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Delmas C, Conil JM, Sztajnic S, Georges B, Biendel C, Dambrin C, Galinier M, Minville V, Fourcade O, Silva S, Marcheix B. Early Prediction of 3-month Survival of Patients in Refractory Cardiogenic Shock and Cardiac Arrest on Extracorporeal Life Support. Indian J Crit Care Med 2017; 21:138-145. [PMID: 28400684 PMCID: PMC5363102 DOI: 10.4103/ijccm.ijccm_32_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background: Extracorporeal life support (ECLS) holds the promise of significant improvement of the survival of patient in refractory cardiogenic shock (CS) or cardiac arrest (CA). Nevertheless, it remains to be shown to which extent these highly invasive supportive techniques could improve long-term patient's outcome. Methods: The outcomes of 82 adult ECLS patients at our institution between January 2012 and December 2013 were retrospectively analyzed. Results: Patients were essentially men (64.7%) and are 54 years old. Preexisting ischemic (53.7%) and dilated cardiomyopathy (14.6%) were frequent. ECLS indications were shared equally between CA and CS. ECLS-specific adverse effects as hemorrhage (30%) and infection (50%) were frequent. ECLS was effective for 43 patients (54%) with recovery for 35 (43%), 5 (6%) heart transplant, and 3 (4%) left ventricular assist device support. Mortality rate at 30 days was 59.8%, but long-term and 3-month survival rates were similar of 31.7%. Initial plasma lactate levels >5.3 mmol/L and glomerular filtration rate <43 ml/min/1.73 m2 were significantly associated with 3-month mortality (risk ratio [RR] 2.58 [1.21–5.48]; P = 0.014; RR 2.10 [1.1–4]; P = 0.024, respectively). Long-term follow-up had shown patients paucisymptomatic (64% New York Heart Association 1–2) and autonomic (activities of daily living [ADL] score 6 ± 1.5). Conclusion: In case of refractory CA or CS, lactates and renal function at ECLS initiation could serve as outcome predictor for risk stratification and ECLS indication.
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Van Mieghem NM, Dumonteil N, Chieffo A, Roux Y, van der Boon RMA, Giustino G, Hartman E, Aga Y, de Jong L, Abi Ghanem M, Marcheix B, Cavazza C, Carrié D, Colombo A, Kappetein AP, de Jaegere PPT, Tchetche D. Current decision making and short-term outcome in patients with degenerative aortic stenosis: the Pooled-RotterdAm-Milano-Toulouse In Collaboration Aortic Stenosis survey. EUROINTERVENTION 2016; 11:e1305-13. [PMID: 26865449 DOI: 10.4244/eijv11i10a253] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to provide a real-world snapshot of contemporary Heart Team decision making on patients with aortic stenosis (AS) and the consequent short-term clinical outcome. METHODS AND RESULTS This was an international multicentre prospective registry encompassing 390 patients with symptomatic severe AS who were prospectively enrolled. Clinical endpoints and the decisive arguments to opt for surgical or transcatheter aortic valve replacement, or medical therapy were recorded separately. The mean age was 76.4±11.6 years, 55% were male and the STS score was 2.9% (IQR 1.6-6.9). The local Heart Teams considered 43%, 25% and 23% to be at low, intermediate and high operative risk with a calculated STS score of 2.18±1.72, 5.08±2.76 and 13.15±9.43, respectively. Overall, 7% were deemed inoperable. Ninety-four percent of patients at low operative risk were sent for SAVR whereas 64% and 92% of intermediate and high-risk patients underwent TAVI. Only 6% of patients did not receive any kind of aortic valve replacement. Overall, 30-day all-cause mortality was 2.8%. TAVI was associated with more major vascular complications, need for permanent pacemakers and post-procedural aortic regurgitation. SAVR had more life-threatening bleedings and new-onset atrial fibrillation. CONCLUSIONS The PRAGMATIC AS survey offers a snapshot of the contemporary management of patients with symptomatic severe AS. Multidisciplinary Heart Teams select an optimal strategy based on age, frailty and comorbidities. Nearly half of all patients are sent for TAVI. Only a small minority of patients will not receive valve replacement therapy.
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Ghanem MA, Gomez-Sanchez M, Chaufour X, Marcheix B. Type B Aortic Dissection Repair Using a Thoraflex Hybrid Prosthesis in a Complex Aortic Arch Anatomy. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2016; 4:11-15. [PMID: 27766268 DOI: 10.12945/j.aorta.2015.15.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 10/19/2015] [Indexed: 11/18/2022]
Abstract
Thoracic endovascular aortic repair (TEVAR) is recognized as an attractive option to treat complicated Type B aortic dissection. Nevertheless, TEVAR is not always technically possible. We report the case of a 53-year-old male with complicated Type B aortic dissection, in the setting of a complex anomalous aortic arch anatomy with an aneurysmal aberrant right subclavian artery. He was successfully treated by the frozen elephant trunk technique using the Thoraflex hybrid graft.
