1
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Araki M, Park SJ, Dauerman HL, Uemura S, Kim JS, Di Mario C, Johnson TW, Guagliumi G, Kastrati A, Joner M, Holm NR, Alfonso F, Wijns W, Adriaenssens T, Nef H, Rioufol G, Amabile N, Souteyrand G, Meneveau N, Gerbaud E, Opolski MP, Gonzalo N, Tearney GJ, Bouma B, Aguirre AD, Mintz GS, Stone GW, Bourantas CV, Räber L, Gili S, Mizuno K, Kimura S, Shinke T, Hong MK, Jang Y, Cho JM, Yan BP, Porto I, Niccoli G, Montone RA, Thondapu V, Papafaklis MI, Michalis LK, Reynolds H, Saw J, Libby P, Weisz G, Iannaccone M, Gori T, Toutouzas K, Yonetsu T, Minami Y, Takano M, Raffel OC, Kurihara O, Soeda T, Sugiyama T, Kim HO, Lee T, Higuma T, Nakajima A, Yamamoto E, Bryniarski KL, Di Vito L, Vergallo R, Fracassi F, Russo M, Seegers LM, McNulty I, Park S, Feldman M, Escaned J, Prati F, Arbustini E, Pinto FJ, Waksman R, Garcia-Garcia HM, Maehara A, Ali Z, Finn AV, Virmani R, Kini AS, Daemen J, Kume T, Hibi K, Tanaka A, Akasaka T, Kubo T, Yasuda S, Croce K, Granada JF, Lerman A, Prasad A, Regar E, Saito Y, Sankardas MA, Subban V, Weissman NJ, Chen Y, Yu B, Nicholls SJ, Barlis P, West NEJ, Arbab-Zadeh A, Ye JC, Dijkstra J, Lee H, Narula J, Crea F, Nakamura S, Kakuta T, Fujimoto J, Fuster V, Jang IK. Author Correction: Optical coherence tomography in coronary atherosclerosis assessment and intervention. Nat Rev Cardiol 2024; 21:348. [PMID: 38110566 DOI: 10.1038/s41569-023-00982-z] [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] [Indexed: 12/20/2023]
Affiliation(s)
| | | | | | | | - Jung-Sun Kim
- Yonsei University College of Medicine, Seoul, South Korea
| | | | - Thomas W Johnson
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Adnan Kastrati
- Technische Universität München and Munich Heart Alliance, Munich, Germany
| | | | | | | | - William Wijns
- National University of Ireland Galway and Saolta University Healthcare Group, Galway, Ireland
| | | | | | - Gilles Rioufol
- Hospices Civils de Lyon and Claude Bernard University, Lyon, France
| | | | | | | | | | | | - Nieves Gonzalo
- Hospital Clinico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | | | - Brett Bouma
- Massachusetts General Hospital, Boston, MA, USA
| | | | - Gary S Mintz
- Cardiovascular Research Foundation, New York, NY, USA
| | - Gregg W Stone
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christos V Bourantas
- Barts Health NHS Trust, University College London and Queen Mary University London, London, UK
| | - Lorenz Räber
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | | | | | - Myeong-Ki Hong
- Yonsei University College of Medicine, Seoul, South Korea
| | - Yangsoo Jang
- Yonsei University College of Medicine, Seoul, South Korea
| | | | - Bryan P Yan
- Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Italo Porto
- University of Genoa, Genoa, Italy, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | | | - Rocco A Montone
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | | | - Harmony Reynolds
- New York University Grossman School of Medicine, New York, NY, USA
| | - Jacqueline Saw
- Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Libby
- Brigham and Women's Hospital, Boston, MA, USA
| | - Giora Weisz
- New York Presbyterian Hospital, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY, USA
| | | | - Tommaso Gori
- Universitäts medizin Mainz and DZHK Rhein-Main, Mainz, Germany
| | | | | | | | | | | | - Osamu Kurihara
- Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | | | | | | | - Tetsumin Lee
- Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Takumi Higuma
- Kawasaki Municipal Tama Hospital, St. Marianna University School of Medicine, Kanagawa, Japan
| | | | - Erika Yamamoto
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Krzysztof L Bryniarski
- Jagiellonian University Medical College, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, Krakow, Poland
| | | | | | | | - Michele Russo
- Catholic University of the Sacred Heart, Rome, Italy
| | | | | | - Sangjoon Park
- Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Marc Feldman
- University of Texas Health, San Antonio, TX, USA
| | | | - Francesco Prati
- UniCamillus - Saint Camillus International University of Health Sciences, Rome, Italy
| | - Eloisa Arbustini
- IRCCS Foundation University Hospital Policlinico San Matteo, Pavia, Italy
| | - Fausto J Pinto
- Santa Maria University Hospital, CHULN Center of Cardiology of the University of Lisbon, Lisbon School of Medicine, Lisbon Academic Medical Center, Lisbon, Portugal
| | - Ron Waksman
- MedStar Washington Hospital Center, Washington, DC, USA
| | | | - Akiko Maehara
- Cardiovascular Research Foundation, New York, NY, USA
| | - Ziad Ali
- Cardiovascular Research Foundation, New York, NY, USA
| | | | | | | | - Joost Daemen
- Erasmus University Medical Centre, Rotterdam, Netherlands
| | | | - Kiyoshi Hibi
- Yokohama City University Medical Center, Kanagawa, Japan
| | | | | | | | - Satoshi Yasuda
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kevin Croce
- Brigham and Women's Hospital, Boston, MA, USA
| | | | | | | | | | | | | | | | | | - Yundai Chen
- Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Bo Yu
- The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | | | - Peter Barlis
- University of Melbourne, Melbourne, Victoria, Australia
| | | | | | - Jong Chul Ye
- Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | | | - Hang Lee
- Massachusetts General Hospital, Boston, MA, USA
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Filippo Crea
- Catholic University of the Sacred Heart, Rome, Italy
| | | | | | - James Fujimoto
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Ik-Kyung Jang
- Massachusetts General Hospital, Boston, MA, USA.
- Kyung Hee University, Seoul, South Korea.
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2
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Balmette V, Mignot N, Amara R, Amabile N. Buddy Wires Strategy for Sheath-Uncrossable Interatrial Septum Management During Left Atrial Appendage Closure. Can J Cardiol 2024; 40:732-733. [PMID: 38122930 DOI: 10.1016/j.cjca.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/28/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Affiliation(s)
- Vincent Balmette
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Nicolas Mignot
- Department of Electrophysiology, Rythmopôle, Paris, France
| | - Rania Amara
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Nicolas Amabile
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France; Institut Cardiovasculaire Paris Sud, Massy, France.
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Mehier B, Mahmoudi K, Veugeois A, Masri A, Amabile N, Giudice CD, Paul JF. Diagnostic performance of deep learning to exclude coronary stenosis on CT angiography in TAVI patients. Int J Cardiovasc Imaging 2024:10.1007/s10554-024-03063-5. [PMID: 38461472 DOI: 10.1007/s10554-024-03063-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 02/03/2024] [Indexed: 03/12/2024]
Abstract
We evaluated the diagnostic performance of a deep-learning model (DLM) (CorEx®, Spimed-AI, Paris, France) designed to automatically detect > 50% coronary stenosis on coronary computed tomography angiography (CCTA) images. We studied inter-observer variability as an additional aim. CCTA images obtained before transcatheter aortic valve implantation (TAVI) were assessed by two radiologists and the DLM, and the results were compared to those of invasive coronary angiography (ICA) used as the reference standard. 165 consecutive patients underwent both CCTA and ICA as part of their TAVI work-up. We excluded the 42 (25.5%) patients with a history of stenting or bypass grafting and the 23 (13.9%) patients with low-quality images. We retrospectively subjected the CCTA images from the remaining 100 patients to evaluation by the DLM and compared the DLM and ICA results. All 25 patients with > 50% stenosis by ICA also had > 50% stenosis by DLM evaluation of CCTA: thus, the DLM had 100% sensitivity and 100% negative predictive value. False-positive DLM results were common, yielding a positive predictive value of only 39% (95% CI, 27-51%). Two radiologists with 3 and 25 years' experience, respectively, performed similarly to the DLM in evaluating the CCTA images; thus, accuracy did not differ significantly between each reader and the DLM (p = 0.625 and p = 0.375, respectively). The DLM had 100% negative predictive value for > 50% stenosis and performed similarly to experienced radiologists. This tool may hold promise for identifying the up to one-third of patients who do not require ICA before TAVI.
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Affiliation(s)
- Benjamin Mehier
- Department of Radiology, Cardiac Imaging, Institut Mutualiste Montsouris, 75014, Paris, France.
| | - Khalil Mahmoudi
- Interventional Cardiology Department, Institut Mutualiste Montsouris, 75014, Paris, France
| | - Aurélie Veugeois
- Interventional Cardiology Department, Institut Mutualiste Montsouris, 75014, Paris, France
| | - Alaa Masri
- Interventional Cardiology Department, Institut Mutualiste Montsouris, 75014, Paris, France
| | - Nicolas Amabile
- Interventional Cardiology Department, Institut Mutualiste Montsouris, 75014, Paris, France
| | - Costantino Del Giudice
- Radiology and Interventional Radiology Department, Cardiac Imaging, Institut Mutualiste Montsouris, 75014, Paris, France
| | - Jean-François Paul
- Department of Radiology, Cardiac Imaging, Institut Mutualiste Montsouris, Spimed-AI, 75014, Paris, France
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4
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Ohashi H, Mizukami T, Sonck J, Boussiet F, Ko B, Nørgaard BL, Mæng M, Jensen JM, Sakai K, Ando H, Amano T, Amabile N, Ali Z, De Bruyne B, Koo B, Otake H, Collet C. Intravascular Imaging Findings After PCI in Patients With Focal and Diffuse Coronary Artery Disease. J Am Heart Assoc 2024; 13:e032605. [PMID: 38390822 PMCID: PMC10944036 DOI: 10.1161/jaha.123.032605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 01/17/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Following percutaneous coronary intervention (PCI), optical coherence tomography provides prognosis information. The pullback pressure gradient is a novel index that discriminates focal from diffuse coronary artery disease based on fractional flow reserve pullbacks. We sought to investigate the association between coronary artery disease patterns, defined by coronary physiology, and optical coherence tomography after stent implantation in stable patients undergoing PCI. METHODS AND RESULTS This multicenter, prospective, single-arm study was conducted in 5 countries (NCT03782688). Subjects underwent motorized fractional flow reserve pullbacks evaluation followed by optical coherence tomography-guided PCI. Post-PCI optical coherence tomography minimum stent area, stent expansion, and the presence of suboptimal findings such as incomplete stent apposition, stent edge dissection, and irregular tissue protrusion were compared between patients with focal versus diffuse disease. Overall, 102 patients (105 vessels) were included. Fractional flow reserve before PCI was 0.65±0.14, pullback pressure gradient was 0.66±0.14, and post-PCI fractional flow reserve was 0.88±0.06. The mean minimum stent area was 5.69±1.99 mm2 and was significantly larger in vessels with focal disease (6.18±2.12 mm2 versus 5.19±1.72 mm2, P=0.01). After PCI, incomplete stent apposition, stent edge dissection, and irregular tissue protrusion were observed in 27.6%, 10.5%, and 51.4% of the cases, respectively. Vessels with focal disease at baseline had a lower prevalence of incomplete stent apposition (11.3% versus 44.2%, P=0.002) and more irregular tissue protrusion (69.8% versus 32.7%, P<0.001). CONCLUSIONS Baseline coronary pathophysiological patterns are associated with suboptimal imaging findings after PCI. Patients with focal disease had larger minimum stent area and a higher incidence of tissue protrusion, whereas stent malapposition was more frequent in patients with diffuse disease.
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Affiliation(s)
- Hirofumi Ohashi
- Cardiovascular Center AalstOLV ClinicAalstBelgium
- Department of CardiologyAichi Medical UniversityAichiJapan
| | - Takuya Mizukami
- Cardiovascular Center AalstOLV ClinicAalstBelgium
- Division of Clinical Pharmacology, Department of PharmacologyShowa UniversityTokyoJapan
- Department of Cardiovascular MedicineGifu Heart CenterGifuJapan
| | - Jeroen Sonck
- Cardiovascular Center AalstOLV ClinicAalstBelgium
| | - Frederic Boussiet
- Cardiovascular Center AalstOLV ClinicAalstBelgium
- Department of CardiologyToulouse University HospitalToulouseFrance
| | - Brian Ko
- Monash Cardiovascular Research CentreMonash University and Monash Heart, Monash HealthClaytonVictoriaAustralia
| | | | - Michael Mæng
- Department of CardiologyAarhus University HospitalAarhusDenmark
| | | | - Koshiro Sakai
- Cardiovascular Center AalstOLV ClinicAalstBelgium
- Department of Medicine, Division of CardiologyShowa University School of MedicineTokyoJapan
| | - Hirohiko Ando
- Department of CardiologyAichi Medical UniversityAichiJapan
| | - Tetsuya Amano
- Department of CardiologyAichi Medical UniversityAichiJapan
| | - Nicolas Amabile
- Department of CardiologyInstitut Mutualiste MontsourisParisFrance
| | - Ziad Ali
- DeMatteis Cardiovascular InstituteSt. Francis Hospital & Heart CenterRoslynNY
| | - Bernard De Bruyne
- Cardiovascular Center AalstOLV ClinicAalstBelgium
- Department of CardiologyLausanne University HospitalLausanneSwitzerland
| | - Bon‐Kwon Koo
- Department of Internal Medicine and Cardiovascular CenterSeoul National University HospitalSeoulSouth Korea
| | - Hiromasa Otake
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
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5
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Eppinger S, Piayda K, Galea R, Sandri M, Maarse M, Güner A, Karabay CY, Pershad A, Ding WY, Aminian A, Akin I, Davtyan KV, Chugunov IA, Marijon E, Rosseel L, Schmidt TR, Amabile N, Korsholm K, Lund J, Guerios E, Amat-Santos IJ, Boccuzzi G, Ellis CR, Sabbag A, Ebelt H, Clapp B, Assa HV, Levi A, Ledwoch J, Lehmann S, Lee OH, Mark G, Schell W, Della Rocca DG, Natale A, de Backer O, Kefer J, Esteban PP, Abelson M, Ram P, Moceri P, Galache Osuna JG, Alvarez XM, Cruz-Gonzalez I, de Potter T, Ghassan M, Osadchiy A, Chen W, Goyal SK, Giannini F, Rivero-Ayerza M, Afzal S, Jung C, Skurk C, Langel M, Spence M, Merkulov E, Lempereur M, Shin SY, Mesnier J, McKinney HL, Schuler BT, Armero S, Gheorghe L, Ancona MBM, Santos L, Mansourati J, Nombela-Franco L, Nappi F, Kühne M, Gaspardone A, van der Pals J, Montorfano M, Fernández-Armenta J, Harvey JE, Rodés-Cabau J, Klein N, Sabir SA, Kim JS, Cook S, Kornowski R, Saraste A, Nielsen-Kudsk JE, Gupta D, Boersma L, Räber L, Sievert K, Sievert H, Bertog S. Embolization of percutaneous left atrial appendage closure devices: timing, management and clinical outcomes. Cardiovasc Revasc Med 2024:S1553-8389(24)00067-8. [PMID: 38448258 DOI: 10.1016/j.carrev.2024.02.014] [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: 09/11/2023] [Revised: 01/25/2024] [Accepted: 02/19/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Left atrial appendage (LAA) occluder embolization is an infrequent but serious complication. OBJECTIVES We aim to describe timing, management and clinical outcomes of device embolization in a multi-center registry. METHODS Patient characteristics, imaging findings and procedure and follow-up data were collected retrospectively. Device embolizations were categorized according to 1) timing 2) management and 3) clinical outcomes. RESULTS Sixty-seven centers contributed data. Device embolization occurred in 108 patients. In 70.4 % of cases, it happened within the first 24 h of the procedure. The device was purposefully left in the LA and the aorta in two (1.9 %) patients, an initial percutaneous retrieval was attempted in 81 (75.0 %) and surgery without prior percutaneous retrieval attempt was performed in 23 (21.3 %) patients. Two patients died before a retrieval attempt could be made. In 28/81 (34.6 %) patients with an initial percutaneous retrieval attempt a second, additional attempt was performed, which was associated with a high mortality (death in patients with one attempt: 2.9 % vs. second attempt: 21.4 %, p < 0.001). The primary outcome (bailout surgery, cardiogenic shock, stroke, TIA, and/or death) occurred in 47 (43.5 %) patients. Other major complications related to device embolization occurred in 21 (19.4 %) patients. CONCLUSIONS The majority of device embolizations after LAA closure occurs early. A percutaneous approach is often the preferred method for a first rescue attempt. Major adverse event rates, including death, are high particularly if the first retrieval attempt was unsuccessful. CONDENSED ABSTRACT This dedicated multicenter registry examined timing, management, and clinical outcome of device embolization. Early embolization (70.4 %) was most frequent. As a first rescue attempt, percutaneous retrieval was preferred in 75.0 %, followed by surgical removal (21.3 %). In patients with a second retrieval attempt a higher mortality (death first attempt: 2.9 % vs. death second attempt: 24.1 %, p < 0.001) was observed. Mortality (10.2 %) and the major complication rate after device embolization were high.
