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Guimbretière G, Sénage T, Boureau AS, Roos JC, Bernard Q, Carlier B, Veziers J, Cueff C, Piriou N, Coste G, Fellah I, Lelarge C, Capoulade R, Jaafar P, Manigold T, Letocart V, Warin-Fresse K, Guérin P, Costa C, Vadori M, Galinañes M, Manez R, Soulillou JP, Cozzi E, Padler-Karavani V, Serfaty JM, Roussel JC, Le Tourneau T. Calcification of surgical aortic bioprostheses and its impact on clinical outcome. Eur Heart J Cardiovasc Imaging 2024:jeae100. [PMID: 38606926 DOI: 10.1093/ehjci/jeae100] [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: 08/11/2023] [Revised: 02/01/2024] [Accepted: 03/25/2024] [Indexed: 04/13/2024] Open
Abstract
AIMS Aortic valve calcification (AVC) of surgical valve bioprostheses (BP) has been poorly explored. We aimed to evaluate in-vivo and ex-vivo BP AVC and its prognosis value. METHODS AND RESULTS Between 2011 and 2019, AVC was assessed using in-vivo computed tomography (CT) in 361 patients who had undergone surgical valve replacement 6.4±4.3 years earlier. Ex-vivo CT scans were performed for 37 explanted BP. The in-vivo CT scans were interpretable for 342 patients (19 patients [5.2%], were excluded). These patients were 77.2±9.1 years old and 64.3% were male. Mean in-vivo AVC was 307±500 Agatston unit (AU). The AVC was 562±570 AU for the 183 (53.5%) patients with structural valve degeneration (SVD) and 13±43 AU for those without SVD (p<0.0001). In-vivo and ex-vivo AVC were strongly correlated (r=0.88, p<0.0001). An in-vivo AVC>100 AU (n=147, 43%) had a specificity of 96% for diagnosing Stage 2-3 SVD (area under the curve=0.92). Patients with AVC>100 AU had a worse outcome compared with those with AVC≤100 AU (n=195). In multivariable analysis, AVC was a predictor of overall mortality (hazard ratio [HR] and 95% confidence interval=1.16[1.04-1.29]; p=0.006), cardiovascular mortality (HR=1.22[1.04-1.43]; p=0.013), cardiovascular events (HR=1.28 [1.16-1.41]; p<0.0001), and re-intervention (HR=1.15 [1.06-1.25]; p<0.0001). After adjustment for Stage 2-3 SVD diagnosis, AVC remained a predictor of overall mortality (HR=1.20 [1.04-1.39]; p=0.015) and cardiovascular events (HR=1.25 [1.09-1.43]; p=0.001). CONCLUSION CT scan is a reliable tool to assess BP leaflet calcification. An AVC>100 AU is tightly associated with SVD and it is a strong predictor of overall mortality and cardiovascular events.
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Affiliation(s)
- Guillaume Guimbretière
- L'institut du thorax, CHU Nantes, Nantes, France
- L'institut du thorax, INSERM UMR 1087, CNRS, UNIV Nantes, Nantes, France
| | - Thomas Sénage
- L'institut du thorax, CHU Nantes, Nantes, France
- INSERM UMR 1246 - SPHERE, Nantes University, Tours University, Nantes, France
| | - Anne-Sophie Boureau
- L'institut du thorax, CHU Nantes, Nantes, France
- L'institut du thorax, INSERM UMR 1087, CNRS, UNIV Nantes, Nantes, France
| | | | | | | | - Joelle Veziers
- INSERM, UMR 1229, RMeS, CHU Nantes, PHU4 OTONN, UNIV Nantes, Nantes, France
- UFR Odontologie, SC3M Plateform, UMS INSERM 016 - CNRS 3556, SFR François Bonamy, Nantes, France
| | - Caroline Cueff
- L'institut du thorax, CHU Nantes, Nantes, France
- L'institut du thorax, INSERM UMR 1087, CNRS, UNIV Nantes, Nantes, France
| | - Nicolas Piriou
- L'institut du thorax, CHU Nantes, Nantes, France
- L'institut du thorax, INSERM UMR 1087, CNRS, UNIV Nantes, Nantes, France
| | | | - Imen Fellah
- L'institut du thorax, CHU Nantes, Nantes, France
- L'institut du thorax, INSERM UMR 1087, CNRS, UNIV Nantes, Nantes, France
| | | | - Romain Capoulade
- L'institut du thorax, INSERM UMR 1087, CNRS, UNIV Nantes, Nantes, France
| | | | | | | | | | - Patrice Guérin
- L'institut du thorax, CHU Nantes, Nantes, France
- L'institut du thorax, INSERM UMR 1087, CNRS, UNIV Nantes, Nantes, France
| | - Cristina Costa
- Infectious Diseases and Transplantation Division, Bellvitge Biomedical Research Institute (IDIBELL) and Bellvitge University Hospital-ICS, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marta Vadori
- Transplant Immunology Unit, Department of Cardiac, Thoracic and Vascular Sciences, Padua University Hospital, Padua, Italy
| | - Manuel Galinañes
- Department of Cardiac Surgery and Reparative Therapy of the Heart, Vall d'Hebron Research Institute (VHIR), University Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rafael Manez
- Infectious Diseases and Transplantation Division, Bellvitge Biomedical Research Institute (IDIBELL) and Bellvitge University Hospital-ICS, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jean-Paul Soulillou
- INSERM, UMR 1064, ITUN, CHU Nantes, Nantes, France; UNIV Nantes, Nantes, France
| | - Emanuele Cozzi
- Transplant Immunology Unit, Department of Cardiac, Thoracic and Vascular Sciences, Padua University Hospital, Padua, Italy
| | - Vered Padler-Karavani
- Department of Cell Research and Immunology, The Shmunis School of Biomedicine and Cancer Research, The George S. Wise Faculty of Life Sciences, Tel Aviv University, Tel Aviv 69978, Israel
| | - Jean-Michel Serfaty
- L'institut du thorax, CHU Nantes, Nantes, France
- L'institut du thorax, INSERM UMR 1087, CNRS, UNIV Nantes, Nantes, France
| | - Jean-Christian Roussel
- L'institut du thorax, CHU Nantes, Nantes, France
- L'institut du thorax, INSERM UMR 1087, CNRS, UNIV Nantes, Nantes, France
| | - Thierry Le Tourneau
- L'institut du thorax, CHU Nantes, Nantes, France
- L'institut du thorax, INSERM UMR 1087, CNRS, UNIV Nantes, Nantes, France
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2
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Dreyfus J, Bohbot Y, Coisne A, Lavie-Badie Y, Flagiello M, Bazire B, Eggenspieler F, Viau F, Riant E, Mbaki Y, Eyharts D, Sénage T, Modine T, Nicol M, Doguet F, Le Tourneau T, Tribouilloy C, Donal E, Tomasi J, Habib G, Selton-Suty C, Radu C, Lim P, Raffoul R, Iung B, Obadia JF, Audureau E, Messika-Zeitoun D. Predictive value of the TRI-SCORE for in-hospital mortality after redo isolated tricuspid valve surgery. Heart 2023; 109:951-958. [PMID: 36828623 DOI: 10.1136/heartjnl-2022-322167] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/02/2023] [Indexed: 02/26/2023] Open
Abstract
