data were obtained from the Infectious Endocarditis After TAVR International Registry, including patients with definite IE after TAVR from 59 centres in 11 countries. Patients were divided into 2 groups according to microbiologic etiology: non-SA IE vs SA IE. Results - SA IE was identified in 141 patients out of 573 (24.6%), methicillin-sensitive SA in most cases (115/141, 81.6%). Self-expanding valves were more common than balloon-expandable valves in patients presenting with early SA IE. Major bleeding and sepsis complicating TAVR, neurologic symptoms or systemic embolism at admission, and IE with cardiac device involvement (other than the TAVR prosthesis) were associated with SA IE (P < 0.05 for all). Among patients with IE after TAVR, the likelihood of SA IE increased from 19% in the absence of those risk factors to 84.6% if ≥ 3 risk factors were present. In-hospital (47.8% vs 26.9%; P < 0.001) and 2-year (71.5% vs 49.6%; P < 0.001) mortality rates were higher among patients with SA IE vs non-SA IE. Surgery at the time of index SA IE episode was associated with lower mortality at follow-up compared with medical therapy alone (adjusted hazard ratio 0.46, 95% CI 0.22-0.96; P = 0.038). Conclusions - SA IE represented approximately 25% of IE cases after TAVR and was associated with very high in-hospital and late mortality. The presence of some features determined a higher likelihood of SA IE and could help to orientate early antibiotic regimen selection. Surgery at index SA IE was associated with improved outcomes, and its role should be evaluated in future studies.
Published: 2022

20. Mitral Valve Infective Endocarditis after Trans-Catheter Aortic Valve Implantation

Author: Vassili Panagides, David del Val, Mohamed Abdel-Wahab, Norman Mangner, Eric Durand, Nikolaj Ihlemann, Marina Urena, Costanza Pellegrini, Francesco Giannini, Piotr Scislo, Zenon Huczek, Martin Landt, Vincent Auffret, Jan Malte Sinning, Asim N. Cheema, Luis Nombela-Franco, Chekrallah Chamandi, Francisco Campelo-Parada, Erika Munoz-Garcia, Howard C Herrmann, Luca Testa, Won-Keun Kim, Juan Carlos Castillo, Alberto Alperi, Didier Tchetche, Antonio L. Bartorelli, Samir Kapadia, Stefan Stortecky, Ignacio Amat-Santos, Harindra C. Wijeysundera, John Lisko, Enrique Gutiérrez-Ibanes, Vicenç Serra, Luisa Salido, Abdullah Alkhodair, Ugolino Livi, Tarun Chakravarty, Stamatios Lerakis, Victoria Vilalta, Ander Regueiro, Rafael Romaguera, Utz Kappert, Marco Barbanti, Jean-Bernard Masson, Frédéric Maes, Claudia Fiorina, Antonio Miceli, Susheel Kodali, Henrique B. Ribeiro, Jose Armando Mangione, Fabio Sandoli de Brito, Guglielmo Mario Actis Dato, Francesco Rosato, Maria-Cristina Ferreira, Valter Correia de Lima, Alexandre Siciliano Colafranceschi, Alexandre Abizaid, Marcos Antonio Marino, Vinicius Esteves, Julio Andrea, Roger R. Godinho, Fernando Alfonso, Helene Eltchaninoff, Lars Søndergaard, Dominique Himbert, Oliver Husser, Azeem Latib, Hervé Le Breton, Clement Servoz, Isaac Pascual, Saif Siddiqui, Paolo Olivares, Rosana Hernandez-Antolin, John G. Webb, Sandro Sponga, Raj Makkar, Annapoorna S. Kini, Marouane Boukhris, Philippe Gervais, Axel Linke, Lisa Crusius, David Holzhey, Josep Rodés-Cabau, Université Laval [Québec] (ULaval), Universität Leipzig [Leipzig], Technische Universität Dresden = Dresden University of Technology (TU Dresden), 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), Rigshospitalet [Copenhagen], Copenhagen University Hospital, AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Deutsches Herzzentrum München (DHM), Ospedale San Raffaele, Medical University of Warsaw - Poland, Service de cardiologie et maladies vasculaires [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes], CHU Pontchaillou [Rennes], 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 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), Hôpital Rangueil, CHU Toulouse [Toulouse], UCL - SSS/IREC/SLUC - Pôle St.-Luc, UCL - (SLuc) Département cardiovasculaire, Universität Leipzig, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)
Subjects: MESH: Endocarditis, Catheters, MESH: Humans, Endocarditis, MESH: Heart Valve Prosthesis, Aortic Valve Insufficiency, Aortic Valve Stenosis, MESH: Aortic Valve Insufficiency, MESH: Mitral Valve, Transcatheter Aortic Valve Replacement, Treatment Outcome, Risk Factors, MESH: Risk Factors, Aortic Valve, Heart Valve Prosthesis, Humans, Mitral Valve, [SDV.IB]Life Sciences [q-bio]/Bioengineering, MESH: Transcatheter Aortic Valve Replacement, MESH: Catheters, Cardiology and Cardiovascular Medicine, 610 Medicine & health, MESH: Aortic Valve, MESH: Aortic Valve Stenosis, MESH: Treatment Outcome
Abstract: Scarce data exist on mitral valve (MV) infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI). This multicenter study included a total of 579 patients with a diagnosis of definite IE after TAVI from the IE after TAVI International Registry and aimed to evaluate the incidence, characteristics, management, and outcomes of MV-IE after TAVI. A total of 86 patients (14.9%) had MV-IE. These patients were compared with 284 patients (49.1%) with involvement of the transcatheter heart valve (THV) only. Two factors were found to be associated with MV-IE: the use of self-expanding valves (adjusted odds ratio 2.49, 95% confidence interval [CI] 1.23 to 5.07, p = 0.012), and the presence of an aortic regurgitation >= 2 at discharge (adjusted odds ratio 3.33; 95% CI 1.43 to 7.73, p < 0.01). There were no differences in IE timing and causative microorganisms between groups, but surgical management was significantly lower in patients with MV-IE (6.0%, vs 21.6% in patients with THV-IE, p = 0.001). All-cause mortality rates at 2-year follow-up were high and similar between patients with MV-IE (51.4%, 95% CI 39.8 to 64.1) and patients with THV-IE (51.5%, 95% CI 45.4 to 58.0) (log-rank p = 0.295). The factors independently associated with increased mortality risk in patients with MV-IE were the occurrence of heart failure (adjusted p < 0.001) and septic shock (adjusted p < 0.01) during the index hospitalization. One of 6 IE episodes after TAVI is localized on the MV. The implantation of a self-expanding THV and the presence of an aortic regurgitation >= 2 at discharge were associated with MV-IE. Patients with MV-IE were rarely operated on and had a poor prognosis at 2-year follow-up. (C) 2022 Elsevier Inc. All rights reserved.
Published: 2022

21. Early and late ventricular arrhythmias complicating ST-segment elevation myocardial infarction

Author: Vincent Auffret, Hamed Bourenane, Sam Sharobeem, Guillaume Leurent, Romain Didier, Martine Gilard, Pierre-Philippe Nicol, Laurent Payot, Emmanuelle Filippi, Jean-Philippe Hacot, Gilles Rouault, Djamel Saouli, Philippe Druelles, Isabelle Coudert, Bertrand Boulanger, Tarik Cherfaoui, Josiane Treuil, Marc Bedossa, Dominique Boulmier, Marielle Le Guellec, Raphael P. Martins, Hervé Le Breton, 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], Hôpital de la Cavale Blanche, Hôpital Yves LE FOLL [Saint-Brieuc], Centre hospitalier Bretagne Atlantique (Morbihan) (CHBA), Groupe Hospitalier Bretagne Sud (GHBS), Centre Hospitalier Intercommunal de Cornouaille [Quimper] (CHI Cornouaille [Quimper]), CH de Saint-Malo [Broussais], Polyclinique Saint Laurent [Rennes], None, 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), CH Yves LE FOLL, and Jonchère, Laurent
Subjects: Score de risque, Myocardial Infarction, 030204 cardiovascular system & hematology, Ventricular Function, Left, 03 medical and health sciences, 0302 clinical medicine, Percutaneous Coronary Intervention, Pronostic, Humans, 030212 general & internal medicine, cardiovascular diseases, Aged, [SDV.IB] Life Sciences [q-bio]/Bioengineering, Arrhythmias, Cardiac, Stroke Volume, General Medicine, Arythmies ventriculaires, Prognosis, Syndrome coronarien aigu avec sus-décalage du segment ST, 3. Good health, ST-segment elevation myocardial infarction, Ventricular arrhythmia, ST Elevation Myocardial Infarction, Risk score, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Cardiology and Cardiovascular Medicine
Abstract: International audience; BACKGROUND: Ventricular arrhythmias can be life-threatening complications of ST-segment elevation myocardial infarction (STEMI). AIMS: To describe the incidence, predictors and in-hospital impact of early ventricular arrhythmia (EVA, occurring
Published: 2022

22. Perivalvular Extension of Infective Endocarditis after Transcatheter Aortic Valve Replacement

Author: Vassili Panagides, David del Val, Mohamed Abdel-Wahab, Norman Mangner, Eric Durand, Nikolaj Ihlemann, Marina Urena, Costanza Pellegrini, Francesco Giannini, Tomasz Gasior, Wojtek Wojakowski, Martin Landt, Vincent Auffret, Jan Malte Sinning, Asim N Cheema, Luis Nombela-Franco, Chekrallah Chamandi, Francisco Campelo-Parada, Erika Munoz-Garcia, Howard C Herrmann, Luca Testa, Won Keun Kim, Juan Carlos Castillo, Alberto Alperi, Didier Tchetche, Antonio L Bartorelli, Samir Kapadia, Stefan Stortecky, Ignacio Amat-Santos, Harindra C Wijeysundera, John Lisko, Enrique Gutiérrez-Ibanes, Vicenç Serra, Luisa Salido, Abdullah Alkhodair, Ugolino Livi, Tarun Chakravarty, Stamatios Lerakis, Victoria Vilalta, Ander Regueiro, Rafael Romaguera, Utz Kappert, Marco Barbanti, Jean Bernard Masson, Frédéric Maes, Claudia Fiorina, Antonio Miceli, Susheel Kodali, Henrique B Ribeiro, Jose Armando Mangione, Fabio Sandoli de Brito, Guglielmo Mario Actis Dato, Francesco Rosato, Maria Cristina Ferreira, Valter Correia de Lima, Alexandre Siciliano Colafranceschi, Alexandre Abizaid, Marcos Antonio Marino, Vinicius Esteves, Julio Andrea, Roger R Godinho, Fernando Alfonso, Helene Eltchaninoff, Lars Søndergaard, Dominique Himbert, Oliver Husser, Azeem Latib, Hervé Le Breton, Clement Servoz, Isaac Pascual, Saif Siddiqui, Paolo Olivares, Rosana Hernandez-Antolin, John G Webb, Sandro Sponga, Raj Makkar, Annapoorna S Kini, Marouane Boukhris, Philippe Gervais, Axel Linke, Lisa Crusius, David Holzhey, Josep Rodés-Cabau, Université Laval [Québec] (ULaval), Universität Leipzig, 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), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), 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], 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), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Clinique Pasteur [Toulouse], Technische Universität Dresden = Dresden University of Technology (TU Dresden), Leipzig University, Universität Leipzig [Leipzig], 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), Hôpital de Rangueil, CHU Toulouse [Toulouse], 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: Microbiology (medical), Coagulase, Infective endocarditis, TAVI, TAVR, heart surgery, Endocarditis, infective endocarditis, 610 Medicine & health, Endocarditis, Bacterial, 030204 cardiovascular system & hematology, Abscess, 3. Good health, Transcatheter Aortic Valve Replacement, 03 medical and health sciences, 0302 clinical medicine, Infectious Diseases, Risk Factors, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Humans, 030212 general & internal medicine, Renal Insufficiency, Chronic, Aneurysm, False
Abstract: Background Infective endocarditis (IE) following transcatheter aortic valve replacement (TAVR) has been associated with a dismal prognosis. However, scarce data exist on IE perivalvular extension (PEE) in such patients. Methods This multicenter study included 579 patients who had the diagnosis of definite IE at a median of 171 (53–421) days following TAVR. PEE was defined as the presence of an intracardiac abscess, pseudoaneurysm, or fistula. Results A total of 105 patients (18.1%) were diagnosed with PEE (perivalvular abscess, pseudoaneurysm, fistula, or a combination in 87, 7, 7, and 4 patients, respectively). A history of chronic kidney disease (adjusted odds ratio [ORadj], 2.08; 95% confidence interval [CI]: 1.27–3.41; P = .003) and IE secondary to coagulase-negative staphylococci (ORadj, 2.71; 95% CI: 1.57–4.69; P Conclusions PEE occurred in about one-fifth of IE post-TAVR patients, with the presence of coagulase-negative staphylococci and chronic kidney disease determining an increased risk. Patients with PEE-IE exhibited high early and late mortality rates, and surgery during IE hospitalization seemed to be associated with better outcomes.
Published: 2021

23. Cardiac Motion Extraction Using 3D Surface Matching in Multislice Computed Tomography.

Author: Antoine Simon, Mireille Garreau, Dominique Boulmier, Jean-Louis Coatrieux, and Hervé Le Breton
Published: 2004
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24. Compared Outcomes of ST-Segment–Elevation Myocardial Infarction Patients With Multivessel Disease Treated With Primary Percutaneous Coronary Intervention and Preserved Fractional Flow Reserve of Nonculprit Lesions Treated Conservatively and of Those With Low Fractional Flow Reserve Managed Invasively: Insights From the FLOWER-MI Trial

