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Auffret V, Boulmier D, Didier R, Leurent G, Bedossa M, Tomasi J, Cayla G, Benamer H, Beurtheret S, Verhoye JP, Commeau P, Lefèvre T, Iung B, Eltchaninoff H, Collet JP, Dumonteil N, Du Chayla F, Gouysse M, Gilard M, Le Breton H. Clinical effects of permanent pacemaker implantation after transcatheter aortic valve implantation: Insights from the nationwide FRANCE-TAVI registry. Arch Cardiovasc Dis 2024; 117:213-223. [PMID: 38388290 DOI: 10.1016/j.acvd.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/24/2023] [Accepted: 12/27/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND The influence of permanent pacemaker implantation upon outcomes after transcatheter aortic valve implantation (TAVI) remains controversial. AIMS To evaluate the impact of permanent pacemaker implantation after TAVI on short- and long-term mortality, and on the risk of hospitalization for heart failure. METHODS Data from the large FRANCE-TAVI registry, linked to the French national health single-payer claims database, were analysed to compare 30-day and long-term mortality rates and hospitalization for heart failure rates among patients with versus without permanent pacemaker implantation after TAVI. Multivariable regressions were performed to adjust for confounders. RESULTS A total of 36,549 patients (mean age 82.6years; 51.6% female) who underwent TAVI from 2013 to 2019 were included in the present analysis. Among them, 6999 (19.1%) received permanent pacemaker implantation during the index hospitalization, whereas 232 (0.6%) underwent permanent pacemaker implantation between hospital discharge and 30days after TAVI, at a median of 11 (interquartile range: 7-18) days. In-hospital permanent pacemaker implantation was not associated with an increased risk of death between discharge and 30days (adjusted odds ratio: 0.91, 95% confidence interval: 0.64-1.29). At 5years, the incidence of all-cause death was higher among patients with versus without permanent pacemaker implantation within 30days of the procedure (adjusted hazard ratio: 1.13, 95% confidence interval: 1.07-1.19). Permanent pacemaker implantation within 30days of TAVI was also associated with a higher 5-year rate of hospitalization for heart failure (adjusted subhazard ratio: 1.17, 95% confidence interval: 1.11-1.23). CONCLUSIONS Permanent pacemaker implantation after TAVI is associated with an increased risk of long-term hospitalization for heart failure and all-cause mortality. Further research to mitigate the risk of postprocedural permanent pacemaker implantation is needed as TAVI indications expand to lower-risk patients.
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Affiliation(s)
- Vincent Auffret
- Service de Cardiologie, CHU de Rennes, Inserm LTSI U1099, Université de Rennes 1, 35000 Rennes, France.
| | - Dominique Boulmier
- Service de Cardiologie, CHU de Rennes, Inserm LTSI U1099, Université de Rennes 1, 35000 Rennes, France
| | - Romain Didier
- Department of Cardiology, Brest University Hospital, Inserm UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, 29200 Brest, France
| | - Guillaume Leurent
- Service de Cardiologie, CHU de Rennes, Inserm LTSI U1099, Université de Rennes 1, 35000 Rennes, France
| | - Marc Bedossa
- Service de Cardiologie, CHU de Rennes, Inserm LTSI U1099, Université de Rennes 1, 35000 Rennes, France
| | - Jacques Tomasi
- Service de Chirurgie Thoracique et Cardiovasculaire, CHU de Rennes, Inserm LTSI U1099, Université de Rennes 1, 35000 Rennes, France
| | - Guillaume Cayla
- Service de Cardiologie, CHU de Nîmes, Université de Montpellier, 30900 Nîmes, France
| | - Hakim Benamer
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques-Cartier, Ramsay Santé, 91300 Massy, France
| | | | - Jean-Philippe Verhoye
- Service de Chirurgie Thoracique et Cardiovasculaire, CHU de Rennes, Inserm LTSI U1099, Université de Rennes 1, 35000 Rennes, France
| | - Philippe Commeau
- Service de Cardiologie Interventionnelle, Polyclinique Les Fleurs, Groupe ELSAN, 83190 Ollioules, France
| | - Thierry Lefèvre
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques-Cartier, Ramsay Santé, 91300 Massy, France
| | - Bernard Iung
- Cardiology Department, Bichat Hospital, AP-HP, Inserm U1148, Université Paris-Cité, 75018 Paris, France
| | - Hélène Eltchaninoff
- Department of Cardiology, CHU de Rouen, UNIROUEN, U1096, Normandie Université, 76000 Rouen, France
| | - Jean-Philippe Collet
- Institut de Cardiologie, Pitié-Salpêtrière University Hospital, AP-HP, ACTION Study Group, Inserm UMRS_1166 and 1146, Sorbonne Université, 75013 Paris, France
| | | | | | | | - Martine Gilard
- Department of Cardiology, Brest University Hospital, Inserm UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, 29200 Brest, France
| | - Hervé Le Breton
- Service de Cardiologie, CHU de Rennes, Inserm LTSI U1099, Université de Rennes 1, 35000 Rennes, France
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Anselmi A, Aymami M, Tomasi J, D'Alessandro G, Langanay T, Corbineau H, Mancini J, Flecher E, Verhoye JP. Late clinical and echocardiographic results with the Magna Ease© pericardial aortic bioprosthesis. Eur J Cardiothorac Surg 2024; 65:ezad351. [PMID: 38001032 DOI: 10.1093/ejcts/ezad351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 08/08/2023] [Accepted: 11/23/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVES The population of candidates to surgical aortic valve replacement (SAVR) is evolving. The Perimount Magna Ease© bioprosthesis has been introduced relatively recently in the practice. We aimed at evaluating its long-term results. METHODS This article describes a single-centre cohort of 1016 consecutive SAVRs with the Magna Ease© valve (2008-2014), consisting of an all-comers population. We performed a prospective collection of in-hospital data, systematic clinical and echocardiographic follow-up. Valve-related events were as follows: structural valve deterioration (SVD; according to modified definition criteria), nonstructural valve dysfunction, patient-prosthesis mismatch (PPM). RESULTS Age at SAVR was 73.4 ± 9.5 years; calcified aortic stenosis was the indication to surgery in 59.6%. A total of 974 patients entered the follow-up; 564 were alive at the last follow-up (median duration: 9.8 years) (up to 13.4 years). New York Heart Association class was I or II in 92.1%. Overall survival at 10 years was 56.8 ± 1.8%. Freedom from SVD at 10 was 96.5 ± 0.8% (Kaplan-Meier) and 97.4 ± 0.6% (competing risks) (28 SVD events after 6.9 ± 3.3 years). There were 15 reinterventions for SVD (redo-SAVR and Transcatheter Aortic Valve Implantation (TAVI)); 10-year freedom from reintervention was 97.8 ± 0.6%. Moderate and severe PPM occurred in 26.8% and 5.4%, respectively, without association with late mortality (P = 0.12 for moderate and P = 0.70 for severe PPM). Freedom from valve-related mortality was 97.8 ± 0.5% at 10 years. CONCLUSIONS In this follow-up of the Magna Ease bioprosthesis for SAVR, data indicate good late outcomes (30-day outcomes are excluded). Continued follow-up is required to further support its use in patients with life expectancy >10-12 years.
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Affiliation(s)
- Amedeo Anselmi
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
- Univ Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, Rennes, France
| | - Marie Aymami
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
- Univ Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, Rennes, France
| | - Jacques Tomasi
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
- Univ Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, Rennes, France
| | - Gemma D'Alessandro
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Thierry Langanay
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Hervé Corbineau
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
- Univ Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, Rennes, France
| | - Julien Mancini
- Aix-Marseille Univ, Inserm, IRD, ISSPAM, APHM, Biostatistics Dept, UMR1252 SESSTIM Research Unit, Marseille, France
| | - Erwan Flecher
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
- Univ Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, Rennes, France
| | - Jean-Philippe Verhoye
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
- Univ Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, Rennes, France
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Martínez A, Hoeijmakers M, Geronzi L, Morgenthaler V, Tomasi J, Rochette M, Biancolini ME. Effect of turbulence and viscosity models on wall shear stress derived biomarkers for aorta simulations. Comput Biol Med 2023; 167:107603. [PMID: 37922602 DOI: 10.1016/j.compbiomed.2023.107603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/12/2023] [Accepted: 10/17/2023] [Indexed: 11/07/2023]
Abstract
Ascending aorta simulations provide insight into patient-specific hemodynamic conditions. Numerous studies have assessed fluid biomarkers which show a potential to aid clinicians in the diagnosis process. Unfortunately, there exists a large disparity in the computational methodology used to model turbulence and viscosity. Recognizing this disparity, some authors focused on analysing the influence of either the turbulence or viscosity models on the biomarkers in order to quantify the importance of these model choices. However, no analysis has yet been done on their combined effect. In order to fully understand and quantify the effect of the computational methodology, an assessment of the combined effect of turbulence and viscosity model choice was performed. Our results show that (1) non-Newtonian viscosity has greater impact (2.9-5.0%) on wall shear stress than Large Eddy Simulation turbulence modelling (0.1-1.4%), (2) the contribution of non-Newtonian viscosity is amplified when combined with a subgrid-scale turbulence model, (3) wall shear stress is underestimated when considering Newtonian viscosity by 2.9-5.0% and (4) cycle-to-cycle variability can impact the results as much as the numerical model if insufficient cycles are performed. These results demonstrate that, when assessing the effect of computational methodologies, the resultant combined effect of the different modelling assumptions differs from the aggregated effect of the isolated modifications. Accurate aortic flow modelling requires non-Newtonian viscosity and Large Eddy Simulation turbulence modelling.
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Affiliation(s)
- Antonio Martínez
- University of Rome Tor Vergata, Rome, Italy; Ansys France, Villeurbanne, France.
| | | | - Leonardo Geronzi
- University of Rome Tor Vergata, Rome, Italy; Ansys France, Villeurbanne, France
| | | | - Jacques Tomasi
- University of Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, F-35000, Rennes, France
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Derycke L, Tomasi J, Desgranges P, Pesteil F, Plissonier D, Pernot M, Millon A, Martinez R, Chakfe N, Alsac JM. Assessment of Thoracic Endovascular Aortic Repair Using Relay Proximal Scallop: Results of a French Prospective Multicentre Study. Eur J Vasc Endovasc Surg 2023; 66:821-829. [PMID: 37567339 DOI: 10.1016/j.ejvs.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 06/01/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023]
Abstract
OBJECTIVE A proximal scallop design allows aortic arch repair without complex endovascular manipulation in the aortic arch. The aim was to assess the safety and efficacy at one year of the Relay proximal scallop stent graft. METHODS A prospective multicentre study evaluated consecutive patients treated with the Relay proximal scallop stent graft in 10 French aortic centres. All consecutive patients eligible for elective thoracic endovascular repair with proximal scallop in the 10 participating centres between January 2015 and July 2018 were included. Primary endpoints were 30 day mortality, stroke, and spinal cord ischaemia (SCI) rates. Outcomes including safety and efficacy, technical and clinical success, all cause death, neurological events, vessel patency, and device specific complications were analysed. Survival and survival without severe complications were estimated using Kaplan-Meier estimates. RESULTS Ten aortic centres treated 40 patients for thoracic aortic aneurysm (45%), penetrating atherosclerotic aneurysm (30%), and dissection (25%). Half of the procedures (50%) targeted zone 0 of the aortic arch (zone 0 in 17.5% and zones 0/1 in 32.5%), 37.5% targeted zone 2 (35% zone 2 alone; 2.5% zones 1/2), and 15% targeted zone 1 (12.5% zone 1 alone). Median follow up was one year. Thirty day mortality, stroke, and SCI rates were 10%, 5%, and 0% respectively. Primary technical success was 95%. Type Ia, Ib, and III endoleaks rates were 5.4%, 0%, and 0% respectively at one month. The overall mortality rate at one year was 17.5%. Aneurysm expansion was > 5 mm in one case at one year associated with type Ia endoleak (3%). There was no supra-aortic trunk thrombosis, one (2%) graft kink, and no migration. CONCLUSION One year outcomes showed that the Relay proximal scallop stent graft is an acceptable answer to thoracic aortic disease to deal with short proximal landing zones.