OBJECTIVES The TRI-SCORE reliably predicts in-hospital mortality after isolated tricuspid valve surgery (ITVS) on native valve but has not been tested in the setting of redo interventions. We aimed to evaluate the predictive value of the TRI-SCORE for in-hospital mortality in patients with redo ITVS and to compare its accuracy with conventional surgical risk scores. METHODS Using a mandatory administrative database, we identified all consecutive adult patients who underwent a redo ITVS at 12 French tertiary centres between 2007 and 2017. Baseline characteristics and outcomes were collected from chart review and surgical scores were calculated. RESULTS We identified 70 patients who underwent a redo ITVS (54±15 years, 63% female). Prior intervention was a tricuspid valve repair in 51% and a replacement in 49%, and was combined with another surgery in 41%. A tricuspid valve replacement was performed in all patients for the redo surgery. Overall, in-hospital mortality and major postoperative complication rates were 10% and 34%, respectively. The TRI-SCORE was the only surgical risk score associated with in-hospital mortality (p=0.005). The area under the receiver operating characteristic curve for the TRI-SCORE was 0.83, much higher than for the logistic EuroSCORE (0.58) or EuroSCORE II (0.61). The TRI-SCORE was also associated with major postoperative complication rates and survival free of readmissions for heart failure. CONCLUSION Redo ITVS was rarely performed and was associated with an overall high in-hospital mortality and morbidity, but hiding important individual disparities. The TRI-SCORE accurately predicted in-hospital mortality after redo ITVS and may guide clinical decision-making process (www.tri-score.com).
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Affiliation(s)
- Julien Dreyfus
- Cardiology Department, Centre Cardiologique du Nord, Saint Denis, France
| | - Yohann Bohbot
- Cardiology Department, University Hospital Centre Amiens-Picardie South Site, Amiens, France
| | - Augustin Coisne
- Department of Echocardiography and Cardiovascular Explorations, Centre Hospitalier Regional Universitaire de Lille, Lille, France
| | - Yoan Lavie-Badie
- Cardiology Department, University Hospital Centre Toulouse, Toulouse, France
| | - Michele Flagiello
- Department of Cardiovascular Surgery and Transplantation, Hopital Cardio-Vasculaire et Pneumologique Louis Pradel, Lyon, France
| | - Baptiste Bazire
- Cardiology Department, Bichat - Claude-Bernard Hospital Cardiology Service, Paris, France
| | | | - Florence Viau
- Cardiology Department, Hôpital de la Timone, Marseille, France
| | - Elisabeth Riant
- Cardiology Department, Centre Cardiologique du Nord, Saint Denis, France.,Cardiology Department, Hospital Henri Mondor, Creteil, France
| | - Yannick Mbaki
- Cardiology Department, University Hospital Centre Rennes, Rennes, France
| | - Damien Eyharts
- Cardiology Department, University Hospital Centre Toulouse, Toulouse, France
| | - Thomas Sénage
- Cardiac Surgery Department, University Hospital Centre Nantes, Nantes, France
| | - Thomas Modine
- Cardiac Surgery Department, Centre Hospitalier Regional Universitaire de Lille, Lille, France
| | - Martin Nicol
- Cardiology Department, Centre Cardiologique du Nord, Saint Denis, France
| | - Fabien Doguet
- Cardiac Surgery Department, University Hospital Centre Rouen, Rouen, France
| | | | - Christophe Tribouilloy
- Cardiology Department, University Hospital Centre Amiens-Picardie South Site, Amiens, France
| | - Erwan Donal
- Cardiology Department, University Hospital Centre Rennes, Rennes, France
| | - Jacques Tomasi
- Cardiac Surgery Department, University Hospital Centre Rennes, Rennes, France
| | - Gilbert Habib
- Cardiology Department, Hôpital de la Timone, Marseille, France
| | | | - Costin Radu
- Cardiology Department, Hospital Henri Mondor, Creteil, France
| | - Pascal Lim
- Cardiology Department, Hospital Henri Mondor, Creteil, France
| | - Richard Raffoul
- Cardiology Department, Bichat - Claude-Bernard Hospital Cardiology Service, Paris, France
| | - Bernard Iung
- Cardiology Department, Bichat - Claude-Bernard Hospital Cardiology Service, Paris, France
| | - Jean-Francois Obadia
- Department of Cardiovascular Surgery and Transplantation, Hopital Cardio-Vasculaire et Pneumologique Louis Pradel, Lyon, France
| | | | - David Messika-Zeitoun
- Cardiology Department, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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3
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Le Picault B, David CH, Alexandre PL, Lenoble C, Bizouarn P, Lepoivre T, Groleau N, Rozec B, Desal H, Roussel JC, Sénage T. Success of Thrombectomy in Management of Ischemic Stroke in Two Patients with SynCardia Total Artificial Heart in Bridge-to-Transplantation. Bioengineering (Basel) 2021; 8:bioengineering8090126. [PMID: 34562948 PMCID: PMC8469750 DOI: 10.3390/bioengineering8090126] [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: 08/23/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction: Circulatory assistance from a SynCardia Total Artificial Heart (SynCardia-TAH) is a reliable bridge-to-transplant solution for patients with end-stage biventricular heart failure. Ischemic strokes affect about 10% of patients with a SynCardia-TAH. We report for the first time in the literature two successful thrombectomies to treat the acute phase of ischemic stroke in two patients treated with a SynCardia-TAH in the bridge-to-transplant (BTT). Case report: We follow two patients with circulatory support from a SynCardia-TAH in the bridge-to-transplant for terminal biventricular cardiac failure with ischemic stroke during the support period. An early in-hospital diagnosis enables the completion of a mechanical thrombectomy within the first 6 h of the onset of symptoms. There was no intracranial hemorrhagic complication during or after the procedure and the patients fully recovered from neurological deficits, allowing a successful heart transplant. Conclusion: This case report describes the possibility of treating ischemic strokes under a SynCardia-TAH by mechanical thrombectomy following the same recommendations as for the general population with excellent results and without any hemorrhagic complication during or after the procedure.