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Giustino G, Van der Boon R, Molina-Martin de Nicolas J, Dumonteil N, Chieffo A, de Jaegere P, Tchetche D, Marcheix B, Millischer D, Cassagneau R, Carrié D, Van Mieghem N, Colombo A. Impact of permanent pacemaker on mortality after transcatheter aortic valve implantation: the PRAGMATIC (Pooled Rotterdam-Milan-Toulouse in Collaboration) Pacemaker substudy. EUROINTERVENTION 2016; 12:1185-1193. [DOI: 10.4244/eijv12i9a192] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Para M, Delmas C, Bocquillon L, Marcheix B, Roncalli J, Galinier M, Dambrin C. 0377: Can we predict right heart failure after implantable left ventricular assist device? ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2016. [DOI: 10.1016/s1878-6480(16)30116-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Para M, Delmas C, Charbonneau H, Marcheix B, Roncalli J, Galinier M, Dambrin C. 0378: Mechanical circulatory support and factor VII: effective but (not so) dangerous? ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2016. [DOI: 10.1016/s1878-6480(16)30117-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Cossin S, Malavaud S, Jarno P, Giard M, L'Hériteau F, Simon L, Bieler L, Molinier L, Marcheix B, Venier AG, Simon L, Ali-Brandmeyer O, Neels C, Jarno P, Aupée M, Perennec M, Astagneau P, L'Hériteau F, Daniel F, Campion C, Giard M, Bernet C, Caillat-Vallet E, Venier AG, Bervas C, Reyreaud E, Baillet P, Costa Y, Jost JL, Merle V, Merlo L, Seguier JC, Malavaud S, Bruyere F, Thiolet JM, Barquin-Guichard S. Surgical site infection after valvular or coronary artery bypass surgery: 2008–2011 French SSI national ISO-RAISIN surveillance. J Hosp Infect 2015; 91:225-30. [DOI: 10.1016/j.jhin.2015.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 07/16/2015] [Indexed: 11/17/2022]
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Chaufour X, Marcheix B, Grunenwald E, Porterie J, Para M, Cron C, Roux D, Glock Y. Surgery of the Elephant Trunk in the era of hybrid Prostheses: Experience with the Thoraflex Hybrid Prosthesis. Ann Vasc Surg 2015. [DOI: 10.1016/j.avsg.2015.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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59
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Gallart JC, Moulie L, Hamon T, Guilbert O, Houze-Cerfon CH, Grunenwald E, Delmas C, Cougot P, Marcheix B, Gaillard Y, Franchitto N. Tentative de suicide à l’If par ingestion de gélules artisanales prise en charge par ECMO. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2015. [DOI: 10.1016/j.toxac.2015.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Chieffo A, Van Mieghem NM, Tchetche D, Dumonteil N, Giustino G, Van der Boon RM, Pierri A, Marcheix B, Misuraca L, Serruys PW, Millischer D, Carrié D, de Jaegere PP, Colombo A. Impact of Mixed Aortic Valve Stenosis on VARC-2 Outcomes and Postprocedural Aortic Regurgitation in Patients Undergoing Transcatheter Aortic Valve Implantation. Catheter Cardiovasc Interv 2015; 86:875-85. [DOI: 10.1002/ccd.25975] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 04/05/2015] [Indexed: 12/20/2022]
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Cazavet A, Alacoque X, Marcheix B, Chaufour X, Rousseau H, Glock Y, Leobon B. Aortic arch aneurysm: short- and mid-term results comparing open arch surgery and the hybrid procedure. Eur J Cardiothorac Surg 2015; 49:134-40. [DOI: 10.1093/ejcts/ezv024] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 01/06/2015] [Indexed: 11/13/2022] Open
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Para M, Bocquillon L, Delmas C, Berry M, Dieye E, Marcheix B, Glock Y, Roncalli J, Galinier M, Dambrin C. 0399: Mechanical circulatory support and infection: a single center experience. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2015. [DOI: 10.1016/s1878-6480(15)71556-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Para M, Bocquillon L, Delmas C, Berry M, Dieye E, Marcheix B, Glock Y, Roncalli J, Galinier M, Dambrin C. 0381: Heart failure and mechanical circulatory support: experience of a “medico-surgical unit “. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2015. [DOI: 10.1016/s1878-6480(15)71555-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Giustino G, Chieffo A, Van Mieghem NM, Tchetche D, DUMONTEIL N, van der Boon RM, Marcheix B, Serruys PW, Millischer D, Carrié D, De Jaegere P, Colombo A. TCT-684 Impact Of Mixed Aortic Valve Stenosis On VARC-2 Outcomes And Post-Procedural Peri-Prosthetic Aortic Regurgitation In Patients Undergoing Transcatheter Aortic Valve Implantation: Results From The International Multicentric Study PRAGMATIC (Pooled Rotterdam – Milan – Toulouse In Collaboration). J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.07.756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Capuani C, Guilbeau-Frugier C, Mokrane FZ, Delisle MB, Marcheix B, Rousseau H, Telmon N, Rougé D, Dedouit F. Tissue microscopic changes and artifacts in multi-phase post-mortem computed tomography angiography in a hospital setting: a fatal case of systemic vasculitis. Forensic Sci Int 2014; 242:e12-e17. [PMID: 25085763 DOI: 10.1016/j.forsciint.2014.06.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 06/27/2014] [Accepted: 06/30/2014] [Indexed: 12/19/2022]
Abstract
A 27-year-old man suddenly died in hospital of acute respiratory distress syndrome secondary to severe systemic vasculitis. Multi-phase post-mortem computed tomography angiography followed by scientific autopsy of the thoracic and abdominal cavity and histology was performed, illustrating the advantages and drawbacks of such techniques. Imaging enabled us to examine the cranium, as the family refused cerebral dissection. MPMCTA revealed absence of opacification of the left middle cerebral artery. But parenchymal findings of thoracic and abdominal organs were still difficult to interpret after both imaging and macroscopic examination during the autopsy. Microscopic examination provided the definitive diagnosis of cause of death. Analysis revealed systemic vasculitis of the lung complicated by diffuse alveolar, mediastinal, splenic and retroperitoneal lesions. We were unable to determine the type of vasculitis, whether polyarteritis nodosa or microscopic polyangiitis, because of artifactual glomerular collapse. We observed some structural changes in tissue secondary to contrast agent injection, affecting the vascular system and renal parenchyma in particular. Such artifacts must be known in order to avoid misinterpreting them as pathological findings. MPMCTA and conventional autopsy are two complementary techniques showing both their specific advantages and limits which have to be known in order to choose the appropriate technique. One limit of both techniques is the detection of microscopic findings which can only be obtained by additional histological examination. This case report underlines this fact and demonstrates that caution is required in some cases if microscopic analyses are carried out after contrast agent injection.
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Lilamand M, Dumonteil N, Nourhashémi F, Hanon O, Marcheix B, Toulza O, Elmalem S, Abellan van Kan G, Raynaud-Simon A, Vellas B, Afilalo J, Cesari M. Gait speed and comprehensive geriatric assessment: Two keys to improve the management of older persons with aortic stenosis. Int J Cardiol 2014; 173:580-2. [DOI: 10.1016/j.ijcard.2014.03.112] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 03/14/2014] [Indexed: 12/27/2022]
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Elmalem S, Dumonteil N, Marcheix B, Toulza O, Vellas B, Carrie D, Nourhashemi F. Health-Related Quality of Life After Transcatheter Aortic Valve Implantation in Elderly Patients With Severe Aortic Stenosis. J Am Med Dir Assoc 2014; 15:201-206. [DOI: 10.1016/j.jamda.2013.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 11/02/2013] [Accepted: 11/12/2013] [Indexed: 10/25/2022]
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Van Der Boon RM, Marcheix B, Tchetche D, Chieffo A, Van Mieghem NM, Dumonteil N, Vahdat O, Maisano F, Serruys PW, Kappetein AP, Fajadet J, Colombo A, Carrié D, Van Domburg R, De Jaegere P. TCT-720 Transapical versus Transfemoral Aortic Valve Implantation: a multi-center propensity matched study. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.1472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Dumonteil N, van der Boon RMA, Tchetche D, Chieffo A, Van Mieghem NM, Marcheix B, Buchanan GL, Vahdat O, Serruys PW, Fajadet J, Colombo A, de Jaegere PPT, Carrié D. Impact of preoperative chronic kidney disease on short- and long-term outcomes after transcatheter aortic valve implantation: a Pooled-RotterdAm-Milano-Toulouse In Collaboration Plus (PRAGMATIC-Plus) initiative substudy. Am Heart J 2013; 165:752-60. [PMID: 23622912 DOI: 10.1016/j.ahj.2012.12.013] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 12/21/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Only limited and conflicting