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Affiliation(s)
- Lucie Derycke
- Department of Cardio-Vascular and Vascular Surgery, Hôpital Européen Georges Pompidou, Paris, France.
| | - Jacques Tomasi
- Department of Thoracic and Cardiovascular Surgery, University Hospital Centre-INSERM LTSI 1099, Rennes, France
| | - Pascal Desgranges
- Department of Vascular Surgery, Centre Hospitalier Universitaire Henri Mondor, Créteil, France
| | - Francis Pesteil
- Department of Vascular Medicine and Surgery, Dupuytren University Hospital, Limoges, France
| | - Didier Plissonier
- Department of Vascular Surgery, Rouen University Hospital, Rouen, France
| | - Mathieu Pernot
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Pessac, France
| | - Antoine Millon
- Department of Vascular and Endovascular Surgery, Hospices Civils de Lyon, Louis Pradel University Hospital, Bron, France
| | - Robert Martinez
- Department of Cardiovascular Surgery, University Hospital of Tours, Tours, France
| | - Nabil Chakfe
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Jean-Marc Alsac
- Department of Cardio-Vascular and Vascular Surgery, Hôpital Européen Georges Pompidou, Paris, France
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Geronzi L, Martinez A, Rochette M, Yan K, Bel-Brunon A, Haigron P, Escrig P, Tomasi J, Daniel M, Lalande A, Lin S, Marin-Castrillon DM, Bouchot O, Porterie J, Valentini PP, Biancolini ME. Computer-aided shape features extraction and regression models for predicting the ascending aortic aneurysm growth rate. Comput Biol Med 2023; 162:107052. [PMID: 37263151 DOI: 10.1016/j.compbiomed.2023.107052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/27/2023] [Accepted: 05/20/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE ascending aortic aneurysm growth prediction is still challenging in clinics. In this study, we evaluate and compare the ability of local and global shape features to predict the ascending aortic aneurysm growth. MATERIAL AND METHODS 70 patients with aneurysm, for which two 3D acquisitions were available, are included. Following segmentation, three local shape features are computed: (1) the ratio between maximum diameter and length of the ascending aorta centerline, (2) the ratio between the length of external and internal lines on the ascending aorta and (3) the tortuosity of the ascending tract. By exploiting longitudinal data, the aneurysm growth rate is derived. Using radial basis function mesh morphing, iso-topological surface meshes are created. Statistical shape analysis is performed through unsupervised principal component analysis (PCA) and supervised partial least squares (PLS). Two types of global shape features are identified: three PCA-derived and three PLS-based shape modes. Three regression models are set for growth prediction: two based on gaussian support vector machine using local and PCA-derived global shape features; the third is a PLS linear regression model based on the related global shape features. The prediction results are assessed and the aortic shapes most prone to growth are identified. RESULTS the prediction root mean square error from leave-one-out cross-validation is: 0.112 mm/month, 0.083 mm/month and 0.066 mm/month for local, PCA-based and PLS-derived shape features, respectively. Aneurysms close to the root with a large initial diameter report faster growth. CONCLUSION global shape features might provide an important contribution for predicting the aneurysm growth.
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Affiliation(s)
- Leonardo Geronzi
- University of Rome Tor Vergata, Department of Enterprise Engineering "Mario Lucertini", Rome, Italy; Ansys France, Villeurbanne, France.
| | - Antonio Martinez
- University of Rome Tor Vergata, Department of Enterprise Engineering "Mario Lucertini", Rome, Italy; Ansys France, Villeurbanne, France
| | | | - Kexin Yan
- Ansys France, Villeurbanne, France; University of Lyon, INSA Lyon, CNRS, LaMCoS, UMR5259, 69621 Villeurbanne, France
| | - Aline Bel-Brunon
- University of Lyon, INSA Lyon, CNRS, LaMCoS, UMR5259, 69621 Villeurbanne, France
| | - Pascal Haigron
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000, Rennes, France
| | - Pierre Escrig
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000, Rennes, France
| | - Jacques Tomasi
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000, Rennes, France
| | - Morgan Daniel
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000, Rennes, France
| | - Alain Lalande
- ICMUB Laboratory, CNRS 6302, University of Burgundy, 21078 Dijon, France; Medical Imaging Department, University Hospital of Dijon, Dijon, France
| | - Siyu Lin
- ICMUB Laboratory, CNRS 6302, University of Burgundy, 21078 Dijon, France; Medical Imaging Department, University Hospital of Dijon, Dijon, France
| | - Diana Marcela Marin-Castrillon
- ICMUB Laboratory, CNRS 6302, University of Burgundy, 21078 Dijon, France; Medical Imaging Department, University Hospital of Dijon, Dijon, France
| | - Olivier Bouchot
- Department of Cardio-Vascular and Thoracic Surgery, University Hospital of Dijon, Dijon, France
| | - Jean Porterie
- Cardiac Surgery Department, Rangueil University Hospital, Toulouse, France
| | - Pier Paolo Valentini
- University of Rome Tor Vergata, Department of Enterprise Engineering "Mario Lucertini", Rome, Italy
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Anselmi A, Tomasi J, Aymami M, Mancini J, Nesseler N, Langanay T, Flecher E, Verhoye JP. Porcine bioprostheses for surgical aortic valve replacement: very long-term performance of a third-generation device. J Cardiovasc Med (Hagerstown) 2023; 24:514-521. [PMID: 37409596 DOI: 10.2459/jcm.0000000000001505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
AIMS We aimed at investigating the long-term durability of the Epic bioprosthesis for surgical aortic valve replacement (SAVR) in a single-centre series of 888 implantations (2001-2018), expanding previous evaluations with shorter follow-up. METHODS We retrieved prospectively collected in-hospital data and performed a systematic follow-up focusing on valve-related events (SVD, structural valve deterioration; PPM, patient-prosthesis mismatch; reoperation) (competing risks, CIF and Kaplan--Meier methods). We distinguished between SVD (permanent changes in valve function due to evolutive structural deterioration, ≥10 mmHg average gradient vs. reference echocardiography) and PPM. RESULTS Average age at SAVR was 75.4 ± 7 years; 855 (96.3%) bioprostheses entered the follow-up and 396 (46.4%) were alive at last assessment. Follow-up was 99.9% complete, median duration was 7.7 years (entire cohort) and 9.9 years (survivors). At 10 years, overall survival was 50% ± 1.9, freedom from SVD was 99.4% ± 0.3 (competing risks) (seven SVD events after 8.1 ± 4.3 years). Freedom from SVD at 15 years was 98.4% ± 0.8 (competing risks). Prevalence of severe PPM was higher in 19 mm (6.5%) and 21 mm (10.2%) size cohorts. PPM (severe or moderate/severe) had no significant impact on overall survival (log-rank P = 0.27 and P = 0.21, respectively). Freedom from any reintervention (reoperation or TAVI Valve-in-Valve) for SVD at 10 years was 99.4% ± 0.3 (competing risks); freedom from any valve-related reintervention was 97.4% ± 0.6 (competing risks). CONCLUSION The Epic bioprosthesis for SAVR is limited by nonnegligible rates of PPM, which have nonetheless no impact on late survival. This device shows excellent durability and low rates of adverse valve-related events.
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Affiliation(s)
- Amedeo Anselmi
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes
| | - Jacques Tomasi
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes
| | - Marie Aymami
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes
| | - Julien Mancini
- Aix Marseille Univ, INSERM, IRD, APHM, ISSPAM, SESSTIM, BIOSTIC, Marseille
| | - Nicolas Nesseler
- Division of Cardiac Anesthesia, Pontchaillou University Hospital, Rennes, France
| | - Thierry Langanay
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes
| | - Erwan Flecher
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes
| | - Jean-Philippe Verhoye
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes
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Dreyfus J, Bohbot Y, Coisne A, Lavie-Badie Y, Flagiello M, Bazire B, Eggenspieler F, Viau F, Riant E, Mbaki Y, Eyharts D, Sénage T, Modine T, Nicol M, Doguet F, Le Tourneau T, Tribouilloy C, Donal E, Tomasi J, Habib G, Selton-Suty C, Radu C, Lim P, Raffoul R, Iung B, Obadia JF, Audureau E, Messika-Zeitoun D. Predictive value of the TRI-SCORE for in-hospital mortality after redo isolated tricuspid valve surgery. Heart 2023; 109:951-958. [PMID: 36828623 DOI: 10.1136/heartjnl-2022-322167] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/02/2023] [Indexed: 02/26/2023] Open
Abstract
OBJECTIVES The TRI-SCORE reliably predicts in-hospital mortality after isolated tricuspid valve surgery (ITVS) on native valve but has not been tested in the setting of redo interventions. We aimed to evaluate the predictive value of the TRI-SCORE for in-hospital mortality in patients with redo ITVS and to compare its accuracy with conventional surgical risk scores. METHODS Using a mandatory administrative database, we identified all consecutive adult patients who underwent a redo ITVS at 12 French tertiary centres between 2007 and 2017. Baseline characteristics and outcomes were collected from chart review and surgical scores were calculated. RESULTS We identified 70 patients who underwent a redo ITVS (54±15 years, 63% female). Prior intervention was a tricuspid valve repair in 51% and a replacement in 49%, and was combined with another surgery in 41%. A tricuspid valve replacement was performed in all patients for the redo surgery. Overall, in-hospital mortality and major postoperative complication rates were 10% and 34%, respectively. The TRI-SCORE was the only surgical risk score associated with in-hospital mortality (p=0.005). The area under the receiver operating characteristic curve for the TRI-SCORE was 0.83, much higher than for the logistic EuroSCORE (0.58) or EuroSCORE II (0.61). The TRI-SCORE was also associated with major postoperative complication rates and survival free of readmissions for heart failure. CONCLUSION Redo ITVS was rarely performed and was associated with an overall high in-hospital mortality and morbidity, but hiding important individual disparities. The TRI-SCORE accurately predicted in-hospital mortality after redo ITVS and may guide clinical decision-making process (www.tri-score.com).
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Affiliation(s)
- Julien Dreyfus
- Cardiology Department, Centre Cardiologique du Nord, Saint Denis, France
| | - Yohann Bohbot
- Cardiology Department, University Hospital Centre Amiens-Picardie South Site, Amiens, France
| | - Augustin Coisne
- Department of Echocardiography and Cardiovascular Explorations, Centre Hospitalier Regional Universitaire de Lille, Lille, France
| | - Yoan Lavie-Badie
- Cardiology Department, University Hospital Centre Toulouse, Toulouse, France
| | - Michele Flagiello
- Department of Cardiovascular Surgery and Transplantation, Hopital Cardio-Vasculaire et Pneumologique Louis Pradel, Lyon, France
| | - Baptiste Bazire
- Cardiology Department, Bichat - Claude-Bernard Hospital Cardiology Service, Paris, France
| | | | - Florence Viau
- Cardiology Department, Hôpital de la Timone, Marseille, France
| | - Elisabeth Riant
- Cardiology Department, Centre Cardiologique du Nord, Saint Denis, France.,Cardiology Department, Hospital Henri Mondor, Creteil, France
| | - Yannick Mbaki
- Cardiology Department, University Hospital Centre Rennes, Rennes, France
| | - Damien Eyharts
- Cardiology Department, University Hospital Centre Toulouse, Toulouse, France
| | - Thomas Sénage
- Cardiac Surgery Department, University Hospital Centre Nantes, Nantes, France
| | - Thomas Modine
- Cardiac Surgery Department, Centre Hospitalier Regional Universitaire de Lille, Lille, France
| | - Martin Nicol
- Cardiology Department, Centre Cardiologique du Nord, Saint Denis, France
| | - Fabien Doguet
- Cardiac Surgery Department, University Hospital Centre Rouen, Rouen, France
| | | | - Christophe Tribouilloy
- Cardiology Department, University Hospital Centre Amiens-Picardie South Site, Amiens, France
| | - Erwan Donal
- Cardiology Department, University Hospital Centre Rennes, Rennes, France
| | - Jacques Tomasi
- Cardiac Surgery Department, University Hospital Centre Rennes, Rennes, France
| | - Gilbert Habib
- Cardiology Department, Hôpital de la Timone, Marseille, France
| | | | - Costin Radu
- Cardiology Department, Hospital Henri Mondor, Creteil, France
| | - Pascal Lim
- Cardiology Department, Hospital Henri Mondor, Creteil, France
| | - Richard Raffoul
- Cardiology Department, Bichat - Claude-Bernard Hospital Cardiology Service, Paris, France
| | - Bernard Iung
- Cardiology Department, Bichat - Claude-Bernard Hospital Cardiology Service, Paris, France
| | - Jean-Francois Obadia
- Department of Cardiovascular Surgery and Transplantation, Hopital Cardio-Vasculaire et Pneumologique Louis Pradel, Lyon, France
| | | | - David Messika-Zeitoun
- Cardiology Department, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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Barili F, Brophy JM, Ronco D, Myers PO, Uva MS, Almeida RMS, Marin-Cuartas M, Anselmi A, Tomasi J, Verhoye JP, Musumeci F, Mandrola J, Kaul S, Papatheodorou S, Parolari A. Risk of Bias in Randomized Clinical Trials Comparing Transcatheter and Surgical Aortic Valve Replacement: A Systematic Review and Meta-analysis. JAMA Netw Open 2023; 6:e2249321. [PMID: 36595294 PMCID: PMC9857525 DOI: 10.1001/jamanetworkopen.2022.49321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
IMPORTANCE Recent European Society of Cardiology/European Association for Cardio-Thoracic Surgery (ESC/EACTS) guidelines highlighted some concerns about the randomized clinical trials (RCTs) comparing transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) for aortic stenosis. Quantification of these biases has not been previously performed. OBJECTIVE To assess whether randomization protects RCTs comparing TAVI and SAVR from biases other than nonrandom allocation. DATA SOURCES A systematic review of the literature between January 1, 2007, and June 6, 2022, on MEDLINE, Embase, and Cochrane Central Register of Controlled Trials was performed. Specialist websites were also checked for unpublished data. STUDY SELECTION The study included RCTs with random allocation to TAVI or SAVR with a maximum 5-year follow-up. DATA EXTRACTION AND SYNTHESIS Data extraction was performed by 2 independent investigators following the PRISMA guidelines. A random-effects meta-analysis was used for quantifying pooled rates and differential rates between treatments of deviation from random assigned treatment (DAT), loss to follow-up, and receipt of additional treatments. MAIN OUTCOMES AND MEASURES The primary outcomes were the proportion of DAT, loss to follow-up, and patients who were provided additional treatments and myocardial revascularization, together with their ratio between treatments. The measures were the pooled overall proportion of the primary outcomes and the risk ratio (RR) in the TAVI vs SAVR groups. RESULTS The search identified 8 eligible trials including 8849 participants randomly assigned to undergo TAVI (n = 4458) or SAVR (n = 4391). The pooled proportion of DAT among the sample was 4.2% (95% CI, 3.0%-5.6%), favoring TAVI (pooled RR vs SAVR, 0.16; 95% CI, 0.08-0.36; P < .001). The pooled proportion of loss to follow-up was 4.8% (95% CI, 2.7%-7.3%). Meta-regression showed a significant association between the proportion of participants lost to follow-up and follow-up time (slope, 0.042; 95% CI, 0.017-0.066; P < .001). There was an imbalance of loss to follow-up favoring TAVI (RR, 0.39; 95% CI, 0.28-0.55; P < .001). The pooled proportion of patients who had additional procedures was 10.4% (95% CI, 4.4%-18.5%): 4.6% (95% CI, 1.5%-9.3%) in the TAVI group and 16.5% (95% CI, 7.5%-28.1%) in the SAVR group (RR, 0.27; 95% CI, 0.15-0.50; P < .001). The imbalance between groups also favored TAVI for additional myocardial revascularization (RR, 0.40; 95% CI, 0.24-0.68; P < .001). CONCLUSIONS AND RELEVANCE This study suggests that, in RCTs comparing TAVI vs SAVR, there are substantial proportions of DAT, loss to follow-up, and additional procedures together with systematic selective imbalance in the same direction characterized by significantly lower proportions of patients undergoing TAVI that might affect internal validity.