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Affiliation(s)
- Brendan Le Picault
- Department of Cardiothoracic Surgery, Nantes University Hospital, 44093 Nantes, France; (C.-H.D.); (J.-C.R.); (T.S.)
- Correspondence:
| | - Charles-Henri David
- Department of Cardiothoracic Surgery, Nantes University Hospital, 44093 Nantes, France; (C.-H.D.); (J.-C.R.); (T.S.)
| | - Pierre-Louis Alexandre
- Department of Neuroradiology, Nantes University Hospital, 44093 Nantes, France; (P.-L.A.); (C.L.); (H.D.)
| | - Cédric Lenoble
- Department of Neuroradiology, Nantes University Hospital, 44093 Nantes, France; (P.-L.A.); (C.L.); (H.D.)
| | - Philippe Bizouarn
- Department of Cardiothoracic Anesthesiology, Nantes University Hospital, 44093 Nantes, France; (P.B.); (T.L.); (N.G.); (B.R.)
| | - Thierry Lepoivre
- Department of Cardiothoracic Anesthesiology, Nantes University Hospital, 44093 Nantes, France; (P.B.); (T.L.); (N.G.); (B.R.)
| | - Nicolas Groleau
- Department of Cardiothoracic Anesthesiology, Nantes University Hospital, 44093 Nantes, France; (P.B.); (T.L.); (N.G.); (B.R.)
| | - Bertrand Rozec
- Department of Cardiothoracic Anesthesiology, Nantes University Hospital, 44093 Nantes, France; (P.B.); (T.L.); (N.G.); (B.R.)
| | - Hubert Desal
- Department of Neuroradiology, Nantes University Hospital, 44093 Nantes, France; (P.-L.A.); (C.L.); (H.D.)
| | - Jean-Christian Roussel
- Department of Cardiothoracic Surgery, Nantes University Hospital, 44093 Nantes, France; (C.-H.D.); (J.-C.R.); (T.S.)
| | - Thomas Sénage
- Department of Cardiothoracic Surgery, Nantes University Hospital, 44093 Nantes, France; (C.-H.D.); (J.-C.R.); (T.S.)
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4
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Sénage T, Bonnet N, Guimbretière G, David CH, Roussel JC, Braunberger E. A simplified delivery frozen elephant trunk technique to reduce circulatory arrest time in hybrid aortic arch surgery. J Card Surg 2021; 36:3371-3373. [PMID: 34076921 DOI: 10.1111/jocs.15708] [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] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/15/2021] [Accepted: 04/20/2021] [Indexed: 11/27/2022]
Abstract
A simplified delivery technique for the frozen elephant trunk procedure allows the distal suture to be performed on a perfused and loaded aorta in moderate hypothermia-or even normothermia-reducing circulatory arrest time to just a few minutes. Two surgical sealing tourniquets are placed around the aortic arch, usually between the brachiocephalic trunk (BCT) and the left common carotid artery and the aorta is cross-clamped and cardioplegia started. Once in mild hypothermia, the BCT is disconnected and circulatory arrest is initiated while cerebral perfusion is maintained. This modified technique can be used in all pathologies, including dissections.
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5
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Chen E, Nesseler N, Martins RP, Goéminne C, Vincentelli A, Delmas C, Porterie J, Nubret K, Pernot M, Kindo M, Hoang Minh T, Gaudard P, Rouvière P, Michel M, Sénage T, Boignard A, Chavanon O, Verdonk C, Para M, Pelcé E, Gariboldi V, Pozzi M, Baudry G, Litzler PY, Anselme F, Blanchart K, Babatasi G, Garnier F, Bielefeld M, Radu C, Lellouche N, Bourguignon T, Genet T, Eschalier R, D'Ostrevy N, Bories MC, Baudinaud P, Vanhuyse F, Blangy H, Leclercq C, Flécher E, Galand V. Comparison of Outcomes and Mortality in Patients Having Left Ventricular Assist Device Implanted Early -vs- Late After Diagnosis of Cardiomyopathy. Am J Cardiol 2021; 146:82-88. [PMID: 33549526 DOI: 10.1016/j.amjcard.2021.01.027] [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: 11/22/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 11/17/2022]
Abstract
LVAD implantation in patients with a recently diagnosed cardiomyopathy has been poorly investigated. This work aims at describing the characteristics and outcomes of patients receiving a LVAD within 30 days following the diagnosis of cardiomyopathy. Patients from the ASSIST-ICD study was divided into recently and remotely diagnosed cardiomyopathy based on the time from initial diagnosis of cardiomyopathy to LVAD implantation using the cut point of 30 days. The primary end point of the study was all-cause mortality at 30-day and during follow-up. A total of 652 patients were included and followed during a median time of 9.1 (2.5 to 22.1) months. In this population, 117 (17.9%) had a recently diagnosed cardiomyopathy and had LVAD implantation after a median time of 15.0 (9.0 to 24.0) days following the diagnosis. This group of patients was significantly younger, with more ischemic cardiomyopathy, more sudden cardiac arrest (SCA) events at the time of the diagnosis and were more likely to receive temporary mechanical support before LVAD compared with the remotely diagnosed group. Postoperative in-hospital survival was similar in groups, but recently diagnosed patients had a better long-term survival after hospital discharge. SCA before LVAD and any cardiac surgery combined with LVAD implantation were identified as 2 independent predictors of postoperative mortality in recently diagnosed patients. In conclusion, rescue LVAD implantation for recently diagnosed severe cardiomyopathy is common in clinical practice. Such patients experience a relatively low postoperative mortality and have a better long-term survival compared with remotely diagnosed patients.