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Affiliation(s)
| | - Kerstin Piayda
- CardioVascular Center (CVC) Frankfurt, Frankfurt, Germany; Department of Cardiology and Angiology, Universitätsklinikum Gießen und Marburg, Gießen, Germany
| | - Roberto Galea
- Department of Cardiology, Universitätsspital Bern, Bern, Switzerland
| | | | - Moniek Maarse
- Department of Cardiology, St. Antonius Ziekenhuis, Nieuwegein, Netherlands
| | - Ahmet Güner
- Department of Cardiology, Mehmet Akif Ersoy Hospital, Istanbul, Turkey
| | - Can Y Karabay
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Education Research Hospital, Istanbul, Turkey
| | - Ashish Pershad
- Department of Cardiology, Banner Health, Phoenix, AZ, USA
| | - Wern Y Ding
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Adel Aminian
- Department of Cardiology, Centre hospitalier universitaire de Charleroi, Charleroi, Belgium
| | - Ibrahim Akin
- Department of Cardiology, Universitätsmedizin Mannheim, Germany
| | - Karapet V Davtyan
- National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russia
| | - Ivan A Chugunov
- National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russia
| | - Eloi Marijon
- Department of Cardiology, Hôpital Européen Georges-Pompidou HEGP, Paris, France
| | | | | | - Nicolas Amabile
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Kasper Korsholm
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Juha Lund
- Heart Center, Turku University Hospital, Turku, Finland
| | - Enio Guerios
- Department of Cardiology, Hospital Nossa Senhora das Graças, Curitiba, Brazil
| | | | - Giacomo Boccuzzi
- Department of Cardiology, Ospedale san Giovanni Bosco, Torino, Italy
| | | | - Avi Sabbag
- Department of Cardiology, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Henning Ebelt
- Department of Cardiology, Katholisches Krankenhaus St. Nepomuk, Erfurt, Germany
| | - Brian Clapp
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Hana Vaknin Assa
- Department of Cardiology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Amos Levi
- Department of Cardiology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | | | - Sonja Lehmann
- Department of Cardiology, Hôpital Fribourgeois, Fribourg, Switzerland
| | - Oh-Hyun Lee
- Department of Cardiology, Yonsei University Hospital, Yongin, Republic of Korea
| | - George Mark
- The Heart House/Cooper University Camden, NJ, USA
| | - Wendy Schell
- Department of Cardiology, Cooper University Hospital, NJ, USA
| | | | - Andrea Natale
- Department of Cardiology, St David's Medical Center, Austin, TX, USA
| | - Ole de Backer
- Department of Cardiology, Rigshospitalet Copenhagen, Copenhagen, Denmark
| | - Joelle Kefer
- Department of Cardiology, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | - Pablo P Esteban
- Department of Cardiology, Hospital Universitario A Coruña, A Coruña, Spain
| | - Mark Abelson
- Department of interventional Cardiology, Mediclinic Vergelegen, Cape Town, South Africa
| | - Pradhum Ram
- Department of Cardiology, Emory University, Atlanta, GA, USA
| | - Pamela Moceri
- Department of Cardiology, Hopital Pasteur 1, Nice, France
| | | | | | | | | | - Moubarak Ghassan
- Department of Cardiology, Clinique Ambroise Paré, Neuilly-sur-Seine, France
| | - Andrey Osadchiy
- Department of Cardiology, City Hospital #40, St. Petersburg, Russia
| | - Weita Chen
- Department of Cardiology, Taipei Municipal Wanfang Hospital, Taipei, Taiwan
| | | | | | | | - Shazia Afzal
- Department of Cardiology, Heinrich-Heine University, University Hospital, Duesseldorf, Germany
| | - Christian Jung
- Department of Cardiology, Heinrich-Heine University, University Hospital, Duesseldorf, Germany
| | - Carsten Skurk
- Department of Cardiology, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Langel
- Department of Cardiology, Klinikum St. Georg, Leipzig, Germany
| | - Mark Spence
- Department of Cardiology, Royal Victoria Hospital, Belfast Trust, Belfast, UK
| | | | | | - Seung Y Shin
- Cardiovascular & Arrhythmia Center, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Jules Mesnier
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Brian T Schuler
- Department of Cardiology, WellSpan York Hospital, York, PA, USA
| | | | - Livia Gheorghe
- Department of Cardiology, Puerta del Mar University Hospital, Cadiz, Spain
| | - Marco B M Ancona
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lino Santos
- Department of Cardiology, Centro Hospitalar Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | | | | | | | - Michael Kühne
- Department of Cardiology, University Hospital Basel, Switzerland
| | | | - Jesper van der Pals
- Department of Cardiology, Lund University and Skane University Hospital, Lund, Sweden
| | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - James E Harvey
- Department of Cardiology, WellSpan York Hospital, York, PA, USA
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Norbert Klein
- Department of Cardiology, Klinikum St. Georg, Leipzig, Germany
| | - Sajjad A Sabir
- Department of Cardiology, Cooper University Hospital, NJ, USA
| | - Jung-Sun Kim
- Department of Cardiology, Yonsei University Hospital, Yongin, Republic of Korea
| | - Stephane Cook
- Department of Cardiology, Hôpital Fribourgeois, Fribourg, Switzerland
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Antti Saraste
- Heart Center, Turku University Hospital, Turku, Finland
| | | | - Dhiraj Gupta
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Lucas Boersma
- Department of Cardiology, St. Antonius Ziekenhuis, Nieuwegein, Netherlands
| | - Lorenz Räber
- Department of Cardiology, Universitätsspital Bern, Bern, Switzerland
| | - Kolja Sievert
- CardioVascular Center (CVC) Frankfurt, Frankfurt, Germany
| | - Horst Sievert
- CardioVascular Center (CVC) Frankfurt, Frankfurt, Germany.
| | - Stefan Bertog
- CardioVascular Center (CVC) Frankfurt, Frankfurt, Germany
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6
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Moreno R, Baptista SB, Valencia J, Gomez-Menchero A, Bouisset F, Ruiz-Arroyo JR, Bento A, Besutti M, Jimenez-Valero S, Rivero-Santana B, Olhmann P, Santos M, Vaquerizo B, Cuissetm T, Lemoine J, Pinar E, Fiarresga A, Urbano C, Marliere S, Braga C, Amat-Santos I, Morgado G, Sarnago F, Telleria M, Van Belle E, Díaz-Fernandez J, Borrego JC, Amabile N, Meneveau N. OPTImized coronary interventions eXplaIn the bEst cliNical outcomEs (OPTI-XIENCE) study. Rationale and study design. Cardiovasc Revasc Med 2024; 59:93-98. [PMID: 37723011 DOI: 10.1016/j.carrev.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 08/29/2023] [Accepted: 08/29/2023] [Indexed: 09/20/2023]
Abstract
INTRODUCTION Clinical events may occur after percutaneous coronary intervention (PCI), particularly in complex lesions and complex patients. The optimization of PCI result, using pressure guidewire and intracoronary imaging techniques, may reduce the risk of these events. The hypothesis of the present study is that the clinical outcome of patients with indication of PCI and coronary stent implantation that are at high risk of events can be improved with an unrestricted use of intracoronary tools that allow PCI optimization. METHODS AND ANALYSIS Observational prospective multicenter international study, with a follow-up of 12 months, including 1064 patients treated with a cobalt‑chromium everolimus-eluting stent. Inclusion criteria include any of the following: Lesion length > 28 mm; Reference vessel diameter < 2.5 mm or > 4.25 mm; Chronic total occlusion; Bifurcation with side branch ≥2.0 mm;Ostial lesion; Left main lesion; In-stent restenosis; >2 lesions stented in the same vessel; Treatment of >2 vessels; Acute myocardial infarction; Renal insufficiency; Left ventricular ejection fraction <30 %; Staged procedure. The control group will be comprised by a similar number of matched patients included in the "extended risk" cohort of the XIENCE V USA study. The primary endpoint will be the 1-year rate of target lesion failure (TLF) (composite of ischemia-driven TLR, myocardial infarction (MI) related to the target vessel, or cardiac death related to the target vessel). Secondary endpoints will include overall mortality, cardiovascular mortality, acute myocardial infarction, TVR, TLR, target vessel failure, and definitive or probable stent thrombosis at 1 year. IMPLICATIONS The ongoing OPTI-XIENCE study will contribute to the growing evidence supporting the use of intra-coronary imaging techniques for stent optimization in patients with complex coronary lesions.
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Affiliation(s)
- Raul Moreno
- Cardiology Department, La Paz University Hospital, Madrid, Spain.
| | | | | | | | | | | | | | | | | | | | - Patrick Olhmann
- Centres Hospitaliers et Universitaires of Strasbourg, France
| | - Miguel Santos
- Professor Doutor Fernando Fonseca Hospital, Portugal
| | | | | | | | | | | | | | | | | | | | | | | | | | - Eric Van Belle
- Centre Hospitalier Regional Universitaire de Lille, France
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7
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Teiger E, Eschalier R, Amabile N, Rioufol G, Ducrocq G, Garot P, Lepillier A, Bille J, Elbaz M, Defaye P, Audureau E, Le Corvoisier P. Left atrial appendage closure in very elderly patients in the French National Registry. Heart 2024; 110:245-253. [PMID: 37813560 DOI: 10.1136/heartjnl-2023-322871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 08/19/2023] [Indexed: 10/17/2023] Open
Abstract
OBJECTIVE Left atrial appendage closure (LAAC) is recommended to decrease the stroke risk in patients with atrial fibrillation and contraindications to anticoagulation. However, age-stratified data are scarce. The aim of this study was to provide information on the safety and efficacy of LAAC, with emphasis on the oldest patients. METHODS A nationwide, prospective, multicentre, observational registry was established by 53 French cardiology centres in 2018-2021. The composite primary endpoint included ischaemic stroke, systemic embolism, and unexplained or cardiovascular death. Separate analyses were done in the groups <80 years and ≥80 years. RESULTS Among the 1053 patients included, median age was 79.7 (73.6-84.3) years; 512 patients (48.6%) were aged ≥80 years. Procedure-related serious adverse events were non-significantly more common in octogenarians (7.0% vs 4.4% in patients aged <80 years, respectively; p=0.07). Despite a higher mean CHA2DS2-VASc score in octogenarians, the rate of thromboembolic events during the study was similar in both groups (3.0 vs 3.1/100 patient-years; p=0.85). By contrast, all-cause mortality was significantly higher in octogenarians (15.3 vs 10.1/100 patient-years, p<0.015), due to a higher rate of non-cardiovascular deaths (8.2 vs 4.9/100 patient-years, p=0.034). The rate of the primary endpoint was 8.1/100 patient-years overall with no statistically significant difference between age groups (9.4 and 7.0/100 patient-years; p=0.19). CONCLUSION Despite a higher mean CHA2DS2-VASc score in octogenarians, the rate of thromboembolic events after LAAC in this age group was similar to that in patients aged <80 years. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03434015).
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Affiliation(s)
- Emmanuel Teiger
- Department of Cardiology, APHP, Henri Mondor University Hospital, Créteil, France
- Clinical Investigation Center 1430 and U955-IMRB team 3, Ecole Nationale Vétérinaire d'Alfort, UPEC, INSERM, Créteil, France
| | - Romain Eschalier
- Cardiology Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
- CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Nicolas Amabile
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Gilles Rioufol
- Department of Interventional Cardiology, Lyon Cardiovascular Hospital, Bron Cedex, France
- CARMEN INSERM 1060, INSERM, Bron, France
| | - Gregory Ducrocq
- Department of Cardiology, FACT (French Alliance for Cardiovascular Trials), DHU-FIRE, Bichat-Claude Bernard University Hospital, Paris, France
| | - Philippe Garot
- Institut Cardiovasculaire Paris-Sud (ICPS), Ramsay-Santé, Hôpital Privé Jacques Cartier, Massy, France
| | - Antoine Lepillier
- Department of Cardiology, Centre Cardiologique du Nord, Saint-Denis, France
| | - Jacques Bille
- Cardiology Department, Saint Joseph Hospital, Marseille, France
| | - Meyer Elbaz
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | - Pascal Defaye
- Department of Rhythmology, Grenoble-Alpes University Hospital, Grenoble, France
| | - Etienne Audureau
- AP-HP, Department of Public Health, Henri Mondor University Hospital, Creteil, France
- Equipe CEpiA, INSERM, UPEC, U955-IMRB, Créteil, France
| | - Philippe Le Corvoisier
- Clinical Investigation Center 1430, APHP, Groupe Hospitalier Henri Mondor, Creteil, France
- Clinical Investigation Center 1430 and U955-IMRB team 3, INSERM, Créteil, France
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8
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De Silva K, Li Kam Wa ME, Wells T, Mozid A, Ladwiniec A, Hynes BG, Kotecha A, Ratib K, Biswas S, Amabile N, Deharo P, McEntagart M, Spratt JC, Digne F, Hogg M, Mailey JA, Walsh SJ, Kalra SS. The everolimus eluting Synergy Megatron TM drug-eluting stent platform: Early outcomes from the European Synergy Megatron TM Implanters' Registry. Catheter Cardiovasc Interv 2023; 102:1222-1228. [PMID: 37948428 PMCID: PMC10903108 DOI: 10.1002/ccd.30902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/03/2023] [Accepted: 10/22/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The Synergy MegatronTM is an everolimus-drug eluting stent that may offer advantages in the treatment of aorto-ostial disease and large proximal vessels. AIMS To report the short- to medium-term clinical outcomes from the European Synergy MegatronTM Implanters' Registry. METHODS This registry was an investigator-initiated study conducted at 14 European centers. The primary outcome was target lesion failure (TLF), defined as the composite of cardiovascular death, target vessel myocardial infarction (MI), and target lesion revascularisation. RESULTS Five hundred seventy-five patients underwent PCI with MegatronTM between 2019 and 2021. Patients were 69 ± 12 years old, 26% had diabetes mellitus, 24% had moderate-severe left ventricular impairment and 59% presented with an acute coronary syndrome. 15% were deemed prohibitively high risk for surgical revascularisation. The target vessel involved the left main stem in 55%, the ostium of the RCA in 13% and was a true bifurcation (Medina 1,1,1) in 50%. At 1 year, TLF was observed in 40 patients, with 26 (65%) occurring within the first 30 days. The cumulative incidence of TLF was 4.5% at 30 days and 8.6% (95% CI 6.3-11.7) at 1 year. The incidence of stent thrombosis was 0.5% with no late stent thromboses. By multivariate analysis, the strongest independent predictors of TLF were severe left ventricular impairment (HR 3.43, 95% CI: 1.67-6.76, p < 0.001) and a target vessel involving the left main (HR 4.00 95% CI 1.81-10.15 p = 0.001). CONCLUSIONS Use of the Synergy MegatronTM everolimus eluting stent in a 'real-world' setting shows favorable outcomes at 30 days and 1 year.
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Affiliation(s)
- Kalpa De Silva
- Cardiovascular Division, St Thomas' HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
- Coronary Research Group, British Heart Foundation Centre of Research ExcellenceKing's College LondonLondonUK
| | - Matthew E. Li Kam Wa
- Cardiovascular Division, St Thomas' HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
- Coronary Research Group, British Heart Foundation Centre of Research ExcellenceKing's College LondonLondonUK
| | - Tim Wells
- Cardiology Department, Salisbury District HospitalSalisbury NHS Foundation TrustSalisburyUK
| | - Abdul Mozid
- Cardio Respiratory Clinical Services Unit, Leeds General InfirmaryThe Leeds Teaching Hospitals NHS TrustLeedsUK
| | - Andrew Ladwiniec
- Department of Cardiology, Glenfield HospitalUniversity Hospitals of Leicester NHS TrustLeicesterUK
| | - Brian G. Hynes
- Cardiology DepartmentUniversity Hospital GalwayGalwayIreland
| | - Ashish Kotecha
- Department of Cardiology, Royal Devon and Exeter HospitalRoyal Devon University Healthcare NHS Foundation TrustExeterUK
| | - Karim Ratib
- Cardiology Department, Royal Stoke University HospitalUniversity Hospitals of North Midlands NHS TrustStokeUK
| | - Sinjini Biswas
- Bristol Heart InstituteUniversity Hospitals Bristol NHS Foundation TrustBristolUK
| | - Nicolas Amabile
- Cardiology DepartmentL'Institut Mutualiste MontsourisParisFrance
| | - Pierre Deharo
- Cardiology DepartmentAssistance Publique Hôpitaux de MarseilleMarseilleFrance
| | | | - James C. Spratt
- Cardiology Clinical Academic Group, St George's University HospitalSt George's University Hospitals NHS Foundation TrustLondonUK
| | - Franck Digne
- Cardiology DepartmentCentre Cardiologique du NordSaint DenisFrance
| | - Meadhbh Hogg
- Department of CardiologyBelfast Health and Social Care TrustBelfastUK
| | | | - Simon J. Walsh
- Department of CardiologyBelfast Health and Social Care TrustBelfastUK
| | - Sundeep S. Kalra
- Cardiology Department, Royal Free HospitalRoyal Free London NHS Foundation TrustLondonUK
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Amabile N, Stefanini G. Reviewing scientific manuscripts in 2023: is it (still) worth the time? EUROINTERVENTION 2023; 19:628-629. [PMID: 37872800 PMCID: PMC10587841 DOI: 10.4244/eij-d-23-00455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 10/25/2023]
Affiliation(s)
- Nicolas Amabile
- Cardiology Department, Institut Mutualiste Montsouris, Paris, France
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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10
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Amabile N, Mahmoudi K, Sebag FA. A thunder out of the blue. Eur Heart J 2023; 44:4292. [PMID: 37529917 DOI: 10.1093/eurheartj/ehad499] [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] [Indexed: 08/03/2023] Open
Affiliation(s)
- Nicolas Amabile
- Department of Cardiology, Institut Mutualiste Montsouris, 42 Bd Jourdan, Paris 75014, France
| | - Khalil Mahmoudi
- Department of Cardiology, Institut Mutualiste Montsouris, 42 Bd Jourdan, Paris 75014, France
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11
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Collet C, Johnson NP, Mizukami T, Fearon WF, Berry C, Sonck J, Collison D, Koo BK, Meneveau N, Agarwal SK, Uretsky B, Hakeem A, Doh JH, Da Costa BR, Oldroyd KG, Leipsic JA, Morbiducci U, Taylor C, Ko B, Tonino PAL, Perera D, Shinke T, Chiastra C, Sposito AC, Leone AM, Muller O, Fournier S, Matsuo H, Adjedj J, Amabile N, Piróth Z, Alfonso F, Rivero F, Ahn JM, Toth GG, Ihdayhid A, West NEJ, Amano T, Wyffels E, Munhoz D, Belmonte M, Ohashi H, Sakai K, Gallinoro E, Barbato E, Engstrøm T, Escaned J, Ali ZA, Kern MJ, Pijls NHJ, Jüni P, De Bruyne B. Impact of Post-PCI FFR Stratified by Coronary Artery. JACC Cardiovasc Interv 2023; 16:2396-2408. [PMID: 37821185 DOI: 10.1016/j.jcin.2023.08.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Low fractional flow reserve (FFR) after percutaneous coronary intervention (PCI) has been associated with adverse clinical outcomes. Hitherto, this assessment has been independent of the epicardial vessel interrogated. OBJECTIVES This study sought to assess the predictive capacity of post-PCI FFR for target vessel failure (TVF) stratified by coronary artery. METHODS We performed a systematic review and individual patient-level data meta-analysis of randomized clinical trials and observational studies with protocol-recommended post-PCI FFR assessment. The difference in post-PCI FFR between left anterior descending (LAD) and non-LAD arteries was assessed using a random-effect models meta-analysis of mean differences. TVF was defined as a composite of cardiac death, target vessel myocardial infarction, and clinically driven target vessel revascularization. RESULTS Overall, 3,336 vessels (n = 2,760 patients) with post-PCI FFR measurements were included in 9 studies. The weighted mean post-PCI FFR was 0.89 (95% CI: 0.87-0.90) and differed significantly between coronary vessels (LAD = 0.86; 95% CI: 0.85 to 0.88 vs non-LAD = 0.93; 95% CI: 0.91-0.94; P < 0.001). Post-PCI FFR was an independent predictor of TVF, with its risk increasing by 52% for every reduction of 0.10 FFR units, and this was mainly driven by TVR. The predictive capacity for TVF was poor for LAD arteries (AUC: 0.52; 95% CI: 0.47-0.58) and moderate for non-LAD arteries (AUC: 0.66; 95% CI: 0.59-0.73; LAD vs non-LAD arteries, P = 0.005). CONCLUSIONS The LAD is associated with a lower post-PCI FFR than non-LAD arteries, emphasizing the importance of interpreting post-PCI FFR on a vessel-specific basis. Although a higher post-PCI FFR was associated with improved prognosis, its predictive capacity for events differs between the LAD and non-LAD arteries, being poor in the LAD and moderate in the non-LAD vessels.