Author: Alicia Le Bras, Philippe Gabriel Steg, Gilles Montalescot, Tabassome Simon, Isabelle Durand-Zaleski, Hervé Le Breton, Francois Schiele, Gérald Vanzetto, Nicolas Danchin, Yann Valy, Denis Angoulvant, Pierre Denormandie, François Roubille, Etienne Puymirat, Gilles Chatellier, Pascal Goube, Guillaume Cayla, Thomas Cuisset, Anaïs Charles-Nelson, Sébastien Levesque, O. Nallet, 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), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université Pierre et Marie Curie - Paris 6 (UPMC), Hémostase, bio-ingénierie et remodelage cardiovasculaires (LBPC), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Institut Galilée-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Université de Montpellier (UM), 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, AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Alliance française pour les essais cliniques cardio-vasculaires - French Alliance for Cardiovascular Trials (FACT), Université Paris Cité (UPCité), Sorbonne Université (SU), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), 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)-CHU Pitié-Salpêtrière [AP-HP], Hôpital Hôtel-Dieu [Paris], 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 Rennes (UR), CHU Pontchaillou [Rennes], Service de Cardiologie La Rochelle (CHU La Rochelle), Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( UR 3920) (PCVP / CARDIO), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Nutrition, obésité et risque thrombotique (NORT), Institut National de la Recherche Agronomique (INRA)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital de la Timone [CHU - APHM] (TIMONE), Aix Marseille Université (AMU), 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), Radiopharmaceutiques biocliniques (LRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes (UGA), Centre Hospitalier Universitaire [Grenoble] (CHU), Université Grenoble Alpes (UGA), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Centre Hospitalier Sud Francilien, Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, EA4245 - Transplantation, Immunologie, Inflammation [Tours] (T2i), Université de Tours (UT), CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), CIC - HEGP (CIC 1418), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-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)-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), MORNET, Dominique, Université Paris Diderot - Paris 7 (UPD7)-Université Paris 13 (UP13)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Galilée, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Université Sorbonne Paris Nord, Université de Paris (UP), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), 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), Université de Rennes (UNIV-RENNES), Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( EA 3920) (PCVP / CARDIO), Université Grenoble Alpes (UGA)-Institut National de la Santé et de la Recherche Médicale (INSERM), CH Evry-Corbeil, Université de Tours, Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), 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), Aix Marseille Université (AMU)-Institut National de la Recherche Agronomique (INRA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), and 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)
Subjects: medicine.medical_specialty, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Myocardial Infarction, Context (language use), Fractional flow reserve, 030204 cardiovascular system & hematology, Coronary Angiography, Revascularization, Culprit, Coronary artery disease, cause of death, 03 medical and health sciences, Percutaneous Coronary Intervention, 0302 clinical medicine, Internal medicine, medicine, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, humans, business.industry, Percutaneous coronary intervention, medicine.disease, follow-up studies, Fractional Flow Reserve, Myocardial, [SDV] Life Sciences [q-bio], surgical procedures, operative, Treatment Outcome, Conventional PCI, Cardiology, ST Elevation Myocardial Infarction, Cardiology and Cardiovascular Medicine, business, coronary artery disease, hospitalization
Abstract: Background: In patients with ST-segment–elevation myocardial infarction and multivessel disease, percutaneous coronary intervention (PCI) for nonculprit lesions guided by fractional flow reserve (FFR) is superior to treatment of the culprit lesion alone. Whether deferring nonculprit PCI is safe in this specific context is questionable. We aimed to assess clinical outcomes at 1 year in ST-segment–elevation myocardial infarction patients with multivessel coronary artery disease and an FFR-guided strategy for nonculprit lesions, according to whether or not ≥1 PCI was performed. Methods: Outcomes were analyzed in patients of the randomized FLOWER-MI (Flow Evaluation to Guide Revascularization in Multivessel ST-Elevation Myocardial Infarction) trial in whom, after successful primary PCI, nonculprit lesions were assessed using FFR. The primary outcome was a composite of all-cause death, nonfatal myocardial infarction, and unplanned hospitalization with urgent revascularization at 1 year. Results: Among 1171 patients enrolled in this study, 586 were assigned to the FFR-guided group: 388 (66%) of them had ≥1 PCI, and 198 (34%) had no PCI. Mean FFR before decision (ie, PCI or not) of nonculprit lesions was 0.75±0.10 and 0.88±0.06, respectively. During follow-up, a primary outcome event occurred in 16 of 388 patients (4.1%) in patients with PCI and in 16 of 198 patients (8.1%) in patients without PCI (adjusted hazard ratio, 0.42 [95% CI, 0.20–0.88]; P =0.02). Conclusions: In patients with ST-segment–elevation myocardial infarction undergoing complete revascularization guided by FFR measurement, those with ≥1 PCI had lower event rates at 1 year, compared with patients with deferred PCI, suggesting that deferring lesions judged relevant by visual estimation but with FFR >0.80 may not be optimal in this context. Future randomized studies are needed to confirm these data. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02943954. Graphic Abstract: A graphic abstract is available for this article.
Published: 2021

25. Surgical Treatment of Patients With Infective Endocarditis After Transcatheter Aortic Valve Implantation

Author: Norman Mangner, David del Val, Mohamed Abdel-Wahab, Lisa Crusius, Eric Durand, Nikolaj Ihlemann, Marina Urena, Costanza Pellegrini, Francesco Giannini, Tomasz Gasior, Wojtek Wojakowski, Martin Landt, Vincent Auffret, Jan Malte Sinning, Asim N. Cheema, Luis Nombela-Franco, Chekrallah Chamandi, Francisco Campelo-Parada, Erika Munoz-Garcia, Howard C. Herrmann, Luca Testa, Won-Keun Kim, Juan Carlos Castillo, Alberto Alperi, Didier Tchetche, Antonio L. Bartorelli, Samir Kapadia, Stefan Stortecky, Ignacio Amat-Santos, Harindra C. Wijeysundera, John Lisko, Enrique Gutiérrez-Ibanes, Vicenç Serra, Luisa Salido, Abdullah Alkhodair, Ugolino Livi, Tarun Chakravarty, Stamatios Lerakis, Victoria Vilalta, Ander Regueiro, Rafael Romaguera, Utz Kappert, Marco Barbanti, Jean-Bernard Masson, Frédéric Maes, Claudia Fiorina, Antonio Miceli, Susheel Kodali, Henrique B. Ribeiro, Jose Armando Mangione, Fabio Sandoli de Brito, Guglielmo Mario Actis Dato, Francesco Rosato, Maria-Cristina Ferreira, Valter Correia de Lima, Alexandre Siciliano Colafranceschi, Alexandre Abizaid, Marcos Antonio Marino, Vinicius Esteves, Julio Andrea, Roger R. Godinho, Fernando Alfonso, Helene Eltchaninoff, Lars Søndergaard, Dominique Himbert, Oliver Husser, Azeem Latib, Hervé Le Breton, Clement Servoz, Isaac Pascual, Saif Siddiqui, Paolo Olivares, Rosana Hernandez-Antolin, John G. Webb, Sandro Sponga, Raj Makkar, Annapoorna S. Kini, Marouane Boukhris, Philippe Gervais, Mélanie Côté, David Holzhey, Axel Linke, Josep Rodés-Cabau, Technische Universität Dresden = Dresden University of Technology (TU Dresden), Université Laval [Québec] (ULaval), Leipzig University, 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), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), 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), CHU Pontchaillou [Rennes], 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), CHU Toulouse [Toulouse], Clinique Pasteur [Toulouse], UCL - SSS/IREC/SLUC - Pôle St.-Luc, UCL - (SLuc) Département cardiovasculaire, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)
Subjects: Aged, 80 and over, Male, Prosthesis-Related Infections, infective endocarditis, Endocarditis, Bacterial, Staphylococcal Infections, Combined Modality Therapy, antibiotics, Anti-Bacterial Agents, TAVI, Transcatheter Aortic Valve Replacement, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, outcome, Humans, cardiac surgery, Female, Cardiac Surgical Procedures, Cardiology and Cardiovascular Medicine, 610 Medicine & health, Aged
Abstract: BACKGROUND The optimal treatment of patients developing infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is uncertain. OBJECTIVES The goal of this study was to investigate the clinical characteristics and outcomes of patients with TAVI-IE treated with cardiac surgery and antibiotics (IE-CS) compared with patients treated with antibiotics alone (IE-AB). METHODS Crude and inverse probability of treatment weighting analyses were applied for the treatment effect of cardiac surgery vs medical therapy on 1-year all-cause mortality in patients with definite TAVI-IE. The study used data from the Infectious Endocarditis after TAVI International Registry. RESULTS Among 584 patients, 111 patients (19%) were treated with IE-CS and 473 patients (81%) with IE-AB. Compared with IE-AB, IE-CS was not associated with a lower in-hospital mortality (HRunadj: 0.85; 95% CI: 0.58-1.25) and 1-year all-cause mortality (HRunadj: 0.88; 95% CI: 0.64-1.22) in the crude cohort. After adjusting for selection and immortal time bias, IE-CS compared with IE-AB was also not associated with lower mortality rates for in-hospital mortality (HRadj: 0.92; 95% CI: 0.80-1.05) and 1-year all-cause mortality (HRadj: 0.95; 95% CI: 0.84-1.07). Results remained similar when patients with and without TAVI prosthesis involvement were analyzed separately. Predictors for in-hospital and 1-year all-cause mortality included logistic EuroSCORE I, Staphylococcus aureus, acute renal failure, persistent bacteremia, and septic shock. CONCLUSIONS In this registry, the majority of patients with TAVI-IE were treated with antibiotics alone. Cardiac surgery was not associated with an improved all-cause in-hospital or 1-year mortality. The high mortality of patients with TAVI-IE was strongly linked to patients' characteristics, pathogen, and IE-related complications. (C) 2022 by the American College of Cardiology Foundation.
Published: 2021

26. Ticagrelor versus clopidogrel in elective percutaneous coronary intervention (ALPHEUS): a randomised, open-label, phase 3b trial