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Affiliation(s)
- Elisabeth Chen
- Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France
| | - Nicolas Nesseler
- Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France
| | | | - 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
| | - Jean Porterie
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Karine Nubret
- Hôpital Cardiologique du Haut-Lévêque, LIRYC institute, Université Bordeaux, Bordeaux, France
| | - Mathieu Pernot
- 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 Anesthesiology and Critical Care Medicine, PhyMedExp, University of Montpellier, INSERM, CNRS, CHU 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, France
| | - Thomas Sénage
- 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
| | - 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
| | - Guillaume Baudry
- 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
| | - Katrien Blanchart
- Department of Cardiology and Cardiac Surgery, University of Caen and University Hospital of Caen, France
| | - Gerard Babatasi
- 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
| | - 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
| | - 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
| | | | - Pierre Baudinaud
- 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
| | | | - Erwan Flécher
- Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France
| | - Vincent Galand
- Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France.
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6
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Marie B, David CH, Guimbretière G, Foucher Y, Buschiazzo A, Letocart V, Manigold T, Plessis J, Jaafar P, Morin H, Rozec B, Roussel JC, Sénage T. Carotid versus femoral access for transcatheter aortic valve replacement: comparable results in the current era. Eur J Cardiothorac Surg 2021; 60:874-879. [PMID: 33724380 DOI: 10.1093/ejcts/ezab109] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 08/30/2020] [Revised: 12/16/2020] [Accepted: 12/29/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The carotid approach for transcatheter aortic valve replacement (TAVR) has been shown to be feasible and safe. The goal of this study was to compare the 30-day outcomes of trans-carotid (TC) and transfemoral (TF) TAVR. METHODS This retrospective study enrolled 500 consecutive patients treated by TC-TAVR (n = 100) or TF-TAVR (n = 400) with percutaneous closure between January 2018 and January 2020 at the Nantes University Hospital. The primary end-point was the occurrence of cardiovascular death and cerebrovascular events at 30 days. RESULTS The mean age was 79.9 ± 8.1 in the TC group and 81.3 ± 6.9 (P = 0.069) in the TF group. The TC group had more men (69% vs 50.5%; P = 0.001) and more patients with peripheral vascular disease (86% vs 14.8%; P < 0.0001). Cardiac characteristics were similar between the groups, and the EuroSCORE II was 3.8 ± 2.6% vs 4.6 ± 6.0%, respectively (P = 0.443). The 30-day mortality was 2% in the TC group versus 1% in the TF group (P = 0.345). TC-TAVR was not associated with an increased risk of stroke (2% vs 2.5%; P = 0.999) or major vascular complications (2% vs 4%; P = 0.548). More permanent pacemakers were implanted in the TF group (14.9% vs 5.6%; P = 0.015), and no moderate or severe aortic regurgitation was observed in the TC group (0 vs 3.3%; P = 0.08). TC-TAVR was not associated with an increased risk of mortality or stroke at 30 days (odds ratio 1.32; 95% confidence interval 0.42-4.21; P = 0.63) in the multivariable analysis. CONCLUSIONS No statistically significant differences between TC-TAVR and TF-TAVR were observed; therefore, TC-TAVR should be the first alternative in patients with anatomical contraindications to the femoral route.
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Affiliation(s)
- Basile Marie
- Department of Thoracic and Cardio-Vascular Surgery, Thorax Institute, Nantes Hospital University, Nantes, France
| | - Charles Henri David
- Department of Thoracic and Cardio-Vascular Surgery, Thorax Institute, Nantes Hospital University, Nantes, France
| | - Guillaume Guimbretière
- Department of Thoracic and Cardio-Vascular Surgery, Thorax Institute, Nantes Hospital University, Nantes, France
| | - Yohann Foucher
- INSERM UMR 1246 - SPHERE, Nantes University, Tours University, Nantes, France
| | - Antoine Buschiazzo
- Department of Thoracic and Cardio-Vascular Surgery, Thorax Institute, Nantes Hospital University, Nantes, France
| | - Vincent Letocart
- Department of Cardiology, Thorax Institute, Nantes Hospital University, Nantes, France
| | - Thibaut Manigold
- Department of Cardiology, Thorax Institute, Nantes Hospital University, Nantes, France
| | - Julien Plessis
- Department of Cardiology, Thorax Institute, Nantes Hospital University, Nantes, France
| | - Philippe Jaafar
- Department of Cardiology, Thorax Institute, Nantes Hospital University, Nantes, France
| | - Hélène Morin
- Department of Anesthesiology, Nantes Hospital University, Nantes, France
| | - Bertrand Rozec
- Department of Anesthesiology, Nantes Hospital University, Nantes, France
| | - Jean Christian Roussel
- Department of Thoracic and Cardio-Vascular Surgery, Thorax Institute, Nantes Hospital University, Nantes, France
| | - Thomas Sénage
- Department of Thoracic and Cardio-Vascular Surgery, Thorax Institute, Nantes Hospital University, Nantes, France.,INSERM UMR 1246 - SPHERE, Nantes University, Tours University, Nantes, France
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7
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David CH, Lacoste P, Nanjaiah P, Bizouarn P, Lepoivre T, Michel M, Pattier S, Toquet C, Périgaud C, Mugniot A, Al Habash O, Petit T, Groleau N, Rozec B, Trochu JN, Roussel JC, Sénage T. A heart transplant after total artificial heart support: initial and long-term results. Eur J Cardiothorac Surg 2020; 58:1175-1181. [PMID: 32830239 DOI: 10.1093/ejcts/ezaa261] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 09/05/2019] [Revised: 06/07/2020] [Accepted: 06/11/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES At our centre, the SynCardia temporary Total Artificial Heart (TAH-t) (SynCardia Systems, LLC, Tucson, AZ, USA) is used to provide long-term support for patients with biventricular failure as a bridge to a transplant. However, a heart transplant (HT) after such support remains challenging. The aim of this retrospective study was to assess the immediate and long-term results following an HT in the cohort of patients who had a TAH-t implant. METHODS A total of 73 patients were implanted with the TAH-t between 1988 and 2019 in our centre. Of these 73 consecutive patients, 50 (68%) received an HT and are included in this retrospective analysis of prospectively collected data. RESULTS In the selected cohort, in-hospital mortality after an HT was 10% (n = 5). The median intensive care unit stay was 33 days (range 5-278). The median hospital stay was 41 days (range 28-650). A partial or total pericardiectomy was performed during the HT procedure in 21 patients (42%) due to a severe pericardial reaction. Long-term survival rates after an HT at 5, 10 and 12 years were 79.1 ± 5.9% (n = 32), 76.5 ± 6.3% (n = 22) and 72.4 ± 7.1% (n = 12), respectively, which was similar to the long-term survival for a primary HT without TAH-t during the same period (n = 686). An HT performed within 3-6 months post-TAH-t implantation appeared to provide the best survival (P = 0.007). Eight (16%) patients required chronic dialysis during the subsequent follow-up period, with 3 patients requiring a kidney transplant. CONCLUSIONS The long-term outcomes with the SynCardia TAH-t as a bridge to transplant in patients with severe biventricular failure are very encouraging. Our review noted that an HT following TAH-t can be technically challenging, especially in the case of a severe pericardial reaction, with potential pitfalls that should be recognized preoperatively.
