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Akamkam A, Galand V, Jungling M, Delmas C, Dambrin C, Pernot M, Kindo M, Gaudard P, Rouviere P, Senage T, Chavanon O, Para M, Gariboldi V, Pozzi M, Litzler PY, Babatasi G, Bouchot O, Radu C, Bourguignon T, D'Ostrevy N, Abi Akar R, Vanhuyse F, Gaillard M, Chatelier G, Fels A, Flecher E, Guihaire J. Association between pulmonary artery pulsatility and mortality after implantation of left ventricular assist device. ESC Heart Fail 2024. [PMID: 38581135 DOI: 10.1002/ehf2.14716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/10/2024] [Accepted: 01/18/2024] [Indexed: 04/08/2024] Open
Abstract
AIMS Right ventricular failure after left ventricular assist device (LVAD) implantation is a major concern that remains challenging to predict. We sought to investigate the relationship between preoperative pulmonary artery pulsatility index (PAPi) and mortality after LVAD implantation. METHODS AND RESULTS A retrospective analysis of the ASSIST-ICD multicentre registry allowed the assessment of PAPi before LVAD according to the formula [(systolic pulmonary artery pressure - diastolic pulmonary artery pressure)/central venous pressure]. The primary endpoint was survival at 3 months, according to the threshold value of PAPi determined by the receiver operating characteristic (ROC) curve. A multivariate analysis including demographic, echographic, haemodynamic, and biological variables was performed to identify predictive factors for 2 year mortality. One hundred seventeen patients were included from 2007 to 2021. The mean age was 58.45 years (±13.16), with 15.4% of women (sex ratio 5.5). A total of 53.4% were implanted as bridge to transplant and 43.1% as destination therapy. Post-operative right ventricular failure was observed in 57 patients (48.7%), with no significant difference between survivors and non-survivors at 1 month (odds ratio 1.59, P = 0.30). The median PAPi for the whole study population was 2.83 [interquartile range 1.63-4.69]. The threshold value of PAPi determined by the ROC curve was 2.84. Patients with PAPi ≥ 2.84 had a higher survival rate at 3 months [PAPi < 2.84: 58.1% [46.3-72.8%] vs. PAPi ≥ 2.84: 89.1% [81.1-97.7%], hazard ratio (HR) 0.08 [0.02-0.28], P < 0.01], with no significant difference after 3 months (HR 0.67 [0.17-2.67], P = 0.57). Other predictors of 2 year mortality were systemic hypertension (HR 4.22 [1.49-11.97], P < 0.01) and diabetes mellitus (HR 4.90 [1.83-13.14], P < 0.01). LVAD implantation as bridge to transplant (HR 0.18 [0.04-0.74], P = 0.02) and heart transplantation (HR 0.02 [0.00-0.18], P < 0.01) were associated with a higher survival rate at 2 years. CONCLUSIONS Preoperative PAPi < 2.84 was associated with a higher risk of early mortality after LVAD implantation without impacting 2 year outcomes among survivors.
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Affiliation(s)
- Ali Akamkam
- Department of Cardiovascular Surgery, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Le Plessis-Robinson, France
| | - Vincent Galand
- Department of Cardiology, University of Rennes, CHU Rennes, Rennes, France
| | - Marie Jungling
- Department of Cardiac Surgery, Lille University Hospital, Heart-Lung Institute, Lille, France
| | - Clément Delmas
- Department of Cardiology, University Hospital of Toulouse, Toulouse, France
| | - Camille Dambrin
- Department of Cardiovascular Surgery, University Hospital of Toulouse, Toulouse, France
| | - Mathieu Pernot
- Haut-Lévêque Cardiological Hospital, Bordeaux II University, Bordeaux, France
| | - Michel Kindo
- Department of Cardiovascular Surgery, University Hospitals of 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
| | - Olivier Chavanon
- Department of Cardiology and Cardiovascular Surgery, CHU Michallon, Grenoble, France
| | - Marylou Para
- Department of Cardiology and Cardiac Surgery, Bichat-Claude Bernard Hospital, Paris, France
| | - Vlad Gariboldi
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Matteo Pozzi
- Department of Cardiac Surgery, 'Louis Pradel' Cardiologic Hospital, Lyon, 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
| | - Olivier Bouchot
- Department of Cardiology and Cardiac Surgery, University Hospital François Mitterrand, Dijon, France
| | - Costin Radu
- Department of Cardiology and Cardiac Surgery, AP-HP CHU Henri Mondor, Créteil, France
| | | | - Nicolas D'Ostrevy
- Department of Cardiac Surgery and Cardiology, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Ramzi Abi Akar
- Department of Cardiovascular Surgery, European Georges Pompidou Hospital, Paris, France
| | - Fabrice Vanhuyse
- Department of Cardiology and Cardiac Surgery, CHU de Nancy, Hôpitaux de Brabois, Nancy, France
| | - Maïra Gaillard
- Department of Cardiovascular Surgery, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Le Plessis-Robinson, France
| | - Gilles Chatelier
- Department of Clinical Research, Hôpital Paris Saint-Joseph, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Audrey Fels
- Department of Clinical Research, Hôpital Paris Saint-Joseph, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Erwan Flecher
- Department of Thoracic and Cardiovascular Surgery, University of Rennes, CHU Rennes, Rennes, France
| | - Julien Guihaire
- Department of Cardiovascular Surgery, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Le Plessis-Robinson, France
- School of Medicine, University of Paris Saclay, Le Kremlin-Bicêtre, France
- Inserm U999, Marie Lannelongue Hospital, Le Plessis-Robinson, France
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Leclercq B, Bertolino J, Rossillon A, Gariboldi V, El Harake S, Silhol F, Bartoli M, Vaisse B, Bartoli A, Sarlon-Bartoli G. Late Post-Dissection Dynamic Intermittent Malperfusion of the Aortic Arch in Association with a Rare Heterogenous LOX Gene Variation. J Clin Med 2024; 13:952. [PMID: 38398265 PMCID: PMC10888595 DOI: 10.3390/jcm13040952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 12/29/2023] [Accepted: 01/26/2024] [Indexed: 02/25/2024] Open
Abstract
Late ischaemic consequences of type A aortic dissection are rare. We present a 6-year late complication of type A aortic dissection treated by Bentall surgery in a 41-year-old patient. The patient presented with several episodes of lipothymia associated with hypertensive attacks with anisotension, cervicalgia, hemicranial headache, abdominal pain and lower limb slipping initially on exertion and later at rest. On dynamic examination, we diagnosed an intermittent dynamic occlusion of the aortic arch and rare LOX gene variation, which is considered to be associated with aneurysm or dissection of the ascending aorta in young patients. Surgical treatment by replacement of the ascending aorta and the aortic arch with reimplantation of the brachiocephalic trunk (BcTr) allowed the symptoms to resolve.
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Affiliation(s)
- Barbara Leclercq
- Vascular Medicine and Arterial Hypertension Departement, La Timone Hospital, CHU Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France; (J.B.); (G.S.-B.)
| | - Julien Bertolino
- Vascular Medicine and Arterial Hypertension Departement, La Timone Hospital, CHU Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France; (J.B.); (G.S.-B.)
| | - Alexandre Rossillon
- Vascular Surgery Department, La Timone Hospital, CHU Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France; (A.R.)
| | - Vlad Gariboldi
- Department of Cardiac Surgery, La Timone Hospital, CHU Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France
| | - Sarah El Harake
- Vascular Medicine and Arterial Hypertension Departement, La Timone Hospital, CHU Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France; (J.B.); (G.S.-B.)
| | - François Silhol
- Vascular Medicine and Arterial Hypertension Departement, La Timone Hospital, CHU Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France; (J.B.); (G.S.-B.)
| | - Michel Bartoli
- Vascular Surgery Department, La Timone Hospital, CHU Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France; (A.R.)
| | - Bernard Vaisse
- Vascular Medicine and Arterial Hypertension Departement, La Timone Hospital, CHU Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France; (J.B.); (G.S.-B.)
| | - Axel Bartoli
- Radiology Department, La Timone Hospital, CHU Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France
| | - Gabrielle Sarlon-Bartoli
- Vascular Medicine and Arterial Hypertension Departement, La Timone Hospital, CHU Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France; (J.B.); (G.S.-B.)
- Center for CardioVascular and Nutrition Research (C2VN), Aix Marseille University, 13005 Marseille, France
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3
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Baudry G, Coutance G, Dorent R, Bauer F, Blanchart K, Boignard A, Chabanne C, Delmas C, D'Ostrevy N, Epailly E, Gariboldi V, Gaudard P, Goéminne C, Grosjean S, Guihaire J, Guillemain R, Mattei M, Nubret K, Pattier S, Vermes E, Sebbag L, Duarte K, Girerd N. Diuretic dose is a strong prognostic factor in ambulatory patients awaiting heart transplantation. ESC Heart Fail 2023; 10:2843-2852. [PMID: 37408178 PMCID: PMC10567662 DOI: 10.1002/ehf2.14467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/21/2023] [Indexed: 07/07/2023] Open
Abstract
AIMS The prognostic value of 'high dose' loop diuretics in advanced heart failure outpatients is unclear. We aimed to assess the prognosis associated with loop diuretic dose in ambulatory patients awaiting heart transplantation (HT). METHODS AND RESULTS All ambulatory patients (n = 700, median age 55 years and 70% men) registered on the French national HT waiting list between 1 January 2013 and 31 December 2019 were included. Patients were divided into 'low dose', 'intermediate dose', and 'high dose' loop diuretics corresponding to furosemide equivalent doses of ≤40, 40-250, and >250 mg, respectively. The primary outcome was a combined criterion of waitlist death and urgent HT. N-terminal pro-B-type natriuretic peptide, creatinine levels, pulmonary capillary wedge pressure, and pulmonary pressures gradually increased with higher diuretic dose. At 12 months, the risk of waitlist death/urgent HT was 7.4%, 19.2%, and 25.6% (P = 0.001) for 'low dose', 'intermediate dose', and 'high dose' patients, respectively. When adjusting for confounders, including natriuretic peptides, hepatic, and renal function, the 'high dose' group was associated with increased waitlist mortality or urgent HT [adjusted hazard ratio (HR) 2.23, 1.33 to 3.73; P = 0.002] and a six-fold higher risk of waitlist death (adjusted HR 6.18, 2.16 to 17.72; P < 0.001) when compared with the 'low dose' group. 'Intermediate doses' were not significantly associated with these two outcomes in adjusted models (P > 0.05). CONCLUSIONS A 'high dose' of loop diuretics is strongly associated with residual congestion and is a predictor of outcome in patients awaiting HT despite adjustment for classical cardiorenal risk factors. This routine variable may be helpful for risk stratification of pre-HT patients.
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Affiliation(s)
- Guillaume Baudry
- Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433, INSERM DCAC, CHRU de Nancy, F‐CRIN INI‐CRCT, ReicatraVandoeuvre‐lès‐Nancy54500France
| | - Guillaume Coutance
- Department of Cardiac and Thoracic SurgeryCardiology Institute, Pitié Salpêtrière Hospital, Assistance Publique‐Hôpitaux de Paris (AP‐HP). Sorbonne University Medical SchoolParisFrance
| | - Richard Dorent
- Department of Cardiac SurgeryCHU Bichat‐Claude Bernard, AP‐HP, Université Paris VIIParisFrance
| | - Fabrice Bauer
- Department of Cardiology and Cardiovascular SurgeryHospital Charles NicolleRouenFrance
| | - Katrien Blanchart
- Department of Cardiology and Cardiac SurgeryUniversity Hospital of Caen, University of CaenCaenFrance
| | - Aude Boignard
- Department of Cardiology and Cardiovascular SurgeryCHU MichallonGrenobleFrance
| | - Céline Chabanne
- Department of Thoracic and Cardiovascular SurgeryCHU Pontchaillou, Inserm U1099RennesFrance
| | - Clément Delmas
- Department of CardiologyCentre Hospitalier Universitaire de ToulouseToulouseFrance
| | - Nicolas D'Ostrevy
- Department of Cardiology and Cardiac SurgeryCHU Clermont‐FerrandClermont‐FerrandFrance
| | - Eric Epailly
- Department of Cardiology and Cardiovascular SurgeryHôpitaux Universitaires de StrasbourgStrasbourgFrance
| | - Vlad Gariboldi
- Department of Cardiac SurgeryLa Timone HospitalMarseilleFrance
| | - Philippe Gaudard
- Department of Cardiac Surgery, Anesthesiology and Critical Care MedicineArnaud de Villeneuve Hospital, CHRU MontpellierMontpellierFrance
| | - Céline Goéminne
- Department of Cardiac SurgeryCHU Lille, Institut Coeur‐PoumonsLilleFrance
| | - Sandrine Grosjean
- Department of Cardiology and Cardiac SurgeryDijon University HospitalDijonFrance
| | - Julien Guihaire
- Department of Cardiothoracic SurgeryMarie Lannelongue Hospital, University of Paris Sud, Inserm U999 (Pulmonary Hypertension: Pathophysiology and Novel Therapies [PAH])Le Plessis RobinsonFrance
| | - Romain Guillemain
- Department of Cardiology and Cardiac SurgeryEuropean Georges Pompidou HospitalParisFrance
| | - Mathieu Mattei
- Department of Cardiology and Cardiac SurgeryCHU de Nancy, Hopital de BraboisNancyFrance
| | - Karine Nubret
- Department of Thoracic and Cardiovascular SurgeryHôpital Cardiologique du Haut‐Lévêque, Université Bordeaux IIBordeauxFrance
| | - Sabine Pattier
- Department of Cardiology and Heart Transplantation UnitCHU NantesNantesFrance
| | - Emmanuelle Vermes
- Department of Cardiothoracic SurgeryTours University HospitalToursFrance
| | - Laurent Sebbag
- Department of Heart Failure and TransplantationHôpital Cardiovasculaire Louis Pradel, Hospices Civils de LyonBronFrance
| | - Kevin Duarte
- Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433, INSERM DCAC, CHRU de Nancy, F‐CRIN INI‐CRCT, ReicatraVandoeuvre‐lès‐Nancy54500France
| | - Nicolas Girerd
- Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433, INSERM DCAC, CHRU de Nancy, F‐CRIN INI‐CRCT, ReicatraVandoeuvre‐lès‐Nancy54500France
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4
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Martins RP, Hamel-Bougault M, Bessière F, Pozzi M, Extramiana F, Brouk Z, Guenancia C, Sagnard A, Ninni S, Goemine C, Defaye P, Boignard A, Maille B, Gariboldi V, Baudinaud P, Martin AC, Champ-Rigot L, Blanchart K, Sellal JM, De Chillou C, Dyrda K, Jesel-Morel L, Kindo M, Chaumont C, Anselme F, Delmas C, Maury P, Arnaud M, Flecher E, Benali K. Heart transplantation as a rescue strategy for patients with refractory electrical storm. Eur Heart J Acute Cardiovasc Care 2023; 12:571-581. [PMID: 37319361 DOI: 10.1093/ehjacc/zuad063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/08/2023] [Accepted: 05/25/2023] [Indexed: 06/17/2023]
Abstract
AIMS Heart transplantation (HT) can be proposed as a therapeutic strategy for patients with severe refractory electrical storm (ES). Data in the literature are scarce and based on case reports. We aimed at determining the characteristics and survival of patients transplanted for refractory ES. METHODS AND RESULTS Patients registered on HT waiting list during the following days after ES and eventually transplanted, from 2010 to 2021, were retrospectively included in 11 French centres. The primary endpoint was in-hospital mortality. Forty-five patients were included [82% men; 55.0 (47.8-59.3) years old; 42.2% and 26.7% non-ischaemic dilated or ischaemic cardiomyopathies, respectively]. Among them, 42 (93.3%) received amiodarone, 29 received (64.4%) beta blockers, 19 (42.2%) required deep sedation, 22 had (48.9%) mechanical circulatory support, and 9 (20.0%) had radiofrequency catheter ablation. Twenty-two patients (62%) were in cardiogenic shock. Inscription on wait list and transplantation occurred 3.0 (1.0-5.0) days and 9.0 (4.0-14.0) days after ES onset, respectively. After transplantation, 20 patients (44.4%) needed immediate haemodynamic support by extracorporeal membrane oxygenation (ECMO). In-hospital mortality rate was 28.9%. Predictors of in-hospital mortality were serum creatinine/urea levels, need for immediate post-operative ECMO support, post-operative complications, and surgical re-interventions. One-year survival was 68.9%. CONCLUSION Electrical storm is a rare indication of HT but may be lifesaving in those patients presenting intractable arrhythmias despite usual care. Most patients can be safely discharged from hospital, although post-operative mortality remains substantial in this context of emergency transplantation. Larger studies are warranted to precisely determine those patients at higher risk of in-hospital mortality.