Author: Johanne Silvain, Benoit Lattuca, Farzin Beygui, Grégoire Rangé, Zuzana Motovska, Jean-Guillaume Dillinger, Ziad Boueri, Philippe Brunel, Thibault Lhermusier, Christophe Pouillot, Elisa Larrieu-Ardilouze, Franck Boccara, Jean-Noël Labeque, Paul Guedeney, Mohamad El Kasty, Mikael Laredo, Raphaëlle Dumaine, Grégory Ducrocq, Jean-Philippe Collet, Guillaume Cayla, Katrien Blanchart, Petr Kala, Eric Vicaut, Gilles Montalescot, Johanne SILVAIN, Jean-Philippe COLLET, Gilles MONTALESCOT, Mathieu KERNEIS, Nassim BRAIK, Olivier BARTHELEMY, Gérard HELFT, Claude LEFEUVRE, Rémi CHOUSSAT, Marie HAUGUEL, Michel ZEITOUNI, Thomas CUISSET, Jean-Louis BONNET, Pierre DEHARO, Benoit LATTUCA, Guillaume CAYLA, Luc CORNILLET, Bertrand LEDERMANN, Clément LONJON, Laurent SCHMUTZ, Grégoire RANGE, Franck ALBERT, Thibault DEMICHELI, Laurent ROUSSEL, Reda BENSAID, Christophe THUAIRE, Jean-Guillaume DILLINGER, Patrick HENRY, Stéphane MANZO-SILBERMAN, Georgios SIDERIS, Damien LOGEART, Vincent SPAGNOLI, Léa CACOUB, Christophe POUILLOT, Jean Richard VI-FANE, Jens GLASENAPP, Karim BOUGRINI, Nicolas COMBARET, Pascal MOTREFF, Géraud SOUTEYRAND, Aimé AMONCHOT, Thomas MOUYEN, Thibault LHERMUSIER, Didier CARRIE, Frédéric BOUISSET, Thomas CHOLLET, Francisco CAMPELO-PARADA, Nicolas DELARCHE, François SCHIELE, Mathieu BESUTTI, Marie HAUGUEL-MOREAU, Rami EL MAHMOUD, Christophe CAUSSIN, Mami ZOHEIR, Aurelie VEUGEOIS, Alain DIBIE, Olivier VARENNE, Fabien PICARD, Alexandre LAFONT, Julien ADJEDJ, Philippe DEGRELL, Farzin BEYGUI, Rémi SABATIER, Vincent ROULE, Mathieux BIGNON, Katrien BLANCHART, Pierre ARDOUIN, Adrien LEMAITRE, Clément BRIET, Ziad BOUERI, Pascal GOUBE, Pierre COSTE, Laura CETRAN, Jérôme CLERC, Hervé LE BRETON, Dominique BOULMIER, Vincent AUFFRET, Jean-Noël LABEQUE, Jean-Luc BONAS, Jean-Louis GEORGES, Bernard LIVAREK, Elodie BLICQ, Nicolas BARON, Géraldine GIBAULT-GENTY, Yves COTTIN, Isabelle LHUILLIER, Carole RICHARD, Luc LORGIS, Philippe BUFFET, Christian SPAULDING, Nicole KARAM, Etienne PUYMIRAT, Marco MENNUNI, Emmanuel POULIDAKIS, Lionel BONNEVIE, Franck BOCCARA, Marion CHAUVET, Laurie DUFOUR, Yann ANCEDY, Stéphane EDERHY, Arnaud ETIENNEY, Anne BELLEMAIN-APPAIX, Nathaniel BITTON, Laurent JACQ, Christophe SAINT-ETIENNE, Florence LECLERCQ, François ROUBILLE, Gilles RIOUFOL, François DERIMAY, Marc GORALSKI, Wael YAFI, Emmanuelle FILIPPI, Alain KERMARREC, Christophe LE RAY, Antoine MERLET, Aurelie LOIRAT, Philippe BRUNEL, Damien BRUNET, Jack RAVISY, Laurent MOCK, Guillaume MOLINS, Max CARRE, Erwan BRESSOLLETTE, Luc CHRISTIAENS, Elisa LARRIEU-ARDILOUZE, Romain CADOR CADOR, Eric VAN BELLE, Gilles LEMESLE, Cédric DELHAYE, Flavien VINCENT, Sina POROUCHANI, Hugues SPILLEMAEKER, Katy PETIT, Olivier RESSENCOURT, Vincent HUMEAU, François JOURDA, Marc-Antoine ARNOULD, Stephen CHASSAING, Karl ISAAZ, Laurent PAYOT, Jacques MONTSEGU, Benjamin FAURIE, Michel PANSIERI, Marc METGE, Karim MOUSSA, Mathieu PANKERT, Olivier MOREL, Sébastien HESS, Luc MAILLARD, Thibault MANIGOLD, Vincent LETOCART, Julien PLESSIS, Pauline BERTHOME, Mickael BONIN, François HUCHET, Emmanuel TEIGER, Romain GALLET, Gauthier MOUILLET, Madjid BOUKANTAR, Mohammed NEJJARI, David ATTIAS, Mathieu STEINECKER, Zuzana MOTOVSKA, Martin KOZEL, Zdenko STELMACH, Ota HLINOMAZ, Michal REZEK, Martin NOVAK, Jan SITAR, Jiri SEMENKA, Petr KALA, Otakar BOCEK, Roman ŠTIPAL, Martin POLOCZEK, Jan KANOVSKÝ, Petr JERABEK, Jiří KARASEK, Sylvie HRUSKOVA, Marian BRANNY, Jan MROZEK, Tomas GREZL, Leos PLEVA, Pavel KUKLA, Martin PORZER, Lesnik, Philippe, 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), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Service de cardiologie et de pathologie vasculaire [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Hôpital Louis Pasteur [Chartres], Charles University [Prague] (CU), Marqueurs cardiovasculaires en situation de stress (MASCOT (UMR_S_942 / U942)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier de Bastia (G2HC), Service de Cardiologie [Hôpital privé Dijon Bourgogne], Hôpital privé Dijon Bourgogne, Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Clinique Sainte Clotilde, Centre hospitalier universitaire de Poitiers (CHU Poitiers), Service de Cardiologie [CHU Saint-Antoine], CHU Saint-Antoine [AP-HP], Centre de Recherche Saint-Antoine (CRSA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Le CHCB, Centre Hospitalier de la Côte Basque, Grand Hôpital de l'Est Francilien (GHEF), Centre de Réadaptation Cardiaque Les Grands Prés [Villeneuve Saint Denis] (CRCLGP), 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, CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), University Hospital Brno, Masaryk University [Brno] (MUNI), Hopital Saint-Louis [AP-HP] (AP-HP), Erasmus University Medical Center [Rotterdam] (Erasmus MC), ALPHEUS investigators: Johanne Silvain, Jean-Philippe Collet, Gilles Montalescot, Mathieu Kerneis, Nassim Braik, Olivier Barthelemy, Gérard Helft, Claude Lefeuvre, Rémi Choussat, Marie Hauguel, Michel Zeitouni, Thomas Cuisset, Jean-Louis Bonnet, Pierre Deharo, Benoit Lattuca, Guillaume Cayla, Luc Cornillet, Bertrand Ledermann, Clément Lonjon, Laurent Schmutz, Grégoire Range, Franck Albert, Thibault Demicheli, Laurent Roussel, Reda Bensaid, Christophe Thuaire, Jean-Guillaume Dillinger, Patrick Henry, Stéphane Manzo-Silberman, Georgios Sideris, Damien Logeart, Vincent Spagnoli, Léa Cacoub, Christophe Pouillot, Jean Richard Vi-Fane, Jens Glasenapp, Karim Bougrini, Nicolas Combaret, Pascal Motreff, Géraud Souteyrand, Aimé Amonchot, Thomas Mouyen, Thibault Lhermusier, Didier Carrie, Frédéric Bouisset, Thomas Chollet, Francisco Campelo-Parada, Nicolas Delarche, François Schiele, Mathieu Besutti, Marie Hauguel-Moreau, Rami El Mahmoud, Christophe Caussin, Mami Zoheir, Aurelie Veugeois, Alain Dibie, Olivier Varenne, Fabien Picard, Alexandre Lafont, Julien Adjedj, Philippe Degrell, Farzin Beygui, Rémi Sabatier, Vincent Roule, Mathieux Bignon, Katrien Blanchart, Pierre Ardouin, Adrien Lemaitre, Clément Briet, Ziad Boueri, Pascal Goube, Pierre Coste, Laura Cetran, Jérôme Clerc, Hervé LE Breton, Dominique Boulmier, Vincent Auffret, Jean-Noël Labeque, Jean-Luc Bonas, Jean-Louis Georges, Bernard Livarek, Elodie Blicq, Nicolas Baron, Géraldine Gibault-Genty, Yves Cottin, Isabelle Lhuillier, Carole Richard, Luc Lorgis, Philippe Buffet, Christian Spaulding, Nicole Karam, Etienne Puymirat, Marco Mennuni, Emmanuel Poulidakis, Lionel Bonnevie, Franck Boccara, Marion Chauvet, Laurie Dufour, Yann Ancedy, Stéphane Ederhy, Arnaud Etienney, Anne Bellemain-Appaix, Nathaniel Bitton, Laurent Jacq, Christophe Saint-Etienne, Florence Leclercq, François Roubille, Gilles Rioufol, François Derimay, Marc Goralski, Wael Yafi, Emmanuelle Filippi, Alain Kermarrec, Christophe LE Ray, Antoine Merlet, Aurelie Loirat, Philippe Brunel, Damien Brunet, Jack Ravisy, Laurent Mock, Guillaume Molins, Max Carre, Erwan Bressollette, Luc Christiaens, Elisa Larrieu-Ardilouze, Romain Cador Cador, Eric VAN Belle, Gilles Lemesle, Cédric Delhaye, Flavien Vincent, Sina Porouchani, Hugues Spillemaeker, Katy Petit, Olivier Ressencourt, Max Carre, Vincent Humeau, François Jourda, Marc-Antoine Arnould, Stephen Chassaing, Karl Isaaz, Laurent Payot, Jacques Montsegu, Benjamin Faurie, Michel Pansieri, Marc Metge, Karim Moussa, Mathieu Pankert, Olivier Morel, Sébastien Hess, Luc Maillard, Thibault Manigold, Vincent Letocart, Julien Plessis, Pauline Berthome, Mickael Bonin, François Huchet, Emmanuel Teiger, Romain Gallet, Gauthier Mouillet, Madjid Boukantar, Rami El Mahmoud, Mohammed Nejjari, David Attias, Léa Cacoub, Mathieu Steinecker, François Huchet, Zuzana Motovska, Martin Kozel, Zdenko Stelmach, Ota Hlinomaz, Michal Rezek, Martin Novak, Jan Sitar, Jiri Semenka, Petr Kala, Otakar Bocek, Roman Štipal, Martin Poloczek, Jan KanovskÝ, Petr Jerabek, Jiří Karasek, Sylvie Hruskova, Marian Branny, Jan Mrozek, Tomas Grezl, Leos Pleva, Pavel Kukla, Martin Porzer., Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), and Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)
Subjects: Male, Ticagrelor, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Population, 030204 cardiovascular system & hematology, Coronary artery disease, 03 medical and health sciences, Percutaneous Coronary Intervention, 0302 clinical medicine, medicine, Humans, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, education, ComputingMilieux_MISCELLANEOUS, education.field_of_study, business.industry, Percutaneous coronary intervention, General Medicine, Middle Aged, medicine.disease, Clopidogrel, 3. Good health, [SDV] Life Sciences [q-bio], Treatment Outcome, Action study, Elective Surgical Procedures, Anesthesia, Conventional PCI, Purinergic P2Y Receptor Antagonists, Female, business, Platelet Aggregation Inhibitors, medicine.drug
Abstract: International audience; Background: Percutaneous coronary intervention (PCI)-related myonecrosis is frequent and can affect the long-term prognosis of patients. To our knowledge, ticagrelor has not been evaluated in elective PCI and could reduce periprocedural ischaemic complications compared with clopidogrel, the currently recommended treatment. The aim of the ALPHEUS study was to examine if ticagrelor was superior to clopidogrel in reducing periprocedural myocardial necrosis in stable coronary patients undergoing high-risk elective PCI.Methods: The ALPHEUS study, a phase 3b, randomised, open-label trial, was done at 49 hospitals in France and Czech Republic. Patients with stable coronary artery disease were eligible for the study if they had an indication for PCI and at least one high-risk characteristic. Eligible patients were randomly assigned (1:1) to either ticagrelor (180 mg loading dose, 90 mg twice daily thereafter for 30 days) or clopidogrel (300-600 mg loading dose, 75 mg daily thereafter for 30 days) by use of an interactive web response system, and stratified by centre. The primary outcome was a composite of PCI-related type 4 (a or b) myocardial infarction or major myocardial injury and the primary safety outcome was major bleeding, both of which were evaluated within 48 h of PCI (or at hospital discharge if earlier). The primary analysis was based on all events that occurred in the intention-to-treat population. The trial was registered with ClinicalTrials.gov, NCT02617290.Findings: Between Jan 9, 2017, and May 28, 2020, 1910 patients were randomly assigned at 49 sites, 956 to the ticagrelor group and 954 to the clopidogrel group. 15 patients were excluded from the ticagrelor group and 12 from the clopidogrel group. At 48 h, the primary outcome was observed in 334 (35%) of 941 patients in the ticagrelor group and 341 (36%) of 942 patients in the clopidogrel group (odds ratio [OR] 0·97, 95% CI 0·80-1·17; p=0·75). The primary safety outcome did not differ between the two groups, but minor bleeding events were more frequently observed with ticagrelor than clopidogrel at 30 days (105 [11%] of 941 patients in the ticagrelor group vs 71 [8%] of 942 patients in the clopidogrel group; OR 1·54, 95% CI 1·12-2·11; p=0·0070).Interpretation: Ticagrelor was not superior to clopidogrel in reducing periprocedural myocardial necrosis after elective PCI and did not cause an increase in major bleeding, but did increase the rate of minor bleeding at 30 days. These results support the use of clopidogrel as the standard of care for elective PCI.Funding: ACTION Study Group and AstraZeneca.
Published: 2020

27. Validation of a Whole Heart Segmentation from Computed Tomography Imaging Using a Deep-Learning Approach

Author: Dominique Boulmier, Mathieu Lederlin, Clément Lagorce, Pascal Haigron, Guillaume Leurent, Vincent Auffret, Florent Lalys, Sam Sharobeem, Hervé Le Breton, Marc Bedossa, 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), CHU Pontchaillou [Rennes], Therenva SAS, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Jonchère, Laurent
Subjects: Transcatheter aortic, Computer science, Pharmaceutical Science, Computed tomography, 030204 cardiovascular system & hematology, Convolutional neural network, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Genetics, medicine, Image Processing, Computer-Assisted, Whole heart segmentation, Humans, Segmentation, Genetics (clinical), [SDV.IB] Life Sciences [q-bio]/Bioengineering, medicine.diagnostic_test, Procedural planning, business.industry, Deep learning, Pattern recognition, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Test set, Fully automatic, Molecular Medicine, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Artificial intelligence, Neural Networks, Computer, Cardiology and Cardiovascular Medicine, business, Tomography, X-Ray Computed, Algorithms
Abstract: International audience; The aim of this study is to develop an automated deep-learning-based whole heart segmentation of ECG-gated computed tomography data. After 21 exclusions, CT acquired before transcatheter aortic valve implantation in 71 patients were reviewed and randomly split in a training (n = 55 patients), validation (n = 8 patients), and a test set (n = 8 patients). A fully automatic deep-learning method combining two convolutional neural networks performed segmentation of 10 cardiovascular structures, which was compared with the manually segmented reference by the Dice index. Correlations and agreement between myocardial volumes and mass were assessed. The algorithm demonstrated high accuracy (Dice score = 0.920; interquartile range: 0.906-0.925) and a low computing time (13.4 s, range 11.9-14.9). Correlations and agreement of volumes and mass were satisfactory for most structures. Six of ten structures were well segmented. Deep-learning-based method allowed automated WHS from ECG-gated CT data with a high accuracy. Challenges remain to improve right-sided structures segmentation and achieve daily clinical application.
Published: 2021

28. 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

29. Conduction disturbances following trancatheter aortic valve implantation: increasing the ‘pace’ towards prospective evidence

Author: Vincent Auffret, Guillaume Leurent, Rishi Puri, Hervé Le Breton, Jonchère, Laurent, Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Cleveland Clinic, 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: Aortic valve, medicine.medical_specialty, [SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery, business.industry, Aortic Valve Stenosis, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, 030204 cardiovascular system & hematology, medicine.disease, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Transcatheter Aortic Valve Replacement, 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Aortic valve replacement, Aortic Valve, Heart Valve Prosthesis, Internal medicine, medicine, Cardiology, Humans, Prospective Studies, 030212 general & internal medicine, Cardiology and Cardiovascular Medicine, business
Abstract: This editorial refers to ‘Clinical impact of conduction disturbances in transcatheter aortic valve replacement recipients: a systematic review and meta-analysis’, by L. Faroux et al., doi:10.1093/eurheartj/ehz924.; International audience
Published: 2020

30. 1-Year Outcomes of the CENTERA-EU Trial Assessing a Novel Self-Expanding Transcatheter Heart Valve