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Affiliation(s)
- Charles-Henri David
- Department of Thoracic and Cardiovascular Surgery, Nantes Hospital University, Nantes, France
| | - Philippe Lacoste
- Department of Thoracic and Cardiovascular Surgery, Nantes Hospital University, Nantes, France
| | - Prakash Nanjaiah
- Department of Cardiac Surgery, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Philippe Bizouarn
- Department of Anesthesiology, Nantes Hospital University, Nantes, France
| | - Thierry Lepoivre
- Department of Anesthesiology, Nantes Hospital University, Nantes, France
| | - Magali Michel
- Department of Thoracic and Cardiovascular Surgery, Nantes Hospital University, Nantes, France.,Thoracic Transplantation Unit, Nantes Hospital University, Nantes, France
| | - Sabine Pattier
- Department of Thoracic and Cardiovascular Surgery, Nantes Hospital University, Nantes, France.,Thoracic Transplantation Unit, Nantes Hospital University, Nantes, France
| | - Claire Toquet
- Department of Cardiology and Vascular Diseases, Institut du thorax, UMR 1087, Clinical Research Unit-INSERM 1413, Teaching Hospital of Nantes, Nantes, France.,Anatomopathology Department, Nantes University Hospital, Nantes, France
| | - Christian Périgaud
- Department of Thoracic and Cardiovascular Surgery, Nantes Hospital University, Nantes, France
| | - Antoine Mugniot
- Department of Thoracic and Cardiovascular Surgery, Nantes Hospital University, Nantes, France
| | - Ousama Al Habash
- Department of Thoracic and Cardiovascular Surgery, Nantes Hospital University, Nantes, France
| | - Thierry Petit
- Thoracic Transplantation Unit, Nantes Hospital University, Nantes, France
| | - Nicolas Groleau
- Department of Anesthesiology, Nantes Hospital University, Nantes, France
| | - Bertrand Rozec
- Department of Anesthesiology, Nantes Hospital University, Nantes, France
| | - Jean Noel Trochu
- Department of Cardiology and Vascular Diseases, Institut du thorax, UMR 1087, Clinical Research Unit-INSERM 1413, Teaching Hospital of Nantes, Nantes, France
| | - Jean Christian Roussel
- Department of Thoracic and Cardiovascular Surgery, Nantes Hospital University, Nantes, France.,Thoracic Transplantation Unit, Nantes Hospital University, Nantes, France
| | - Thomas Sénage
- Department of Thoracic and Cardiovascular Surgery, Nantes Hospital University, Nantes, France.,Thoracic Transplantation Unit, Nantes Hospital University, Nantes, France.,INSERM 1246, Methods in Patients-Centered Outcomes and Health Research - SPHERE, Nantes University, Nantes, France
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8
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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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9
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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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10
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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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11
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Tattevin P, Flécher E, Auffret V, Leclercq C, Boulé S, Vincentelli A, Dambrin C, Delmas C, Barandon L, Veniard V, Kindo M, Cardi T, Gaudard P, Rouvière P, Sénage T, Jacob N, Defaye P, Chavanon O, Verdonk C, Para M, Pelcé E, Gariboldi V, Pozzi M, Grinberg D, Savouré A, Litzler PY, Babatasi G, Belin A, Garnier F, Bielefeld M, Hamon D, Lellouche N, Bernard L, Bourguignon T, Eschalier R, D'Ostrevy N, Jouan J, Varlet E, Vanhuyse F, Blangy H, Martins RP, Galand V. Risk factors and prognostic impact of left ventricular assist device-associated infections. Am Heart J 2019; 214:69-76. [PMID: 31174053 DOI: 10.1016/j.ahj.2019.04.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 02/27/2019] [Accepted: 04/26/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Left ventricular assist device (LVAD)-associated infections may be life-threatening and impact patients' outcome. We aimed to identify the characteristics, risk factors, and prognosis of LVAD-associated infections. METHODS Patients included in the ASSIST-ICD study (19 centers) were enrolled. The main outcome was the occurrence of LVAD-associated infection (driveline infection, pocket infection, or pump/cannula infection) during follow-up. RESULTS Of the 652 patients enrolled, 201 (30.1%) presented a total of 248 LVAD infections diagnosed 6.5 months after implantation, including 171 (26.2%), 51 (7.8%), and 26 (4.0%) percutaneous driveline infection, pocket infection, or pump/cannula infection, respectively. Patients with infections were aged 58.7 years, and most received HeartMate II (82.1%) or HeartWare (13.4%). Most patients (62%) had implantable cardioverter-defibrillators (ICDs) before LVAD, and 104 (16.0%) had ICD implantation, extraction, or replacement after the LVAD surgery. Main pathogens found among the 248 infections were Staphylococcus aureus (n = 113' 45.4%), Enterobacteriaceae (n = 61; 24.6%), Pseudomonas aeruginosa (n = 34; 13.7%), coagulase-negative staphylococci (n = 13; 5.2%), and Candida species (n = 13; 5.2%). In multivariable analysis, HeartMate II (subhazard ratio, 1.56; 95% CI, 1.03 to 2.36; P = .031) and ICD-related procedures post-LVAD (subhazard ratio, 1.43; 95% CI, 1.03-1.98; P = .031) were significantly associated with LVAD infections. Infections had no detrimental impact on survival. CONCLUSIONS Left ventricular assist device-associated infections affect one-third of LVAD recipients, mostly related to skin pathogens and gram-negative bacilli, with increased risk with HeartMate II as compared with HeartWare, and in patients who required ICD-related procedures post-LVAD. This is a plea to better select patients needing ICD implantation/replacement after LVAD implantation.