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Affiliation(s)
- Raphael P Martins
- Service de Cardiologie, Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, CVHU de Rennes, 2 rue Henri Le Guilloux, F-35000 Rennes, France
| | - Mathilde Hamel-Bougault
- Service de Cardiologie, Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, CVHU de Rennes, 2 rue Henri Le Guilloux, F-35000 Rennes, France
| | - Francis Bessière
- Service de Cardiologie, Hôpital Louis Pradel, CHU de Lyon, Lyon, France
| | - Matteo Pozzi
- Service de Cardiologie, Hôpital Louis Pradel, CHU de Lyon, Lyon, France
| | | | - Zohra Brouk
- Service de Cardiologie, Hôpital Bichat, AP-HP, Paris, France
| | | | | | - Sandro Ninni
- Service de Cardiologie, Service de Cardiologie, CHU de Lille, Lille, France
| | - Céline Goemine
- Service de Cardiologie, Service de Cardiologie, CHU de Lille, Lille, France
| | - Pascal Defaye
- Service de Cardiologie, CHU de Grenoble, Grenoble, France
| | - Aude Boignard
- Service de Cardiologie, CHU de Grenoble, Grenoble, France
| | | | - Vlad Gariboldi
- Service de Cardiologie, CHU La Timone, Marseille, France
| | - Pierre Baudinaud
- Service de Cardiologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Anne-Céline Martin
- Service de Cardiologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | | | | | | | | | - Katia Dyrda
- Institut de Cardiologie de Montréal, Montréal, Canada
| | | | - Michel Kindo
- Service de Cardiologie, CHU de Strasbourg, Strasbourg, France
| | | | | | - Clément Delmas
- Service de Cardiologie, CHU de Toulouse, Toulouse, France
| | - Philippe Maury
- Service de Cardiologie, CHU de Toulouse, Toulouse, France
| | - Marine Arnaud
- Service de Cardiologie, Institut du Thorax, Nantes, France
| | - Erwan Flecher
- Service de Cardiologie, Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, CVHU de Rennes, 2 rue Henri Le Guilloux, F-35000 Rennes, France
| | - Karim Benali
- Service de Cardiologie, Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, CVHU de Rennes, 2 rue Henri Le Guilloux, F-35000 Rennes, France
- Service de Cardiologie, CHU de Saint-Etienne, Saint-Etienne, France
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5
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Porto A, Stolpe G, Badaoui R, Boudouresques V, Deutsch C, Amanatiou C, Riberi A, Gariboldi V, Collart F, Theron A. One-year clinical outcomes following Edwards INSPIRIS RESILIA aortic valve implantation in 487 young patients with severe aortic stenosis: a single-center experience. Front Cardiovasc Med 2023; 10:1196447. [PMID: 37600038 PMCID: PMC10435896 DOI: 10.3389/fcvm.2023.1196447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/26/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction The use of an aortic bioprosthesis is on the rise in younger patients with severe aortic stenosis despite the risk of accelerated structural valve degeneration (SVD). In the search for an optimal valve substitute that would not be prone to SVD, the INSPIRIS bioprosthesis represents a promising solution to lowering the risk of SVD. Here, we report the 1-year outcomes of the INSPIRIS RESILIA aortic bioprosthesis in a population of young patients who underwent aortic valve replacement. Methods In this prospective single-center study, we included all consecutive patients receiving INSPIRIS RESILIA bioprosthesis between June 2017 and July 2021. Patients with isolated severe aortic regurgitation were excluded. Clinical assessment and transthoracic echocardiography were performed preoperatively and at 1 year post-operatively. The primary outcome was overall mortality at one year. Results A total of 487 patients were included. The mean age was 58.2 ± 11.5 years, 75.2% were men. Most of the interventions were elective, with a mean EuroSCORE II of 4.8 ± 7.9. The valve annulus size in most cases was either 23 mm or 25 mm. Overall mortality at 1-year was 4.1%. At 1-year, 7 patients (1.4%) had a stroke, 4 patients (0.8%) had a myocardial infarction, and 20 patients (4.1%) were hospitalized for congestive heart failure. The Kaplan-Meier estimated survival rates and survival without major adverse cardiac events at 1-year were 96.4% and 96.7%, respectively. At 1-year follow-up, 10 patients (2.1%) had endocarditis and 1 patient (0.2%) had partial prosthetic thrombosis. Pacemaker implantation at 1-year post-operative was necessary in 27 patients (5.5%). Severe patient prosthesis mismatch and severe intra valvular regurgitation were 1.2% and 0.6%, respectively. The Kaplan-Meier estimated survival rates at 1-year of no infective endocarditis preoperative and infective endocarditis preoperative were 97.9 ± 0.7% and 89.5 ± 3.3%, respectively (P < 0.001). Excluding endocarditis-related complication, no structural valve deterioration and no valve failure requiring redo surgery were reported. Conclusion This is the largest single-center descriptive study of the 1-year outcomes after INSPIRIS RESILIA bioprosthesis implantation. The EDWARDS INSPIRIS RESILIA bioprosthesis provides encouraging clinical outcomes with an excellent 1- year survival rates and good hemodynamic performance. Long-term studies are mandatory to assess valve durability.
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Affiliation(s)
- Alizee Porto
- Department of Cardiac Surgery, APHM, Timone Hospital, Marseille, France
| | - Gregoire Stolpe
- Department of Cardiac Surgery, APHM, Timone Hospital, Marseille, France
| | - Rita Badaoui
- Department of Cardiac Surgery, APHM, Timone Hospital, Marseille, France
| | | | - Cornelia Deutsch
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Cecile Amanatiou
- Department of Cardiac Surgery, APHM, Timone Hospital, Marseille, France
| | - Alberto Riberi
- Department of Cardiac Surgery, APHM, Timone Hospital, Marseille, France
| | - Vlad Gariboldi
- Department of Cardiac Surgery, APHM, Timone Hospital, Marseille, France
| | - Frédéric Collart
- Department of Cardiac Surgery, APHM, Timone Hospital, Marseille, France
| | - Alexis Theron
- Department of Cardiac Surgery, APHM, Timone Hospital, Marseille, France
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6
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Azogui R, Porto A, Castelli M, Omnes V, De Masi M, Bartoli M, Piquet P, Gariboldi V, Busa T, Jacquier A, Bal L, Gaudry M. In Marfan Syndrome and Related Diseases, STABILISE Technique Should Be Used with Care: Results from a Volumetric Comparative Study of Endovascular Treatment for Aortic Dissection. J Clin Med 2023; 12:4378. [PMID: 37445413 DOI: 10.3390/jcm12134378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/20/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023] Open
Abstract
Objectives: Aortic dissection in patients with Marfan and related syndromes (HTAD) is a serious pathology whose treatment by thoracic endovascular repair (TEVAR) is still under debate. The aim of this study was to assess the results of the TEVAR for aortic dissection in patients with HTAD as compared to a young population without HTAD. Methods: The study received the proper ethical oversight. We performed an observational exposed (confirmed HTAD) vs. non-exposed (<65 years old) study of TEVAR-treated patients. The preoperative, 1 year, and last available CT scans were analyzed. The thoracic and abdominal aortic diameters, aortic length, and volumes were measured. The entry tears and false lumen (FL) status were assessed. The demographic, clinical, and anatomic data were collected during the follow-up. Results: Between 2011 and 2021, 17 patients were included in the HTAD group and 22 in the non-HTAD group. At 1 year, the whole aortic volume increased by +21.2% in the HTAD group and by +0.2% the non-HTAD groups, p = 0.005. An increase in the whole aortic volume > 10% was observed in ten cases (58.8%) in the HTAD group and in five cases (22.7%) in the non-HTAD group (p = 0.022). FL thrombosis was achieved in nine cases (52.9%) in the HTAD group vs. twenty (90.9%) cases in the non-HTAD group (p < 0.01). The risk factors for unfavorable anatomical evolution were male gender and the STABILISE technique. With a linear model, we observed a significantly different aortic volume evolution between the two groups (p < 0.01) with the STABILISE technique; this statistical difference was not found in the TEVAR subgroup. In the HTAD patients, there was a significant difference in the total aortic volume evolution progression between the patients treated with the STABILISE technique and the patients treated with TEVAR (+160.1 ± 52.3% vs. +47 ± 22.5%, p < 0.01 and +189.5 ± 92.5% vs. +58.6 ± 34.8%, p < 0.01 at 1 year and at the end of follow-up, respectively). Conclusions: TEVAR in the HTAD patients seemed to be associated with poorer anatomical outcomes at 1 year. This result was strongly related to the STABILISE technique which should be considered with care in these specific patients.
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Affiliation(s)
- Ron Azogui
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France
| | - Alizee Porto
- Department of Cardiac Surgery, APHM, Timone Hospital, 13005 Marseille, France
| | - Maxime Castelli
- Department of Radiology, APHM, Timone Hospital, 13005 Marseille, France
| | - Virgile Omnes
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France
| | - Mariangela De Masi
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France
| | - Michel Bartoli
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France
| | - Philippe Piquet
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France
| | - Vlad Gariboldi
- Department of Cardiac Surgery, APHM, Timone Hospital, 13005 Marseille, France
| | - Tiffany Busa
- Department of Genetic, APHM, Timone Hospital, 13005 Marseille, France
| | - Alexis Jacquier
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France
- Department of Radiology, APHM, Timone Hospital, 13005 Marseille, France
| | - Laurence Bal
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France
- Timone Aortic Center, APHM, Centre de Référence Marfan et Apparentés, 13005 Marseille, France
| | - Marine Gaudry
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France
- Timone Aortic Center, APHM, Centre de Référence Marfan et Apparentés, 13005 Marseille, France
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7
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Porto A, Omnes V, Bartoli MA, Azogui R, Resseguier N, De Masi M, Bal L, Imbert L, Jaussaud N, Morera P, Jacquier A, Barral PA, Gariboldi V, Gaudry M. Reintervention of Residual Aortic Dissection after Type A Aortic Repair: Results of a Prospective Follow-Up at 5 Years. J Clin Med 2023; 12:jcm12062363. [PMID: 36983363 PMCID: PMC10054589 DOI: 10.3390/jcm12062363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
Background After a type A aortic dissection repair, a patent false lumen in the descending aorta is the most common situation encountered, and is a well-known risk factor for aortic growth, reinterventions and mortality. The aim of this study was to analyze the long-term results of residual aortic dissection (RAD) at a high-volume aortic center with prospective follow-up. Methods In this prospective single-center study, all patients operated for type A aortic dissection between January 2017 and December 2022 were included. Patients without postoperative computed tomography scans or during follow-up at our center, and patients without RAD were excluded. The primary endpoint was all-cause mortality during follow-up for patients with RAD. The secondary endpoints were perioperative mortality, rate of distal aneurysmal evolution, location of distal aneurysmal evolution, rate of distal reinterventions, outcomes of distal reinterventions, and aortic-related death during follow-up. Results In total, 200 survivors of RAD comprised the study group. After a mean follow-up of 27.2 months (1-66), eight patients (4.0%) died and 107 (53.5%) had an aneurysmal progression. The rate of distal reintervention was 19.5% (39/200), for malperfusion syndrome in seven cases (3.5%) and aneurysmal evolution in 32 cases (16.0%). Most reinterventions occurred during the first 2 years (82.1%). Twenty-seven patients were treated for an aneurysmal evolution of RAD including aortic arch with hybrid repair in 21 cases and branched aortic arch endoprosthesis in six cases. In the hybrid repair group, there was no death, and the rate of morbidity was 28.6% (6/21) (one minor stroke, one pulmonary complication, one recurrent paralysis with complete recovery and three major bleeding events). In the branched endograft group, there was no death, no stroke, and no paraplegia. There was one case (16.7%) of carotid dissection. Complete aortic remodeling or complete FL thrombosis on the thoracic aorta was found in 18 cases (85.7%) and in five cases (83.3%) in the hybrid and branched endograft groups, respectively. Conclusions: Despite a critical course in most cases of RAD, with a high rate of aneurysmal evolution and reintervention, the long-term mortality rate remains low with a close follow-up and a multidisciplinary management in an expert center.