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Affiliation(s)
- Carlos Collet
- Cardiovascular Center Aalst, onze lieve vrouw Clinic, Aalst, Belgium.
| | - Nils P Johnson
- Division of Cardiology, Department of Medicine, McGovern Medical School at University of Texas Health and Memorial Hermann Hospital, Houston, Texas, USA
| | - Takuya Mizukami
- Cardiovascular Center Aalst, onze lieve vrouw Clinic, Aalst, Belgium; Department of Pharmacology, Showa University School of Medicine, Tokyo, Japan
| | - William F Fearon
- Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford, California, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Colin Berry
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom; West of Scotland Regional Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom
| | - Jeroen Sonck
- Cardiovascular Center Aalst, onze lieve vrouw Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Damien Collison
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom; West of Scotland Regional Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Nicolas Meneveau
- Department of Cardiology, University Hospital Jean Minjoz, Besançon, France; University of Burgundy Franche-Comté, Besançon, France
| | - Shiv Kumar Agarwal
- Division of Cardiology, Central Arkansas Veterans Health System, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Barry Uretsky
- Division of Cardiology, Central Arkansas Veterans Health System, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Abdul Hakeem
- Division of Cardiovascular Diseases and Cardiovascular Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Bruno R Da Costa
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Keith G Oldroyd
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom; West of Scotland Regional Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom
| | - Jonathon A Leipsic
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Umberto Morbiducci
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | | | - Brian Ko
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Victoria, Australia
| | - Pim A L Tonino
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Divaka Perera
- National Institute for Health Research Guy's and St Thomas' Biomedical Research Centre, King's College London and Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Claudio Chiastra
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Andrei C Sposito
- Department of Internal Medicine, Discipline of Cardiology, University of Campinas, Campinas, Brazil
| | - Antonio Maria Leone
- Center of Excellence in Cardiovascular Sciences, Ospedale Fatebenefratelli Isola Tiberina Gemelli Isola, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Stephane Fournier
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Julien Adjedj
- Department of Cardiology, Arnault Tzanck Institute Saint Laurent du Var, France
| | - Nicolas Amabile
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Zsolt Piróth
- Gottsegen National Cardiovascular Center, Budapest, Hungary
| | - Fernando Alfonso
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, Madrid, Spain
| | - Fernando Rivero
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, Madrid, Spain
| | - Jung-Min Ahn
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gabor G Toth
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, Graz, Austria
| | - Abdul Ihdayhid
- Fiona Stanley Hospital, Harry Perkins Institute of Medical Research, Curtin University, Perth, Australia
| | | | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Aichi, Japan
| | - Eric Wyffels
- Cardiovascular Center Aalst, onze lieve vrouw Clinic, Aalst, Belgium
| | - Daniel Munhoz
- Cardiovascular Center Aalst, onze lieve vrouw Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy; Department of Internal Medicine, Discipline of Cardiology, University of Campinas, Campinas, Brazil
| | - Marta Belmonte
- Cardiovascular Center Aalst, onze lieve vrouw Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Hirofumi Ohashi
- Cardiovascular Center Aalst, onze lieve vrouw Clinic, Aalst, Belgium; Department of Cardiology, Aichi Medical University, Aichi, Japan
| | - Koshiro Sakai
- Cardiovascular Center Aalst, onze lieve vrouw Clinic, Aalst, Belgium; Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Emanuele Gallinoro
- Cardiovascular Center Aalst, onze lieve vrouw Clinic, Aalst, Belgium; Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Emanuele Barbato
- Cardiovascular Center Aalst, onze lieve vrouw Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Thomas Engstrøm
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Javier Escaned
- Instituto de Investigacion Sanitaria Del Hospital Clinico San Carlos, Complutense University, Madrid, Spain
| | - Ziad A Ali
- St. Francis Hospital & Heart Center, Roslyn, NY, USA
| | - Morton J Kern
- University of California Irvine and Veterans Affairs Long Beach Healthcare System, Irvine, California, USA
| | - Nico H J Pijls
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Peter Jüni
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, onze lieve vrouw Clinic, Aalst, Belgium; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland.
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Rangé G, Motreff P, Benamer H, Commeau P, Cayla G, Chassaing S, Laure C, Monsegu J, Van Belle E, Py A, Amabile N, Beygui F, Honton B, Lhermusier T, Boiffard E, Boueri Z, Lhoest N, Deharo P, Adjedj J, Pouillot C, Pereira B, Koning R, Collet JP. The France PCI registry: Design, methodology and key findings. Arch Cardiovasc Dis 2023:S1875-2136(23)00169-9. [PMID: 37783602 DOI: 10.1016/j.acvd.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/30/2023] [Accepted: 08/01/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Obstructive coronary artery disease is the main cause of death worldwide. By tracking events and gaining feedback on patient management, the most relevant information is provided to public health services to further improve prognosis. AIMS To create an inclusive and accurate registry of all percutaneous coronary intervention (PCI) procedures performed in France, to assess and improve the quality of care and create research incentives. Also, to describe the methodology of this French national registry of interventional cardiology, and present early key findings. METHODS The France PCI registry is a multicentre observational registry that includes consecutive patients undergoing coronary angiography and/or PCI. The registry was set up to provide online data analysis and structured reports of PCI activity, including process of care measures and assessment of risk-adjusted outcomes in all French PCI centres that are willing to participate. More than 150 baseline data items, describing demographic status, PCI indications and techniques, and in-hospital and 1-year outcomes, are captured into local reporting software by medical doctors and local research technicians, with subsequent encryption and internet transfer to central data servers. Annual activity reports and scoring tools available on the France PCI website enable users to benchmark and improve clinical practices. External validation and consistency assessments are performed, with feedback of data completeness to centres. RESULTS Between 01 January 2014 and 31 December 2022, participating centres increased from six to 47, and collected 364,770 invasive coronary angiograms and 176,030 PCIs, including 54,049 non-ST-segment elevation myocardial infarction cases and 31,631 ST-segment elevation myocardial infarction cases. Fifteen studies stemming from the France PCI registry have already been published. CONCLUSIONS This fully electronic, daily updated, high-quality, low-cost, national registry is sustainable, and is now expanding. Merging with medicoeconomic databases and nested randomized scientific studies are ongoing steps to expand its scientific potential.
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Affiliation(s)
- Grégoire Rangé
- Cardiology Department, Les Hôpitaux de Chartres, 28630 Chartres, France.
| | - Pascal Motreff
- Cardiology Department, University Hospital Gabriel-Montpied, 63000 Clermont-Ferrand, France
| | - Hakim Benamer
- Cardiology Department, Clinique de la Roseraie, 02200 Soissons, France
| | - Philippe Commeau
- Cardiology Department, Polyclinique Les Fleurs, Groupe ELSAN, 83190 Ollioules, France
| | - Guillaume Cayla
- Cardiology Department, Centre Hospitalier Universitaire de Nîmes, 30029 Nîmes, France
| | - Stephan Chassaing
- Cardiology Department, Nouvelle Clinique Tourangelle, 37540 Saint-Cyr-sur-Loire, France
| | - Christophe Laure
- Cardiology Department, Les Hôpitaux de Chartres, 28630 Chartres, France
| | - Jacques Monsegu
- Department of Interventional Cardiology, Institut Cardio-Vasculaire, Groupe Hospitalier Mutualiste, 38028 Grenoble, France
| | - Eric Van Belle
- Department of Cardiology, Institut Coeur-Poumon-CHU Lille and INSERM U1011, 59000 Lille, France
| | - Antoine Py
- Department of Cardiology, Clinique Victor Pauchet, 80094 Amiens, France
| | - Nicolas Amabile
- Cardiology Department, Institut Mutualiste Montsouris, 75014 Paris, France
| | - Farzin Beygui
- Cardiology Department, CHU de Caen, 14000 Caen, France
| | - Benjamin Honton
- Department of Interventional Cardiology, Clinique Pasteur, 31076 Toulouse, France
| | - Thomas Lhermusier
- Department of Cardiology, Toulouse University Hospital, 31000 Toulouse, France
| | - Emmanuel Boiffard
- Department of Cardiology, Centre Hospitalier Départemental de Vendée, 85000 La Roche-sur-Yon, France
| | - Ziad Boueri
- Department of Cardiology, Centre Hospitalier de Bastia, 20600 Bastia, France
| | - Nicolas Lhoest
- Department of Cardiology, Clinique Rhéna, 67000 Strasbourg, France
| | - Pierre Deharo
- Department of Cardiology, CHU Timone, Aix Marseille Université, INSERM, INRA, C2VN, 13005 Marseille, France
| | - Julien Adjedj
- Department of Cardiology, Arnault Tzanck Institute, 06700 Saint-Laurent-du-Var, France
| | - Christophe Pouillot
- Department of Cardiology, Clinique Sainte Clotilde, 97400 Saint-Denis, Reunion
| | - Bruno Pereira
- Cardiology Department, University Hospital Gabriel-Montpied, 63000 Clermont-Ferrand, France
| | - René Koning
- Cardiology Department, Clinique Saint-Hilaire, 76000 Rouen, France
| | - Jean-Philippe Collet
- Sorbonne Université, Action Study Group (action-groupe.org), Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France
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Mahmoudi K, Galea R, Elhadad S, Temperli F, Sebag F, Gräni C, Rezine Z, Roten L, Landolff Q, Brugger N, Masri A, Räber L, Amabile N. Computed Tomography Scan Evidence for Left Atrial Appendage Short-Term Remodeling Following Percutaneous Occlusion: Impact of Device Oversizing. J Am Heart Assoc 2023; 12:e030037. [PMID: 37609989 PMCID: PMC10547351 DOI: 10.1161/jaha.123.030037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/11/2023] [Indexed: 08/24/2023]
Abstract
Background The interrelationships between left atrial appendage (LAA) dimensions and device following implantation are unknown. We aimed to analyze the impact of Watchman device implantation on LAA dimensions following its percutaneous closure and potential predictors of remodeling. Methods and Results All consecutive LAA closure procedures performed at 2 centers between November 2017 and December 2020 were included in the WATCH-DUAL (Watchman 2.5 Versus Watchman FLX in a Dual-Center Left Atrial Appendage Closure Cohort) registry. This study included patients who had pre- and postintervention computed tomography scan analysis. The LAA and device dimensions were measured in a centralized core lab by 3-dimensional computed tomography scan reconstruction methods, focusing on the device landing zone. This analysis included 104 patients (age, 76.0 [range, 72.0-83.0] years; 72% men; 53% Watchman FLX; 47% Watchman 2.5). The baseline characteristics were comparable between Watchman 2.5 and Watchman FLX groups, except for the higher use of oversizing in the latter group. The median delay for computed tomography control was 49 (range, 43-64) days. The landing zone area (median, 446 [range, 363-523] versus 290 [222-366] mm2; P<0.001) and minimal diameter (median, 23.0 [range, 20.7-24.8] versus 16.7 [14.7-19.4] mm; P<0.001) significantly increased after implantation. The absolute (median, 157 [range, 98-220] versus 85 [18-148] mm2, P<0.001) and relative (median, 50% [range, 32%-79%] versus 26% [4%-50%]; P<0.001) increases in landing zone area were more pronounced in patients with oversized device. Baseline LAA dimensions were smaller, landing zone eccentricity larger, and oversized device more frequent in patients with significant overexpansion compared with the others. Conclusions LAA dimensions increased at the site of the Watchman prosthesis after implantation, suggesting a local positive remodeling after the procedure. This phenomenon was more pronounced in the case of oversized devices.
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Affiliation(s)
- Khalil Mahmoudi
- Cardiology DepartmentInstitut Mutualiste MontsourisParisFrance
| | - Roberto Galea
- Cardiology Department, Inselspital, Bern University HospitalUniversity of BernSwitzerland
| | - Simon Elhadad
- Cardiology Department, Centre Hospitalier Marne la Vallée, JossignyFrance
| | - Fabrice Temperli
- Cardiology Department, Inselspital, Bern University HospitalUniversity of BernSwitzerland
| | - Frederic Sebag
- Cardiology DepartmentInstitut Mutualiste MontsourisParisFrance
| | - Christoph Gräni
- Cardiology Department, Inselspital, Bern University HospitalUniversity of BernSwitzerland
| | - Zhor Rezine
- Cardiology Department, Centre Hospitalier Marne la Vallée, JossignyFrance
| | - Laurent Roten
- Cardiology Department, Inselspital, Bern University HospitalUniversity of BernSwitzerland
| | | | - Nicolas Brugger
- Cardiology Department, Inselspital, Bern University HospitalUniversity of BernSwitzerland
| | - Alaa Masri
- Cardiology DepartmentInstitut Mutualiste MontsourisParisFrance
| | - Lorenz Räber
- Cardiology Department, Inselspital, Bern University HospitalUniversity of BernSwitzerland
| | - Nicolas Amabile
- Cardiology DepartmentInstitut Mutualiste MontsourisParisFrance
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14
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Landolff Q, Godin M, Canville A, Honton B, Monsegu J, Quillot M, Berland J, Koning R, Amabile N. Sodium Chloride Physiological Saline Solution Versus Water Preparations Injectable in the Use of Shockwave Intravascular Lithotripsy: A Single-Center Experience. Cardiol Res 2023; 14:149-152. [PMID: 37091886 PMCID: PMC10116940 DOI: 10.14740/cr1489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 03/17/2023] [Indexed: 04/25/2023] Open
Abstract
Background Shockwave intravascular lithotripsy (IVL) coronary system is a very useful new technology for de novo severely calcified coronary artery plaques before percutaneous coronary intervention (PCI). The device uses a semi-compliant low-pressure balloon, integrated into a sterile catheter, to deliver by vaporizing fluid an expanding bubble that generates high-pressure ultrasonic energy by waves that create multiplane longitudinal micro-macro fractures in calcified plaques, which facilitate optimal stent placement and expansion, and luminal gain. Methods The use of Shockwave IVL coronary system in our cardiac catheterization laboratory (Cath lab) at the "Clinique Saint-Hilaire" in Rouen, France, started in March 2019, with 42 procedures performed since this date: two patients in 2019, two patients in 2020, seven patients in 2021, 23 patients in 2022, and eight patients since the beginning of 2023. Results We had experienced problems at the beginning of our activity for the first 11 patients (two patients in 2019, two patients in 2020, and seven patients in 2021): after less than five pulses, the shock therapy stopped. We used initially for Shockwave IVL semi-compliant low-pressure integrated balloons a mixture of 50% contrast and 50% water preparations injectable (PPI). After changing water PPI by sodium chloride physiological saline solution, we never encountered this problem again for the following 31 patients (23 patients in 2022, and eight patients since the beginning of 2023). In fact, the proper functioning of Shockwave IVL system requires ions in balloon mixture in addition to the contrast. It is thanks to the ions contained in sodium chloride physiological saline solution that the spark necessary for shocks delivery after balloon inflation is produced. Conclusions Water PPI or sodium chloride physiological saline solution is used in angioplasty balloons in a lot of Cath labs worldwide. It is therefore essential to disseminate in the worldwide Cath lab the obligation to put in Shockwave IVL semi-compliant low-pressure integrated balloons sodium chloride physiological saline solution, rather than water PPI for optimal performance, and the importance of Shockwave Medical reporting this to interventional cardiologists.