Author: Mark S. Spence, Hervé Le Breton, Lars Søndergaard, Tomas Hovorka, Didier Tchetche, Mohamed Abdel-Wahab, Axel Linke, Stephan Windecker, A. Markus Kasel, Philipp Blanke, Hermann Reichenspurner, Sonia Petronio, Ulrich Schaefer, Helmut Baumgartner, Stephen G. Worthley, Groupe Cardiovasculaire Interventionnel [Toulouse] (Clinique Pasteur), Clinique Pasteur [Toulouse], Bern University Hospital [Berne] (Inselspital), West German Heart Center, Universität Duisburg-Essen = University of Duisburg-Essen [Essen], Department of Cardiology [Hamburg, Germany], Marienkrankenhaus Hamburg [Germany], Royal Adelaide Hospital [Adelaide Australia], Technische Universität Dresden = Dresden University of Technology (TU Dresden), Universität Leipzig, CHU Pontchaillou [Rennes], Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Rigshospitalet [Copenhagen], Copenhagen University Hospital, Royal Victoria Hospital [Belfast, UK], Pisa, Ospedale Cisanello [Italia], University Hospital Münster - Universitaetsklinikum Muenster [Germany] (UKM), Edwards Lifesciences [Prague, Czech Republic], University of British Columbia (UBC), University Heart Center [Hamburg], Edwards Lifesciences, Universität Duisburg-Essen [Essen], Universität Leipzig [Leipzig], 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), University of Zurich, Tchétché, Didier, and Jonchère, Laurent
Subjects: Male, Time Factors, aortic stenosis, CENTERA THV, high-risk patients, self-expanding valve, transcatheter aortic valve implantation, medicine.medical_treatment, Hemodynamics, 030204 cardiovascular system & hematology, Severity of Illness Index, Postoperative Complications, 0302 clinical medicine, Valve replacement, Risk Factors, Clinical endpoint, Medicine, Prospective Studies, 030212 general & internal medicine, Aged, 80 and over, Incidence (epidemiology), 3. Good health, Europe, Treatment Outcome, medicine.anatomical_structure, Aortic Valve, Heart Valve Prosthesis, 10209 Clinic for Cardiology, Cardiology, Female, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Core laboratory, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, 610 Medicine & health, Regurgitation (circulation), Prosthesis Design, 2705 Cardiology and Cardiovascular Medicine, Transcatheter Aortic Valve Replacement, 03 medical and health sciences, Internal medicine, Humans, Heart valve, Aged, Bioprosthesis, [SDV.IB] Life Sciences [q-bio]/Bioengineering, business.industry, Australia, Aortic Valve Stenosis, Recovery of Function, Permanent pacemaker, business, New Zealand
Abstract: International audience; Objectives: The purpose of this study is to report the 1-year results of the CENTERA-EU trial.Background: The CENTERA transcatheter heart valve (THV) (Edwards Lifesciences, Irvine, California) is a low-profile (14-F eSheath compatible), self-expanding nitinol valve, with a motorized delivery system allowing for repositionability. The 30-day results of the CENTERA-EU trial demonstrated the short-term safety and effectiveness of the valve.Methods: Implantations were completed in 23 centers in Europe, Australia, and New Zealand. Transfemoral access was used in all patients. Echocardiographic outcomes were adjudicated by a core laboratory at baseline, discharge, 30 days, 6 months, and 1 year. Major adverse clinical events were adjudicated by an independent clinical events committee.Results: Between March 2015 and July 2016, 203 high-risk patients (age 82.7 ± 5.5 years, 67.5% women, 68.0% New York Heart Association functional class III or IV, Society of Thoracic Surgeons score 6.1 ± 4.2%) with severe, symptomatic aortic stenosis underwent transcatheter aortic valve replacement with the CENTERA THV. The primary endpoint of the study was 30-day mortality (1.0%). At 1 year, overall mortality was 9.1%, cardiovascular mortality was 4.6%, disabling stroke was 4.1%, new permanent pacemakers were implanted in 6.5% of patients at risk, and cardiac-related rehospitalization was 6.8%. Hemodynamic parameters were stable at 1 year, with a mean aortic valve gradient of 8.1 ± 4.7 mm Hg, a mean effective orifice area of 1.7 ± 0.42 cm2, and no incidences of severe or moderate aortic regurgitation.Conclusions: The CENTERA-EU trial demonstrated mid-term safety and effectiveness of the CENTERA THV, with low mortality, sustained improvements in hemodynamic performances, and low incidence of permanent pacemaker implantations in high-risk patients with symptomatic aortic stenosis. (Safety and Performance of the Edwards CENTERA-EU Self-Expanding Transcatheter Heart Valve [CENTERA-2]; NCT02458560).
Published: 2019

31. Idiopathic/Iatrogenic Left Bundle Branch Block–Induced Reversible Left Ventricle Dysfunction

Author: Philippe Mabo, Vincent Auffret, Raphaël P. Martins, Hervé Le Breton, Claude Daubert, Christophe Leclercq, and Erwan Donal
Subjects: Aortic valve, medicine.medical_specialty, Left bundle branch block, business.industry, medicine.medical_treatment, Cardiomyopathy, Cardiac resynchronization therapy, 030204 cardiovascular system & hematology, medicine.disease, 3. Good health, 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, Valve replacement, Ventricle, Internal medicine, Heart failure, medicine, Cardiology, 030212 general & internal medicine, Cardiology and Cardiovascular Medicine, business, Ventricular dyssynchrony
Abstract: Idiopathic or iatrogenic left bundle branch block (LBBB) is a unique model of electro-mechanical ventricular dyssynchrony with concordant changes in electrical activation sequence and mechanical ventricle synchronization. In chronic animal models, isolated LBBB induces structural remodeling with progressive left ventricular (LV) dysfunction. Most abnormalities can be reverted after cardiac resynchronization therapy (CRT). In humans, 2 principal models of LBBB dyssynchronopathy can be observed: the chronic model of isolated LBBB and an acute iatrogenic model of new-onset LBBB after aortic valve interventions. Although epidemiological evidence and clinical data need to be strengthened, there is a strong presumption that they may lead to LBBB-induced cardiomyopathy and benefit from CRT to prevent progression to heart failure. A large cohort study with prospective follow-up would be required to better define actual incidence, evolution over time, and predisposing factors. Parallel randomized CRT clinical trials should be conducted in selected at-risk populations: namely, patients with persistent LBBB after transcatheter aortic valve replacement.
Published: 2018

32. Current indications for the intra-aortic balloon pump: The CP-GARO registry

Author: Denis Angoulvant, Hervé Le Breton, Régis Delaunay, Marc Bedossa, Dominique Boulmier, Grégoire Rangé, Benoit Helleu, Vincent Letocart, Vincent Auffret, Philippe Commeau, Rémi Sabatier, Fabrice Prunier, Martine Gilard, Emmanuelle Filippi, Guillaume Leurent, Stephan Chassaing, 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), Service de cardiologie et maladies vasculaires [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes], CHU Pontchaillou [Rennes], 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), Centre hospitalier universitaire de Nantes (CHU Nantes), Clinique Saint Gatien, Cellules Dendritiques, Immunomodulation et Greffes, Université de Tours (UT), Polyclinique Les Fleurs, Service de cardiologie [Chartres], Les hôpitaux de Chartres [Chartres], Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC), Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Biologie Neurovasculaire et Mitochondriale Intégrée (BNMI), Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université d'Angers (UA), CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Centre hospitalier de Vannes, Centre hospitalier Saint-Brieuc, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), and MitoVasc - Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC)
Subjects: Male, Registry, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Shock, Cardiogenic, Hemodynamics, 030204 cardiovascular system & hematology, Balloon, Revascularization, law.invention, 03 medical and health sciences, 0302 clinical medicine, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Randomized controlled trial, Risk Factors, law, medicine, Humans, Hospital Mortality, Prospective Studies, Registries, 030212 general & internal medicine, Cardiogenic shock, Aged, Intra-aortic balloon pump, Intra-Aortic Balloon Pumping, business.industry, Mortality rate, Assistance circulatoire, Recovery of Function, General Medicine, Middle Aged, medicine.disease, 3. Good health, Surgery, Treatment Outcome, Registre, Etiology, Circulatory assistance, Female, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Cardiology and Cardiovascular Medicine, business, Contre-pulsion par ballonnet intra-aortique, Choc cardiogénique
Abstract: Summary Background Intra-aortic balloon pumps (IABPs) have been used routinely since the 1970s. Recently, large randomized trials failed to show that IABP therapy has meaningful benefit, and international recommendations downgraded its place, particularly in cardiogenic shock. Aims The aim of this registry was to describe the contemporary use of IABP therapy, in light of these new data. Methods This prospective multicentre registry included 172 patients implanted with an IABP in 19 French cardiac centres in 2015. Baseline characteristics, aetiologies leading to IABP use, and IABP-related and disease-related complications were assessed. In-hospital and 1-year mortality rates were studied. Results A total of 172 patients were included (mean age 65.5 ± 12.0 years; 118 men [68.6%]). The reasons for IABP implantation were mainly haemodynamic (n = 107; 62.2%), followed by bridge to revascularization (n = 34; 19.8%) and four other “rare” aetiologies (n = 29 patients; 16.8%). In-hospital and 1-year mortality rates were 40.7% and 45.8%, respectively. Fourteen patients (8.1%) experienced ischaemic or haemorrhagic complications, which were directly related to the IABP in seven patients (4.1%). Conclusions Despite current international guidelines regarding the place of IABPs in ischaemic cardiogenic shock without mechanical complications, this aetiology remains the leading cause for its utilization in the contemporary era.
Published: 2018

33. ST-Segment Elevation Myocardial Infarction Following Transcatheter Aortic Valve Replacement

Author: Hervé Le Breton, Jean-Michal Paradis, Marco Barbanti, Marcelo Santaló-Corcoy, Victor Fradejas-Sastre, Montserrat Bach-Oller, François Roubille, Giuliano Costa, Vincent Auffret, Stefan Toggweiler, Lluis Asmarats, Giuseppe Patti, Stephan Windecker, Sameh Elsaify, Christian Hengstenberg, Lars Søndergaard, Juan G. Córdoba-Soriano, Flavien Vincent, Georg Goliasch, Saifullah Siddiqui, Henrique Barbosa Ribeiro, Jesus Jimenez-Mazuecos, Uri Landes, Eric Van Belle, Quentin Fischer, Pierre Donaint, Luis Nombela-Franco, Troels Jorgensen, Andrea Rognoni, Enrique Gutiérrez-Ibañes, Antonio J. Muñoz-García, Mohamed Abdel-Wahab, Antonio Mangieri, Harindra C. Wijeysundera, Francisco Campelo-Parada, Guillem Muntané-Carol, Francesco Bruno, Thomas Pilgrim, Damien Metz, Marina Urena, Mohammed Nejjari, Josep Rodés-Cabau, Joan Antoni Gómez-Hospital, Giuseppe Tarantini, Gabriela Veiga, Rosana Hernández-Antolín, Didier Tchetche, Laurent Faroux, Diego Carter Campanha-Borges, Chekrallah Chamandi, Thibault Lhermusier, Victor Alfonso Jimenez-Diaz, Chiara Fraccaro, Ramiro Trillo-Nouche, Fabrizio D'Ascenzo, Eric Durand, Francesco Saia, Erika Muñoz-García, Ignacio Cruz-González, Maria Tamargo, John G. Webb, Hélène Eltchaninoff, Raúl Moreno, German Armijo, Vicens Serra, Université Laval [Québec] (ULaval), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Récepteurs Nucléaires, Maladies Métaboliques et Cardiovasculaires - U1011 (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), Clinique Pasteur [Toulouse], 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), 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), Centre Hospitalier Universitaire de Reims (CHU Reims), 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), Centre cardiologique du Nord (CCN), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Hôpital de Rangueil, CHU Toulouse [Toulouse], Récepteurs Nucléaires, Maladies Métaboliques et Cardiovasculaires (RNMCD - U1011), 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: Male, Time Factors, acute coronary syndrome, mortality, percutaneous coronary intervention, ST-segment elevation myocardial infarction, transcatheter aortic valve replacement, IMPACT, medicine.medical_treatment, [SDV]Life Sciences [q-bio], 030204 cardiovascular system & hematology, Coronary Angiography, Global Health, ACUTE CORONARY SYNDROME, 0302 clinical medicine, Postoperative Complications, Valve replacement, Interquartile range, Risk Factors, ST segment, 030212 general & internal medicine, Myocardial infarction, Hospital Mortality, 610 Medicine & health, ComputingMilieux_MISCELLANEOUS, Aged, 80 and over, education.field_of_study, OUTCOMES, Incidence, FRENCH REGISTRY, 3. Good health, surgical procedures, operative, Cardiology, Female, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, Acute coronary syndrome, Population, Risk Assessment, Transcatheter Aortic Valve Replacement, 03 medical and health sciences, Percutaneous Coronary Intervention, Internal medicine, medicine, MANAGEMENT, Humans, cardiovascular diseases, education, business.industry, Percutaneous coronary intervention, Aortic Valve Stenosis, medicine.disease, OSTIA, Conventional PCI, ST Elevation Myocardial Infarction, business, Follow-Up Studies
Abstract: BACKGROUND Among patients with acute coronary syndrome following transcatheter aortic valve replacement (TAVR), those presenting with ST-segment elevation myocardial infarction (STEMI) are at highest risk. OBJECTIVES The goal of this study was to determine the clinical characteristics, management, and outcomes of STEMI after TAVR.METHODS This was a multicenter study including 118 patients presenting with STEMI at a median of 255 days (inter quartile range: 9 to 680 days) after TAVR. Procedural features of STEMI after TAVR managed with primary percutaneous coronary intervention (PCI) were compared with all-comer STEMI: 439 non-TAVR patients who had primary PCI within the 2 weeks before and after each post-TAVR STEMI case in 5 participating centers from different countries.RESULTS Median door-to-balloon time was higher in TAVR patients (40 min [interquartile range: 25 to 57 min] vs. 30 min [interquartile range: 25 to 35 min]; p = 0.003). Procedural time, fluoroscopy time, dose-area product, and contrast volume were also higher in TAVR patients (p < 0.01 for all). PCI failure occurred more frequently in patients with previous TAVR (16.5% vs. 3.9%; p < 0.001), including 5 patients in whom the culprit lesion was not revascularized owing to coronary ostia cannulation failure. In-hospital and late (median of 7 months [interquartile range: 1 to 21 months]) mortality rates were 25.4% and 42.4%, respectively (20.6% and 38.2% in primary PCI patients), and estimated glomerular filtration rate < 60 ml/min (hazard ratio [HR]: 3.02; 95% confidence interval [CI]: 1.42 to 6.43; p = 0.004), Killip class $2 (HR: 2.74; 95% CI: 1.37 to 5.49; p = 0.004), and PCI failure (HR: 3.23; 95% CI: 1.42 to 7.31; p = 0.005) determined an increased risk.CONCLUSIONS STEMI after TAVR was associated with very high in-hospital and mid-term mortality. Longer door-to balloon times and a higher PCI failure rate were observed in TAVR patients, partially due to coronary access issues specific to the TAVR population, and this was associated with poorer outcomes. (J Am Coll Cardiol 2021;77:2187-99)(c) 2021 by the American College of Cardiology Foundation.
Published: 2021