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Affiliation(s)
- Fabio Barili
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy
| | - James M. Brophy
- Department of Medicine, McGill Health University Center, Montreal, Quebec, Canada
| | - Daniele Ronco
- Department of University Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | - Patrick O. Myers
- Division of Cardiac Surgery, CHUV–Lausanne University Hospital, Lausanne, Switzerland
| | - Miguel Sousa Uva
- Department of Cardiac Surgery, Hospital Santa Cruz, Carnaxide, Portugal
- Department of Cardiac Surgery and Physiology, Porto University Medical School, Porto, Portugal
| | - Rui M. S. Almeida
- University Center Assis Gurgacz Foundation, Cascavel, Paraná, Brazil
| | - Mateo Marin-Cuartas
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Amedeo Anselmi
- Department of Thoracic and Cardiovascular Surgery, University Hospital of Rennes, Rennes, France
| | - Jacques Tomasi
- Department of Thoracic and Cardiovascular Surgery, University Hospital of Rennes, Rennes, France
| | - Jean-Philippe Verhoye
- Department of Thoracic and Cardiovascular Surgery, University Hospital of Rennes, Rennes, France
| | - Francesco Musumeci
- Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | | | - Sanjay Kaul
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Stefania Papatheodorou
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Alessandro Parolari
- Department of University Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
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9
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Sharobeem S, Boulmier D, Leurent G, Bedossa M, Leclercq C, Mabo P, Raphaël Pedro M, Tomasi J, Verhoye JP, Donal E, Sost G, Le Guellec M, Le Breton H, Auffret V. Prognostic impact of permanent pacemaker implantation after transcatheter aortic valve replacement. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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10
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Geronzi L, Haigron P, Martinez A, Yan K, Rochette M, Bel-Brunon A, Porterie J, Lin S, Marin-Castrillon DM, Lalande A, Bouchot O, Daniel M, Escrig P, Tomasi J, Valentini PP, Biancolini ME. Assessment of shape-based features ability to predict the ascending aortic aneurysm growth. Front Physiol 2023; 14:1125931. [PMID: 36950300 PMCID: PMC10025384 DOI: 10.3389/fphys.2023.1125931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/24/2023] [Indexed: 03/08/2023] Open
Abstract
The current guidelines for the ascending aortic aneurysm (AsAA) treatment recommend surgery mainly according to the maximum diameter assessment. This criterion has already proven to be often inefficient in identifying patients at high risk of aneurysm growth and rupture. In this study, we propose a method to compute a set of local shape features that, in addition to the maximum diameter D, are intended to improve the classification performances for the ascending aortic aneurysm growth risk assessment. Apart from D, these are the ratio DCR between D and the length of the ascending aorta centerline, the ratio EILR between the length of the external and the internal lines and the tortuosity T. 50 patients with two 3D acquisitions at least 6 months apart were segmented and the growth rate (GR) with the shape features related to the first exam computed. The correlation between them has been investigated. After, the dataset was divided into two classes according to the growth rate value. We used six different classifiers with input data exclusively from the first exam to predict the class to which each patient belonged. A first classification was performed using only D and a second with all the shape features together. The performances have been evaluated by computing accuracy, sensitivity, specificity, area under the receiver operating characteristic curve (AUROC) and positive (negative) likelihood ratio LHR+ (LHR-). A positive correlation was observed between growth rate and DCR (r = 0.511, p = 1.3e-4) and between GR and EILR (r = 0.472, p = 2.7e-4). Overall, the classifiers based on the four metrics outperformed the same ones based only on D. Among the diameter-based classifiers, k-nearest neighbours (KNN) reported the best accuracy (86%), sensitivity (55.6%), AUROC (0.74), LHR+ (7.62) and LHR- (0.48). Concerning the classifiers based on the four shape features, we obtained the best accuracy (94%), sensitivity (66.7%), specificity (100%), AUROC (0.94), LHR+ (+∞) and LHR- (0.33) with support vector machine (SVM). This demonstrates how automatic shape features detection combined with risk classification criteria could be crucial in planning the follow-up of patients with ascending aortic aneurysm and in predicting the possible dangerous progression of the disease.
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Affiliation(s)
- Leonardo Geronzi
- Department of Enterprise Engineering “Mario Lucertini”, University of Rome Tor Vergata, Rome, Italy
- Ansys France, Villeurbanne, France
- *Correspondence: Leonardo Geronzi,
| | - Pascal Haigron
- LTSI–UMR 1099, CHU Rennes, Inserm, University of Rennes, Rennes, France
| | - Antonio Martinez
- Department of Enterprise Engineering “Mario Lucertini”, University of Rome Tor Vergata, Rome, Italy
- Ansys France, Villeurbanne, France
| | - Kexin Yan
- Ansys France, Villeurbanne, France
- LaMCoS, Laboratoire de Mécanique des Contacts et des Structures, CNRS UMR5259, INSA Lyon, University of Lyon, Villeurbanne, France
| | | | - Aline Bel-Brunon
- LaMCoS, Laboratoire de Mécanique des Contacts et des Structures, CNRS UMR5259, INSA Lyon, University of Lyon, Villeurbanne, France
| | - Jean Porterie
- Cardiac Surgery Department, Rangueil University Hospital, Toulouse, France
| | - Siyu Lin
- IMVIA Laboratory, University of Burgundy, Dijon, France
- Medical Imaging Department, University Hospital of Dijon, Dijon, France
| | - Diana Marcela Marin-Castrillon
- IMVIA Laboratory, University of Burgundy, Dijon, France
- Medical Imaging Department, University Hospital of Dijon, Dijon, France
| | - Alain Lalande
- IMVIA Laboratory, University of Burgundy, Dijon, France
- Medical Imaging Department, University Hospital of Dijon, Dijon, France
| | - Olivier Bouchot
- Department of Cardio-Vascular and Thoracic Surgery, University Hospital of Dijon, Dijon, France
| | - Morgan Daniel
- LTSI–UMR 1099, CHU Rennes, Inserm, University of Rennes, Rennes, France
| | - Pierre Escrig
- LTSI–UMR 1099, CHU Rennes, Inserm, University of Rennes, Rennes, France
| | - Jacques Tomasi
- LTSI–UMR 1099, CHU Rennes, Inserm, University of Rennes, Rennes, France
| | - Pier Paolo Valentini
- Department of Enterprise Engineering “Mario Lucertini”, University of Rome Tor Vergata, Rome, Italy
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11
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Dubost C, Tomasi J, Ducroix A, Pluchon K, Escrig P, Fouquet O, Aupart A, Mirza A, Fellah I, Bezon E, Baufreton C, El Arid JM, Roussel JC, Verhoye JP, Senage T. AORTLANTIC: French registry of aortic valve-sparing root replacement, preliminary multicenter results from Western France. Interact Cardiovasc Thorac Surg 2022; 35:6730752. [PMID: 36173328 PMCID: PMC9550271 DOI: 10.1093/icvts/ivac240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/27/2022] [Indexed: 11/21/2022] Open
Affiliation(s)
- Clément Dubost
- Thorax Institute, Nantes Hospital University Department of Thoracic and Cardiovascular Surgery, , Nantes, France
| | - Jacques Tomasi
- University Hospital Centre Department of Thoracic and Cardiovascular Surgery, , Rennes, France—INSERM LTSI 1099
| | - Antoine Ducroix
- University Hospital Department of Thoracic and Cardiovascular Surgery, , Angers, France
| | - Kevin Pluchon
- Brest University Hospital Department of Cardiovascular and Thoracic Surgery, , Brest, France
| | - Pierre Escrig
- University Hospital Centre Department of Thoracic and Cardiovascular Surgery, , Rennes, France—INSERM LTSI 1099
| | - Olivier Fouquet
- University Hospital Department of Thoracic and Cardiovascular Surgery, , Angers, France
| | - Arthur Aupart
- Trousseau University Hospital Department of Cardiothoracic Surgery, , Tours, France
| | - Alain Mirza
- New Clinic St Gatien Department of Cardiac Surgery, , Tours, France
| | - Imen Fellah
- Thorax Institute, Nantes Hospital University Department of Thoracic and Cardiovascular Surgery, , Nantes, France
| | - Eric Bezon
- Brest University Hospital Department of Cardiovascular and Thoracic Surgery, , Brest, France
| | - Christophe Baufreton
- University Hospital Department of Thoracic and Cardiovascular Surgery, , Angers, France
| | - Jean Marc El Arid
- Trousseau University Hospital Department of Cardiothoracic Surgery, , Tours, France
| | - Jean-Christian Roussel
- Thorax Institute, Nantes Hospital University Department of Thoracic and Cardiovascular Surgery, , Nantes, France
| | - Jean-Philippe Verhoye
- University Hospital Centre Department of Thoracic and Cardiovascular Surgery, , Rennes, France—INSERM LTSI 1099
| | - Thomas Senage
- Thorax Institute, Nantes Hospital University Department of Thoracic and Cardiovascular Surgery, , Nantes, France
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12
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Sousa-Uva M, Magro P, Tomasi J. Uncertainties, trade-offs and avoidance of harm. Eur J Cardiothorac Surg 2022; 62:ezac389. [PMID: 35894787 DOI: 10.1093/ejcts/ezac389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Indexed: 06/15/2023] Open
Affiliation(s)
- Miguel Sousa-Uva
- Cardiac Surgery Department, Hospital de Santa Cruz, Lisbon, Portugal
| | - Pedro Magro
- Cardiac Surgery Department, Hospital de Santa Cruz, Lisbon, Portugal
| | - Jacques Tomasi
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Rennes, France
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13
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Sharobeem S, Boulmier D, Leurent G, Bedossa M, Leclercq C, Mabo P, Martins RP, Tomasi J, Verhoye JP, Donal E, Sost G, Le Guellec M, Le Breton H, Auffret V. Prognostic impact of permanent pacemaker implantation following transcatheter aortic valve replacement. Heart Rhythm 2022; 19:1124-1132. [DOI: 10.1016/j.hrthm.2022.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/18/2022] [Accepted: 03/01/2022] [Indexed: 11/25/2022]
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14
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Dib N, Lapotre T, Tomasi J, Gueddari NE, Anselmi A, de laTour BR, Verhoye JP. A rare case of Neuhauser syndrome associated with a Kommerell diverticulum. Indian J Thorac Cardiovasc Surg 2022; 38:105-107. [PMID: 34898888 PMCID: PMC8630107 DOI: 10.1007/s12055-021-01264-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/20/2021] [Accepted: 08/22/2021] [Indexed: 01/03/2023] Open
Abstract
Neuhauser syndrome is a rare vascular anomaly characterized by the esophagus and trachea circling via the ligamentum arteriosum and right aortic arch. Kommerell's diverticulum have the same characteristic by an outpouch at the onset of an aberrant left subclavian artery worsening this compression. The association between these pathologies is very rare and the operative strategy is unclear. We describe a case with the association with a computed tomography scanner aortic reconstruction and a repair's operative strategy.
