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Dreyfus J, Galloo X, Taramasso M, Heitzinger G, Benfari G, Kresoja KP, Juarez-Casso F, Omran H, Bohbot Y, Iliadis C, Russo G, Topilsky Y, Weber M, Nombela-Franco L, Sala A, Eixerés-Esteve A, Iung B, Obadia JF, Estevez Loureiro R, Riant E, Donal E, Hausleiter J, Badano L, Le Tourneau T, Coisne A, Modine T, Latib A, Praz F, Windecker S, Zamorano JL, von Bardeleben RS, Tang GHL, Hahn R, Webb J, Muraru D, Nejjari M, Chan V, De Bonis M, Carnero-Alcazar M, Nickenig G, Pfister R, Tribouilloy C, Rudolph V, Crestanello J, Lurz P, Bartko P, Maisano F, Bax J, Enriquez-Sarano M, Messika-Zeitoun D. TRI-SCORE and benefit of intervention in patients with severe tricuspid regurgitation. Eur Heart J 2024; 45:586-597. [PMID: 37624856 DOI: 10.1093/eurheartj/ehad585] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 08/04/2023] [Revised: 08/20/2023] [Accepted: 08/23/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND AND AIMS Benefit of tricuspid regurgitation (TR) correction and timing of intervention are unclear. This study aimed to compare survival rates after surgical or transcatheter intervention to conservative management according to a TR clinical stage as assessed using the TRI-SCORE. METHODS A total of 2,413 patients with severe isolated functional TR were enrolled in TRIGISTRY (1217 conservatively managed, 551 isolated tricuspid valve surgery, and 645 transcatheter valve repair). The primary endpoint was survival at 2 years. RESULTS The TRI-SCORE was low (≤3) in 32%, intermediate (4-5) in 33%, and high (≥6) in 35%. A successful correction was achieved in 97% and 65% of patients in the surgical and transcatheter groups, respectively. Survival rates decreased with the TRI-SCORE in the three treatment groups (all P < .0001). In the low TRI-SCORE category, survival rates were higher in the surgical and transcatheter groups than in the conservative management group (93%, 87%, and 79%, respectively, P = .0002). In the intermediate category, no significant difference between groups was observed overall (80%, 71%, and 71%, respectively, P = .13) but benefit of the intervention became significant when the analysis was restricted to patients with successful correction (80%, 81%, and 71%, respectively, P = .009). In the high TRI-SCORE category, survival was not different to conservative management in the surgical and successful repair group (61% and 68% vs 58%, P = .26 and P = .18 respectively). CONCLUSIONS Survival progressively decreased with the TRI-SCORE irrespective of treatment modality. Compared to conservative management, an early and successful surgical or transcatheter intervention improved 2-year survival in patients at low and, to a lower extent, intermediate TRI-SCORE, while no benefit was observed in the high TRI-SCORE category.
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Affiliation(s)
- Julien Dreyfus
- Department of Cardiology, Centre Cardiologique du Nord, Saint-Denis, France
| | - Xavier Galloo
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Cardiology, Free University Brussels (VUB), University Hospital Brussels (UZ Brussel), Brussels, Belgium
| | | | - Gregor Heitzinger
- Department for Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria
| | - Giovanni Benfari
- Cardiovascular Disease Department, Mayo Clinic, Rochester, MN, USA
- Section of Cardiology, Department of Medicine, University of Verona, Italy
| | - Karl-Patrick Kresoja
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | | | - Hazem Omran
- General and Interventional Cardiology, Heart & Diabetes Center NRW, University Hospital of the Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Yohann Bohbot
- Department of Cardiology, Amiens University Hospital, Amiens, France
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
| | - Christos Iliadis
- Department for Internal Medicine III, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Giulio Russo
- Policlinico Tor Vergata, University of Rome, Rome, Italy
| | - Yan Topilsky
- Department of Cardiology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv, Israel
| | | | | | - Alessandra Sala
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Bernard Iung
- Cardiology Department, Bichat Hospital, APHP, and INSERM LVTS U1148, Université de Paris, Paris, France
| | - Jean-François Obadia
- Department of Cardiovascular Surgery and Transplantation, Louis Pradel Cardiovascular Hospital, Claude Bernard University, Bron, France
| | | | - Elisabeth Riant
- Department of Cardiology, Centre Cardiologique du Nord, Saint-Denis, France
| | - Erwan Donal
- Cardiology Department, LTSI UMR1099, INSERM, Université de Rennes-1, CHU de RENNES, Rennes, France
| | - Jörg Hausleiter
- Medical Clinic and Polyclinic I, University Hospital of Munich, Munich, Germany
| | - Luigi Badano
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Thierry Le Tourneau
- CNRS, INSERM, l'institut du thorax, Université de Nantes, CHU de Nantes, Nantes, France
| | - Augustin Coisne
- Department of Clinical Physiology and Echocardiography-Heart Valve Clinic, CHU Lille, Lille, France
- Institut Pasteur de Lille, U1011- EGID, Univ. Lille, Inserm, CHU Lille, Lille, France
| | - Thomas Modine
- Department of Cardiology and Cardio-Vascular Surgery, Hôpital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Bordeaux, France
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, New York, NY, USA
| | - Fabien Praz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Jose Luis Zamorano
- Department of Cardiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY, USA
| | - Rebecca Hahn
- Cardiology Department, NewYork-Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - John Webb
- St. Paul Hospital, Vancouver, British Columbia, Canada
| | - Denisa Muraru
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Mohammed Nejjari
- Department of Cardiology, Centre Cardiologique du Nord, Saint-Denis, France
| | - Vincent Chan
- Department of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Michele De Bonis
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | | | | | - Roman Pfister
- Department for Internal Medicine III, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Christophe Tribouilloy
- Department of Cardiology, Amiens University Hospital, Amiens, France
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
| | - Volker Rudolph
- General and Interventional Cardiology, Heart & Diabetes Center NRW, University Hospital of the Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Juan Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Philipp Lurz
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Philipp Bartko
- Department for Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria
| | - Francesco Maisano
- Cardiac Surgery and Heart Valve Center, Ospedale San Raffaele, University Vita Salute, Milano, Italy
| | - Jeroen Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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Lapeze J, Robin J, Ninet J, Obadia JF, Farhat F. Is a severe preoperative condition a contraindication for aortic valve-sparing reimplantation in type A aortic dissection? J Cardiovasc Surg (Torino) 2024; 65:69-75. [PMID: 38300164 DOI: 10.23736/s0021-9509.24.12638-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
BACKGROUND Type A aortic dissection (TAAD) surgical management is still under debate. The purpose of this study was to demonstrate the feasibility and safety of the aortic valve-sparing root reconstruction (AVSR) procedure in 92 consecutive patients operated for TAAD, even when preoperative condition was severe (malperfusion, shock or both). METHODS Our hospital database was reviewed to identify all patients who underwent an AVSR procedure for TAAD over 14 years. From May 2000 to June 2014, 92 consecutive patients were studied regarding to their preoperative condition. RESULTS Age (61±13 years) and logistic Euroscore (23.4±15.3%) as well as cross-clamping (113±39 min), cardiopulmonary bypass (142±49 min) and circulatory arrest (22±13 min) times were collected. Hospital mortality was 16.3%. Mean follow-up was complete for a mean period of 27.6 months. One patient had early reoperation for aortic insufficiency. Actuarial survival at 1 year was 82.5%. The analysis of each group showed comparable mortality and morbidity in between patients. CONCLUSIONS Based upon our experience in the management of TAAD, a reimplantation procedure could be performed regardless preoperative malperfusion or shock, with an acceptable postoperative over mortality or morbidity. A word of caution should be brought to patients over 70 years old.
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Affiliation(s)
- Joël Lapeze
- Department of Cardiovascular Surgery, Infirmerie Protestante, Caluire et Cuire, France
| | - Jacques Robin
- Department of Cardiovascular Surgery, Louis Pradel Hospital, Bron, France
| | - Jean Ninet
- Department of Cardiovascular Surgery, Louis Pradel Hospital, Bron, France
| | | | - Fadi Farhat
- Department of Cardiovascular Surgery, Infirmerie Protestante, Caluire et Cuire, France -
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Ronco D, Matteucci M, Ravaux JM, Kowalewski M, Massimi G, Torchio F, Trumello C, Naito S, Bonaros N, De Bonis M, Fina D, Kowalówka A, Deja M, Jiritano F, Serraino GF, Kalisnik JM, De Vincentiis C, Ranucci M, Fischlein T, Russo CF, Carrozzini M, Boeken U, Kalampokas N, Golino M, De Ponti R, Pozzi M, Obadia JF, Thielmann M, Scrofani R, Blasi S, Troise G, Antona C, De Martino A, Falcetta G, Actis Dato G, Severgnini P, Musazzi A, Lorusso R. Impact of COVID-19 on incidence and outcomes of post-infarction mechanical complications in Europe. Interdiscip Cardiovasc Thorac Surg 2023; 37:ivad198. [PMID: 38109676 PMCID: PMC10749759 DOI: 10.1093/icvts/ivad198] [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] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/07/2023] [Accepted: 12/17/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVES Post-acute myocardial infarction mechanical complications (post-AMI MCs) represent rare but life-threatening conditions, including free-wall rupture, ventricular septal rupture and papillary muscle rupture. During the coronavirus disease-19 (COVID-19) pandemic, an overwhelming pressure on healthcare systems led to delayed and potentially suboptimal treatments for time-dependent conditions. As AMI-related hospitalizations decreased, limited information is available whether higher rates of post-AMI MCs and related deaths occurred in this setting. This study was aimed to assess how COVID-19 in Europe has impacted the incidence, treatment and outcome of MCs. METHODS The CAUTION-COVID19 study is a multicentre retrospective study collecting 175 patients with post-AMI MCs in 18 centres from 6 European countries, aimed to compare the incidence of such events, related patients' characteristics, and outcomes, between the first year of pandemic and the 2 previous years. RESULTS A non-significant increase in MCs was observed [odds ratio (OR) = 1.15, 95% confidence interval (CI) 0.85-1.57; P = 0.364], with stronger growth in ventricular septal rupture diagnoses (OR = 1.43, 95% CI 0.95-2.18; P = 0.090). No significant differences in treatment types and mortality were found between the 2 periods. In-hospital mortality was 50.9% and was higher for conservatively managed cases (90.9%) and lower for surgical patients (44.0%). Patients admitted during COVID-19 more frequently had late-presenting infarction (OR = 2.47, 95% CI 1.24-4.92; P = 0.010), more stable conditions (OR = 2.61, 95% CI 1.27-5.35; P = 0.009) and higher EuroSCORE II (OR = 1.04, 95% CI 1.01-1.06; P = 0.006). CONCLUSIONS A non-significant increase in MCs incidence occurred during the first year of COVID-19, characterized by a significantly higher rate of late-presenting infarction, stable conditions and EuroSCORE-II if compared to pre-pandemic data, without affecting treatment and mortality.
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Affiliation(s)
- Daniele Ronco
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands
- Department of Medicine and Surgery, Circolo Hospital, University of Insubria, Varese, Italy
- Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
- Congenital Cardiac Surgery Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Cardiac Surgery Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milan, Italy
| | - Matteo Matteucci
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands
- Department of Medicine and Surgery, Circolo Hospital, University of Insubria, Varese, Italy
- Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
| | - Justine Mafalda Ravaux
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Mariusz Kowalewski
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands
- Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw, Poland
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
| | - Giulio Massimi
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands
- Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
- Cardiac Surgery Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milan, Italy
| | - Federica Torchio
- Department of Medicine and Surgery, Circolo Hospital, University of Insubria, Varese, Italy
- Cardiac Surgery Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Cinzia Trumello
- Cardiothoracic Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Shiho Naito
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Michele De Bonis
- Cardiothoracic Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Dario Fina
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands
- Department of Cardiology, Città di Lecce Hospital, GVM Care and Research, Lecce, Italy
| | - Adam Kowalówka
- Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
- Department of Cardiac Surgery, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
- Department of Cardiac Surgery, Upper-Silesian Heart Center, Katowice, Poland
| | - Marek Deja
- Department of Cardiac Surgery, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
- Department of Cardiac Surgery, Upper-Silesian Heart Center, Katowice, Poland
| | - Federica Jiritano
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands
- Department of Experimental and Clinical Medicine, “Magna Graecia” University of Catanzaro, Catanzaro, Italy
| | | | - Jurij Matija Kalisnik
- Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Carlo De Vincentiis
- Cardiac Surgery Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Marco Ranucci
- Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Theodor Fischlein
- Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | | | | | - Udo Boeken
- Department of Cardiovascular Surgery, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Nikolaos Kalampokas
- Department of Cardiovascular Surgery, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Michele Golino
- Department of Medicine and Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Roberto De Ponti
- Department of Medicine and Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Matteo Pozzi
- Department of Cardiac Surgery, Louis Pradel Cardiologic Hospital, Lyon, France
| | | | - Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West-German Heart Center, University of Duisburg-Essen, Essen, Germany
| | - Roberto Scrofani
- Cardiac Surgery Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefania Blasi
- Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Giovanni Troise
- Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Carlo Antona
- Cardiac Surgery Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Giosuè Falcetta
- Section of Cardiac Surgery, University Hospital, Pisa, Italy
| | | | - Paolo Severgnini
- Department of Biotechnology and Sciences of Life, Circolo Hospital, University of Insubria, Varese, Italy
| | | | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands
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Ronco D, Ariza-Solé A, Kowalewski M, Matteucci M, Di Mauro M, López-de-Sá E, Ranucci M, Sionis A, Bonaros N, De Bonis M, Russo CF, Uribarri A, Montero S, Fischlein T, Kowalówka A, Naito S, Obadia JF, Martín-Asenjo R, Aboal J, Thielmann M, Simon C, Andrea-Riba R, Parra C, Folliguet T, Martínez-Sellés M, Sanmartín Fernández M, Al-Attar N, Viana Tejedor A, Serraino GF, Burgos Palacios V, Boeken U, Raposeiras Roubin S, Solla Buceta MA, Sánchez Fernández PL, Scrofani R, Pastor Báez G, Jorge Pérez P, Actis Dato G, Garcia-Rubira JC, de Gea Garcia JH, Massimi G, Musazzi A, Lorusso R. The current clinical practice for management of post-infarction ventricular septal rupture: a European survey. Eur Heart J Open 2023; 3:oead091. [PMID: 37840585 PMCID: PMC10568658 DOI: 10.1093/ehjopen/oead091] [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] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/17/2023] [Accepted: 09/01/2023] [Indexed: 10/17/2023]
Abstract
Aims Many historical and recent reports showed that post-infarction ventricular septal rupture (VSR) represents a life-threatening condition and the strategy to optimally manage it remains undefined. Therefore, disparate treatment policies among different centres with variable results are often described. We analysed data from European centres to capture the current clinical practice in VSR management. Methods and results Thirty-nine centres belonging to eight European countries participated in a survey, filling a digital form of 38 questions from April to October 2022, to collect information about all the aspects of VSR treatment. Most centres encounter 1-5 VSR cases/year. Surgery remains the treatment of choice over percutaneous closure (71.8% vs. 28.2%). A delayed repair represents the preferred approach (87.2%). Haemodynamic conditions influence the management in almost all centres, although some try to achieve patients stabilization and delayed surgery even in cardiogenic shock. Although 33.3% of centres do not perform coronarography in unstable patients, revascularization approaches are widely variable. Most centres adopt mechanical circulatory support (MCS), mostly extracorporeal membrane oxygenation, especially pre-operatively to stabilize patients and achieve delayed repair. Post-operatively, such MCS are more often adopted in patients with ventricular dysfunction. Conclusion In real-life, delayed surgery, regardless of the haemodynamic conditions, is the preferred strategy for VSR management in Europe. Extracorporeal membrane oxygenation is becoming the most frequently adopted MCS as bridge-to-operation. This survey provides a useful background to develop dedicated, prospective studies to strengthen the current evidence on VSR treatment and to help improving its currently unsatisfactory outcomes.
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Affiliation(s)
- Daniele Ronco
- Congenital Cardiac Surgery Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
| | - Albert Ariza-Solé
- Cardiology Department, Bellvitge University Hospital, Barcelona, Spain
| | - Mariusz Kowalewski
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
- Department of Cardiac Surgery and Transplantology, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Matteo Matteucci
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
- Cardiac Surgery Unit, ASST dei Sette Laghi, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Michele Di Mauro
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Esteban López-de-Sá
- Department of Cardiology, IDIPAZ, Hospital Universitario La Paz, Madrid, Spain
| | - Marco Ranucci
- Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alessandro Sionis
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Michele De Bonis
- Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
| | | | - Aitor Uribarri
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Santiago Montero
- Acute Cardiovascular Care Unit, Cardiology, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Spain
| | - Theodor Fischlein
- Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Adam Kowalówka
- Department of Cardiac Surgery, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| | - Shiho Naito
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | | | - Roberto Martín-Asenjo
- Intensive Cardiac Care Unit, Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre, Madrid, Spain
| | - Jaime Aboal
- Cardiology Department, Hospital Josep Trueta, Girona, Spain
| | - Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Germany
| | - Caterina Simon
- Cardiovascular and Transplant Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Rut Andrea-Riba
- Acute Cardiac Care Unit, Cardiology Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Carolina Parra
- Cardiology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Thierry Folliguet
- Department of Cardio-Thoracic Surgery, University Hospital Henri-Mondor, Assistance Publique–Hopitaux de Paris Créteil, Paris, France
| | - Manuel Martínez-Sellés
- Department of Cardiology, Hospital General Universitario Gregorio Marañon, CIBERCV, and Universidad Europea, Universidad Complutense, Madrid, Spain
| | | | - Nawwar Al-Attar
- Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, UK
| | - Ana Viana Tejedor
- Department of Cardiology, Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | | | - Udo Boeken
- Department of Cardiac Surgery, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | | | | | | | - Roberto Scrofani
- Cardiac Surgery Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Gemma Pastor Báez
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Pablo Jorge Pérez
- Cardiology Unit, University Hospital of the Canary Islands, La Laguna, Spain
| | | | | | - Jose H de Gea Garcia
- Coronary Care Unit, Department of Intensive Care Medicine, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Giulio Massimi
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
| | - Andrea Musazzi
- Cardiac Surgery Unit, ASST dei Sette Laghi, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
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Ludwig S, Perrin N, Coisne A, Ben Ali W, Weimann J, Duncan A, Akodad M, Scotti A, Kalbacher D, Bleiziffer S, Nickenig G, Hausleiter J, Ruge H, Adam M, Petronio AS, Dumonteil N, Sondergaard L, Adamo M, Regazzoli D, Garatti A, Schmidt T, Dahle G, Taramasso M, Walther T, Kempfert J, Obadia JF, Chehab O, Tang GHL, Latib A, Goel SS, Fam NP, Andreas M, Muller DW, Denti P, Praz F, von Bardeleben RS, Granada JF, Modine T, Conradi L. Clinical outcomes of transcatheter mitral valve replacement: two-year results of the CHOICE-MI Registry. EUROINTERVENTION 2023; 19:512-525. [PMID: 37235388 PMCID: PMC10436071 DOI: 10.4244/eij-d-22-01037] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 03/31/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Transcatheter mitral valve replacement (TMVR) using dedicated devices is an alternative therapy for high-risk patients with symptomatic mitral regurgitation (MR). AIMS This study aimed to assess the 2-year outcomes and predictors of mortality in patients undergoing TMVR from the multicentre CHOICE-MI Registry. METHODS The CHOICE-MI Registry included consecutive patients with symptomatic MR treated with 11 different dedicated TMVR devices at 31 international centres. The investigated endpoints included mortality and heart failure hospitalisation rates, procedural complications, residual MR, and functional status. Multivariable Cox regression analysis was applied to identify independent predictors of 2-year mortality. RESULTS A total of 400 patients, median age 76 years (interquartile range [IQR] 71, 81), 59.5% male, EuroSCORE II 6.2% (IQR 3.8, 12.0), underwent TMVR. Technical success was achieved in 95.2% of patients. MR reduction to ≤1+ was observed in 95.2% at discharge with durable results at 1 and 2 years. New York Heart Association Functional Class had improved significantly at 1 and 2 years. All-cause mortality was 9.2% at 30 days, 27.9% at 1 year and 38.1% at 2 years after TMVR. Chronic obstructive pulmonary disease, reduced glomerular filtration rate, and low serum albumin were independent predictors of 2-year mortality. Among the 30-day complications, left ventricular outflow tract obstruction, access site and bleeding complications showed the strongest impact on 2-year mortality. CONCLUSIONS In this real-world registry of patients with symptomatic MR undergoing TMVR, treatment with TMVR was associated with a durable resolution of MR and significant functional improvement at 2 years. Two-year mortality was 38.1%. Optimised patient selection and improved access site management are mandatory to improve outcomes.
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Affiliation(s)
- Sebastian Ludwig
- Department of Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Cardiovascular Research Foundation, New York, NY, USA
| | - Nils Perrin
- Structural Valve Program, Montreal Heart Institute, Montreal, QC, Canada
| | - Augustin Coisne
- Cardiovascular Research Foundation, New York, NY, USA
- CHU Lille, Institut Pasteur de Lille, Lille, France
| | - Walid Ben Ali
- Structural Valve Program, Montreal Heart Institute, Montreal, QC, Canada
| | - Jessica Weimann
- Department of Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | | | | | - Andrea Scotti
- Cardiovascular Research Foundation, New York, NY, USA
- Montefiore Einstein Center for Heart and Vascular Care, Montefiore Medical Center, New York, NY, USA
| | - Daniel Kalbacher
- Department of Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Sabine Bleiziffer
- Department of Cardiothoracic Surgery, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany and Ruhr University Bochum, Bochum, Germany
| | | | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Hendrik Ruge
- Department of Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
- INSURE – Institute for Translational Cardiac Surgery, Department of Cardiovascular Surgery, German Heart Centre Munich, Germany
| | - Matti Adam
- Department of Cardiology, Heart Center, University Hospital Cologne, Cologne, Germany
| | - Anna Sonia Petronio
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Nicolas Dumonteil
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur Toulouse, Toulouse, France
| | | | - Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili di Brescia, Brescia, Italy and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | | | | | - Tobias Schmidt
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Gry Dahle
- Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | | | | | | | | | | | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY, USA
| | - Azeem Latib
- Montefiore Einstein Center for Heart and Vascular Care, Montefiore Medical Center, New York, NY, USA
| | - Sachin S Goel
- Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Neil P Fam
- St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | | | | | - Fabien Praz
- Universitätsklinik für Kardiologie, Inselspital Bern, Bern, Switzerland
| | | | | | - Thomas Modine
- Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
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Ludwig S, Conradi L, Cohen DJ, Coisne A, Scotti A, Abraham WT, Ben Ali W, Zhou Z, Li Y, Kar S, Duncan A, Lim DS, Adamo M, Redfors B, Muller DWM, Webb JG, Petronio AS, Ruge H, Nickenig G, Sondergaard L, Adam M, Regazzoli D, Garatti A, Schmidt T, Andreas M, Dahle G, Walther T, Kempfert J, Tang GH, Redwood SR, Taramasso M, Praz F, Fam NP, Dumonteil N, Obadia JF, von Bardeleben RS, Rudolph TK, Reardon MJ, Metra M, Denti P, Mack MJ, Hausleiter J, Asch FM, Latib A, Lindenfeld J, Modine T, Stone GW, Granada JF. Transcatheter Mitral Valve Replacement versus Medical Therapy for Secondary Mitral Regurgitation: A Propensity Score-Matched Comparison. Circ Cardiovasc Interv 2023. [PMID: 37194288 DOI: 10.1161/circinterventions.123.013045] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Background: Transcatheter mitral valve replacement (TMVR) is an emerging therapeutic alternative for patients with secondary mitral regurgitation (MR). Outcomes of TMVR versus guideline-directed medical therapy (GDMT) have not been investigated for this population. This study aimed to compare clinical outcomes of patients with secondary MR undergoing TMVR versus GDMT alone. Methods: The CHOICE-MI registry included patients with MR undergoing TMVR using dedicated devices. Patients with MR etiologies other than secondary MR were excluded. Patients treated with GDMT alone were derived from the control arm of the COAPT trial. We compared outcomes between the TMVR and GDMT groups, using propensity score (PS)-matching to adjust for baseline differences. Results: After PS-matching, 97 patient pairs undergoing TMVR (72.9±8.7 years, 60.8% male, transapical access 91.8%) versus GDMT (73.1±11.0 years, 59.8% male) were compared. At 1 and 2 years, residual MR was ≤1+ in all patients of the TMVR group compared to 6.9% and 7.7%, respectively, in those receiving GDMT alone (both p<0.001). The 2-year rate of HF hospitalization was significantly lower in the TMVR group (32.8% vs. 54.4%, HR 0.59, 95% CI 0.35-0.99; p=0.04). Among survivors, a higher proportion of patients were in NYHA functional class I or II in the TMVR group at 1 year (78.2% vs. 59.7%, p=0.03) and at 2 years (77.8% vs. 53.2%, p=0.09). Two-year mortality was similar in the two groups (TMVR vs. GDMT, 36.8% vs. 40.8%, HR 1.01, 95% CI 0.62-1.64; p=0.98). Conclusions: In this observational comparison, over 2-year follow-up, TMVR using mostly transapical devices in patients with secondary MR was associated with significant reduction of MR, symptomatic improvement, less frequent hospitalizations for HF and similar mortality compared with GDMT.