34. Stroke Complicating Infective Endocarditis After Transcatheter Aortic Valve Replacement

Author: Fernando Alfonso, Marco Barbanti, Alexandre Abizaid, Howard C. Herrmann, John Lisko, Luis Nombela-Franco, Eric Durand, Julio Andrea, Sandro Sponga, Oliver Husser, Vincent Auffret, Ander Regueiro, Susheel Kodali, Victoria Vilalta, Marcos Antonio Marino, Marouane Boukhris, Asim N. Cheema, Saif Siddiqui, Isaac Pascual, David Holzhey, Paolo Olivares, Josep Rodés-Cabau, Maria Cristina Ferreira, Hervé Le Breton, Norman Mangner, Vinicius Esteves, Tarun Chakravarty, Vicenç Serra, Martin Landt, Guglielmo Mario Actis Dato, Abdullah Alkhodair, Francesco Giannini, Dominique Himbert, Tomasz Gasior, Wojtek Wojakowski, Valter C. Lima, Azeem Latib, Utz Kappert, Antonio L. Bartorelli, Annapoorna Kini, Enrique Gutiérrez-Ibañes, Juan C. Castillo, Mohamed Abdel-Wahab, Erika Muñoz-García, José Armando Mangione, Clement Servoz, Ignacio J. Amat-Santos, Francisco Campelo-Parada, Stefan Stortecky, Francesco Rosato, Luca Testa, Marina Urena, Luisa Salido, Ugolino Livi, Alexandre Siciliano Colafranceschi, Chekrallah Chamandi, Lisa Crusius, Samir R. Kapadia, Harindra C. Wijeysundera, Roger R. Godinho, Stamatios Lerakis, Frédéric Maes, Jean Bernard Masson, Rosana Hernández-Antolín, Didier Tchetche, Antonio Miceli, Fabio Sandoli de Brito, David del Val, Axel Linke, Lars Søndergaard, Costanza Pellegrini, Alberto Alperi, Jan Malte Sinning, John G. Webb, Claudia Fiorina, Kim Won-Keun, Hélène Eltchaninoff, Henrique Barbosa Ribeiro, Nikolaj Ihlemann, Rafael Romaguera, Philippe Gervais, Raj Makkar, Université Laval [Québec] (ULaval), Universität Leipzig [Leipzig], Technische Universität Dresden = Dresden University of Technology (TU Dresden), 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), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Pontchaillou [Rennes], 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 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), Hôpital de Rangueil, CHU Toulouse [Toulouse], Clinique Pasteur [Toulouse], Universität Leipzig, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)
Subjects: Male, medicine.medical_specialty, infective endocarditis, prosthetic valve endocarditis, stroke, TAVR, transcatheter aortic valve implantation, medicine.medical_treatment, 030204 cardiovascular system & hematology, Transcatheter Aortic Valve Replacement, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Valve replacement, Risk Factors, Internal medicine, medicine, Humans, Endocarditis, 030212 general & internal medicine, Embolization, 610 Medicine & health, Stroke, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Incidence, Mortality rate, Incidence (epidemiology), Endocarditis, Bacterial, medicine.disease, 3. Good health, Infective endocarditis, Bacteremia, Cardiology, Female, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Cardiology and Cardiovascular Medicine, business
Abstract: BACKGROUND Stroke is one of the most common and potentially disabling complications of infective endocarditis (IE). However, scarce data exist about stroke complicating IE after transcatheter aortic valve replacement (TAVR). OBJECTIVES The purpose of this study was to determine the incidence, risk factors, clinical characteristics, management, and outcomes of patients with definite IE after TAVR complicated by stroke during index IE hospitalization. METHODS Data from the Infectious Endocarditis after TAVR International Registry (including 569 patients who developed definite IE following TAVR from 59 centers in 11 countries) was analyzed. Patients were divided into two groups according to stroke occurrence during IE admission (stroke [S-IE] vs. no stroke [NS-IE]). RESULTS A total of 57 (10%) patients had a stroke during IE hospitalization, with no differences in causative microorganism between groups. S-IE patients exhibited higher rates of acute renal failure, systemic embolization, and persistent bacteremia (p < 0.05 for all). Previous stroke before IE, residual aortic regurgitation >= moderate after TAVR, balloon-expandable valves, IE within 30 days after TAVR, and vegetation size >8 mm were associated with a higher risk of stroke during the index IE hospitalization (p < 0.05 for all). Stroke rate in patients with no risk factors was 3.1% and increased up to 60% in the presence of >3 risk factors. S-IE patients had higher rates of in-hospital mortality (54.4% vs. 28.7%; p < 0.001) and overall mortality at 1 year (66.3% vs. 45.6%; p < 0.001). Surgical treatment was not associated with improved outcomes in S-IE patients (in-hospital mortality: 46.2% in surgical vs. 58.1% in no surgical treatment; p = 0.47). CONCLUSIONS Stroke occurred in 1 of 10 patients with IE post-TAVR. A history of stroke, short time between TAVR and IE, vegetation size, valve prosthesis type, and residual aortic regurgitation determined an increased risk. The occurrence of stroke was associated with increased in-hospital and 1-year mortality rates, and surgical treatment failed to improve clinical outcomes. (C) 2021 by the American College of Cardiology Foundation.
Published: 2021

35. Electrophysiological Study-Guided Permanent Pacemaker Implantation In Patients With Conduction Disturbances Following Transcatheter Aortic Valve Implantation

Author: Raphaël P. Martins, Camille Pichard, Baptiste Polin, Marc Bedossa, Hamed Bourenane, Dominique Boulmier, Christophe Leclercq, Guillaume Leurent, Hervé Le Breton, Marielle Le Guellec, Vincent Auffret, Jacques Tomasi, D. Pavin, Vincent Galand, Sam Sharobeem, Erwan Donal, Jean-Philippe Verhoye, Nathalie Behar, 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], No funding, Jonchère, Laurent, 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: Male, medicine.medical_specialty, Pacemaker, Artificial, Transcatheter aortic, Bundle-Branch Block, 030204 cardiovascular system & hematology, Prosthesis Implantation, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Cardiac Conduction System Disease, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Internal medicine, atrioventricular block, medicine, bundle branch block, Humans, In patient, False Positive Reactions, 030212 general & internal medicine, False Negative Reactions, Aged, [SDV.IB] Life Sciences [q-bio]/Bioengineering, Aged, 80 and over, business.industry, Cardiac Pacing, Artificial, Aortic Valve Stenosis, Ventricular pacing, medicine.disease, Transcatheter aortic valve replacement, Optimal management, pacemaker, 3. Good health, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Electrophysiology, Treatment Outcome, Cardiology, Female, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Electrophysiological study, Permanent pacemaker, Cardiology and Cardiovascular Medicine, business, Index hospitalization, Electrophysiologic Techniques, Cardiac, Atrioventricular block
Abstract: International audience; Conduction disturbances remain common following transcatheter aortic valve implantation (TAVI). Aside from high-degree atrioventricular block (HAVB), their optimal management remains elusive. Invasive electrophysiological studies (EPS) may help stratify patients at low or high risk of HAVB allowing for an early discharge or permanent pacemaker (PPM) implantation among patients with conduction disturbances. We evaluated the safety and diagnostic performances of an EPS-guided PPM implantation strategy among TAVI recipients with conduction disturbances not representing absolute indications for PPM. All patients who underwent TAVI at a single expert center from June 2017 to July 2020 who underwent an EPS during the index hospitalization were included in the present study. False negative outcomes were defined as patients discharged without PPM implantation who required PPM for HAVB within 6 months of the initial EPS. False positive outcomes were defined as patients discharged with a PPM with a ventricular pacing percentage < 1% at follow-up. A total of 78 patients were included (median age: 82.4 years, 38% female), among whom 35 patients (45%) received a PPM following EPS. The sensitivity, specificity, positive and negative predictive values of the EPS-guided PPM implantation strategy were 100%, 89.6%, 81.5%, and 100%, respectively. Six patients suffered a mechanical HAVB during EPS and received a PPM. These 6 patients showed PPM dependency at follow-up. In conclusion, an EPS-guided PPM implantation strategy for managing post-TAVI conduction disturbances appears effective to identify patients who can be safely discharged without PPM implantation.
Published: 2021

36. 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

37. Temporal Trends, Characteristics, and Outcomes of Infective Endocarditis After Transcatheter Aortic Valve Replacement

Author: Rosana Hernández-Antolín, Didier Tchetche, Dominique Himbert, Rafael Romaguera, Ander Regueiro, Alexandre Abizaid, Clement Servoz, Maria-Cristina Ferreira, Martin Landt, Axel Linke, Vincent Auffret, Marco Barbanti, Raj Makkar, Marcos Antonio Marino, David Holzhey, Nikolaj Ihlemann, Valter Correa Lima, Vicenç Serra, Guglielmo Mario Actis Dato, Ignacio J. Amat-Santos, Josep Rodés-Cabau, Frédéric Maes, Francisco Campelo-Parada, Julio Andrea, Stamatios Lerakis, Paolo Olivares, Marouane Boukhris, Henrique Barbosa Ribeiro, Fabio Sandoli de Brito, Azeem Latib, Francesco Giannini, Asim N. Cheema, José Armando Mangione, Susheel Kodali, Enrique Gutiérrez-Ibañes, Marina Urena, Luca Testa, Vinicius Esteves, Luisa Salido, Ugolino Livi, Saif Siddiqui, Samir R. Kapadia, John G. Webb, Lars Søndergaard, Alexandre Siciliano Colafranceschi, Claudia Fiorina, Chekrallah Chamandi, Kim Won-Keun, Hélène Eltchaninoff, Oliver Husser, Isaac Pascual, Lisa Crusius, Costanza Pellegrini, Alberto Alperi, Jan Malte Sinning, David del Val, Hervé Le Breton, Abdullah Alkhodair, Howard C. Herrmann, John Lisko, Juan C. Castillo, Antonio J. Muñoz-García, Norman Mangner, Eric Durand, Antonio L. Bartorelli, Luis Nombela-Franco, Antonio Miceli, Annapoorna Kini, Mohamed Abdel-Wahab, Harindra C. Wijeysundera, Jean-Bernard Masson, Roger R. Godinho, Francesco Rosato, Victoria Vilalta, Stefan Stortecky, Sandro Sponga, Tarun Chakravarty, UCL - SSS/IREC/SLUC - Pôle St.-Luc, and UCL - (SLuc) Département cardiovasculaire
Subjects: Microbiology (medical), medicine.medical_specialty, medicine.medical_treatment, Settore MED/11 - Malattie dell'Apparato Cardiovascolare, 030204 cardiovascular system & hematology, TAVR, Transcatheter Aortic Valve Replacement, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Valve replacement, infective endocarditis, prosthetic valve endocarditis, transcatheter aortic valve replacement, Risk Factors, Internal medicine, Medicine, Humans, 030212 general & internal medicine, 610 Medicine & health, Stroke, Endocarditis, business.industry, Incidence (epidemiology), Mortality rate, Incidence, Acute kidney injury, Endocarditis, Bacterial, medicine.disease, Infectious Diseases, Treatment Outcome, Infective endocarditis, Heart failure, Cohort, Cardiology, business
Abstract: BackgroundProcedural improvements combined with the contemporary clinical profile of patients undergoing transcatheter aortic valve replacement (TAVR) may have influenced the incidence and outcomes of infective endocarditis (IE) following TAVR. We aimed to determine the temporal trends, characteristics, and outcomes of IE post-TAVR.MethodsObservational study including 552 patients presenting definite IE post-TAVR. Patients were divided in 2 groups according to the timing of TAVR (historical cohort [HC]: before 2014; contemporary cohort [CC]: after 2014).ResultsOverall incidence rates of IE were similar in both cohorts (CC vs HC: 5.45 vs 6.52 per 1000 person-years; P = .12), but the rate of early IE was lower in the CC (2.29‰ vs 4.89‰, P ConclusionsAlthough overall IE incidence has remained stable, the incidence of early IE has declined in recent years. The microorganism, high rate of complications, and very low rate of surgical treatment remained similar. In-hospital and 1-year mortality rates were high but progressively decreased over time.
Published: 2021
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38. 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