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Affiliation(s)
- Nabil Dib
- grid.414271.5Division of Thoracic, Cardiac and Vascular Surgery, Pontchaillou University Hospital, 2 rue Henri le Guilloux, 35000 Rennes, France
| | - Thibaut Lapotre
- grid.414271.5Division of Radiology, Pontchaillou University Hospital, Rennes, France
| | - Jacques Tomasi
- grid.414271.5Division of Thoracic, Cardiac and Vascular Surgery, Pontchaillou University Hospital, 2 rue Henri le Guilloux, 35000 Rennes, France
| | - Nabila El Gueddari
- grid.414271.5Division of Thoracic, Cardiac and Vascular Surgery, Pontchaillou University Hospital, 2 rue Henri le Guilloux, 35000 Rennes, France
| | - Amedeo Anselmi
- grid.414271.5Division of Thoracic, Cardiac and Vascular Surgery, Pontchaillou University Hospital, 2 rue Henri le Guilloux, 35000 Rennes, France
| | - Bertrand Richard de laTour
- grid.414271.5Division of Thoracic, Cardiac and Vascular Surgery, Pontchaillou University Hospital, 2 rue Henri le Guilloux, 35000 Rennes, France
| | - Jean-Philippe Verhoye
- grid.414271.5Division of Thoracic, Cardiac and Vascular Surgery, Pontchaillou University Hospital, 2 rue Henri le Guilloux, 35000 Rennes, France
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15
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Tomasi J, Anselmi A. Commentary: The many shades of grey in thoracoabdominal aortic repair. JTCVS Tech 2021; 10:34-35. [PMID: 34977701 PMCID: PMC8691768 DOI: 10.1016/j.xjtc.2021.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jacques Tomasi
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Amedeo Anselmi
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
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16
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Dreyfus J, Audureau E, Bohbot Y, Coisne A, Lavie-Badie Y, Bouchery M, Flagiello M, Bazire B, Eggenspieler F, Viau F, Riant E, Mbaki Y, Eyharts D, Senage T, Modine T, Nicol M, Doguet F, Nguyen V, Le Tourneau T, Tribouilloy C, Donal E, Tomasi J, Habib G, Selton-Suty C, Raffoul R, Iung B, Obadia JF, Messika-Zeitoun D. TRI-SCORE: a new risk score for in-hospital mortality prediction after isolated tricuspid valve surgery. Eur Heart J 2021; 43:654-662. [PMID: 34586392 PMCID: PMC8843795 DOI: 10.1093/eurheartj/ehab679] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/09/2021] [Accepted: 09/13/2021] [Indexed: 11/14/2022] Open
Abstract
Aims Isolated tricuspid valve surgery (ITVS) is considered to be a high-risk procedure, but in-hospital mortality is markedly variable. This study sought to develop a dedicated risk score model to predict the outcome of patients after ITVS for severe tricuspid regurgitation (TR). Methods and results All consecutive adult patients who underwent ITVS for severe non-congenital TR at 12 French centres between 2007 and 2017 were included. We identified 466 patients (60 ± 16 years, 49% female, functional TR in 49%). In-hospital mortality rate was 10%. We derived and internally validated a scoring system to predict in-hospital mortality using multivariable logistic regression and bootstrapping with 1000 re-samples. The final risk score ranged from 0 to 12 points and included eight parameters: age ≥70 years, New York Heart Association Class III–IV, right-sided heart failure signs, daily dose of furosemide ≥125 mg, glomerular filtration rate <30 mL/min, elevated bilirubin, left ventricular ejection fraction <60%, and moderate/severe right ventricular dysfunction. Tricuspid regurgitation mechanism was not an independent predictor of outcome. Observed and predicted in-hospital mortality rates increased from 0% to 60% and from 1% to 65%, respectively, as the score increased from 0 up to ≥9 points. Apparent and bias-corrected areas under the receiver operating characteristic curves were 0.81 and 0.75, respectively, much higher than the logistic EuroSCORE (0.67) or EuroSCORE II (0.63). Conclusion We propose TRI-SCORE as a dedicated risk score model based on eight easy to ascertain parameters to inform patients and physicians regarding the risk of ITVS and guide the clinical decision-making process of patients with severe TR, especially as transcatheter therapies are emerging (www.tri-score.com).
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Affiliation(s)
- Julien Dreyfus
- Cardiology Department, Centre Cardiologique du Nord, 32-36 rue des moulins gémeaux, Saint-Denis 93200, France
| | - Etienne Audureau
- Public Health Department, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil 94010, France.,Univ Paris Est Creteil, INSERM, IMRB, CEpiA Team, Creteil 94010, France
| | - Yohann Bohbot
- Department of Cardiology, Amiens University Hospital, 1 Rue du Professeur Christian Cabrol, Amiens 80054, France.,UR UPJV 7517, Jules Verne University of Picardie, 51 Boulevard de Châteaudun, Amiens 80000, France
| | - Augustin Coisne
- CHU Lille, Department of Clinical Physiology and Echocardiography, Heart Valve Clinic, 2 Avenue Oscar Lambret, Lille 59000, France.,Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011 - EGID, Lille 59000, France
| | - Yoan Lavie-Badie
- Department of Cardiology, Rangueil University Hospital, 9 Place Lange, Toulouse 31000, France
| | - Maxime Bouchery
- AP-HP (Assistance Publique-Hôpitaux de Paris), Clinical Research Unit (URC Mondor), Henri Mondor University Hospital, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil 94010, France
| | - Michele Flagiello
- Department of Cardiovascular Surgery and Transplantation, Louis Pradel Cardiovascular Hospital, Claude Bernard University, 59 Boulevard Pinel, Bron 69500, France
| | - Baptiste Bazire
- Department of Cardiology, Bichat Claude Bernard Hospital, 46 Rue Henri Huchard, Paris 75018, France
| | - Florian Eggenspieler
- Department of Cardiology, University Hospital of Nancy-Brabois, 29 Avenue du Maréchal de Lattre de Tassigny, Nancy 54000, France
| | - Florence Viau
- Cardiology Department, APHM, La Timone Hospital, 278 Rue Saint-Pierre, Marseille 13005, France
| | - Elisabeth Riant
- Cardiology Department, Centre Cardiologique du Nord, 32-36 rue des moulins gémeaux, Saint-Denis 93200, France.,Cardiology Department, Expert Valve Center, Henri Mondor Hospital, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil 94010, France
| | - Yannick Mbaki
- Cardiology Department, CHU de RENNES, LTSI UMR1099, INSERM, Université de Rennes-1, 2 Rue Henri le Guilloux, Rennes 35000, France
| | - Damien Eyharts
- Department of Cardiology, Rangueil University Hospital, 9 Place Lange, Toulouse 31000, France
| | - Thomas Senage
- Department of Cardiac Surgery, INSERM 1246, Université de Nantes, CHU de Nantes, 8 Quai Moncousu, Nantes 44007, France
| | - Thomas Modine
- CHU Lille, Department of Clinical Physiology and Echocardiography, Heart Valve Clinic, 2 Avenue Oscar Lambret, Lille 59000, France
| | - Martin Nicol
- Cardiology Department, Centre Cardiologique du Nord, 32-36 rue des moulins gémeaux, Saint-Denis 93200, France
| | - Fabien Doguet
- Service de chirurgie cardiovasculaire et thoracique, CHU Charles Nicolle, 37 Boulevard Gambetta, Rouen 76000, France.,Normandie Univ, Unirouen, INSERM U1096, Rouen 76000, France
| | - Virginia Nguyen
- Cardiology Department, Centre Cardiologique du Nord, 32-36 rue des moulins gémeaux, Saint-Denis 93200, France
| | - Thierry Le Tourneau
- Université de Nantes, CHU de Nantes, CNRS, INSERM, L'institut du thorax, Nantes 44000, France
| | - Christophe Tribouilloy
- Department of Cardiology, Amiens University Hospital, 1 Rue du Professeur Christian Cabrol, Amiens 80054, France.,UR UPJV 7517, Jules Verne University of Picardie, 51 Boulevard de Châteaudun, Amiens 80000, France
| | - Erwan Donal
- Cardiology Department, CHU de RENNES, LTSI UMR1099, INSERM, Université de Rennes-1, 2 Rue Henri le Guilloux, Rennes 35000, France
| | - Jacques Tomasi
- Department of Cardiac Surgery, CHU de RENNES, Université de Rennes-1, 2 Rue Henri le Guilloux, Rennes 35000, France
| | - Gilbert Habib
- Cardiology Department, APHM, La Timone Hospital, 278 Rue Saint-Pierre, Marseille 13005, France.,Aix Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, 19-21 Boulevard Jean Moulin, Marseille 13005, France
| | - Christine Selton-Suty
- Department of Cardiology, University Hospital of Nancy-Brabois, 29 Avenue du Maréchal de Lattre de Tassigny, Nancy 54000, France
| | - Richard Raffoul
- Department of Cardiac Surgery, AP-HP, Bichat Hospital, 46 Rue Henri Huchard, Paris 75018, France
| | - Bernard Iung
- Cardiology Department, AP-HP, Bichat Hospital, Université de Paris, 46 Rue Henri Huchard, Paris 75018, France
| | - Jean-François Obadia
- Department of Cardiovascular Surgery and Transplantation, Louis Pradel Cardiovascular Hospital, Claude Bernard University, 59 Boulevard Pinel, Bron 69500, France
| | - David Messika-Zeitoun
- Department of Cardiology, University of Ottawa Heart Institute, 40 ruskin street, Ottawa, Ontario, Canada
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17
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Mauduit M, Anselmi A, Soulami RB, Tomasi J, Flecher E, Langanay T, Corbineau H, Rouzé S, Verhoye JP. Early and long-term results of hypothermic circulatory arrest in aortic surgery: a 20-year single-centre experience. J Cardiovasc Med (Hagerstown) 2021; 22:572-578. [PMID: 33534299 DOI: 10.2459/jcm.0000000000001152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to document the postoperative outcomes of patients who underwent hypothermic circulatory arrest (HCA), the evolution of HCA management over time and to identify the risks factor for early mortality and postoperative stroke. METHODS Four hundred and twenty-four patients who underwent aortic surgery with HCA at our institution between January 1995 and June 2016 were consecutively included. RESULTS The main indications were degenerative aneurysm (254; 59.9%) and acute type A aortic dissection (146; 34.4%). Interventions were performed under deep (18.4 ± 0.9°C; n = 350; 82.5%) or moderate (23.9 ± 1.9°C; n = 74; 17.5%) hypothermia. Antegrade cerebral perfusion (ACP) was employed in 86 (20.3%) cases. The use of moderate hypothermia significantly increased from 2011, to become the preferred strategy in 2016. The in-hospital mortality was 12.5% and the postoperative stroke rate was 7.1%. Kaplan--Meier 5-year survival was 65.7%. Nonelective timing [odds ratio (OR) 4.05; P < 0.001], stroke (OR 3.77' P = 0.032), renal failure (OR 2.49; P = 0.023), redo surgery (2.42; P = 0.049) and CPB time (OR 1.05; P = 0.03) were independent risk factors for in-hospital mortality in multivariate analysis. Femoral cannulation was the only independent risk factor for stroke (OR 3.97; P = 0.002). The level of hypothermia and the use of ACP were not associated with either in-hospital mortality or postoperative stroke. CONCLUSION HCA might be widely considered to achieve a radical treatment of the aortic disease, provided that hypothermia is maintained below the 24°C safety threshold and ACP is used for HCA exceeding 30 min, to ensure optimal brain, spinal cord and visceral organs protection.