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Affiliation(s)
- Pierre Tattevin
- 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
| | | | - Stéphane Boulé
- 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
| | - 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
| | - Vincent Veniard
- 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
| | - 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
| | - 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
| | - Daniel Grinberg
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Lyon, France
| | - Arnaud Savouré
- 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, France
| | - Annette Belin
- 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
| | - Louis Bernard
- 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
- CHU Clermont-Ferrand, Cardiology Department, Clermont-Ferrand, France
| | - Nicolas D'Ostrevy
- CHU Clermont-Ferrand, Cardiology Department, Clermont-Ferrand, France
| | - Jérôme Jouan
- Cardiology Department, European Georges Pompidou Hospital, Paris, France
| | - Emilie Varlet
- 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
| | | | - Vincent Galand
- Univ Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, Rennes, France.
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12
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Sénage T, Gillaizeau F, Le Tourneau T, Marie B, Roussel JC, Foucher Y. Structural valve deterioration of bioprosthetic aortic valves: An underestimated complication. J Thorac Cardiovasc Surg 2018; 157:1383-1390.e5. [PMID: 30415900 DOI: 10.1016/j.jtcvs.2018.08.086] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 06/14/2017] [Revised: 07/30/2018] [Accepted: 08/03/2018] [Indexed: 02/09/2023]
Abstract
OBJECTIVES Structural valve deterioration (SVD) remains a major bioprosthesis-related complication, as recently described for the Mitroflow valve (models LX and 12A) (LivaNova, London, United Kingdom). The real incidence of the SVD risk remains unclear, often due to methodologic pitfalls by systematically using the Kaplan-Meier estimator and/or the Cox model. In this report, we propose for the first time a precise statistical modeling of this issue. METHODS Five hundred sixty-one patients who underwent aortic valve replacement with the aortic Mitroflow valve between 2002 and 2007 were included. We used an illness-death model for interval-censored data. Median follow-up was 6.6 years; 103 cases of SVD were diagnosed. RESULTS The 4-year and 7-year SVD cumulative incidences after the first anniversary of surgery were 15.2% (95% confidence interval, 11.9-19.1) and 31.0% (95% confidence interval, 25.8-37.2), respectively. Female gender, dyslipidemia, chronic obstructive pulmonary disease, and severe patient-prosthesis mismatch were significant risk factors of SVD. The occurrence of SVD was associated with a 2-fold increase in the risk of death. CONCLUSIONS Appropriate statistical models should be used to avoid underestimating the SVD complication associated with worse long-term survival.
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Affiliation(s)
- Thomas Sénage
- INSERM UMR 1246 - SPHERE for Nantes University, Tours University, Tours, France; Cardiothoracic Surgical Unit, Thorax Institute, St Herblain, France.
| | - Florence Gillaizeau
- INSERM UMR 1246 - SPHERE for Nantes University, Tours University, Tours, France; Center for Research in Transplantation and Immunology, Institute of Transplantation Urology and Nephrology, St Herblain, France; Department of Statistical Science for University College London, London, United Kingdom
| | - Thierry Le Tourneau
- Department of Physiology, Thorax Institute, St Herblain, France; National Center for Scientific Research (CNRS) UMR 6291, for University of Nantes, St Herblain, France
| | - Basile Marie
- Cardiothoracic Surgical Unit, Thorax Institute, St Herblain, France
| | | | - Yohann Foucher
- INSERM UMR 1246 - SPHERE for Nantes University, Tours University, Tours, France; Center for Research in Transplantation and Immunology, Institute of Transplantation Urology and Nephrology, St Herblain, France
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13
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Gillaizeau F, Sénage T, Le Borgne F, Le Tourneau T, Roussel JC, Leffondrè K, Porcher R, Giraudeau B, Dantan E, Foucher Y. Inverse probability weighting to control confounding in an illness-death model for interval-censored data. Stat Med 2017; 37:1245-1258. [PMID: 29205409 DOI: 10.1002/sim.7550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 07/19/2017] [Accepted: 10/09/2017] [Indexed: 11/12/2022]
Abstract
Multistate models with interval-censored data, such as the illness-death model, are still not used to any considerable extent in medical research regardless of the significant literature demonstrating their advantages compared to usual survival models. Possible explanations are their uncommon availability in classical statistical software or, when they are available, by the limitations related to multivariable modelling to take confounding into consideration. In this paper, we propose a strategy based on propensity scores that allows population causal effects to be estimated: the inverse probability weighting in the illness semi-Markov model with interval-censored data. Using simulated data, we validated the performances of the proposed approach. We also illustrated the usefulness of the method by an application aiming to evaluate the relationship between the inadequate size of an aortic bioprosthesis and its degeneration or/and patient death. We have updated the R package multistate to facilitate the future use of this method.
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Affiliation(s)
- Florence Gillaizeau
- SPHERE, INSERM UMR 1246, Nantes University, Tours University, France.,INSERM CR1064, France.,Centre Hospitalier Universitaire de Nantes, Nantes, France.,Department of Statistical Science, University College London, London, U.K
| | - Thomas Sénage
- SPHERE, INSERM UMR 1246, Nantes University, Tours University, France.,Centre Hospitalier Universitaire de Nantes, Nantes, France.,Department of Thoracic and CardioVascular Surgery, Nantes Hospital University, France
| | - Florent Le Borgne
- SPHERE, INSERM UMR 1246, Nantes University, Tours University, France.,A2COM-IDBC, Nantes, France
| | - Thierry Le Tourneau
- Centre Hospitalier Universitaire de Nantes, Nantes, France.,INSERM UMR1087, CNRS UMR 6291, l'Institut du Thorax, Nantes University, France
| | - Jean-Christian Roussel
- Centre Hospitalier Universitaire de Nantes, Nantes, France.,Department of Thoracic and CardioVascular Surgery, Nantes Hospital University, France
| | - Karen Leffondrè
- ISPED, Centre INSERM U897 Epidemiology and Biostatistics, University of Bordeaux, Bordeaux, France
| | - Raphaël Porcher
- METHODS Team, INSERM UMR 1153, Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité, Paris, France
| | - Bruno Giraudeau
- SPHERE, INSERM UMR 1246, Nantes University, Tours University, France.,INSERM CIC1415, CHRU de Tours, Tours, France
| | - Etienne Dantan
- SPHERE, INSERM UMR 1246, Nantes University, Tours University, France
| | - Yohann Foucher
- SPHERE, INSERM UMR 1246, Nantes University, Tours University, France.,Centre Hospitalier Universitaire de Nantes, Nantes, France
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14
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Roussel JC, Sénage T. [Circulatory assistance, an alternative to heart transplantation]. Soins 2017; 62:26-28. [PMID: 29153213 DOI: 10.1016/j.soin.2017.09.005] [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] [Indexed: 11/16/2022]
Abstract
Circulatory assistance is developing as a treatment for patients with end-stage heart failure. There are two alternative devices: a univentricular circulatory assist pump, or a total artificial heart. It is used to bridge the time to transplantation and, increasingly, as a definitive alternative to a heart transplant.