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Affiliation(s)
- Quentin Landolff
- Department of Interventional Cardiology, Clinique Saint Hilaire, Rouen, France
- Corresponding Author: Quentin Landolff, Department of Interventional Cardiology, Clinique Saint Hilaire, Rouen, France.
| | - Matthieu Godin
- Department of Interventional Cardiology, Clinique Saint Hilaire, Rouen, France
| | - Alexandre Canville
- Department of Interventional Cardiology, Clinique Saint Hilaire, Rouen, France
| | - Benjamin Honton
- Department of Interventional Cardiology, Clinique Pasteur, Toulouse, France
| | - Jacques Monsegu
- Department of Interventional Cardiology, Institut Cardio-Vasculaire, Groupe Hospitalier Mutualiste Grenoble, France
| | - Marine Quillot
- Department of Interventional Cardiology, Centre Hospitalier Henri Duffaut, Avignon, France
| | - Jacques Berland
- Department of Interventional Cardiology, Clinique Saint Hilaire, Rouen, France
| | - Rene Koning
- Department of Interventional Cardiology, Clinique Saint Hilaire, Rouen, France
| | - Nicolas Amabile
- Department of Interventional Cardiology, Institut Mutualiste Montsouris, Paris, France
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15
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Cao D, Amabile N, Chiarito M, Lee VT, Angiolillo DJ, Capodanno D, Bhatt DL, Mack MJ, Storey RF, Schmoeckel M, Gibson CM, Deliargyris EN, Mehran R. Reversal and removal of oral antithrombotic drugs in patients with active or perceived imminent bleeding. Eur Heart J 2023; 44:1780-1794. [PMID: 36988155 DOI: 10.1093/eurheartj/ehad119] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 02/02/2023] [Accepted: 02/17/2023] [Indexed: 03/30/2023] Open
Abstract
Remarkable progress has been made in the pharmacological management of patients with cardiovascular disease, including the frequent use of antithrombotic agents. Nonetheless, bleeding complications remain frequent and potentially life-threatening. Therapeutic interventions relying on prompt antithrombotic drug reversal or removal have been developed to assist clinicians in treating patients with active bleeding or an imminent threat of major bleeding due to urgent surgery or invasive procedures. Early phase studies on these novel strategies have shown promising results using surrogate pharmacodynamic endpoints. However, the benefit of reversing/removing antiplatelet or anticoagulant drugs should always be weighed against the possible prothrombotic effects associated with withdrawal of antithrombotic protection, bleeding, and surgical trauma. Understanding the ischemic-bleeding risk tradeoff of antithrombotic drug reversal and removal strategies in the context of urgent high-risk settings requires dedicated clinical investigations, but challenges in trial design remain, with relevant practical, financial, and ethical implications.
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Affiliation(s)
- Davide Cao
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
- Department of Cardiology, Humanitas Gavazzeni, Bergamo, Italy
| | - Nicolas Amabile
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Mauro Chiarito
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
- Department of Cardiology, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | | | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Davide Capodanno
- Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico 'G. Rodolico-San Marco', University of Catania, Catania, Italy
| | - Deepak L Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael J Mack
- Department of Cardiac Surgery, Baylor Scott and White Health, Plano, TX, USA
| | - Robert F Storey
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Michael Schmoeckel
- Department of Cardiac Surgery, Asklepios Klinik St. Georg, Hamburg, Germany
| | - C Michael Gibson
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Roxana Mehran
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
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16
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Massoullié G, Ploux S, Souteyrand G, Mondoly P, Pereira B, Amabile N, Jean F, Irles D, Mansourati J, Combaret N, Mechulan A, Badoz M, Da Costa A, Defaye P, Motreff P, Clerfond G, Bordachar P, Eschalier R. Incidence and management of atrioventricular conduction disorders in new-onset left bundle branch block after TAVI: A prospective multicenter study. Heart Rhythm 2023; 20:699-706. [PMID: 36646235 DOI: 10.1016/j.hrthm.2023.01.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND New-onset left bundle branch block (LBBB) is one of the most frequent complications after transcatheter aortic valve implantation (TAVI) and is associated with delayed high degree atrioventricular (AV) block. OBJECTIVES The objectives of this study were to determine the incidence of AV block in such a population and to assess the performance and safety of a risk stratification algorithm on the basis of electrophysiology study (EPS) followed by implantation of a pacemaker or implantable loop recorder (ILR). METHODS This was a prospective open-label study with 12-month follow-up. From June 8, 2015, to November 8, 2018, 183 TAVI recipients (mean age 82.3 ± 5.9 years) were included at 10 centers. New-onset LBBB after TAVI persisting for >24 hours was assessed by electrophysiology study during initial hospitalization. High-risk patients (His-ventricle interval ≥70 ms) were implanted with a dual-chamber pacemaker recording AV conduction disturbance episodes. Patients at lower risk were implanted with an ILR with automatic remote monitoring. RESULTS A high-grade AV conduction disorder was identified in 56 patients (30.6%) at 12 months. Four subjects were symptomatic, all in the ILR group. No complications were associated with the stratification procedure. Patients with His-ventricle interval ≥70 ms displayed more high-grade AV conduction disorders (53.2% [25 of 47] vs 22.8% [31 of 136]; P < .001). In a multivariate analysis, His-ventricle interval ≥70 ms was independently associated with the occurrence of a high-grade conduction disorder (subdistribution hazard ratio 2.4; 95% confidence interval 1.2-4.8; P = .010). CONCLUSION New-onset LBBB after TAVI was associated with high rates of high-grade AV conduction disturbances. The stratification algorithm provided safe and valuable aid to management decisions and reliable guidance on pacemaker implantation.
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Affiliation(s)
- Grégoire Massoullié
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France; Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Sylvain Ploux
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Bordeaux, IHU LIRYC, Bordeaux, France
| | - Géraud Souteyrand
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France; Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Pierre Mondoly
- Federation of Cardiology, University Hospital Rangueil, Toulouse cedex, France
| | - Bruno Pereira
- Biostatistics Unit (Clinical Research and Innovation Direction), CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Frédéric Jean
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | | | - Nicolas Combaret
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France; Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Alexis Mechulan
- Ramsay Générale de Santé, Hôpital Privé de Clairval, Marseille, France
| | - Marc Badoz
- Department of Cardiology, University Hospital Jean Minjoz, Besançon, France
| | | | - Pascal Defaye
- Arrhythmia Unit, Cardiology Department, University Hospital, Grenoble, France
| | - Pascal Motreff
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France; Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Guillaume Clerfond
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France; Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Pierre Bordachar
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Bordeaux, IHU LIRYC, Bordeaux, France
| | - Romain Eschalier
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France; Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France.
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17
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Oliva A, Maria Ioppolo A, Chiarito M, Cremonesi A, Azzano A, Micciché E, Mangiameli A, Ariano F, Ferrante G, Reimers B, Garot P, Amabile N, Condorelli G, Stefanini G, Cao D. 481 VITAMIN K ANTAGONISTS, DIRECT ORAL ANTICOAGULANTS, OR LEFT ATRIAL APPENDAGE CLOSURE FOR PATIENTS WITH NONVALVULAR ATRIAL FIBRILLATION: A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Percutaneous left atrial appendage closure (LAAC) has emerged as a non-pharmacological alternative to long-term oral anticoagulation with vitamin K antagonists (VKA) or direct oral anticoagulants (DOAC) for stroke prevention in patients with non-valvular atrial fibrillation.
Methods
We searched PubMed and Embase for randomized controlled trials (RCT) comparing 3 different strategies (DOAC vs VKA, LAAC vs VKA, LAAC vs DOAC). Treatment effects were calculated from a network meta-analysis using random-effect model with inverse-variance weighting. The ranking probability of each treatment was based on SUCRA. The primary endpoint was a composite of stroke or systemic embolism.
Results
A total of 7 RCTs and 73,106 patients were included. The risk of the primary endpoint was comparable between LAAC and oral anticoagulation (LAAC vs VKA: OR 0.87, 95% CI 0.55-1.39; LAAC vs DOAC: OR 1.00, 95% CI 0.62-1.61) while it was reduced with DOAC vs VKA (OR 0.87, 95% CI 0.77-0.98). Major bleeding was numerically lower with LAAC vs VKA (OR 0.74, 95% CI 0.48-1.16) and similar between LAAC and DOAC (OR 0.93, 95% CI 0.61-1.42). LAAC significantly reduced the risk of mortality compared with both VKA (OR 0.52, 95% CI 0.37-0.73) and DOAC (OR 0.58, 95% CI 0.42-0.82). The probability of being the best treatment for stroke or systemic embolism prevention was similar for DOAC (51%) and LAAC (48%) whereas LAAC ranked as best treatment for reducing major bleeding (64%) and mortality (100%).
Conclusions
LAAC is a safe and effective alternative to DOAC and VKA for the secondary prevention of patients with non-valvular atrial fibrillation.
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Affiliation(s)
- Angelo Oliva
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele (MI) , Italy
- Cardio Center, Humanitas Clinical And Research Hospital Irccs , Rozzano (MI) , Italy
| | | | - Mauro Chiarito
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele (MI) , Italy
- Cardio Center, Humanitas Clinical And Research Hospital Irccs , Rozzano (MI) , Italy
| | | | - Alessia Azzano
- Cardiovascular Department , Humanitas Gavazzeni, Bergamo , Italy
| | - Eligio Micciché
- Cardiovascular Department , Humanitas Gavazzeni, Bergamo , Italy
| | | | - Francesco Ariano
- Cardiovascular Department , Humanitas Gavazzeni, Bergamo , Italy
| | - Giuseppe Ferrante
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele (MI) , Italy
- Cardio Center, Humanitas Clinical And Research Hospital Irccs , Rozzano (MI) , Italy
| | - Bernhard Reimers
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele (MI) , Italy
- Cardio Center, Humanitas Clinical And Research Hospital Irccs , Rozzano (MI) , Italy
| | - Philippe Garot
- Institut Cardiovasculaire Paris Sud, Cmr Department , Hopital Privé Jacques Cartier, Ramsay Santé, Massy , France
| | - Nicolas Amabile
- Department Of Cardiology, Institut Mutualiste Mountsouris , Paris , France
| | - Gianluigi Condorelli
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele (MI) , Italy
- Cardio Center, Humanitas Clinical And Research Hospital Irccs , Rozzano (MI) , Italy
| | - Giulio Stefanini
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele (MI) , Italy
- Cardio Center, Humanitas Clinical And Research Hospital Irccs , Rozzano (MI) , Italy
| | - Davide Cao
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele (MI) , Italy
- Cardiovascular Department , Humanitas Gavazzeni, Bergamo , Italy
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18
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Amabile N, Bressollette E, Souteyrand G, Landolff Q, Veugeois A, Honton B. [Invasive and non-invasive imaging analysis for calcified coronary artery lesions]. Ann Cardiol Angeiol (Paris) 2022; 71:372-380. [PMID: 36220707 DOI: 10.1016/j.ancard.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 09/17/2022] [Indexed: 06/16/2023]
Abstract
Coronary calcifications are frequently identified within coronary lesions as their incidence increases with age and cardiovascular risk factors. Their location can be superficial or deep, according to different pathological process. In all cases, the presence of calcifications within the vascular wall predicts poor clinical prognosis and unfavorable evolution after percutaneous revascularization. Coronary calcifications can be analyzed by angiography, CT or intracoronary imaging (IVUS or OCT) with variable accuracies. Angiography is the most frequently used method but is not very sensitive (sensitivity close to 50%) and insufficient for their precise quantification. The CT scan is a more effective non-invasive method leading to an accurate analysis of the lesion before coronary angiography. IVUS and OCT have an excellent spatial resolution and are the most sensitive methods for the identification (present in nearly 75-80% of lesions) and quantification of calcifications. These intracoronary imaging techniques offer interesting perspectives for identification of the highest-risk lesions, PCI procedures planning (including the choice of an optimal dedicated plaque preparation devices), the monitoring of their execution and the evaluation of the immediate post-stenting results.
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Affiliation(s)
- Nicolas Amabile
- Service de Cardiologie, Institut Mutualiste Montsouris, Paris, France.
| | | | - Géraud Souteyrand
- Service de Cardiologie, CHU Gabriel Montpied, Clermont Ferrand, France
| | | | - Aurèlie Veugeois
- Service de Cardiologie, Institut Mutualiste Montsouris, Paris, France
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Biondi R, Ribeyrolles S, Diakov C, Amabile N, Ricciardi G, Khelil N, Berrebi A, Zannis K. Mapping of the myxomatous mitral valve: The three-dimensional extension of mitral annular disjunction in surgically repaired mitral prolapse. Front Cardiovasc Med 2022; 9:1036400. [DOI: 10.3389/fcvm.2022.1036400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 11/11/2022] [Indexed: 11/30/2022] Open
Abstract
ObjectivesThis study aimed to describe the heterogeneous extension of mitral annular disjunction (MAD) and assess the hypotesis that different phenotypes of disjunction are not associated with increased surgical challenges.BackgroundMitral regurgitation (MR) is the most common end-stage scenario of degenerative mitral valve disease (DMVD). Few data exist on the three-dimensional extension and geometry of MAD, as well as for its role in valvular dynamic and coaptation.MethodsA total of 85 consecutive subjects, who underwent elective mitral valve repair (MVR) for MMVD at our Institution between November 2019 and October 2021, were studied retrospectively. The extension and geometry of MAD was assessed using the digitally stored volumetric datasets of real-time 3D transesophageal echocardiography (TEE). Annular phenotypes and surgical repair techniques were analyzed.ResultsMitral annular disjunction was diagnosed in 50 out of 85 patients (59%) with Barlow disease (BD). A detailed analysis of MAD extension was conducted on 33 patients. Two pattern of disjunction were identified: a bimodal shape was highlighted in 21 patients, while a more uniform distribution of the disjuncted annulus was observed in 12 patients. The bimodal pattern was characterized by lower disjunction distance (DD) at the 140°–220° arch (3.6 ± 2.2 mm), while a more regular DD was measured in the remaining patients. All patients successfully underwent MVR. Triangular leaflet resection was performed in 58% of the cases, neochordae implantation in 9%, and notably a 27% received an isolated annuloplasty.ConclusionRather than a binary feature, MAD should be taken into account in its complex and heterogeneous morphology, where two major phenotypes can be identified. Despite its anatomical complexity, MAD was not associated with an increased surgical challenge; conversely a peculiar subgroup of patient was successfully treated with an isolated annuloplasty.
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Araki M, Park SJ, Dauerman HL, Uemura S, Kim JS, Di Mario C, Johnson TW, Guagliumi G, Kastrati A, Joner M, Holm NR, Alfonso F, Wijns W, Adriaenssens T, Nef H, Rioufol G, Amabile N, Souteyrand G, Meneveau N, Gerbaud E, Opolski MP, Gonzalo N, Tearney GJ, Bouma B, Aguirre AD, Mintz GS, Stone GW, Bourantas CV, Räber L, Gili S, Mizuno K, Kimura S, Shinke T, Hong MK, Jang Y, Cho JM, Yan BP, Porto I, Niccoli G, Montone RA, Thondapu V, Papafaklis MI, Michalis LK, Reynolds H, Saw J, Libby P, Weisz G, Iannaccone M, Gori T, Toutouzas K, Yonetsu T, Minami Y, Takano M, Raffel OC, Kurihara O, Soeda T, Sugiyama T, Kim HO, Lee T, Higuma T, Nakajima A, Yamamoto E, Bryniarski KL, Di Vito L, Vergallo R, Fracassi F, Russo M, Seegers LM, McNulty I, Park S, Feldman M, Escaned J, Prati F, Arbustini E, Pinto FJ, Waksman R, Garcia-Garcia HM, Maehara A, Ali Z, Finn AV, Virmani R, Kini AS, Daemen J, Kume T, Hibi K, Tanaka A, Akasaka T, Kubo T, Yasuda S, Croce K, Granada JF, Lerman A, Prasad A, Regar E, Saito Y, Sankardas MA, Subban V, Weissman NJ, Chen Y, Yu B, Nicholls SJ, Barlis P, West NEJ, Arbab-Zadeh A, Ye JC, Dijkstra J, Lee H, Narula J, Crea F, Nakamura S, Kakuta T, Fujimoto J, Fuster V, Jang IK. Optical coherence tomography in coronary atherosclerosis assessment and intervention. Nat Rev Cardiol 2022; 19:684-703. [PMID: 35449407 PMCID: PMC9982688 DOI: 10.1038/s41569-022-00687-9] [Citation(s) in RCA: 93] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 02/07/2023]
Abstract
Since optical coherence tomography (OCT) was first performed in humans two decades ago, this imaging modality has been widely adopted in research on coronary atherosclerosis and adopted clinically for the optimization of percutaneous coronary intervention. In the past 10 years, substantial advances have been made in the understanding of in vivo vascular biology using OCT. Identification by OCT of culprit plaque pathology could potentially lead to a major shift in the management of patients with acute coronary syndromes. Detection by OCT of healed coronary plaque has been important in our understanding of the mechanisms involved in plaque destabilization and healing with the rapid progression of atherosclerosis. Accurate detection by OCT of sequelae from percutaneous coronary interventions that might be missed by angiography could improve clinical outcomes. In addition, OCT has become an essential diagnostic modality for myocardial infarction with non-obstructive coronary arteries. Insight into neoatherosclerosis from OCT could improve our understanding of the mechanisms of very late stent thrombosis. The appropriate use of OCT depends on accurate interpretation and understanding of the clinical significance of OCT findings. In this Review, we summarize the state of the art in cardiac OCT and facilitate the uniform use of this modality in coronary atherosclerosis. Contributions have been made by clinicians and investigators worldwide with extensive experience in OCT, with the aim that this document will serve as a standard reference for future research and clinical application.