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Affiliation(s)
- Sebastian Ludwig
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; German Center for Cardiovascular Research (DZHK): Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany; Cardiovascular Research Foundation, New York, NY
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - David J Cohen
- Cardiovascular Research Foundation, New York, NY; St. Francis Hospital, Roslyn, NY
| | - Augustin Coisne
- Cardiovascular Research Foundation, New York, NY; Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011- EGID, F-59000 Lille, France
| | - Andrea Scotti
- Cardiovascular Research Foundation, New York, NY; Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, New York, NY
| | - William T Abraham
- Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart & Lung Research Institute, The Ohio State University, Columbus, OH
| | - Walid Ben Ali
- Structural Valve Program, Montreal Heart Institute, Montréal, Canada
| | - Zhipeng Zhou
- Cardiovascular Research Foundation, New York, NY
| | - Yanru Li
- Cardiovascular Research Foundation, New York, NY
| | - Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, CA; Bakersfield Heart Hospital, Bakersfield, CA
| | | | - D Scott Lim
- Division of Cardiology, University of Virginia, Charlottesville, VA
| | - Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Björn Redfors
- Cardiovascular Research Foundation, New York, NY; NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden and Wallenberg Laboratory, Institute of Medicine, University of Gothenburg, Sweden
| | - David W M Muller
- Cardiology Dept, St. Vincent's Hospital, Sydney, Australia and School of Clinical Medicine, UNSW Medicine and Health UNSW Sydney, NSW 2052, Australia
| | - John G Webb
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Anna Sonia Petronio
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Hendrik Ruge
- German Heart Center Munich, Department of Cardiovascular Surgery, Munich, Germany; INSURE Institute for Translational Cardiac Surgery, Department of Cardiovascular Surgery, German Heart Center Munich, Germany
| | | | | | - Matti Adam
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | | | | | - Tobias Schmidt
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Gry Dahle
- Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | | | | | - Gilbert Hl Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY
| | | | | | - Fabien Praz
- Universitätsklinik für Kardiologie, Inselspital Bern, Bern, Switzerland
| | - Neil P Fam
- St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Nicolas Dumonteil
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur Toulouse, Toulouse, France
| | | | | | - Tanja Katharina Rudolph
- Department of Interventional and General Cardiology, Heart- and Diabetes Center Nordrhine-Westphalia, Bad Oeynhausen, Ruhr University Bochum, Germany
| | | | - Marco Metra
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | | | | | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Federico M Asch
- Cardiovascular Core Laboratories, MedStar Health Research Institute, Washington, DC
| | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, New York, NY
| | - JoAnn Lindenfeld
- Advanced Heart Failure and Cardiac Transplantation Section, Vanderbilt Heart and Vascular Institute, Nashville, TN
| | - Thomas Modine
- Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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Connock M, Auguste P, Capelle A, Hénaine AM, Obadia JF, Armoiry X. Potential impact on cost-effectiveness estimates of using immature survival data: a case study based on transcatheter edge-to-edge repair (TEER) used for patients with severe mitral regurgitation at high surgical risk. BMJ Open 2023; 13:e060423. [PMID: 36918244 PMCID: PMC10016287 DOI: 10.1136/bmjopen-2021-060423] [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] [Indexed: 03/16/2023] Open
Abstract
OBJECTIVE To review the survival modelling used in cost-effectiveness studies evaluating an interventional procedure and to discuss implications for decision-makers. DESIGN A case study of three economic evaluations that each used immature data from the EVEREST II High Surgical Risk (HSR) Study of transcatheter edge-to-edge repair (TEER) for patients with severe mitral regurgitation (MR) who were at high risk of surgery. SETTING Estimation of patient survival in cost-effectiveness studies. PARTICIPANTS The EVEREST II HSR Study included 78 patients who had TEER of the mitral valve using the MitraClip device and a retrospectively identified control group of 36 patients who received medical management and were followed up for 12 months. Observed survival (TEER arm only) was updated at 5 years. RESULTS Two studies used 12-month observed mortality from EVEREST II HSR to model survival over lifetime horizons. Observed and modelled survival were associated with considerable uncertainty due to short follow-up and small numbers of participants. Modelling control patients' survival required an approximate 10-fold extrapolation based on 12-month observation of only 38 patients. Observed 5-year survival in the TEER group differed from that less mature follow-up suggesting that survival modelling based on shorter follow-up was unsatisfactory. No public domain data for the control group are available beyond 12-month follow-up so meaningful estimates using mature data for both arms are currently not possible. A third study developed survival models using incompletely reported transitions between MR grades in EVEREST II HSR and mortality rates observed for different MR grades derived from a study in an unrelated population. CONCLUSIONS Modelling survival in such small samples followed up for only 12 months is associated with great uncertainty, and cost-effectiveness results based on these analyses should be viewed as premature and used cautiously in reimbursement decisions.
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Affiliation(s)
- Martin Connock
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Peter Auguste
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Aude Capelle
- Pharmacy Department, Saint-Etienne University Hospital Bellevue Site, Saint-Etienne, France
| | | | - Jean-François Obadia
- Hôpital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque, Hospices Civils de Lyon and Claude Bernard University, Lyon, France
| | - Xavier Armoiry
- Warwick Medical School, University of Warwick, Coventry, UK
- School of Pharmacy (ISPB)/UMR CNRS 5510 MATEIS/ Edouard Herriot Hospital, Pharmacy Department, University of Lyon, Lyon, France
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8
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Connock M, Auguste P, Obadia JF, Andronis L, Armoiry X. Impact of updated trial data on the cost-effectiveness of percutaneous mitral repair. PLoS One 2023; 18:e0280554. [PMID: 36701304 PMCID: PMC9879464 DOI: 10.1371/journal.pone.0280554] [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] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 01/03/2023] [Indexed: 01/27/2023] Open
Abstract
When updated clinical trial data becomes available reassessing the cost-effectiveness of technologies may modify estimates and influence decision-making. We investigated the impact of updated trial outcomes on the cost-effectiveness of percutaneous mitral repair (PR) for secondary mitral regurgitation. We updated our previous three-state time-varying Markov model to assess the cost-effectiveness of PR + guideline directed medical treatment (GDMT) versus GDMT alone. Key clinical inputs (overall survival (OS) and heart failure hospitalisations (HFH)) were obtained using the 3-year trial findings from the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy) RCT. We calculated incremental cost-effectiveness ratios (ICER) and report how these differ between analyses based on early (2-year) and updated (3-year) evidence. Updated trial data showed an increase in mortality in the intervention arm between two and three years follow-up that was not seen in the control arm. Deterministic and multivariate cost-effectiveness modelling yielded incremental cost effectiveness ratios ICERs of €38,123 and €31,227 /QALY. Compared to our 2-year based estimate (€21,918 / QALY) these results imply an approximate 1.5-fold increase in ICER. The availability of updated survival analyses from the COAPT pivotal trial suggests previous estimates based on 2-year trial findings were over optimistic for the intervention.
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Affiliation(s)
- Martin Connock
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Peter Auguste
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Jean-François Obadia
- Chirurgie Cardio-Vasculaire et Transplantation Cardiaque, Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon and Claude Bernard University, Lyon, France
| | - Lazaros Andronis
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Xavier Armoiry
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Pharmacy Department, School of Pharmacy (ISPB) / UMR CNRS 5510 MATEIS / Edouard Herriot Hospital, University of Lyon, Lyon, France
- * E-mail:
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9
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Dreyfus J, Bohbot Y, Coisne A, Lavie-Badie Y, Riant E, Modine T, Le Tourneau T, Tribouilloy C, Donal E, Habib G, Selton-Suty C, Iung B, Obadia JF, Audureau E, Messika-Zeitoun D. Redo isolated tricuspid valve surgery: prediction of in-hospital mortality using the TRI-SCORE. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1600] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Redo isolated tricuspid valve surgery (ITVS) is rarely performed. The TRI-SCORE reliably predicts in-hospital mortality after ITVS on native valve but has not been tested in the setting of redo interventions.
Purpose
We aimed to compare the predictive value of the TRI-SCORE to other surgical risk scores for redo ITVS.
Methods
Using a mandatory administrative database, we identified all consecutive adult patients who underwent a redo ITVS at 12 French tertiary centers between 2007 and 2017. Baseline characteristics and outcomes were collected from chart review and the TRI-SCORE, Logistic EuroSCORE, EuroSCORE II and STS were calculated.
Results
We identified 70 patients who underwent a redo ITVS (mean age 54±15 years, 63% female). Prior intervention was a repair in 51% and a replacement in 49%. A tricuspid valve replacement was performed in all patients. In-hospital mortality was 10%. The TRI-SCORE was the only risk score associated with in-hospital mortality (p=0.01). Area under the receiver operating characteristic curve for the TRI-SCORE was 0.83, much higher than with logistic EuroSCORE (0.58), EuroSCORE II (0.61) or STS (0.59). The table presents the observed and predicted values of in-hospital mortality according to TRI-SCORE categories.
Conclusion
The TRI-SCORE accurately predicted in-hospital mortality after redo isolated tricuspid valve surgery and may guide the clinical decision-making process especially as transcatheter therapies are emerging.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Dreyfus
- Centre Cardiologique du Nord (CCN) , Saint Denis , France
| | - Y Bohbot
- University Hospital of Amiens , Amiens , France
| | - A Coisne
- Chru De Lille - Institut Coeur-Poumons , Lille , France
| | - Y Lavie-Badie
- Toulouse Rangueil University Hospital (CHU) , Toulouse , France
| | - E Riant
- University Hospital Henri Mondor , Creteil , France
| | - T Modine
- Chru De Lille - Institut Coeur-Poumons , Lille , France
| | | | | | - E Donal
- Hospital Pontchaillou of Rennes , Rennes , France
| | - G Habib
- Aix-Marseille University , Marseille , France
| | | | - B Iung
- AP-HP-Bichat Hospital-Cardiology Department , Paris , France
| | - J F Obadia
- Hospital Louis Pradel of Bron , Lyon , France
| | - E Audureau
- University Hospital Henri Mondor , Creteil , France
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Leurent G, Auffret V, Donal E, Corbineau H, Grinberg D, Bonnet G, Leroux PY, Guérin P, Wautot F, Lefèvre T, Messika-Zeitoun D, Iung B, Armoiry X, Trochu JN, Boutitie F, Obadia JF. Delayed hospitalisation for heart failure after transcatheter repair or medical treatment for secondary mitral regurgitation: a landmark analysis of the MITRA-FR trial. EUROINTERVENTION 2022; 18:514-523. [PMID: 35611516 PMCID: PMC10241268 DOI: 10.4244/eij-d-21-00846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 04/05/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND In the MITRA-FR trial, transcatheter mitral valve repair (TMVR) was not associated with a 2-year clinical benefit in patients with secondary mitral regurgitation (SMR). AIMS This landmark analysis aimed at investigating a potential reduction of the hospitalisation rate for heart failure (HF) between 12 and 24 months after inclusion in the MITRA-FR trial in patients randomised to the intervention group (TMVR with the MitraClip device), as compared with patients randomised to the control group (guideline-directed medical therapy [GDMT]). METHODS The MITRA-FR trial randomised 307 patients with SMR for TMVR on top of GDMT (TMVR group; n=152) or for GDMT alone (control group; n=155). We conducted a 12-month landmark analysis in surviving patients who were not hospitalised for HF within the first 12 months of follow-up. The primary endpoint was the 1-year cumulative number of HF hospitalisations. RESULTS A total of 140 patients (TMVR group: 67; GDMT group: 73) were selected for this landmark analysis with similar characteristics at inclusion in the trial. The primary endpoint was 28 events per 100 patient-years in the TMVR group, as compared with 60 events per 100 patient-years in the GDMT group (hazard ratio [HR] 0.46, 95% confidence interval [CI]: 0.20-1.02; p=0.057). CONCLUSIONS In this landmark analysis of the MITRA-FR trial, the cumulative rate of HF hospitalisation between 12 and 24 months among patients treated with TMVR on top of GDMT was approximately half as many as those of patients treated with GDMT alone, a difference which did not reach statistical significance in the setting of a low number of events.
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Affiliation(s)
- Guillaume Leurent
- Université de Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France
- Service de Cardiologie, CHU Rennes, Rennes, France
| | - Vincent Auffret
- Université de Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France
- Service de Cardiologie, CHU Rennes, Rennes, France
| | - Erwan Donal
- Université de Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France
- Service de Cardiologie, CHU Rennes, Rennes, France
| | - Hervé Corbineau
- Division of Thoracic and Cardiovascular Surgery, CHU Rennes, Rennes, France
| | - Daniel Grinberg
- Hôpital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque, Hospices Civils de Lyon and Claude Bernard University, Lyon, France
| | - Guillaume Bonnet
- Service de Cardiologie Interventionnelle, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France and Aix-Marseille Université, INSERM, Marseille, France
| | - Pierre-Yves Leroux
- Cardiologie Médicale et Structurelle, Médipôle Lyon-Villeurbanne, France
| | - Patrice Guérin
- Université Nantes, CHU Nantes, CNRS, INSERM, L'institut du Thorax, Nantes, France
| | | | - Thierry Lefèvre
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | | | - Bernard Iung
- Hôpital Bichat - Claude Bernard, DHU FIRE, Paris, France and Université de Paris and INSERM 1148, Paris, France
| | - Xavier Armoiry
- Pharmacy Department, University of Lyon, School of Pharmacy (ISPB)/UMR CNRS 5510 MATEIS/Edouard Herriot Hospital, Lyon, France
- University of Warwick, Warwick Medical School, Coventry, United Kingdom
| | - Jean-Noël Trochu
- Université Nantes, CHU Nantes, CNRS, INSERM, L'institut du Thorax, Nantes, France
| | - Florent Boutitie
- Service de Biostatistique - Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon; and Université Lyon 1, Villeurbanne, France; and CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Jean-François Obadia
- Hôpital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque, Hospices Civils de Lyon and Claude Bernard University, Lyon, France
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11
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Jabeur M, Carabelli A, Jacon P, Venier S, Obadia JF, Defaye P. Mitral valve perforation after left lateral accessory pathway ablation: a case report. J Cardiothorac Surg 2022; 17:30. [PMID: 35255938 PMCID: PMC8903660 DOI: 10.1186/s13019-021-01710-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 11/01/2021] [Indexed: 11/15/2022] Open
Abstract
Background Radiofrequency catheter ablation is considered to be a relatively safe procedure. This is an unusual case report in which severe mitral regurgitation was occurred after left lateral accessory pathway radiofrequency catheter ablation. Case presentation A 15-year-old man without structural heart disease was referred for ablation of a left lateral accessory pathway. He was a rugby player who had lived with Wolff–Parkinson–White syndrome since 2017. In 2017, two failed extensive radiofrequency catheter ablations of a left lateral accessory pathway had been performed in another center. In June 2018, he underwent a third radiofrequency catheter ablation of a left lateral accessory pathway using an anterograde transseptal approach with an early recurrence one month later. A successful fourth procedure was performed in August 2018 using a retrograde aortic approach. Three months later, the patient presented to the hospital with atypical chest pain and dyspnea on exertion. Transthoracic echocardiography revealed severe mitral regurgitation caused by a perforation of the posterior leaflet. Given the symptoms and the severity of the mitral valve regurgitation, the decision was taken to proceed with surgical intervention. Posterior mitral leaflet perforation was confirmed intraoperatively. The patient underwent video-assisted mitral valve repair via Minithoracotomy approach. Conclusion This case demonstrates a very rare complication of Wolff–Parkinson–White radiofrequency ablation.
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Affiliation(s)
- Mariem Jabeur
- Arrhythmias Unit, Department of Cardiology, Grenoble University Hospital, CS 10217, 38043, Grenoble Cedex 09, France
| | - Adrien Carabelli
- Arrhythmias Unit, Department of Cardiology, Grenoble University Hospital, CS 10217, 38043, Grenoble Cedex 09, France
| | - Peggy Jacon
- Arrhythmias Unit, Department of Cardiology, Grenoble University Hospital, CS 10217, 38043, Grenoble Cedex 09, France
| | - Sandrine Venier
- Arrhythmias Unit, Department of Cardiology, Grenoble University Hospital, CS 10217, 38043, Grenoble Cedex 09, France
| | - Jean-François Obadia
- Department of Cardiovascular Surgery, Louis Pradel Hospital, 59 Boulevard Pinel, 69500, Bron, France
| | - Pascal Defaye
- Arrhythmias Unit, Department of Cardiology, Grenoble University Hospital, CS 10217, 38043, Grenoble Cedex 09, France.
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12
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Dreyfus J, Obadia JF, Messika-Zeitoun D. Tricuspid regurgitation: Light at the end of the tunnel? Arch Cardiovasc Dis 2022; 115:117-121. [DOI: 10.1016/j.acvd.2021.12.008] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/05/2021] [Accepted: 12/06/2021] [Indexed: 11/24/2022]
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13
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Hayek A, Azar L, Pozzi M, Grinberg D, Abou-Saleh I, Simion H, Tomasevic D, Prieur C, Kochly F, Scheppler B, Rioufol G, Derimay F, Farhat F, Obadia JF, Mewton N, Bonnefoy-Cudraz E, Bochaton T. Ventricular septal rupture: insights into an old disease. Heart Vessels 2022; 37:1305-1315. [PMID: 35133497 DOI: 10.1007/s00380-022-02031-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/21/2022] [Indexed: 11/04/2022]
Abstract
Ventricular septal rupture (VSR) is a serious complication of ST-elevation myocardial infarction (STEMI) and surgery is the reference treatment. We aimed at describing trends in management and mortality during the last four decades and reporting mortality predictors in these patients. We conducted a single-center retrospective study of patients sustaining a VSR from 1981 to 2020. We screened 274 patients and included 265 for analysis. The number of patients decreased over the years: 80, 88, 56, and 50 in each 10-year time span. In-hospital mortality decreased significantly since 1990 (logrank 0.007). The median age was 72.0 years IQR [66-78] and 188 patients (70.9%) were operated on. IABP was used more routinely (p < 0.0001). In-hospital mortality was assessed at 66.8% (177 patients) and main predictors of death were a time from MI to surgery < 8 days HR 2.7 IC95% [1.9-3.8] p < 0.0001, a Killip class > 2 HR 2.5 IC [1.9-3.4] p < 0.0001 and Euroscore 2 > 20 HR 2.4 IC [1.8-3.2] p < 0.0001. A "time from MI to surgery" of 8 days offers the best ability to discriminate between patients with or without mortality. The ability of "Euroscore 2 and Killip" to detect the patients most likely to wait 8 days for surgery was at 0.81 [0.73-0.89] p < 0.0001. Mortality remains high over the years. Euroscore 2, Killip class, and time from MI to surgery are the main mortality predictors. Patients with a Killip < 3 and a Euroscore < 20 should be monitored at least 8 days since MI before being referred to surgery.
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Affiliation(s)
- Ahmad Hayek
- Cardiac Intensive Care Unit, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France. .,Claude Bernard University Lyon 1, Villeurbanne, France. .,INSERM U1060, CarMeN laboratory, Université de Lyon, Groupement Hospitalier Est, Bâtiment B13, 59 boulevard Pinel, 69500, Bron, France.
| | - Léa Azar
- Cardiac Intensive Care Unit, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France.,Claude Bernard University Lyon 1, Villeurbanne, France
| | - Matteo Pozzi
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, 28 Avenue du Doyen Lépine, 69500, Lyon, France
| | - Daniel Grinberg
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, 28 Avenue du Doyen Lépine, 69500, Lyon, France
| | - Iyad Abou-Saleh
- Cardiac Intensive Care Unit, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France.,Claude Bernard University Lyon 1, Villeurbanne, France
| | - Héléna Simion
- Cardiac Intensive Care Unit, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France.,Claude Bernard University Lyon 1, Villeurbanne, France
| | - Danka Tomasevic
- Cardiac Intensive Care Unit, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France.,Claude Bernard University Lyon 1, Villeurbanne, France
| | - Cyril Prieur
- Cardiac Intensive Care Unit, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France.,Claude Bernard University Lyon 1, Villeurbanne, France
| | - Flora Kochly
- Cardiac Intensive Care Unit, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France.,Claude Bernard University Lyon 1, Villeurbanne, France
| | - Bertrand Scheppler
- Cardiac Intensive Care Unit, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France.,Claude Bernard University Lyon 1, Villeurbanne, France
| | - Gilles Rioufol
- Claude Bernard University Lyon 1, Villeurbanne, France.,Department of Cardiology and Interventional Cardiology, Hôpital Cardiologique Louis Pradel, Université Claude-Bernard, Inserm UMR 1060, Lyon, France
| | - François Derimay
- Claude Bernard University Lyon 1, Villeurbanne, France.,Department of Cardiology and Interventional Cardiology, Hôpital Cardiologique Louis Pradel, Université Claude-Bernard, Inserm UMR 1060, Lyon, France
| | - Fadi Farhat
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, 28 Avenue du Doyen Lépine, 69500, Lyon, France
| | - Jean-François Obadia
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, 28 Avenue du Doyen Lépine, 69500, Lyon, France
| | - Nathan Mewton
- Claude Bernard University Lyon 1, Villeurbanne, France.,Centre d'investigation Clinique, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France
| | - Eric Bonnefoy-Cudraz
- Cardiac Intensive Care Unit, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France.,Claude Bernard University Lyon 1, Villeurbanne, France
| | - Thomas Bochaton
- Cardiac Intensive Care Unit, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France.,Claude Bernard University Lyon 1, Villeurbanne, France.,INSERM U1060, CarMeN laboratory, Université de Lyon, Groupement Hospitalier Est, Bâtiment B13, 59 boulevard Pinel, 69500, Bron, France
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14
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Donal E, Leurent G, Ganivet A, Lurz P, Coisne A, De Groote P, Lafitte S, Leroux L, Karam N, Biere L, Rouleau F, Sportouch C, Dreyfus J, Nejjari M, Josselin JM, Anselmi A, Galli E, Bajeux E, Guerin P, Obadia JF, Trochu JN, Oger E. Multicentric randomized evaluation of a tricuspid valve percutaneous repair system (clip for the tricuspid valve) in the treatment of severe secondary tricuspid regurgitation Tri.Fr Design paper. Eur Heart J Cardiovasc Imaging 2021; 23:1617-1627. [PMID: 34871375 DOI: 10.1093/ehjci/jeab255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/11/2021] [Accepted: 11/11/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS Tricuspid regurgitation (TR) is associated with significant morbidity and mortality. Its independent prognostic role has been repeatedly demonstrated. However, this valvular heart condition is largely undertreated because of the increased risk of surgical repair. Recently, transcatheter techniques for the treatment of TR have emerged, but their implications for the clinical endpoints are still unknown. METHODS AND RESULTS The Tri.fr trial will be a multicentre, controlled, randomized (1:1 ratio), superior, open-label, and parallel-group study conducted in 300 patients with severe secondary TR that is considered non-surgical by heart teams. Inclusion will be possible only after core laboratory review of transthoracic and transoesophageal echocardiography and after validation by the clinical eligibility committee. A description of the mechanisms of the TR will be conducted by the core laboratory. Atrial or ventricular impacts on the severity of the secondary TR will be taken into account for the randomization. The patients will be followed for 12-month, and the primary outcome will be the Packer composite clinical endpoint [combining New York Heart Association class, patient global assessment (PGA), and major cardiovascular events]. It will test the hypothesis that a tricuspid valve percutaneous repair strategy using a clip dedicated to the tricuspid valve is superior to best guideline-directed medical therapy in symptomatic patients with severe secondary TR. CONCLUSION Tri.fr will be the first randomized, academic, multicentre study testing the value of percutaneous correction in patients with severe secondary TR.
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Affiliation(s)
- Erwan Donal
- Univ Rennes, CHU Rennes, Inserm, LTSI-UMR, 1099 Rennes, France
| | | | - Anne Ganivet
- Direction for Research and Innovation, CHU Rennes, Rennes, France
| | - Philip Lurz
- Heart Center at University of Leipzig, Leipzig, Germany
| | - Augustin Coisne
- CHU Lille, Department of Clinical Physiology and Echocardiography, Univ Lille, U1011 -EGID Lille, France
| | - Pascal De Groote
- CHU Lille, Department of Clinical Physiology and Echocardiography, Univ Lille, U1011 -EGID Lille, France
| | | | - Lionel Leroux
- CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Nicole Karam
- University of Paris, Medico-Surgical Heart Valve Unit, European Hospital Georges-Pompidou, INSERM, U970 Paris, France
| | - Loic Biere
- Institute MitoVasc, Angers University, CHU Angers, CNRS UMR6015, INSERM U, 1083 Angers, France
| | - Frederic Rouleau
- Institute MitoVasc, Angers University, CHU Angers, CNRS UMR6015, INSERM U, 1083 Angers, France
| | | | | | | | | | - Amedeo Anselmi
- Univ Rennes, CHU Rennes, Inserm, LTSI-UMR, 1099 Rennes, France
| | - Elena Galli
- Univ Rennes, CHU Rennes, Inserm, LTSI-UMR, 1099 Rennes, France
| | - Emma Bajeux
- INSERM1085, IRSET, University Rennes, CHU Rennes, Rennes, France
| | - Patrice Guerin
- Institut du Thorax, CHU Nantes, University Nantes, Nantes, France
| | - Jean-François Obadia
- Department of Cardiac Surgery, Cardiologic CHU Lyon, University Lyon, Lyon, France
| | - Jean-Noel Trochu
- Institut du Thorax, CHU Nantes, University Nantes, Nantes, France
| | - Emmanuel Oger
- EA Reperes, CHU Rennes, University Rennes, Rennes, France
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15
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Bouleti C, Michel M, Jobbe Duval A, Hemery T, Nicol PP, Didier R, Zeyons F, Zouaghi O, Tchetche D, Delon C, Delomez M, Dibie A, Attias D, Le Breton H, Cormier B, Obadia JF, Tribouilloy C, Lansac E, Chevreul K, Naccache N, Eltchaninoff H, Gilard M, Iung B. Current treatment of symptomatic aortic stenosis in elderly patients: Do risk scores really matter after 80 years of age? Arch Cardiovasc Dis 2021; 114:624-633. [PMID: 34600866 DOI: 10.1016/j.acvd.2021.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/08/2021] [Revised: 04/28/2021] [Accepted: 06/10/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND According to the guidelines, surgical aortic valve replacement (SAVR) is recommended in patients at low surgical risk (EuroSCORE II<4%), whereas for other patients, the decision between transcatheter aortic valve implantation (TAVI) and surgery should be made by the Heart Team, with TAVI being favoured in elderly patients. AIM The RAC prospective multicentre survey assessed the respective contributions of age and surgical risk scores in therapeutic decision making in elderly patients with severe symptomatic aortic stenosis. METHODS In September and October 2016, 1049 consecutive patients aged ≥ 75 years were included in 32 centres with on-site TAVI and surgical facilities. The primary endpoint was the decision between medical management, TAVI or SAVR. RESULTS Mean age was 84±5 years and 53% of patients were female. The surgical risk was classified as high (EuroSCORE II>8%) in 18% of patients, intermediate (EuroSCORE II 4-8%) in 34% and low (EuroSCORE II≤4%) in 48%. TAVI was preferred in 71% of patients, SAVR in 19% and medical treatment in 10%. The choice of TAVI over SAVR was associated with older age (P<0.0001) and a higher EuroSCORE II (P=0.008). However, the weight of EuroSCORE II in therapeutic decision making markedly decreased after the age of 80 years. Indeed, 77% of patients aged ≥ 80 years were referred for TAVI, despite a low estimated surgical risk. CONCLUSIONS The impact of risk scores depends strongly on age, and decreases considerably after 80 years, most patients being referred for TAVI, independent of their estimated surgical risk. Despite medical advancements, 10% of patients were still denied any intervention.