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Affiliation(s)
- Alizée Porto
- Department of Cardiac Surgery, Timone Hospital, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Virgile Omnes
- Department of Vascular Surgery, Timone Aortic Center, Timone Hospital, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Michel A Bartoli
- Department of Vascular Surgery, Timone Aortic Center, Timone Hospital, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Ron Azogui
- Department of Vascular Surgery, Timone Aortic Center, Timone Hospital, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Noémie Resseguier
- Department of Epidemiology and Public Health Cost, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Mariangela De Masi
- Department of Vascular Surgery, Timone Aortic Center, Timone Hospital, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Laurence Bal
- Department of Vascular Surgery, Timone Aortic Center, Timone Hospital, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Laura Imbert
- Department of Epidemiology and Public Health Cost, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Nicolas Jaussaud
- Department of Cardiac Surgery, Timone Hospital, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Pierre Morera
- Department of Cardiac Surgery, Timone Hospital, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Alexis Jacquier
- Department of Radiology, Timone Hospital, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Pierre-Antoine Barral
- Department of Radiology, Timone Hospital, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Vlad Gariboldi
- Department of Cardiac Surgery, Timone Hospital, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Marine Gaudry
- Department of Vascular Surgery, Timone Aortic Center, Timone Hospital, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
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8
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Deharo P, Leroux L, Theron A, Ferrara J, Vaillier A, Jaussaud N, Porto A, Morera P, Gariboldi V, Iung B, Lefevre T, Commeau P, Gouysse M, du Chayla F, Glatt N, Cayla G, Le Breton H, Benamer H, Beurtheret S, Verhoye JP, Eltchaninoff H, Gilard M, Collet JP, Dumonteil N, Collart F, Modine T, Cuisset T. Long-Term Prognosis Value of Paravalvular Leak and Patient–Prosthesis Mismatch Following Transcatheter Aortic Valve Implantation: Insight from the France-TAVI Registry. J Clin Med 2022; 11:jcm11206117. [PMID: 36294438 PMCID: PMC9604905 DOI: 10.3390/jcm11206117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Transcatheter aortic valve implantation (TAVI) is the preferred treatment for symptomatic severe aortic stenosis (AS) in a majority of patients across all surgical risks. Patients and methods: Paravalvular leak (PVL) and patient–prosthesis mismatch (PPM) are two frequent complications of TAVI. Therefore, based on the large France-TAVI registry, we planned to report the incidence of both complications following TAVI, evaluate their respective risk factors, and study their respective impacts on long-term clinical outcomes, including mortality. Results: We identified 47,494 patients in the database who underwent a TAVI in France between 1 January 2010 and 31 December 2019. Within this population, 17,742 patients had information regarding PPM status (5138 with moderate-to-severe PPM, 29.0%) and 20,878 had information regarding PVL (4056 with PVL ≥ 2, 19.4%). After adjustment, the risk factors for PVL ≥ 2 were a lower body mass index (BMI), a high baseline mean aortic gradient, a higher body surface area, a lower ejection fraction, a smaller diameter of TAVI, and a self-expandable TAVI device, while for moderate-to-severe PPM we identified a younger age, a lower BMI, a larger body surface area, a low aortic annulus area, a low ejection fraction, and a smaller diameter TAVI device (OR 0.85; 95% CI, 0.83–0.86) as predictors. At 6.5 years, PVL ≥ 2 was an independent predictor of mortality and was associated with higher mortality risk. PPM was not associated with increased risk of mortality. Conclusions: Our analysis from the France-TAVI registry showed that both moderate-to-severe PPM and PVL ≥ 2 continue to be frequently observed after the TAVI procedure. Different risk factors, mostly related to the patient’s anatomy and TAVI device selection, for both complications have been identified. Only PVL ≥ 2 was associated with higher mortality during follow-up.
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Affiliation(s)
- Pierre Deharo
- Département de Cardiologie, CHU Timone, 13385 Marseille, France
- INSERM, Inra, C2VN, Aix Marseille La Timone University, 13005 Marseille, France
- Faculté de Médecine, Aix-Marseille Université, 13005 Marseille, France
| | - Lionel Leroux
- Département de Cardiologie, CHU Bordeaux, 33075 Bordeaux, France
| | - Alexis Theron
- Département de Chirurgie Cardiaque, CHU Timone, 13005 Marseille, France
| | - Jérome Ferrara
- Département de Cardiologie, CHU Timone, 13385 Marseille, France
| | | | - Nicolas Jaussaud
- Département de Chirurgie Cardiaque, CHU Timone, 13005 Marseille, France
| | - Alizée Porto
- Département de Chirurgie Cardiaque, CHU Timone, 13005 Marseille, France
| | - Pierre Morera
- Département de Chirurgie Cardiaque, CHU Timone, 13005 Marseille, France
| | - Vlad Gariboldi
- INSERM, Inra, C2VN, Aix Marseille La Timone University, 13005 Marseille, France
- Faculté de Médecine, Aix-Marseille Université, 13005 Marseille, France
- Département de Chirurgie Cardiaque, CHU Timone, 13005 Marseille, France
| | - Bernard Iung
- AP-HP, Cardiology Department, Bichat Hospital, Université Paris Cité, INSERM 1148, 46 rue Henri Huchard, 75018 Paris, France
| | - Thierry Lefevre
- Hopital Privé Jacques Cartier, 6 Av. Noyer Lambert, 91300 Massy, France
| | - Philippe Commeau
- Cardiologie Interventionnelle, Polyclinique Les Fleurs, Groupe ELSAN, 83190 Ollioules, France
| | | | | | | | | | - Herve Le Breton
- Service de Cardiologie, Hôpital Pontchaillou, Centre Hospitalier Universitaire de Rennes, 35033 Rennes, France
| | - Hakim Benamer
- Hopital Privé Jacques Cartier, 6 Av. Noyer Lambert, 91300 Massy, France
| | | | | | - Helene Eltchaninoff
- Department of Cardiology, Normandie University, UNIROUEN, U1096, CHU Rouen, 76000 Rouen, France
| | - Martine Gilard
- Department of Cardiology, CHRU Brest, 29200 Brest, France
| | - Jean Philippe Collet
- Department of Cardiology, Sorbonne Université, INSERM UMRS_1166, Pitié Salpêtrière (AP-HP), 75000 Paris, France
| | - Nicolas Dumonteil
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, 31300 Toulouse, France
| | - Frederic Collart
- INSERM, Inra, C2VN, Aix Marseille La Timone University, 13005 Marseille, France
- Faculté de Médecine, Aix-Marseille Université, 13005 Marseille, France
- Département de Cardiologie, CHU Bordeaux, 33075 Bordeaux, France
| | - Thomas Modine
- Département de Cardiologie, CHU Bordeaux, 33075 Bordeaux, France
| | - Thomas Cuisset
- Département de Cardiologie, CHU Timone, 13385 Marseille, France
- INSERM, Inra, C2VN, Aix Marseille La Timone University, 13005 Marseille, France
- Faculté de Médecine, Aix-Marseille Université, 13005 Marseille, France
- Correspondence: ; Tel.: +33-4-91-38-59-74; Fax: +33-4-91-38-59-74
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9
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Gaudry M, Azogui R, Castelli M, Bartoli M, Omnes V, Demasi M, Jacquier A, Piquet P, Gariboldi V, Busa T, Bal L. Endovascular treatment of aortic dissections in patients presenting a syndrome of Marfan or a related disease: Results of a comparative study. Ann Vasc Surg 2022. [DOI: 10.1016/j.avsg.2022.06.037] [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]
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10
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Baudry G, Coutance G, Dorent R, Bauer F, Blanchart K, Boignard A, Chabanne C, Delmas C, D'Ostrevy N, Epailly E, Gariboldi V, Gaudard P, Goéminne C, Grosjean S, Guihaire J, Guillemain R, Mattei M, Nubret K, Pattier S, Pozzi M, Rossignol P, Vermes E, Sebbag L, Girerd N. Prognosis value of Forrester's classification in advanced heart failure patients awaiting heart transplantation. ESC Heart Fail 2022; 9:3287-3297. [PMID: 35801277 DOI: 10.1002/ehf2.14037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/04/2022] [Accepted: 06/03/2022] [Indexed: 11/09/2022] Open
Abstract
AIMS The value of Forrester's perfusion/congestion profiles assessed by invasive catheter evaluation in non-inotrope advanced heart failure patients listed for heart transplant (HT) is unclear. We aimed to assess the value of haemodynamic evaluation according to Forrester's profiles to predict events on the HT waitlist. METHODS AND RESULTS All non-inotrope patients (n = 837, 79% ambulatory at listing) registered on the French national HT waiting list between 1 January 2013 and 31 December 2019 with right heart catheterization (RHC) were included. The primary outcome was a combined criteria of waitlist death, delisting for aggravation, urgent HT or left ventricular assist device implantation. Secondary outcome was waitlist death. The 'warm-dry', 'cold-dry', 'warm-wet', and 'cold-wet' profiles represented 27%, 18%, 27%, and 28% of patients, respectively. At 12 months, the respective rates of primary outcome were 15%, 17%, 25%, and 29% (P = 0.008). Taking the 'warm-dry' category as reference, a significant increase in the risk of primary outcome was observed only in the 'wet' categories, irrespectively of 'warm/cold' status: hazard ratios, 1.50; 1.06-2.13; P = 0.024 in 'warm-wet' and 1.77; 1. 25-2.49; P = 0.001 in 'cold-wet'. CONCLUSIONS Haemodynamic assessment of advanced HF patients using perfusion/congestion profiles predicts the risk of the combine endpoint of waitlist death, delisting for aggravation, urgent heart transplantation, or left ventricular assist device implantation. 'Wet' patients had the worst prognosis, independently of perfusion status, thus placing special emphasis on the cardinal prominence of persistent congestion in advanced HF.