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Affiliation(s)
| | | | | | | | - Jung-Sun Kim
- Yonsei University College of Medicine, Seoul, South Korea
| | | | - Thomas W Johnson
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Adnan Kastrati
- Technische Universität München and Munich Heart Alliance, Munich, Germany
| | | | | | | | - William Wijns
- National University of Ireland Galway and Saolta University Healthcare Group, Galway, Ireland
| | | | | | - Gilles Rioufol
- Hospices Civils de Lyon and Claude Bernard University, Lyon, France
| | | | | | | | | | | | - Nieves Gonzalo
- Hospital Clinico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | | | - Brett Bouma
- Massachusetts General Hospital, Boston, MA, USA
| | | | - Gary S Mintz
- Cardiovascular Research Foundation, New York, NY, USA
| | - Gregg W Stone
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christos V Bourantas
- Barts Health NHS Trust, University College London and Queen Mary University London, London, UK
| | - Lorenz Räber
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | | | | | - Myeong-Ki Hong
- Yonsei University College of Medicine, Seoul, South Korea
| | - Yangsoo Jang
- Yonsei University College of Medicine, Seoul, South Korea
| | | | - Bryan P Yan
- Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Italo Porto
- University of Genoa, Genoa, Italy, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | | | - Rocco A Montone
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | | | - Harmony Reynolds
- New York University Grossman School of Medicine, New York, NY, USA
| | - Jacqueline Saw
- Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Libby
- Brigham and Women's Hospital, Boston, MA, USA
| | - Giora Weisz
- New York Presbyterian Hospital, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY, USA
| | | | - Tommaso Gori
- Universitäts medizin Mainz and DZHK Rhein-Main, Mainz, Germany
| | | | | | | | | | | | - Osamu Kurihara
- Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | | | | | | | - Tetsumin Lee
- Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Takumi Higuma
- Kawasaki Municipal Tama Hospital, St. Marianna University School of Medicine, Kanagawa, Japan
| | | | - Erika Yamamoto
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Krzysztof L Bryniarski
- Jagiellonian University Medical College, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, Krakow, Poland
| | | | | | | | - Michele Russo
- Catholic University of the Sacred Heart, Rome, Italy
| | | | | | - Sangjoon Park
- Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Marc Feldman
- University of Texas Health, San Antonio, TX, USA
| | | | - Francesco Prati
- UniCamillus - Saint Camillus International University of Health Sciences, Rome, Italy
| | - Eloisa Arbustini
- IRCCS Foundation University Hospital Policlinico San Matteo, Pavia, Italy
| | - Fausto J Pinto
- Santa Maria University Hospital, CHULN Center of Cardiology of the University of Lisbon, Lisbon School of Medicine, Lisbon Academic Medical Center, Lisbon, Portugal
| | - Ron Waksman
- MedStar Washington Hospital Center, Washington, DC, USA
| | | | - Akiko Maehara
- Cardiovascular Research Foundation, New York, NY, USA
| | - Ziad Ali
- Cardiovascular Research Foundation, New York, NY, USA
| | | | | | | | - Joost Daemen
- Erasmus University Medical Centre, Rotterdam, Netherlands
| | | | - Kiyoshi Hibi
- Yokohama City University Medical Center, Kanagawa, Japan
| | | | | | | | - Satoshi Yasuda
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kevin Croce
- Brigham and Women's Hospital, Boston, MA, USA
| | | | | | | | | | | | | | | | | | - Yundai Chen
- Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Bo Yu
- The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | | | - Peter Barlis
- University of Melbourne, Melbourne, Victoria, Australia
| | | | | | - Jong Chul Ye
- Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | | | - Hang Lee
- Massachusetts General Hospital, Boston, MA, USA
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Filippo Crea
- Catholic University of the Sacred Heart, Rome, Italy
| | | | | | - James Fujimoto
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Ik-Kyung Jang
- Massachusetts General Hospital, Boston, MA, USA.
- Kyung Hee University, Seoul, South Korea.
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21
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Ioppolo AM, Chiarito M, Cremonesi A, Azzano A, Miccichè E, Mangiameli A, Ferrante G, Reimers B, Garot P, Amabile N, Stefanini G, Cao D. TCT-381 Vitamin K Antagonists, Direct Oral Anticoagulants, or Left Atrial Appendage Closure for Patients With Nonvalvular Atrial Fibrillation: A Systematic Review and Network Meta-Analysis. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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22
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Amabile N, Masri A, Mahmoudi K, Diakov C, Del Giudice C. Percutaneous Coiling for Late-Acquired Peri-Device Leak Following Left Atrial Appendage Occlusion. JACC Case Rep 2022; 4:962-966. [PMID: 35935153 PMCID: PMC9350899 DOI: 10.1016/j.jaccas.2022.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 05/31/2022] [Indexed: 11/24/2022]
Abstract
A 77-year-old patient with previous left atrial appendage (LAA) closure suffered from transient ischemic attack 6 years after the initial procedure. Computed tomography (CT) revealed appendage patency related to a late-acquired semicircular peri-device leak. The leak was treated by percutaneous LAA coiling. Subsequent clinical evolution was uneventful. (Level of Difficulty: Advanced.)
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23
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Honton B, Lipiecki J, Monségu J, Leroy F, Benamer H, Commeau P, Motreff P, Cayla G, Banos JL, Bouchou G, Laperche C, Farah B, Rangé G, Lefèvre T, Amabile N. Mid-term outcome of de novo lesions vs. in stent restenosis treated by intravascular lithotripsy procedures: Insights from the French Shock Initiative. Int J Cardiol 2022; 365:106-111. [PMID: 35870637 DOI: 10.1016/j.ijcard.2022.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Intravascular lithotripsy (IVL) is a promising new technology for disrupting de-novo calcified coronary lesions (DNL) before percutaneous coronary intervention (PCI). We assessed 12-month outcomes of IVL in patients undergoing PCI for DNL or intra stent restenosis (ISR) lesions related to device underexpansion. METHODS Prospective analysis of patients in the multicentre all-comers French Shock Initiative IVL registry. The primary safety endpoints in this analysis were in-hospital and 12-month major adverse cardiovascular events (MACE: cardiac death, myocardial infarction or target vessel revascularization). The primary effectiveness endpoint was procedural success, defined as <30% residual stenosis without severe angiographic complications. Event rates were analysed for the cohort and for DNL and ISR procedures separately. RESULTS A total of 220 lesions were treated (76.7% DNL and 23.3% ISR) in 202 patients. Procedural success was achieved in 95.5% of patients (DNL group: 96.5%; ISR group: 92.0%). In-hospital MACE occurred in 6.4% of cases, mainly driven by periprocedural infarctions. The rate of MACE-free survival at 1 year was 86.6% in the overall cohort. Rates of target vessel (TVR) and lesion (TLR) revascularisation were 6.4% and 2.5%, respectively. The 1-year MACE rate was 91.5% in DNL group and 83.8% in ISR group. CONCLUSIONS In this large all-comers IVL cohort, rates of in-hospital and 1-year MACE were moderate. The safety and efficiency of IVL was comparable in DNL and ISR lesions. A comparative study of the impact of IVL on outcomes appears warranted.
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Affiliation(s)
- Benjamin Honton
- Department of Interventional Cardiology, Clinique Pasteur, Toulouse, France.
| | - Janusz Lipiecki
- Department of Interventional Cardiology, Pole Santé République, Clermont-Ferrand, France
| | - Jacques Monségu
- Department of Interventional Cardiology, Institut Cardio Vasculaire, Groupe Hospitalier Mutualiste, Grenoble, France
| | - Fabrice Leroy
- Department of Interventional Cardiology, Clinique La Louviere, Lille, France
| | - Hakim Benamer
- Department of Interventional Cardiology, Hôpital La Roseraie, Aubervilliers, France
| | - Philippe Commeau
- Department of Interventional Cardiology, Polyclinique Les Fleurs, Ollioules, France
| | - Pascal Motreff
- Department of Interventional Cardiology, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Guillaume Cayla
- Department of Interventional Cardiology, Nimes University Hospital, University of Montpellier-Nimes, France
| | - Jean Luc Banos
- Department of Interventional Cardiology, Centre cardiologique du Pays Basque, Bayonne, France
| | - Gael Bouchou
- Department of Interventional Cardiology, Saint Etienne University Hospital, Saint Etienne, France
| | - Clémence Laperche
- Department of Interventional Cardiology, Clinique Pasteur, Toulouse, France
| | - Bruno Farah
- Department of Interventional Cardiology, Clinique Pasteur, Toulouse, France
| | - Grégoire Rangé
- Department of Interventional Cardiology, Centre Hospitalier, Chartres, France
| | - Thierry Lefèvre
- Department of Interventional Cardiology, Institut Cardio-Vasculaire Paris Sud, Ramsay Générale de Santé, Massy, France
| | - Nicolas Amabile
- Department of Interventional Cardiology, Institut Mutualiste Montsouris, Paris, France
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24
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Sebag FA, Garot P, Galea R, de Backer O, Lepillier A, De Meesteer A, Hildick-Smith D, Armero S, Moubarak G, Ducrocq G, Eschalier R, Aminian A, Sauguet A, Lellouche N, Mahmoudi K, Räber L, Amabile N. Left atrial appendage closure for thrombus trapping: the international, multicentre TRAPEUR registry. EUROINTERVENTION 2022; 18:50-57. [PMID: 34794937 PMCID: PMC9903160 DOI: 10.4244/eij-d-21-00713] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Although the presence of a thrombus contraindicates left atrial appendage closure procedure (LAAC), a previous study reported the feasibility of the thrombus trapping procedure (TTP) technique to overcome this limitation. AIMS This study aimed to analyse the short-term outcomes in a series of patients who underwent LAAC using the TTP (TTP-LAAC). METHODS This retrospective series included patients who underwent TTP-LAAC between January 2018 and May 2020 in 13 European centres. Device choice, pre-interventional work-up and post-discharge antithrombotic therapy regimens were left to the discretion of the operators. The primary endpoint was the 30-day occurrence of stroke, systemic embolism or cardiovascular death. RESULTS During the study period, a total of 1,918 patients underwent LAAC. A thrombus was identified in 71 cases but completely disappeared in 24 patients before procedure. TTP-LAAC was finally performed in 53 cases (3%). Thrombi were identified ahead of the actual day of implantation in 47 patients (87%) and were mostly limited in size (50 cases with extension <50% of the LAA surface). The Amplatzer Amulet and WATCHMAN FLX occluders were implanted in 44 and 9 patients, respectively. A single deployment approach was applied in 70% and a cerebral embolic protection system was used in 9% of the patients. The overall success rate was 100%. Small pericardial effusion without tamponade was observed in 6% of the cases. Patients were discharged with 72% under antiplatelet therapy and 10% under short-term oral anticoagulation. The primary endpoint occurred in one patient. CONCLUSIONS TTP-LAAC might be used in a minority of LAAC procedures but appears to be feasible and safe in the short-term, in select cases.
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Affiliation(s)
- Frederic A. Sebag
- Service de Cardiologie, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014 Paris, France
| | - Philippe Garot
- Hôpital Privé Jacques Cartier, Institut Cardiovasculaire Paris Sud (ICPS), Ramsay Santé, Massy, France
| | - Roberto Galea
- Department of Cardiology, Inselspital, Bern, Switzerland
| | - Ole de Backer
- Department of Cardiology, Rigshospital, Copenhagen, Denmark
| | - Antoine Lepillier
- Department of Cardiology, Centre Cardiologique du Nord, Saint Denis, France
| | | | - David Hildick-Smith
- Cardiology Department, Royal Sussex Cardiac Centre, Brighton, United Kingdom
| | | | | | - Gregory Ducrocq
- Department of Cardiology, Hôpital Bichat - Claude-Bernard, Paris, France
| | - Romain Eschalier
- Department of Cardiology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Adel Aminian
- Department of Cardiology, C.H.U. de Charleroi, Charleroi, Belgium
| | | | | | - Khalil Mahmoudi
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Lorenz Räber
- Department of Cardiology, Inselspital, Bern, Switzerland
| | - Nicolas Amabile
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
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25
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Galea R, Mahmoudi K, Gräni C, Elhadad S, Huber AT, Heg D, Siontis GCM, Brugger N, Sebag F, Windecker S, Valgimigli M, Landolff Q, Roten L, Amabile N, Räber L. Watchman FLX vs. Watchman 2.5 in a Dual-Center Left Atrial Appendage Closure Cohort: the WATCH-DUAL study. Europace 2022; 24:1441-1450. [PMID: 35253840 DOI: 10.1093/europace/euac021] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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: 10/27/2021] [Accepted: 02/09/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS No studies have compared Watchman 2.5 (W2.5) with Watchman FLX (FLX) devices to date. We aimed at comparing the FLX with W2.5 devices with respect to clinical outcomes, left atrial appendage (LAA) sealing properties and device-related thrombus (DRT). METHODS AND RESULTS All consecutive left atrial appendage closure (LAAC) procedures performed at two European centres between November 2017 and February 2021 were included. Procedure-related complications and net adverse cardiovascular events (NACE) at 6 months after LAAC were recorded. At 45-day computed tomography (CT) follow-up, intra- (IDL) and peri- (PDL) device leak, residual patent neck area (RPNA), and DRT were assessed by a Corelab. Out of 144 LAAC consecutive procedures, 71 and 73 interventions were performed using W2.5 and FLX devices, respectively. There were no differences in terms of procedure-related complications (4.2% vs. 2.7%, P = 0.626). At 45-day CT, the FLX was associated with lower frequency of IDL [21.3% vs. 40.0%; P = 0.032; odds ratio (OR): 0.375; 95% confidence interval (CI): 0.160-0.876; P = 0.024], similar rate of PDL (29.5% vs. 42.0%; P = 0.170), and smaller RPNA [6 (0-36) vs. 40 (6-115) mm2; P = 0.001; OR: 0.240; 95% CI: 0.100-0.577; P = 0.001] compared with the W2.5 group. At 45 days, rate of DRT as detected by CT and/or transoesophageal echocardiography (TOE), was higher with W2.5 (6.0% vs. 0%, P = 0.045). At 6-month follow-up, NACE did not differ between groups. CONCLUSIONS In this cohort of consecutive LAACs, FLX as compared to W2.5, was associated with similar procedure-related complications and 6-month NACE, but with improved LAA neck coverage, and lower IDL and DRT.
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Affiliation(s)
- Roberto Galea
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland
| | - Khalil Mahmoudi
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland
| | - Simon Elhadad
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France.,Cardiology Department, Jossigny, France
| | - Adrian T Huber
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland
| | - Dik Heg
- Clinical Trials Unit, University of Bern, Bern, Switzerland
| | - George C M Siontis
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland
| | - Frederic Sebag
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland
| | - Marco Valgimigli
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland.,Cardiocentro Ticino, Institute and Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Quentin Landolff
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland
| | - Nicolas Amabile
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Lorenz Räber
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland
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26
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Massoullié G, Ploux S, Mondoly P, Souteyrand G, Pereira B, Jean F, Amabile N, Irles D, Mansourati J, Combaret N, Mechulan X, Badoz M, Da Costa A, Defaye P, Clerfond G, Bordachar P, Eschalier R. Occurrence of high-grade conduction disorder after the onset of left bundle branch block in post-TAVI. The French multicenter LBBB-TAVI study. Archives of Cardiovascular Diseases Supplements 2022. [DOI: 10.1016/j.acvdsp.2021.09.170] [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: 11/29/2022]
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27
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Mahmoudi K, Galea R, Elhadad S, Rezine LZ, Sebag F, Landolff Q, Raber L, Amabile N. Left atrial appendage remodeling following percutaneous closure with WATCHMAN 2.5 and FLX: insights from the WATCH-DUAL registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Percutaneous left atrial appendage closure (LAAC) has emerged as a valid option for prevention of thromboembolic events in patients with non-valvular atrial fibrillation and contraindications for oral anticoagulation. The most recent devices have been created to improve the intervention efficiency and to allow the procedure in a wider range of anatomies. The new-generation Watchman FLX (WMFLX) features a new design but its in vivo performances have not been compared to the previous WATCHMAN 2.5 (WM2.5) prosthesis. Hence, the data regarding conformability, compression and device-related LAA remodeling are scarce.
Purpose
To compare the anatomical results of WM2.5 and WMFLX implantation and impact on LAA dimensions.
Methods
This study included LAAC patients from the WATCH-DUAL registry who benefited from a pre- and post-intervention CT scan. The WATCH-DUAL study was a dual center observational study including all the LAAC procedures prospectively collected in local registries from two high-volume centres between November 2017 and December 2020. The LAA and device dimensions were measured in a centralized core lab by 3D CT scan reconstruction methods, focusing on the device landing zone (LZ/defined as the cross section of the appendage that was perpendicular to its axis and connected the circumflex artery to a point 1 to 2 cm inside the LAA).
Results
This analysis included n=107 patients (n=58 WMFLX, n=49 WM2.5). The patients clinical profiles didn't differ, except for a higher proportion of coronary artery disease in WM2.5 group. The LAA dimensions were comparable between groups. There was a significantly higher proportion of chickenwing shapes in the WMFLX patients. The mean device baseline diameter was in the WMFLX compared to the WM2.5 patients (28.8±0.5 vs. 25.7±0.4 mm, p<0.001).
The median delay for CT control was 48 (43–62) days. The LZ area (451 (363–521) vs. 366 (260–459) mm2, p<0.001) and minimal diameter (23.0 (20.7–24.8) vs. 18.7 (15.9–21.8) mm, p<0.001) significantly increased after implantation among patients. The LZ area increase absolute value and percentage were 101 (18–151) mm2 and 28 (4–54) % respectively. The LZ dimensions increase was more pronounced in the WMFLX group: these patients exhibited post LAAC larger LZ area and dimensions compared to the WM2.5 cases. The LAA eccentricity was reduced after implantation: the ratio LZ maximal/LZ minimal diameter significantly decreased for all patients (r=1.28 (1.18–1.40) vs. 1.06 (1.05–1.09), p<0.001). Comparable results were observed in WMFLX and WM2.5 patients.
A multivariable regression analysis demonstrated that baseline LAA length, baseline LZ eccentricity and WM FLX use were independent predictors of LAA remodeling/dimensions increase.