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Affiliation(s)
- Claire Bouleti
- CIC Inserm 1402, Cardiology Department, Poitiers University Hospital, Poitiers University, 2, rue de la Milétrie, 86000 Poitiers, France.
| | - Morgane Michel
- ECEVE UMR 1123, Inserm, Hôpital Robert-Debré, URC Eco, Hotel-Dieu, AP-HP, 75019 Paris, France
| | | | | | | | | | | | | | | | | | | | - Alain Dibie
- Institut Mutualiste Montsouris, 75014 Paris, France
| | - David Attias
- Centre Cardiologique du Nord, 93200 Saint-Denis, France
| | | | | | | | | | | | - Karine Chevreul
- ECEVE UMR 1123, Inserm, Hôpital Robert-Debré, URC Eco, Hotel-Dieu, AP-HP, 75019 Paris, France
| | - Nicole Naccache
- Commission des Registres, French Society of Cardiology, Paris, France
| | | | | | - Bernard Iung
- Bichat Hospital, DHU Fire, Université de Paris, AP-HP, 75018 Paris, France
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16
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Ronco D, Matteucci M, Kowalewski M, De Bonis M, Formica F, Jiritano F, Fina D, Folliguet T, Bonaros N, Russo CF, Sponga S, Vendramin I, De Vincentiis C, Ranucci M, Suwalski P, Falcetta G, Fischlein T, Troise G, Villa E, Dato GA, Carrozzini M, Serraino GF, Shah SH, Scrofani R, Fiore A, Kalisnik JM, D’Alessandro S, Lodo V, Kowalówka AR, Deja MA, Almobayedh S, Massimi G, Thielmann M, Meyns B, Khouqeer FA, Al-Attar N, Pozzi M, Obadia JF, Boeken U, Kalampokas N, Fino C, Simon C, Naito S, Beghi C, Lorusso R. Surgical Treatment of Postinfarction Ventricular Septal Rupture. JAMA Netw Open 2021; 4:e2128309. [PMID: 34668946 PMCID: PMC8529403 DOI: 10.1001/jamanetworkopen.2021.28309] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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: 12/15/2022] Open
Abstract
IMPORTANCE Ventricular septal rupture (VSR) is a rare but life-threatening mechanical complication of acute myocardial infarction associated with high mortality despite prompt treatment. Surgery represents the standard of care; however, only small single-center series or national registries are usually available in literature, whereas international multicenter investigations have been poorly carried out, therefore limiting the evidence on this topic. OBJECTIVES To assess the clinical characteristics and early outcomes for patients who received surgery for postinfarction VSR and to identify factors independently associated with mortality. DESIGN, SETTING, AND PARTICIPANTS The Mechanical Complications of Acute Myocardial Infarction: an International Multicenter Cohort (CAUTION) Study is a retrospective multicenter international cohort study that includes patients who were treated surgically for mechanical complications of acute myocardial infarction. The study was conducted from January 2001 to December 2019 at 26 different centers worldwide among 475 consecutive patients who underwent surgery for postinfarction VSR. EXPOSURES Surgical treatment of postinfarction VSR, independent of the technique, alone or combined with other procedures (eg, coronary artery bypass grafting). MAIN OUTCOMES AND MEASURES The primary outcome was early mortality; secondary outcomes were postoperative complications. RESULTS Of the 475 patients included in the study, 290 (61.1%) were men, with a mean (SD) age of 68.5 (10.1) years. Cardiogenic shock was present in 213 patients (44.8%). Emergent or salvage surgery was performed in 212 cases (44.6%). The early mortality rate was 40.4% (192 patients), and it did not improve during the nearly 20 years considered for the study (median [IQR] yearly mortality, 41.7% [32.6%-50.0%]). Low cardiac output syndrome and multiorgan failure were the most common causes of death (low cardiac output syndrome, 70 [36.5%]; multiorgan failure, 53 [27.6%]). Recurrent VSR occurred in 59 participants (12.4%) but was not associated with mortality. Cardiogenic shock (survived: 95 [33.6%]; died, 118 [61.5%]; P < .001) and early surgery (time to surgery ≥7 days, survived: 105 [57.4%]; died, 47 [35.1%]; P < .001) were associated with lower survival. At multivariate analysis, older age (odds ratio [OR], 1.05; 95% CI, 1.02-1.08; P = .001), preoperative cardiac arrest (OR, 2.71; 95% CI, 1.18-6.27; P = .02) and percutaneous revascularization (OR, 1.63; 95% CI, 1.003-2.65; P = .048), and postoperative need for intra-aortic balloon pump (OR, 2.98; 95% CI, 1.46-6.09; P = .003) and extracorporeal membrane oxygenation (OR, 3.19; 95% CI, 1.30-7.38; P = .01) were independently associated with mortality. CONCLUSIONS AND RELEVANCE In this study, surgical repair of postinfarction VSR was associated with a high risk of early mortality; this risk has remained unchanged during the last 2 decades. Delayed surgery seemed associated with better survival. Age, preoperative cardiac arrest and percutaneous revascularization, and postoperative need for intra-aortic balloon pump and extracorporeal membrane oxygenation were independently associated with early mortality. Further prospective studies addressing preoperative and perioperative patient management are warranted to hopefully improve the currently suboptimal outcome.
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Affiliation(s)
- Daniele Ronco
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Medicine and Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Matteo Matteucci
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Medicine and Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Mariusz Kowalewski
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands
- Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior in Warsaw, Warsaw, Poland
| | - Michele De Bonis
- Cardiothoracic Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Francesco Formica
- Department of Medicine and Surgery, Cardiac Surgery Clinic, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
- Department of Medicine and Surgery, University of Parma, Cardiac Surgery Unit, University Hospital of Parma, Parma, Italy
| | - Federica Jiritano
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Experimental and Clinical Medicine, “Magna Graecia” University of Catanzaro, Catanzaro, Italy
| | - Dario Fina
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Cardiovascular Anesthesia and Intensive Care, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato, San Donato Milanese, Italy
| | - Thierry Folliguet
- Department of Cardio-Thoracic Surgery, University Hospital Henri-Mondor, Assistance Publique–Hopitaux de Paris Créteil, Paris, France
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Sandro Sponga
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Igor Vendramin
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Carlo De Vincentiis
- Cardiac Surgery Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Marco Ranucci
- Department of Cardiovascular Anesthesia and Intensive Care, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato, San Donato Milanese, Italy
| | - Piotr Suwalski
- Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior in Warsaw, Warsaw, Poland
| | - Giosuè Falcetta
- Section of Cardiac Surgery, University Hospital, Pisa, Italy
| | - Theodor Fischlein
- Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Giovanni Troise
- Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Emmanuel Villa
- Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | | | | | | | - Shabir Hussain Shah
- Cardiovascular and Thoracic Surgery Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Antonio Fiore
- Department of Cardio-Thoracic Surgery, University Hospital Henri-Mondor, Assistance Publique–Hopitaux de Paris Créteil, Paris, France
| | - Jurij Matija Kalisnik
- Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Stefano D’Alessandro
- Department of Medicine and Surgery, Cardiac Surgery Clinic, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Vittoria Lodo
- Cardiac Surgery Department, Mauriziano Hospital, Turin, Italy
| | - Adam R. Kowalówka
- Department of Cardiac Surgery, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
- Department of Cardiac Surgery, Upper-Silesian Heart Center, Katowice, Poland
| | - Marek A. Deja
- Department of Cardiac Surgery, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
- Department of Cardiac Surgery, Upper-Silesian Heart Center, Katowice, Poland
| | - Salman Almobayedh
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Giulio Massimi
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West-German Heart Center, University of Duisburg-Essen, Essen, Germany
| | - Bart Meyns
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Fareed A. Khouqeer
- Department of Cardiac Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Nawwar Al-Attar
- Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, Scotland
| | - Matteo Pozzi
- Department of Cardiac Surgery, Louis Pradel Cardiologic Hospital, Lyon, France
| | | | - Udo Boeken
- Department of Cardiovascular Surgery, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Nikolaos Kalampokas
- Department of Cardiovascular Surgery, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Carlo Fino
- Cardiovascular and Transplant Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Caterina Simon
- Cardiovascular and Transplant Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Shiho Naito
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Cesare Beghi
- Department of Medicine and Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
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17
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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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18
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Anselmi A, Galand V, Vincentelli A, Boule S, Dambrin C, Delmas C, Barandon L, Pernot M, Kindo M, Tam HM, Gaudard P, Rouviere P, Senage T, Michel M, Boignard A, Chavanon O, Verdonk C, Para M, Gariboldi V, Pelce E, Pozzi M, Obadia JF, Anselme F, Litzler PY, Babatasi G, Belin A, Garnier F, Bielefeld M, Guihaire J, Kloeckner M, Radu C, Lellouche N, Bourguignon T, Genet T, D'Ostrevy N, Duband B, Jouan J, Bories MC, Vanhuyse F, Blangy H, Colas F, Verhoye JP, Martins R, Flecher E. Current results of left ventricular assist device therapy in France: the ASSIST-ICD registry. Eur J Cardiothorac Surg 2021; 58:112-120. [PMID: 32298439 DOI: 10.1093/ejcts/ezaa055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 04/12/2019] [Revised: 01/13/2020] [Accepted: 01/16/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Our goal was to provide a picture of left ventricular assist device (LVAD) activity in France between 2007 and 2016 based on the multicentric ASSIST-ICD registry. METHODS We retrospectively collected 136 variables including in-hospital data, follow-up survival rates and adverse events from 671 LVAD recipients at 20 out of 24 LVAD implant centres in France. The average follow-up time was 1.2 years (standard deviation: 1.4); the total follow-up time was 807.5 patient-years. RESULTS The included devices were the HeartMate II®, HeartWare LVAS® or Jarvik 2000®. The overall likelihood of being alive while on LVAD support or having a transplant (primary end point) at 1, 2, 3 and 5 years postimplantation was 65.2%, 59.7%, 55.9% and 47.7%, respectively, given a cumulative incidence of 29.2% of receiving a transplant at year 5. At implantation, 21.5% of patients were on extracorporeal life support. The overall rate of cardiogenic shock at implantation was 53%. The major complications were driveline infection (26.1%), pump pocket or cannula infection (12.6%), LVAD thrombosis (12.2%), ischaemic (12.8%) or haemorrhagic stroke (5.4%; all strokes 18.2%), non-cerebral haemorrhage (9.1%) and LVAD exchange (5.2%). The primary end point (survival) was stratified by age at surgery and by the type of device used, with inference from baseline profiles. The primary end point combined with an absence of complications (secondary end point) was also stratified by device type. CONCLUSIONS The ASSIST-ICD registry provides a real-life picture of LVAD use in 20 of the 24 implant centres in France. Despite older average age and a higher proportion of patients chosen for destination therapy, survival rates improved compared to those in previous national registry results. This LVAD registry contrasts with other international registries because patients with implants have more severe disease, and the national policy for graft attribution is distinct. We recommend referring patients for LVAD earlier and suggest a discussion of the optimal timing of a transplant for bridged patients (more dismal results after the second year of support?).
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Affiliation(s)
- Amedeo Anselmi
- Division of Thoracic and Cardiovascular Surgery, Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France
| | - Vincent Galand
- Division of Cardiology, Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France
| | - André Vincentelli
- Department of Cardiac Surgery, CHU Lille, Institut Coeur-Poumons, Lille, France
| | - Stéphane Boule
- Department of Cardiology, CHU Lille, Institut Coeur-Poumons, Lille, France
| | - Camille Dambrin
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Clément Delmas
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Laurent Barandon
- Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux II, Bordeaux, France
| | - Mathieu Pernot
- Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux II, Bordeaux, France
| | - Michel Kindo
- Département de Chirurgie Cardiovasculaire, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Hoang Minh Tam
- Département de Chirurgie Cardiovasculaire, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Philippe Gaudard
- Department of Anesthesiology and Critical Care Medicine, PhyMedExp, University of Montpellier, INSERM, CNRS, CHU Montpellier, Montpellier, France
| | - Philippe Rouviere
- Department of Cardiac Surgery, University of Montpellier, CHU Montpellier, Montpellier, France
| | - Thomas Senage
- Department of Cardiology and Heart Transplantation Unit, CHU Nantes, Nantes, France
| | - Magali Michel
- Department of Cardiology and Heart Transplantation Unit, CHU Nantes, Nantes, France
| | - Aude Boignard
- Department of Cardiology and Cardiovascular Surgery, CHU Michallon, Grenoble, France
| | - Olivier Chavanon
- Department of Cardiology and Cardiovascular Surgery, CHU Michallon, Grenoble, France
| | - Constance Verdonk
- Department of Cardiology and Cardiac Surgery, Bichat-Hospital, Paris, France
| | - Marylou Para
- Department of Cardiology and Cardiac Surgery, Bichat-Hospital, Paris, France
| | - Vlad Gariboldi
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Edeline Pelce
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Matteo Pozzi
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Lyon, France
| | - Jean-François Obadia
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Lyon, France
| | - Frederic Anselme
- Department of Cardiology and Cardiovascular Surgery, Hospital Charles Nicolle, Rouen, France
| | - Pierre-Yves Litzler
- Department of Cardiology and Cardiovascular Surgery, Hospital Charles Nicolle, Rouen, France
| | - Gerard Babatasi
- Department of Cardiology and Cardiac Surgery, University of Caen and University Hospital of Caen, Caen, France
| | - Annette Belin
- Department of Cardiology and Cardiac Surgery, University of Caen and University Hospital of Caen, Caen, France
| | - Fabien Garnier
- Department of Cardiology and Cardiac Surgery, University Hospital François Mitterrand, Dijon, France
| | - Marie Bielefeld
- Department of Cardiology and Cardiac Surgery, University Hospital François Mitterrand, Dijon, France
| | - Julien Guihaire
- Department of Cardiac Surgery, Research and Innovation Unit, INSERM U999, Marie Lannelongue Hospital, Paris Sud University, Le Plessis Robinson, France
| | - Martin Kloeckner
- Department of Cardiac Surgery, Marie Lannelongue Hospital, Paris Sud University, Le Plessis Robinson, France
| | - Costin Radu
- Department of Cardiology and Cardiac Surgery, AP-HP CHU Henri Mondor, Créteil, France
| | - Nicolas Lellouche
- Department of Cardiology and Cardiac Surgery, AP-HP CHU Henri Mondor, Créteil, France
| | | | - Thibaud Genet
- Department of Cardiology, Tours University Hospital, Tours, France
| | - Nicolas D'Ostrevy
- Cardiac Surgery and Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Benjamin Duband
- Cardiac Surgery and Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Jerome Jouan
- Cardiology Department, European Georges Pompidou Hospital, Paris, France
| | | | - Fabrice Vanhuyse
- Department of Cardiology and Cardiac Surgery, CHU de Nancy, Hopital de Brabois, Nancy, France
| | - Hugues Blangy
- Department of Cardiology and Cardiac Surgery, CHU de Nancy, Hopital de Brabois, Nancy, France
| | - Fabrice Colas
- Division of Thoracic and Cardiovascular Surgery, Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France
| | - Jean-Philippe Verhoye
- Division of Thoracic and Cardiovascular Surgery, Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France
| | - Raphael Martins
- Division of Cardiology, Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France
| | - Erwan Flecher
- Division of Thoracic and Cardiovascular Surgery, Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France
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19
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Armoiry X, Obadia JF, Auguste P, Connock M. Conflicting findings between the Mitra-Fr and the Coapt trials: Implications regarding the cost-effectiveness of percutaneous repair for heart failure patients with severe secondary mitral regurgitation. PLoS One 2020; 15:e0241361. [PMID: 33166308 PMCID: PMC7652317 DOI: 10.1371/journal.pone.0241361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 10/13/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Two randomized controlled trials (RCTs), Mitra-Fr and Coapt, evaluating the benefit of percutaneous repair (PR) for heart failure (HF) patients with severe mitral regurgitation, have led to conflicting results. We aimed to evaluate the impact of these trial results on the cost-effectiveness of PR using effectiveness inputs from the two RCTs. METHODS We developed a time varying Markov type model with three mutually exclusive health states: alive without HF hospitalisation, alive with HF hospitalisation, and dead. Clinically plausible extrapolations beyond observed data were obtained by developing parametric modelling for overall survival and HF hospitalisations using published data from each trial. We adopted the perspective of the French Health System and used a 30-year time horizon. Results were expressed as € / quality-adjusted life year (QALY) gained using utility inputs from literature. FINDINGS Results are presented using treatment efficacy measures from Mitra-F and Coapt trials respectively. With the Mitra-Fr data, after annual discounting, the base case model generated an incremental 0.00387 QALY at a cost of €25,010, yielding an incremental cost effectiveness ratio (ICER) of €6,467,032 / QALY. The model was sensitive to changes made to model inputs. There was no potential of PR being cost-effective. With the Coapt data, the model generated 1.19 QALY gain at a cost of €26,130 yielding an ICER of €21,918 / QALY and at a threshold of >€50,000/QALY PR had a probability of 1 of being cost-effective. IMPLICATIONS Cost effectiveness results were conflicting; reconciling differences between trials is a priority and could promote optimal cost effectiveness analyses and resource allocation.
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Affiliation(s)
- Xavier Armoiry
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
- School of Pharmacy (ISPB)/UMR CNRS 5510 MATEIS/Edouard Herriot Hospital, Pharmacy Department, University of Lyon, Lyon, France
- * E-mail:
| | - Jean-François Obadia
- Hôpital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque, Hospices Civils de Lyon and Claude Bernard University, Lyon, France
| | - Peter Auguste
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Martin Connock
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
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20
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Payet C, Polazzi S, Obadia JF, Armoiry X, Labarère J, Rabilloud M, Duclos A. High-dimensional propensity scores improved the control of indication bias in surgical comparative effectiveness studies. J Clin Epidemiol 2020; 130:78-86. [PMID: 33065165 DOI: 10.1016/j.jclinepi.2020.10.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 09/18/2020] [Accepted: 10/06/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The objective of the study is to evaluate the performance of high-dimensional propensity scores (hdPSs) for controlling indication bias as compared with propensity scores (PSs) in surgical comparative effectiveness studies. STUDY DESIGN AND SETTING Patients who underwent interventional transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR) between 2013 and 2017 were included from the French nationwide hospitals. At each hospital level, matched pairs of patients who underwent TAVI and SAVR were formed using PSs, considering 20 patient baseline characteristics, and hdPSs, considering the same patient characteristics and 300 additional variables from procedure and diagnosis codes the year before surgery. We compared death, reoperation, and stroke up to 3 years between TAVI and SAVR using Cox or Fine and Gray models. RESULTS Before matching, 12 of 20 patient characteristics were imbalanced between the included patients who underwent TAVI and SAVR. No significant imbalance persisted after matching with both methods. Hazard ratio of 1-year death, reoperation, and stroke was 1.3 [1.1; 1.4], 1.6 [1.1; 2.4], and 1.4 [1.2; 1.7] for TAVI relative to SAVR with PSs (n = 9,498 pairs) and 1.1 [1.0; 1.3], 1.3 [0.8; 2.0], and 1.3 [1.0; 1.6] with hdPSs (n = 7,157). CONCLUSION HdPS estimations were more consistent with results seen in randomized controlled trials. The HdPS is a promising alternative for the PS to control indication bias in comparative studies of surgical procedures.
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Affiliation(s)
- Cécile Payet
- Health Data Department, Hospices Civils de Lyon, F-69003 lyon, France; Health Services and Performance Research Lab (HESPER EA7425), Université Claude Bernard Lyon 1, F-69008 Lyon, France.
| | - Stéphanie Polazzi
- Health Data Department, Hospices Civils de Lyon, F-69003 lyon, France; Health Services and Performance Research Lab (HESPER EA7425), Université Claude Bernard Lyon 1, F-69008 Lyon, France
| | - Jean-François Obadia
- Department of Cardio-Thoracic Surgery and Transplantation, Hospices Civils de Lyon, F-69500 Bron, France
| | - Xavier Armoiry
- Division of Health Sciences, University of Warwick, Warwick medical school, Gibbet Hill Road, CV47AL Coventry, UK; Pharmacy Department, Hospices Civils de Lyon, F-69003 lyon, France; MATEIS lab, UMR-CNRS 5510, F-69008, Lyon, France
| | - José Labarère
- TIMC lab, UMR 5525 CNRS, Univ. Grenoble Alpes, F-38706 Grenoble, France; Quality of Care Unit, CIC 1406, Grenoble Alpes University Hospital, F-38043 Grenoble, France
| | - Muriel Rabilloud
- Department of Biostatistics, Hospices Civils de Lyon, F-69003, Lyon, France; LBBE lab, Biostatistics Health Group, CNRS, UMR5558, Université de Lyon, F-69100 Villeurbanne, France
| | - Antoine Duclos
- Health Data Department, Hospices Civils de Lyon, F-69003 lyon, France; Health Services and Performance Research Lab (HESPER EA7425), Université Claude Bernard Lyon 1, F-69008 Lyon, France
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21
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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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22
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Galand V, Flécher E, Chabanne C, Lelong B, Goéminne C, Vincentelli A, Delmas C, Dambrin C, Nubret K, Pernot M, Kindo M, Hoang Minh T, Gaudard P, Frapier JM, Michel M, Sénage T, Boignard A, Chavanon O, Verdonk C, Para M, Pelcé E, Gariboldi V, Pozzi M, Obadia JF, Litlzer PY, Anselme F, Babatasi G, Plane AF, Garnier F, Bielefeld M, Hamon D, Radu C, Bourguignon T, Genet T, Eschalier R, D'Ostrevy N, Bories MC, Marijon E, Vanhuyse F, Blangy H, Leclercq C, Martins RP. Septuagenarian population has similar survival and outcomes to younger patients after left ventricular assist device implantation. Arch Cardiovasc Dis 2020; 113:701-709. [PMID: 32952086 DOI: 10.1016/j.acvd.2020.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/06/2020] [Revised: 03/20/2020] [Accepted: 05/12/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Left ventricular assist device (LVAD) implantation may be an attractive alternative therapeutic option for elderly patients with heart failure who are ineligible for heart transplantation. AIM We aimed to describe the characteristics and outcomes of elderly patients (i.e. aged≥70 years) receiving an LVAD. METHODS This observational study was conducted in 19 centres between 2006 and 2016. Patients were divided into two groups-younger (aged<70 years) and elderly (aged≥70 years), based on age at time of LVAD implantation. RESULTS A total of 652 patients were included in the final analysis, and 74 patients (11.3%) were aged≥70 years at the time of LVAD implantation (maximal age 77.6 years). The proportion of elderly patients receiving an LVAD each year was constant, with a median of 10.6% (interquartile range 8.0-15.4%) per year, and all were implanted as destination therapy. Elderly and younger patients had similar durations of hospitalization in intensive care units and total lengths of hospital stays. Both age groups experienced similar rates of LVAD-related complications (i.e. stroke, bleeding, driveline infection and LVAD exchange), and the occurrence of LVAD complications did not impact survival in the elderly group compared with the younger group. Lastly, when compared with younger patients implanted as destination therapy, the elderly group also exhibited similar mid-term survival. CONCLUSION This work strongly suggests that selected elderly adults can be scheduled for LVAD implantation.
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Affiliation(s)
- Vincent Galand
- LTSI-UMR 1099, INSERM, Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, Université de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France.
| | - Erwan Flécher
- LTSI-UMR 1099, INSERM, Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, Université de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - Céline Chabanne
- LTSI-UMR 1099, INSERM, Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, Université de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - Bernard Lelong
- LTSI-UMR 1099, INSERM, Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, Université de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - Céline Goéminne
- Cardiac Intensive Care Unit, Department of Cardiology, Department of Cardiac Surgery, Institut Coeur-Poumons, CHU de Lille, 59000 Lille, France
| | - André Vincentelli
- Cardiac Intensive Care Unit, Department of Cardiology, Department of Cardiac Surgery, Institut Coeur-Poumons, CHU de Lille, 59000 Lille, France
| | | | | | - Karine Nubret
- LIRYC Institute, Hôpital Cardiologique du Haut-Lévêque, Université de Bordeaux, 33600 Pessac, France
| | - Mathieu Pernot
- LIRYC Institute, Hôpital Cardiologique du Haut-Lévêque, Université de Bordeaux, 33600 Pessac, France
| | - Michel Kindo
- Department of Cardiovascular Surgery, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Tam Hoang Minh
- Department of Cardiovascular Surgery, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Philippe Gaudard
- Department of Anaesthesiology, Critical Care Medicine and Cardiac Surgery, Hôpital Arnaud de Villeneuve, CHU de Montpellier, Université de Montpellier, PhyMedExp, INSERM, CNRS, 34090 Montpellier, France
| | - Jean Marc Frapier
- Department of Anaesthesiology, Critical Care Medicine and Cardiac Surgery, Hôpital Arnaud de Villeneuve, CHU de Montpellier, Université de Montpellier, PhyMedExp, INSERM, CNRS, 34090 Montpellier, France
| | - Magali Michel
- Department of Cardiology and Heart Transplantation Unit, CHU de Nantes, 44093 Nantes, France
| | - Thomas Sénage
- Department of Cardiology and Heart Transplantation Unit, CHU de Nantes, 44093 Nantes, France
| | - Aude Boignard
- Department of Cardiology and Cardiovascular Surgery, Hôpital Albert Michallon, CHU de Grenoble, 38700 La Tronche, France
| | - Olivier Chavanon
- Department of Cardiology and Cardiovascular Surgery, Hôpital Albert Michallon, CHU de Grenoble, 38700 La Tronche, France
| | - Constance Verdonk
- Department of Cardiology and Cardiac Surgery, Hôpital Bichat, 75018 Paris, France
| | - Marylou Para
- Department of Cardiology and Cardiac Surgery, Hôpital Bichat, 75018 Paris, France
| | - Edeline Pelcé
- Department of Cardiac Surgery, Hôpital de la Timone, 13005 Marseille, France
| | - Vlad Gariboldi
- Department of Cardiac Surgery, Hôpital de la Timone, 13005 Marseille, France
| | - Matteo Pozzi
- Department of Cardiac Surgery, Hôpital Cardio-Vasculaire Louis Pradel, 69500 Bron, France
| | - Jean-François Obadia
- Department of Cardiac Surgery, Hôpital Cardio-Vasculaire Louis Pradel, 69500 Bron, France
| | - Pierre Yves Litlzer
- Department of Cardiology and Cardiovascular Surgery, Hôpital Charles Nicolle, 76000 Rouen, France
| | - Frédéric Anselme
- Department of Cardiology and Cardiovascular Surgery, Hôpital Charles Nicolle, 76000 Rouen, France
| | - Gerard Babatasi
- Department of Cardiology and Cardiac Surgery, Université de Caen and CHU de Caen, 14000 Caen, France
| | - Anne Flore Plane
- Department of Cardiology and Cardiac Surgery, Université de Caen and CHU de Caen, 14000 Caen, France
| | - Fabien Garnier
- Department of Cardiology and Cardiac Surgery, CHU de Dijon, 21000 Dijon, France
| | - Marie Bielefeld
- Department of Cardiology and Cardiac Surgery, CHU de Dijon, 21000 Dijon, France
| | - David Hamon
- Department of Cardiology and Cardiac Surgery, Hôpital Henri Mondor, AP-HP, 94010 Créteil, France
| | - Costin Radu
- Department of Cardiology and Cardiac Surgery, Hôpital Henri Mondor, AP-HP, 94010 Créteil, France
| | - Thierry Bourguignon
- Department of Cardiology and Cardiac Surgery, CHRU de Tours, 37000 Tours, France
| | - Thibaud Genet
- Department of Cardiology and Cardiac Surgery, CHRU de Tours, 37000 Tours, France
| | - Romain Eschalier
- Cardiology Department, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Nicolas D'Ostrevy
- Cardiology Department, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Marie-Cécile Bories
- Cardiology Department, Hôpital Européen Georges-Pompidou, AP-HP, 75015 Paris, France
| | - Eloi Marijon
- Cardiology Department, Hôpital Européen Georges-Pompidou, AP-HP, 75015 Paris, France
| | - Fabrice Vanhuyse
- Department of Cardiology and Cardiac Surgery, Hopital de Brabois, CHU de Nancy, 54500 Vandœuvre-lès-Nancy, France
| | - Hugues Blangy
- Department of Cardiology and Cardiac Surgery, Hopital de Brabois, CHU de Nancy, 54500 Vandœuvre-lès-Nancy, France
| | - Christophe Leclercq
- LTSI-UMR 1099, INSERM, Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, Université de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - Raphaël P Martins
- LTSI-UMR 1099, INSERM, Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, Université de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
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23
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Galand V, Leclercq C, Bourenane H, Boulé S, Vincentelli A, Maury P, Mondoly P, Picard F, Welté N, Kindo M, Cardi T, Pasquié JL, Gaudard P, Gourraud JB, Probst V, Defaye P, Boignard A, Para M, Algalarrondo V, Pelcé E, Gariboldi V, Pozzi M, Obadia JF, Anselme F, Litzler PY, Blanchart K, Babatasi G, Garnier F, Bielefeld M, Hamon D, Lellouche N, Bourguignon T, Pierre B, Eschalier R, D'Ostrevy N, Varlet E, Marijon E, Blangy H, Sadoul N, Flécher E, Martins RP. Implantable cardiac defibrillator leads dysfunction after LVAD implantation. Pacing Clin Electrophysiol 2020; 43:1309-1317. [PMID: 32627211 DOI: 10.1111/pace.14004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/03/2020] [Accepted: 06/28/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Implantable cardioverter-defibrillator (ICD) lead dysfunction has been reported after left ventricular assist device (LVAD) implantation in limited single-center studies. We aimed at describing and characterizing the incidence of ICD lead parameters dysfunction after LVAD implantation. METHODS Among the 652 patients enrolled in the ASSIST-ICD study, only patients with an ICD prior to LVAD were included (n = 401). ICD lead parameters dysfunction following LVAD implantation is defined as follows: (a) >50% decrease in sensing threshold, (b) pacing lead impedance increase/decrease by >100Ω, and (c) >50% increase in pacing threshold. RESULTS One hundred twenty-two patients with an ICD prior to LVAD had available ICD interrogation reports prior and after LVAD. A total of 67 (55%) patients exhibited at least one significant lead dysfunction: 17 (15%) exhibited >50% decrease in right ventricular (RV) sensing, 51 (42%) had >100 Ω increase/decrease in RV pacing impedance, and 24 (20%) experienced >50% increase in RV pacing threshold. A total of 52 patients experienced ventricular arrhythmia during follow-up and all were successfully detected and treated by the device. All lead dysfunction could be managed conservatively. CONCLUSION More than 50% of LVAD-recipients may experience >1 significant change in lead parameters but none had severe clinical consequences.