39. Oral Anticoagulation Continuation Throughout TAVR: High Risk-High Reward or Marginal Gains?

Author: Vincent, Auffret, Guillaume, Leurent, and Hervé, Le Breton
Subjects: Transcatheter Aortic Valve Replacement, Treatment Outcome, Vitamin K, Reward, Anticoagulants, Humans, Aortic Valve Stenosis
Published: 2020

40. 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

41. Determinants and Impact of Heart Failure Readmission Following Transcatheter Aortic Valve Replacement

Author: Elena Galli, Jean-Philippe Verhoye, Dominique Boulmier, Gwenaelle Sost, Reda Belhaj Soulami, Marielle Le Guellec, Erwan Donal, Aurélie Loirat, Sam Sharobeem, Hervé Le Breton, Vincent Auffret, Abdelkader Bakhti, Marc Bedossa, Jacques Tomasi, 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], 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), 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: Male, medicine.medical_specialty, Time Factors, Transcatheter aortic, medicine.medical_treatment, heart failure, renin-angiotensin system, Comorbidity, 030204 cardiovascular system & hematology, Patient Readmission, Risk Assessment, Severity of Illness Index, 03 medical and health sciences, 0302 clinical medicine, Valve replacement, Aortic valve replacement, Risk Factors, Internal medicine, Diabetes mellitus, Renin–angiotensin system, medicine, Humans, 030212 general & internal medicine, Registries, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Incidence (epidemiology), Aortic Valve Stenosis, medicine.disease, 3. Good health, Treatment Outcome, Heart failure, Aortic Valve, diabetes mellitus, Cardiology, incidence, transcatheter aortic valve replacement, Female, [SDV.IB]Life Sciences [q-bio]/Bioengineering, France, Cardiology and Cardiovascular Medicine, business
Abstract: Background: Heart failure (HF) readmission is common post–transcatheter aortic valve replacement (TAVR). Nonetheless, limited data are available regarding its predictors and clinical impact. This study evaluated the incidence, predictors, and impact of HF readmission within 1-year post-TAVR, and assessed the effects of the prescription of HF therapies at discharge on the risk of HF readmission and death. Methods: Patients included in the TAVR registry of a single expert center from 2009 to 2017 were analyzed. Competing-risk and Cox regressions were performed to identify predictors of HF readmission and death. Results: Among 750 patients, 102 (13.6%) were readmitted for HF within 1-year post-TAVR. Overall, 53 patients (7.1%) experienced late readmissions (>30 days post-TAVR), and 17 (2.3%) had multiple readmissions. In ≈30% of readmissions, no trigger could be identified. Predominant causes of readmissions were changes in medication/nonadherence and supraventricular arrhythmia. Independent predictors of HF readmission included diabetes mellitus, chronic lung disease, previous acute HF, grade III or IV aortic regurgitation, and pulmonary hypertension both at discharge from the index hospitalization but not HF therapies. Overall, HF readmission did not significantly impact all-cause mortality (hazard ratio [HR], 1.36 [95% CI, 0.99–1.85]). However, late (HR, 1.90 [95% CI, 1.30–2.78]) and multiple HF readmissions (HR, 2.10 [95% CI,1.17–3.76]) were significantly associated with all-cause mortality. Prescription of renin-angiotensin system inhibitors at discharge was associated with a lower rate of all-cause mortality, especially among patients receiving doses of 25% to Conclusions: HF readmission is common within 1-year of TAVR. Late and multiple HF readmissions associate with an increased risk of long-term all-cause mortality. Baseline comorbidities (diabetes, chronic lung disease, previous acute HF) and echocardiographic findings at discharge (grade III or IV aortic regurgitation, pulmonary hypertension) identified patients at high risk of HF readmission.
Published: 2020

42. Blunting periprocedural myocardial necrosis: Rationale and design of the randomized ALPHEUS study

Author: François Jourda, Christophe Saint-Etienne, Luc Christiaens, Grégoire Rangé, Benoit Lattuca, Philippe Brunel, Paul Guedeney, Hervé Le Breton, Marie Hauguel-Moreau, Eric Vicaut, Anne Bellemain-Appaix, Jean-Louis Georges, Guillaume Cayla, Christophe Pouillot, Christophe Caussin, Gregory Ducrocq, Ziad Boueri, Farzin Beygui, Johanne Silvain, Thibault Lhermusier, Gilles Montalescot, Jean-Noël Labèque, Jean-Philippe Collet, Zuzana Motovska, Franck Boccara, Mohamad El Kasty, Raphaelle Dumaine, Jean-Guillaume Dillinger, Mikael Laredo, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases [IHU ICAN], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Service de cardiologie et de pathologie vasculaire [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Service de cardiologie [Chartres], Les hôpitaux de Chartres [Chartres], Marqueurs cardiovasculaires en situation de stress (MASCOT (UMR_S_942 / U942)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPC)-Université Sorbonne Paris Nord, Hôpital de Bastia, Service de Cardiologie [Hôpital privé Dijon Bourgogne], Hôpital privé Dijon Bourgogne, Clinique Sainte Clotilde, Centre de Recherche Saint-Antoine (CRSA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Service de cardiologie [CHU de Poitiers], Centre hospitalier universitaire de Poitiers (CHU Poitiers), Service de cardiologie [Centre Hospitalier de la Côte Basque, Bayonne], Centre Hospitalier de la Côte Basque, CHU Toulouse [Toulouse], Centre Hospitalier de Versailles André Mignot (CHV), Cardiology Department, Centre Hospitalier d'Antibes Juan les Pins, Antibes, 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), CHU Pontchaillou [Rennes], Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Trousseau [APHP], Institut Mutualiste de Montsouris (IMM), Hôpital d'Auxerre, Partenaires INRAE, Grand Hôpital de l'Est Francilien (GHEF), 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, AstraZeneca France Novartis Daiichi-Sankyo Bristol-Myers Squibb, BMS Eli Lilly and Company Bayer AstraZeneca France Boston Scientific Corporation, BSC Abbott Laboratories Medtronic Biotronik Fédération Française de Cardiologie, FFC, The ALPHEUS and the Bio-ALPHEUS studies are funded by the Fond de dotation ACTION ( www.action-fonds.org ) and a grant from AstraZeneca . The Bio-ALPHEUS study is also funded by the Institute of Cardiometabolism and Nutrition . The first draft of the paper was developed by Dr Silvain and Dr Montalescot, and all authors subsequently contributed to its development and final content and are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of the paper, and its final contents. AstraZeneca reviewed the manuscript and was allowed to make suggestions, but final content was determined by the authors., Dr Silvain reports receiving consulting and lecture or travel support from AstraZeneca, Bayer HealthCare SAS, Biotronik, BPI France, Boehringer Ingelheim France, CSL Behring SA, Gilead Science, Sanofi-Aventis France, Terumo France SAS, Abbott Medical France SAS, and Zoll and is a stockholder of Pharmaseeds. Dr Cayla reports speaker or congress fees and has received research grants/consultant fees/lectures fees from Amgen, AstraZeneca, Abbott, Bayer, Biotronik, Bristol-Myers Squibb, Pfizer, and Sanofi-Aventis. Dr Beygui reports receiving consulting and lecture fees from Astrazeneca, Bristol-Myers Squibb, Medtronic, Biosensors, Boston Scientific Institutional and research grants from Medtronic, Biosensors, Acist, and Boston scientific. Dr Rangé reports receiving speaker’s and/or consulting fees from Abbott. Dr Lattuca has received research grants from Biotronik, Boston Scientific, Daiichi-Sankyo, Fédération Française de Cardiologie, and Institute of CardioMetabolism and Nutrition, consultant fees from Daiichi-Sankyo and Eli Lilly, and lecture fees from AstraZeneca, Medtronic, and Novartis. Dr Collet reports receiving consulting and lecture fees from AstraZeneca, Bayer, Bristol-Myers Squibb, Fédération Française de Cardiologie, Lead-Up, Medtronic, MSD, Sanofi-Aventis, and WebMD. Dr Dillinger reports receiving consulting and lecture fees from AstraZeneca, Bayer, Boehringer-Ingelheim, Bristol-Myers Squibb/Pfizer, and Sanofi and grants from Bayer, Bristol-Myers Squibb/Pfizer, and Biosensors. Dr Boueri reports receiving consulting and lecture fees from Novartis and Astra Zeneca. Dr Boccara reports consulting or speaker fees from Amgen, Gilead, ViiV Healthcare, Amgen, Sanofi, MSD, and Servier outside the submitted work. Dr Christiaens reports consulting or speaker fees from Astra Zeneca. Dr Lhermusier reports consulting or speaker fees from Astra Zeneca, Boston Scientifics, and Abbott and a research grant from Astra Zeneca. Dr Georges reports consulting or speaker fees from AstraZeneca France, Sanofi-Aventis, Amgen, and Merck Sharpe and Dohme. Dr Bellemain-Appaix reports consulting or speaker fees from Astra Zeneca, Novartis, and Pfizer. Dr Saint-Etienne reports consulting or speaker fees from Abbott, Medtronic, Edwards, and Biotronik. Dr Motovska reports consulting or speaker fees from Astrazeneca. Dr Laredo reports fellowship grants from Medtronic, Biotronik, and Boston Scientific. Dr Ducrocq reports consulting or speaker fees from Amgen, Astra Zeneca, Bayer, BMS, Janssen, Sanofi, and Terumo, proctoring: Boston scientific, CEC: Novo Nordisk, and travel fees: Astra Zeneca, Bayer, and BMS. Dr Vicaut reports consulting or speaker fees from Abbott, Bristol Myers Squibb, Celgene, Edwards, Pfizer, Sanofi, and Novartis. Dr Montalescot reports consulting or speaker fees from Abbott, AIM group, Amgen, Actelion, American College of Cardiology Foundation, Astrazeneca, Axis-Santé, Bayer, Boston-Scientific, Bristol-Myers Squibb, Beth Israel Deaconess Medical, Brigham Women’s Hospital, Fréquence Médicale, ICOM, Idorsia, Elsevier, Fédération Française de Cardiologie, Fréquence Médicale, Institute of Cardiometabolism and Nutrition, Lead-Up, Menarini, Medtronic, MSD, Novo-Nordisk, Pfizer, Quantum Genomics, Sanofi-Aventis, SCOR global life, Servier, and WebMD. Other authors have no conflict of interest to report., Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université de Paris (UP)-Université Sorbonne Paris Nord, Centre de Recherche Saint-Antoine (CR Saint-Antoine), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Saint-Antoine [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), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Université Sorbonne Paris Nord, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Centre Hospitalier de la Côte Basque (CHCB), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier d'Auxerre (CHA), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord
Subjects: medicine.medical_specialty, Ticlopidine, medicine.medical_treatment, Myocardial Infarction, Coronary Disease, 030204 cardiovascular system & hematology, Coronary Angiography, Loading dose, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Percutaneous Coronary Intervention, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Internal medicine, medicine, Humans, 030212 general & internal medicine, Myocardial infarction, cardiovascular diseases, Aged, Aspirin, business.industry, Percutaneous coronary intervention, medicine.disease, Clopidogrel, 3. Good health, Conventional PCI, Cardiology, Purinergic P2Y Receptor Antagonists, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Cardiology and Cardiovascular Medicine, business, Ticagrelor, Platelet Aggregation Inhibitors, medicine.drug
Abstract: International audience; Background: Clopidogrel associated with aspirin is the recommended treatment for patients undergoing elective percutaneous coronary intervention (PCI). Although severe PCI-related events are rare, evidence suggests that PCI-related myocardial infarction and myocardial injury are frequent complications that can impact the clinical prognosis of the patients. Antiplatelet therapy with a potent P2Y12 receptor inhibitor such as ticagrelor may reduce periprocedural ischemic complications while maintaining a similar safety profile as compared with conventional dual antiplatelet therapy by aspirin and clopidogrel in this setting. Methods: Assessment of Loading with the P2Y12 inhibitor ticagrelor or clopidogrel to Halt ischemic Events in patients Undergoing elective coronary Stenting (ALPHEUS) (NCT02617290) is an international, multicenter, randomized, parallel-group, open-label study in patients with stable coronary artery disease who are planned for an elective PCI. In total, 1,900 patients will be randomized before a planned PCI to a loading dose of ticagrelor 180 mg or a loading dose of clopidogrel (300 or 600 mg) in addition to aspirin. Patients will then receive a dual antiplatelet therapy with aspirin and ticagrelor 90 mg twice daily or clopidogrel 75 mg once daily for 30 days. The primary ischemic end point is PCI-related myocardial infarction (myocardial infarction type 4a or 4b) or major myocardial injury within 48 hours (or at hospital discharge if earlier) after elective PCI/stent. Safety will be evaluated by major bleeding events (Bleeding Academic Research Consortium type 3 or 5) at 48 hours (or discharge if it occurs earlier). Conclusion: ALPHEUS is the first properly sized trial comparing ticagrelor to clopidogrel in the setting of elective PCI and is especially designed to show a reduction in periprocedural events, a surrogate end point for mortality.
Published: 2020

43. Balloon-Expandable Versus Self-Expanding Transcatheter Aortic Valve Replacement: A Propensity-Matched Comparison From the FRANCE-TAVI Registry