Conclusion
LAA dimensions increased over time at the site of WM prosthesis implantation suggesting a local positive appendage remodeling after procedure. This phenomenon appears to be more pronounced with the WMFLX device.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K Mahmoudi
- Institut Mutualiste Montsouris, Paris, France
| | - R Galea
- Inselspital - University of Bern, Bern, Switzerland
| | - S Elhadad
- JOSSIGNY SITE OF GHEF MARNE LA VALLEE, Jossigny, France
| | - L Z Rezine
- JOSSIGNY SITE OF GHEF MARNE LA VALLEE, Jossigny, France
| | - F Sebag
- Institut Mutualiste Montsouris, Paris, France
| | - Q Landolff
- Institut Mutualiste Montsouris, Paris, France
| | - L Raber
- Inselspital - University of Bern, Bern, Switzerland
| | - N Amabile
- Institut Mutualiste Montsouris, Paris, France
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28
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Zannis K, Biondi R, Diakov C, Dreyfus G, Foussier C, Paul JF, Amabile N. Mitral Annular Disjunction: An Additional Player Into Barlow's Coaptation Loss. Circ Cardiovasc Imaging 2021; 14:e012571. [PMID: 34428916 DOI: 10.1161/circimaging.121.012571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Konstantinos Zannis
- Department of Cardiovascular Surgery (K.Z., R.B., G.D.), Institut Mutualiste Montsouris, Paris, France
| | - Raoul Biondi
- Department of Cardiovascular Surgery (K.Z., R.B., G.D.), Institut Mutualiste Montsouris, Paris, France
| | - Christelle Diakov
- Department of Cardiology (C.D., N.A.), Institut Mutualiste Montsouris, Paris, France
| | - Gilles Dreyfus
- Department of Cardiovascular Surgery (K.Z., R.B., G.D.), Institut Mutualiste Montsouris, Paris, France
| | - Cedric Foussier
- Department of Radiology (F.C., J.-F.P.), Institut Mutualiste Montsouris, Paris, France
| | - Jean-François Paul
- Department of Radiology (F.C., J.-F.P.), Institut Mutualiste Montsouris, Paris, France
| | - Nicolas Amabile
- Department of Cardiology (C.D., N.A.), Institut Mutualiste Montsouris, Paris, France
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Boulanger CM, Loyer X, Coly PM, Amabile N. Messages from the heart. Eur Heart J 2021; 42:2793-2795. [PMID: 34115830 DOI: 10.1093/eurheartj/ehab323] [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] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Xavier Loyer
- Université de Paris, PARCC, INSERM UMR 970, Paris, France
| | | | - Nicolas Amabile
- Université de Paris, PARCC, INSERM UMR 970, Paris, France.,Cardiology Department, Institut Mutualiste Montsouris, Paris, France
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30
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Ribeyrolles S, Rohnean A, Amabile N, Paul JF. Comprehensive diagnosis of septal myocardial infarction using optimized delayed enhancement cardiac computed tomography. Eur Heart J Cardiovasc Imaging 2021; 21:1004. [PMID: 32402063 DOI: 10.1093/ehjci/jeaa078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/24/2020] [Accepted: 03/31/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sophie Ribeyrolles
- Department of Cardiovascular Medicine, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014 Paris, France
| | - Adela Rohnean
- Department of Cardiovascular Imaging, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014 Paris, France
| | - Nicolas Amabile
- Department of Cardiovascular Medicine, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014 Paris, France
| | - Jean-François Paul
- Department of Cardiovascular Imaging, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014 Paris, France
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31
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Amabile N, Rangé G, Souteyrand G, Godin M, Boussaada M, Meneveau N, Cayla G, Casassus F, Lefèvre T, Hakim R, Bagdadi I, Motreff P, Caussin C. Optical coherence tomography to guide percutaneous coronary intervention of the left main coronary artery: the LEMON study. EUROINTERVENTION 2021; 17:e124-e131. [PMID: 33226003 PMCID: PMC9724912 DOI: 10.4244/eij-d-20-01121] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Intravascular ultrasound (IVUS)-guided PCI improves the prognosis of left main stem (LMS) PCI and is currently recommended by international guidelines. Although OCT resolution is greater than that of IVUS, this tool is not yet recommended in LMS angioplasty due to the absence of data. AIMS This pilot study aimed to analyse the feasibility, safety and impact of OCT-guided LMS PCI. METHODS This prospective, multicentre trial investigated whether patients might benefit from OCT-guided PCI for mid/distal LMS according to a pre-specified protocol. The primary endpoint was procedural success defined as follows: residual angiographic stenosis <50% + TIMI 3 flow in all branches + adequate OCT stent expansion (LEMON criteria). RESULTS Seventy patients were included in the final analysis (median age: 72 [64-81] years, 73% male). The OCT pre-specified protocol was applied in all patients. The primary endpoint was achieved in 86% of subjects. Adequate stent expansion was observed in 86%, significant edge dissection in 30% and residual significant strut malapposition in 24% of the cases. OCT guidance modified the operators' strategy in 26% of the patients. The rate of one-year survival free from major adverse clinical events was 98.6% (97.2-100). CONCLUSIONS This pilot study is the first to report the feasibility and performance of OCT-guided LMS PCI according to a pre-specified protocol.
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Affiliation(s)
- Nicolas Amabile
- Department of Cardiology, Institut Mutualiste Montsouris, 42 Bd Jourdan, 75014 Paris, France
| | - Grégoire Rangé
- Cardiology Department, Les Hôpitaux de Chartres, Chartres, France
| | - Geraud Souteyrand
- Department of Cardiology, University Hospital Gabriel Montpied, and Université d’Auvergne, Clermont Ferrand, France
| | - Matthieu Godin
- Cardiology Department, Clinique St Hilaire, Rouen, France
| | - Mohamed Boussaada
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Nicolas Meneveau
- Department of Cardiology, EA3920, University Hospital Jean Minjoz, Besançon, France
| | - Guillaume Cayla
- Cardiology Department, CHU Nimes, University of Montpellier, Nimes, France
| | | | - Thierry Lefèvre
- Institut Cardio-Vasculaire Paris Sud, Hopital Privé Jacques Cartier, Massy, France
| | - Radwane Hakim
- Cardiology Department, Les Hôpitaux de Chartres, Chartres, France
| | - Imane Bagdadi
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Pascal Motreff
- Department of Cardiology, University Hospital Gabriel Montpied, and Université d’Auvergne, Clermont Ferrand, France
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Belguidoum S, Meneveau N, Motreff P, Ohlman P, Boussaada M, Silvain J, Guillon B, Descotes-Genon V, Lefrançois Y, Morel O, Amabile N. Relationship between stent expansion and fractional flow reserve after percutaneous coronary intervention: a post hoc analysis of the DOCTORS trial. EUROINTERVENTION 2021; 17:e132-e139. [PMID: 32392171 PMCID: PMC9724874 DOI: 10.4244/eij-d-19-01103] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The best criteria for adequate stent expansion assessment by intracoronary imaging remain debated and their correlation with post-PCI FFR values is unknown. AIMS This study aimed to analyse the relationship between stent expansion criteria using optical coherence tomography (OCT) analysis and the final PCI functional result. METHODS This post hoc analysis of the DOCTORS study included non-ST-elevation segment ACS patients undergoing OCT-guided PCI. The procedure functional result was assessed by the measurement of fractional flow reserve (FFR). Stent expansion was assessed on OCT runs according to the DOCTORS criteria and ILUMIEN III criteria. RESULTS The study included N=116 patients (age: 60.8±11.5 years; male gender: 71%). The final expansion was considered optimal in 10%, acceptable in 9% and unacceptable in 81% of the stents according to ILUMIEN III criteria, although being successful in 70% of the patients according to the DOCTORS criteria. Hypertension and larger proximal reference segment dimension were independent predictors of inadequate device ILUMIEN III expansion. FFR values were, respectively, 0.93 (0.91-0.95) versus 0.95 (0.92-0.97) in patients with optimal+acceptable versus unacceptable ILUMIEN III expansion (p=0.22), 0.94 (0.91-0.97) versus 0.95 (0.93-0.97) in patients with optimal versus non-optimal DOCTORS expansion (p=0.23), and 0.95 (0.92-0.97) versus 0.92 (0.90-0.95) in patients with minimal stent area ≥4.5 mm2 versus <4.5 mm2 (p=0.03). CONCLUSIONS In this selected population, no relationship was observed between optimal stent expansion according to ILUMIEN III or DOCTORS OCT criteria and final post-PCI FFR values.
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Affiliation(s)
- Salim Belguidoum
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Nicolas Meneveau
- Department of Cardiology, University Hospital Jean Minjoz, Besançon, France
| | - Pascal Motreff
- Department of Cardiology, University Hospital Gabriel Montpied, and Université d’Auvergne, Clermont Ferrand, France
| | - Patrick Ohlman
- Department of Cardiology, Nouvel Hôpital Civil, Strasbourg, France
| | - Mohamed Boussaada
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Johanne Silvain
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Benoit Guillon
- Department of Cardiology, University Hospital Jean Minjoz, Besançon, France
| | | | | | - Olivier Morel
- Department of Cardiology, Nouvel Hôpital Civil, Strasbourg, France
| | - Nicolas Amabile
- Department of Cardiology, Institut Mutualiste Montsouris, 42 Bd Jourdan, 75014 Paris, France
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33
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Dibie A, Landolff Q, Veugeois A, Amabile N. Chimney technique in a TAVR-in-TAVR procedure with high risk of left main artery ostium occlusion. Eur Heart J 2021; 42:1051. [PMID: 33188594 DOI: 10.1093/eurheartj/ehaa817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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34
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Dvir D, Simonato M, Amat-Santos I, Latib A, Kargoli F, Nombela-Franco L, Agrifoglio M, Giannini F, Regazzoli D, Reimers B, Villa E, M Becerra-Muñoz V, Mennuni M, Rognoni A, Modine T, Leroux L, Estévez-Loureiro R, Nerla R, Castriota F, Cerillo A, Søndergaard L, Iadanza A, Duncan A, Vincent F, Mancone M, Birtolo L, Maestrini V, Testa L, Wojakowski W, Salizzoni S, Esteves V, Mangione F, Zukowski C, Amabile N, Shuvy M, Stone GW. Severe Valvular Heart Disease and COVID-19: Results from the Multicenter International Valve Disease Registry. Struct Heart 2021; 5:424-426. [PMID: 35340822 PMCID: PMC8935903 DOI: 10.1080/24748706.2021.1908646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/22/2021] [Accepted: 03/04/2021] [Indexed: 01/10/2023]
Affiliation(s)
- Danny Dvir
- Shaare Zedek Medical Centre, Hebrew University, Jerusalem, Israel.,Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Matheus Simonato
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Ignacio Amat-Santos
- Cardiac Catheterization and Interventional Cardiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Azeem Latib
- Interventional Cardiology & Structural Heart Interventions, Montefiore Medical Center, New York, New York, USA
| | - Faraj Kargoli
- Interventional Cardiology & Structural Heart Interventions, Montefiore Medical Center, New York, New York, USA
| | | | | | - Francesco Giannini
- GVM Care and Research, Unit of Interventional Cardiology, Maria Cecilia Hospital, Cotignola, Italy
| | - Damiano Regazzoli
- Cardiac Center, Humanitas Clinical and Research Hospital, IRCCS, Rozzano, Milan, Italy
| | - Bernhard Reimers
- Cardiac Center, Humanitas Clinical and Research Hospital, IRCCS, Rozzano, Milan, Italy
| | - Emmanuel Villa
- Cardio-Surgery Operating Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Victor M Becerra-Muñoz
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Málaga, Spain
| | - Marco Mennuni
- Emodinamica e cardiologia interventistica, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Andrea Rognoni
- Emodinamica e cardiologia interventistica, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Thomas Modine
- Service Médico-Chirurgical, Valvulopathies - Chirurgie Cardiaque - Cardiologie Interventionnelle Structurelle, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Lionel Leroux
- Service Médico-Chirurgical, Valvulopathies - Chirurgie Cardiaque - Cardiologie Interventionnelle Structurelle, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | | | - Roberto Nerla
- Cardiologia Interventistica, Humanitas Gavazzeni, Bergamo, Italy
| | - Fausto Castriota
- Cardiologia Interventistica, Humanitas Gavazzeni, Bergamo, Italy
| | - Alfredo Cerillo
- Cardiochirurgia, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | | | - Alessandro Iadanza
- Cardiovascular Department, Invasive Cardiology, Ospedale Le Scotte, Siena, Italy
| | - Alison Duncan
- Department of Echocardiography, Royal Brompton Hospital, London, UK
| | - Flavien Vincent
- Institut Cœur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Massimo Mancone
- Cardio-Toraco-Vascolare, Chirurgia dei Trapianti d'Organo, Policlinico Umberto I, Rome, Italy
| | - Lucia Birtolo
- Cardio-Toraco-Vascolare, Chirurgia dei Trapianti d'Organo, Policlinico Umberto I, Rome, Italy
| | - Viviana Maestrini
- Cardio-Toraco-Vascolare, Chirurgia dei Trapianti d'Organo, Policlinico Umberto I, Rome, Italy
| | - Luca Testa
- Coronary Revascularization Unit, Policlinico San Donato, Milan, Italy
| | - Wojtek Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | - Vinicius Esteves
- Cardiologia Intervencionista, Hospital São Luiz, São Paulo, Brazil
| | - Fernanda Mangione
- Hemodinâmica e Cardiologia Intervencionista, Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - Cleverson Zukowski
- Hemodinâmica e Cardiologia Invasiva, Hospital Copa D'or, Rio de Janeiro, Brazil
| | | | - Mony Shuvy
- Hadassah Medical Centre, Hebrew University, Jerusalem, Israel
| | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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35
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Simonato M, Whisenant B, Ribeiro HB, Webb JG, Kornowski R, Guerrero M, Wijeysundera H, Søndergaard L, De Backer O, Villablanca P, Rihal C, Eleid M, Kempfert J, Unbehaun A, Erlebach M, Casselman F, Adam M, Montorfano M, Ancona M, Saia F, Ubben T, Meincke F, Napodano M, Codner P, Schofer J, Pelletier M, Cheung A, Shuvy M, Palma JH, Gaia DF, Duncan A, Hildick-Smith D, Veulemans V, Sinning JM, Arbel Y, Testa L, de Weger A, Eltchaninoff H, Hemery T, Landes U, Tchetche D, Dumonteil N, Rodés-Cabau J, Kim WK, Spargias K, Kourkoveli P, Ben-Yehuda O, Teles RC, Barbanti M, Fiorina C, Thukkani A, Mackensen GB, Jones N, Presbitero P, Petronio AS, Allali A, Champagnac D, Bleiziffer S, Rudolph T, Iadanza A, Salizzoni S, Agrifoglio M, Nombela-Franco L, Bonaros N, Kass M, Bruschi G, Amabile N, Chhatriwalla A, Messina A, Hirji SA, Andreas M, Welsh R, Schoels W, Hellig F, Windecker S, Stortecky S, Maisano F, Stone GW, Dvir D. Transcatheter Mitral Valve Replacement After Surgical Repair or Replacement. Circulation 2021; 143:104-116. [DOI: 10.1161/circulationaha.120.049088] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Mitral valve-in-valve (ViV) and valve-in-ring (ViR) are alternatives to surgical reoperation in patients with recurrent mitral valve failure after previous surgical valve repair or replacement. Our aim was to perform a large-scale analysis examining midterm outcomes after mitral ViV and ViR.
Methods:
Patients undergoing mitral ViV and ViR were enrolled in the Valve-in-Valve International Data Registry. Cases were performed between March 2006 and March 2020. Clinical endpoints are reported according to the Mitral Valve Academic Research Consortium (MVARC) definitions. Significant residual mitral stenosis (MS) was defined as mean gradient ≥10 mm Hg and significant residual mitral regurgitation (MR) as ≥ moderate.
Results:
A total of 1079 patients (857 ViV, 222 ViR; mean age 73.5±12.5 years; 40.8% male) from 90 centers were included. Median STS-PROM score 8.6%; median clinical follow-up 492 days (interquartile range, 76–996); median echocardiographic follow-up for patients that survived 1 year was 772.5 days (interquartile range, 510–1211.75). Four-year Kaplan-Meier survival rate was 62.5% in ViV versus 49.5% for ViR (
P
<0.001). Mean gradient across the mitral valve postprocedure was 5.7±2.8 mm Hg (≥5 mm Hg; 61.4% of patients). Significant residual MS occurred in 8.2% of the ViV and 12.0% of the ViR patients (
P
=0.09). Significant residual MR was more common in ViR patients (16.6% versus 3.1%;
P
<0.001) and was associated with lower survival at 4 years (35.1% versus 61.6%;
P
=0.02). The rates of Mitral Valve Academic Research Consortium–defined device success were low for both procedures (39.4% total; 32.0% ViR versus 41.3% ViV;
P
=0.01), mostly related to having postprocedural mean gradient ≥5 mm Hg. Correlates for residual MS were smaller true internal diameter, younger age, and larger body mass index. The only correlate for residual MR was ViR. Significant residual MS (subhazard ratio, 4.67; 95% CI, 1.74–12.56;
P
=0.002) and significant residual MR (subhazard ratio, 7.88; 95% CI, 2.88–21.53;
P
<0.001) were both independently associated with repeat mitral valve replacement.
Conclusions:
Significant residual MS and/or MR were not infrequent after mitral ViV and ViR procedures and were both associated with a need for repeat valve replacement. Strategies to improve postprocedural hemodynamics in mitral ViV and ViR should be further explored.
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Affiliation(s)
- Matheus Simonato
- The Cardiovascular Research Foundation, New York (M.Simonato, G.W.S., O.B-Y.)
- Escola Paulista de Medicina – Universidade Federal de São Paulo, São Paulo, Brazil (M.Simonato, J.H.P., D.F.G.)
| | | | - Henrique Barbosa Ribeiro
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil (H.B.R., J.H.P.)
| | - John G. Webb
- St. Paul’s Hospital, Vancouver, Canada (J.G.W., A.Cheung, U.L.)
| | - Ran Kornowski
- Rabin Medical Center, Petah Tikva, Israel (R.K., P.C.)
| | | | | | | | | | | | | | | | - Jörg Kempfert
- Deutsches Herzzentrum Berlin, Berlin, Germany (J.K., A.U.)
| | - Axel Unbehaun
- Deutsches Herzzentrum Berlin, Berlin, Germany (J.K., A.U.)
| | | | | | | | | | - Marco Ancona
- I.R.C.C.S. Ospedale San Raffaele, Milan, Italy (M.M., M.Ancona)
| | | | - Timm Ubben
- Asklepios Klinik St. Georg, Hamburg, Germany (T.U., F.Meincke)
| | - Felix Meincke
- Asklepios Klinik St. Georg, Hamburg, Germany (T.U., F.Meincke)
| | | | - Pablo Codner
- Rabin Medical Center, Petah Tikva, Israel (R.K., P.C.)
| | | | - Marc Pelletier
- University Hospitals Harrington Heart and Vascular Institute, Cleveland, OH (M.P.)
| | - Anson Cheung
- St. Paul’s Hospital, Vancouver, Canada (J.G.W., A.Cheung, U.L.)
| | - Mony Shuvy
- Hadassah Medical Center, Jerusalem, Israel (M.Shuvy)
| | - José Honório Palma
- Escola Paulista de Medicina – Universidade Federal de São Paulo, São Paulo, Brazil (M.Simonato, J.H.P., D.F.G.)