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Affiliation(s)
- Guillaume Baudry
- Department of heart failure and transplantation, Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon, 69500, Bron, France.,Centre d'Investigations Cliniques Plurithématique 1433, INSERM DCAC, CHRU de Nancy, F-CRIN INI-CRCT, Université de Lorraine, 54500, Vandoeuvre-lès-Nancy, Nancy, France
| | - Guillaume Coutance
- Department of Cardiac and Thoracic Surgery, Cardiology Institute, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP). Sorbonne University Medical School, Paris, France
| | - Richard Dorent
- Department of Cardiac Surgery, CHU Bichat-Claude Bernard, AP-HP, Université Paris VII, 75877, Paris, France
| | - Fabrice Bauer
- Department of Cardiology and Cardiovascular Surgery, Hospital Charles Nicolle, Rouen, France
| | - Katrien Blanchart
- Department of Cardiology and Cardiac Surgery, University Hospital of Caen, University of Caen, Caen, France
| | - Aude Boignard
- Department of Cardiology and Cardiovascular Surgery, CHU Michallon, Grenoble, France
| | - Céline Chabanne
- Department of Thoracic and Cardiovascular Surgery, CHU Pontchaillou, Inserm U1099, 35000, Rennes, France
| | - Clément Delmas
- Department of Cardiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Nicolas D'Ostrevy
- Cardiology and Cardiac Surgery Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Eric Epailly
- Department of Cardiology and Cardiovascular Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Vlad Gariboldi
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Philippe Gaudard
- Department of Cardiac Surgery, Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, CHRU Montpellier, Montpellier, France
| | - Céline Goéminne
- Department of Cardiac Surgery, CHU Lille, Institut Coeur Poumons, Lille, France
| | - Sandrine Grosjean
- Department of Cardiology and Cardiac Surgery, University Hospital of Dijon, Dijon, France
| | - Julien Guihaire
- Department of Cardiothoracic Surgery, Marie Lannelongue Hospital, University of Paris Sud, Inserm U999 [Pulmonary Hypertension: Pathophysiology and Novel Therapies (PAH)], 92350, Le Plessis Robinson, France
| | - Romain Guillemain
- Cardiology and Cardiac Surgery Department, European Georges Pompidou Hospital, Paris, France
| | - Mathieu Mattei
- Department of Cardiology and Cardiac Surgery, CHU de Nancy, Hopital de Brabois, Nancy, France
| | - Karine Nubret
- Department of Thoracic and Cardiovascular Surgery, Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux II, Bordeaux, France
| | - Sabine Pattier
- Department of Cardiology and Heart Transplantation Unit, CHU de Nantes, Nantes, France
| | - Matteo Pozzi
- Department of heart failure and transplantation, Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon, 69500, Bron, France
| | - Patrick Rossignol
- Centre d'Investigations Cliniques Plurithématique 1433, INSERM DCAC, CHRU de Nancy, F-CRIN INI-CRCT, Université de Lorraine, 54500, Vandoeuvre-lès-Nancy, Nancy, France
| | - Emmanuelle Vermes
- Cardiothoracic Surgery Department, Tours University Hospital, Tours, France
| | - Laurent Sebbag
- Department of heart failure and transplantation, Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon, 69500, Bron, France
| | - Nicolas Girerd
- Centre d'Investigations Cliniques Plurithématique 1433, INSERM DCAC, CHRU de Nancy, F-CRIN INI-CRCT, Université de Lorraine, 54500, Vandoeuvre-lès-Nancy, Nancy, France
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11
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Deharo P, Porto A, Bourguignon T, Herbert J, Etienne CS, Semaan C, Genet T, Jaussaud N, Morera P, Theron A, Gariboldi V, Collart F, Cuisset T, Fauchier L. Myocardial Revascularization Strategies in ST Elevation Myocardial Infarction Without Urgent Revascularization: Insight From a Nationwide Study. Mayo Clin Proc 2022; 97:905-918. [PMID: 35184879 DOI: 10.1016/j.mayocp.2021.10.023] [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: 04/20/2021] [Revised: 09/14/2021] [Accepted: 10/15/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To analyze the outcomes of patients presenting with ST-segment elevation myocardial infarction (STEMI) without early (<48 hours) revascularization, according to percutaneous versus surgical revascularization. PATIENTS AND METHODS Based on the French administrative hospital discharge database, the study collected information for all consecutive patients seen for a STEMI in France between January 1, 2010, to June 31, 2019, who underwent either a first percutaneous coronary intervention (PCI) or a first coronary artery bypass graft between 48 hours and 90 days after the index hospitalization. Propensity score matching was used for the analysis of outcomes. RESULTS Of 71,365 patients with STEMI in the analysis, 59,340 patients underwent PCI and 12,025 patients underwent coronary artery bypass graft. In a matched analysis of 12,012 patients by arm, surgical revascularization was associated with lower rates of all cause (5.1% vs 7.1%; hazard ratio [HR], 0.70; 95% CI, 0.66 to 0.75) and cardiovascular (2.6% vs 3.1%; HR, 0.83; 95% CI, 0.76 to 0.91) death. Rehospitalization for heart failure was less often reported after surgery (5.5% vs 7.5%; HR, 0.76; 95% CI, 0.71 to 0.81) whereas stroke incidence was not statistically different between the two arms (2.1% vs 2.3%; HR, 0.90; 95% CI, 0.80 to 1.00). Major bleeding was less often reported in the PCI arm (4.6% vs 6.1%; HR, 1.31; 95% CI, 1.22 to 1.41). CONCLUSION In patients with STEMI who did not undergo urgent revascularization (ie, within 48 hours after presentation), surgical revascularization was associated with better outcomes and should be individually considered as an alternative to PCI.
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Affiliation(s)
- Pierre Deharo
- Département de Cardiologie, CHU Timone, Marseille, France; Aix Marseille Univ, Inserm, Inra, C2VN, Marseille, France; Aix-Marseille Université, Faculté de Médecine, Marseille, France.
| | - Alizée Porto
- Département de Chirurgie Cardiaque, CHU Timone, Marseille, France
| | - Thierry Bourguignon
- Service de Chirurgie Cardiaque, Centre Hospitalier Universitaire et Faculté de Médecine, Université de Tours, France
| | - Julien Herbert
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université de Tours, France; Service d'information médicale, d'épidémiologie et d'économie de la santé, Centre Hospitalier Universitaire et Faculté de Médecine, EA7505, Université de Tours, France
| | - Christophe Saint Etienne
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université de Tours, France
| | - Carl Semaan
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université de Tours, France
| | - Thibaud Genet
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université de Tours, France
| | - Nicolas Jaussaud
- Département de Chirurgie Cardiaque, CHU Timone, Marseille, France
| | - Pierre Morera
- Département de Chirurgie Cardiaque, CHU Timone, Marseille, France
| | - Alexis Theron
- Aix-Marseille Université, Faculté de Médecine, Marseille, France; Département de Chirurgie Cardiaque, CHU Timone, Marseille, France
| | - Vlad Gariboldi
- Aix Marseille Univ, Inserm, Inra, C2VN, Marseille, France; Aix-Marseille Université, Faculté de Médecine, Marseille, France; Département de Chirurgie Cardiaque, CHU Timone, Marseille, France
| | - Frederic Collart
- Aix-Marseille Université, Faculté de Médecine, Marseille, France; Département de Chirurgie Cardiaque, CHU Timone, Marseille, France
| | - Thomas Cuisset
- Département de Cardiologie, CHU Timone, Marseille, France; Aix Marseille Univ, Inserm, Inra, C2VN, Marseille, France; Aix-Marseille Université, Faculté de Médecine, Marseille, France
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université de Tours, France
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12
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Maille B, Fromonot J, Guiol C, Marlinge M, Baptiste F, Lim S, Colombani C, Chaptal MC, Chefrour M, Gastaldi M, Franceschi F, Deharo JC, Gariboldi V, Ruf J, Mottola G, Guieu R. A 2 Adenosine Receptor Subtypes Overproduction in Atria of Perioperative Atrial Fibrillation Patients Undergoing Cardiac Surgery: A Pilot Study. Front Cardiovasc Med 2021; 8:761164. [PMID: 34805317 PMCID: PMC8595247 DOI: 10.3389/fcvm.2021.761164] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/01/2021] [Indexed: 01/01/2023] Open
Abstract
Objective: Although atrial fibrillation is a common cardiac arrhythmia in humans, the mechanism that leads to the onset of this condition is poorly elucidated. Adenosine is suspected to be implicated in the trigger of atrial fibrillation (AF) through the activation of its membrane receptors, mainly adenosine receptor (AR) subtypes A1R and A2R. In this study, we compared blood adenosine concentration (BAC), and A1R, A2AR, and A2BR production in right (RA) and left atrium (LA), and on peripheral blood mononuclear cells (PBMCs) in patients with underlying structural heart disease undergoing cardiac surgery with or without peri-operative AF (PeOpAF). Methods: The study group consisted of 39 patients (30 men and 9 women, mean age, range 65 [40–82] years) undergoing cardiac surgery and 20 healthy patients (8 women and 12 men; mean age, range 60 [39–72] years) as controls were included. Among patients, 15 exhibited PeOpAF. Results: Blood adenosine concentration was higher in patients with PeOpAF than others. A2AR and A2BR production was higher in PBMCs of patients compared with controls and was higher in PeOpAF patients than other patients. In LA and RA, the production of A2AR and A2BR was higher in patients with PeOpAF than in other patients. Both A2AR and A2BR production were higher in LA vs. RA. A1R production was unchanged in all situations. Finally, we observed a correlation between A1R, A2AR, and A2BR production evaluated on PBMCs and those evaluated in LA and RA. Conclusions: Perioperative AF was associated with high BAC and high A2AR and A2BR expression, especially in the LA, after cardiac surgery in patients with underlying structural heart disease. Whether these increases the favor in triggering the AF in this patient population needs further investigation.
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Affiliation(s)
- Baptiste Maille
- Aix Marseille Univ, INSERM, INRAE, C2VN, Marseille, France.,Department of Cardiology, Timone University Hospital, Marseille, France
| | - Julien Fromonot
- Aix Marseille Univ, INSERM, INRAE, C2VN, Marseille, France.,Laboratory of Biochemistry, Timone University Hospital, AP-HM, Marseille, France
| | - Claire Guiol
- Aix Marseille Univ, INSERM, INRAE, C2VN, Marseille, France
| | - Marion Marlinge
- Aix Marseille Univ, INSERM, INRAE, C2VN, Marseille, France.,Laboratory of Biochemistry, Timone University Hospital, AP-HM, Marseille, France
| | - Florian Baptiste
- Aix Marseille Univ, INSERM, INRAE, C2VN, Marseille, France.,Department of Cardiology, Timone University Hospital, Marseille, France.,Laboratory of Biochemistry, Timone University Hospital, AP-HM, Marseille, France
| | - Suzy Lim
- Laboratory of Biochemistry, Timone University Hospital, AP-HM, Marseille, France
| | - Charlotte Colombani
- Laboratory of Biochemistry, Timone University Hospital, AP-HM, Marseille, France
| | | | - Mohamed Chefrour
- Laboratory of Biochemistry, Timone University Hospital, AP-HM, Marseille, France
| | | | - Frederic Franceschi
- Aix Marseille Univ, INSERM, INRAE, C2VN, Marseille, France.,Department of Cardiology, Timone University Hospital, Marseille, France
| | - Jean-Claude Deharo
- Aix Marseille Univ, INSERM, INRAE, C2VN, Marseille, France.,Department of Cardiology, Timone University Hospital, Marseille, France
| | - Vlad Gariboldi
- Aix Marseille Univ, INSERM, INRAE, C2VN, Marseille, France.,Department of Cardiac Surgery, Timone University Hospital, Marseille, France
| | - Jean Ruf
- Aix Marseille Univ, INSERM, INRAE, C2VN, Marseille, France
| | | | - Régis Guieu
- Aix Marseille Univ, INSERM, INRAE, C2VN, Marseille, France.,Laboratory of Biochemistry, Timone University Hospital, AP-HM, Marseille, France
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13
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Baudry G, Nesseler N, Flecher E, Vincentelli A, Goeminne C, Delmas C, Porterie J, Nubret K, Pernot M, Kindo M, Hoang Minh T, Rouvière P, Gaudard P, Michel M, Senage T, Boignard A, Chavanon O, Para M, Verdonk C, Pelcé E, Gariboldi V, Anselme F, Litzler PY, Blanchart K, Babatasi G, Bielefeld M, Bouchot O, Hamon D, Lellouche N, Bailleul X, Genet T, Eschalier R, d'Ostrevy N, Bories MC, Akar RA, Blangy H, Vanhuyse F, Obadia JF, Galand V, Pozzi M. Characteristics and outcome of ambulatory heart failure patients receiving a left ventricular assist device. ESC Heart Fail 2021; 8:5159-5167. [PMID: 34494391 PMCID: PMC8712824 DOI: 10.1002/ehf2.13592] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/12/2021] [Accepted: 08/19/2021] [Indexed: 02/04/2023] Open
Abstract
Aims Despite regularly updated guidelines, there is still a delay in referral of advanced heart failure patients to mechanical circulatory support and transplant centres. We aimed to analyse characteristics and outcome of non‐inotrope‐dependent patients implanted with a left ventricular assist device (LVAD). Methods and results The ASSIST‐ICD registry collected LVAD data in 19 centres in France between February 2006 and December 2016. We used data of patients in Interagency Registry for Mechanically Assisted Circulatory Support Classes 4–7. The primary endpoint was survival analysis. Predictors of mortality were searched with multivariable analyses. A total of 303 patients (mean age 61.0 ± 9.9 years, male sex 86.8%) were included in the present analysis. Ischaemic cardiomyopathy was the leading heart failure aetiology (64%), and bridge to transplantation was the main implantation strategy (56.1%). The overall likelihood of being alive while on LVAD support or having a transplant at 1, 2, 3, and 5 years was 66%, 61.7%, 58.7%, and 55.1%, respectively. Age [hazard ratio (HR) 1.03, 95% confidence interval (CI) 1.00–1.05; P = 0.02], a concomitant procedure (HR 2.32, 95% CI 1.52–3.53; P < 0.0001), and temporary mechanical right ventricular support during LVAD implantation (HR 2.94, 95% CI 1.49–5.77; P = 0.002) were the only independent variables associated with mortality. Heart failure medications before or after LVAD implantation were not associated with survival. Conclusion Ambulatory heart failure patients displayed unsatisfactory survival rates after LVAD implantation. A better selection of patients who can benefit from LVAD may help improving outcomes.