Author: Hervé Le Breton, Augustin Coisne, Vincent Auffret, Emmanuel Teiger, Dominique Himbert, Jean-Phillipe Collet, Emmanuel Robin, Olivier Bar, Thierry Folliguet, Sina Porouchani, Eric Van Belle, Thomas Cuisset, Patrick Joly, Frédéric Pinaud, Martine Gilard, Cédric Delhaye, Gilles Rioufol, Alessandro Cosenza, Said Ghostine, Florence Leclercq, Thomas Gandet, Nicolas Amabile, M. Richardson, Nicolas Meneveau, Géraud Souteyrand, Bernard Iung, Christian Spaulding, Flavien Vincent, N Debry, Thomas Modine, Pascal Motreff, Guillaume Cayla, Philippe Commeau, T. Lhermusier, Hélène Eltchaninoff, Alain Duhamel, Olivier Darremont, Guillaume Schurtz, René Koning, Gilles Bayet, Julien Labreuche, Thibaut Manigold, Thierry Lefèvre, Patrick Ohlmann, Pascal Leprince, Jean-Phillipe Verhoye, Didier Champagnac, Lionel Leroux, Benoit Lattuca, Récepteurs nucléaires, maladies cardiovasculaires et diabète (EGID), Université de Lille, Droit et Santé-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Santé publique : épidémiologie et qualité des soins-EA 2694 (CERIM), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), 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), CIC-IT Rennes, Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Pharmacologie des Dysfonctionnements Endotheliaux et Myocardiques, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU), 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), 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), CIC CHU Lyon (inserm), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC), Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Nutriments Lipidiques et Prévention des Maladies Métaboliques, Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA)-Université de la Méditerranée - Aix-Marseille 2, Image Science for Interventional Techniques (ISIT), Clermont Université-Centre National de la Recherche Scientifique (CNRS)-Université d'Auvergne - Clermont-Ferrand I (UdA), Récepteurs nucléaires, maladies cardiovasculaires et diabète - U 1011 (RNMCD), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Université de Lille, Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS), 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), Université de la Méditerranée - Aix-Marseille 2-Institut National de la Recherche Agronomique (INRA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université d'Auvergne - Clermont-Ferrand I (UdA)-Clermont Université-Centre National de la Recherche Scientifique (CNRS), 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), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Unité de recherche de l'institut du thorax (ITX-lab), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), MitoVasc - Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC), 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), Département de Cardiologie [Hôpital de la Timone - APHM], Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, 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), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université d'Angers (UA), and Hôpital de la Timone [CHU - APHM] (TIMONE)-Assistance Publique - Hôpitaux de Marseille (APHM)
Subjects: Aortic valve, medicine.medical_specialty, medicine.medical_treatment, heart valve disease, aortic valve stenosis, 030204 cardiovascular system & hematology, aortic valve insufficiency, 03 medical and health sciences, 0302 clinical medicine, Valve replacement, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Interquartile range, Physiology (medical), medicine, 030212 general & internal medicine, business.industry, Hazard ratio, medicine.disease, mortality, 3. Good health, Surgery, Stenosis, medicine.anatomical_structure, Aortic valve stenosis, Relative risk, Propensity score matching, transcatheter aortic valve replacement, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Cardiology and Cardiovascular Medicine, business
Abstract: Background: No randomized study powered to compare balloon expandable (BE) with self expanding (SE) transcatheter heart valves (THVs) on individual end points after transcatheter aortic valve replacement has been conducted to date. Methods: From January 2013 to December 2015, the FRANCE-TAVI nationwide registry (Registry of Aortic Valve Bioprostheses Established by Catheter) included 12 141 patients undergoing BE-THV (Edwards, n=8038) or SE-THV (Medtronic, n=4103) for treatment of native aortic stenosis. Long term mortality status was available in all patients (median 20 months; interquartile range, 14 to 30). Patients treated with BE-THV (n=3910) were successfully matched 1:1 with 3910 patients treated with SE-THV by using propensity score (25 clinical, anatomical, and procedural variables) and by date of the procedure (within 3 months). The first coprimary outcome was ≥ moderate occurrence of paravalvular regurgitation or in-hospital mortality, or both. The second coprimary outcome was 2-year all-cause mortality. Results: In propensity–matched analyses, the incidence of the first coprimary outcome was higher with SE-THV (19.8%) compared with BE-THV (11.9%; relative risk, 1.68 [95% CI, 1.46–1.91]; P P P =0.01). During follow up, all cause mortality occurred in 899 patients treated with SE-THV (2-year mortality, 29.8%) and in 801 patients treated with BE-THV (2-year mortality, 26.6%; hazard ratio, 1.17 [95% CI, 1.06–1.29]; P =0.003). Similar results were found using inverse probability of treatment weighting using propensity score analysis. Conclusion: The present study suggests that use of SE-THV was associated with a higher risk of paravalvular regurgitation and higher in-hospital and 2-year mortality compared with use of BE-THV. These data strongly support the need for a randomized trial sufficiently powered to compare the latest generation of SE-THV and BE-THV. Clinical Trial Registration: https://www.clinicaltrials.gov . Unique identifier: NCT01777828.
Published: 2020

44. Evaluation of length of stay after transfemoral transcatheter aortic valve implantation with SAPIEN 3 prosthesis A French multicentre prospective observational trial

Author: Dominique Himbert, N. Bettinger, Vincent Auffret, Martine Gilard, Hélène Eltchaninoff, Bernard Chevalier, Bernard Iung, Marina Urena Alcazar, Eric Durand, Delphine M. Béziau, Hervé Le Breton, Thierry Lefèvre, Romain Didier, 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), 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), CHU Pontchaillou [Rennes], Hôpital de la Cavale Blanche - CHRU Brest (CHU - BREST ), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Privé Jacques Cartier [Massy], Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Edwards Lifesciences, and ANR-16-RHUS-0003,STOP-AS,STOP-AS(2016)
Subjects: Male, Time Factors, Observational Trial, medicine.medical_treatment, 030204 cardiovascular system & hematology, Prosthesis, Severity of Illness Index, 0302 clinical medicine, Risk Factors, 030212 general & internal medicine, Hospital Mortality, Prospective Studies, Registries, Early discharge, Aged, 80 and over, Mortality rate, General Medicine, Patient Discharge, Durée du séjour, 3. Good health, Femoral Artery, Treatment Outcome, Aortic Valve, Female, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, Logistic euroscore, Transcatheter aortic, SAPIEN-3, Transcatheter Aortic Valve Replacement, TAVI, 03 medical and health sciences, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Catheterization, Peripheral, medicine, Humans, SAPIEN 3, Aged, Transcatheter aortic valve implantation, business.industry, Aortic stenosis, Mean age, Aortic Valve Stenosis, Rétrécissement aortique, medicine.disease, Surgery, Stenosis, Length of stay, business
Abstract: Summary Background Complications decrease after transfemoral transcatheter aortic valve implantation (TAVI), and early discharge is feasible and safe in selected populations. Aims To evaluate length of stay (LOS) and reasons for prolonged hospitalisation after transfemoral TAVI in unselected patients. Methods Patients with severe aortic stenosis, who had transfemoral TAVI with the SAPIEN 3 prosthesis using exclusively local anaesthesia, were prospectively and consecutively included at five French high-volume centres. LOS was calculated from TAVI procedure to discharge. Reasons for prolonged hospitalisation (i.e. > 3 days) were evaluated. Results Between 2017 and 2018, 293 patients were included, with a mean age of 82.4 ± 6.5 years and a mean logistic EuroSCORE of 13.7 ± 9.0%. The in-hospital mortality rate was 1.4%. The median LOS was 5 (3–7) days, and varied considerably between centres (from 2 to 7 days). Sixty-four (21.8%) patients were discharged within 3 days after transfemoral TAVI. Reported reasons for prolonged hospitalisation were complications in 62.2%, loss of autonomy in 3.1%, discharge refusal in 2.2% and logistical reasons in 0.9%. In 31.6% of cases, the investigators reported no apparent reasons. Conclusions The results of our study suggest that LOS after transfemoral TAVI, using the SAPIEN 3 prosthesis and a minimalist approach, varies considerably between centres. In almost a third of cases, hospitalisation was prolonged without any apparent reason. Efforts should be made to educate centres to reduce LOS.
Published: 2020

45. Long-Term Outcomes After Infective Endocarditis After Transcatheter Aortic Valve Replacement

Author: Asim N. Cheema, Lars Søndergaard, Tarun Chakravarty, Ignacio J. Amat-Santos, Josep Rodés-Cabau, Antonio J. Muñoz-García, Norman Mangner, Vincent Auffret, Costanza Pellegrini, Enrique Gutiérrez-Ibanez, Jan Malte Sinning, Didier Tchetche, Luca Testa, Dominique Himbert, Francesco Rosato, David del Val, Antonio L. Bartorelli, John G. Webb, Luis Nombela-Franco, Antonio Miceli, Alexandre Abizaid, Claudia Fiorina, Hervé Le Breton, Azeem Latib, Kim Won-Keun, Marcos Antonio Marino, Hélène Eltchaninoff, Marco Barbanti, Vinicius Esteves, José Armando Mangione, Howard C. Herrmann, John Lisko, Abdullah Alkhodair, Fabio Sandoli de Brito, Vicenç Serra, Guglielmo Mario Actis Dato, Martin Landt, Harindra C. Wijeysundera, Juan C. Castillo, Eric Durand, Stamatios Lerakis, Axel Linke, Marina Urena, Paolo Olivares, Maria Cristina Ferreira, Ugolino Livi, Jean Bernard Masson, Mohamed Abdel-Wahab, Alexandre Siciliano Colafranceschi, Lisa Crusius, Fabian Nietlispach, Oliver Husser, Susheel Kodali, Thomas Pilgrim, Stefan Stortecky, Ander Regueiro, David Holzhey, Julio Andrea, Raj Makkar, Nikolaj Ihlemann, Valter Correa Lima, and Henrique Barbosa Ribeiro
Subjects: Male, medicine.medical_specialty, Transcatheter aortic, medicine.medical_treatment, Treatment outcome, MEDLINE, heart valve diseases, Postoperative Complications, Valve replacement, Physiology (medical), medicine, Long term outcomes, Humans, Endocarditis, Hospital Mortality, Registries, 610 Medicine & health, Aged, business.industry, Endocarditis, Bacterial, Middle Aged, medicine.disease, Surgery, Infective endocarditis, endocarditis, transcatheter aortic valve replacement, treatment outcome, Female, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Published: 2020
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46. Transcatheter Aortic Valve Replacement in the Catheterization Laboratory Versus Hybrid Operating Room

Author: Mauro Romano, Eric Van Belle, Hervé Le Breton, Hélène Eltchaninoff, Thomas Hovasse, Bernard Chevalier, Marco Spaziano, Jean Philippe Verhoye, Thierry Lefèvre, Pascal Motreff, P Garot, Martine Gilard, Bernard Iung, René Koning, and Pascal Leprince
Subjects: medicine.medical_specialty, Logistic euroscore, Transcatheter aortic, Cath lab, business.industry, Mortality rate, medicine.medical_treatment, 030204 cardiovascular system & hematology, 3. Good health, Surgery, 03 medical and health sciences, 0302 clinical medicine, Valve replacement, medicine, Clinical endpoint, Hybrid operating room, 030212 general & internal medicine, Cardiology and Cardiovascular Medicine, business, Major bleeding
Abstract: OBJECTIVES This study sought to compare outcomes of patients undergoing transcatheter aortic valve replacement (TAVR) in a catheterization laboratory (cath lab) to those undergoing TAVR in a hybrid operating room (OR). BACKGROUND TAVR can be performed in a cath lab or in a hybrid OR. Comparisons between these locations are scarce. METHODS All TAVRs performed in 48 centers across France between January 2013 and December 2015 were prospectively included in the FRANCE TAVI (French Transcatheter Aortic Valve Implantation) registry. The primary endpoint of this study was all-cause mortality at 1 year. Secondary endpoints consisted of 30-day complications and 3-year mortality. All analyses were adjusted for baseline and procedural characteristics. RESULTS A total of 12,121 patients were included in this study, 62% of which underwent TAVR in a cath lab versus 38% in a hybrid OR. Mean age was 82.9 +/- 7.2 years, 48.9% of patients were men, and mean Logistic EuroScore was 17.9% +/- 12.3%. Both procedure locations showed similar, below 2% rates of intraprocedural complications. After adjusting for baseline and procedural characteristics, major bleeding and infections were significantly higher in the hybrid OR group (bleeding, 6.3% vs. 4.8%; infection, 6.1% vs. 3.5%; p < 0.05). Adjusted mortality rates at 1 and 3 years did not differ significantly between groups (for cath lab vs. hybrid OR, respectively 1 year 16.2% vs. 15.8%; p = 0.91; 3 years 38.4% vs. 36.4%; p = 0.49). CONCLUSIONS Midterm mortality after TAVR was similar between the cath lab and the hybrid OR. These findings support the performance of TAVR in either location, which has important implications on health care organization and costs. (c) 2018 Published by Elsevier on behalf of the American College of Cardiology Foundation.
Published: 2018

47. Impact of Direct Transcatheter Aortic Valve Replacement Without Balloon Aortic Valvuloplasty on Procedural and Clinical Outcomes

Author: Dominique Grisoli, Pierre Deharo, Thierry Lefèvre, Thomas Cuisset, Pascal Leprince, Olivier Camus, Eric Van Belle, Hélène Eltchaninoff, Hervé Le Breton, Frédéric Collart, René Koning, Nicolas Jaussaud, Bernard Iung, Noémie Resseguier, Marc Lambert, Jean Philippe Verhoye, Vincent Auffret, and Martine Gilard
Subjects: medicine.medical_specialty, Transcatheter aortic, business.industry, medicine.medical_treatment, 030204 cardiovascular system & hematology, Balloon, Aortic valvuloplasty, 03 medical and health sciences, 0302 clinical medicine, Valve replacement, Internal medicine, cardiovascular system, medicine, Cardiology, 030212 general & internal medicine, Cardiology and Cardiovascular Medicine, business
Abstract: Objectives: This study sought to describe the current practices and compare outcomes according to the use of balloon aortic valvuloplasty (BAV) or not during transcatheter aortic valve repl...
Published: 2018