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Affiliation(s)
- Jean-Christian Roussel
- Service de chirurgie thoracique et cardiovasculaire, Unité de transplantation thoracique, CHU de Nantes, hôpital Nord Laënnec, boulevard Jacques-Monod, Saint-Herblain, 44093 Nantes cedex 1, France.
| | - Thomas Sénage
- Service de chirurgie thoracique et cardiovasculaire, Unité de transplantation thoracique, CHU de Nantes, hôpital Nord Laënnec, boulevard Jacques-Monod, Saint-Herblain, 44093 Nantes cedex 1, France
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15
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Gillaizeau F, Sénage T, Le Tourneau T, Roussel JC, Foucher Y. La détérioration de bioprothèse valvulaire : un problème majeur de santé publique largement sous-estimé par la non-prise en compte de la censure par intervalle et l’évolution multi-états de la maladie. Rev Epidemiol Sante Publique 2015. [DOI: 10.1016/j.respe.2015.03.031] [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: 11/24/2022] Open
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16
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Sénage T, Le Tourneau T, Foucher Y, Pattier S, Cueff C, Michel M, Serfaty JM, Mugniot A, Périgaud C, Carton HF, Al Habash O, Baron O, Roussel JC. Early Structural Valve Deterioration of Mitroflow Aortic Bioprosthesis. Circulation 2014; 130:2012-20. [DOI: 10.1161/circulationaha.114.010400] [Citation(s) in RCA: 159] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Thomas Sénage
- From the Department of Thoracic and Cardiovascular Surgery (T.S., S.P., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Institut du Thorax (T.S., T.L.T., S.P., C.C., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Department of Cardiology (T.L.T., C.C.), and Department of Radiology (J.S.), University Hospital, Nantes, France; Member of Translink European Network (dedicated to structural valve deterioration) (T.S., T.L.T., C.C., J.C.R.); INSERM UMR1087, Nantes, France (T.L.T.); and EA 4275 SPHERE
| | - Thierry Le Tourneau
- From the Department of Thoracic and Cardiovascular Surgery (T.S., S.P., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Institut du Thorax (T.S., T.L.T., S.P., C.C., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Department of Cardiology (T.L.T., C.C.), and Department of Radiology (J.S.), University Hospital, Nantes, France; Member of Translink European Network (dedicated to structural valve deterioration) (T.S., T.L.T., C.C., J.C.R.); INSERM UMR1087, Nantes, France (T.L.T.); and EA 4275 SPHERE
| | - Yohann Foucher
- From the Department of Thoracic and Cardiovascular Surgery (T.S., S.P., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Institut du Thorax (T.S., T.L.T., S.P., C.C., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Department of Cardiology (T.L.T., C.C.), and Department of Radiology (J.S.), University Hospital, Nantes, France; Member of Translink European Network (dedicated to structural valve deterioration) (T.S., T.L.T., C.C., J.C.R.); INSERM UMR1087, Nantes, France (T.L.T.); and EA 4275 SPHERE
| | - Sabine Pattier
- From the Department of Thoracic and Cardiovascular Surgery (T.S., S.P., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Institut du Thorax (T.S., T.L.T., S.P., C.C., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Department of Cardiology (T.L.T., C.C.), and Department of Radiology (J.S.), University Hospital, Nantes, France; Member of Translink European Network (dedicated to structural valve deterioration) (T.S., T.L.T., C.C., J.C.R.); INSERM UMR1087, Nantes, France (T.L.T.); and EA 4275 SPHERE
| | - Caroline Cueff
- From the Department of Thoracic and Cardiovascular Surgery (T.S., S.P., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Institut du Thorax (T.S., T.L.T., S.P., C.C., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Department of Cardiology (T.L.T., C.C.), and Department of Radiology (J.S.), University Hospital, Nantes, France; Member of Translink European Network (dedicated to structural valve deterioration) (T.S., T.L.T., C.C., J.C.R.); INSERM UMR1087, Nantes, France (T.L.T.); and EA 4275 SPHERE
| | - Magali Michel
- From the Department of Thoracic and Cardiovascular Surgery (T.S., S.P., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Institut du Thorax (T.S., T.L.T., S.P., C.C., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Department of Cardiology (T.L.T., C.C.), and Department of Radiology (J.S.), University Hospital, Nantes, France; Member of Translink European Network (dedicated to structural valve deterioration) (T.S., T.L.T., C.C., J.C.R.); INSERM UMR1087, Nantes, France (T.L.T.); and EA 4275 SPHERE
| | - Jean-Michel Serfaty
- From the Department of Thoracic and Cardiovascular Surgery (T.S., S.P., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Institut du Thorax (T.S., T.L.T., S.P., C.C., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Department of Cardiology (T.L.T., C.C.), and Department of Radiology (J.S.), University Hospital, Nantes, France; Member of Translink European Network (dedicated to structural valve deterioration) (T.S., T.L.T., C.C., J.C.R.); INSERM UMR1087, Nantes, France (T.L.T.); and EA 4275 SPHERE
| | - Antoine Mugniot
- From the Department of Thoracic and Cardiovascular Surgery (T.S., S.P., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Institut du Thorax (T.S., T.L.T., S.P., C.C., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Department of Cardiology (T.L.T., C.C.), and Department of Radiology (J.S.), University Hospital, Nantes, France; Member of Translink European Network (dedicated to structural valve deterioration) (T.S., T.L.T., C.C., J.C.R.); INSERM UMR1087, Nantes, France (T.L.T.); and EA 4275 SPHERE
| | - Christian Périgaud
- From the Department of Thoracic and Cardiovascular Surgery (T.S., S.P., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Institut du Thorax (T.S., T.L.T., S.P., C.C., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Department of Cardiology (T.L.T., C.C.), and Department of Radiology (J.S.), University Hospital, Nantes, France; Member of Translink European Network (dedicated to structural valve deterioration) (T.S., T.L.T., C.C., J.C.R.); INSERM UMR1087, Nantes, France (T.L.T.); and EA 4275 SPHERE
| | - Hubert François Carton
- From the Department of Thoracic and Cardiovascular Surgery (T.S., S.P., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Institut du Thorax (T.S., T.L.T., S.P., C.C., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Department of Cardiology (T.L.T., C.C.), and Department of Radiology (J.S.), University Hospital, Nantes, France; Member of Translink European Network (dedicated to structural valve deterioration) (T.S., T.L.T., C.C., J.C.R.); INSERM UMR1087, Nantes, France (T.L.T.); and EA 4275 SPHERE