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Affiliation(s)
- Guillaume Baudry
- Heart Failure Unit, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
| | | | - Erwan Flecher
- Univ Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, Rennes, France
| | - André Vincentelli
- Cardiac Intensive Care Unit, Department of Cardiology, Department of Cardiac Surgery, CHU Lille, Institut Coeur-Poumons, Lille, France
| | - Céline Goeminne
- Cardiac Intensive Care Unit, Department of Cardiology, Department of Cardiac Surgery, CHU Lille, Institut Coeur-Poumons, 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, 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
| | - Tam Hoang Minh
- Département de Chirurgie Cardiovasculaire, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Philippe Rouvière
- Department of Cardiac Surgery, Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, CHRU Montpellier, Montpellier, France
| | - Philippe Gaudard
- 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
| | - Thomas Senage
- 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
| | - Marylou Para
- Department of Cardiac Surgery and Cardiology, Bichat-Hospital, Paris, France
| | - Constance Verdonk
- Department of Cardiac Surgery and Cardiology, 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
| | - 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
| | - 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
| | - Marie Bielefeld
- Department of Cardiology and Cardiac Surgery, University Hospital, Dijon, Dijon, France
| | - Olivier Bouchot
- Department of Cardiology and Cardiac Surgery, University Hospital, Dijon, Dijon, France
| | - David Hamon
- Department of Cardiology, AP-HP CHU Henri Mondor, Créteil, France
| | | | - Xavier Bailleul
- Cardiac Surgery Department and Cardiology Department, Cardiac Intensive Care Unit, Tours University Hospital, Tours, France
| | - Thibaud Genet
- Cardiac Surgery Department and Cardiology Department, Cardiac Intensive Care Unit, Tours University Hospital, Tours, France
| | - Romain Eschalier
- Cardiology and Cardiac Surgery Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Nicolas d'Ostrevy
- Cardiology and Cardiac Surgery Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Marie-Cécile Bories
- Cardiology and Cardiac Surgery Department, European Georges Pompidou Hospital, Paris, France
| | - Ramzi Abi Akar
- Cardiology and Cardiac Surgery Department, European Georges Pompidou Hospital, Paris, France
| | - Hugues Blangy
- Department of Cardiology and Cardiac Surgery, CHU de Nancy, Hopital de Brabois, Nancy, France
| | - Fabrice Vanhuyse
- Department of Cardiology and Cardiac Surgery, CHU de Nancy, Hopital de Brabois, Nancy, France
| | - Jean François Obadia
- Department of Cardiology and Cardiac Surgery, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
| | - Vincent Galand
- Univ Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, Rennes, France
| | - Matteo Pozzi
- Department of Cardiology and Cardiac Surgery, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
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14
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Gaudry M, Porto A, Guivier-Curien C, Blanchard A, Bal L, Resseguier N, Omnes V, De Masi M, Ejargue M, Jacquier A, Gariboldi V, Deplano V, Piquet P. Results of a prospective follow-up study after type A aortic dissection repair: a high rate of distal aneurysmal evolution and reinterventions. Eur J Cardiothorac Surg 2021; 61:152-159. [PMID: 34355742 DOI: 10.1093/ejcts/ezab317] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES We investigated the anatomical evolution of residual aortic dissection after type A repair and factors associated with poor prognosis at a high-volume aortic centre. METHODS Between 2017 and 2019, all type A aortic dissections were included for prospective follow-up. Patients without follow-up computed tomography (CT) scan available for radiological analysis and patients without residual aortic dissection were excluded from this study. The primary end point was a composite end point defined as dissection-related events including aneurysmal evolution (increased diameter > 5 mm/year), aortic reintervention for malperfusion syndrome, aortic diameter >55 mm, rapid aortic growth >10 mm/year or aortic rupture and death. The secondary end points were risk factors for dissection-related events and reintervention analysis. All immediate and last postoperative CT scans were analysed. RESULTS Among 104 patients, after a mean follow-up of 20.4 months (8-41), the risk of dissection-related events was 46.1% (48/104) and the risk of distal reintervention was 17.3% (18/104). Marfan syndrome (P < 0.01), aortic bicuspid valve (P = 0.038), innominate artery debranching (P = 0.025), short aortic cross-clamp time (P = 0.011), initial aortic diameter >40 mm (P < 0.01) and absence of resection of the primary entry tear (P = 0.015) were associated with an increased risk of dissection-related events or reintervention during follow-up. CONCLUSIONS Residual aortic dissection is a serious disease requiring close follow-up at an expert centre. This study shows higher reintervention and aneurysmal development rates than currently published. To improve long-term outcomes, the early demographic and anatomic poor prognostic factors identified may be used for more aggressive treatment at an early phase.
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Affiliation(s)
- Marine Gaudry
- Department of Vascular Surgery, APHM, Timone Hospital, Timone Aortic Center, Marseille, France
| | - Alizée Porto
- Department of Cardiac Surgery, APHM, Timone Hospital, Marseille, France
| | - Carine Guivier-Curien
- Aix-Marseille Université, CNRS, Ecole Centrale Marseille, IRPHE UMR 7342, Marseille, France
| | - Arnaud Blanchard
- Department of Vascular Surgery, APHM, Timone Hospital, Timone Aortic Center, Marseille, France
| | - Laurence Bal
- Department of Vascular Surgery, APHM, Timone Hospital, Timone Aortic Center, Marseille, France
| | - Noemie Resseguier
- Department of Epidemiology and Public Health Cost, APHM, Marseille, France
| | - Virgile Omnes
- Department of Vascular Surgery, APHM, Timone Hospital, Timone Aortic Center, Marseille, France
| | - Mariangela De Masi
- Department of Vascular Surgery, APHM, Timone Hospital, Timone Aortic Center, Marseille, France
| | - Meghann Ejargue
- Department of Vascular Surgery, APHM, Timone Hospital, Timone Aortic Center, Marseille, France
| | - Alexis Jacquier
- Department of Radiology, APHM, Timone Hospital, Marseille, France
| | - Vlad Gariboldi
- Department of Cardiac Surgery, APHM, Timone Hospital, Marseille, France
| | - Valérie Deplano
- Aix-Marseille Université, CNRS, Ecole Centrale Marseille, IRPHE UMR 7342, Marseille, France
| | - Philippe Piquet
- Department of Vascular Surgery, APHM, Timone Hospital, Timone Aortic Center, Marseille, France
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15
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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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16
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Pelce E, Porto A, Gariboldi V, Ben Lagha A, Amanatiou C, Collart F, Theron A. Five-year outcomes of rapid-deployment aortic valve replacement with the Edwards Intuity valve. J Card Surg 2021; 36:2826-2833. [PMID: 34036633 DOI: 10.1111/jocs.15665] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/28/2021] [Accepted: 05/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND This report presents 5-year outcomes of the rapid-deployment Edwards Intuity valve in a prospective, single-center study. METHODS All patients who underwent an aortic valve replacement (AVR) with an Edwards Intuity bioprosthesis at La Timone Hospital, Marseille, France, from July 2012 to June 2015 were assessed over a 5-year follow-up period. The primary outcome was overall mortality at 5 years. Secondary outcomes were reoperation, overall mortality and stroke, cardiovascular mortality, composite endpoints defined by the updated Valve Academic Research Consortium-2 (VARC-2), periprosthetic regurgitation, prosthesis-patient mismatch, and the need for new pacemaker implantation. RESULTS In total, 170 consecutive patients were assessed, of which 67.1% were males. The mean age was 76 years, mean EuroSCORE II was 3.5% and 5-year overall mortality was 12.4%. At 5 years, reoperation was 2.9%, overall mortality and stroke was 4.1% per patient-year, and cardiovascular mortality was 4.7%. VARC clinical efficacy and VARC time-related valve safety were achieved in 46.0% and 59.9% of patients, respectively. At one month VARC device success was 71.2% and VARC early safety was 87.1%. At one year, mild and moderate periprosthetic regurgitation were 2.4% and 0.6%, respectively, and moderate and severe prosthesis-patient mismatch were 18.8% and 4.8%, respectively. Conduction disturbances needing new PPI occurred in 3.5% patients. CONCLUSION The 5-year outcomes of AVR with the Edwards Intuity valve system demonstrate satisfactory midterm safety and excellent haemodynamic performance.
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Affiliation(s)
- E Pelce
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - A Porto
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - V Gariboldi
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - A Ben Lagha
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - C Amanatiou
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - F Collart
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - A Theron
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
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17
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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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Ferrara J, Deharo P, Resseguier N, Porto A, Jaussaud N, Morera P, Amanatiou C, Gariboldi V, Collart F, Cuisset T, Theron A. Rapid deployment versus trans-catheter aortic valve replacement in intermediate-risk patients: A propensity score analysis. J Card Surg 2021; 36:2004-2012. [PMID: 33686755 DOI: 10.1111/jocs.15483] [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] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND There are insufficient studies comparing rapid deployment aortic valve replacement (RDAVR) and trans-aortic valve replacement (TAVR) in intermediate-risk patients with severe aortic stenosis (AS). AIMS We compared 2-year outcomes between RDAVR with INTUITY and TAVR with SAPIEN 3 in intermediate-risk patients with AS. METHODS Inclusion criteria were patients with severe AS at a EuroSCORE II ≥ 4%, who received RDAVR or TAVR implantation and clinical evaluation by the Heart Team. Regression adjustment for the propensity score was used to compare RDAVR and TAVR. Primary outcome was the composite criterion of death, disabling stroke, or rehospitalization. SECONDARY OUTCOMES major bleeding complications postoperation, paravalvular regurgitation ≥ 2, patient-prosthesis mismatch, and pacemaker implantation. RESULTS A total of 152 patients were included from 2012 to 2018: 48 in the RDAVR group and 104 in the TAVR group. The mean age was 82.7 ± 6.0,51.3% patients were female, the mean EuroSCORE II was 6.03 ± 1.6%, mean baseline LVEF was 56 ± 13%, mean indexed effective orifice area was 0.41 ± 0.1 cm/m2 , and the mean gradient was 51.7 ± 14.7 mmHg. RDAVR patients were younger (79.5 ± 6 years vs. 82.6 ± 6 years; p = .01), and at higher risk (EuroSCORE II, 6.61 ± 1.8% vs. 5.63 ± 1.5%; p = .005), Twenty-two patients (45.99%) in the RDAVR group and 32 (66.67%) in the TAVR group met the composite criterion. Through the 1:1 propensity score matching analysis, there was a significant difference between the groups, favoring RDAVR (HR = 0.58 [95% CI: 0.34-1.00]; p = .04). No differences were observed in terms of patient-prosthesis mismatch (0.83 [0.35-1.94]; p = .67), major bleeding events (1.33 [0.47-3.93]; p = .59), paravalvular regurgitation ≥ 2 (0.33[0-6.28]; p = .46), or pacemaker implantation (0.84 [0.25-2.84]; p = .77) CONCLUSION: RDAVR was associated with better 2-year outcomes than TAVR in intermediate-risk patients with severe symptomatic AS.
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Affiliation(s)
- Jérome Ferrara
- Department of Cardiology, La Timone Hospital, Marseille, France
| | - Pierre Deharo
- Department of Cardiology, La Timone Hospital, Marseille, France
| | | | - Alizée Porto
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Nicolas Jaussaud
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Pierre Morera
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Cécile Amanatiou
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Vlad Gariboldi
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Frederic Collart
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Thomas Cuisset
- Department of Cardiology, La Timone Hospital, Marseille, France
| | - Alexis Theron
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
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Gaudry M, Ejargue M, Porto A, Omnes V, de Masi M, Bolomey S, Gariboldi V, Leveille L, Soler R, Barral PA, Jacquier A, Bal L, Piquet P. Anatomical evolution of residual type B aortic dissections and associated prognostic factors: One year results of the prospective follow-up in an expert center. Ann Vasc Surg 2020. [DOI: 10.1016/j.avsg.2020.08.017] [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: 11/28/2022]
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20
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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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Foussier C, Barral PA, Jerosh-Herold M, Gariboldi V, Rapacchi S, Gallon A, Bartoli A, Bentatou Z, Guye M, Bernard M, Jacquier A. Quantification of diffuse myocardial fibrosis using CMR extracellular volume fraction and serum biomarkers of collagen turnover with histologic quantification as standard of reference. Diagn Interv Imaging 2020; 102:163-169. [PMID: 32830084 DOI: 10.1016/j.diii.2020.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/16/2020] [Accepted: 07/28/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To compare the assessment of diffuse interstitial myocardial fibrosis in valvular diseases using cardiac magnetic resonance (CMR) extracellular volume fraction (ECV) quantification and serum biomarkers of collagen turnover using results of myocardial biopsy as standard of reference. MATERIALS AND METHODS This prospective monocentric study included consecutive patients before aortic valvular replacement. All patients underwent: i), 1.5T CMR with pre and post contrast T1 mapping sequence and ECV computation; ii), serum quantification of matrix metalloproteinases (MMPs) and tissue inhibitor of metalloproteinases (TIMPs) and iii), myocardial biopsies were collected during surgery to assess collagen volume fraction (CVF). Patients with coronary artery disease were excluded. Correlation between native T1, ECV, CVF and serum biomarkers were assessed using Pearson correlation test. Agreement between basal anteroseptal ECV with global ECV was assessed using Bland-Altman test. RESULTS Twenty-one patients, 16 with aortic stenosis and 5 with aortic regurgitation were included. There were 12 men and 9 women with a mean age of 74.1±6.8 (SD) years (range: 32-84 years). Mean global ECV value was 26.7±2.7 (SD) % (range: 23.4-32.5%) and mean CVF value was 12.4±9.7% (range: 3.2-25.7%). ECV assessed at the basal anteroseptal segment correlated moderately with CVF (r=0.6; P=0.0026). There was a strong correlation and agreement between basal anteroseptal ECV and global ECV, (r=0.8; P<0.0001; bias 5.4±6.1%) but no correlation between global ECV and CVF (r=0.5; P=0.10). Global ECV poorly correlated with serum TIMP-1 (r=0.4; P=0.037) and MMP-2 (r=0.4; P=0.047). No correlation was found between serum biomarkers and basal anteroseptal- ECV or native T1. CONCLUSION In patients with severe aortic valvulopathy, diffuse myocardial fibrosis assessed by anterosepto-basal ECV correlates with histological myocardial fibrosis. Anteroseptobasal ECV strongly correlates with global ECV, which poorly correlates with TIMP-1 and MMP-2, serum biomarkers involved in the progression of heart failure.