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Affiliation(s)
- Vincent Galand
- CHU Rennes, INSERM, University of Rennes, Rennes, France
| | | | | | - Stéphane Boulé
- Cardiac Intensive Care Unit, Department of Cardiology and Cardiac Surgery, CHU Lille, Institut Coeur-Poumons, Lille, France
| | - André Vincentelli
- Cardiac Intensive Care Unit, Department of Cardiology and Cardiac Surgery, CHU Lille, Institut Coeur-Poumons, Lille, France
| | - Philippe Maury
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Pierre Mondoly
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - François Picard
- Hôpital Cardiologique du Haut-Lévêque, LIRYC institute, Université Bordeaux, Bordeaux, France
| | - Nicolas Welté
- Hôpital Cardiologique du Haut-Lévêque, LIRYC institute, Université Bordeaux, Bordeaux, France
| | - Michel Kindo
- Département de chirurgie cardiovasculaire, hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Thomas Cardi
- Département de chirurgie cardiovasculaire, hôpitaux universitaires de Strasbourg, Strasbourg, France
| | | | - Philippe Gaudard
- Department of Anesthesiology and Critical Care Medicine, PhyMedExp, University of Montpellier, INSERM, CNRS, CHU Montpellier, Montpellier, France
| | | | - Vincent Probst
- Department of Cardiology and Heart Transplantation Unit, CHU Nantes, Nantes, France
| | - Pascal Defaye
- Department of Cardiology and Cardiovascular Surgery, CHU Michallon, Grenoble, France
| | - Aude Boignard
- Department of Cardiology and Cardiovascular Surgery, CHU Michallon, Grenoble, France
| | - Marylou Para
- Department of Cardiology and Cardiac Surgery, Bichat-Hospital, Paris, France
| | | | - Edeline Pelcé
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Vlad Gariboldi
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Matteo Pozzi
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Lyon, France
| | - Jean-François Obadia
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Lyon, France
| | - Frédéric Anselme
- Department of Cardiology and Cardiovascular Surgery, Hospital Charles Nicolle, Rouen, France
| | - Pierre-Yves Litzler
- Department of Cardiology and Cardiovascular Surgery, Hospital Charles Nicolle, Rouen, France
| | - Katrien Blanchart
- Department of Cardiology and Cardiac Surgery, University of Caen and University Hospital of Caen, Caen, France
| | - Gerard Babatasi
- Department of Cardiology and Cardiac Surgery, University of Caen and University Hospital of Caen, Caen, France
| | - Fabien Garnier
- Department of Cardiology and Cardiac Surgery, University Hospital, Dijon, France
| | - Marie Bielefeld
- Department of Cardiology and Cardiac Surgery, University Hospital, Dijon, France
| | - David Hamon
- Department of Cardiology and Cardiac Surgery, AP-HP CHU Henri Mondor, Créteil, France
| | - Nicolas Lellouche
- Department of Cardiology and Cardiac Surgery, AP-HP CHU Henri Mondor, Créteil, France
| | - Thierry Bourguignon
- Department of Cardiology and Cardiac Surgery, Tours University Hospital, Tours, France
| | - Bertrand Pierre
- Department of Cardiology and Cardiac Surgery, Tours University Hospital, Tours, France
| | - Romain Eschalier
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Nicolas D'Ostrevy
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Emilie Varlet
- Cardiology Department, European Georges Pompidou Hospital, Paris, France
| | - Eloi Marijon
- Cardiology Department, European Georges Pompidou Hospital, Paris, France
| | - Hugues Blangy
- Department of Cardiology and Cardiac Surgery, CHU de Nancy, Hopital de Brabois, Nancy, France
| | - Nicolas Sadoul
- Department of Cardiology and Cardiac Surgery, CHU de Nancy, Hopital de Brabois, Nancy, France
| | - Erwan Flécher
- CHU Rennes, INSERM, University of Rennes, Rennes, France
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24
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Gatti G, Chocron S, Obadia JF, Duval X, Iung B, Alla F, Chirouze C, Lecompte T, Hoen B, Delahaye F, Tattevin P, Le Moing V, Perrotti A. Using surgical risk scores in nonsurgically treated infective endocarditis patients. Hellenic J Cardiol 2020; 61:246-252. [DOI: 10.1016/j.hjc.2019.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/03/2019] [Accepted: 01/11/2019] [Indexed: 11/25/2022] Open
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25
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Galand V, Flécher E, Chabanne C, Lelong B, Goéminne C, Vincentelli A, Delmas C, Dambrin C, Picard F, Sacher F, Kindo M, Minh TH, Gaudard P, Rouvière P, Sénage T, Michel M, Boignard A, Chavanon O, Verdonk C, Ghodhbane W, Pelcé E, Gariboldi V, Pozzi M, Obadia JF, Litzler PY, Anselme F, Babatasi G, Blanchart K, Garnier F, Bielefeld M, Hamon D, Lellouche N, Bourguignon T, Genet T, Eschalier R, D'Ostrevy N, Varlet E, Jouan J, Vanhuyse F, Blangy H, Leclercq C, Martins RP. Outcomes of Left Ventricular Assist Device Implantation in Patients With Uncommon Etiology Cardiomyopathy. Am J Cardiol 2020; 125:1421-1428. [PMID: 32145895 DOI: 10.1016/j.amjcard.2020.01.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 01/22/2020] [Accepted: 01/24/2020] [Indexed: 11/18/2022]
Abstract
The impact of uncommon etiology cardiomyopathies on Left-ventricular assist device (LVAD)-recipient outcomes is not very well known. This study aimed to characterize patients with uncommon cardiomyopathy etiologies and examine the outcomes between uncommon and ischemic/idiopathic dilated cardiomyopathy. This observational study was conducted in 19 centers between 2006 and 2016. Baseline characteristics and outcomes of patients with uncommon etiology were compared to patients with idiopathic dilated/ischemic cardiomyopathies. Among 652 LVAD-recipients included, a total of 590 (90.5%) patients were classified as ischemic/idiopathic and 62 (9.5%) patients were classified in the "uncommon etiologies" group. Main uncommon etiologies were: hypertrophic (n = 12(19%)); cancer therapeutics-related cardiac dysfunction (CTRCD) (n = 12(19%)); myocarditis (n = 11(18%)); valvulopathy (n = 9(15%)) and others (n = 18(29%)). Patients with uncommon etiologies were significantly younger with more female and presented less co-morbidities. Additionally, patients with uncommon cardiomyopathies were less implanted as destination therapy compared with ischemic/idiopathic group (29% vs 38.8%). During a follow-up period of 9.1 months, both groups experienced similar survival. However, subgroup of hypertrophic/valvular cardiomyopathies and CTRCD had significantly higher mortality compared to the ischemic/idiopathic or myocarditis/others cardiomyopathies. Conversely, patients with myocarditis/others etiologies experienced a better survival. Indeed, the 12-months survival in the myocarditis/others; ischemic/idiopathic and hypertrophic/CTRCD/valvulopathy group were 77%; 65%, and 46% respectively. In conclusion, LVAD-recipients with hypertrophic cardiomyopathy, valvular heart disease and CTRCD experienced the higher mortality rate.
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Affiliation(s)
| | | | | | | | - Céline Goéminne
- CHU Lille, Institut Coeur-Poumons, Cardiac Intensive Care Unit, Department of Cardiology, Department of Cardiac Surgery, Lille, France
| | - André Vincentelli
- CHU Lille, Institut Coeur-Poumons, Cardiac Intensive Care Unit, Department of Cardiology, Department of Cardiac Surgery, Lille, France
| | - Clément Delmas
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Camille Dambrin
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - François Picard
- Hôpital Cardiologique du Haut-Lévêque, LIRYC Institute, Université Bordeaux, Bordeaux, France
| | - Frédéric Sacher
- Hôpital Cardiologique du Haut-Lévêque, LIRYC Institute, Université Bordeaux, Bordeaux, France
| | - Michel Kindo
- Département de chirurgie cardiovasculaire, hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Tam Hoang Minh
- Département de chirurgie cardiovasculaire, hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Philippe Gaudard
- Department of Cardiac Surgery, Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, CHRU Montpellier, Montpellier, France
| | - Philippe Rouvière
- Department of Cardiac Surgery, Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, CHRU Montpellier, Montpellier, France
| | - Thomas Sénage
- Department of Cardiology and Heart Transplantation Unit, CHU Nantes, France
| | - Magali Michel
- Department of Cardiology and Heart Transplantation Unit, CHU Nantes, France
| | - Aude Boignard
- Department of Cardiology and Cardiovascular Surgery, CHU Michallon, Grenoble, France
| | - Olivier Chavanon
- Department of Cardiology and Cardiovascular Surgery, CHU Michallon, Grenoble, France
| | - Constance Verdonk
- Department of Cardiology and Cardiac Surgery, Bichat-Hospital, Paris, France
| | - Walid Ghodhbane
- Department of Cardiology and Cardiac Surgery, Bichat-Hospital, Paris, France
| | - Edeline Pelcé
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Vlad Gariboldi
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Matteo Pozzi
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Lyon, France
| | - Jean-François Obadia
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Lyon, France
| | - Pierre-Yvesl Litzler
- Department of Cardiology and Cardiovascular Surgery, Hospital Charles Nicolle, Rouen, France
| | - Frédéric Anselme
- Department of Cardiology and Cardiovascular Surgery, Hospital Charles Nicolle, Rouen, France
| | - Gerard Babatasi
- Department of Cardiology and Cardiac Surgery, University of Caen and University Hospital of Caen, France
| | - Katrien Blanchart
- Department of Cardiology and Cardiac Surgery, University of Caen and University Hospital of Caen, France
| | - Fabien Garnier
- Department of Cardiology and cardiac surgery, University Hospital, Dijon, France
| | - Marie Bielefeld
- Department of Cardiology and cardiac surgery, University Hospital, Dijon, France
| | - David Hamon
- Department of Cardiology and Cardiac Surgery, AP-HP CHU Henri Mondor, Créteil, France
| | - Nicolas Lellouche
- Department of Cardiology and Cardiac Surgery, AP-HP CHU Henri Mondor, Créteil, France
| | - Thierry Bourguignon
- Department of Cardiology and Cardiac Surgery, Tours University Hospital, Tours, France
| | - Thibaud Genet
- Department of Cardiology and Cardiac Surgery, Tours University Hospital, Tours, France
| | - Romain Eschalier
- CHU Clermont-Ferrand, Cardiology Department, Clermont-Ferrand, France
| | - Nicolas D'Ostrevy
- CHU Clermont-Ferrand, Cardiology Department, Clermont-Ferrand, France
| | - Emilie Varlet
- European Georges Pompidou Hospital, Cardiology Department, Paris, France
| | - Jérôme Jouan
- European Georges Pompidou Hospital, Cardiology Department, Paris, France
| | - Fabrice Vanhuyse
- Department of Cardiology and Cardiac Surgery, CHU de Nancy, Hopital de Brabois, Nancy, France
| | - Hugues Blangy
- Department of Cardiology and Cardiac Surgery, CHU de Nancy, Hopital de Brabois, Nancy, France
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26
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Monin P, Reynaud N, Hanna N, Dupuis-Girod S, Till M, Arnaud P, Labalme A, Alix E, Poizat-Amar C, Faoucher M, Ravella L, Debost B, Obadia JF, Zech JC, Boileau C, Sanlaville D, Edery P, Putoux A, Schluth-Bolard C. A Case of Trisomy 13 Mosaicism Presenting with a Severe Aortic Root Dilatation and Marfanoid Habitus due to an Unpredictable Cytogenetic Mechanism. Cytogenet Genome Res 2020; 160:72-79. [PMID: 32187601 DOI: 10.1159/000506319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2020] [Indexed: 11/19/2022] Open
Abstract
In this report, we present a new case of mosaic trisomy 13 with prolonged survival, firstly detected by array-CGH analysis which was carried out because of moderate intellectual disability with postaxial hexadactyly, dermatologic features, ventricular septal defect, bicuspid aortic valve, and aortic dystrophy in a 19-year-old male patient. In a subset of 15% of the cells, the patient carried a derivative chromosome 10 generated by a nonreciprocal (10;13) translocation inherited from his healthy mother who carried the translocation in a balanced and homogeneous state. FISH analyses showed interstitial telomeric sequences at the breakpoints. To our knowledge, this is the second report of a patient with trisomy 13 mosaicism displaying a severe aortic root dilatation. We also discuss the mechanisms which could explain the mosaic state, the most likely one being related to the instability of the interstitial telomere.
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27
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Charton M, Flécher E, Leclercq C, Delmas C, Dambrin C, Goeminne C, Vincentelli A, Michel M, Lehelias L, Verdonk C, Para M, Pozzi M, Obadia JF, Boignard A, Chavanon O, Barandon L, Nubret K, Kindo M, Minh TH, Gaudard P, Pelcé E, Gariboldi V, Litzler PY, Anselme F, Babatasi G, Belin A, Garnier F, Bielefeld M, Hamon D, Lellouche N, Bourguignon T, Genet T, Eschalier R, D'Ostrevy N, Bories MC, Jouan J, Vanhuyse F, Blangy H, Doucerain J, Martins RP, Galand V. Suicide Attempts Among LVAD Recipients: Real-Life Data From the ASSIST-ICD Study. Circulation 2020; 141:934-936. [PMID: 32153210 DOI: 10.1161/circulationaha.119.041910] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 11/16/2022]
Affiliation(s)
- Marion Charton
- INSERM, LTSI-UMR 1099, Univ Rennes (M.C., E.F., C.L., R.P.M., V. Galand), CHU Rennes, France
| | - Erwan Flécher
- INSERM, LTSI-UMR 1099, Univ Rennes (M.C., E.F., C.L., R.P.M., V. Galand), CHU Rennes, France.,Department of Cardiac Surgery and Heart Transplantation Unit (E.F.), CHU Rennes, France
| | - Christophe Leclercq
- INSERM, LTSI-UMR 1099, Univ Rennes (M.C., E.F., C.L., R.P.M., V. Galand), CHU Rennes, France
| | - Clément Delmas
- Centre Hospitalier Universitaire de Toulouse, France (C. Delmas, C. Dambrin)
| | - Camille Dambrin
- Centre Hospitalier Universitaire de Toulouse, France (C. Delmas, C. Dambrin)
| | - Céline Goeminne
- Department of Cardiac Surgery, Cardiology, Cardiac Intensive Care Unit, Institut Coeur-Poumons, CHU Lille, France (C.G., A.V.)
| | - André Vincentelli
- Department of Cardiac Surgery, Cardiology, Cardiac Intensive Care Unit, Institut Coeur-Poumons, CHU Lille, France (C.G., A.V.)
| | - Magali Michel
- Department of Cardiology and Heart Transplantation Unit, CHU Nantes, France (M.M., L.L.)
| | - Laurence Lehelias
- Department of Cardiology and Heart Transplantation Unit, CHU Nantes, France (M.M., L.L.)
| | - Constance Verdonk
- Department of Cardiology and Cardiac Surgery, Bichat-Hospital, Paris, France (C.V., M. Para)
| | - Marylou Para
- Department of Cardiology and Cardiac Surgery, Bichat-Hospital, Paris, France (C.V., M. Para)
| | - Matteo Pozzi
- Department of Cardiac Surgery, Louis Pradel Cardiologic Hospital, Lyon, France (M. Pozzi, J.-F.O.)
| | - Jean-François Obadia
- Department of Cardiac Surgery, Louis Pradel Cardiologic Hospital, Lyon, France (M. Pozzi, J.-F.O.)
| | - Aude Boignard
- Department of Cardiology and Cardiovascular Surgery, CHU Michallon, Grenoble, France (A.B., O.C.)
| | - Olivier Chavanon
- Department of Cardiology and Cardiovascular Surgery, CHU Michallon, Grenoble, France (A.B., O.C.)
| | - Laurent Barandon
- Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux II, France (L.B., K.N.)
| | - Karine Nubret
- Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux II, France (L.B., K.N.)
| | - Michel Kindo
- Département de Chirurgie Cardiovasculaire, Hôpitaux Universitaires de Strasbourg, France (M.K., T.H.M.)
| | - Tam Hoang Minh
- Département de Chirurgie Cardiovasculaire, Hôpitaux Universitaires de Strasbourg, France (M.K., T.H.M.)
| | - Philippe Gaudard
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Arnaud De Villeneuve Department of Anesthesiology and Critical Care Medicine, CHU Montpellier, France (P.G.)
| | - Edeline Pelcé
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France (E.P., V. Gariboldi)
| | - Vlad Gariboldi
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France (E.P., V. Gariboldi)
| | - Pierre-Yves Litzler
- Department of Cardiology and Cardiovascular Surgery, Hospital Charles Nicolle, Rouen, France (P.-Y.L., F.A.)
| | - Frédéric Anselme
- Department of Cardiology and Cardiovascular Surgery, Hospital Charles Nicolle, Rouen, France (P.-Y.L., F.A.)
| | - Gerard Babatasi
- Department of Cardiology and Cardiac Surgery, University of Caen and University Hospital of Caen, France (G.B., A.B.)
| | - Annette Belin
- Department of Cardiology and Cardiac Surgery, University of Caen and University Hospital of Caen, France (G.B., A.B.)
| | - Fabien Garnier
- Department of Cardiology and Cardiac Surgery, University Hospital, Dijon, France (F.G., M.B.)
| | - Marie Bielefeld
- Department of Cardiology and Cardiac Surgery, University Hospital, Dijon, France (F.G., M.B.)
| | - David Hamon
- Department of Cardiology and Cardiac Surgery, AP-HP CHU Henri Mondor, Créteil, France (D.H., N.L.)
| | - Nicolas Lellouche
- Department of Cardiology and Cardiac Surgery, AP-HP CHU Henri Mondor, Créteil, France (D.H., N.L.)
| | - Thierry Bourguignon
- Department of Cardiology and Cardiac Surgery, Tours University Hospital, France (T.B., T.G.)
| | - Thibaud Genet
- Department of Cardiology and Cardiac Surgery, Tours University Hospital, France (T.B., T.G.)
| | - Romain Eschalier
- CHU Clermont-Ferrand, Cardiology Department, Clermont-Ferrand, France (R.E., N.D.)
| | - Nicolas D'Ostrevy
- CHU Clermont-Ferrand, Cardiology Department, Clermont-Ferrand, France (R.E., N.D.)
| | - Marie-Cécile Bories
- European Georges Pompidou Hospital, Cardiology Department, Paris, France (M.-C.B., J.J.)
| | - Jérôme Jouan
- European Georges Pompidou Hospital, Cardiology Department, Paris, France (M.-C.B., J.J.)
| | - Fabrice Vanhuyse
- Department of Cardiology and Cardiac Surgery, CHU de Nancy, Hopital de Brabois, Nancy, France (F.V., H.B.)
| | - Hugues Blangy
- Department of Cardiology and Cardiac Surgery, CHU de Nancy, Hopital de Brabois, Nancy, France (F.V., H.B.)
| | | | - Raphael P Martins
- INSERM, LTSI-UMR 1099, Univ Rennes (M.C., E.F., C.L., R.P.M., V. Galand), CHU Rennes, France
| | - Vincent Galand
- INSERM, LTSI-UMR 1099, Univ Rennes (M.C., E.F., C.L., R.P.M., V. Galand), CHU Rennes, France
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Grinberg D, Bruhat A, Obadia JF, Cottinet P, Pandis D, Costa A, Adams D. Mitral valve repair based on intraoperative objective parameters measurement: State of the art and perspective. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.374] [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: 10/25/2022]
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Galand V, Flécher E, Auffret V, Pichard C, Boulé S, Vincentelli A, Rollin A, Mondoly P, Barandon L, Pernot M, Kindo M, Cardi T, Gaudard P, Rouvière P, Sénage T, Jacob N, Defaye P, Chavanon O, Verdonk C, Ghodbane W, Pelcé E, Gariboldi V, Pozzi M, Obadia JF, Savouré A, Anselme F, Babatasi G, Belin A, Garnier F, Bielefeld M, Hamon D, Lellouche N, Pierre B, Bourguignon T, Eschalier R, D'Ostrevy N, Bories MC, Marijon E, Vanhuyse F, Blangy H, Verhoye JP, Leclercq C, Martins RP. Early Ventricular Arrhythmias After LVAD Implantation Is the Strongest Predictor of 30-Day Post-Operative Mortality. JACC Clin Electrophysiol 2019; 5:944-954. [PMID: 31439296 DOI: 10.1016/j.jacep.2019.05.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 01/11/2019] [Revised: 05/22/2019] [Accepted: 05/30/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This study aimed to evaluate incidence, clinical significance, and predictors of early ventricular arrhythmias (VAs) in left ventricular assist device (LVAD) recipients. BACKGROUND LVAD implantation is increasingly used in patients with end-stage heart failure. Early VAs may occur during the 30-day post-operative period, but many questions remain unanswered regarding their incidence and clinical impact. METHODS This observational study was conducted in 19 centers between 2006 and 2016. Early VAs were defined as sustained ventricular tachycardia and/or ventricular fibrillation occurring <30 days post-LVAD implantation and requiring appropriate implantable cardioverter-defibrillator therapy, external electrical shock, or medical therapy. RESULTS A total of 652 patients (median age: 59.8 years; left ventricular ejection fraction: 20.7 ± 7.4%; HeartMate 2: 72.8%; HeartWare: 19.5%; Jarvik 2000: 7.7%) were included in the analysis. Early VAs occurred in 162 patients (24.8%), most frequently during the first week after LVAD implantation. Multivariable analysis identified history of VAs prior to LVAD and any combined surgery with LVAD as 2 predictors of early VAs. The occurrence of early VAs with electrical storm was the strongest predictor of 30-day post-operative mortality, associated with a 7-fold increase of 30-day mortality. However, in patients discharged alive from hospital, occurrence of early VAs did not influence long-term survival. CONCLUSIONS Early VAs are common after LVAD implantation and increase 30-day post-operative mortality, without affecting long-term survival. Further studies will be needed to analyze whether pre- or pre-operative ablation of VAs may improve post-operative outcomes. (Determination of Risk Factors of Ventricular Arrhythmias After Implantation of Continuous Flow Left Ventricular Assist Device With Continuous Flow Left Ventricular Assist Device [ASSIST-ICD]; NCT02873169).