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Affiliation(s)
- Marion Mauduit
- Université Rennes1
- Department of Cardio-thoracic and Vascular Surgery, CHU Rennes, Rennes, France
| | - Amedeo Anselmi
- Université Rennes1
- Department of Cardio-thoracic and Vascular Surgery, CHU Rennes, Rennes, France
| | - Reda Belhaj Soulami
- Université Rennes1
- Department of Cardio-thoracic and Vascular Surgery, CHU Rennes, Rennes, France
| | - Jacques Tomasi
- Université Rennes1
- Department of Cardio-thoracic and Vascular Surgery, CHU Rennes, Rennes, France
| | - Erwan Flecher
- Université Rennes1
- Department of Cardio-thoracic and Vascular Surgery, CHU Rennes, Rennes, France
| | - Thierry Langanay
- Université Rennes1
- Department of Cardio-thoracic and Vascular Surgery, CHU Rennes, Rennes, France
| | - Hervé Corbineau
- Université Rennes1
- Department of Cardio-thoracic and Vascular Surgery, CHU Rennes, Rennes, France
| | - Simon Rouzé
- Université Rennes1
- Department of Cardio-thoracic and Vascular Surgery, CHU Rennes, Rennes, France
| | - Jean-Philippe Verhoye
- Université Rennes1
- Department of Cardio-thoracic and Vascular Surgery, CHU Rennes, Rennes, France
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Anselmi A, Aymami M, Tomasi J, Chabanne C, Beneux X, Corbineau H, Verhoye JP. DURABILITY OF MITRAL VALVE REPLACEMENT WITH A 3 RD GENERATION BIOPROSTHESIS. Ann Thorac Surg 2021; 113:837-844. [PMID: 33901453 DOI: 10.1016/j.athoracsur.2021.03.097] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 02/05/2021] [Accepted: 03/09/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND To evaluate the durability of a third-generation porcine bioprosthesis (Epic® valve) in the mitral position, according to patients' age at surgery. METHODS A total of 482 mitral valve replacements (MVR) using the Epic® valve at a single center were included (2009-2018). Perioperative and early postoperative data were prospectively collected. A systematic follow-up was performed (99% complete, 1,609.5 patient/years, average: 3.8 ± 2.5 years). Standardized definitions of valve-related events were adopted. Age at MVR was 68.1 ± 10.4 years. RESULTS Operative mortality was 9.3%. The were 5 early valve-related reoperations, mainly due to recurrent infectious endocarditis. Global survival at 8.8 years was 69.5% ± 5. There were 9 SVD events during the follow-up (3 receiving reoperations, 4 TMVR valve-in-valve, and 2 medical treatment only). The freedom from SVD at 5 and 10 years was 97.4% ± 1.2 and 89.6% ± 4.4 (actuarial), and 97.8% ± 1 and 91.9% ± 3.3, respectively (competing risks). After stratification into subgroups by age at surgery (≤59: 50.8%, 60-69: 32.8%, ≥70: 16.4%) there was no significant intergroup difference in freedom from SVD (log-rank p=0.24). The overall freedom from any reintervention for SVD at 10 years was 90.5% ± 4.4 (actuarial) and 92.7% ± 3.3 (competing risks), with no intergroup difference (log-rank p=0.14). The freedom from any valve-related complication at 8.4 years was 83.2% ± 4.5 (actuarial). CONCLUSIONS The Epic® bioprosthesis shows good durability at 5 to 10 years in the mitral position.
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Affiliation(s)
- Amedeo Anselmi
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France.
| | - Marie Aymami
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Jacques Tomasi
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Celine Chabanne
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Xavier Beneux
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Hervé Corbineau
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Jean-Philippe Verhoye
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
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19
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Mauduit M, Anselmi A, Tomasi J, Belhaj Soulami R, Le Bars F, Flecher E, Verhoye JP. Does Hypothermic Circulatory Arrest for Aortic Surgery Trigger Near-Death Experience? Incidence of Near-Death Experiences after Aortic Surgeries Performed under Hypothermic Circulatory Arrest. Aorta (Stamford) 2021; 9:76-82. [PMID: 34666377 PMCID: PMC8526149 DOI: 10.1055/s-0041-1725091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 11/11/2020] [Indexed: 10/26/2022]
Abstract
BACKGROUND Understanding near-death experiences (NDE) could provide a new insight into the analysis of human consciousness and the neurocognitive processes happening upon the approach of death. With a temporary interruption of systemic perfusion, aortic surgery under hypothermic circulatory arrest (HCA) may be the only available model of reversible clinical death. We present, herein, the results of an observational study designed to assess the incidence of NDE after aortic surgery. METHODS We performed a prospective study including consecutive patients who underwent thoracic aortic surgery between July 2018 and September 2019 at our institution. Procedures without HCA were included to constitute a control group. The primary outcome was the incidence of NDE assessed with the Greyson NDE scale during the immediate postoperative course, via a standardized interview of the patients in the surgical ward. RESULTS One hundred and one patients were included. Twenty-one patients (20.8%) underwent nonelective interventions for aortic dissection. Ninety-one patients had hemiarch replacement (90.1%). Sixty-seven (66.3%) interventions were performed with HCA, with an average circulatory arrest duration of 26.9 ± 25.5 minutes, and a mean body temperature of 23.7 ± 3.8°C. None of the patients reported any recollection from their period of unconsciousness. There was no NDE experiencer in the study cohort. CONCLUSION Several confounding factors regarding anesthesia, or NDE evaluation, might have impaired the chance of NDE recollections, and might have contributed to this negative result. Whether HCA may trigger NDE remains unknown.
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Affiliation(s)
- Marion Mauduit
- Department of Thoracic and Cardiovascular Surgery, Rennes University Hospital Center, Rennes, France
| | - Amedeo Anselmi
- Department of Thoracic and Cardiovascular Surgery, Rennes University Hospital Center, Rennes, France
| | - Jacques Tomasi
- Department of Thoracic and Cardiovascular Surgery, Rennes University Hospital Center, Rennes, France
| | - Reda Belhaj Soulami
- Department of Thoracic and Cardiovascular Surgery, Rennes University Hospital Center, Rennes, France
| | - Florent Le Bars
- Department of Thoracic and Cardiovascular Surgery, Rennes University Hospital Center, Rennes, France
| | - Erwan Flecher
- Department of Thoracic and Cardiovascular Surgery, Rennes University Hospital Center, Rennes, France
| | - Jean-Philippe Verhoye
- Department of Thoracic and Cardiovascular Surgery, Rennes University Hospital Center, Rennes, France
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20
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Nader J, Anselmi A, Tomasi J, Martin A, Aymami M, Rouze S, Corbineau H, Langanay T, Flecher E, Nesseler N, Verhoye JP. Adult cardiac surgery during COVID-19 lockdown: Impact on activity and outcomes in a high-volume centre. Arch Cardiovasc Dis 2021; 114:364-370. [PMID: 33541832 PMCID: PMC7826100 DOI: 10.1016/j.acvd.2020.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/09/2020] [Accepted: 12/22/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) outbreak had a direct impact on adult cardiac surgery activity, which systematically necessitates a postoperative stay in intensive care. AIM To study the effect of the COVID-19 lockdown on cardiac surgery activity and outcomes, by making a comparison with the corresponding period in 2019. METHODS This prospective observational cohort study compared adult cardiac surgery activity in our high-volume referral university hospital from 9 March to 10 May 2020 versus 9 March to 10 May 2019. Data were collected in our local certified database and a national database sponsored by the French society of thoracic and cardiovascular surgery. The primary study endpoints were operative mortality and postoperative complications. RESULTS With 105 interventions in 2020, our activity dropped by 57% compared with the same period in 2019. Patients were at higher risk, with a significantly higher EuroSCORE II score (3.8±4.5% vs. 2.0±1.8%; P<0.001) and higher rates of active endocarditis (7.6% vs. 2.9%; P=0.047) and recent myocardial infarction (9.5% vs. 0%; P<0.001). The weight and priority of the interventions were significantly different in 2020 (P=0.019 and P<0.001, respectively). The rate of acute aortic syndromes was also significantly higher in 2020 (P<0.001). Operative mortality was higher during the lockdown period (5.7% vs. 1.7%; P=0.038). The postoperative course was more complicated in 2020, with more postoperative bleeding (P=0.003), mechanical circulatory support (P=0.032) and prolonged mechanical ventilation (P=0.005). Only two patients (1.8%) developed a positive status for severe acute respiratory syndrome coronavirus 2 after discharge. CONCLUSIONS Adult cardiac surgery was heavily affected by the COVID-19 lockdown. A further modulation plan is necessary to improve outcomes and reduce postponed operations to decrease operative mortality and morbidity.
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Affiliation(s)
- Joseph Nader
- Division of thoracic and cardiovascular surgery, Rennes university hospital, 35000 Rennes, France
| | - Amedeo Anselmi
- Division of thoracic and cardiovascular surgery, Rennes university hospital, 35000 Rennes, France.
| | - Jacques Tomasi
- Division of thoracic and cardiovascular surgery, Rennes university hospital, 35000 Rennes, France
| | - Amandine Martin
- Division of thoracic and cardiovascular surgery, Rennes university hospital, 35000 Rennes, France
| | - Marie Aymami
- Division of thoracic and cardiovascular surgery, Rennes university hospital, 35000 Rennes, France
| | - Simon Rouze
- Division of thoracic and cardiovascular surgery, Rennes university hospital, 35000 Rennes, France
| | - Hervé Corbineau
- Division of thoracic and cardiovascular surgery, Rennes university hospital, 35000 Rennes, France
| | - Thierry Langanay
- Division of thoracic and cardiovascular surgery, Rennes university hospital, 35000 Rennes, France
| | - Erwan Flecher
- Division of thoracic and cardiovascular surgery, Rennes university hospital, 35000 Rennes, France
| | - Nicolas Nesseler
- Division of cardiac anaesthesia, Rennes university hospital, 35000 Rennes, France
| | - Jean-Philippe Verhoye
- Division of thoracic and cardiovascular surgery, Rennes university hospital, 35000 Rennes, France
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21
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Tomasi J, Belhaj Soulami R, Rolland M, Verhoye JP. Endovascular Repair of a Dacron Pseudoaneurysm in an Ascending-to-Descending Aortic Bypass. Aorta (Stamford) 2020; 8:104-106. [PMID: 33307590 PMCID: PMC7732562 DOI: 10.1055/s-0040-1715087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In the setting of postcoarctation aortic repair, Dacron graft dilatation and late aneurysms are not uncommon. Reintervention usually involves redo open surgery and replacement of the aneurysmal graft or the pseudoaneurysmal suture line. The present case describes the endovascular repair of a Dacron anastomotic false aneurysm in an extra-anatomic ascending-to-descending aortic bypass, 19 years after surgical correction of aortic recoarctation.
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Affiliation(s)
- Jacques Tomasi
- Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Reda Belhaj Soulami
- Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Marion Rolland
- Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Jean-Philippe Verhoye
- Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
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22
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Danion J, Thuillier R, Allain G, Bruneval P, Tomasi J, Pinsard M, Hauet T, Kerforne T. Evaluation of Liver Quality after Circulatory Death Versus Brain Death: A Comparative Preclinical Pig Model Study. Int J Mol Sci 2020; 21:ijms21239040. [PMID: 33261172 PMCID: PMC7730280 DOI: 10.3390/ijms21239040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/14/2020] [Accepted: 11/21/2020] [Indexed: 02/07/2023] Open
Abstract
The current organ shortage in hepatic transplantation leads to increased use of marginal livers. New organ sources are needed, and deceased after circulatory death (DCD) donors present an interesting possibility. However, many unknown remains on these donors and their pathophysiology regarding ischemia reperfusion injury (IRI). Our hypothesis was that DCD combined with abdominal normothermic regional recirculation (ANOR) is not inferior to deceased after brain death (DBD) donors. We performed a mechanistic comparison between livers from DBD and DCD donors in a highly reproducible pig model, closely mimicking donor conditions encountered in the clinic. DCD donors were conditioned by ANOR. We determined that from the start of storage, pro-lesion pathways such as oxidative stress and cell death were induced in both donor types, but to a higher extent in DBD organs. Furthermore, pro-survival pathways, such as resistance to hypoxia and regeneration showed activation levels closer to healthy livers in DCD-ANOR rather than in DBD organs. These data highlight critical differences between DBD and DCD-ANOR livers, with an apparent superiority of DCD in terms of quality. This confirms our hypothesis and further confirms previously demonstrated benefits of ANOR. This encourages the expended use of DCD organs, particularly with ANOR preconditioning.
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Affiliation(s)
- Jérôme Danion
- Inserm U1082, F-86000 Poitiers, France; (J.D.); (R.T.); (G.A.); (T.K.)
- Faculté de Médecine et de Pharmacie, Université de Poitiers, F-86000 Poitiers, France
- CHU de Poitiers, Service de Chirurgie Générale et Endocrinienne, F-86021 Poitiers, France
| | - Raphael Thuillier
- Inserm U1082, F-86000 Poitiers, France; (J.D.); (R.T.); (G.A.); (T.K.)