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Affiliation(s)
- C Foussier
- Department of Radiology, Hôpital de la Timone, 13385 Marseille, France; UMR CNRS 7339, Aix-Marseille University, 13385 Marseille, France; Centre de Résonance Magnétique Biologique et Médicale, Hôpital de la Timone, AP-HM, 13385 Marseille cedex 05, France
| | - P A Barral
- Department of Radiology, Hôpital de la Timone, 13385 Marseille, France; UMR CNRS 7339, Aix-Marseille University, 13385 Marseille, France; Centre de Résonance Magnétique Biologique et Médicale, Hôpital de la Timone, AP-HM, 13385 Marseille cedex 05, France
| | - M Jerosh-Herold
- Non-Invasive Cardiovascular Imaging Section, Brigham and Women's Hospital, Boston, MA 02215, USA
| | - V Gariboldi
- Department of Heart Surgery, Hôpital de la Timone, 13385 Marseille cedex 05, France
| | - S Rapacchi
- UMR CNRS 7339, Aix-Marseille University, 13385 Marseille, France; Centre de Résonance Magnétique Biologique et Médicale, Hôpital de la Timone, AP-HM, 13385 Marseille cedex 05, France
| | - A Gallon
- Department of Radiology, Hôpital de la Timone, 13385 Marseille, France
| | - A Bartoli
- Department of Radiology, Hôpital de la Timone, 13385 Marseille, France
| | - Z Bentatou
- UMR CNRS 7339, Aix-Marseille University, 13385 Marseille, France; Centre de Résonance Magnétique Biologique et Médicale, Hôpital de la Timone, AP-HM, 13385 Marseille cedex 05, France
| | - M Guye
- UMR CNRS 7339, Aix-Marseille University, 13385 Marseille, France; Centre de Résonance Magnétique Biologique et Médicale, Hôpital de la Timone, AP-HM, 13385 Marseille cedex 05, France
| | - M Bernard
- UMR CNRS 7339, Aix-Marseille University, 13385 Marseille, France; Centre de Résonance Magnétique Biologique et Médicale, Hôpital de la Timone, AP-HM, 13385 Marseille cedex 05, France; Aix-Marseille Univ, CNRS, CRMBM, 13000 Marseille, France
| | - A Jacquier
- Department of Radiology, Hôpital de la Timone, 13385 Marseille, France; UMR CNRS 7339, Aix-Marseille University, 13385 Marseille, France; Centre de Résonance Magnétique Biologique et Médicale, Hôpital de la Timone, AP-HM, 13385 Marseille cedex 05, France.
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Gaudry M, Vairo D, Marlinge M, Gaubert M, Guiol C, Mottola G, Gariboldi V, Deharo P, Sadrin S, Maixent JM, Fenouillet E, Ruf J, Guieu R, Paganelli F. Adenosine and Its Receptors: An Expected Tool for the Diagnosis and Treatment of Coronary Artery and Ischemic Heart Diseases. Int J Mol Sci 2020; 21:ijms21155321. [PMID: 32727116 PMCID: PMC7432452 DOI: 10.3390/ijms21155321] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/15/2020] [Accepted: 07/21/2020] [Indexed: 12/14/2022] Open
Abstract
Adenosine is an endogenous nucleoside which strongly impacts the cardiovascular system. Adenosine is released mostly by endothelial cells and myocytes during ischemia or hypoxia and greatly regulates the cardiovascular system via four specific G-protein-coupled receptors named A1R, A2AR, A2BR, and A3R. Among them, A2 subtypes are strongly expressed in coronary tissues, and their activation increases coronary blood flow via the production of cAMP in smooth muscle cells. A2A receptor modulators are an opportunity for intense research by the pharmaceutical industry to develop new cardiovascular therapies. Most innovative therapies are mediated by the modulation of adenosine release and/or the activation of the A2A receptor subtypes. This review aims to focus on the specific exploration of the adenosine plasma level and its relationship with the A2A receptor, which seems a promising biomarker for a diagnostic and/or a therapeutic tool for the screening and management of coronary artery disease. Finally, a recent class of selective adenosine receptor ligands has emerged, and A2A receptor agonists/antagonists are useful tools to improve the management of patients suffering from coronary artery disease.
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Affiliation(s)
- Marine Gaudry
- Department of Vascular Surgery, Timone Hospital, F-13008 Marseille, France;
| | - Donato Vairo
- C2VN, INSERM, INRA, Aix-Marseille University, F-13015 Marseille, France; (D.V.); (M.M.); (M.G.); (C.G.); (G.M.); (V.G.); (P.D.); (E.F.); (J.R.); (R.G.)
| | - Marion Marlinge
- C2VN, INSERM, INRA, Aix-Marseille University, F-13015 Marseille, France; (D.V.); (M.M.); (M.G.); (C.G.); (G.M.); (V.G.); (P.D.); (E.F.); (J.R.); (R.G.)
- Laboratory of Biochemistry, Timone Hospital, F-13008 Marseille, France
| | - Melanie Gaubert
- C2VN, INSERM, INRA, Aix-Marseille University, F-13015 Marseille, France; (D.V.); (M.M.); (M.G.); (C.G.); (G.M.); (V.G.); (P.D.); (E.F.); (J.R.); (R.G.)
| | - Claire Guiol
- C2VN, INSERM, INRA, Aix-Marseille University, F-13015 Marseille, France; (D.V.); (M.M.); (M.G.); (C.G.); (G.M.); (V.G.); (P.D.); (E.F.); (J.R.); (R.G.)
| | - Giovanna Mottola
- C2VN, INSERM, INRA, Aix-Marseille University, F-13015 Marseille, France; (D.V.); (M.M.); (M.G.); (C.G.); (G.M.); (V.G.); (P.D.); (E.F.); (J.R.); (R.G.)
- Laboratory of Biochemistry, Timone Hospital, F-13008 Marseille, France
| | - Vlad Gariboldi
- C2VN, INSERM, INRA, Aix-Marseille University, F-13015 Marseille, France; (D.V.); (M.M.); (M.G.); (C.G.); (G.M.); (V.G.); (P.D.); (E.F.); (J.R.); (R.G.)
- Department of Cardiac Surgery, Timone Hospital, F-13008 Marseille, France
| | - Pierre Deharo
- C2VN, INSERM, INRA, Aix-Marseille University, F-13015 Marseille, France; (D.V.); (M.M.); (M.G.); (C.G.); (G.M.); (V.G.); (P.D.); (E.F.); (J.R.); (R.G.)
- Department of Cardiology, Timone Hospital, F-13008 Marseille, France
| | | | - Jean Michel Maixent
- Unité de Recherche Clinique Pierre Deniker (URC C.S. 10587) Centre Hospitalier Henri Laborit, 86000 Poitiers, France
- I.A.P.S. Equipe Emergeante, Université de Toulon, 83957 Toulon-La Garde, UFR S.F.A., F-86073 Poitiers, France
- Correspondence: (J.M.M.); (F.P.)
| | - Emmanuel Fenouillet
- C2VN, INSERM, INRA, Aix-Marseille University, F-13015 Marseille, France; (D.V.); (M.M.); (M.G.); (C.G.); (G.M.); (V.G.); (P.D.); (E.F.); (J.R.); (R.G.)
| | - Jean Ruf
- C2VN, INSERM, INRA, Aix-Marseille University, F-13015 Marseille, France; (D.V.); (M.M.); (M.G.); (C.G.); (G.M.); (V.G.); (P.D.); (E.F.); (J.R.); (R.G.)
| | - Regis Guieu
- C2VN, INSERM, INRA, Aix-Marseille University, F-13015 Marseille, France; (D.V.); (M.M.); (M.G.); (C.G.); (G.M.); (V.G.); (P.D.); (E.F.); (J.R.); (R.G.)
- Laboratory of Biochemistry, Timone Hospital, F-13008 Marseille, France
| | - Franck Paganelli
- C2VN, INSERM, INRA, Aix-Marseille University, F-13015 Marseille, France; (D.V.); (M.M.); (M.G.); (C.G.); (G.M.); (V.G.); (P.D.); (E.F.); (J.R.); (R.G.)
- Department of Cardiology, Nord Hospital, ARCHANTEC, F-13015 Marseille, France
- Correspondence: (J.M.M.); (F.P.)
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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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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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25
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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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26
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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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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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Deplano V, Boufi M, Gariboldi V, Loundou AD, D'Journo XB, Cautela J, Djemli A, Alimi YS. Mechanical characterisation of human ascending aorta dissection. J Biomech 2019; 94:138-146. [PMID: 31400813 DOI: 10.1016/j.jbiomech.2019.07.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 12/11/2018] [Revised: 06/10/2019] [Accepted: 07/22/2019] [Indexed: 01/03/2023]
Abstract
Mechanical characteristics of both the healthy ascending aorta and acute type A aortic dissection were investigated using in vitro biaxial tensile tests, in vivo measurements via transoesophageal echocardiography and histological characterisations. This combination of analysis at tissular, structural and microstructural levels highlighted the following: (i) a linear mechanical response for the dissected intimomedial flap and, conversely, nonlinear behaviour for both healthy and dissected ascending aorta; all showed anisotropy; (ii) a stiffer mechanical response in the longitudinal than in the circumferential direction for the healthy ascending aorta, consistent with the histological quantification of collagen and elastin fibre density; (iii) a link between dissection and ascending aorta stiffening, as revealed by biaxial tensile tests. This result was corroborated by in vivo measurements with stiffness index, β, and Peterson modulus, Ep, higher for patients with dissection than for control patients. It was consistent with histological analysis on dissected samples showing elastin fibre dislocations, reduced elastin density and increased collagen density. To our knowledge, this is the first study to report biaxial tensile tests on the dissected intimomedial flap and in vivo stiffness measurements of acute type A dissection in humans.
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Affiliation(s)
- Valérie Deplano
- Aix Marseille Univ, CNRS, IRPHE, Ecole Centrale Marseille, Marseille, France.
| | - Mourad Boufi
- Aix Marseille Univ, APHM, IFSTTAR, LBA, North Hospital, Department of Vascular Surgery, Marseille, France; Aix Marseille Univ, CNRS, IRPHE, Ecole Centrale Marseille, Marseille, France
| | - Vlad Gariboldi
- Aix Marseille Univ, APHM, Timone Hospital, Department of Cardiac Surgery, Marseille, France
| | - Anderson D Loundou
- Aix Marseille Univ, SPMC EA3279, Department of Public Health, Marseille, France
| | - Xavier Benoit D'Journo
- Aix Marseille Univ, APHM, North Hospital, Department of Thoracic Surgery, Marseille, France
| | - Jennifer Cautela
- Aix Marseille Univ, APHM, North Hospital, Department of Cardiology, Marseille, France
| | - Amina Djemli
- Aix Marseille Univ, APHM, North Hospital, Department of Pathology, Marseille, France
| | - Yves S Alimi
- Aix Marseille Univ, APHM, IFSTTAR, LBA, North Hospital, Department of Vascular Surgery, Marseille, France
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Martins RP, Leclercq C, Bourenane H, Auffret V, Boulé S, Loobuyck V, Dambrin C, Mondoly P, Sacher F, Bordachar P, Kindo M, Cardi T, Gaudard P, Rouvière P, Michel M, Gourraud JB, Defaye P, Chavanon O, Kerneis C, Ghodhbane W, Pelcé E, Gariboldi V, Pozzi M, Grinberg D, Litzler PY, Anselme F, Babatasi G, Belin A, Garnier F, Bielefeld M, Hamon D, Lellouche N, Pierre B, Bourguignon T, Eschallier R, D'Ostrevy N, Bories MC, Jouan J, Vanhuyse F, Sadoul N, Flécher E, Galand V. Incidence, predictors, and clinical impact of electrical storm in patients with left ventricular assist devices: New insights from the ASSIST-ICD study. Heart Rhythm 2019; 16:1506-1512. [PMID: 31255846 DOI: 10.1016/j.hrthm.2019.06.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 03/22/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Ventricular arrhythmias (VAs) can occur after continuous flow left ventricular assist device (LVAD) implantation as a single arrhythmic event or as electrical storm (ES) with multiple repetitive VA episodes. OBJECTIVE We aimed at analyzing the incidence, predictors, and clinical impact of ES in LVAD recipients. METHODS Patients analyzed were those included in the multicenter ASSIST-ICD observational study. ES was consensually defined as occurrence of ≥3 separate episodes of sustained VAs within a 24-hour interval. RESULTS Of 652 patients with an LVAD, 61 (9%) presented ES during a median follow-up period of 9.1 (interquartile range [IQR] 2.5-22.1) months. The first ES occurred after 17 (IQR 4.0-56.2) days post LVAD implantation, most of them during the first month after the device implantation (63%). The incidence then tended to decrease during the initial years of follow-up and increased again after the third year post LVAD implantation. History of VAs before LVAD implantation and heart failure duration > 84 months were independent predictors of ES. The occurrence of ES was associated with an increased early mortality since 20 patients (33%) died within the first 2 weeks of ES. Twenty-two patients (36.1%) presented at least 1 recurrence of ES, occurring 43.0 (IQR 8.0-69.0) days after the initial ES. Patients experiencing ES had a significantly lower 1-year survival rate than did those free from ES (log-rank, P = .039). CONCLUSION There is a significant incidence of ES in patients with an LVAD. The short-term mortality after ES is high, and one-third of patients will die within 15 days. Whether radiofrequency ablation of arrhythmias improves outcomes would require further studies.