| | - Ousama Al Habash
- From the Department of Thoracic and Cardiovascular Surgery (T.S., S.P., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Institut du Thorax (T.S., T.L.T., S.P., C.C., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Department of Cardiology (T.L.T., C.C.), and Department of Radiology (J.S.), University Hospital, Nantes, France; Member of Translink European Network (dedicated to structural valve deterioration) (T.S., T.L.T., C.C., J.C.R.); INSERM UMR1087, Nantes, France (T.L.T.); and EA 4275 SPHERE
| | - Olivier Baron
- From the Department of Thoracic and Cardiovascular Surgery (T.S., S.P., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Institut du Thorax (T.S., T.L.T., S.P., C.C., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Department of Cardiology (T.L.T., C.C.), and Department of Radiology (J.S.), University Hospital, Nantes, France; Member of Translink European Network (dedicated to structural valve deterioration) (T.S., T.L.T., C.C., J.C.R.); INSERM UMR1087, Nantes, France (T.L.T.); and EA 4275 SPHERE
| | - Jean Christian Roussel
- From the Department of Thoracic and Cardiovascular Surgery (T.S., S.P., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Institut du Thorax (T.S., T.L.T., S.P., C.C., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Department of Cardiology (T.L.T., C.C.), and Department of Radiology (J.S.), University Hospital, Nantes, France; Member of Translink European Network (dedicated to structural valve deterioration) (T.S., T.L.T., C.C., J.C.R.); INSERM UMR1087, Nantes, France (T.L.T.); and EA 4275 SPHERE
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17
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El Arid JM, Sénage T, Toquet C, Al Habash O, Mugniot A, Baron O, Roussel JC. Human comparative experimental study of surgical treatment of atrial fibrillation by epicardial techniques. J Cardiothorac Surg 2013; 8:140. [PMID: 23725512 PMCID: PMC3679832 DOI: 10.1186/1749-8090-8-140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 05/22/2013] [Indexed: 11/10/2022] Open
Abstract
Background To set up an experimental model of cadaveric heart in order to evaluate and compare histologic transmurality of lesions immediately caused by different energy sources of anti-arrhythmic epicardial devices. Methods Procedures were performed on a cadaveric human heart in orthotopic position with an ischemic time of 48 h at 37° and supported through the use of cardiopulmonary bypass. Three anti-arrhythmic epicardial devices were studied: the bipolar forceps Cardioblate BP (Medtronic) for the radiofrequency, the Epicor Ultracinch LP Ablation device (St. Jude) for ultrasound and the Cardioblate CryoFlex (Medtronic) device for cryoablation. Histological features of lesions made at the pulmonary venous confluence assessed the effectiveness of different energy sources. Results Over 45 experimentations performed, only 28 were considered correct and retained for histological analysis. Three distinct groups were studied according to the type of procedure performed: group 1 (Radiofrequency, n = 12), group 2 (ultrasound, n = 4), group 3 (cryoablation, n = 10) and controls (n = 2). All analysed samples showed histological changes with a success rates of transmurality of 33% for radiofrequency, 25% for ultrasound and 90% for cryotherapy (p <0.001). The average length of transmurality, when it was reached and the proportion of transmurality over the total length of the lesion were respectively 12 ± 6 mm and 37 ± 18% for group 1, 10 mm and 33% for group 2 and 11.1 ± 1.1 mm and 35 ± 5% for group 3. Conclusion Immediate detectable histological transmural lesions after epicardial procedure are discontinuous whatever the kind of energy source tested in this work and it strongly encourages the repetition of radiofrequency procedures. Nevertheless, our experimental model seems inadequate to assess ultrasound energy efficacy.
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Roussel JC, Sénage T, Baron O, Périgaud C, Habash O, Rigal JC, Treilhaud M, Trochu JN, Despins P, Duveau D. CardioWest (Jarvik) total artificial heart: a single-center experience with 42 patients. Ann Thorac Surg 2009; 87:124-9; discussion 130. [PMID: 19101284 DOI: 10.1016/j.athoracsur.2008.09.048] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [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: 01/18/2008] [Revised: 09/21/2008] [Accepted: 09/23/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND When implanted in patients with biventricular failure, the CardioWest total artificial heart has asserted itself over time as a reliable bridge-to-transplant device that as yet is used by only a few international teams. The aim of this single-center retrospective study is to assess both the comorbidity and survival of patients awaiting heart transplants while receiving circulatory support with a CardioWest total artificial heart. METHODS From 1990 to December 2006, 42 patients received a CardioWest total artificial heart at our center. Mean age at the time of implantation was 45.7 +/- 9.5 years, and 40 patients (95%) were men. Idiopathic or dilated cardiomyopathy was diagnosed in 45.2% (n = 19) of the patients and ischemic cardiomyopathy in 42.8% (n = 18). Average body surface area was 1.9 +/- 0.22 m(2). RESULTS Duration of support was 1 to 292 days (mean, 101 +/- 86 days). Twelve patients died (28.5%) while receiving device support, and 30 patients (71.5%) underwent transplantation. Actuarial survival rates for the transplanted patients were 90% (n = 25), 81% (n = 14), and 76% (n = 10) at 1, 5, and 10 years, respectively. Causes of death during device support included multiorgan failure in 6 (50%), sepsis in 2, acute respiratory distress syndrome in 2, alveolar hemorrhage in 1, and other cause in 1. There were no device malfunctions that led to patient death. Adverse events included stroke in 3 patients (7%) and infections in 35 patients (85%) during support. CONCLUSIONS The CardioWest total artificial heart is an excellent bridge-to-transplant device for patients with biventricular failure. Our study demonstrates excellent safety, reliability, and efficiency. Exceptional outcome after transplantation underlines its capacity to aid in end-organ recovery.
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Affiliation(s)
- Jean Christian Roussel
- Department of Thoracic and Cardiovascular Surgery, Institut du Thorax, Nantes Hospital University, Nantes, France.
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