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil (H.B.R., J.H.P.)
| | - Diego Felipe Gaia
- Escola Paulista de Medicina – Universidade Federal de São Paulo, São Paulo, Brazil (M.Simonato, J.H.P., D.F.G.)
| | - Alison Duncan
- The Royal Brompton Hospital, London, United Kingdom (A.D.)
| | | | | | | | - Yaron Arbel
- Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel (Y.A.)
| | - Luca Testa
- I.R.C.C.S. Policlinico San Donato, Milan, Italy (L.T.)
| | - Arend de Weger
- Leids Universitair Medisch Centrum, Leiden, the Netherlands (A.d.W.)
| | | | | | - Uri Landes
- St. Paul’s Hospital, Vancouver, Canada (J.G.W., A.Cheung, U.L.)
| | | | | | - Josep Rodés-Cabau
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Canada (J.R-C.)
| | | | | | | | - Ori Ben-Yehuda
- The Cardiovascular Research Foundation, New York (M.Simonato, G.W.S., O.B-Y.)
- University of California San Diego (O.B-Y.)
| | | | - Marco Barbanti
- Università degli Studi di Catania, Catania, Italy (M.B.)
| | | | | | | | - Noah Jones
- Mount Carmel Health System, Columbus, OH (N.J.)
| | | | | | | | | | - Sabine Bleiziffer
- Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany (S.B.)
| | | | | | - Stefano Salizzoni
- Città della Salute e della Scienza - “Molinette” Hospital, Torino, Italy (S.Salizzoni)
| | | | | | | | - Malek Kass
- University of Manitoba, Winnipeg, Canada (M.K.)
| | | | | | - Adnan Chhatriwalla
- Saint Luke’s Mid America Heart Institute, Kansas City, MO (A.Chhatriwalla)
| | - Antonio Messina
- Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (A.M.)
| | | | - Martin Andreas
- Medizinische Universität Wien, Vienna, Austria (M.Andreas)
| | | | | | - Farrel Hellig
- Sunninghill Hospital, Johannesburg, South Africa (F.H.)
| | | | | | | | - Gregg W. Stone
- The Cardiovascular Research Foundation, New York (M.Simonato, G.W.S., O.B-Y.)
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (G.W.S.)
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Le Breton C, Lansac E, Amabile N, Khelil N, Berrebi A, Mankoubi L, Noghin M, Debauchez M, Monin J. Standardization of bicuspid valve repair with aortic annuloplasty provides similar results to tricuspid aortic valve repair. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Bicuspid aortic valves (BAV) represent the main cause of severe dystrophic aortic insufficiency in young patients and are mostly replaced with high rates of valve-related events and altered quality of life in case of mechanical prosthesis. Valve repair is now recommended for root aneurysm and tricuspid aortic valves (TAV) when feasible. However, concerns remain regarding the long-term durability of BAV repair, compared to TAV.
Purpose
Our objective is to compare the long-term results of repair between TAV and BAV, in consecutive patients operated on with a standardized approach according to each phenotype of the dystrophic ascending aorta.
Methods
Data were prospectively collected into the multicenter international AVIATOR registry (AorticValve repair InternATiOnal Registry). Between 2003 and 2019, according to ascending aorta phenotypes, 226 patients with BAV and 309 patients with TAV underwent either isolated valve repair with external ring annuloplasty (26,2%), or root remodeling with external ring (59,4%), or a supra-coronary graft with external ring (14,4%).
Results
Cusp repair was performed in 95,1% patients in the BAV group and in 63,8% in the TAV group. The 30-day operative mortality was 0,93% (n=5). Mean follow-up was 5,5±4,4 years. The actuarial survival rate at 12 years was 93,2% in the BAV group and 87,8% in the TAV group (p=0,14). Freedom from reoperation at 12 years was similar between groups being 94,9% for bicuspid and 93,2% for tricuspid (p=0,75). Freedom from major adverse valve-related events at 12 years was 82,8% and 82,9% in BAV and TAV groups respectively (p=0,17). At 12 years, freedom from AI ≥Grade 2 or ≥Grade 3 was 68,7% and 94,3% for BAV and 76,5% and 94,7% for TAV group, with no significant difference (respectively p=0,16 and p=0,92).
Conclusion
Aortic valve repair with a standardized approach adapted to the aorta phenotype provides excellent long-term results with a low rate of valve-related events. Similar results were achieved between BAV and TAV patients.
freedom from reoperation for BAV and TAV
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- C Le Breton
- MONTSOURIS MUTUALIST INSTITUTE, Paris, France
| | - E Lansac
- MONTSOURIS MUTUALIST INSTITUTE, Paris, France
| | - N Amabile
- MONTSOURIS MUTUALIST INSTITUTE, Paris, France
| | - N Khelil
- MONTSOURIS MUTUALIST INSTITUTE, Paris, France
| | - A Berrebi
- MONTSOURIS MUTUALIST INSTITUTE, Paris, France
| | - L Mankoubi
- MONTSOURIS MUTUALIST INSTITUTE, Paris, France
| | - M Noghin
- MONTSOURIS MUTUALIST INSTITUTE, Paris, France
| | - M Debauchez
- MONTSOURIS MUTUALIST INSTITUTE, Paris, France
| | - J.L Monin
- MONTSOURIS MUTUALIST INSTITUTE, Paris, France
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Amabile N, Rangé G, Souteyrand G, Godin M, Meneveau N, Cayla G, Casassus F, Lefevre T, Bagdadi I, Caussin C. TCT CONNECT-313 OCT-Guided Left Main Stem Percutaneous Coronary Interventions: Results of the Multicenter LEMON (Left Main OCT-Guided Interventions) Cohort Study. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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38
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Sebag F, Galea R, Lepillier A, Moubarak G, Darmon A, Raber L, Amabile N. TCT CONNECT-444 Feasibility and Safety of Left Atrial Appendage (LAA) Occlusion in Presence of LAA Thrombus: The TRAPEUR Registry (Thrombus Trapping European Registry). J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Landolff Q, Sebag F, Costanzo A, Honton B, Amabile N. Covered Stent Implantation for Treatment of Iliac Vein Rupture During Percutaneous Left Atrial Appendage Occlusion. JACC Case Rep 2020; 2:894-897. [PMID: 34317376 PMCID: PMC8302053 DOI: 10.1016/j.jaccas.2020.05.010] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/26/2020] [Accepted: 05/05/2020] [Indexed: 06/13/2023]
Abstract
An 82-year-old woman who experienced an iatrogenic external iliac vein perforation during a left atrial appendage occlusion procedure was successfully treated by endovascular graft implantation. We report the short- and long-term outcomes of the procedure. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Quentin Landolff
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Frederic Sebag
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Alessandro Costanzo
- Department of Vascular Surgery, Institut Mutualiste Montsouris, Paris, France
| | - Benjamin Honton
- Department of Interventional Cardiology, Clinique Pasteur, Toulouse, France
| | - Nicolas Amabile
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
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Amabile N, Bagdadi I, Armero S, Elhadad S, Sebag F, Landolff Q, Saby L, Mechulan A, Boulanger CM, Caussin C. Impact of left atrial appendage closure on circulating microvesicles levels: The MICROPLUG study. Int J Cardiol 2020; 307:24-30. [PMID: 31668659 DOI: 10.1016/j.ijcard.2019.10.026] [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: 04/14/2019] [Revised: 09/05/2019] [Accepted: 10/14/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Left atrial appendage occlusion (LAAO) has emerged as a valid alternative to oral anticoagulation therapy for the prevention of systemic embolism in patients with non-valvular atrial fibrillation (NVAF). Microvesicles (MVs) are shed-membrane particles generated during various cellular types activation/apoptosis that carry out diverse biological effects. LAA has been suspected to be a potential source of MVs during AF, but the effects its occlusion on circulating MVs levels are unknown. METHODS N = 25 LAAO and n = 25 control patients who underwent coronary angiography were included. Blood samples were drawn before and 48 h after procedure for all. A third sample was collected 6 weeks after procedure in LAAO patients. In N = 10 extra patients, samples were collected from right atrium, LAA and pulmonary vein during LAAO procedure. Circulating AnnV + procoagulant, endothelial, platelets, red blood cells/RBC and leukocytes derived-MVs were measured using flow cytometry methods. RESULTS In the LAAO group, AnnV+, platelets, RBC, and leukocytes MVs were significantly increased following intervention, whereas only AnnV + MVs levels significantly rose in controls. The 6-w analysis showed that RBC-MVs and AnnV + MVs levels were still significantly elevated compared to baseline values in LAAO patients. The in-site analysis revealed that leukocytes and CD62e + endothelial-MVs were significantly higher in left atrial appendage compared to pulmonary vein, suggesting a local increased production. No major adverse event was observed in any patient post procedural course. CONCLUSIONS LAAO impacts circulating MVs and might create mild pro-coagulant status and potential erythrocytes activation due to the device healing during the first weeks following intervention.
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Affiliation(s)
- Nicolas Amabile
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France.
| | - Imane Bagdadi
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | | | - Simon Elhadad
- Department of Cardiology, CH Marne La Vallée, Jossigny, France
| | - Frederic Sebag
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Quentin Landolff
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Ludivine Saby
- Department of Cardiology, Hôpital Européen, Marseille, France
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Mercanti F, Rosseel L, Neylon A, Bagur R, Sinning JM, Nickenig G, Grube E, Hildick-Smith D, Tavano D, Wolf A, Colonna G, Latib A, Mitomo S, Petronio AS, Angelillis M, Tchétché D, De Biase C, Adamo M, Nejjari M, Digne F, Schäfer U, Amabile N, Achkouty G, Makkar RR, Yoon SH, Finkelstein A, Dvir D, Jones T, Chevalier B, Lefevre T, Piazza N, Mylotte D. Chimney Stenting for Coronary Occlusion During TAVR. JACC Cardiovasc Interv 2020; 13:751-761. [DOI: 10.1016/j.jcin.2020.01.227] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/21/2020] [Accepted: 01/23/2020] [Indexed: 10/24/2022]
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Honton B, Sauguet A, Fajadet J, Laperche C, Amabile N. First Report of Peripheral Balloon-Expandable Stent Underexpansion Treated by Intravascular Lithotripsy. JACC Cardiovasc Interv 2020; 13:530-531. [DOI: 10.1016/j.jcin.2019.09.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 08/27/2019] [Accepted: 09/04/2019] [Indexed: 11/15/2022]
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Van Belle E, Vincent F, Labreuche J, Auffret V, Debry N, Lefèvre T, Eltchaninoff H, Manigold T, Gilard M, Verhoye JP, Himbert D, Koning R, Collet JP, Leprince P, Teiger E, Duhamel A, Cosenza A, Schurtz G, Porouchani S, Lattuca B, Robin E, Coisne A, Modine T, Richardson M, Joly P, Rioufol G, Ghostine S, Bar O, Amabile N, Champagnac D, Ohlmann P, Meneveau N, Lhermusier T, Leroux L, Leclercq F, Gandet T, Pinaud F, Cuisset T, Motreff P, Souteyrand G, Iung B, Folliguet T, Commeau P, Cayla G, Bayet G, Darremont O, Spaulding C, Le Breton H, Delhaye C. Balloon-Expandable Versus Self-Expanding Transcatheter Aortic Valve Replacement. Circulation 2020; 141:243-259. [DOI: 10.1161/circulationaha.119.043785] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background:
No randomized study powered to compare balloon expandable (BE) with self expanding (SE) transcatheter heart valves (THVs) on individual end points after transcatheter aortic valve replacement has been conducted to date.
Methods:
From January 2013 to December 2015, the FRANCE-TAVI nationwide registry (Registry of Aortic Valve Bioprostheses Established by Catheter) included 12 141 patients undergoing BE-THV (Edwards, n=8038) or SE-THV (Medtronic, n=4103) for treatment of native aortic stenosis. Long term mortality status was available in all patients (median 20 months; interquartile range, 14 to 30). Patients treated with BE-THV (n=3910) were successfully matched 1:1 with 3910 patients treated with SE-THV by using propensity score (25 clinical, anatomical, and procedural variables) and by date of the procedure (within 3 months). The first coprimary outcome was ≥ moderate occurrence of paravalvular regurgitation or in-hospital mortality, or both. The second coprimary outcome was 2-year all-cause mortality.
Results:
In propensity–matched analyses, the incidence of the first coprimary outcome was higher with SE-THV (19.8%) compared with BE-THV (11.9%; relative risk, 1.68 [95% CI, 1.46–1.91];
P
<0.0001). Each component of the outcome was also higher in patients receiving SE-THV: ≥ moderate paravalvular regurgitation (15.5% versus 8.3%; relative risk, 1.90 [95% CI, 1.63–2.22];
P
<0.0001) and in hospital mortality (5.6% versus 4.2%; relative risk, 1.34 [95% CI, 1.07–1.66];
P
=0.01). During follow up, all cause mortality occurred in 899 patients treated with SE-THV (2-year mortality, 29.8%) and in 801 patients treated with BE-THV (2-year mortality, 26.6%; hazard ratio, 1.17 [95% CI, 1.06–1.29];
P
=0.003). Similar results were found using inverse probability of treatment weighting using propensity score analysis.
Conclusion:
The present study suggests that use of SE-THV was associated with a higher risk of paravalvular regurgitation and higher in-hospital and 2-year mortality compared with use of BE-THV. These data strongly support the need for a randomized trial sufficiently powered to compare the latest generation of SE-THV and BE-THV.
Clinical Trial Registration:
https://www.clinicaltrials.gov
. Unique identifier: NCT01777828.
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Affiliation(s)
- Eric Van Belle
- Département de Cardiologie, Institut Coeur Poumon, Inserm U1011, Institut Pasteur de Lille, EGID (E.V.B., F.V., N.D., A. Cosenza, G. Schurtz, S.P., E.R., A. Coisne, T. Modine, M.R., C.D.)
| | - Flavien Vincent
- Département de Cardiologie, Institut Coeur Poumon, Inserm U1011, Institut Pasteur de Lille, EGID (E.V.B., F.V., N.D., A. Cosenza, G. Schurtz, S.P., E.R., A. Coisne, T. Modine, M.R., C.D.)
| | - Julien Labreuche
- Department of Biostatistics, EA 2694-Santé Publique: épidémiologie et Qualité des Soins (J.L., A.D.)
| | - Vincent Auffret
- CHU de Lille, Université de Lille, France. CHU Pontchaillou, Service de Cardiologie et Maladies Vasculaires, CIC-IT 804, Université de Rennes 1, Laboratoire de Traitement du Signal et de l’Image, Inserm U1099, Rennes, France (V.A., J.P.-V., H.L.B.)
| | - Nicolas Debry
- Département de Cardiologie, Institut Coeur Poumon, Inserm U1011, Institut Pasteur de Lille, EGID (E.V.B., F.V., N.D., A. Cosenza, G. Schurtz, S.P., E.R., A. Coisne, T. Modine, M.R., C.D.)
| | - Thierry Lefèvre
- Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques-Cartier, Massy, France (T. Lefèvre)
| | - Helene Eltchaninoff
- CHU Rouen–Charles-Nicolle, Service de Cardiologie, Inserm U644, Rouen, France (H.E.)
| | - Thibaut Manigold
- CHU Guillaume et René Laennec, Institut du Thorax, Service de Cardiologie, Nantes, France (T. Manigold)
| | - Martine Gilard
- CHU La Cavale Blanche, Département de Cardiologie, Optimisation des Régulations Physiologiques, UFR Sciences et Techniques, Brest, France (M.G.)
| | - Jean-Phillipe Verhoye
- CHU de Lille, Université de Lille, France. CHU Pontchaillou, Service de Cardiologie et Maladies Vasculaires, CIC-IT 804, Université de Rennes 1, Laboratoire de Traitement du Signal et de l’Image, Inserm U1099, Rennes, France (V.A., J.P.-V., H.L.B.)
| | - Dominique Himbert
- AP–HP, Hôpital Bichat, Département de Cardiologie, Université Paris-Diderot, France (D.H., B.I.)
| | - Rene Koning
- Clinique Saint-Hilaire, Service de Cardiologie, Rouen, France (R.K.)
| | - Jean-Phillipe Collet
- AP–HP, CHU La Pitié-Salpêtrière, Service de Cardiologie, Paris, France (J.-P.C., P.L.)
| | - Pascal Leprince
- AP–HP, CHU La Pitié-Salpêtrière, Service de Cardiologie, Paris, France (J.-P.C., P.L.)
| | - Emmanuel Teiger
- Hôpital Henri-Mondor Assistance Publique Hôpitaux de Paris, Département de Cardiologie, Créteil, France (E.T.)
| | - Alain Duhamel
- Department of Biostatistics, EA 2694-Santé Publique: épidémiologie et Qualité des Soins (J.L., A.D.)
| | - Alessandro Cosenza
- Département de Cardiologie, Institut Coeur Poumon, Inserm U1011, Institut Pasteur de Lille, EGID (E.V.B., F.V., N.D., A. Cosenza, G. Schurtz, S.P., E.R., A. Coisne, T. Modine, M.R., C.D.)
| | - Guillaume Schurtz
- Département de Cardiologie, Institut Coeur Poumon, Inserm U1011, Institut Pasteur de Lille, EGID (E.V.B., F.V., N.D., A. Cosenza, G. Schurtz, S.P., E.R., A. Coisne, T. Modine, M.R., C.D.)
| | - Sina Porouchani
- Département de Cardiologie, Institut Coeur Poumon, Inserm U1011, Institut Pasteur de Lille, EGID (E.V.B., F.V., N.D., A. Cosenza, G. Schurtz, S.P., E.R., A. Coisne, T. Modine, M.R., C.D.)