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Affiliation(s)
| | | | - Hamed Bourenane
- Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France
| | - Vincent Auffret
- Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France
| | - Stéphane Boulé
- Department of Cardiology, CHU Lille, Institut Coeur-Poumons, Lille, France
| | - Valentin Loobuyck
- Department of Cardiology, CHU Lille, Institut Coeur-Poumons, Lille, France
| | | | - Pierre Mondoly
- Department of Cardiology, CHU de Toulouse, Toulouse, France
| | - Frédéric Sacher
- Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux, Bordeaux, France
| | - Pierre Bordachar
- Hôpital Cardiologique du Haut-Lévêque, 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 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
| | - Caroline Kerneis
- 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
| | - Daniel Grinberg
- 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, University of Caen and University Hospital of Caen, Caen, France
| | - Annette Belin
- Department of Cardiology, 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
| | - 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 Eschallier
- Department of Cardiology, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Nicolas D'Ostrevy
- Department of Cardiology, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Jérôme Jouan
- Department of Cardiology, European Georges Pompidou Hospital, Paris, France
| | - Fabrice Vanhuyse
- 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
- 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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30
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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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Ravis E, Theron A, Lecomte B, Gariboldi V. Pulmonary cyst embolism: a rare complication of hydatidosis. Eur J Cardiothorac Surg 2017; 53:286-287. [DOI: 10.1093/ejcts/ezx286] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 07/11/2017] [Indexed: 11/13/2022] Open
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Boufi M, Guivier-Curien C, Loundou A, Deplano V, Boiron O, Chaumoitre K, Gariboldi V, Alimi Y. Morphological Analysis of Healthy Aortic Arch. Eur J Vasc Endovasc Surg 2017; 53:663-670. [DOI: 10.1016/j.ejvs.2017.02.023] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 02/20/2017] [Indexed: 11/30/2022]
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Theron A, Ravis E, Grisoli D, Jaussaud N, Morera P, Candolfi P, Boleckova J, Lagier D, Amanatiou C, Messous L, Gariboldi V, Collart F. Rapid-deployment aortic valve replacement for severe aortic stenosis: 1-year outcomes in 150 patients†. Interact Cardiovasc Thorac Surg 2017; 25:68-74. [DOI: 10.1093/icvts/ivx050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 02/01/2017] [Indexed: 11/13/2022] Open
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Theron A, Pinto J, Grisoli D, Griffiths K, Salaun E, Jaussaud N, Ravis E, Lambert M, Messous L, Amanatiou C, Cuisset T, Gariboldi V, Giorgi R, Habib G, Collart F. Patient-prosthesis mismatch in new generation trans-catheter heart valves: a propensity score analysis. Eur Heart J Cardiovasc Imaging 2017; 19:225-233. [DOI: 10.1093/ehjci/jex019] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 01/24/2017] [Indexed: 11/14/2022] Open
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Gariboldi V, Vairo D, Guieu R, Marlingue M, Ravis E, Lagier D, Mari A, Thery E, Collart F, Gaudry M, Bonello L, Paganelli F, Condo J, Kipson N, Fenouillet E, Ruf J, Mottola G. Expressions of adenosine A 2A receptors in coronary arteries and peripheral blood mononuclear cells are correlated in coronary artery disease patients. Int J Cardiol 2016; 230:427-431. [PMID: 28041708 DOI: 10.1016/j.ijcard.2016.12.089] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [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: 07/11/2016] [Revised: 11/15/2016] [Accepted: 12/16/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Altered coronary blood flow occurs in patients with coronary artery disease (CAD). Adenosine strongly impacts blood flow mostly via adenosine A2A receptor (A2AR) expressed in coronary tissues. As part of a systemic regulation of the adenosinergic system, we compared A2AR expression in situ, and on peripheral blood mononuclear cells (PBMC) in CAD patients. METHODS AND RESULTS Aortic and coronary tissues, and PBMC were sampled in 20 CAD patients undergoing coronary artery bypass surgery and consecutively included. Controls were PBMC obtained from 15 healthy subjects. Expression and activity of A2AR were studied by Western blotting and cAMP measurement, respectively. A2AR expression on PBMC was lower in patients than in controls (0.83±0.31 vs 1.2±0.35 arbitrary units; p<0.01), and correlated with A2AR expression in coronary and aortic tissues (Pearson's r: 0.77 and 0.59, p<0.01, respectively). Basal and maximal cAMP productions following agonist stimulation of PBMC were significantly lower in patients than in controls (120±42 vs 191±65 and 360±113 vs 560±215pg/106 cells, p<0.05, respectively). In CAD patients, the increase from basal to maximal cAMP production in PBMC and aortic tissues was similar (+300% and +246%, respectively). CONCLUSION Expression of A2AR on PBMC correlated with those measured in coronary artery and aortic tissues in CAD patients, A2AR activity of PBMC matched that observed in aorta, and A2AR expression and activity in PBMC were found reduced as compared to controls. Measuring the expression level of A2AR on PBMC represents a good tool to address in situ expression in coronary tissues of CAD patients.
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Affiliation(s)
- Vlad Gariboldi
- Department of Cardiac Surgery, Timone University Hospital, Marseille, France
| | - Donato Vairo
- UMR MD2, Aix-Marseille University and IRBA, Marseille, France
| | - Régis Guieu
- UMR MD2, Aix-Marseille University and IRBA, Marseille, France; Laboratory of Biochemistry, Timone University Hospital, Marseille, France.
| | - Marion Marlingue
- Laboratory of Biochemistry, Timone University Hospital, Marseille, France
| | - Eléonore Ravis
- Department of Cardiology, Timone University Hospital, Marseille, France
| | - David Lagier
- Department of Anesthesia, Timone University Hospital, Marseille, France
| | - Alissa Mari
- UMR MD2, Aix-Marseille University and IRBA, Marseille, France
| | - Elsa Thery
- Laboratory of Biochemistry, Timone University Hospital, Marseille, France
| | - Frédéric Collart
- Department of Cardiac Surgery, Timone University Hospital, Marseille, France
| | - Marine Gaudry
- Department of Vascular Surgery, Timone University Hospital, Marseille, France
| | - Laurent Bonello
- Department of Cardiology, North University Hospital, Marseille, France
| | - Franck Paganelli
- Department of Cardiology, North University Hospital, Marseille, France
| | - Jocelyne Condo
- UMR MD2, Aix-Marseille University and IRBA, Marseille, France
| | - Nathalie Kipson
- UMR MD2, Aix-Marseille University and IRBA, Marseille, France
| | | | - Jean Ruf
- UMR MD2, Aix-Marseille University and IRBA, Marseille, France
| | - Giovanna Mottola
- UMR MD2, Aix-Marseille University and IRBA, Marseille, France; Laboratory of Biochemistry, Timone University Hospital, Marseille, France
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Ruf J, Paganelli F, Bonello L, Kipson N, Mottola G, Fromonot J, Condo J, Boussuges A, Bruzzese L, Kerbaul F, Jammes Y, Gariboldi V, Franceschi F, Fenouillet E, Guieu R. Spare Adenosine A2a Receptors Are Associated With Positive Exercise Stress Test In Coronary Artery Disease. Mol Med 2016; 22:530-536. [PMID: 27463334 DOI: 10.2119/molmed.2016.00052] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 02/24/2016] [Accepted: 06/15/2016] [Indexed: 01/15/2023] Open
Abstract
During exercise, cardiac oxygen-consumption increases and the resulting low oxygen level in myocardium triggers coronary vasodilation. This response to hypoxia is controlled notably by the vasodilator adenosine and its A2A receptor (A2AR). According to the "spare receptor" pharmacological model, a strong A2AR-mediated response can occur in the context of a large number of receptors remaining unoccupied, activation of only a weak fraction of A2AR (evaluated using KD) resulting in maximal cAMP production (evaluated using EC50), and hence in maximal coronary vasodilation. In coronary artery disease (CAD), myocardial ischemia limits adaptation to exercise, which is commonly detected using the exercise stress test (EST). We hypothesized that spare A2AR are present in CAD patients to correct ischemia. Seventeen patients with angiographically-documented CAD and 17 control subjects were studied. We addressed adenosine-plasma concentration and A2AR-expression at the mononuclear cell-surface, which reflects cardiovascular expression. The presence of spare A2AR was tested using an innovative pharmacological approach based on a homemade monoclonal antibody with agonist properties. EST was positive in 82% of patients, and in none of the controls. Adenosine plasma-concentration increased by 60% at peak exercise in patients only (p<0.01). Most patients (65%), and none of the controls, had spare A2AR (identified when EC50/KD≤0.1) and a low A2AR-expression (mean: -37% vs controls; p<0.01). All patients with spare A2AR had a positive EST whereas the subjects without spare A2AR had a negative EST (p<0.05). Spare A2AR are therefore associated with positive EST in CAD patients and their detection may be used as a diagnostic marker.
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Affiliation(s)
- Jean Ruf
- UMR MD2, Aix-Marseille University and Institute of Biological Research of the French Army, Marseille.,INSERM, Marseille, France
| | | | | | - Nathalie Kipson
- UMR MD2, Aix-Marseille University and Institute of Biological Research of the French Army, Marseille, France
| | - Giovanna Mottola
- UMR MD2, Aix-Marseille University and Institute of Biological Research of the French Army, Marseille, France
| | - Julien Fromonot
- UMR MD2, Aix-Marseille University and Institute of Biological Research of the French Army, Marseille, France.,Laboratory of Biochemistry, Timone Hospital, Marseille, France
| | - Jocelyne Condo
- UMR MD2, Aix-Marseille University and Institute of Biological Research of the French Army, Marseille, France
| | - Alain Boussuges
- UMR MD2, Aix-Marseille University and Institute of Biological Research of the French Army, Marseille, France
| | - Laurie Bruzzese
- UMR MD2, Aix-Marseille University and Institute of Biological Research of the French Army, Marseille, France
| | - Françis Kerbaul
- Department of Intensive Care, Timone Hospital, Marseille, France
| | - Yves Jammes
- UMR MD2, Aix-Marseille University and Institute of Biological Research of the French Army, Marseille, France
| | - Vlad Gariboldi
- Department of Cardiac Surgery, Timone Hospital, Marseille, France
| | - Frédéric Franceschi
- UMR MD2, Aix-Marseille University and Institute of Biological Research of the French Army, Marseille, France
| | - Emmanuel Fenouillet
- UMR MD2, Aix-Marseille University and Institute of Biological Research of the French Army, Marseille, France.,Institut des Sciences Biologiques, CNRS, Marseille, France
| | - Régis Guieu
- UMR MD2, Aix-Marseille University and Institute of Biological Research of the French Army, Marseille, France.,Department of Cardiology, Nord Hospital, Marseille, France
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Theron A, Gariboldi V, Grisoli D, Jaussaud N, Morera P, Lagier D, Leroux S, Amanatiou C, Guidon C, Riberi A, Collart F. Rapid Deployment of Aortic Bioprosthesis in Elderly Patients With Small Aortic Annulus. Ann Thorac Surg 2016; 101:1434-41. [DOI: 10.1016/j.athoracsur.2015.09.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 08/31/2015] [Accepted: 09/08/2015] [Indexed: 11/16/2022]
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Kerbaul F, Bénard F, Giorgi R, Youlet B, Carrega L, Zouher I, Mercier L, Gérolami V, Bénas V, Blayac D, Gariboldi V, Collart F, Guieu R. Adenosine A2A Receptor Hyperexpression in Patients With Severe SIRS After Cardiopulmonary Bypass. J Investig Med 2016; 56:864-71. [DOI: 10.2310/jim.0b013e3181788d02] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
ObjectiveAdenosine (ADO) is an endogenous nucleoside, which has been involved in blood pressure failure during severe systemic inflammatory response syndrome (severe SIRS) after cardiac surgery with cardiopulmonary bypass (CPB). Adenosine acts via its receptor subtypes, namely A1, A2A, A2B, or A3. Because A2A receptors are implicated in vascular tone, their expression might contribute to severe SIRS. We compared adenosine plasma levels (APLs) and A2A ADO receptor expression (ie, B, K, and mRNA amount) in patients with or without postoperative SIRS.PatientsThis was a prospective comparative observational study. Forty-four patients who underwent cardiac surgery involving CPB. Ten healthy subjects served as controls.Measurements and ResultsAmong the patients, 11 presented operative vasoplegia and postoperative SIRS (named complicated patients) and 33 were without vasoplegia or SIRS (named uncomplicated patients). Adenosine plasma levels, K, B, and mRNA amount (mean ± SD) were measured on peripheral blood mononuclear cells. Adenosine plasma levels, B, and K were significantly higher in complicated patients than in uncomplicated patients (APLs: 2.7 ± 1.0 vs 1.0 ± 0.5 μmol l−1, P < 0.05; B: 210 ± 43 vs 65 ± 26 fmol/mg, P < 0.05; K: 35 ± 10 vs 2 ± 1 nM, P < 0.05). In uncomplicated patients, APLs remain higher than in controls (1 ± 0.5 vs 0.6 ± 0.25 μmol/L; P < 0.05).Mean arterial pressure was inversely correlated to APLs (R = −0.58; P < 0.001) and B (R = −0.64; P < 0.001) leading to an increased requirement of vasoactive drugs during the postoperative period in vasoplegic patients.ConclusionsHigh expression of A2A ADO receptor and high APLs may be a predictive factor of postoperative severe SIRS after CPB.
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Gaborit B, Venteclef N, Ancel P, Pelloux V, Gariboldi V, Leprince P, Amour J, Hatem SN, Jouve E, Dutour A, Clément K. Human epicardial adipose tissue has a specific transcriptomic signature depending on its anatomical peri-atrial, peri-ventricular, or peri-coronary location. Cardiovasc Res 2015; 108:62-73. [PMID: 26239655 DOI: 10.1093/cvr/cvv208] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [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: 01/06/2015] [Accepted: 07/23/2015] [Indexed: 11/14/2022] Open
Abstract
AIMS Human epicardial adipose tissue (EAT) is a visceral and perivascular fat that has been shown to act locally on myocardium, atria, and coronary arteries. Its abundance has been linked to coronary artery disease (CAD) and atrial fibrillation. However, its physiological function remains highly debated. The aim of this study was to determine a specific EAT transcriptomic signature, depending on its anatomical peri-atrial (PA), peri-ventricular (PV), or peri-coronary location. METHODS AND RESULTS Samples of EAT and thoracic subcutaneous fat, obtained from 41 patients paired for cardiovascular risk factors, CAD, and atrial fibrillation were analysed using a pangenomic approach. We found 2728 significantly up-regulated genes in the EAT vs. subcutaneous fat with 400 genes being common between PA, PV, and peri-coronary EAT. These common genes were related to extracellular matrix remodelling, inflammation, infection, and thrombosis pathways. Omentin (ITLN1) was the most up-regulated gene and secreted adipokine in EAT (fold-change >12, P < 0.0001). Among EAT-enriched genes, we observed different patterns depending on adipose tissue location. A beige expression phenotype was found in EAT but PV EAT highly expressed uncoupled protein 1 (P = 0.01). Genes overexpressed in peri-coronary EAT were implicated in proliferation, O-N glycan biosynthesis, and sphingolipid metabolism. PA EAT displayed an atypical pattern with genes implicated in cardiac muscle contraction and intracellular calcium signalling pathway. CONCLUSION This study opens new perspectives in understanding the physiology of human EAT and its local interaction with neighbouring structures.