- Faculté de Médecine et de Pharmacie, Université de Poitiers, F-86000 Poitiers, France
- CHU Poitiers, Service de Biochimie, F-86021 Poitiers, France
| | - Géraldine Allain
- Inserm U1082, F-86000 Poitiers, France; (J.D.); (R.T.); (G.A.); (T.K.)
- Faculté de Médecine et de Pharmacie, Université de Poitiers, F-86000 Poitiers, France
- CHU Poitiers, Service de Chirurgie Cardiothoracique et Vasculaire, F-86021 Poitiers, France;
| | - Patrick Bruneval
- Hôpital Européen Georges Pompidou, Service D’anatomie Pathologique, F-75015 Paris, France;
- Faculté de Médecine, Université Paris-Descartes, F-75006 Paris, France
| | - Jacques Tomasi
- CHU Poitiers, Service de Chirurgie Cardiothoracique et Vasculaire, F-86021 Poitiers, France;
| | - Michel Pinsard
- CHU Poitiers, Service de Réanimation Chirurgie Cardio-Thoracique et Vasculaire, Coordination des P.M.O., F-86021 Poitiers, France;
| | - Thierry Hauet
- Inserm U1082, F-86000 Poitiers, France; (J.D.); (R.T.); (G.A.); (T.K.)
- Faculté de Médecine et de Pharmacie, Université de Poitiers, F-86000 Poitiers, France
- CHU Poitiers, Service de Biochimie, F-86021 Poitiers, France
- Fédération Hospitalo-Universitaire SUPORT, F-86000 Poitiers, France
- IBiSA Plateforme ‘Plate-Forme MOdélisation Préclinique—Innovation Chirurgicale et Technologique (MOPICT)’, Domaine Expérimental du Magneraud, F-17700 Surgères, France
- Pr. Thierry HAUET, INSERM U1082, CHU de Poitiers, 2 rue de la Miletrie, CEDEX BP 577, 86021 Poitiers, France
- Correspondence: ; Tel.: +33-5-49-44-48-29; Fax: +33-5-49-44-38-34
| | - Thomas Kerforne
- Inserm U1082, F-86000 Poitiers, France; (J.D.); (R.T.); (G.A.); (T.K.)
- Faculté de Médecine et de Pharmacie, Université de Poitiers, F-86000 Poitiers, France
- CHU Poitiers, Service de Réanimation Chirurgie Cardio-Thoracique et Vasculaire, Coordination des P.M.O., F-86021 Poitiers, France;
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Belhaj Soulami R, Anselmi A, Tomasi J, Verhoye JP. Late surgical explantation of a transcatheter heart valve in a patient with a porcelain aorta. Eur J Cardiothorac Surg 2020; 55:1008-1011. [PMID: 30289474 DOI: 10.1093/ejcts/ezy327] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 08/22/2018] [Accepted: 08/30/2018] [Indexed: 01/16/2023] Open
Abstract
Structural valve deterioration is a well-studied phenomenon in bioprosthetic heart valves. Conversely, structural valve deterioration after transcatheter aortic valve implantation is not as well-elucidated. Therefore, late surgical explantation after transcatheter aortic valve implantation is an infrequent procedure, and thus, surgical findings and management of such cases remain unclear, particularly in patients previously labelled as 'inoperable' or at 'high risk'. Herein, we report the case of a late surgical explantation of a transcatheter heart valve (THV) 7 years after its implantation in a patient with a porcelain aorta and periprosthetic regurgitation.
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Affiliation(s)
- Réda Belhaj Soulami
- Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Amedeo Anselmi
- Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Jacques Tomasi
- Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Jean-Philippe Verhoye
- Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
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24
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Dreyfus J, Flagiello M, Bazire B, Eggenspieler F, Viau F, Riant E, Mbaki Y, Bohbot Y, Eyharts D, Senage T, Dubrulle H, Nicol M, Doguet F, Nguyen V, Coisne A, Le Tourneau T, Lavie-Badie Y, Tribouilloy C, Donal E, Tomasi J, Habib G, Selton-Suty C, Raffoul R, Iung B, Obadia JF, Messika-Zeitoun D. Isolated tricuspid valve surgery: impact of aetiology and clinical presentation on outcomes. Eur Heart J 2020; 41:4304-4317. [DOI: 10.1093/eurheartj/ehaa643] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/21/2020] [Accepted: 07/23/2020] [Indexed: 01/26/2023] Open
Abstract
Abstract
Aims
The aim of this study was to identify determinants of in-hospital and mid-term outcomes after isolated tricuspid valve surgery (ITVS) and more specifically the impact of tricuspid regurgitation (TR) mechanism and clinical presentation.
Methods and results
Among 5661 consecutive adult patients who underwent a tricuspid valve (TV) surgery at 12 French tertiary centres in 2007–2017 collected from a mandatory administrative database, we identified 466 patients (8% of all tricuspid surgeries) who underwent an ITVS. Most patients presented with advanced disease [47% in New York Heart Association (NYHA) III/IV, 57% with right-sided heart failure (HF) signs]. Tricuspid regurgitation was functional in 49% (22% with prior left-sided heart valve surgery and 27% isolated) and organic in 51% (infective endocarditis in 31% and other causes in 20%). In-hospital mortality and major complications rates were 10% and 31%, respectively. Rates of survival and survival free of HF readmission were 75% and 62% at 5 years. Patients with functional TR incurred a worse in-hospital mortality than those with organic TR (14% vs. 6%, P = 0.004), but presentation was more severe. Independent determinants of outcomes were NYHA Class III/IV [odd ratios (OR) = 2.7 (1.2–6.1), P = 0.01], moderate/severe right ventricular dysfunction [OR = 2.6 (1.2–5.8), P = 0.02], lower prothrombin time [OR = 0.98 (0.96–0.99), P = 0.008], and with borderline statistical significance, right-sided HF signs [OR = 2.4 (0.9–6.5), P = 0.06] while TR mechanism was not [OR = 0.7 (0.3–1.8), P = 0.88].
Conclusion
Isolated TV surgery was associated with high mortality and morbidity, both in hospital and during follow-up, predicted by the severity of the presentation but not by TR mechanism. Our results suggest that TV intervention should be performed earlier in the course of the disease.
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Affiliation(s)
- Julien Dreyfus
- Cardiology Department, Centre Cardiologique du Nord, 32-36 rue des moulins gémeaux, Saint-Denis 93200, France
| | - Michele Flagiello
- Department of Cardiovascular Surgery and Transplantation, Louis Pradel Cardiovascular Hospital, Claude Bernard University, 59 Boulevard Pinel, 69500 Bron, France
| | - Baptiste Bazire
- Department of Cardiology, Bichat Claude Bernard Hospital, 46 Rue Henri Huchard, 75018 Paris, France
| | - Florian Eggenspieler
- Department of Cardiology, University Hospital of Nancy-Brabois, 29 Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France
| | - Florence Viau
- Cardiology Department, APHM, La Timone Hospital, 278 Rue Saint-Pierre, 13005 Marseille, France
| | - Elisabeth Riant
- Cardiology Department, Expert Valve Center, Henri Mondor Hospital, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Yannick Mbaki
- Cardiology Department, CHU de RENNES, LTSI UMR1099, INSERM, Université de Rennes-1, 2 Rue Henri le Guilloux, 35000 Rennes, France
| | - Yohann Bohbot
- Department of Cardiology, Amiens University Hospital, 1 Rue du Professeur Christian Cabrol, 80054 Amiens, France
- UR UPJV 7517, Jules Verne University of Picardie, 51 Boulevard de Châteaudun, 80000 Amiens, France
| | - Damien Eyharts
- Department of Cardiology, Rangueil University Hospital, 9 Place Lange, 31300 Toulouse, France
| | - Thomas Senage
- Department of Cardiac Surgery, INSERM 1246, Université de Nantes, CHU de Nantes, 8 Quai Moncousu, 44007 Nantes, France
| | - Henri Dubrulle
- Department of Clinical Physiology and Echocardiography – Heart Valve Clinic, CHU Lille, 2 Avenue Oscar Lambret, 59000 Lille, France
| | - Martin Nicol
- Cardiology Department, Centre Cardiologique du Nord, 32-36 rue des moulins gémeaux, Saint-Denis 93200, France
| | - Fabien Doguet
- Service de chirurgie cardiovasculaire et thoracique, CHU Charles Nicolle, 37 Boulevard Gambetta, 76000 Rouen, France
- Normandie Univ, Unirouen, INSERM U1096, Rouen 76000, France
| | - Virginia Nguyen
- Cardiology Department, Centre Cardiologique du Nord, 32-36 rue des moulins gémeaux, Saint-Denis 93200, France
| | - Augustin Coisne
- Department of Clinical Physiology and Echocardiography – Heart Valve Clinic, CHU Lille, 2 Avenue Oscar Lambret, 59000 Lille, France
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011 - EGID, Lille F-59000, France
| | - Thierry Le Tourneau
- Université de Nantes, CHU de Nantes, CNRS, INSERM, l’institut du thorax, Nantes F-44000, France
| | - Yoan Lavie-Badie
- Department of Cardiology, Rangueil University Hospital, 9 Place Lange, 31300 Toulouse, France
| | - Christophe Tribouilloy
- Department of Cardiology, Amiens University Hospital, 1 Rue du Professeur Christian Cabrol, 80054 Amiens, France
- UR UPJV 7517, Jules Verne University of Picardie, 51 Boulevard de Châteaudun, 80000 Amiens, France
| | - Erwan Donal
- Cardiology Department, CHU de RENNES, LTSI UMR1099, INSERM, Université de Rennes-1, 2 Rue Henri le Guilloux, 35000 Rennes, France
| | - Jacques Tomasi
- Department of Cardiac Surgery, CHU de RENNES, Université de Rennes-1, 2 Rue Henri le Guilloux, 35000 Rennes, France
| | - Gilbert Habib
- Cardiology Department, APHM, La Timone Hospital, 278 Rue Saint-Pierre, 13005 Marseille, France
- Aix Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005 Marseille, France
| | - Christine Selton-Suty
- Department of Cardiology, University Hospital of Nancy-Brabois, 29 Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France
| | - Richard Raffoul
- Department of Cardiac Surgery, AP-HP, Bichat Hospital, 46 Rue Henri Huchard, 75018 Paris, France
| | - Bernard Iung
- Cardiology Department, AP-HP, DHU Fire, Bichat Hospital, Université de Paris, 46 Rue Henri Huchard, 75018 Paris, France
| | - Jean-François Obadia
- Department of Cardiovascular Surgery and Transplantation, Louis Pradel Cardiovascular Hospital, Claude Bernard University, 59 Boulevard Pinel, 69500 Bron, France
| | - David Messika-Zeitoun
- Department of Cardiology, University of Ottawa Heart Institute, 40 ruskin street, Ottawa, Ontario, Canada
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Auffret V, Bakhti A, Leurent G, Bedossa M, Tomasi J, Belhaj Soulami R, Verhoye JP, Donal E, Galli E, Loirat A, Sharobeem S, Sost G, Le Guellec M, Boulmier D, Le Breton H. Determinants and Impact of Heart Failure Readmission Following Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2020; 13:e008959. [DOI: 10.1161/circinterventions.120.008959] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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 <50% (HR, 0.67 [95% CI, 0.48–0.94]) and 75% to 100% (HR, 0.61 [95% CI, 0.37–0.98]) of the optimal daily dose.
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.