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Affiliation(s)
- Vincent Galand
- Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France
| | - Erwan Flécher
- Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France
| | - Vincent Auffret
- Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France
| | - Camille Pichard
- Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France
| | - Stéphane Boulé
- Department of Cardiology and Cardiac Surgery, CHU Lille, Institut Coeur-Poumons, Lille, France
| | - André Vincentelli
- Department of Cardiology and Cardiac Surgery, CHU Lille, Institut Coeur-Poumons, Lille, France
| | - Anne Rollin
- Department of Cardiology, Department of Cardiac Surgery, CHU de Toulouse, Toulouse, France
| | - Pierre Mondoly
- Department of Cardiology, Department of Cardiac Surgery, CHU de Toulouse, Toulouse, France
| | - Laurent Barandon
- Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux II, Bordeaux, France
| | - Mathieu Pernot
- Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux II, Bordeaux, France
| | - Michel Kindo
- Department of Cardiovascular Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Thomas Cardi
- Department of Cardiovascular Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Philippe Gaudard
- Department of Anesthesiology and Critical Care Medicine, PhyMedExp, University of Montpellier, INSERM, CNRS, Department of Cardiac Surgery, University of Montpellier, CHU Montpellier, Montpellier, France
| | - Philippe Rouvière
- Department of Anesthesiology and Critical Care Medicine, PhyMedExp, University of Montpellier, INSERM, CNRS, Department of Cardiac Surgery, University of Montpellier, CHU Montpellier, Montpellier, France
| | - Thomas Sénage
- Department of Cardiology and Heart Transplantation Unit, CHU Nantes, France
| | - Nicolas Jacob
- Department of Cardiology and Heart Transplantation Unit, CHU Nantes, France
| | - Pascal Defaye
- Department of Cardiology and Cardiovascular Surgery, CHU Michallon, Grenoble, France
| | - Olivier Chavanon
- Department of Cardiology and Cardiovascular Surgery, CHU Michallon, Grenoble, France
| | - Constance Verdonk
- Department of Cardiology and Cardiac Surgery, Bichat-Hospital, Paris, France
| | - Walid Ghodbane
- Department of Cardiology and Cardiac Surgery, Bichat-Hospital, Paris, France
| | - Edeline Pelcé
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Vlad Gariboldi
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Matteo Pozzi
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Lyon, France
| | - Jean-François Obadia
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Lyon, France
| | - Arnaud Savouré
- Department of Cardiology and Cardiovascular Surgery, Hospital Charles Nicolle, Rouen, France
| | - Frédéric Anselme
- Department of Cardiology and Cardiovascular Surgery, Hospital Charles Nicolle, Rouen, France
| | - Gerard Babatasi
- Department of Cardiology and Cardiac Surgery, University Hospital of Caen, University of Caen, Caen, France
| | - Annette Belin
- Department of Cardiology and Cardiac Surgery, University Hospital of Caen, University of Caen, Caen, France
| | - Fabien Garnier
- Department of Cardiology and Cardiac Surgery, University Hospital, Dijon, France
| | - Marie Bielefeld
- Department of Cardiology and Cardiac Surgery, University Hospital, Dijon, France
| | - David Hamon
- Department of Cardiology and Cardiac Surgery, Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, Créteil, France
| | - Nicolas Lellouche
- Department of Cardiology and Cardiac Surgery, Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, Créteil, France
| | - Bertrand Pierre
- Department of Cardiology and Cardiac Surgery, Tours University Hospital, Tours, France
| | - Thierry Bourguignon
- Department of Cardiology and Cardiac Surgery, Tours University Hospital, Tours, France
| | - Romain Eschalier
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Nicolas D'Ostrevy
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Eloi Marijon
- Cardiology Department, European Georges Pompidou Hospital, Paris, France
| | - Fabrice Vanhuyse
- Department of Cardiology and Cardiac Surgery, CHU de Nancy, Hopital de Brabois, Nancy, France
| | - Hugues Blangy
- Department of Cardiology and Cardiac Surgery, CHU de Nancy, Hopital de Brabois, Nancy, France
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Piriou N, Al Habash O, Donal E, Senage T, Le Tourneau T, Pattier S, Guyomarch B, Roussel JC, Trochu JN, Vahanian A, Obadia JF, Iung B, Guérin P. The MITRA-HR study: design and rationale of a randomised study of MitraClip transcatheter mitral valve repair in patients with severe primary mitral regurgitation eligible for high-risk surgery. EUROINTERVENTION 2019; 15:e329-e335. [DOI: 10.4244/eij-d-18-01086] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Grinberg D, Pozzi M, Bordet M, Nouhou KA, Kwon YJ, Obadia JF, Vola M. Minithoracotomy and Beating Heart Strategy for Mitral Surgery in Secondary Mitral Regurgitation. Thorac Cardiovasc Surg 2019; 68:462-469. [PMID: 31242521 DOI: 10.1055/s-0039-1692403] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND In patients with secondary mitral regurgitation (MR) associated with low ejection fraction or previous heart surgery, minimally invasive mitral valve surgery without aortic cross-clamp (MIMVS-WAC) has shown promising results. We report our experience for this strategy in our centers. METHODS Between August 2011 and April 2017, 46 patients (mean age 69 ± 11 years, 76% males) received MIMVS-WAC. Indications for this technique were prior coronary bypass surgery (26%), severe or recent left ventricular (LV) dysfunction (30%), or both (39%). The mean EuroSCORE II was 12 ± 10. RESULTS For each procedure, we conducted right minithoracotomy and hypothermic cardiopulmonary bypass (CPB) after peripheral cannulation. Mean CPB time was 159 ± 39 minutes. A mitral valve replacement (MVR) was performed in 23 cases (50%), an annuloplasty in 22 cases (48%), and a prosthesis pannus removal in 1 case (2%). Mean hospital length of stay was 12 ± 5.4 days. We report no sternotomy conversions, six reoperations for bleeding, and three deaths at 30 days. Transfusion was requested in 62% (mean infusion 2 ± 2.4 packed red blood cells). The postoperative echocardiography showed an LV function preservation in 69% of cases and a reduction of pulmonary arterial pressure in 73% of cases. Four additional deaths occurred in the long-term follow-up (mean 637 ± 381 days, median 593 days). No mitral reoperation was required, with a MR ≤ 2 in 90% of patients. CONCLUSION In high-risk patients, the MIMVS-WAC is a safe technique. It avoids hard dissections while ensuring excellent preservation of cardiac function.
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Affiliation(s)
- Daniel Grinberg
- Department of Adult Cardiac Surgery, Hôpital Cardiologique Louis Pradel, Lyon Medical School, Lyon, France.,Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.,Sinai Biodesign and department of neurosurgery at Icahn School of Medicine and Mount Sinai Health system, New York, New York
| | - Matteo Pozzi
- Department of Adult Cardiac Surgery, Hôpital Cardiologique Louis Pradel, Lyon Medical School, Lyon, France
| | - Marine Bordet
- Department of Adult Cardiac Surgery, Hôpital Cardiologique Louis Pradel, Lyon Medical School, Lyon, France
| | - Kaled Adamou Nouhou
- Department of Adult Cardiac Surgery, Hôpital Cardiologique Louis Pradel, Lyon Medical School, Lyon, France
| | - Young Joon Kwon
- Sinai Biodesign and department of neurosurgery at Icahn School of Medicine and Mount Sinai Health system, New York, New York
| | - Jean-François Obadia
- Department of Adult Cardiac Surgery, Hôpital Cardiologique Louis Pradel, Lyon Medical School, Lyon, France
| | - Marco Vola
- Department of Adult Cardiac Surgery, Hôpital Cardiologique Louis Pradel, Lyon Medical School, Lyon, France.,Department of Cardiovascular Surgery, Saint-Etienne Medical School, Saint-Etienne, France
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Flécher E, Guihaire J, Pozzi M, Ouattara A, Baudry G, Berthelot E, Beauvais F, Radu C, Dorent R, Sebbag L, Galli E, Roubille F, Damy T, Verhoye JP, Leprince P, Obadia JF, Lebreton G. Extracorporeal membrane oxygenation support in acute circulatory failure: A plea for regulation and better organization. Arch Cardiovasc Dis 2019; 112:441-449. [DOI: 10.1016/j.acvd.2019.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/18/2019] [Accepted: 04/23/2019] [Indexed: 12/28/2022]
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de Heer F, Kluin J, Elkhoury G, Jondeau G, Enriquez-Sarano M, Schäfers HJ, Takkenberg JJ, Lansac E, Dinges C, Steindl J, Ziller R, De Kerchove L, Benkacem T, Coulon C, Elkhoury G, Kaddouri F, Vanoverschelde JL, de Meester C, Pasquet A, Nijs J, Van Mosselvelde V, Loeys B, Meuris B, Schepmans E, Van den Bossche K, Verbrugghe P, Goossens W, Gutermann H, Pettinari M, El-Hamamsy I, Lenoir M, Noly PE, Tousch M, Shah P, Boodhwani M, Rudez I, Baric D, Unic D, Varvodic J, Gjorgijevska S, Vojacek J, Zacek P, Karalko M, Hlubocky J, Novotny R, Slautin A, Soliman S, Arnaud-Crozat E, Boignard A, Fayad G, Bouchot O, Albat B, Leguerrier A, Doguet F, Fuzellier JF, Glock Y, Jondeau G, Fernandez G, Chatel D, Zeitoun DM, Jouan J, Di Centa I, Obadia JF, Leprince P, Houel R, Bergoend E, Lopez S, Berrebi A, Tubach F, Lansac E, Lejeune S, Monin JL, Pousset S, Mankoubi L, Noghin M, Diakov C, Czytrom D, Schäfers HJ, Borger M, Aicher D, Theisohn F, Ferrero P, Stoica S, Matuszewski M, Yiu P, Bashir M, Ceresa F, Patane F, De Paulis R, Chirichilli I, Masat M, Antona C, Contino M, Mangini A, Romagnoni C, Grigioni F, Rosa R, Okita Y, Miyairi T, Kunihara T, de Heer F, Koolbergen D, Marsman M, Gökalp A, Kluin J, Bekkers J, Duininck L, Takkenberg JJ, Klautz R, Van Brakel T, Arabkhani B, Mecozzi G, Accord R, Jasinski M, Aminov V, Svetkin M, Kolesar A, Sabol F, Toporcer T, Bibiloni I, Rábago G, Alvarez-Asiain V, Melero A, Sadaba R, Aramendi J, Crespo A, Porras C, Evangelista Masip A, Kelley S, Bavaria J, Milewski R, Moeller P, Wenger I, Enriquez-Sarano M, Alger S, Alger A, Leavitt K. AVIATOR: An open international registry to evaluate medical and surgical outcomes of aortic valve insufficiency and ascending aorta aneurysm. J Thorac Cardiovasc Surg 2019; 157:2202-2211.e7. [DOI: 10.1016/j.jtcvs.2018.10.076] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 10/02/2018] [Accepted: 10/16/2018] [Indexed: 01/08/2023]
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Grinberg D, Donal E, Obadia JF. What do MITRA-FR and COAPT teach us about the percutaneous treatment of secondary mitral regurgitation? EUROINTERVENTION 2019; 14:1713-1715. [DOI: 10.4244/eijv14i17a295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Obadia JF, Messika-Zeitoun D, Leurent G, Iung B, Bonnet G, Piriou N, Lefèvre T, Piot C, Rouleau F, Carrié D, Nejjari M, Ohlmann P, Leclercq F, Saint Etienne C, Teiger E, Leroux L, Karam N, Michel N, Gilard M, Donal E, Trochu JN, Cormier B, Armoiry X, Boutitie F, Maucort-Boulch D, Barnel C, Samson G, Guerin P, Vahanian A, Mewton N. Percutaneous Repair or Medical Treatment for Secondary Mitral Regurgitation. N Engl J Med 2018; 379:2297-2306. [PMID: 30145927 DOI: 10.1056/nejmoa1805374] [Citation(s) in RCA: 1123] [Impact Index Per Article: 187.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND In patients who have chronic heart failure with reduced left ventricular ejection fraction, severe secondary mitral-valve regurgitation is associated with a poor prognosis. Whether percutaneous mitral-valve repair improves clinical outcomes in this patient population is unknown. METHODS We randomly assigned patients who had severe secondary mitral regurgitation (defined as an effective regurgitant orifice area of >20 mm2 or a regurgitant volume of >30 ml per beat), a left ventricular ejection fraction between 15 and 40%, and symptomatic heart failure, in a 1:1 ratio, to undergo percutaneous mitral-valve repair in addition to receiving medical therapy (intervention group; 152 patients) or to receive medical therapy alone (control group; 152 patients). The primary efficacy outcome was a composite of death from any cause or unplanned hospitalization for heart failure at 12 months. RESULTS At 12 months, the rate of the primary outcome was 54.6% (83 of 152 patients) in the intervention group and 51.3% (78 of 152 patients) in the control group (odds ratio, 1.16; 95% confidence interval [CI], 0.73 to 1.84; P=0.53). The rate of death from any cause was 24.3% (37 of 152 patients) in the intervention group and 22.4% (34 of 152 patients) in the control group (hazard ratio, 1.11; 95% CI, 0.69 to 1.77). The rate of unplanned hospitalization for heart failure was 48.7% (74 of 152 patients) in the intervention group and 47.4% (72 of 152 patients) in the control group (hazard ratio, 1.13; 95% CI, 0.81 to 1.56). CONCLUSIONS Among patients with severe secondary mitral regurgitation, the rate of death or unplanned hospitalization for heart failure at 1 year did not differ significantly between patients who underwent percutaneous mitral-valve repair in addition to receiving medical therapy and those who received medical therapy alone. (Funded by the French Ministry of Health and Research National Program and Abbott Vascular; MITRA-FR ClinicalTrials.gov number, NCT01920698 .).
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Affiliation(s)
- Jean-François Obadia
- From Hopital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque (J.-F.O.), Pharmacy Department and Laboratoire Mateis (X.A.), and Hopital Cardiovasculaire Louis Pradel, Clinical Investigation Center and Heart Failure Department, INSERM 1407 (C.B., G.S., N. Mewton), Hospices Civils de Lyon and Claude Bernard University, Lyon, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Bichat (D.M.-Z., B.I., A.V.), and APHP, Hôpital Européen Georges Pompidou (N.K.), Paris, Centre Hospitalier Universitaire (CHU) Rennes, Hôpital Pontchaillou, Rennes (G.L., E.D.), Assistance Publique-Hôpitaux de Marseille (APHM), Hôpital de la Timone (G.B.), and Hôpital Saint Joseph (N. Michel), Marseille, CHU Nantes, Hôpital Guillaume et René Laennec, Nantes (N.P., J.-N.T., P.G.), Institut Jacques Cartier, Massy (T.L., B.C.), Clinique du Millénaire (C.P.) and CHU Montpellier, Hôpital Arnaud-de-Villeneuve (F.L.), Montpellier, CHU Angers, Angers (F.R.), CHU Toulouse, Hôpital Rangueil, Toulouse (D.C.), Centre Cardiologique du Nord, Saint-Denis (M.N.), Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg (P.O.), Centre Hospitalier Régional Universitaire (CHRU) de Tours, Hôpital Trousseau, Tours (C.S.E.), APHP, Hôpital Henri Mondor, Créteil (E.T.), CHU Bordeaux, Hôpital Haut-Lévêque, Pessac (L.L.), CHRU Brest, Hôpital de La Cavale Blanche, Brest (M.G.), and Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Centre National de la Recherche Scientifique (CNRS), and Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne (F.B., D.M.-B.) - all in France; and the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Canada (D.M.-Z.)
| | - David Messika-Zeitoun
- From Hopital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque (J.-F.O.), Pharmacy Department and Laboratoire Mateis (X.A.), and Hopital Cardiovasculaire Louis Pradel, Clinical Investigation Center and Heart Failure Department, INSERM 1407 (C.B., G.S., N. Mewton), Hospices Civils de Lyon and Claude Bernard University, Lyon, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Bichat (D.M.-Z., B.I., A.V.), and APHP, Hôpital Européen Georges Pompidou (N.K.), Paris, Centre Hospitalier Universitaire (CHU) Rennes, Hôpital Pontchaillou, Rennes (G.L., E.D.), Assistance Publique-Hôpitaux de Marseille (APHM), Hôpital de la Timone (G.B.), and Hôpital Saint Joseph (N. Michel), Marseille, CHU Nantes, Hôpital Guillaume et René Laennec, Nantes (N.P., J.-N.T., P.G.), Institut Jacques Cartier, Massy (T.L., B.C.), Clinique du Millénaire (C.P.) and CHU Montpellier, Hôpital Arnaud-de-Villeneuve (F.L.), Montpellier, CHU Angers, Angers (F.R.), CHU Toulouse, Hôpital Rangueil, Toulouse (D.C.), Centre Cardiologique du Nord, Saint-Denis (M.N.), Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg (P.O.), Centre Hospitalier Régional Universitaire (CHRU) de Tours, Hôpital Trousseau, Tours (C.S.E.), APHP, Hôpital Henri Mondor, Créteil (E.T.), CHU Bordeaux, Hôpital Haut-Lévêque, Pessac (L.L.), CHRU Brest, Hôpital de La Cavale Blanche, Brest (M.G.), and Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Centre National de la Recherche Scientifique (CNRS), and Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne (F.B., D.M.-B.) - all in France; and the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Canada (D.M.-Z.)
| | - Guillaume Leurent
- From Hopital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque (J.-F.O.), Pharmacy Department and Laboratoire Mateis (X.A.), and Hopital Cardiovasculaire Louis Pradel, Clinical Investigation Center and Heart Failure Department, INSERM 1407 (C.B., G.S., N. Mewton), Hospices Civils de Lyon and Claude Bernard University, Lyon, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Bichat (D.M.-Z., B.I., A.V.), and APHP, Hôpital Européen Georges Pompidou (N.K.), Paris, Centre Hospitalier Universitaire (CHU) Rennes, Hôpital Pontchaillou, Rennes (G.L., E.D.), Assistance Publique-Hôpitaux de Marseille (APHM), Hôpital de la Timone (G.B.), and Hôpital Saint Joseph (N. Michel), Marseille, CHU Nantes, Hôpital Guillaume et René Laennec, Nantes (N.P., J.-N.T., P.G.), Institut Jacques Cartier, Massy (T.L., B.C.), Clinique du Millénaire (C.P.) and CHU Montpellier, Hôpital Arnaud-de-Villeneuve (F.L.), Montpellier, CHU Angers, Angers (F.R.), CHU Toulouse, Hôpital Rangueil, Toulouse (D.C.), Centre Cardiologique du Nord, Saint-Denis (M.N.), Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg (P.O.), Centre Hospitalier Régional Universitaire (CHRU) de Tours, Hôpital Trousseau, Tours (C.S.E.), APHP, Hôpital Henri Mondor, Créteil (E.T.), CHU Bordeaux, Hôpital Haut-Lévêque, Pessac (L.L.), CHRU Brest, Hôpital de La Cavale Blanche, Brest (M.G.), and Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Centre National de la Recherche Scientifique (CNRS), and Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne (F.B., D.M.-B.) - all in France; and the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Canada (D.M.-Z.)
| | - Bernard Iung
- From Hopital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque (J.-F.O.), Pharmacy Department and Laboratoire Mateis (X.A.), and Hopital Cardiovasculaire Louis Pradel, Clinical Investigation Center and Heart Failure Department, INSERM 1407 (C.B., G.S., N. Mewton), Hospices Civils de Lyon and Claude Bernard University, Lyon, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Bichat (D.M.-Z., B.I., A.V.), and APHP, Hôpital Européen Georges Pompidou (N.K.), Paris, Centre Hospitalier Universitaire (CHU) Rennes, Hôpital Pontchaillou, Rennes (G.L., E.D.), Assistance Publique-Hôpitaux de Marseille (APHM), Hôpital de la Timone (G.B.), and Hôpital Saint Joseph (N. Michel), Marseille, CHU Nantes, Hôpital Guillaume et René Laennec, Nantes (N.P., J.-N.T., P.G.), Institut Jacques Cartier, Massy (T.L., B.C.), Clinique du Millénaire (C.P.) and CHU Montpellier, Hôpital Arnaud-de-Villeneuve (F.L.), Montpellier, CHU Angers, Angers (F.R.), CHU Toulouse, Hôpital Rangueil, Toulouse (D.C.), Centre Cardiologique du Nord, Saint-Denis (M.N.), Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg (P.O.), Centre Hospitalier Régional Universitaire (CHRU) de Tours, Hôpital Trousseau, Tours (C.S.E.), APHP, Hôpital Henri Mondor, Créteil (E.T.), CHU Bordeaux, Hôpital Haut-Lévêque, Pessac (L.L.), CHRU Brest, Hôpital de La Cavale Blanche, Brest (M.G.), and Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Centre National de la Recherche Scientifique (CNRS), and Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne (F.B., D.M.-B.) - all in France; and the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Canada (D.M.-Z.)
| | - Guillaume Bonnet
- From Hopital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque (J.-F.O.), Pharmacy Department and Laboratoire Mateis (X.A.), and Hopital Cardiovasculaire Louis Pradel, Clinical Investigation Center and Heart Failure Department, INSERM 1407 (C.B., G.S., N. Mewton), Hospices Civils de Lyon and Claude Bernard University, Lyon, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Bichat (D.M.-Z., B.I., A.V.), and APHP, Hôpital Européen Georges Pompidou (N.K.), Paris, Centre Hospitalier Universitaire (CHU) Rennes, Hôpital Pontchaillou, Rennes (G.L., E.D.), Assistance Publique-Hôpitaux de Marseille (APHM), Hôpital de la Timone (G.B.), and Hôpital Saint Joseph (N. Michel), Marseille, CHU Nantes, Hôpital Guillaume et René Laennec, Nantes (N.P., J.-N.T., P.G.), Institut Jacques Cartier, Massy (T.L., B.C.), Clinique du Millénaire (C.P.) and CHU Montpellier, Hôpital Arnaud-de-Villeneuve (F.L.), Montpellier, CHU Angers, Angers (F.R.), CHU Toulouse, Hôpital Rangueil, Toulouse (D.C.), Centre Cardiologique du Nord, Saint-Denis (M.N.), Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg (P.O.), Centre Hospitalier Régional Universitaire (CHRU) de Tours, Hôpital Trousseau, Tours (C.S.E.), APHP, Hôpital Henri Mondor, Créteil (E.T.), CHU Bordeaux, Hôpital Haut-Lévêque, Pessac (L.L.), CHRU Brest, Hôpital de La Cavale Blanche, Brest (M.G.), and Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Centre National de la Recherche Scientifique (CNRS), and Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne (F.B., D.M.-B.) - all in France; and the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Canada (D.M.-Z.)
| | - Nicolas Piriou
- From Hopital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque (J.-F.O.), Pharmacy Department and Laboratoire Mateis (X.A.), and Hopital Cardiovasculaire Louis Pradel, Clinical Investigation Center and Heart Failure Department, INSERM 1407 (C.B., G.S., N. Mewton), Hospices Civils de Lyon and Claude Bernard University, Lyon, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Bichat (D.M.-Z., B.I., A.V.), and APHP, Hôpital Européen Georges Pompidou (N.K.), Paris, Centre Hospitalier Universitaire (CHU) Rennes, Hôpital Pontchaillou, Rennes (G.L., E.D.), Assistance Publique-Hôpitaux de Marseille (APHM), Hôpital de la Timone (G.B.), and Hôpital Saint Joseph (N. Michel), Marseille, CHU Nantes, Hôpital Guillaume et René Laennec, Nantes (N.P., J.-N.T., P.G.), Institut Jacques Cartier, Massy (T.L., B.C.), Clinique du Millénaire (C.P.) and CHU Montpellier, Hôpital Arnaud-de-Villeneuve (F.L.), Montpellier, CHU Angers, Angers (F.R.), CHU Toulouse, Hôpital Rangueil, Toulouse (D.C.), Centre Cardiologique du Nord, Saint-Denis (M.N.), Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg (P.O.), Centre Hospitalier Régional Universitaire (CHRU) de Tours, Hôpital Trousseau, Tours (C.S.E.), APHP, Hôpital Henri Mondor, Créteil (E.T.), CHU Bordeaux, Hôpital Haut-Lévêque, Pessac (L.L.), CHRU Brest, Hôpital de La Cavale Blanche, Brest (M.G.), and Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Centre National de la Recherche Scientifique (CNRS), and Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne (F.B., D.M.-B.) - all in France; and the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Canada (D.M.-Z.)
| | - Thierry Lefèvre
- From Hopital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque (J.-F.O.), Pharmacy Department and Laboratoire Mateis (X.A.), and Hopital Cardiovasculaire Louis Pradel, Clinical Investigation Center and Heart Failure Department, INSERM 1407 (C.B., G.S., N. Mewton), Hospices Civils de Lyon and Claude Bernard University, Lyon, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Bichat (D.M.-Z., B.I., A.V.), and APHP, Hôpital Européen Georges Pompidou (N.K.), Paris, Centre Hospitalier Universitaire (CHU) Rennes, Hôpital Pontchaillou, Rennes (G.L., E.D.), Assistance Publique-Hôpitaux de Marseille (APHM), Hôpital de la Timone (G.B.), and Hôpital Saint Joseph (N. Michel), Marseille, CHU Nantes, Hôpital Guillaume et René Laennec, Nantes (N.P., J.-N.T., P.G.), Institut Jacques Cartier, Massy (T.L., B.C.), Clinique du Millénaire (C.P.) and CHU Montpellier, Hôpital Arnaud-de-Villeneuve (F.L.), Montpellier, CHU Angers, Angers (F.R.), CHU Toulouse, Hôpital Rangueil, Toulouse (D.C.), Centre Cardiologique du Nord, Saint-Denis (M.N.), Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg (P.O.), Centre Hospitalier Régional Universitaire (CHRU) de Tours, Hôpital Trousseau, Tours (C.S.E.), APHP, Hôpital Henri Mondor, Créteil (E.T.), CHU Bordeaux, Hôpital Haut-Lévêque, Pessac (L.L.), CHRU Brest, Hôpital de La Cavale Blanche, Brest (M.G.), and Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Centre National de la Recherche Scientifique (CNRS), and Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne (F.B., D.M.-B.) - all in France; and the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Canada (D.M.-Z.)
| | - Christophe Piot
- From Hopital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque (J.-F.O.), Pharmacy Department and Laboratoire Mateis (X.A.), and Hopital Cardiovasculaire Louis Pradel, Clinical Investigation Center and Heart Failure Department, INSERM 1407 (C.B., G.S., N. Mewton), Hospices Civils de Lyon and Claude Bernard University, Lyon, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Bichat (D.M.-Z., B.I., A.V.), and APHP, Hôpital Européen Georges Pompidou (N.K.), Paris, Centre Hospitalier Universitaire (CHU) Rennes, Hôpital Pontchaillou, Rennes (G.L., E.D.), Assistance Publique-Hôpitaux de Marseille (APHM), Hôpital de la Timone (G.B.), and Hôpital Saint Joseph (N. Michel), Marseille, CHU Nantes, Hôpital Guillaume et René Laennec, Nantes (N.P., J.-N.T., P.G.), Institut Jacques Cartier, Massy (T.L., B.C.), Clinique du Millénaire (C.P.) and CHU Montpellier, Hôpital Arnaud-de-Villeneuve (F.L.), Montpellier, CHU Angers, Angers (F.R.), CHU Toulouse, Hôpital Rangueil, Toulouse (D.C.), Centre Cardiologique du Nord, Saint-Denis (M.N.), Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg (P.O.), Centre Hospitalier Régional Universitaire (CHRU) de Tours, Hôpital Trousseau, Tours (C.S.E.), APHP, Hôpital Henri Mondor, Créteil (E.T.), CHU Bordeaux, Hôpital Haut-Lévêque, Pessac (L.L.), CHRU Brest, Hôpital de La Cavale Blanche, Brest (M.G.), and Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Centre National de la Recherche Scientifique (CNRS), and Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne (F.B., D.M.-B.) - all in France; and the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Canada (D.M.-Z.)
| | - Frédéric Rouleau
- From Hopital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque (J.-F.O.), Pharmacy Department and Laboratoire Mateis (X.A.), and Hopital Cardiovasculaire Louis Pradel, Clinical Investigation Center and Heart Failure Department, INSERM 1407 (C.B., G.S., N. Mewton), Hospices Civils de Lyon and Claude Bernard University, Lyon, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Bichat (D.M.-Z., B.I., A.V.), and APHP, Hôpital Européen Georges Pompidou (N.K.), Paris, Centre Hospitalier Universitaire (CHU) Rennes, Hôpital Pontchaillou, Rennes (G.L., E.D.), Assistance Publique-Hôpitaux de Marseille (APHM), Hôpital de la Timone (G.B.), and Hôpital Saint Joseph (N. Michel), Marseille, CHU Nantes, Hôpital Guillaume et René Laennec, Nantes (N.P., J.-N.T., P.G.), Institut Jacques Cartier, Massy (T.L., B.C.), Clinique du Millénaire (C.P.) and CHU Montpellier, Hôpital Arnaud-de-Villeneuve (F.L.), Montpellier, CHU Angers, Angers (F.R.), CHU Toulouse, Hôpital Rangueil, Toulouse (D.C.), Centre Cardiologique du Nord, Saint-Denis (M.N.), Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg (P.O.), Centre Hospitalier Régional Universitaire (CHRU) de Tours, Hôpital Trousseau, Tours (C.S.E.), APHP, Hôpital Henri Mondor, Créteil (E.T.), CHU Bordeaux, Hôpital Haut-Lévêque, Pessac (L.L.), CHRU Brest, Hôpital de La Cavale Blanche, Brest (M.G.), and Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Centre National de la Recherche Scientifique (CNRS), and Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne (F.B., D.M.-B.) - all in France; and the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Canada (D.M.-Z.)