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Affiliation(s)
- Bénédicte Gaborit
- Institute of Cardiometabolism and Nutrition, ICAN, Heart and Nutrition Department, Assistance-Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris F-75013, France Sorbonne Universities, University Pierre et Marie Curie-Paris 6, UMRS 1166, Paris F-75006, France INSERM, Nutriomics (team6 and Team3), UMR_S U1166, Paris F-75013, France Aix-Marseille Université, Faculté de Médecine, Department 'Nutrition, Obésité et Risque Thrombotique', INSERM, UMR 1062, INRA 1260, 13385 Marseille, France
| | - Nicolas Venteclef
- Institute of Cardiometabolism and Nutrition, ICAN, Heart and Nutrition Department, Assistance-Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris F-75013, France Sorbonne Universities, University Pierre et Marie Curie-Paris 6, UMRS 1166, Paris F-75006, France INSERM, UMRS_S1138, Paris F-75006, France
| | - Patricia Ancel
- Institute of Cardiometabolism and Nutrition, ICAN, Heart and Nutrition Department, Assistance-Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris F-75013, France Sorbonne Universities, University Pierre et Marie Curie-Paris 6, UMRS 1166, Paris F-75006, France INSERM, Nutriomics (team6 and Team3), UMR_S U1166, Paris F-75013, France Aix-Marseille Université, Faculté de Médecine, Department 'Nutrition, Obésité et Risque Thrombotique', INSERM, UMR 1062, INRA 1260, 13385 Marseille, France
| | - Véronique Pelloux
- Institute of Cardiometabolism and Nutrition, ICAN, Heart and Nutrition Department, Assistance-Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris F-75013, France Sorbonne Universities, University Pierre et Marie Curie-Paris 6, UMRS 1166, Paris F-75006, France INSERM, Nutriomics (team6 and Team3), UMR_S U1166, Paris F-75013, France
| | - Vlad Gariboldi
- Assistance-Publique Hôpitaux de Marseille, Cardiac Surgery, La Timone Hospital,13005 Marseille, France
| | - Pascal Leprince
- Institute of Cardiometabolism and Nutrition, ICAN, Heart and Nutrition Department, Assistance-Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris F-75013, France Sorbonne Universities, University Pierre et Marie Curie-Paris 6, UMRS 1166, Paris F-75006, France Assistance-Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Heart Department, 73013 Paris, France
| | - Julien Amour
- Institute of Cardiometabolism and Nutrition, ICAN, Heart and Nutrition Department, Assistance-Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris F-75013, France Sorbonne Universities, University Pierre et Marie Curie-Paris 6, UMRS 1166, Paris F-75006, France Assistance-Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Heart Department, 73013 Paris, France
| | - Stéphane N Hatem
- Institute of Cardiometabolism and Nutrition, ICAN, Heart and Nutrition Department, Assistance-Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris F-75013, France Sorbonne Universities, University Pierre et Marie Curie-Paris 6, UMRS 1166, Paris F-75006, France INSERM, Nutriomics (team6 and Team3), UMR_S U1166, Paris F-75013, France Assistance-Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Heart Department, 73013 Paris, France
| | - Elisabeth Jouve
- Assistance-Publique Hôpitaux de Marseille, Medical Evaluation Department, CIC-CPCET, 13005 Marseille, France
| | - Anne Dutour
- Aix-Marseille Université, Faculté de Médecine, Department 'Nutrition, Obésité et Risque Thrombotique', INSERM, UMR 1062, INRA 1260, 13385 Marseille, France
| | - Karine Clément
- Institute of Cardiometabolism and Nutrition, ICAN, Heart and Nutrition Department, Assistance-Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris F-75013, France Sorbonne Universities, University Pierre et Marie Curie-Paris 6, UMRS 1166, Paris F-75006, France INSERM, Nutriomics (team6 and Team3), UMR_S U1166, Paris F-75013, France
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Theron A, Gariboldi V, Grisoli D, Morera P, Jaussaud N, Leroux S, Cecile A, Riberi A, Collart F. 0316: Assessment of left ventricular mass regression after implantation of a new generation of sutureless aortic bioprosthesis. Archives of Cardiovascular Diseases Supplements 2015. [DOI: 10.1016/s1878-6480(15)71592-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Theron A, Jacquier A, Ravis E, Ronchard T, Gaubert JY, Grisoli D, Gariboldi V, Collart F. Role of three-dimensional transesophageal echocardiography in diagnosis of coronary anomalies. Echocardiography 2014; 31:E317-8. [PMID: 25251738 DOI: 10.1111/echo.12751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Alexis Theron
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
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Obadia B, Théron A, Gariboldi V, Collart F. Extracorporeal membrane oxygenation as a bridge to surgery for ischemic papillary muscle rupture. J Thorac Cardiovasc Surg 2014; 147:e82-4. [DOI: 10.1016/j.jtcvs.2014.03.003] [Citation(s) in RCA: 8] [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] [Received: 12/09/2013] [Revised: 02/01/2014] [Accepted: 03/03/2014] [Indexed: 10/25/2022]
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Guervilly C, Hraiech S, Gariboldi V, Xeridat F, Dizier S, Toesca R, Forel JM, Adda M, Grisoli D, Collart F, Roch A, Papazian L. Prone positioning during veno-venous extracorporeal membrane oxygenation for severe acute respiratory distress syndrome in adults. Minerva Anestesiol 2014; 80:307-313. [PMID: 24257150] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is an effective rescue therapy for improving oxygenation in selected severe acute respiratory distress syndrome (ARDS). Prone position (PP) is usually considered before vvECMO and few data are available on the association of PP during VV-ECMO. Thus, we investigated the effect on oxygenation and the safety of PP during vvECMO. METHODS During a two-year period, 15 patients with severe ARDS were turned into PP during VV-ECMO therapy for at least one of the three following conditions: severe hypoxemia (PaO2/FiO2 ratio below 70) despite maximal oxygenation, injurious ventilation parameters with plateau pressure exceeding 32 cmH2O or failure of attempt to wean ECMO after at least 10 days on ECMO support. RESULTS PP was considered after a median of 9 days of ECMO and applied for a median of 12 hours and an average of 1.4 sessions per patient resulting in a total of 21 procedures. We found significant improvement in PaO2/FiO2 ratio at 6 hours (P=0.03) and 12 hours (P=0.007) after reversal. The improvement in oxygenation has still persisted 1hour (P=0.017) and 6 hours (P=0.013) after back to the supine position. No change in PaCO2, respiratory system (RS) compliance was observed. ECMO flow was maintained constant during the procedure. No complication related to PP was detected. CONCLUSION PP may be considered in selected patients difficult to wean or remaining very hypoxemic despite VV-ECMO support.
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Affiliation(s)
- C Guervilly
- Medical Intensive Care Unit, Respiratory Distress and Severe Infections, North Hospital, URMITE CNRS-UMR 6236, Aix-Marseille University, Assistance Publique HÔpitaux de Marseille, Marseille, France -
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Gariboldi V, Grisoli D, Devin A, Nee L, Theron A, Hubert S, Jaussaud N, Morera P, Collart F. Reoperation for failure of freestyle bioprosthesis using an Edwards intuity valve. Ann Thorac Surg 2013; 96:e47-8. [PMID: 23910145 DOI: 10.1016/j.athoracsur.2013.01.061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Revised: 01/10/2013] [Accepted: 01/15/2013] [Indexed: 11/19/2022]
Abstract
We report the first case of a successful implantation of the new Edwards Intuity rapid-deployment bioprosthesis in a 50-year-old man with acute failure of a Freestyle Medtronic root with severe aortic regurgitation and massive calcification of the root and both coronary buttons.
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Affiliation(s)
- Vlad Gariboldi
- Service de Chirurgie Cardiaque, Hôpital de la Timone Adultes, Marseille, France.
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Joulia F, Coulange M, Lemaitre F, Costalat G, Franceschi F, Gariboldi V, Nee L, Fromonot J, Bruzzese L, Gravier G, Kipson N, Jammes Y, Boussuges A, Brignole M, Deharo JC, Guieu R. Plasma adenosine release is associated with bradycardia and transient loss of consciousness during experimental breath-hold diving. Int J Cardiol 2013; 168:e138-41. [DOI: 10.1016/j.ijcard.2013.08.053] [Citation(s) in RCA: 16] [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] [Received: 05/05/2013] [Revised: 08/09/2013] [Accepted: 08/18/2013] [Indexed: 11/28/2022]
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Piccardo A, Le Guyader A, Regesta T, Gariboldi V, Zannis K, Tapia M, Collart F, Kirsch M, Caus T, Cornu E, Laskar M. Octogenarians with uncomplicated acute type a aortic dissection benefit from emergency operation. Ann Thorac Surg 2013; 96:851-6. [PMID: 23916804 DOI: 10.1016/j.athoracsur.2013.04.066] [Citation(s) in RCA: 33] [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: 09/10/2012] [Revised: 04/06/2013] [Accepted: 04/22/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND The management of acute type A aortic dissection (aTAAD) in octogenarian patients is controversial. This study analyzed the surgical outcomes to identify patients who should undergo operations. METHODS Beginning in January 2000, we established a registry including all octogenarian patients operated on for type A acute aortic dissection. We evaluated 79 consecutive patients enrolled up to December 2010. Their median age was 81.6 years (range, 80 to 89 years). Sixteen patients (20%) presented a complicated type because of a neurologic deficit, mesenteric ischemia, a requirement for cardiopulmonary resuscitation, or some combination of those features. Operations followed the standard procedure recommended for younger patients. Follow-up was 95% complete (mean, 4.6±2.8 years). RESULTS The overall in-hospital mortality was 44.3%. The in-hospital mortality among patients with uncomplicated aTAAD was 33.3%. Multivariate analysis identified complicated aTAAD as the only risk factors for in-hospital mortality (p<0.0001). Postoperative complications occurred in 50 patients (68.5%) and were associated with a higher mortality (p<0.0001). The overall survival was 53% at 1 year and 32% at 5 years. In uncomplicated aTAAD, the overall survival was 63% at 1 year and 38% at 5 years. CONCLUSIONS Octogenarians with uncomplicated aTAAD benefit from emergency surgical repair. In those patients, early and midterm outcomes are good and are similar to those in published series of younger patients. Complicated aTAAD should be medically managed.
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Théron A, Gariboldi V, Grisoli D, Maysou LA, Jaussaud N, Morera P, Cuisset T, Quilici J, Thuny F, Riberi A, Avierinos JF, Collart F. Three-Dimensional Transesophageal Echocardiography Assessment of a Successful Transcatheter Mitral Valve in Valve Implantation for Degenerated Bioprosthesis. Echocardiography 2013; 30:E152-5. [DOI: 10.1111/echo.12177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Alexis Théron
- Department of Cardiac Surgery; La Timone Hospital; Marseille; France
| | - Vlad Gariboldi
- Department of Cardiac Surgery; La Timone Hospital; Marseille; France
| | - Dominique Grisoli
- Department of Cardiac Surgery; La Timone Hospital; Marseille; France
| | | | - Nicolas Jaussaud
- Department of Cardiac Surgery; La Timone Hospital; Marseille; France
| | - Pierre Morera
- Department of Cardiac Surgery; La Timone Hospital; Marseille; France
| | - Thomas Cuisset
- Department of Cardiology; La Timone Hospital; Marseille; France
| | - Jacques Quilici
- Department of Cardiology; La Timone Hospital; Marseille; France
| | - Franck Thuny
- Department of Cardiology; La Timone Hospital; Marseille; France
| | - Alberto Riberi
- Department of Cardiac Surgery; La Timone Hospital; Marseille; France
| | | | - Frederic Collart
- Department of Cardiac Surgery; La Timone Hospital; Marseille; France
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Nee L, Franceschi F, Resseguier N, Gravier G, Giorgi R, Gariboldi V, Collart F, Michelet P, Deharo JC, Guieu R, Kerbaul F. High endogenous adenosine plasma concentration is associated with atrial fibrillation during cardiac surgery with cardiopulmonary bypass. Int J Cardiol 2012; 165:201-4. [PMID: 23026311 DOI: 10.1016/j.ijcard.2012.08.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Accepted: 08/22/2012] [Indexed: 11/25/2022]
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Theron A, Tavano A, Gariboldi V. A rare case of aortic stenosis in adulthood. Arch Cardiovasc Dis 2012; 105:187-9. [PMID: 22520803 DOI: 10.1016/j.acvd.2011.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 06/24/2011] [Accepted: 06/27/2011] [Indexed: 11/16/2022]
Affiliation(s)
- Alexis Theron
- Service de chirurgie cardiaque adulte, hôpital La Timone, Marseille cedex, France.
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50
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Grisoli D, Gariboldi V, Quilici J. An unusual complication after coronary catheterization. J Invasive Cardiol 2012; 24:E22-E23. [PMID: 22294541] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Valvular complications after coronary catheterization are extremely rare and are seldom reported in the literature. We report a patient who experienced acute traumatic aortic regurgitation after repeated coronary transcatheter procedures. Despite clinical stabilization under medical treatment, his clinical course led to an aortic-valve replacement.
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Affiliation(s)
- Dominique Grisoli
- Department of Cardiac Surgery, Hôpital de la Timone, Université de la Méditerranée, Marseilles, France.
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