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Affiliation(s)
- Vincent Auffret
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
| | - Abdelkader Bakhti
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
| | - Guillaume Leurent
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
| | - Marc Bedossa
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
| | - Jacques Tomasi
- Université de Rennes 1, CHU Rennes Service de Chirurgie Cardiaque, Inserm LTSI U1099, F 35000 Rennes, France (J.T., R.B.S., J.-P.V.)
| | - Reda Belhaj Soulami
- Université de Rennes 1, CHU Rennes Service de Chirurgie Cardiaque, Inserm LTSI U1099, F 35000 Rennes, France (J.T., R.B.S., J.-P.V.)
| | - Jean-Philippe Verhoye
- Université de Rennes 1, CHU Rennes Service de Chirurgie Cardiaque, Inserm LTSI U1099, F 35000 Rennes, France (J.T., R.B.S., J.-P.V.)
| | - Erwan Donal
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
| | - Elena Galli
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
| | - Aurélie Loirat
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
| | - Sam Sharobeem
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
| | - Gwenaelle Sost
- Université de Rennes 1, CHU Rennes Service de Gériatrie, F 35000 Rennes, France (G.S.)
| | - Marielle Le Guellec
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
| | - Dominique Boulmier
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
| | - Hervé Le Breton
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
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Le Bars F, Tomasi J, Belhaj Soulami R, Colas F, Anselmi A, Verhoye JP. Long-term follow-up of the Shelhigh™ superstentless bioprosthesis aortic valve and valved conduit in a monocentric experience. J Cardiovasc Surg (Torino) 2020; 61:776-783. [PMID: 32558524 DOI: 10.23736/s0021-9509.20.11219-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The Shelhigh™ SuperStentless (Shelhigh, INC., Union, NJ, USA) is a stentless aortic valve bioprosthesis and aortic root valved conduit. In 2007, this device was recalled by FDA due to malfunction, and subsequently reintegrated by BioIntegral Surgical™ Few data are available over late durability of this device. We performed a long-term follow-up of Shelhigh™ devices implanted at our center. METHODS Between 2002 and 2007, 44 patients underwent aortic valve replacement with a Shelhigh™ device (40 aortic valve bioprosthesis and 4 valved conduit). We performed a clinical and echocardiographic follow-up (9.2 years±4.3). Standardized definitions of valve-related events were adopted. RESULTS At discharge, maximum and mean aortic gradients averaged 36.1±11.3 and 21.0±6.8 mmHg, respectively. The 30-days mortality was 2.3%. Over the follow-up period, 29 patients died (65.9%); 2 deaths were valve related. Overall survival at 1, 5 and 10 years was 97.7%, 85.8% and 54% respectively. At last echocardiography, average transvalvular gradients had remained globally stable in the population (33.6±12 and 20.4±10.5 mmHg). Eight (19%) structural valve deterioration (SVD) events were reported. Two (5%) non-structural valve dysfunction (NSVD) events occurred (periprosthetic leak). Two (5%) infectious endocarditis events and two (5%) valve thromboses were also deplored. Three (7%) patients required re-operation (2 due to SVD and 1 due to endocarditis). CONCLUSIONS The immediate hemodynamic performance of the Shelhigh™ aortic bioprostheses was unexpectedly suboptimal. Despite this, hemodynamic performance remained stable over time. Patients survival at follow-up was satisfactory, however, continued surveillance is necessary.
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Affiliation(s)
- Florent Le Bars
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital Center, Rennes, France
| | - Jacques Tomasi
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital Center, Rennes, France
| | - Reda Belhaj Soulami
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital Center, Rennes, France
| | - Fabrice Colas
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital Center, Rennes, France
| | - Amedeo Anselmi
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital Center, Rennes, France -
| | - Jean-Philippe Verhoye
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital Center, Rennes, France
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Bounader K, Flecher E, Chabanne C, Lelong B, Aymami M, Martin A, Rouze S, Belhaj R, Tomasi J, Langanay T, Corbineau H, Anselmi A, Nessler N, Verhoye J. Ratio of Pulmonary Artery Diameter to Ascending Aortic Diameter as a Predictive Tool for Severe Primary Graft Dysfunction in Heart Transplants. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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28
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Verhoye JP, Belhaj Soulami R, Tomasi J, Di Perna D, Leurent G, Rosier S, Biedermann S, Anselmi A. Early outcomes of transcarotid access for transcatheter aortic valve implantation. EUROINTERVENTION 2020; 15:e1332-e1334. [PMID: 31186217 DOI: 10.4244/eij-d-18-01192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jean-Philippe Verhoye
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
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Mauduit M, Anselmi A, Tomasi J, Belhaj Soulami R, Roisné A, Flecher E, Rouze S, Verhoye JP. Early and late outcomes of aortic surgery under hypothermic circulatory arrest in the elderly: a single center study. J Cardiovasc Surg (Torino) 2019; 60:733-741. [PMID: 31599143 DOI: 10.23736/s0021-9509.19.10874-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND With the progressive aging of the population, aortic surgeons are caring for an increasing number of elderly patients. The objective of this study was to analyze early and late outcomes of aortic surgery with hypothermic circulatory arrest in patients aged 70 and above at our institution. METHODS We performed a retrospective cohort study including every patient aged 70 years or older who underwent aortic surgery with hypothermic circulatory arrest between January 1995 and June 2016 at our institution. Operative results were compared with the contemporary younger counterparts aged <70 years. In-hospital mortality and postoperative stroke were primary outcomes of interest. The main secondary outcomes included acute renal failure, reoperation for bleeding, and spinal cord injury. RESULTS In the study population, the in-hospital mortality was 16.8% (21/125). Ten (8.0%) patients presented postoperative stroke, and 6 had temporary neurologic disturbance (4.8%). Spinal cord injury occurred in 1 (0.8%) patient. For elective interventions and type A aortic dissections, the in-hospital mortality and stroke rates were 4.6% (3/65) and 7.7% (5/65), 26.8% (11/41) and 12.2% (5/41), respectively. The proportion of non-elective interventions, including type A aortic dissection, and the type of neuroprotective strategy were similar in septuagenarians and younger patients. Patients aged ≥70 had significant shorter cardiopulmonary bypass, myocardial ischemia, and circulatory arrest durations, compared to their younger counterparts. The in-hospital mortality of septuagenarians and younger patients were similar for elective surgery (4.6% vs. 4.7%, P=0.900) and aortic dissections (26.8% vs. 15.1%, P=0.107). There was no statistically significant difference between the two age groups regarding postoperative stroke, spinal cord injury, renal failure requiring dialysis or reintervention for bleeding. Estimated 1-, 3-, and 5-year survival was 78.0%, 70.6%, and 65.7%, respectively. The 5-year survival for elective surgery was 74.9% and 56.0% for non-elective procedures. CONCLUSIONS Aortic surgery with circulatory arrest in the elderly demonstrated favorable early and late results when compared with younger individuals, with an acceptable operative risk even under emergency conditions, and should not be denied only because of the chronological age of the patients.
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Affiliation(s)
- Marion Mauduit
- Department of Thoracic and Cardio-Vascular Surgery, Rennes University Hospital Center, Rennes, France -
| | - Amedeo Anselmi
- Department of Thoracic and Cardio-Vascular Surgery, Rennes University Hospital Center, Rennes, France
| | - Jacques Tomasi
- Department of Thoracic and Cardio-Vascular Surgery, Rennes University Hospital Center, Rennes, France
| | - Reda Belhaj Soulami
- Department of Thoracic and Cardio-Vascular Surgery, Rennes University Hospital Center, Rennes, France
| | - Antoine Roisné
- Department of Thoracic and Cardio-Vascular Surgery, Rennes University Hospital Center, Rennes, France
| | - Erwan Flecher
- Department of Thoracic and Cardio-Vascular Surgery, Rennes University Hospital Center, Rennes, France
| | - Simon Rouze
- Department of Thoracic and Cardio-Vascular Surgery, Rennes University Hospital Center, Rennes, France
| | - Jean-Philippe Verhoye
- Department of Thoracic and Cardio-Vascular Surgery, Rennes University Hospital Center, Rennes, France
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30
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Langanay T, Rouzé S, Tomasi J, Aymami M, Rehman SM, Anselmi A, Corbineau H, Flécher E, Logeais Y, Leguerrier A, Verhoye JP. Conventional aortic valve replacement in 2005 elderly patients: a 32-year experience. Eur J Cardiothorac Surg 2019; 54:446-452. [PMID: 29566140 DOI: 10.1093/ejcts/ezy072] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 02/02/2018] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES Considering the good immediate results reported for transcatheter aortic valve implantation in high-risk patients, the role of conventional aortic valve replacement (AVR) is being questioned, especially in elderly patients. The aim of this study was to evaluate our long-term results of conventional AVR in octogenarians. METHODS A total of 2005 patients aged ≥80 years underwent AVR for aortic stenosis in our institution between 1978 and 2011. Of these, 1009 (50%) patients had an associated extracardiac comorbidity and 650 (32%) patients had coronary lesions. Valve replacement was the sole procedure in 1515 (76%) patients, and 396 (19%) patients had concomitant coronary artery bypass grafting. Data were collected at the time of surgery in our database, and regularly updated by mailed questionnaires and telephone contact. RESULTS Early mortality of isolated AVR was 5.5% for the last 10 years of the series. Significant risk factors were chronic obstructive pulmonary disease, chronic renal failure, advanced cardiac disease [left or right ventricular failure, New York Heart Association (NYHA) Class IV and atrial fibrillation] and coronary disease. Long-term follow-up was 99.5% complete (9 patients lost to follow-up), totalling 8849 patient-years. Nine hundred and one patients died at late follow-up with a median survival of 7.1 years, with 7 patients becoming centenarian. Apart from older age, main late causes of death were cardiovascular (20.5%), neurological deficit (10.2%) and cancer (10.2%). Actuarial survival was 83%, 62.5% and 25% at 2, 5 and 10 years, respectively. This survival compares favourably with that of a French-matched population. Above all, 90% of late survivors reported functional improvement. Univariable and multivariable analysis identified risk factors of late death as male gender, associated comorbidity, renal failure, advanced cardiac disease, atrial fibrillation and impaired ventricular function. Coronary lesions, associated cardiac surgery and small diameter prostheses (19 or 21 mm) did not impair long-term survival. CONCLUSIONS AVR is effective for all age groups to treat aortic stenosis. Elderly people should not be denied surgery only because of their old age as conventional AVR provides an excellent quality of life and restores life expectancy. Percutaneous valve implantation is to be considered, in cases of non-operable or high-risk patients. However, to date, open-heart surgery remains the treatment of choice for aortic stenosis for the majority of patients.
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Affiliation(s)
- Thierry Langanay
- Department of Cardiovascular and Thoracic Surgery, Rennes University Hospital, Rennes, France
| | - Simon Rouzé
- Department of Cardiovascular and Thoracic Surgery, Rennes University Hospital, Rennes, France
| | - Jacques Tomasi
- Department of Cardiovascular and Thoracic Surgery, Rennes University Hospital, Rennes, France
| | - Marie Aymami
- Department of Cardiovascular and Thoracic Surgery, Rennes University Hospital, Rennes, France
| | - Syed M Rehman
- Department of Cardiovascular and Thoracic Surgery, Rennes University Hospital, Rennes, France.,Department of Cardiac and Thoracic Surgery, Southampton General Hospital, Southampton, UK
| | - Amedeo Anselmi
- Department of Cardiovascular and Thoracic Surgery, Rennes University Hospital, Rennes, France
| | - Hervé Corbineau
- Department of Cardiovascular and Thoracic Surgery, Rennes University Hospital, Rennes, France
| | - Erwan Flécher
- Department of Cardiovascular and Thoracic Surgery, Rennes University Hospital, Rennes, France
| | - Yves Logeais
- Department of Cardiovascular and Thoracic Surgery, Rennes University Hospital, Rennes, France
| | - Alain Leguerrier
- Department of Cardiovascular and Thoracic Surgery, Rennes University Hospital, Rennes, France
| | - Jean-Philippe Verhoye
- Department of Cardiovascular and Thoracic Surgery, Rennes University Hospital, Rennes, France
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31
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Beve M, Auffret V, Belhaj Soulami R, Tomasi J, Anselmi A, Roisne A, Boulmier D, Bedossa M, Leurent G, Donal E, Le Breton H, Verhoye JP. Comparison of the Transarterial and Transthoracic Approaches in Nontransfemoral Transcatheter Aortic Valve Implantation. Am J Cardiol 2019; 123:1501-1509. [PMID: 30777318 DOI: 10.1016/j.amjcard.2019.01.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 01/22/2019] [Accepted: 01/25/2019] [Indexed: 10/27/2022]
Abstract
Transfemoral approach stands as the reference access-route for transcatheter aortic valve implantation (TAVI). Nonetheless, alternatives approaches are still needed in a significant proportion of patients. This study aimed at comparing outcomes between transthoracic-approach (transapical or transaortic) and transarterial-approach (transcarotid or subclavian) TAVI. Data from 191 consecutive patients who underwent surgical-approach TAVI from May 2009 to September 2017 were analyzed. Patients were allocated in 2 groups according to the approach. The primary end point was the 30-day composite of death of any cause, need for open surgery, tamponade, stroke, major or life-threatening bleeding, stage 2 or 3 acute kidney injury, coronary obstruction, or major vascular complications. During the study period, 104 patients underwent transthoracic TAVI (transapical: 60.6%, transaortic: 39.4%) whereas 87 patients underwent transarterial TAVI (subclavian: 83.9%, transcarotid: 16.1%). Logistic EuroSCORE I tended to be higher in transthoracic-TAVI recipients. In-hospital and 30-day composite end point rates were 25.0% and 11.5% (p = 0.025), and 26.0% and 14.9% (p = 0.075) for the transthoracic and transarterial cohorts, respectively. Propensity score-adjusted logistic regression demonstrated no significant detrimental association between the 30-day composite end point and transthoracic access (odds ratio 2.12 95% confidence interval 0.70 to 6.42; p = 0.18). Transarterial TAVI was associated with a shorter length of stay (median: 6 vs 7 days, p <0.001). TAVI approach was not an independent predictor of midterm mortality. In conclusion, nontransfemoral transarterial-approach TAVI is safe, feasible, and associated with comparable rates of major perioperative complications, and midterm mortality compared with transthoracic-approach TAVI.