| | - Didier Carrié
- From Hopital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque (J.-F.O.), Pharmacy Department and Laboratoire Mateis (X.A.), and Hopital Cardiovasculaire Louis Pradel, Clinical Investigation Center and Heart Failure Department, INSERM 1407 (C.B., G.S., N. Mewton), Hospices Civils de Lyon and Claude Bernard University, Lyon, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Bichat (D.M.-Z., B.I., A.V.), and APHP, Hôpital Européen Georges Pompidou (N.K.), Paris, Centre Hospitalier Universitaire (CHU) Rennes, Hôpital Pontchaillou, Rennes (G.L., E.D.), Assistance Publique-Hôpitaux de Marseille (APHM), Hôpital de la Timone (G.B.), and Hôpital Saint Joseph (N. Michel), Marseille, CHU Nantes, Hôpital Guillaume et René Laennec, Nantes (N.P., J.-N.T., P.G.), Institut Jacques Cartier, Massy (T.L., B.C.), Clinique du Millénaire (C.P.) and CHU Montpellier, Hôpital Arnaud-de-Villeneuve (F.L.), Montpellier, CHU Angers, Angers (F.R.), CHU Toulouse, Hôpital Rangueil, Toulouse (D.C.), Centre Cardiologique du Nord, Saint-Denis (M.N.), Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg (P.O.), Centre Hospitalier Régional Universitaire (CHRU) de Tours, Hôpital Trousseau, Tours (C.S.E.), APHP, Hôpital Henri Mondor, Créteil (E.T.), CHU Bordeaux, Hôpital Haut-Lévêque, Pessac (L.L.), CHRU Brest, Hôpital de La Cavale Blanche, Brest (M.G.), and Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Centre National de la Recherche Scientifique (CNRS), and Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne (F.B., D.M.-B.) - all in France; and the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Canada (D.M.-Z.)
| | - Mohammed Nejjari
- From Hopital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque (J.-F.O.), Pharmacy Department and Laboratoire Mateis (X.A.), and Hopital Cardiovasculaire Louis Pradel, Clinical Investigation Center and Heart Failure Department, INSERM 1407 (C.B., G.S., N. Mewton), Hospices Civils de Lyon and Claude Bernard University, Lyon, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Bichat (D.M.-Z., B.I., A.V.), and APHP, Hôpital Européen Georges Pompidou (N.K.), Paris, Centre Hospitalier Universitaire (CHU) Rennes, Hôpital Pontchaillou, Rennes (G.L., E.D.), Assistance Publique-Hôpitaux de Marseille (APHM), Hôpital de la Timone (G.B.), and Hôpital Saint Joseph (N. Michel), Marseille, CHU Nantes, Hôpital Guillaume et René Laennec, Nantes (N.P., J.-N.T., P.G.), Institut Jacques Cartier, Massy (T.L., B.C.), Clinique du Millénaire (C.P.) and CHU Montpellier, Hôpital Arnaud-de-Villeneuve (F.L.), Montpellier, CHU Angers, Angers (F.R.), CHU Toulouse, Hôpital Rangueil, Toulouse (D.C.), Centre Cardiologique du Nord, Saint-Denis (M.N.), Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg (P.O.), Centre Hospitalier Régional Universitaire (CHRU) de Tours, Hôpital Trousseau, Tours (C.S.E.), APHP, Hôpital Henri Mondor, Créteil (E.T.), CHU Bordeaux, Hôpital Haut-Lévêque, Pessac (L.L.), CHRU Brest, Hôpital de La Cavale Blanche, Brest (M.G.), and Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Centre National de la Recherche Scientifique (CNRS), and Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne (F.B., D.M.-B.) - all in France; and the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Canada (D.M.-Z.)
| | - Patrick Ohlmann
- From Hopital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque (J.-F.O.), Pharmacy Department and Laboratoire Mateis (X.A.), and Hopital Cardiovasculaire Louis Pradel, Clinical Investigation Center and Heart Failure Department, INSERM 1407 (C.B., G.S., N. Mewton), Hospices Civils de Lyon and Claude Bernard University, Lyon, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Bichat (D.M.-Z., B.I., A.V.), and APHP, Hôpital Européen Georges Pompidou (N.K.), Paris, Centre Hospitalier Universitaire (CHU) Rennes, Hôpital Pontchaillou, Rennes (G.L., E.D.), Assistance Publique-Hôpitaux de Marseille (APHM), Hôpital de la Timone (G.B.), and Hôpital Saint Joseph (N. Michel), Marseille, CHU Nantes, Hôpital Guillaume et René Laennec, Nantes (N.P., J.-N.T., P.G.), Institut Jacques Cartier, Massy (T.L., B.C.), Clinique du Millénaire (C.P.) and CHU Montpellier, Hôpital Arnaud-de-Villeneuve (F.L.), Montpellier, CHU Angers, Angers (F.R.), CHU Toulouse, Hôpital Rangueil, Toulouse (D.C.), Centre Cardiologique du Nord, Saint-Denis (M.N.), Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg (P.O.), Centre Hospitalier Régional Universitaire (CHRU) de Tours, Hôpital Trousseau, Tours (C.S.E.), APHP, Hôpital Henri Mondor, Créteil (E.T.), CHU Bordeaux, Hôpital Haut-Lévêque, Pessac (L.L.), CHRU Brest, Hôpital de La Cavale Blanche, Brest (M.G.), and Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Centre National de la Recherche Scientifique (CNRS), and Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne (F.B., D.M.-B.) - all in France; and the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Canada (D.M.-Z.)
| | - Florence Leclercq
- From Hopital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque (J.-F.O.), Pharmacy Department and Laboratoire Mateis (X.A.), and Hopital Cardiovasculaire Louis Pradel, Clinical Investigation Center and Heart Failure Department, INSERM 1407 (C.B., G.S., N. Mewton), Hospices Civils de Lyon and Claude Bernard University, Lyon, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Bichat (D.M.-Z., B.I., A.V.), and APHP, Hôpital Européen Georges Pompidou (N.K.), Paris, Centre Hospitalier Universitaire (CHU) Rennes, Hôpital Pontchaillou, Rennes (G.L., E.D.), Assistance Publique-Hôpitaux de Marseille (APHM), Hôpital de la Timone (G.B.), and Hôpital Saint Joseph (N. Michel), Marseille, CHU Nantes, Hôpital Guillaume et René Laennec, Nantes (N.P., J.-N.T., P.G.), Institut Jacques Cartier, Massy (T.L., B.C.), Clinique du Millénaire (C.P.) and CHU Montpellier, Hôpital Arnaud-de-Villeneuve (F.L.), Montpellier, CHU Angers, Angers (F.R.), CHU Toulouse, Hôpital Rangueil, Toulouse (D.C.), Centre Cardiologique du Nord, Saint-Denis (M.N.), Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg (P.O.), Centre Hospitalier Régional Universitaire (CHRU) de Tours, Hôpital Trousseau, Tours (C.S.E.), APHP, Hôpital Henri Mondor, Créteil (E.T.), CHU Bordeaux, Hôpital Haut-Lévêque, Pessac (L.L.), CHRU Brest, Hôpital de La Cavale Blanche, Brest (M.G.), and Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Centre National de la Recherche Scientifique (CNRS), and Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne (F.B., D.M.-B.) - all in France; and the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Canada (D.M.-Z.)
| | - Christophe Saint Etienne
- From Hopital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque (J.-F.O.), Pharmacy Department and Laboratoire Mateis (X.A.), and Hopital Cardiovasculaire Louis Pradel, Clinical Investigation Center and Heart Failure Department, INSERM 1407 (C.B., G.S., N. Mewton), Hospices Civils de Lyon and Claude Bernard University, Lyon, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Bichat (D.M.-Z., B.I., A.V.), and APHP, Hôpital Européen Georges Pompidou (N.K.), Paris, Centre Hospitalier Universitaire (CHU) Rennes, Hôpital Pontchaillou, Rennes (G.L., E.D.), Assistance Publique-Hôpitaux de Marseille (APHM), Hôpital de la Timone (G.B.), and Hôpital Saint Joseph (N. Michel), Marseille, CHU Nantes, Hôpital Guillaume et René Laennec, Nantes (N.P., J.-N.T., P.G.), Institut Jacques Cartier, Massy (T.L., B.C.), Clinique du Millénaire (C.P.) and CHU Montpellier, Hôpital Arnaud-de-Villeneuve (F.L.), Montpellier, CHU Angers, Angers (F.R.), CHU Toulouse, Hôpital Rangueil, Toulouse (D.C.), Centre Cardiologique du Nord, Saint-Denis (M.N.), Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg (P.O.), Centre Hospitalier Régional Universitaire (CHRU) de Tours, Hôpital Trousseau, Tours (C.S.E.), APHP, Hôpital Henri Mondor, Créteil (E.T.), CHU Bordeaux, Hôpital Haut-Lévêque, Pessac (L.L.), CHRU Brest, Hôpital de La Cavale Blanche, Brest (M.G.), and Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Centre National de la Recherche Scientifique (CNRS), and Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne (F.B., D.M.-B.) - all in France; and the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Canada (D.M.-Z.)
| | - Emmanuel Teiger
- From Hopital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque (J.-F.O.), Pharmacy Department and Laboratoire Mateis (X.A.), and Hopital Cardiovasculaire Louis Pradel, Clinical Investigation Center and Heart Failure Department, INSERM 1407 (C.B., G.S., N. Mewton), Hospices Civils de Lyon and Claude Bernard University, Lyon, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Bichat (D.M.-Z., B.I., A.V.), and APHP, Hôpital Européen Georges Pompidou (N.K.), Paris, Centre Hospitalier Universitaire (CHU) Rennes, Hôpital Pontchaillou, Rennes (G.L., E.D.), Assistance Publique-Hôpitaux de Marseille (APHM), Hôpital de la Timone (G.B.), and Hôpital Saint Joseph (N. Michel), Marseille, CHU Nantes, Hôpital Guillaume et René Laennec, Nantes (N.P., J.-N.T., P.G.), Institut Jacques Cartier, Massy (T.L., B.C.), Clinique du Millénaire (C.P.) and CHU Montpellier, Hôpital Arnaud-de-Villeneuve (F.L.), Montpellier, CHU Angers, Angers (F.R.), CHU Toulouse, Hôpital Rangueil, Toulouse (D.C.), Centre Cardiologique du Nord, Saint-Denis (M.N.), Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg (P.O.), Centre Hospitalier Régional Universitaire (CHRU) de Tours, Hôpital Trousseau, Tours (C.S.E.), APHP, Hôpital Henri Mondor, Créteil (E.T.), CHU Bordeaux, Hôpital Haut-Lévêque, Pessac (L.L.), CHRU Brest, Hôpital de La Cavale Blanche, Brest (M.G.), and Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Centre National de la Recherche Scientifique (CNRS), and Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne (F.B., D.M.-B.) - all in France; and the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Canada (D.M.-Z.)
| | - Lionel Leroux
- From Hopital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque (J.-F.O.), Pharmacy Department and Laboratoire Mateis (X.A.), and Hopital Cardiovasculaire Louis Pradel, Clinical Investigation Center and Heart Failure Department, INSERM 1407 (C.B., G.S., N. Mewton), Hospices Civils de Lyon and Claude Bernard University, Lyon, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Bichat (D.M.-Z., B.I., A.V.), and APHP, Hôpital Européen Georges Pompidou (N.K.), Paris, Centre Hospitalier Universitaire (CHU) Rennes, Hôpital Pontchaillou, Rennes (G.L., E.D.), Assistance Publique-Hôpitaux de Marseille (APHM), Hôpital de la Timone (G.B.), and Hôpital Saint Joseph (N. Michel), Marseille, CHU Nantes, Hôpital Guillaume et René Laennec, Nantes (N.P., J.-N.T., P.G.), Institut Jacques Cartier, Massy (T.L., B.C.), Clinique du Millénaire (C.P.) and CHU Montpellier, Hôpital Arnaud-de-Villeneuve (F.L.), Montpellier, CHU Angers, Angers (F.R.), CHU Toulouse, Hôpital Rangueil, Toulouse (D.C.), Centre Cardiologique du Nord, Saint-Denis (M.N.), Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg (P.O.), Centre Hospitalier Régional Universitaire (CHRU) de Tours, Hôpital Trousseau, Tours (C.S.E.), APHP, Hôpital Henri Mondor, Créteil (E.T.), CHU Bordeaux, Hôpital Haut-Lévêque, Pessac (L.L.), CHRU Brest, Hôpital de La Cavale Blanche, Brest (M.G.), and Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Centre National de la Recherche Scientifique (CNRS), and Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne (F.B., D.M.-B.) - all in France; and the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Canada (D.M.-Z.)
| | - Nicole Karam
- From Hopital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque (J.-F.O.), Pharmacy Department and Laboratoire Mateis (X.A.), and Hopital Cardiovasculaire Louis Pradel, Clinical Investigation Center and Heart Failure Department, INSERM 1407 (C.B., G.S., N. Mewton), Hospices Civils de Lyon and Claude Bernard University, Lyon, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Bichat (D.M.-Z., B.I., A.V.), and APHP, Hôpital Européen Georges Pompidou (N.K.), Paris, Centre Hospitalier Universitaire (CHU) Rennes, Hôpital Pontchaillou, Rennes (G.L., E.D.), Assistance Publique-Hôpitaux de Marseille (APHM), Hôpital de la Timone (G.B.), and Hôpital Saint Joseph (N. Michel), Marseille, CHU Nantes, Hôpital Guillaume et René Laennec, Nantes (N.P., J.-N.T., P.G.), Institut Jacques Cartier, Massy (T.L., B.C.), Clinique du Millénaire (C.P.) and CHU Montpellier, Hôpital Arnaud-de-Villeneuve (F.L.), Montpellier, CHU Angers, Angers (F.R.), CHU Toulouse, Hôpital Rangueil, Toulouse (D.C.), Centre Cardiologique du Nord, Saint-Denis (M.N.), Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg (P.O.), Centre Hospitalier Régional Universitaire (CHRU) de Tours, Hôpital Trousseau, Tours (C.S.E.), APHP, Hôpital Henri Mondor, Créteil (E.T.), CHU Bordeaux, Hôpital Haut-Lévêque, Pessac (L.L.), CHRU Brest, Hôpital de La Cavale Blanche, Brest (M.G.), and Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Centre National de la Recherche Scientifique (CNRS), and Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne (F.B., D.M.-B.) - all in France; and the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Canada (D.M.-Z.)
| | - Nicolas Michel
- From Hopital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque (J.-F.O.), Pharmacy Department and Laboratoire Mateis (X.A.), and Hopital Cardiovasculaire Louis Pradel, Clinical Investigation Center and Heart Failure Department, INSERM 1407 (C.B., G.S., N. Mewton), Hospices Civils de Lyon and Claude Bernard University, Lyon, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Bichat (D.M.-Z., B.I., A.V.), and APHP, Hôpital Européen Georges Pompidou (N.K.), Paris, Centre Hospitalier Universitaire (CHU) Rennes, Hôpital Pontchaillou, Rennes (G.L., E.D.), Assistance Publique-Hôpitaux de Marseille (APHM), Hôpital de la Timone (G.B.), and Hôpital Saint Joseph (N. Michel), Marseille, CHU Nantes, Hôpital Guillaume et René Laennec, Nantes (N.P., J.-N.T., P.G.), Institut Jacques Cartier, Massy (T.L., B.C.), Clinique du Millénaire (C.P.) and CHU Montpellier, Hôpital Arnaud-de-Villeneuve (F.L.), Montpellier, CHU Angers, Angers (F.R.), CHU Toulouse, Hôpital Rangueil, Toulouse (D.C.), Centre Cardiologique du Nord, Saint-Denis (M.N.), Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg (P.O.), Centre Hospitalier Régional Universitaire (CHRU) de Tours, Hôpital Trousseau, Tours (C.S.E.), APHP, Hôpital Henri Mondor, Créteil (E.T.), CHU Bordeaux, Hôpital Haut-Lévêque, Pessac (L.L.), CHRU Brest, Hôpital de La Cavale Blanche, Brest (M.G.), and Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Centre National de la Recherche Scientifique (CNRS), and Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne (F.B., D.M.-B.) - all in France; and the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Canada (D.M.-Z.)
| | - Martine Gilard
- From Hopital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque (J.-F.O.), Pharmacy Department and Laboratoire Mateis (X.A.), and Hopital Cardiovasculaire Louis Pradel, Clinical Investigation Center and Heart Failure Department, INSERM 1407 (C.B., G.S., N. Mewton), Hospices Civils de Lyon and Claude Bernard University, Lyon, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Bichat (D.M.-Z., B.I., A.V.), and APHP, Hôpital Européen Georges Pompidou (N.K.), Paris, Centre Hospitalier Universitaire (CHU) Rennes, Hôpital Pontchaillou, Rennes (G.L., E.D.), Assistance Publique-Hôpitaux de Marseille (APHM), Hôpital de la Timone (G.B.), and Hôpital Saint Joseph (N. Michel), Marseille, CHU Nantes, Hôpital Guillaume et René Laennec, Nantes (N.P., J.-N.T., P.G.), Institut Jacques Cartier, Massy (T.L., B.C.), Clinique du Millénaire (C.P.) and CHU Montpellier, Hôpital Arnaud-de-Villeneuve (F.L.), Montpellier, CHU Angers, Angers (F.R.), CHU Toulouse, Hôpital Rangueil, Toulouse (D.C.), Centre Cardiologique du Nord, Saint-Denis (M.N.), Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg (P.O.), Centre Hospitalier Régional Universitaire (CHRU) de Tours, Hôpital Trousseau, Tours (C.S.E.), APHP, Hôpital Henri Mondor, Créteil (E.T.), CHU Bordeaux, Hôpital Haut-Lévêque, Pessac (L.L.), CHRU Brest, Hôpital de La Cavale Blanche, Brest (M.G.), and Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Centre National de la Recherche Scientifique (CNRS), and Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne (F.B., D.M.-B.) - all in France; and the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Canada (D.M.-Z.)
| | - Erwan Donal
- From Hopital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque (J.-F.O.), Pharmacy Department and Laboratoire Mateis (X.A.), and Hopital Cardiovasculaire Louis Pradel, Clinical Investigation Center and Heart Failure Department, INSERM 1407 (C.B., G.S., N. Mewton), Hospices Civils de Lyon and Claude Bernard University, Lyon, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Bichat (D.M.-Z., B.I., A.V.), and APHP, Hôpital Européen Georges Pompidou (N.K.), Paris, Centre Hospitalier Universitaire (CHU) Rennes, Hôpital Pontchaillou, Rennes (G.L., E.D.), Assistance Publique-Hôpitaux de Marseille (APHM), Hôpital de la Timone (G.B.), and Hôpital Saint Joseph (N. Michel), Marseille, CHU Nantes, Hôpital Guillaume et René Laennec, Nantes (N.P., J.-N.T., P.G.), Institut Jacques Cartier, Massy (T.L., B.C.), Clinique du Millénaire (C.P.) and CHU Montpellier, Hôpital Arnaud-de-Villeneuve (F.L.), Montpellier, CHU Angers, Angers (F.R.), CHU Toulouse, Hôpital Rangueil, Toulouse (D.C.), Centre Cardiologique du Nord, Saint-Denis (M.N.), Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg (P.O.), Centre Hospitalier Régional Universitaire (CHRU) de Tours, Hôpital Trousseau, Tours (C.S.E.), APHP, Hôpital Henri Mondor, Créteil (E.T.), CHU Bordeaux, Hôpital Haut-Lévêque, Pessac (L.L.), CHRU Brest, Hôpital de La Cavale Blanche, Brest (M.G.), and Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Centre National de la Recherche Scientifique (CNRS), and Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne (F.B., D.M.-B.) - all in France; and the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Canada (D.M.-Z.)
| | - Jean-Noël Trochu
- From Hopital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque (J.-F.O.), Pharmacy Department and Laboratoire Mateis (X.A.), and Hopital Cardiovasculaire Louis Pradel, Clinical Investigation Center and Heart Failure Department, INSERM 1407 (C.B., G.S., N. Mewton), Hospices Civils de Lyon and Claude Bernard University, Lyon, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Bichat (D.M.-Z., B.I., A.V.), and APHP, Hôpital Européen Georges Pompidou (N.K.), Paris, Centre Hospitalier Universitaire (CHU) Rennes, Hôpital Pontchaillou, Rennes (G.L., E.D.), Assistance Publique-Hôpitaux de Marseille (APHM), Hôpital de la Timone (G.B.), and Hôpital Saint Joseph (N. Michel), Marseille, CHU Nantes, Hôpital Guillaume et René Laennec, Nantes (N.P., J.-N.T., P.G.), Institut Jacques Cartier, Massy (T.L., B.C.), Clinique du Millénaire (C.P.) and CHU Montpellier, Hôpital Arnaud-de-Villeneuve (F.L.), Montpellier, CHU Angers, Angers (F.R.), CHU Toulouse, Hôpital Rangueil, Toulouse (D.C.), Centre Cardiologique du Nord, Saint-Denis (M.N.), Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg (P.O.), Centre Hospitalier Régional Universitaire (CHRU) de Tours, Hôpital Trousseau, Tours (C.S.E.), APHP, Hôpital Henri Mondor, Créteil (E.T.), CHU Bordeaux, Hôpital Haut-Lévêque, Pessac (L.L.), CHRU Brest, Hôpital de La Cavale Blanche, Brest (M.G.), and Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Centre National de la Recherche Scientifique (CNRS), and Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne (F.B., D.M.-B.) - all in France; and the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Canada (D.M.-Z.)
| | - Bertrand Cormier
- From Hopital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque (J.-F.O.), Pharmacy Department and Laboratoire Mateis (X.A.), and Hopital Cardiovasculaire Louis Pradel, Clinical Investigation Center and Heart Failure Department, INSERM 1407 (C.B., G.S., N. Mewton), Hospices Civils de Lyon and Claude Bernard University, Lyon, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Bichat (D.M.-Z., B.I., A.V.), and APHP, Hôpital Européen Georges Pompidou (N.K.), Paris, Centre Hospitalier Universitaire (CHU) Rennes, Hôpital Pontchaillou, Rennes (G.L., E.D.), Assistance Publique-Hôpitaux de Marseille (APHM), Hôpital de la Timone (G.B.), and Hôpital Saint Joseph (N. Michel), Marseille, CHU Nantes, Hôpital Guillaume et René Laennec, Nantes (N.P., J.-N.T., P.G.), Institut Jacques Cartier, Massy (T.L., B.C.), Clinique du Millénaire (C.P.) and CHU Montpellier, Hôpital Arnaud-de-Villeneuve (F.L.), Montpellier, CHU Angers, Angers (F.R.), CHU Toulouse, Hôpital Rangueil, Toulouse (D.C.), Centre Cardiologique du Nord, Saint-Denis (M.N.), Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg (P.O.), Centre Hospitalier Régional Universitaire (CHRU) de Tours, Hôpital Trousseau, Tours (C.S.E.), APHP, Hôpital Henri Mondor, Créteil (E.T.), CHU Bordeaux, Hôpital Haut-Lévêque, Pessac (L.L.), CHRU Brest, Hôpital de La Cavale Blanche, Brest (M.G.), and Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Centre National de la Recherche Scientifique (CNRS), and Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne (F.B., D.M.-B.) - all in France; and the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Canada (D.M.-Z.)
| | - Xavier Armoiry
- From Hopital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque (J.-F.O.), Pharmacy Department and Laboratoire Mateis (X.A.), and Hopital Cardiovasculaire Louis Pradel, Clinical Investigation Center and Heart Failure Department, INSERM 1407 (C.B., G.S., N. Mewton), Hospices Civils de Lyon and Claude Bernard University, Lyon, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Bichat (D.M.-Z., B.I., A.V.), and APHP, Hôpital Européen Georges Pompidou (N.K.), Paris, Centre Hospitalier Universitaire (CHU) Rennes, Hôpital Pontchaillou, Rennes (G.L., E.D.), Assistance Publique-Hôpitaux de Marseille (APHM), Hôpital de la Timone (G.B.), and Hôpital Saint Joseph (N. Michel), Marseille, CHU Nantes, Hôpital Guillaume et René Laennec, Nantes (N.P., J.-N.T., P.G.), Institut Jacques Cartier, Massy (T.L., B.C.), Clinique du Millénaire (C.P.) and CHU Montpellier, Hôpital Arnaud-de-Villeneuve (F.L.), Montpellier, CHU Angers, Angers (F.R.), CHU Toulouse, Hôpital Rangueil, Toulouse (D.C.), Centre Cardiologique du Nord, Saint-Denis (M.N.), Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg (P.O.), Centre Hospitalier Régional Universitaire (CHRU) de Tours, Hôpital Trousseau, Tours (C.S.E.), APHP, Hôpital Henri Mondor, Créteil (E.T.), CHU Bordeaux, Hôpital Haut-Lévêque, Pessac (L.L.), CHRU Brest, Hôpital de La Cavale Blanche, Brest (M.G.), and Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Centre National de la Recherche Scientifique (CNRS), and Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne (F.B., D.M.-B.) - all in France; and the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Canada (D.M.-Z.)
| | - Florent Boutitie
- From Hopital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque (J.-F.O.), Pharmacy Department and Laboratoire Mateis (X.A.), and Hopital Cardiovasculaire Louis Pradel, Clinical Investigation Center and Heart Failure Department, INSERM 1407 (C.B., G.S., N. Mewton), Hospices Civils de Lyon and Claude Bernard University, Lyon, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Bichat (D.M.-Z., B.I., A.V.), and APHP, Hôpital Européen Georges Pompidou (N.K.), Paris, Centre Hospitalier Universitaire (CHU) Rennes, Hôpital Pontchaillou, Rennes (G.L., E.D.), Assistance Publique-Hôpitaux de Marseille (APHM), Hôpital de la Timone (G.B.), and Hôpital Saint Joseph (N. Michel), Marseille, CHU Nantes, Hôpital Guillaume et René Laennec, Nantes (N.P., J.-N.T., P.G.), Institut Jacques Cartier, Massy (T.L., B.C.), Clinique du Millénaire (C.P.) and CHU Montpellier, Hôpital Arnaud-de-Villeneuve (F.L.), Montpellier, CHU Angers, Angers (F.R.), CHU Toulouse, Hôpital Rangueil, Toulouse (D.C.), Centre Cardiologique du Nord, Saint-Denis (M.N.), Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg (P.O.), Centre Hospitalier Régional Universitaire (CHRU) de Tours, Hôpital Trousseau, Tours (C.S.E.), APHP, Hôpital Henri Mondor, Créteil (E.T.), CHU Bordeaux, Hôpital Haut-Lévêque, Pessac (L.L.), CHRU Brest, Hôpital de La Cavale Blanche, Brest (M.G.), and Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Centre National de la Recherche Scientifique (CNRS), and Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne (F.B., D.M.-B.) - all in France; and the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Canada (D.M.-Z.)