| | - Benoit Lattuca
- CHU Nîmes, Cardiologie, Université Montpellier, Nimes, France (B.L., G.C.)
| | - Emmanuel Robin
- Département de Cardiologie, Institut Coeur Poumon, Inserm U1011, Institut Pasteur de Lille, EGID (E.V.B., F.V., N.D., A. Cosenza, G. Schurtz, S.P., E.R., A. Coisne, T. Modine, M.R., C.D.)
| | - Augustin Coisne
- Département de Cardiologie, Institut Coeur Poumon, Inserm U1011, Institut Pasteur de Lille, EGID (E.V.B., F.V., N.D., A. Cosenza, G. Schurtz, S.P., E.R., A. Coisne, T. Modine, M.R., C.D.)
| | - Thomas Modine
- Département de Cardiologie, Institut Coeur Poumon, Inserm U1011, Institut Pasteur de Lille, EGID (E.V.B., F.V., N.D., A. Cosenza, G. Schurtz, S.P., E.R., A. Coisne, T. Modine, M.R., C.D.)
| | - Marjorie Richardson
- Département de Cardiologie, Institut Coeur Poumon, Inserm U1011, Institut Pasteur de Lille, EGID (E.V.B., F.V., N.D., A. Cosenza, G. Schurtz, S.P., E.R., A. Coisne, T. Modine, M.R., C.D.)
| | - Patrick Joly
- Hopital Saint-Joseph, Fédération de Cardiologie, Marseille, France (P.J.)
| | - Gilles Rioufol
- CHU Louis Pradel, Division de Cardiologie, Centre d’Investigation Clinique de Lyon (CIC), Bron, France (G.R.)
| | - Said Ghostine
- Centre Marie Lannelongue, Département de Cardiologie, Le Plessis Robinson, France (S.G.)
| | - Olivier Bar
- Clinique Saint Gatien, Service de Cardiologie, Tours, France (O.B.)
| | - Nicolas Amabile
- Institut Mutualiste Montsouris, Département de Cardiologie, Paris, France (N.A.)
| | - Didier Champagnac
- Clinique du Tonkin, Service de Cardiologie, Villeurbanne, France (D.C.)
| | - Patrick Ohlmann
- CHU de Strasbourg, Nouvel Hôpital Civil, Département de Cardiologie, Université de Strasbourg, France (P.O.)
| | - Nicolas Meneveau
- CHU Besançon, Cardiologie, Hopital Jean Minjoz, Besançon, France (N.M.)
| | - Thibaut Lhermusier
- CHU de Toulouse, Département de Cardiologie, Inserm U1048, Université de Toulouse 3, France (T. Lhermusier)
| | - Lionel Leroux
- Hôpital Cardiologique du Haut-Lévêque, Département de Cardiologie Interventionnelle, Université de Bordeaux, Pessac, France (L.L.)
| | - Florence Leclercq
- CHU Arnaud de Villeneuve, Service de Cardiologie, Montpellier, France (F.L., T.G.)
| | - Thomas Gandet
- CHU Arnaud de Villeneuve, Service de Cardiologie, Montpellier, France (F.L., T.G.)
| | - Frédéric Pinaud
- CHU d’Angers, Service de Chirurgie Cardiaque, CNRS UMR 6214, INSERM 1083, Université d’Angers, France (F.P.)
| | - Thomas Cuisset
- CHU La Timone Assistance Publique Hôpitaux de Marseille, Département de Cardiologie, Inserm UMR1062, INRA UMR 1260, Université d’Aix-Marseille, France (T.C.)
| | - Pascal Motreff
- CHU Gabriel Montpied, Département de Cardiologie, ISIT, CaVITI, CNRS (UMR-6284), Université d’Auvergne, Clermont-Ferrand, France (P.M., G. Souteyrand)
| | - Géraud Souteyrand
- CHU Gabriel Montpied, Département de Cardiologie, ISIT, CaVITI, CNRS (UMR-6284), Université d’Auvergne, Clermont-Ferrand, France (P.M., G. Souteyrand)
| | - Bernard Iung
- AP–HP, Hôpital Bichat, Département de Cardiologie, Université Paris-Diderot, France (D.H., B.I.)
| | - Thierry Folliguet
- CHU de Nancy, Service de Chirurgie Cardiovasculaire, Vandoeuvre-lès-Nancy, France (T.F.)
| | | | - Guillaume Cayla
- CHU Nîmes, Cardiologie, Université Montpellier, Nimes, France (B.L., G.C.)
| | - Gilles Bayet
- Hôpital Privé Clairval, Service de Cardiologie, Marseille, France (G.B.)
| | - Olivier Darremont
- Clinique Saint Augustin, Service de Cardiologie, Bordeaux, France (O.D.)
| | | | - Hervé Le Breton
- CHU de Lille, Université de Lille, France. CHU Pontchaillou, Service de Cardiologie et Maladies Vasculaires, CIC-IT 804, Université de Rennes 1, Laboratoire de Traitement du Signal et de l’Image, Inserm U1099, Rennes, France (V.A., J.P.-V., H.L.B.)
| | - Cédric Delhaye
- Département de Cardiologie, Institut Coeur Poumon, Inserm U1011, Institut Pasteur de Lille, EGID (E.V.B., F.V., N.D., A. Cosenza, G. Schurtz, S.P., E.R., A. Coisne, T. Modine, M.R., C.D.)
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Rubimbura V, Guillon B, Fournier S, Amabile N, Chi Pan C, Combaret N, Eeckhout E, Kibler M, Silvain J, Wijns W, Schiele F, Muller O, Meneveau N, Adjedj J. Quantitative flow ratio virtual stenting and post stenting correlations to post stenting fractional flow reserve measurements from the DOCTORS (Does Optical Coherence Tomography Optimize Results of Stenting) study population. Catheter Cardiovasc Interv 2019; 96:1145-1153. [DOI: 10.1002/ccd.28615] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 07/19/2019] [Accepted: 11/12/2019] [Indexed: 12/11/2022]
Affiliation(s)
| | - Benoit Guillon
- Department of Cardiology, EA3920 University Hospital Jean Minjoz Besançon France
| | | | | | - Chan Chi Pan
- Centre Hospitalier Universitaire Vaudois Lausanne Switzerland
| | | | - Eric Eeckhout
- Centre Hospitalier Universitaire Vaudois Lausanne Switzerland
| | - Marion Kibler
- Departement de cardiologie, Nouvel Hôpital Civil Centre Hospitalier Universitaire Strasbourg France
| | - Johanne Silvain
- Université Paris 6, ACTION Study Group, Institut de Cardiologie (AP‐HP) Centre Hospitalier Universitaire Pitié‐Salpêtrière, INSERM UMRS Paris France
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam National University of Ireland Galway Ireland
| | - Francois Schiele
- Department of Cardiology, EA3920 University Hospital Jean Minjoz Besançon France
| | - Olivier Muller
- Centre Hospitalier Universitaire Vaudois Lausanne Switzerland
| | - Nicolas Meneveau
- Department of Cardiology, EA3920 University Hospital Jean Minjoz Besançon France
| | - Julien Adjedj
- Centre Hospitalier Universitaire Vaudois Lausanne Switzerland
- Department of Cardiology Arnault Tzanck Institute Saint Laurent du Var France
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Ribeyrolles S, Zannis K, Lefèvre M, Paul JF, Amabile N. Delayed Left Atrial Appendage Closure Following Percutaneous Intervention: Correlations Between Imaging, Macroscopic Examination, and Pathology. JACC Cardiovasc Interv 2019; 12:e181-e182. [PMID: 31563675 DOI: 10.1016/j.jcin.2019.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 07/09/2019] [Indexed: 11/28/2022]
Affiliation(s)
| | - Kostantinos Zannis
- Department of Cardiac Surgery, Institut Mutualiste Montsouris, Paris, France
| | - Marine Lefèvre
- Department of Pathology, Institut Mutualiste Montsouris, Paris, France
| | | | - Nicolas Amabile
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France.
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Amabile N, Veugeois A. Ruptured and healed atherosclerotic plaques: breaking bad? EUROINTERVENTION 2019; 15:e742-e744. [PMID: 31579010 DOI: 10.4244/eijv15i9a138] [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] [Indexed: 11/23/2022]
Affiliation(s)
- Nicolas Amabile
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
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Guillon B, Moris M, Besutti M, Lefrancois Y, Amabile N, Combaret N, Ohlmann P, Belle L, Silvain J, Schiele F, Meneveau N. 5032Evaluation of the EAPCI OCT criteria for optimization of angioplasty in the DOCTORS study population. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The recent expert consensus of the EAPCI suggested OCT criteria for the optimization of PCT after stent implantation. Using the data from the randomized, controlled DOCTORS study, we aimed to analyze the proportion of OCT criteria that were met immediately after stent implantation, and to evaluate the changes made to the revascularization strategy in order to optimize the procedure.
Methods
The DOCTORS study population consisted of patients admitted for non ST elevation myocardial infarction (NSTEMI) and presenting an indication for PCI with stent implantation of the target lesion. In the 120 patients randomized to the OCT-guided group, OCT was performed after initial coronary angiography and repeated immediately after stent implantation. The operator was required to evaluate quantitative measures of the reference diameter and reference area of the vessel and the length of the lesion based on the OCT images acquired before PCI. All OCT images were analyzed in a centralized core laboratory by 2 independent operators blinded to the angiographic findings. Post-PCI optimization targets to be achieved following stent implantation included optimal stent expansion (minimal stent area (MSA)/average reference lumen >80%), avoidance of landing zone in plaque burden >50% or lipid rich tissue; avoidance of large malapposition regions (axial distance <0.4 mm and <1 mm length), no extensive irregular tissue protrusion, and limited dissections (<60°, flap limited to intima, <2 mm length).
Results
Among the 120 patients who had an OCT run performed immediately after stent implantation, 50 patients (42%) had stent under-expansion, 59 (49%) had landing zone in plaque burden >50% or lipid rich tissue, 27 (22.5%) had stent malapposition, 25 (20.8%) had extensive irregular tissue protrusion and 45 (37.5%) had extensive edge dissection. Only 2 patients (1.7%) fullfiled all criteria of post-PCI optimization immediately after stent implantation, while no criterion was reached in 15 patients (12.5%). Post-stent overdilation was performed in all patients with stent underexpansion, and in 22/27 patients (81.5%) with stent malapposition. Additional stent implantation was performed in 32 patients (24 for landing zone in plaque burden >50% and 8 for extensive adventitial edge dissection). Overall, the use of OCT led the operator to optimize the procedural strategy in 60 patients (50%).
Conclusion
The proportion of suboptimal results as evaluated by OCT and based on the EAPCI criteria immediately after stent implantation was very high in the DOCTORS study, even though the choice of stent in these patients was based on pre-PCI OCT data. The post-PCI OCT findings led to a change of strategy to optimize the procedure in 50% of patients. It remains to be determined through a larger prospective study whether this optimization of PCI strategy is associated with a clinical benefit in the long term.
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Affiliation(s)
- B Guillon
- University Hospital of Besancon - Hospital Jean Minjoz, Besancon, France
| | - M Moris
- University Hospital of Besancon - Hospital Jean Minjoz, Besancon, France
| | - M Besutti
- University Hospital of Besancon - Hospital Jean Minjoz, Besancon, France
| | - Y Lefrancois
- Hospital Belfort-Montbeliard, Montbeliard, France
| | - N Amabile
- Institut Mutualiste Montsouris, Paris, France
| | - N Combaret
- University Hospital Gabriel Montpied, Clermont-Ferrand, France
| | - P Ohlmann
- University Hospital of Strasbourg, Strasbourg, France
| | - L Belle
- Hospital of Annecy, Annecy, France
| | - J Silvain
- Hospital Pitie-Salpetriere, Paris, France
| | - F Schiele
- University Hospital of Besancon - Hospital Jean Minjoz, Besancon, France
| | - N Meneveau
- University Hospital of Besancon - Hospital Jean Minjoz, Besancon, France
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48
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Amabile N, Bagdadi I, Armero S, Elhadad S, Sebag F, Saby L, Mammhoudi K, Mechulan A, Landolff Q, Caussin C, Boulanger CM. P3725Impact of left atrial appendage closure on circulating microvesicles levels: the MICROPLUG study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Percutaneous left atrial appendage occlusion (LAAO) has emerged as a valid alternative to oral anticoagulation therapy for the prevention of systemic embolism in patients with non-valvular atrial fibrillation (AF). Microvesicles (MVs) are shed-membrane particles generated during various cellular types activation/ apoptosis that carry out diverse biological effects, including procoagulant effects. Left atrial appendage has been suspected to be a potential source of MVs during AF, but the effects of LAAO on MVs production and circulating levels are unknown.The aim of this work study was to assess the variations of circulating MVs levels following LAAO.
Methods
The study includedn=25 LAAO patients and n=25 control patients who underwent coronary angiography. LAAO and control patients were treated by clopidogrel+ aspirin loading doses before procedures. Blood samples were drawn before antiplatelets therapy & 2 days after for all. A third sample was collected 6 weeks after procedure in LAAO patients. In N=10 extra patients, blood samples were collected from right atrium, left appendage and pulmonary vein during LAAO procedure. Circulating procoagulant (AnnV+), endothelial (CD62e+), platelets (CD41+), red blood cells/RBC (CD235+), leukocytes (CD11+) derived-MVs were measured using flow cytometry methods.
Results
Control and LAAO groups baseline characteristics were comparable, except for the higher age & incidence of previous stroke and lower incidence of coronary artery disease in LAAO patients. Baseline levels of the different microvesicles were comparable in both groups. In the LAAO group, we observed a significant increase of AnnV+ MVs (4355 [1712–8478] vs. 1798 [1006–2759] ev/μL, p=0.001), platelets (1615 [833–4772] vs. 802 [358–1376] ev/, p=0.005), RBC (207 [85–708] vs. 35 [5–84] ev/μL, p<0.001), and leukocytes MVs (1368 [783–2319] vs. 1067 [827–1564] ev/μL, p=0.02) following intervention, whereas only AnnV+ MVs levels significantly rose in controls (3701 [2043–7017] vs. 1506 [1033–4899] ev/μL, p=0.03). The 6-w analysis showed that RBC-MVs (55 [8–182 ev/μL]and AnnV+ MVs levels (2468 [1813–5576 ev/μL]were still significantly increased compared to baseline values in LAAO patients (p<0.05). The in-site analysis revealed that leukocyte MVs and CD62e+ endothelial-MVs were significantly higher in left atrial appendage compared to pulmonary vein (respectively 430 [26–700 vs. 161 [0–426] and 344 [22–723] vs. 200 [120–326] ev/μL, p<0.05), suggesting a local increased production. No major adverse ischemic or bleeding event was observed in any patient post procedural course.
Conclusions
LAAO impact circulating MVs and could create mild pro-coagulant status, inflammation and potential erythrocytes activation due to device presence during the first 6 weeks following intervention. These results suggest that careful attention should be paid in the anti-platelet/anti-coagulant therapy in the post procedural course.
Acknowledgement/Funding
This work was funded by a research grant from the French Society of Cardiology and a research grant from St Jude/Abbott
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Affiliation(s)
- N Amabile
- Institut Mutualiste Montsouris, Department of Cardiology, Paris, France
| | - I Bagdadi
- Institut Mutualiste Montsouris, Department of Cardiology, Paris, France
| | - S Armero
- Hôpital Européen Marseille, Marseille, France
| | - S Elhadad
- CH Marne la Vallée, Jossigny, France
| | - F Sebag
- Institut Mutualiste Montsouris, Department of Cardiology, Paris, France
| | - L Saby
- Hôpital Européen Marseille, Marseille, France
| | - K Mammhoudi
- Institut Mutualiste Montsouris, Department of Cardiology, Paris, France
| | - A Mechulan
- CHP Clairval, Department of Cardiology, Marseille, France
| | - Q Landolff
- Institut Mutualiste Montsouris, Department of Cardiology, Paris, France
| | - C Caussin
- Institut Mutualiste Montsouris, Department of Cardiology, Paris, France
| | - C M Boulanger
- Paris Cardiovascular Research Center (PARCC), Paris, France
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49
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Mahmoudi K, Elhadad S, Landolf Q, Sebag F, Rezine LZ, Paul JF, Caussin C, Amabile N. TCT-374 Residual Left Atrial Appendage Patency Identified by Early Computed Tomography Analysis Following Percutaneous Occlusion: Prevalence and Impact on Outcome. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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50
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Landolff Q, Veugeois A, Godin M, Boussaada MM, Dibie A, Caussin C, Amabile N. [Hot issues in bifurcation lesions PCI in 2019]. Ann Cardiol Angeiol (Paris) 2019; 68:325-332. [PMID: 31542202 DOI: 10.1016/j.ancard.2019.08.004] [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: 07/15/2019] [Accepted: 08/28/2019] [Indexed: 11/27/2022]
Abstract
Coronary bifurcations are involved in 15-20% of all percutaneous coronary interventions (PCI) and remain one of the most challenging lesions in interventional cardiology in terms of procedural success rate as well as long-term cardiac events. The optimal management of bifurcation lesions is still debated but involves careful assessment, planning and a sequential provisional approach. The preferential strategy for PCI of bifurcation lesions remains to use main vessel (MV) stenting with a proximal optimisation technique (POT) and provisional side branch (SB) stenting as a preferred approach. Final kissing balloon inflation is not recommended in all cases. In the minority of lesions where two stents are required, careful deployment and optimal expansion are essential to achieve a long-term result. Intracoronary imaging techniques (IVUS, OCT) and FFR are useful endovascular tools to achieve optimal results.
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Affiliation(s)
- Q Landolff
- Service de cardiologie, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - A Veugeois
- Service de cardiologie, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - M Godin
- Service de cardiologie, clinique St-Hilaire, Rouen, France
| | - M M Boussaada
- Service de cardiologie, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - A Dibie
- Service de cardiologie, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - C Caussin
- Service de cardiologie, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - N Amabile
- Service de cardiologie, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France.
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