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Shao C, Tomasi J, Morgenthaler V, Lederlin M, Verhoye JP, Haigron P. Reduced order model for patient specific fluid transient simulation of blood flow in aortic cross. Comput Methods Biomech Biomed Engin 2019. [DOI: 10.1080/10255842.2020.1713477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- C. Shao
- Ansys France
- Univ Rennes, CHU Rennes, Inserm, LTSI – UMR 1099, Rennes, France
| | - J. Tomasi
- Univ Rennes, CHU Rennes, Inserm, LTSI – UMR 1099, Rennes, France
| | | | - M. Lederlin
- Univ Rennes, CHU Rennes, Inserm, LTSI – UMR 1099, Rennes, France
| | - J. P. Verhoye
- Univ Rennes, CHU Rennes, Inserm, LTSI – UMR 1099, Rennes, France
| | - P. Haigron
- Univ Rennes, CHU Rennes, Inserm, LTSI – UMR 1099, Rennes, France
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Anselmi A, Tomasi J, Giardinelli F, Bedossa M, Rosier S, Verhoye JP. Safety and effectiveness of the transsubclavian approach for transcatheter aortic valve implantation with the 14-F CoreValve Evolut R device. J Cardiovasc Med (Hagerstown) 2018; 19:664-668. [DOI: 10.2459/jcm.0000000000000706] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Lalys F, Esneault S, Castro M, Royer L, Haigron P, Auffret V, Tomasi J. Automatic aortic root segmentation and anatomical landmarks detection for TAVI procedure planning. MINIM INVASIV THER 2018; 28:157-164. [DOI: 10.1080/13645706.2018.1488734] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | | | - Miguel Castro
- INSERM, Rennes, France
- Signal and Image Processing Laboratory (LTSI), University Rennes 1, Rennes, France
| | | | - Pascal Haigron
- INSERM, Rennes, France
- Signal and Image Processing Laboratory (LTSI), University Rennes 1, Rennes, France
| | - Vincent Auffret
- INSERM, Rennes, France
- Signal and Image Processing Laboratory (LTSI), University Rennes 1, Rennes, France
- Department of Cardiothoracic and Vascular Surgery, CHU Rennes, Rennes, France
| | - Jacques Tomasi
- Department of Cardiothoracic and Vascular Surgery, CHU Rennes, Rennes, France
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35
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Verhoye JP, Belhaj Soulami R, Fouquet O, Ruggieri VG, Kaladji A, Tomasi J, Sellin M, Farhat F, Anselmi A. Elective frozen elephant trunk procedure using the E-Vita Open Plus prosthesis in 94 patients: a multicentre French registry. Eur J Cardiothorac Surg 2017; 52:733-739. [DOI: 10.1093/ejcts/ezx159] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 03/17/2017] [Indexed: 11/14/2022] Open
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Anselmi A, Ruggieri VG, Letheulle J, Robert AL, Tomasi J, Le Tulzo Y, Verhoye JP, Flécher E. Extracorporeal Membrane Oxygenation in Pregnancy. J Card Surg 2015; 30:781-6. [DOI: 10.1111/jocs.12605] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Amedeo Anselmi
- Division of Thoracic, Cardiac and Vascular Surgery; Pontchaillou University Hospital; Rennes France
- INSERM (French National Institution for Healthcare and Medical Research) Unit 1099; University of Rennes 1; Rennes France
| | - Vito G. Ruggieri
- Division of Thoracic, Cardiac and Vascular Surgery; Pontchaillou University Hospital; Rennes France
- INSERM (French National Institution for Healthcare and Medical Research) Unit 1099; University of Rennes 1; Rennes France
| | - Julien Letheulle
- Division of Medical Intensive Care Unit; Pontchaillou University Hospital; Rennes France
| | - Anne L. Robert
- Division of Obstetrics and Gynecology; Pontchaillou University Hospital; Rennes France
| | - Jacques Tomasi
- Division of Thoracic, Cardiac and Vascular Surgery; Pontchaillou University Hospital; Rennes France
| | - Yves Le Tulzo
- Division of Medical Intensive Care Unit; Pontchaillou University Hospital; Rennes France
| | - Jean-Philippe Verhoye
- Division of Thoracic, Cardiac and Vascular Surgery; Pontchaillou University Hospital; Rennes France
- INSERM (French National Institution for Healthcare and Medical Research) Unit 1099; University of Rennes 1; Rennes France
| | - Erwan Flécher
- Division of Thoracic, Cardiac and Vascular Surgery; Pontchaillou University Hospital; Rennes France
- INSERM (French National Institution for Healthcare and Medical Research) Unit 1099; University of Rennes 1; Rennes France
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Hajj-Chahine J, Tomasi J, Corbi P. Multilevel obstruction of left ventricular outflow tract in Shone complex adult. Asian Cardiovasc Thorac Ann 2014; 23:231. [PMID: 24887923 DOI: 10.1177/0218492313515499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jamil Hajj-Chahine
- Department of Cardiothoracic Surgery, University Hospital of Poitiers, Poitiers, France
| | - Jacques Tomasi
- Department of Cardiothoracic Surgery, University Hospital of Poitiers, Poitiers, France
| | - Pierre Corbi
- Department of Cardiothoracic Surgery, University Hospital of Poitiers, Poitiers, France
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Allain G, Hajj-Chahine J, Lacroix C, Tomasi J, Corbi P, Jayle C. Surgical management of an epithelioid hemangioendothelioma of the superior vena cava protruding into the right atrium. J Card Surg 2014; 29:779-81. [PMID: 24893561 DOI: 10.1111/jocs.12370] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Epithelioid hemangioendothelioma (EH) is a rare malignant tumor of vascular origin that often involves soft tissues and visceral organs, and less commonly, large veins. We report a case of EH of the superior vena cava protruding into the right atrium and its surgical management.
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Affiliation(s)
- G Allain
- Department of Cardiothoracic Surgery, University Hospital of Poitiers, Poitiers, France
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Hajj-Chahine J, Tomasi J, Corbi P, Jayle C. Abnormal origin of the right coronary artery in a patient with left ventricular non-compaction. Eur J Cardiothorac Surg 2014; 46:506. [PMID: 24401690 DOI: 10.1093/ejcts/ezt591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jamil Hajj-Chahine
- Department of Cardio-thoracic Surgery, University Hospital of Poitiers, Poitiers, France
| | - Jacques Tomasi
- Department of Cardio-thoracic Surgery, University Hospital of Poitiers, Poitiers, France
| | - Pierre Corbi
- Department of Cardio-thoracic Surgery, University Hospital of Poitiers, Poitiers, France
| | - Christophe Jayle
- Department of Cardio-thoracic Surgery, University Hospital of Poitiers, Poitiers, France
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Hajj-Chahine J, Jayle C, Tomasi J, Corbi P. TachoSil to prevent postoperative pericardial adhesions. Ann Thorac Surg 2014; 97:378-9. [PMID: 24384202 DOI: 10.1016/j.athoracsur.2013.06.075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Revised: 05/25/2013] [Accepted: 06/11/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Jamil Hajj-Chahine
- Department of Cardiothoracic Surgery, University Hospital of Poitiers, 2 Rue de la Milétrie, 86021 Poitiers cedex, France.
| | - Christophe Jayle
- Department of Cardiothoracic Surgery, University Hospital of Poitiers, 2 Rue de la Milétrie, 86021 Poitiers cedex, France
| | - Jacques Tomasi
- Department of Cardiothoracic Surgery, University Hospital of Poitiers, 2 Rue de la Milétrie, 86021 Poitiers cedex, France
| | - Pierre Corbi
- Department of Cardiothoracic Surgery, University Hospital of Poitiers, 2 Rue de la Milétrie, 86021 Poitiers cedex, France
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Hajj-Chahine J, Allain G, Tomasi J, Jayle C, Corbi P. Aortic root replacement in a patient with left ventricular noncompaction. Ann Thorac Surg 2014; 97:e1-3. [PMID: 24384213 DOI: 10.1016/j.athoracsur.2013.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 07/27/2013] [Accepted: 08/07/2013] [Indexed: 11/26/2022]
Abstract
We describe the case of a 57-year-old woman with noncompaction of the left ventricle and regurgitant bicuspid aortic valve who presented with progressive congestive heart failure and was successfully treated with aortic root replacement. The long-term outcome for these patients is poor because of progressive left ventricular impairment, increased rates of life-threatening arrhythmias, and intraventricular thrombi. To our knowledge, only 3 patient with noncompaction of the left ventricle has been reported to have undergone aortic valve replacement for severely regurgitant bicuspid aortic valve. Herein, we describe a patient with noncompaction of the left ventricle who underwent successful mechanical aortic root replacement.
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Affiliation(s)
- Jamil Hajj-Chahine
- Department of Cardiothoracic Surgery, University Hospital of Poitiers, Poitiers, France.
| | - Géraldine Allain
- Department of Cardiothoracic Surgery, University Hospital of Poitiers, Poitiers, France
| | - Jacques Tomasi
- Department of Cardiothoracic Surgery, University Hospital of Poitiers, Poitiers, France
| | - Christophe Jayle
- Department of Cardiothoracic Surgery, University Hospital of Poitiers, Poitiers, France
| | - Pierre Corbi
- Department of Cardiothoracic Surgery, University Hospital of Poitiers, Poitiers, France
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Affiliation(s)
- Jamil Hajj-Chahine
- Department of Cardio-Thoracic Surgery, University Hospital of Poitiers, Poitiers, France
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Hajj-Chahine J, Allain G, Tomasi J, Corbi P, Jayle C. Late postcardiotomy sternal dehiscence: a simple approach using Stratos® system. J Card Surg 2013; 28:632-4. [PMID: 23656221 DOI: 10.1111/jocs.12123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Management of late sternal dehiscence is challenging and time consuming. Although numerous techniques exist including rewiring and titanium plates screwing to stabilize the sternum, we describe an alternative technique by using four titanium clips and one connecting bar.
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Affiliation(s)
- Jamil Hajj-Chahine
- Department of Cardio-thoracic Surgery, University Hospital of Poitiers, Poitiers, France
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44
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Affiliation(s)
- Jamil Hajj-Chahine
- Department of Cardio-Thoracic surgery, University Hospital of Poitiers, Poitiers, France
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45
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Hajj-Chahine J, Tomasi J, Houmaida H, Corbi P. Cardiac tamponade as a manifestation of acute mediastinitis. Interact Cardiovasc Thorac Surg 2013; 16:704. [PMID: 23606298 DOI: 10.1093/icvts/ivt105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jamil Hajj-Chahine
- Department of Cardio-Thoracic Surgery, University Hospital of Poitiers, Poitiers, France
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46
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Affiliation(s)
- Jamil Hajj-Chahine
- Department of Cardio-Thoracic surgery, University Hospital of Poitiers, Poitiers, France
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Hajj-Chahine J, Jayle C, Tomasi J, Houmaida H, Allain G, Danion J, Corbi P. Left thoracotomy for coronary artery bypass grafting in a patient with an ileo-coloplasty. Heart Lung Circ 2012; 22:392-3. [PMID: 23168350 DOI: 10.1016/j.hlc.2012.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 10/15/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Jamil Hajj-Chahine
- Department of Cardio-Thoracic Surgery, University Hospital of Poitiers, Poitiers, France.
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Hajj-Chahine J, Jayle C, Tomasi J, Corbi P. eComment. Left tilt position for cardiopulmonary bypass in parturient patients. Interact Cardiovasc Thorac Surg 2012; 15:287. [PMID: 22802512 DOI: 10.1093/icvts/ivs222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jamil Hajj-Chahine
- Department of Cardio-Thoracic Surgery, University Hospital of Poitiers, Poitiers, France
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Hajj-Chahine J, Jayle C, Tomasi J, Corbi P. eComment. Cardiac resynchronization therapy in cardiac surgery. Interact Cardiovasc Thorac Surg 2012; 15:923-4. [PMID: 23100557 PMCID: PMC3480625 DOI: 10.1093/icvts/ivs407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jamil Hajj-Chahine
- Department of Cardio-Thoracic Surgery, University Hospital of Poitiers, Poitiers, France
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Hajj-Chahine J, Houmaida H, Danion J, Tomasi J. eComment. The risk of loss of the breast flap after coronary artery bypass grafting. Interact Cardiovasc Thorac Surg 2012; 15:815. [PMID: 23100549 DOI: 10.1093/icvts/ivs416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jamil Hajj-Chahine
- Department of Cardio-Thoracic Surgery, University Hospital of Poitiers, Poitiers, France
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