| | - Delphine Maucort-Boulch
- From Hopital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque (J.-F.O.), Pharmacy Department and Laboratoire Mateis (X.A.), and Hopital Cardiovasculaire Louis Pradel, Clinical Investigation Center and Heart Failure Department, INSERM 1407 (C.B., G.S., N. Mewton), Hospices Civils de Lyon and Claude Bernard University, Lyon, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Bichat (D.M.-Z., B.I., A.V.), and APHP, Hôpital Européen Georges Pompidou (N.K.), Paris, Centre Hospitalier Universitaire (CHU) Rennes, Hôpital Pontchaillou, Rennes (G.L., E.D.), Assistance Publique-Hôpitaux de Marseille (APHM), Hôpital de la Timone (G.B.), and Hôpital Saint Joseph (N. Michel), Marseille, CHU Nantes, Hôpital Guillaume et René Laennec, Nantes (N.P., J.-N.T., P.G.), Institut Jacques Cartier, Massy (T.L., B.C.), Clinique du Millénaire (C.P.) and CHU Montpellier, Hôpital Arnaud-de-Villeneuve (F.L.), Montpellier, CHU Angers, Angers (F.R.), CHU Toulouse, Hôpital Rangueil, Toulouse (D.C.), Centre Cardiologique du Nord, Saint-Denis (M.N.), Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg (P.O.), Centre Hospitalier Régional Universitaire (CHRU) de Tours, Hôpital Trousseau, Tours (C.S.E.), APHP, Hôpital Henri Mondor, Créteil (E.T.), CHU Bordeaux, Hôpital Haut-Lévêque, Pessac (L.L.), CHRU Brest, Hôpital de La Cavale Blanche, Brest (M.G.), and Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Centre National de la Recherche Scientifique (CNRS), and Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne (F.B., D.M.-B.) - all in France; and the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Canada (D.M.-Z.)
| | - Cécile Barnel
- From Hopital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque (J.-F.O.), Pharmacy Department and Laboratoire Mateis (X.A.), and Hopital Cardiovasculaire Louis Pradel, Clinical Investigation Center and Heart Failure Department, INSERM 1407 (C.B., G.S., N. Mewton), Hospices Civils de Lyon and Claude Bernard University, Lyon, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Bichat (D.M.-Z., B.I., A.V.), and APHP, Hôpital Européen Georges Pompidou (N.K.), Paris, Centre Hospitalier Universitaire (CHU) Rennes, Hôpital Pontchaillou, Rennes (G.L., E.D.), Assistance Publique-Hôpitaux de Marseille (APHM), Hôpital de la Timone (G.B.), and Hôpital Saint Joseph (N. Michel), Marseille, CHU Nantes, Hôpital Guillaume et René Laennec, Nantes (N.P., J.-N.T., P.G.), Institut Jacques Cartier, Massy (T.L., B.C.), Clinique du Millénaire (C.P.) and CHU Montpellier, Hôpital Arnaud-de-Villeneuve (F.L.), Montpellier, CHU Angers, Angers (F.R.), CHU Toulouse, Hôpital Rangueil, Toulouse (D.C.), Centre Cardiologique du Nord, Saint-Denis (M.N.), Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg (P.O.), Centre Hospitalier Régional Universitaire (CHRU) de Tours, Hôpital Trousseau, Tours (C.S.E.), APHP, Hôpital Henri Mondor, Créteil (E.T.), CHU Bordeaux, Hôpital Haut-Lévêque, Pessac (L.L.), CHRU Brest, Hôpital de La Cavale Blanche, Brest (M.G.), and Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Centre National de la Recherche Scientifique (CNRS), and Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne (F.B., D.M.-B.) - all in France; and the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Canada (D.M.-Z.)
| | - Géraldine Samson
- From Hopital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque (J.-F.O.), Pharmacy Department and Laboratoire Mateis (X.A.), and Hopital Cardiovasculaire Louis Pradel, Clinical Investigation Center and Heart Failure Department, INSERM 1407 (C.B., G.S., N. Mewton), Hospices Civils de Lyon and Claude Bernard University, Lyon, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Bichat (D.M.-Z., B.I., A.V.), and APHP, Hôpital Européen Georges Pompidou (N.K.), Paris, Centre Hospitalier Universitaire (CHU) Rennes, Hôpital Pontchaillou, Rennes (G.L., E.D.), Assistance Publique-Hôpitaux de Marseille (APHM), Hôpital de la Timone (G.B.), and Hôpital Saint Joseph (N. Michel), Marseille, CHU Nantes, Hôpital Guillaume et René Laennec, Nantes (N.P., J.-N.T., P.G.), Institut Jacques Cartier, Massy (T.L., B.C.), Clinique du Millénaire (C.P.) and CHU Montpellier, Hôpital Arnaud-de-Villeneuve (F.L.), Montpellier, CHU Angers, Angers (F.R.), CHU Toulouse, Hôpital Rangueil, Toulouse (D.C.), Centre Cardiologique du Nord, Saint-Denis (M.N.), Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg (P.O.), Centre Hospitalier Régional Universitaire (CHRU) de Tours, Hôpital Trousseau, Tours (C.S.E.), APHP, Hôpital Henri Mondor, Créteil (E.T.), CHU Bordeaux, Hôpital Haut-Lévêque, Pessac (L.L.), CHRU Brest, Hôpital de La Cavale Blanche, Brest (M.G.), and Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Centre National de la Recherche Scientifique (CNRS), and Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne (F.B., D.M.-B.) - all in France; and the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Canada (D.M.-Z.)
| | - Patrice Guerin
- From Hopital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque (J.-F.O.), Pharmacy Department and Laboratoire Mateis (X.A.), and Hopital Cardiovasculaire Louis Pradel, Clinical Investigation Center and Heart Failure Department, INSERM 1407 (C.B., G.S., N. Mewton), Hospices Civils de Lyon and Claude Bernard University, Lyon, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Bichat (D.M.-Z., B.I., A.V.), and APHP, Hôpital Européen Georges Pompidou (N.K.), Paris, Centre Hospitalier Universitaire (CHU) Rennes, Hôpital Pontchaillou, Rennes (G.L., E.D.), Assistance Publique-Hôpitaux de Marseille (APHM), Hôpital de la Timone (G.B.), and Hôpital Saint Joseph (N. Michel), Marseille, CHU Nantes, Hôpital Guillaume et René Laennec, Nantes (N.P., J.-N.T., P.G.), Institut Jacques Cartier, Massy (T.L., B.C.), Clinique du Millénaire (C.P.) and CHU Montpellier, Hôpital Arnaud-de-Villeneuve (F.L.), Montpellier, CHU Angers, Angers (F.R.), CHU Toulouse, Hôpital Rangueil, Toulouse (D.C.), Centre Cardiologique du Nord, Saint-Denis (M.N.), Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg (P.O.), Centre Hospitalier Régional Universitaire (CHRU) de Tours, Hôpital Trousseau, Tours (C.S.E.), APHP, Hôpital Henri Mondor, Créteil (E.T.), CHU Bordeaux, Hôpital Haut-Lévêque, Pessac (L.L.), CHRU Brest, Hôpital de La Cavale Blanche, Brest (M.G.), and Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Centre National de la Recherche Scientifique (CNRS), and Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne (F.B., D.M.-B.) - all in France; and the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Canada (D.M.-Z.)
| | - Alec Vahanian
- From Hopital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque (J.-F.O.), Pharmacy Department and Laboratoire Mateis (X.A.), and Hopital Cardiovasculaire Louis Pradel, Clinical Investigation Center and Heart Failure Department, INSERM 1407 (C.B., G.S., N. Mewton), Hospices Civils de Lyon and Claude Bernard University, Lyon, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Bichat (D.M.-Z., B.I., A.V.), and APHP, Hôpital Européen Georges Pompidou (N.K.), Paris, Centre Hospitalier Universitaire (CHU) Rennes, Hôpital Pontchaillou, Rennes (G.L., E.D.), Assistance Publique-Hôpitaux de Marseille (APHM), Hôpital de la Timone (G.B.), and Hôpital Saint Joseph (N. Michel), Marseille, CHU Nantes, Hôpital Guillaume et René Laennec, Nantes (N.P., J.-N.T., P.G.), Institut Jacques Cartier, Massy (T.L., B.C.), Clinique du Millénaire (C.P.) and CHU Montpellier, Hôpital Arnaud-de-Villeneuve (F.L.), Montpellier, CHU Angers, Angers (F.R.), CHU Toulouse, Hôpital Rangueil, Toulouse (D.C.), Centre Cardiologique du Nord, Saint-Denis (M.N.), Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg (P.O.), Centre Hospitalier Régional Universitaire (CHRU) de Tours, Hôpital Trousseau, Tours (C.S.E.), APHP, Hôpital Henri Mondor, Créteil (E.T.), CHU Bordeaux, Hôpital Haut-Lévêque, Pessac (L.L.), CHRU Brest, Hôpital de La Cavale Blanche, Brest (M.G.), and Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Centre National de la Recherche Scientifique (CNRS), and Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne (F.B., D.M.-B.) - all in France; and the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Canada (D.M.-Z.)
| | - Nathan Mewton
- From Hopital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque (J.-F.O.), Pharmacy Department and Laboratoire Mateis (X.A.), and Hopital Cardiovasculaire Louis Pradel, Clinical Investigation Center and Heart Failure Department, INSERM 1407 (C.B., G.S., N. Mewton), Hospices Civils de Lyon and Claude Bernard University, Lyon, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Bichat (D.M.-Z., B.I., A.V.), and APHP, Hôpital Européen Georges Pompidou (N.K.), Paris, Centre Hospitalier Universitaire (CHU) Rennes, Hôpital Pontchaillou, Rennes (G.L., E.D.), Assistance Publique-Hôpitaux de Marseille (APHM), Hôpital de la Timone (G.B.), and Hôpital Saint Joseph (N. Michel), Marseille, CHU Nantes, Hôpital Guillaume et René Laennec, Nantes (N.P., J.-N.T., P.G.), Institut Jacques Cartier, Massy (T.L., B.C.), Clinique du Millénaire (C.P.) and CHU Montpellier, Hôpital Arnaud-de-Villeneuve (F.L.), Montpellier, CHU Angers, Angers (F.R.), CHU Toulouse, Hôpital Rangueil, Toulouse (D.C.), Centre Cardiologique du Nord, Saint-Denis (M.N.), Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg (P.O.), Centre Hospitalier Régional Universitaire (CHRU) de Tours, Hôpital Trousseau, Tours (C.S.E.), APHP, Hôpital Henri Mondor, Créteil (E.T.), CHU Bordeaux, Hôpital Haut-Lévêque, Pessac (L.L.), CHRU Brest, Hôpital de La Cavale Blanche, Brest (M.G.), and Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Centre National de la Recherche Scientifique (CNRS), and Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne (F.B., D.M.-B.) - all in France; and the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Canada (D.M.-Z.)
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Grinberg D, Cottinet PJ, Thivolet S, Audigier D, Capsal JF, Le MQ, Obadia JF. Measuring chordae tension during transapical neochordae implantation: Toward understanding objective consequences of mitral valve repair. J Thorac Cardiovasc Surg 2018; 158:746-755. [PMID: 30454983 DOI: 10.1016/j.jtcvs.2018.10.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 05/10/2018] [Revised: 09/17/2018] [Accepted: 10/02/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Complex structure of mitral valve and its central position in the heart limit assessment of mitral function to standardized calculated parameters assessed using medical imaging (echocardiography). Novel techniques, which allow mitral valve repair (MVr) in a beating heart, offer the opportunity for innovative objective assessment in physiologic and pathologic conditions. We report, to our knowledge, the first data of real-time chordal tension measurement during a transapical neochordae implantation. METHODS Seven patients with severe degenerative mitral regurgitation due to posterior prolapse underwent transapical MVr using the NeoChord DS 1000 (NeoChord Inc, Minneapolis, Minn). During prolapse correction, the tension applied on the neochordae was measured in addition to hemodynamic and echocardiographic parameters. RESULTS The traction applied on 1 chorda sustaining the P2 segment was measured at between 0.7 and 0.9 N, and oscillated with respiration. When several neochordae were set in tension, this initial tension was spread homogeneously on each chorda (mean sum of the amplitude of tension 0.98 ± 0.08 N). To achieve an optimal echocardiographic correction, a complementary synchronous traction on all chordae was required. During this adjustment, the sum of the tension decreased (mean 12 ± 2%; P = .018), suggesting that when normal physiology was restored, the valvular apparatus was in a low-stress state. This method allowed us to apply a precise and reproducible technique, leading to a good procedural success rate with a low morbidity and mortality rate. CONCLUSIONS The tension applied on chordae during transapical implantation of neochordae for degenerative mitral regurgitation can be measured, providing original data about the objective consequences of MVr on the mitral apparatus.
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Affiliation(s)
- Daniel Grinberg
- Department of Adult Cardiac Surgery, Hôpital cardiologique Louis Pradel, Lyon Medical School, Bron, France; Univ Lyon, INSA-Lyon, LGEF (Lab of electrical engineering and ferroelectricity), Villeurbanne, France; Department of Cardiovascular Surgery, Mount Sinai Hospital, New York, NY.
| | - Pierre-Jean Cottinet
- Univ Lyon, INSA-Lyon, LGEF (Lab of electrical engineering and ferroelectricity), Villeurbanne, France
| | - Sophie Thivolet
- Department of Adult Cardiac Surgery, Hôpital cardiologique Louis Pradel, Lyon Medical School, Bron, France
| | - David Audigier
- Univ Lyon, INSA-Lyon, LGEF (Lab of electrical engineering and ferroelectricity), Villeurbanne, France
| | - Jean-Fabien Capsal
- Univ Lyon, INSA-Lyon, LGEF (Lab of electrical engineering and ferroelectricity), Villeurbanne, France
| | - Minh-Quyen Le
- Univ Lyon, INSA-Lyon, LGEF (Lab of electrical engineering and ferroelectricity), Villeurbanne, France
| | - Jean-François Obadia
- Department of Adult Cardiac Surgery, Hôpital cardiologique Louis Pradel, Lyon Medical School, Bron, France
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Galand V, Flécher E, Auffret V, Boulé S, Vincentelli A, Dambrin C, Mondoly P, Sacher F, Nubret K, Kindo M, Cardi T, Gaudard P, Rouvière P, Michel M, Gourraud JB, Defaye P, Chavanon O, Verdonk C, Ghodbane W, Pelcé E, Gariboldi V, Pozzi M, Obadia JF, Litzler PY, Anselme F, Babatasi G, Belin A, Garnier F, Bielefeld M, Hamon D, Radu C, Pierre B, Bourguignon T, Eschalier R, D'Ostrevy N, Bories MC, Marijon E, Vanhuyse F, Blangy H, Verhoye JP, Leclercq C, Martins RP. Predictors and Clinical Impact of Late Ventricular Arrhythmias in Patients With Continuous-Flow Left Ventricular Assist Devices. JACC Clin Electrophysiol 2018; 4:1166-1175. [PMID: 30236390 DOI: 10.1016/j.jacep.2018.05.006] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [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: 02/05/2018] [Revised: 04/26/2018] [Accepted: 05/17/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to evaluate the incidence, clinical impact, and predictors of late ventricular arrhythmias (VAs) in left ventricular assist device (LVAD) recipients aiming to clarify implantable cardioverter-defibrillator (ICD) indications. BACKGROUND The arrhythmic risk and need for ICD in patients implanted with an LVAD are not very well known. METHODS This observational study was conducted in 19 centers between 2006 and 2016. Late VAs were defined as sustained ventricular tachycardia or fibrillation occurring >30 days post-LVAD implantation, without acute reversible cause and requiring appropriate ICD therapy, external electrical shock, or medical therapy. RESULTS Among 659 LVAD recipients, 494 (median 58.9 years of age; mean left ventricular ejection fraction 20.7 ± 7.4%; 73.1% HeartMate II, 18.6% HeartWare, 8.3% Jarvik 2000) were discharged alive from hospital and included in the final analysis. Late VAs occurred in 133 (26.9%) patients. Multivariable analysis identified 6 independent predictors of late VAs: VAs before LVAD implantation, atrial fibrillation before LVAD implantation, idiopathic etiology of the cardiomyopathy, heart failure duration >12 months, early VAs (<30 days post-LVAD), and no angiotensin-converting enzyme inhibitors during follow-up. The "VT-LVAD score" was created, identifying 4 risk groups: low (score 0 to 1), intermediate (score 2 to 4), high (score 5 to 6), and very high (score 7 to 10). The rates of VAs at 1 year were 0.0%, 8.0%, 31.0% and 55.0%, respectively. CONCLUSIONS Late VAs are common after LVAD implantation. The VT-LVAD score may help to identify patients at risk of late VAs and guide ICD indications in previously nonimplanted patients. (Determination of Risk Factors of Ventricular Arrhythmias [VAs] after implantation of continuous flow left ventricular assist device with continuous flow left ventricular assist device [CF-LVAD] [ASSIST-ICD]; NCT02873169).
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Affiliation(s)
- Vincent Galand
- Service de Cardiologie et Maladies Vasculaires, CHU Rennes, Rennes, France; Université de Rennes 1, Rennes, France; U1099, INSERM, Rennes, France
| | - Erwan Flécher
- Université de Rennes 1, Rennes, France; Service de chirurgie cardiaque et thoracique, Rennes, France
| | - Vincent Auffret
- Service de Cardiologie et Maladies Vasculaires, CHU Rennes, Rennes, France; Université de Rennes 1, Rennes, France; U1099, INSERM, Rennes, France
| | - Stéphane Boulé
- Department of Cardiac Surgery, Department of Cardiology, Cardiac Intensive Care Unit, Institut Coeur-Poumons, CHU Lille, Lille, France
| | - André Vincentelli
- Department of Cardiac Surgery, Department of Cardiology, Cardiac Intensive Care Unit, Institut Coeur-Poumons, CHU Lille, Lille, France
| | - Camille Dambrin
- Service de Cardiologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Pierre Mondoly
- Service de Cardiologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Frédéric Sacher
- Service de Cardiologie, Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux II, Bordeaux, France
| | - Karine Nubret
- Service de Cardiologie, Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux II, Bordeaux, France
| | - Michel Kindo
- Département de chirurgie cardiovasculaire, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Thomas Cardi
- Département de chirurgie cardiovasculaire, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Philippe Gaudard
- Department of Cardiac Surgery, Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, CHRU Montpellier, Montpellier, France
| | - Philippe Rouvière
- Department of Cardiac Surgery, Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, CHRU Montpellier, Montpellier, France
| | - Magali Michel
- Department of Cardiology and Heart Transplantation Unit, CHU Nantes, Nantes, France
| | | | - Pascal Defaye
- Department of Cardiology and Cardiovascular Surgery, CHU Michallon, Grenoble, France
| | - Olivier Chavanon
- Department of Cardiology and Cardiovascular Surgery, CHU Michallon, Grenoble, France
| | - Constance Verdonk
- Department of Cardiology and Cardiac Surgery, Bichat-Hospital, Paris, France
| | - Walid Ghodbane
- Department of Cardiology and Cardiac Surgery, Bichat-Hospital, Paris, France
| | - Edeline Pelcé
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Vlad Gariboldi
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Matteo Pozzi
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Lyon, France
| | - Jean-François Obadia
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Lyon, France
| | - Pierre-Yves Litzler
- Department of Cardiology and Cardiovascular Surgery, Hospital Charles Nicolle, Rouen, France
| | - Frédéric Anselme
- Department of Cardiology and Cardiovascular Surgery, Hospital Charles Nicolle, Rouen, France
| | - Gerard Babatasi
- Department of Cardiology and Cardiac Surgery, University Hospital of Caen, University of Caen, Caen, France
| | - Annette Belin
- Department of Cardiology and Cardiac Surgery, University Hospital of Caen, University of Caen, Caen, France
| | - Fabien Garnier
- Department of Cardiology and Cardiac Surgery, University Hospital Dijon Bourgogne, Dijon, France
| | - Marie Bielefeld
- Department of Cardiology and Cardiac Surgery, University Hospital Dijon Bourgogne, Dijon, France
| | - David Hamon
- Department of Cardiology and Cardiac Surgery, AP-HP CHU Henri Mondor, Créteil, France
| | - Costin Radu
- Department of Cardiology and Cardiac Surgery, AP-HP CHU Henri Mondor, Créteil, France
| | - Bertrand Pierre
- Department of Cardiology and Cardiac Surgery, Tours University Hospital, Tours, France
| | - Thierry Bourguignon
- Department of Cardiology and Cardiac Surgery, Tours University Hospital, Tours, France
| | - Romain Eschalier
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Nicolas D'Ostrevy
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Eloi Marijon
- Cardiology Department, European Georges Pompidou Hospital, Paris, France
| | - Fabrice Vanhuyse
- Department of Cardiology and Cardiac Surgery, Hopital de Brabois, CHU de Nancy, Nancy, France
| | - Hugues Blangy
- Department of Cardiology and Cardiac Surgery, Hopital de Brabois, CHU de Nancy, Nancy, France
| | | | - Christophe Leclercq
- Service de Cardiologie et Maladies Vasculaires, CHU Rennes, Rennes, France; Université de Rennes 1, Rennes, France; U1099, INSERM, Rennes, France
| | - Raphaël P Martins
- Service de Cardiologie et Maladies Vasculaires, CHU Rennes, Rennes, France; Université de Rennes 1, Rennes, France; U1099, INSERM, Rennes, France.
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Zenses AS, Evin MA, Stanová V, Clavel MA, Barragan P, Rodés-Cabau J, Obadia JF, Pibarot P, Rieu R. Effect of size and position of self-expanding transcatheter valve on haemodynamics following valve-in-valve procedure in small surgical bioprostheses: an in vitro study. EUROINTERVENTION 2018. [DOI: 10.4244/eij-d-17-00875] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Dorent R, Gandjbakhch E, Goéminne C, Ivanes F, Sebbag L, Bauer F, Epailly E, Boissonnat P, Nubret K, Amour J, Vermes E, Ou P, Guendouz S, Chevalier P, Lebreton G, Flecher E, Obadia JF, Logeart D, de Groote P. Assessment of potential heart donors: A statement from the French heart transplant community. Arch Cardiovasc Dis 2017; 111:126-139. [PMID: 29277435 DOI: 10.1016/j.acvd.2017.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 10/10/2017] [Revised: 11/30/2017] [Accepted: 12/01/2017] [Indexed: 12/20/2022]
Abstract
Assessment of potential donors is an essential part of heart transplantation. Despite the shortage of donor hearts, donor heart procurement from brain-dead organ donors remains low in France, which may be explained by the increasing proportion of high-risk donors, as well as the mismatch between donor assessment and the transplant team's expectations. Improving donor and donor heart assessment is essential to improve the low utilization rate of available donor hearts without increasing post-transplant recipient mortality. This document provides information to practitioners involved in brain-dead donor management, evaluation and selection, concerning the place of medical history, electrocardiography, cardiac imaging, biomarkers and haemodynamic and arrhythmia assessment in the characterization of potential heart donors.
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Affiliation(s)
- Richard Dorent
- Agence de la biomédecine, direction prélèvement greffe organes-tissus, 1, avenue du Stade-de-France, 93212 Saint-Denis-La-Plaine cedex, France.
| | - Estelle Gandjbakhch
- Département de cardiologie, hôpital Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - Céline Goéminne
- Service de cardiologie, hôpital cardiologique, centre hospitalier régional et universitaire de Lille, 59000 Lille, France
| | - Fabrice Ivanes
- Service de cardiologie, hôpital Trousseau, centre hospitalier régional et universitaire de Tours, 37170 Tours, France
| | - Laurent Sebbag
- Pôle médicochirurgical de transplantation cardiaque adulte, hôpital Louis-Pradel, hospices civils de Lyon, 69500 Bron, France
| | - Fabrice Bauer
- Département de cardiologie, hôpital Charles-Nicolle, centre hospitalier universitaire de Rouen, 76000 Rouen, France
| | - Eric Epailly
- Service de chirurgie cardiaque, nouvel hôpital civil, centre hospitalier universitaire de Strasbourg, 67091 Strasbourg, France
| | - Pascale Boissonnat
- Pôle médicochirurgical de transplantation cardiaque adulte, hôpital Louis-Pradel, hospices civils de Lyon, 69500 Bron, France
| | - Karine Nubret
- Département d'anesthésie-réanimation II, centre hospitalier universitaire de Bordeaux, 33600 Pessac, France
| | - Julien Amour
- Département d'anesthésie-réanimation, hôpital Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - Emmanuelle Vermes
- Service de chirurgie cardiaque, hôpital Trousseau, centre hospitalier régional et universitaire de Tours, 37170 Tours, France
| | - Phalla Ou
- Département de radiologie, hôpital Bichat, Assistance publique-Hôpitaux de Paris, 75877 Paris, France
| | - Soulef Guendouz
- Département de cardiologie, hôpital Henri-Mondor, Assistance publique-Hôpitaux de Paris, 94010 Créteil, France
| | - Philippe Chevalier
- Service de rythmologie, hôpital Louis-Pradel, hospices civils de Lyon, 69500 Bron, France
| | - Guillaume Lebreton
- Service de chirurgie cardiovasculaire, hôpital Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - Erwan Flecher
- Service de chirurgie cardiovasculaire, centre hospitalier universitaire de Rennes, 35000 Rennes, France
| | - Jean-François Obadia
- Service de chirurgie cardiovasculaire, hôpital Louis-Pradel, hospices civils de Lyon, 69500 Bron, France
| | - Damien Logeart
- Département de cardiologie, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, 75475 Paris, France
| | - Pascal de Groote
- Service de cardiologie, hôpital cardiologique, centre hospitalier régional et universitaire de Lille, 59000 Lille, France
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Antunes MJ, Rodríguez-Palomares J, Prendergast B, De Bonis M, Rosenhek R, Al-Attar N, Barili F, Casselman F, Folliguet T, Iung B, Lancellotti P, Muneretto C, Obadia JF, Pierard L, Suwalski P, Zamorano P. Management of tricuspid valve regurgitation. Eur J Cardiothorac Surg 2017; 52:1022-1030. [DOI: 10.1093/ejcts/ezx279] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 06/27/2017] [Indexed: 12/18/2022] Open
Affiliation(s)
- Manuel J Antunes
- Department of Cardiothoracic Surgery and Transplantation of Thoracic Organs, University Hospital and Faculty of Medicine of Coimbra, Coimbra, Portugal
| | - José Rodríguez-Palomares
- Department of Cardiology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Institut de Recerca (VHIR), Universitat Autónoma de Barcelona, Barcelona, Spain
| | | | - Michele De Bonis
- Department of Cardiac Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital, Milan, Italy
| | - Raphael Rosenhek
- Department of Cardiology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Nawwar Al-Attar
- Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Clydebank, UK
| | - Fabio Barili
- Department of Cardiovascular Surgery, S. Croce Hospital, Cuneo, Italy
| | - Filip Casselman
- Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
| | - Thierry Folliguet
- Department of Cardiothoracic Surgery and Transplantation, University of Lorraine, Centre Hospitalier Universitaire Brabois, Vandoeuvre les Nancy, France
| | - Bernard Iung
- Department of Cardiology, Bichat Hospital, APHP, Paris Diderot University, DHU Fire, Paris, France
| | - Patrizio Lancellotti
- Department of Cardiology, GIGA Cardiovascular Sciences, Heart Valve Clinic, University of Liège Hospital, Liège, Belgium
- Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
| | - Claudio Muneretto
- Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy
| | - Jean-François Obadia
- Chirurgie Cardiothoracique et Transplantation Cardiaque, Hôpital Louis Pradel, Lyon, France
| | - Luc Pierard
- Department of Cardiology, University Hospital Sart Tilman, Liège, Belgium
| | - Piotr Suwalski
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland
- Pulaski University of Technology and Humanities, Radom, Poland
| | - Pepe Zamorano
- University Alcala, Hospital Ramon y Cajal, Madrid, Spain
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Gatti G, Perrotti A, Obadia JF, Duval X, Iung B, Alla F, Chirouze C, Selton-Suty C, Hoen B, Sinagra G, Delahaye F, Tattevin P, Le Moing V, Pappalardo A, Chocron S. Simple Scoring System to Predict In-Hospital Mortality After Surgery for Infective Endocarditis. J Am Heart Assoc 2017; 6:JAHA.116.004806. [PMID: 28729412 PMCID: PMC5586260 DOI: 10.1161/jaha.116.004806] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [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] [Indexed: 12/15/2022]
Abstract
Background Aspecific scoring systems are used to predict the risk of death postsurgery in patients with infective endocarditis (IE). The purpose of the present study was both to analyze the risk factors for in‐hospital death, which complicates surgery for IE, and to create a mortality risk score based on the results of this analysis. Methods and Results Outcomes of 361 consecutive patients (mean age, 59.1±15.4 years) who had undergone surgery for IE in 8 European centers of cardiac surgery were recorded prospectively, and a risk factor analysis (multivariable logistic regression) for in‐hospital death was performed. The discriminatory power of a new predictive scoring system was assessed with the receiver operating characteristic curve analysis. Score validation procedures were carried out. Fifty‐six (15.5%) patients died postsurgery. BMI >27 kg/m2 (odds ratio [OR], 1.79; P=0.049), estimated glomerular filtration rate <50 mL/min (OR, 3.52; P<0.0001), New York Heart Association class IV (OR, 2.11; P=0.024), systolic pulmonary artery pressure >55 mm Hg (OR, 1.78; P=0.032), and critical state (OR, 2.37; P=0.017) were independent predictors of in‐hospital death. A scoring system was devised to predict in‐hospital death postsurgery for IE (area under the receiver operating characteristic curve, 0.780; 95% CI, 0.734–0.822). The score performed better than 5 of 6 scoring systems for in‐hospital death after cardiac surgery that were considered. Conclusions A simple scoring system based on risk factors for in‐hospital death was specifically created to predict mortality risk postsurgery in patients with IE.