48. Evolution of Length of Stay After Surgical and Transcatheter Aortic Valve Implantation Over 8 Years in 1,849 Patients >75 Years of Age and Comparison Between Transfemoral and Transsubclavian Transcatheter Aortic Valve Implantation

Author: Vincent Auffret, Hervé Le Breton, Antoine Roisne, Marc Bedossa, Annamaria Dachille, Amedeo Anselmi, Jean-Philippe Verhoye, and Majid Harmouche
Subjects: Male, medicine.medical_specialty, Transcatheter aortic, Femoral vein, 030204 cardiovascular system & hematology, Subclavian Vein, Lower risk, Transcatheter Aortic Valve Replacement, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Cause of Death, Internal medicine, Humans, Medicine, Hospital Mortality, 030212 general & internal medicine, Survival rate, Aged, Retrospective Studies, Cause of death, Aged, 80 and over, business.industry, Retrospective cohort study, Aortic Valve Stenosis, Femoral Vein, Length of Stay, Survival Rate, Treatment Outcome, Echocardiography, Cohort, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Subclavian vein
Abstract: Minimized length of hospitalization (LoS) and lower risk of hospitalization-related complications are key requirements in the treatment of aortic valve disease, mainly in the elderly candidates. Our objective was to evaluate evolution of LoS after surgical (SAVR) or transcatheter aortic valve implantation (TAVI) and its predictors. We enrolled 1,849 elderly (aged >75) patients receiving SAVR or TAVI from 2009 to 2016. In the surgical cohort (n = 1,006) the mean LoS slightly decreased from 13.81 ± 9.27 days (2009) to 10.96 ± 3.77 (2016); in the TAVI cohort (n = 843), LoS passed from 13.33 ± 9.17 (2009) to 6.21 ± 4.30 days (2016). All-cause mortality at 1 month was 3.77 % (SAVR) versus 4.7% (TAVI) (p >0.05). Among Transfemoral TAVI (TF, n = 681), and Transsubclavian TAVI (TS, n = 62), average LoS was comparable (7.38 days ± 7.11 vs 7.31 ± 4.32; median 6.0 and 6.0 days, p = 0.07). Procedural success was reached in 93% (TF) and in 85.4% (TS) (p = 0.20). There were no meaningful differences among TF and TS in terms of VARC-2 postprocedural morbidity, except for the rate of vascular access-related complications; these occurred in 8.8% of cases in the TF group versus 1.6% in the TS group (p = 0.05). In conclusion the present analysis showed a faster improvement in terms of LoS for TAVI compared with SAVR over 8 years of activity. The 2 strategies presented comparable all-causes mortality at 30 days. LoS, rates of procedural success and complications were comparable among TF and TS TAVI; nonetheless, vascular access-related complications were more frequent in the TF cohort. This suggests the validity of the TS route as an alternative to the TF approach.
Published: 2018

49. Femoral Versus Nonfemoral Peripheral Access for Transcatheter Aortic Valve Replacement

Author: Remi Houel, Eric Van Belle, Hervé Le Breton, Julien Seitz, Jacques Billé, Thomas Cuisset, Pascal Leprince, Nicolas Barra, Alain Tavildari, René Koning, Michel Pansieri, Arnaud Maudiere, Thierry Lefèvre, Martine Gilard, P. Khanoyan, Chekrallah Chamandi, Jean Philippe Verhoye, Bernard Iung, Sébastien Armero, Didier Blanchard, Bertrand Villette, Yvan Le Dolley, Paul Achouh, Sylvain Beurtheret, Mathieu Pankert, Thomas Modine, Hélène Eltchaninoff, Antoine Lafont, O. Com, Philippe Commeau, Patrick Joly, Eloi Marijon, Sabrina Siame, Noémie Resseguier, Christian Spaulding, Nicole Karam, Thierry Folliguet, Ramzi Abi-Akar, Marc Laskar, Richard Gelisse, Hôpital Saint-Joseph [Marseille], Paris-Centre de Recherche Cardiovasculaire (PARCC - UMR-S 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)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital de la Timone [CHU - APHM] (TIMONE), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Clinique Saint-Hilaire [Rouen], 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), Université de Bretagne Occidentale - UFR Médecine et Sciences de la Santé (UBO UFR MSS), Université de Brest (UBO), Service de cardiologie [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), 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), CIC - CHU Bichat, Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Service de chirurgie cardiaque et vasculaire [CHU HEGP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-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)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-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), 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), 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), and Jonchère, Laurent
Subjects: Male, medicine.medical_specialty, Time Factors, [SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery, Transcatheter aortic, medicine.medical_treatment, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, 030204 cardiovascular system & hematology, TAVR, Severity of Illness Index, Transcatheter Aortic Valve Replacement, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Valve replacement, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Catheterization, Peripheral, medicine, Humans, Prospective Studies, Registries, 030212 general & internal medicine, Propensity Score, Aged, 80 and over, Vascular disease, business.industry, Incidence, Gold standard, Aortic Valve Stenosis, Odds ratio, medicine.disease, Confidence interval, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, 3. Good health, Peripheral, Surgery, access site, Femoral Artery, Survival Rate, Aortic Valve, Propensity score matching, outcome, Female, France, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract: International audience; BACKGROUND:Femoral access is the gold standard for transcatheter aortic valve replacement (TAVR). Guidelines recommend reconsidering surgery when this access is not feasible. However, alternative peripheral accesses exist, although they have not been accurately compared with femoral access.OBJECTIVES:This study compared nonfemoral peripheral (n-FP) TAVR with femoral TAVR.METHODS:Using the data from the national prospective French registry (FRANCE TAVI [French Transcatheter Aortic Valve Implantation]), this study compared the characteristics and outcomes of TAVR procedures according to whether they were performed through a femoral or a n-FP access, using a pre-specified propensity score-based matching between groups. Subanalysis during 2 study periods (2013 to 2015 and 2016 to 2017) and among low/intermediate-low and intermediate-high/high volume centers were performed. RESULTS:Among 21,611 patients, 19,995 (92.5%) underwent femoral TAVR and 1,616 (7.5%) underwent n-FP TAVR (transcarotid, n = 914 or trans-subclavian, n = 702). Patients in the n-FP access group had more severe disease (mean logistic EuroSCORE 19.95 vs. 16.95; p < 0.001), with a higher rate of peripheral vascular disease, known coronary artery disease, chronic pulmonary disease, and renal failure. After matching, there was no difference in the rate of post-procedural death and complications according to access site, except for a 2-fold lower rate of major vascular complications (odds ratio: 0.45; 95% confidence interval: 0.21 to 0.93; p = 0.032) and unplanned vascular repairs (odds ratio: 0.41; 95% confidence interval: 0.29 to 0.59; p < 0.001) in those who underwent n-FP access. The comparison of outcomes provided similar results during the second study period and in intermediate-high/high volume centers.CONCLUSIONS:n-FP TAVR is associated with similar outcomes compared with femoral peripheral TAVR, except for a 2-fold lower rate of major vascular complications and unplanned vascular repairs. n-FP TAVR may be favored over surgery in patients who are deemed ineligible for femoral TAVR and may be a safe alternative when femoral access risk is considered too high.
Published: 2019

50. Influence of gender on delays and early mortality in ST-segment elevation myocardial infarction: Insight from the first French Metaregistry, 2005–2012 patient-level pooled analysis

Author: Yves Cottin, Francis Couturaud, Vincent Auffret, Sandrine Charpentier, Carlos El Khoury, Tabassome Simon, Stéphane Manzo-Silberman, Martine Gilard, Francois Schiele, Loic Belle, Stéphanie Marlière, Marianne Zeller, Nicolas Danchin, Hervé Le Breton, Biomarqueurs CArdioNeuroVASCulaires (BioCANVAS), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), CIC Brest, Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital de la Cavale Blanche, Département de Médecine Interne et Pneumologie [Brest] (DMIP - Brest), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Epidémiologie et analyses en santé publique : risques, maladies chroniques et handicaps (LEASP), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), 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), Service de cardiologie et maladies vasculaires [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes], CHU Pontchaillou [Rennes], Centre hospitalier Lucien Hussel, Service de Cardiologie (hôpital d'Annecy), Centre hospitalier de la région d'Annecy, Département de cardiologie [CHU de Grenoble], Centre Hospitalier Universitaire [Grenoble] (CHU), Laboratoire de Physiopathologie et Pharmacologie Cardio-Métaboliques (U866, Lipides et nutrition, équipe 5) (LPPCM), Lipides - Nutrition - Cancer (U866) (LNC), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Bourgogne (UB)-Ecole Nationale Supérieure de Biologie Appliquée à la Nutrition et à l'Alimentation de Dijon (ENSBANA)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Bourgogne (UB)-Ecole Nationale Supérieure de Biologie Appliquée à la Nutrition et à l'Alimentation de Dijon (ENSBANA)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement, Service de Cardiologie [CHU de Dijon], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), 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), Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148)), 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), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Service de cardiologie [CHRU de Besançon], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), 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), Université de Toulouse (UT)-Université de Toulouse (UT)-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), Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Ecole Nationale Supérieure de Biologie Appliquée à la Nutrition et à l'Alimentation de Dijon (ENSBANA)-Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Ecole Nationale Supérieure de Biologie Appliquée à la Nutrition et à l'Alimentation de Dijon (ENSBANA), Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( UR 3920) (PCVP / CARDIO), Unité mixte de recherche 942 - BIOCANVAS - Biomarqueurs cardiovasculaires ( UMR 942 ), Institut National de la Santé et de la Recherche Médicale ( INSERM ), Service de cardiologie (APHP-Hôpital Lariboisière), Hôpital Lariboisière-APHP, Université de Brest ( UBO ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Hôpital de la Cavale Blanche, Département de Médecine Interne et Pneumologie [Brest] ( DMIP - Brest ), Centre Hospitalier Régional Universitaire de Brest ( CHRU Brest ), Epidémiologie et analyses en santé publique : risques, maladies chroniques et handicaps [Toulouse], Université Paul Sabatier - Toulouse 3 ( UPS ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), 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 ), Service de cardiologie et maladies vasculaires [CHU de Rennes], Département de cardiologie (CHU de Grenoble), Centre Hospitalier Universitaire [Grenoble] ( CHU ), Laboratoire de Physiopathologie et Pharmacologie Cardio-Métaboliques (U866, Lipides et nutrition, équipe 5) ( LPPCM ), Lipides - Nutrition - Cancer (U866) ( LNC ), Université de Bourgogne ( UB ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Ecole Nationale Supérieure de Biologie Appliquée à la Nutrition et à l'Alimentation de Dijon ( ENSBANA ) -Université de Bourgogne ( UB ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Ecole Nationale Supérieure de Biologie Appliquée à la Nutrition et à l'Alimentation de Dijon ( ENSBANA ), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), Hôpital Européen Georges Pompidou [APHP] ( HEGP ), Laboratoire de Recherche Vasculaire Translationnelle ( LVTS ), Université Paris 13 ( UP13 ) -Université Paris Diderot - Paris 7 ( UPD7 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( PCVP / CARDIO ), Université Bourgogne Franche-Comté ( UBFC ) -Université de Franche-Comté ( UFC ) -Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ), Optimisation des régulations physiologiques ( ORPHY (EA 4324) ), Université de Brest ( UBO ) -Institut Brestois du Numérique et des Mathématiques ( IBNM ), and Université de Brest ( UBO ) -Université de Brest ( UBO )
Subjects: Male, medicine.medical_specialty, Time Factors, medicine.medical_treatment, 030204 cardiovascular system & hematology, Coronary Angiography, Clinical research, STEMI, Electrocardiography, 03 medical and health sciences, Sex Factors, 0302 clinical medicine, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Risk Factors, Gender issues, medicine, Humans, ST segment, Registries, 030212 general & internal medicine, Myocardial infarction, Sex Distribution, Survival rate, Aged, Retrospective Studies, Aged, 80 and over, medicine.diagnostic_test, business.industry, Percutaneous coronary intervention, Retrospective cohort study, Emergency department, Middle Aged, [ SDV.MHEP.CSC ] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Prognosis, medicine.disease, 3. Good health, Survival Rate, Emergency medicine, ST Elevation Myocardial Infarction, Female, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract: International audience; Background - Women show greater mortality after acute myocardial infarction. We decided to investigate whether gender affects delays and impacts in-hospital mortality in a large population.Methods and results - We performed a patient-level analysis of 7 French MI registries from different regions from January 2005 to December 2012. All patients with acute STEMI were included within 12 h from symptom onset and a first medical contact with a mobile intensive care unit an emergency department of a hospital with percutaneous coronary intervention facility. Primary study outcomes were STEMI, patient and system, delays. Secondary outcome was in-hospital mortality. 16,733 patients were included with 4021 females (24%). Women were significantly older (mean age 70.6 vs 60.6), with higher diabetes (19.6% vs 15.4%) and hypertension rates (58.7% vs 38.8%). Patient delay was longer in women with adjusted mean difference of 14.4 min (p Conclusions - This overview of 16,733 real-life consecutive STEMI patients in prospective registries over an extensive period strongly indicates gender-related discrepancies, highlighting clinically relevant delays in seeking medical attention. However, higher in-hospital mortality was not totally explained by clinical characteristics or delays. Dedicated studies of specific mechanisms underlying this female disadvantage are mandatory to reduce this gender gap.
Published: 2018

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