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Affiliation(s)
- Giuseppe Gatti
- Cardiovascular Department, University Hospital of Trieste, Italy
| | - Andrea Perrotti
- Department of Thoracic and Cardiovascular Surgery, EA3920, University Hospital Jean Minjoz, Besançon, France
| | | | - Xavier Duval
- IAME, Inserm UMR 1137, University Paris Diderot Sorbonne Paris Cité, Paris, France.,Inserm Clinical Investigation Center 1425, Paris, France
| | - Bernard Iung
- Department of Cardiology, AP-HP, Bichat Hospital, Paris, France.,DHU Fire, Paris, France
| | | | - Catherine Chirouze
- Department of Infective and Tropical Diseases, University Hospital Jean Minjoz, Besançon, France
| | | | - Bruno Hoen
- Department of Infective and Tropical Diseases, University Hospital of Pointe à Pitre, France
| | | | | | - Pierre Tattevin
- Department of Infective and Tropical Diseases, University Regional Hospital, Rennes, France
| | - Vincent Le Moing
- Department of Infective and Tropical Diseases, University Regional Hospital, Rennes, France.,UMI 233, Institute of Development Research, University of Montpellier, France
| | | | - Sidney Chocron
- Department of Thoracic and Cardiovascular Surgery, EA3920, University Hospital Jean Minjoz, Besançon, France
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Auffret V, Lefevre T, Van Belle E, Eltchaninoff H, Iung B, Koning R, Motreff P, Leprince P, Verhoye JP, Manigold T, Souteyrand G, Boulmier D, Joly P, Pinaud F, Himbert D, Collet JP, Rioufol G, Ghostine S, Bar O, Dibie A, Champagnac D, Leroux L, Collet F, Teiger E, Darremont O, Folliguet T, Leclercq F, Lhermusier T, Olhmann P, Huret B, Lorgis L, Drogoul L, Bertrand B, Spaulding C, Quilliet L, Cuisset T, Delomez M, Beygui F, Claudel JP, Hepp A, Jegou A, Gommeaux A, Mirode A, Christiaens L, Christophe C, Cassat C, Metz D, Mangin L, Isaaz K, Jacquemin L, Guyon P, Pouillot C, Makowski S, Bataille V, Rodés-Cabau J, Gilard M, Le Breton H, Le Breton H, Eltchaninoff H, Gilard M, Iung B, Le Breton H, Lefevre T, Van Belle E, Laskar M, Leprince P, Iung B, Bataille V, Chevalier B, Garot P, Hovasse T, Lefevre T, Donzeau Gouge P, Farge A, Romano M, Cormier B, Bouvier E, Bauchart JJ, Bodart JC, Delhaye C, Houpe D, Lallemant R, Leroy F, Sudre A, Van Belle E, Juthier F, Koussa M, Modine T, Rousse N, Auffray JL, Richardson M, Berland J, Eltchaninoff H, Godin M, Koning R, Bessou JP, Letocart V, Manigold T, Roussel JC, Jaafar P, Combaret N, Souteyrand G, D’Ostrevy N, Innorta A, Clerfond G, Vorilhon C, Auffret V, Bedossa M, Boulmier D, Le Breton H, Leurent G, Anselmi A, Harmouche M, Verhoye JP, Donal E, Bille J, Joly P, Houel R, Vilette B, Abi Khalil W, Delepine S, Fouquet O, Pinaud F, Rouleau F, Abtan J, Himbert D, Urena M, Alkhoder S, Ghodbane W, Arangalage D, Brochet E, Goublaire C, Barthelemy O, Choussat R, Collet JP, Lebreton G, Leprince P, Mastrioanni C, Isnard R, Dauphin R, Dubreuil O, Durand De Gevigney G, Finet G, Harbaoui B, Ranc S, Rioufol G, Farhat F, Jegaden O, Obadia JF, Pozzi M, Ghostine S, Brenot P, Fradi S, Azmoun A, Deleuze P, Kloeckner M, Bar O, Blanchard D, Barbey C, Chassaing S, Chatel D, Le Page O, Tauran A, Bruere D, Bodson L, Meurisse Y, Seemann A, Amabile N, Caussin C, Dibie A, Elhaddad S, Drieu L, Ohanessian A, Philippe F, Veugeois A, Debauchez M, Zannis K, Czitrom D, Diakov C, Raoux F, Champagnac D, Lienhart Y, Staat P, Zouaghi O, Doisy V, Frieh JP, Wautot F, Dementhon J, Garrier O, Jamal F, Leroux PY, Casassus F, Leroux L, Seguy B, Barandon L, Labrousse L, Peltan J, Cornolle C, Dijos M, Lafitte S, Bayet G, Charmasson C, Collet F, Vaillant A, Vicat J, Giacomoni MP, Teiger E, Bergoend E, Zerbib C, Darremont O, Louis Leymarie J, Clerc P, Choukroun E, Elia N, Grimaud JP, Guibaud JP, Wroblewski S, Abergel E, Bogino E, Chauvel C, Dehant P, Simon M, Angioi M, Lemoine J, Lemoine S, Popovic B, Folliguet T, Maureira P, Huttin O, Selton Suty C, Cayla G, Delseny D, Leclercq F, Levy G, Macia JC, Maupas E, Piot C, Rivalland F, Robert G, Schmutz L, Targosz F, Albat B, Dubar A, Durrleman N, Gandet T, Munos E, Cade S, Cransac F, Bouisset F, Lhermusier T, Grunenwald E, Marcheix B, Fournier P, Morel O, Ohlmann P, Kindo M, Hoang MT, Petit H, Samet H, Trinh A, Huret B, Lecoq G, Morelle JF, Richard P, Derieux T, Monier E, Joret C, Lorgis L, Bouchot O, Eicher JC, Drogoul L, Meyer P, Lopez S, Tapia M, Teboul J, Elbeze JP, Mihoubi A, Bertrand B, Vanzetto G, Wittenberg O, Bach V, Martin C, Sauier C, Casset C, Castellant P, Gilard M, Bezon E, Choplain JN, Kallifa A, Nasr B, Jobic Y, Blanchard D, Lafont A, Pagny JY, Spaulding C, Abi Akar R, Fabiani JN, Zegdi R, Berrebi A, Puscas T, Desveaux B, Ivanes F, Quilliet L, Saint Etienne C, Bourguignon T, Aupy B, Perault R, Bonnet JL, Cuisset T, Lambert M, Grisoli D, Jaussaud N, Salaun E, Delomez M, Laghzaoui A, Savoye C, Beygui F, Bignon M, Roule V, Sabatier R, Ivascau C, Saplacan V, Saloux E, Bouchayer D, Claudel JP, Tremeau G, Diab C, Lapeze J, Pelissier F, Sassard T, Matz C, Monsarrat N, Carel I, Hepp A, Sibellas F, Curtil A, Dambrin G, Favereau X, Jegou A, Ghorayeb G, Guesnier L, Khoury W, Kucharski C, Pouzet B, Vaislic C, Cheikh-Khelifa R, Hilpert L, Maribas P, Gommeaux A, Hannebicque G, Hochart P, Paris M, Pecheux M, Fabre O, Guesnier L, Leborgne L, Mirode A, Peltier M, Trojette F, Carmi D, Tribouilloy C, Christiaens L, Mergy J, Corbi P, Raud Raynier P, Carillo S, Christophe C, Hueber A, Moulin F, Pinelli G, Cassat C, Darodes N, Pesteil F, Metz D, Aludaat C, Torossian F, Belle L, Mangin L, Chavanis N, Akret C, Cerisier A, Isaaz K, Favre JP, Fuzellier JF, Pierrard R, Jacquemin L, Roth O, Wiedemann JY, Bischoff N, Gavra G, Bourrely N, Digne F, Guyon P, Najjari M, Stratiev V, Bonnet N, Mesnildrey P, Attias D, Dreyfus J, Karila Cohen D, Laperche T, Nahum J, Scheuble A, Pouillot C, Rambaud G, Brauberger E, Ah Hot M, Allouch P, Beverelli F, Makowski S, Rosencher J, Aubert S, Grinda JM, Waldman T. Temporal Trends in Transcatheter Aortic Valve Replacement in France. J Am Coll Cardiol 2017; 70:42-55. [DOI: 10.1016/j.jacc.2017.04.053] [Citation(s) in RCA: 207] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 04/05/2017] [Accepted: 04/24/2017] [Indexed: 10/19/2022]
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Armoiry X, Obadia JF, Iung B, Polazzi S, Duclos A. Clinical outcomes and direct costs after transcatheter aortic valve implantation in French centres: a longitudinal study of 1332 patients using a national database. Interact Cardiovasc Thorac Surg 2016; 23:883-888. [DOI: 10.1093/icvts/ivw278] [Citation(s) in RCA: 8] [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] [Received: 03/15/2016] [Revised: 05/23/2016] [Accepted: 07/20/2016] [Indexed: 11/14/2022] Open
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Pozzi M, Lantelme P, Obadia JF. Systematic Venoarterial Extracorporeal Membrane Oxygenation After Surgical Correction of Post-Infarction Ventricular Septal Defect. Artif Organs 2016; 40:811-2. [DOI: 10.1111/aor.12796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 05/11/2016] [Accepted: 06/02/2016] [Indexed: 12/28/2022]
Affiliation(s)
- Matteo Pozzi
- Department of Cardiac Surgery; “Louis Pradel” Cardiologic Hospital, “Claude Bernard” University; Lyon France
| | - Pierre Lantelme
- Department of Cardiology; “Croix Rousse” Hospital; Lyon France
| | - Jean-François Obadia
- Department of Cardiac Surgery; “Louis Pradel” Cardiologic Hospital, “Claude Bernard” University; Lyon France
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Selton-Suty C, Delahaye F, Tattevin P, Federspiel C, Le Moing V, Chirouze C, Nazeyrollas P, Vernet-Garnier V, Bernard Y, Chocron S, Obadia JF, Alla F, Hoen B, Duval X. Symptomatic and Asymptomatic Neurological Complications of Infective Endocarditis: Impact on Surgical Management and Prognosis. PLoS One 2016; 11:e0158522. [PMID: 27400273 PMCID: PMC4939966 DOI: 10.1371/journal.pone.0158522] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 06/16/2016] [Indexed: 11/26/2022] Open
Abstract
Objectives Symptomatic neurological complications (NC) are a major cause of mortality in infective endocarditis (IE) but the impact of asymptomatic complications is unknown. We aimed to assess the impact of asymptomatic NC (AsNC) on the management and prognosis of IE. Methods From the database of cases collected for a population-based study on IE, we selected 283 patients with definite left-sided IE who had undergone at least one neuroimaging procedure (cerebral CT scan and/or MRI) performed as part of initial evaluation. Results Among those 283 patients, 100 had symptomatic neurological complications (SNC) prior to the investigation, 35 had an asymptomatic neurological complications (AsNC), and 148 had a normal cerebral imaging (NoNC). The rate of valve surgery was 43% in the 100 patients with SNC, 77% in the 35 with AsNC, and 54% in the 148 with NoNC (p<0.001). In-hospital mortality was 42% in patients with SNC, 8.6% in patients with AsNC, and 16.9% in patients with NoNC (p<0.001). Among the 135 patients with NC, 95 had an indication for valve surgery (71%), which was performed in 70 of them (mortality 20%) and not performed in 25 (mortality 68%). In a multivariate adjusted analysis of the 135 patients with NC, age, renal failure, septic shock, and IE caused by S. aureus were independently associated with in-hospital and 1-year mortality. In addition SNC was an independent predictor of 1-year mortality. Conclusions The presence of NC was associated with a poorer prognosis when symptomatic. Patients with AsNC had the highest rate of valve surgery and the lowest mortality rate, which suggests a protective role of surgery guided by systematic neuroimaging results.
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Affiliation(s)
| | - François Delahaye
- Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon; Université Claude Bernard, Lyon, France
| | - Pierre Tattevin
- Maladies Infectieuses et Réanimation Médicale, Centre Hospitalier Universitaire, Rennes, France
| | - Claire Federspiel
- Cardiologie, Centre Hospitalier Départemental Vendée, La Roche sur Yon, France
| | - Vincent Le Moing
- Maladies infectieuses et tropicales, Centre Hospitalier Régional Universitaire; UMI 233 Institut de Recherche sur le Développement, Université de Montpellier, Montpellier, France
| | - Catherine Chirouze
- UMR 6249 Laboratoire Chrono-environnement, université de Franche-Comté; Maladies infectieuses et tropicales, Centre Hospitalier Universitaire, Besançon, France
| | | | | | - Yvette Bernard
- Cardiologie, Centre Hospitalier Universitaire, Besançon, France
| | - Sidney Chocron
- Chirurgie Cardiaque, Centre Hospitalier Universitaire, Besançon, France
| | - Jean-François Obadia
- Uninté INSERM 886 « cardioprotection », laboratoire de physiologie Lyon nord, UCBL1; Hôpital Louis Pradel–Chirurgie Cardiothoracique et Transplantation, Lyon, France
| | - François Alla
- Université de Lorraine, Université Paris Descartes, Apemac, EA4360; INSERM, CIC‐EC, CIE6, Nancy, France
| | - Bruno Hoen
- Maladies infectieuses et tropicales, Centre Hospitalier Universitaire, Point à Pitre, France
| | - Xavier Duval
- Inserm CIC 1425, AP-HP, Hôpital Universitaire Bichat; Inserm U1137 IAME; Université Paris Diderot, Paris 7, UFR de Médecine-Bichat, Paris, France
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Iung B, Doco-Lecompte T, Chocron S, Strady C, Delahaye F, Le Moing V, Poyart C, Alla F, Cambau E, Tattevin P, Chirouze C, Obadia JF, Duval X, Hoen B. Cardiac surgery during the acute phase of infective endocarditis: discrepancies between European Society of Cardiology guidelines and practices. Eur Heart J 2015; 37:840-8. [PMID: 26685134 DOI: 10.1093/eurheartj/ehv650] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [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: 07/17/2015] [Accepted: 11/12/2015] [Indexed: 12/20/2022] Open
Abstract
AIMS Indications for surgery in acute infective endocarditis (IE) are detailed in guidelines, but their application is not well known. We analysed the agreement between the patient's attending physicians and European Society of Cardiology guidelines regarding indications for surgery. We also assessed whether surgery was performed in patients who had an indication. METHODS AND RESULTS From the 2008 prospective population-based French survey on IE, 303 patients with definite left-sided native IE were identified. For each case, we prospectively recorded (i) indication for surgery according to the attending physicians and (ii) indication for surgery according to guidelines. Surgery was indicated in 194 (65%) patients according to attending physicians and in 221 (73%) according to guidelines, while 139 (46%) underwent surgery. Agreement was moderate between attending physicians and guidelines (kappa 0.41-0.59) and between indication according to guidelines and the performance of surgery (kappa 0.38). Of the 90 (30%) patients not operated despite indication, contraindication to surgery was reported by the attending physicians in 42 (47%), and indication was not identified in 48 (53%). One-year survival was 76% in patients with indication and surgery performed (n = 131), 69% in patients without indication and no surgery (n = 74), 56% in patients with identified indication and contraindication to surgery (n = 42), and 60% in patients with no identified indication (n = 48; P = 0.059). CONCLUSION Cardiac surgery during acute IE was recommended in almost three out of four patients, although fewer than half were actually operated. Indication was not acknowledged by the attending physicians in one out of six patients.
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Affiliation(s)
- Bernard Iung
- Département de Cardiologie, AP-HP, Hôpital Bichat, Université Paris-Diderot, DHU Fire, 46 rue Henri Huchard, 75018 Paris, France
| | - Thanh Doco-Lecompte
- Maladies Infectieuses et Tropicales, Hôpitaux Universitaires de Genève, Geneve, Switzerland
| | - Sidney Chocron
- Service de Chirurgie Cardiaque, Centre Hospitalier Universitaire, Besançon, France
| | - Christophe Strady
- Cabinet d'Infectiologie. Clinique Saint André-Groupe Courlancy, Reims, France
| | - François Delahaye
- Hôpital Louis Pradel, Hospices Civils de Lyon, Université Claude Bernard, Lyon, France
| | - Vincent Le Moing
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, France Unité Mixte de Recherche 145 Institut de Recherche sur le Développement/Université Montpellier 1, Montpellier, France
| | - Claire Poyart
- AP-HP, Service de Bactériologie, Centre National de Référence des Streptocoques (CNR-Strep), Hôpital Cochin, Paris, France Institut Cochin, Université Paris Descartes, Faculté de médecine, CNRS (UMR 8104), Paris, France Inserm, U1016, Paris, France
| | - François Alla
- EA 4003, Université de Nancy, Nancy, France Inserm CIC 007, Nancy, France
| | - Emmanuelle Cambau
- AP-HP, Hôpital Lariboisière, Service de Bactériologie, Paris, France Université Paris Diderot, Sorbonne Paris Cité, IAME UMR1137, Paris, France
| | - Pierre Tattevin
- Unité de Soins Intensifs et de Maladies Infectieuses, Hôpital Universitaire Pontchaillou, Rennes, France
| | - Catherine Chirouze
- Maladies Infectieuses et Tropicales. Centre Hospitalier Universitaire, Besançon, France
| | - Jean-François Obadia
- Hôpital Louis Pradel, Lyon, Chirurgie Cardiothoracique et Transplantation, Bron, France
| | - Xavier Duval
- AP-HP, Centre d'Investigation Clinique Inserm 1425, Hôpital Bichat, Université Paris-Diderot, Inserm U1137, Paris, France
| | - Bruno Hoen
- Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud, EA 4537, Pointe-à-Pitre, France Centre Hospitalier Universitaire de Pointe-à-Pitre, Inserm CIC1424, Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne, Pointe-à-Pitre, France
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Thonnerieux M, Alexander B, Binet C, Obadia JF, Bastien O, Desebbe O. The Ability of esCCO™ and ECOM™ Monitors to Measure Trends in Cardiac Output During Alveolar Recruitment Maneuver After Cardiac Surgery. Anesth Analg 2015; 121:383-91. [DOI: 10.1213/ane.0000000000000753] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Dementhon J, Rioufol G, Obadia JF, Vergnat M, Green L, Croisille P, Boussel L, Peron J, Revel D, Finet G. A novel contribution towards coherent and reproducible intravalvular measurement of the aortic annulus by multidetector computed tomography ahead of transcatheter aortic valve implantation. Arch Cardiovasc Dis 2015; 108:281-92. [PMID: 25863427 DOI: 10.1016/j.acvd.2014.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 09/04/2014] [Revised: 10/10/2014] [Accepted: 11/27/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND As current multidetector computed tomography (MDCT) measurements underestimate the size of the aortic annulus ahead of transcatheter aortic valve implantation (TAVI), a strategy of approximate annulus area oversizing has been adopted recently. AIMS To measure the aortic annulus using a novel complementary intravalvular MDCT slice. METHODS Fifty-five patients with severe aortic stenosis were selected for MDCT ahead of and 1 month after CoreValve(®) TAVI. Two MDCT slices were analysed and compared: the current standard virtual basal ring (VBR) at the nadir of the aortic cusps; and a novel slice, defined as the basal (lowest) complete commissural coaptation (BCCC) plane. RESULTS BCCC is an intravalvular plane lying 5.2±0.8 mm above the VBR. The BCCC annulus is almost circular, unlike the VBR (mean eccentricity index 0.09±0.04 vs 0.3±0.1, respectively). The mean BCCC annulus diameter was 26.6±2.3 mm, 16% larger than that of the VBR (23.9±2.2 mm; P<0.001). The BCCC annulus area proved coherent with the orifice area measured after TAVI on the projection of the same slice (i.e. systematically equal to or greater than the latter [mean difference, +2.3±1.4 mm]), in contrast to the wider scatter found for the VBR (-1.3±2.0 mm). Once the sclerotic calcified valves have been pushed back by the implant, the aortic orifice after TAVI will inevitably be equal to or less than the diameter of the virtually unvalved annulus before TAVI. CONCLUSION Based on the present results, we recommend including a BCCC slice to complete aortic annulus sizing, in order to optimize implant calibration.
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Affiliation(s)
- Julie Dementhon
- Department of Cardiology and Interventional Cardiology, Hôpital Cardiologique Louis-Pradel, Université Claude-Bernard, Inserm UMR 1060, Lyon, France
| | - Gilles Rioufol
- Department of Cardiology and Interventional Cardiology, Hôpital Cardiologique Louis-Pradel, Université Claude-Bernard, Inserm UMR 1060, Lyon, France
| | - Jean-François Obadia
- Department of Cardiovascular Surgery, Hôpital Cardiologique Louis-Pradel, Université Claude-Bernard, Inserm UMR 1060, Lyon, France
| | - Mathieu Vergnat
- Department of Cardiovascular Surgery, Hôpital Cardiologique Louis-Pradel, Université Claude-Bernard, Inserm UMR 1060, Lyon, France
| | - Lisa Green
- Department of Cardiology and Interventional Cardiology, Hôpital Cardiologique Louis-Pradel, Université Claude-Bernard, Inserm UMR 1060, Lyon, France
| | - Pierre Croisille
- Department of Radiology, Hôpital Cardiologique Louis-Pradel, Université Claude-Bernard, Lyon, France
| | - Loïc Boussel
- Department of Radiology, Hôpital de la Croix-Rousse, Université Claude-Bernard, Lyon, France
| | - Julien Peron
- Department of Biostatistics, UMR 5558, Hospices Civils de Lyon, Université Claude-Bernard, Lyon, France
| | - Didier Revel
- Department of Radiology, Hôpital Cardiologique Louis-Pradel, Université Claude-Bernard, Lyon, France
| | - Gérard Finet
- Department of Cardiology and Interventional Cardiology, Hôpital Cardiologique Louis-Pradel, Université Claude-Bernard, Inserm UMR 1060, Lyon, France.
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Ennezat PV, Bruneval P, Maréchaux S, Bellemin JP, Senellart F, Arnaud-Crozat E, Ramadan R, Obadia JF, Touati G, Fleury JP, Tribouilloy C. Operative finding of aortic cusp prolapse in benfluorex-induced aortic regurgitation. Int J Cardiol 2015; 186:231-2. [PMID: 25828122 DOI: 10.1016/j.ijcard.2015.03.191] [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: 02/12/2015] [Accepted: 03/17/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Pierre-Vladimir Ennezat
- Department of Cardiology and Cardiovascular Surgery, Centre Hospitalier Universitaire de Grenoble, France.
| | - Patrick Bruneval
- Department of Pathology, Hôpital Européen Georges Pompidou, Paris-Descartes University, France
| | - Sylvestre Maréchaux
- Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté libre de médecine, France
| | | | - François Senellart
- Department of Cardiology Cardiovascular Surgery and Pathology Clinique Belledonne Saint-Martin-d'Hères, France
| | - Eric Arnaud-Crozat
- Department of Cardiology and Cardiovascular Surgery, Centre Hospitalier Universitaire de Grenoble, France; Department of Cardiology Cardiovascular Surgery and Pathology Clinique Belledonne Saint-Martin-d'Hères, France
| | - Ramzi Ramadan
- Department of Adult Heart Surgery, Centre Chirurgical Marie Lannelongue, Robinson, France
| | - Jean-François Obadia
- Department of Cardiothoracic Surgery and Transplantation, Hôpital Louis Pradel, Lyon, France
| | - Gilles Touati
- Departments of Cardiology and Cardiovascular Surgery, Centre Hospitalier Universitaire d'Amiens, France
| | - Jean-Pierre Fleury
- Department of Cardiology and Cardiovascular Surgery, Centre Hospitalier Universitaire de Grenoble, France; Department of Cardiology Cardiovascular Surgery and Pathology Clinique Belledonne Saint-Martin-d'Hères, France
| | - Christophe Tribouilloy
- Departments of Cardiology and Cardiovascular Surgery, Centre Hospitalier Universitaire d'Amiens, France
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Obadia JF, Armoiry X, Iung B, Lefèvre T, Mewton N, Messika-Zeitoun D, Cormier B, Berthiller J, Maucort-Boulch D, Boutitie F, Vaz B, Trochu JN, Vahanian A. The MITRA-FR study: design and rationale of a randomised study of percutaneous mitral valve repair compared with optimal medical management alone for severe secondary mitral regurgitation. EUROINTERVENTION 2015; 10:1354-60. [DOI: 10.4244/eijv10i11a232] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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