data on the impact of preoperative chronic kidney disease (CKD) on outcomes after transcatheter aortic valve implantation (TAVI) are available. METHODS We retrospectively analyzed pooled data from the prospective TAVI databases of 4 centers (942 patients). Valve Academic Research Consortium end point definitions were used. The outcomes were compared among patients with normal estimated glomerular filtration rate (≥90 mL/min), mild (60-89 mL/min), moderate (30-59 mL/min), and severe (<30 mL/min) CKD and those on chronic hemodialysis (HD). The primary end point was 1-year survival. RESULTS A total of 109 patients had a normal estimated glomerular filtration rate (11.6%); 329 (34.9%) had mild, 399 (42.5%) moderate, 72 (7.5%) severe CKD, and 33 (3.5%) were on HD. Baseline and procedural characteristics were similar among all groups except for Logistic EuroSCORE. Major stroke, life-threatening bleeding, all-cause 30-day mortality (HD 15.2%, severe CKD 8.3%, moderate CKD 8.3%, mild CKD 6.7%, normal 1.8%, P = .007) and 1-year survival (HD 54.8%, severe CKD 67.2%, moderate CKD 80.0%, mild CKD 85.2%, normal eGFR 91.4%, HD vs severe CKD P = .23, severe CKD vs moderate CKD P = .002, moderate CKD vs mild CKD P = .04, moderate CKD vs normal eGFR P = .03, by log-rank test) differed significantly across groups. Through multivariable analysis, HD and severe CKD were independently associated with an increased risk of 1-year mortality (hazard ratios 5.07 [95% CI 1.79-14.35, P = .002] and 4.03 [95% CI 1.52-10.69, P = .005], respectively). CONCLUSIONS Patients with CKD who undergo TAVI have a higher-risk profile and worse 30-day and 1-year outcomes. Chronic hemodialysis and severe preprocedural CKD are independently associated with an increased risk of 1-year mortality after TAVI.
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Dumonteil N, Marcheix B, Grunenwald E, Roncalli J, Massabuau P, Carrié D. Left Ventricular Embolization of an Aortic Balloon-Expandable Bioprosthesis. JACC Cardiovasc Interv 2013; 6:308-10. [DOI: 10.1016/j.jcin.2012.08.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Accepted: 08/02/2012] [Indexed: 11/27/2022]
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Zeidan S, Ribes D, Cointault O, Gautier M, Marcheix B, Kamar N. Everolimus-induced recurrent pericardial effusion after kidney transplantation. Transpl Int 2013; 26:e36-7. [DOI: 10.1111/tri.12075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Chieffo A, Buchanan GL, Van Mieghem NM, Tchetche D, Dumonteil N, Latib A, van der Boon RM, Vahdat O, Marcheix B, Farah B, Serruys PW, Fajadet J, Carrié D, de Jaegere PP, Colombo A. Transcatheter Aortic Valve Implantation With the Edwards SAPIEN Versus the Medtronic CoreValve Revalving System Devices. J Am Coll Cardiol 2013; 61:830-6. [DOI: 10.1016/j.jacc.2012.11.050] [Citation(s) in RCA: 154] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 11/05/2012] [Accepted: 11/20/2012] [Indexed: 01/05/2023]
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Van Mieghem NM, Chieffo A, Dumonteil N, Tchetche D, van der Boon RM, Buchanan GL, Marcheix B, Vahdat O, Serruys PW, Fajadet J, Carrié D, Colombo A, de Jaegere PP. Trends in outcome after transfemoral transcatheter aortic valve implantation. Am Heart J 2013; 165:183-92. [PMID: 23351821 DOI: 10.1016/j.ahj.2012.11.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Accepted: 11/16/2012] [Indexed: 12/20/2022]
Abstract
BACKGROUND Transfemoral transcatheter aortic valve implantation (TF-TAVI) is a viable and safe treatment strategy for patients with symptomatic severe aortic stenosis and high operative risk and has been introduced as such in the recently updated European guidelines on the management of valvular heart disease.Our aim was to assess trends in outcome after TF-TAVI. METHODS Propensity score-matched analysis of a multicenter registry of consecutive patients undergoing TF-TAVI subdivided into 3 tertiles based on enrollment date was performed. Three tertiles of 214 propensity score-matched patients were compared. RESULTS With mounting experience and moving from the initial to the last cohort, procedural contrast volume and radiation time decreased. Over time, there were less major vascular complications (15% vs 7.9%, P = .023), life-threatening bleedings (17.8% vs 7.9%, P = .003), and major bleedings (22.4% vs 12.1%, P = .007). Major vascular complications and life-threatening bleedings caused by closure device failure decreased significantly (9.2% vs 3.1% [P = .01] and 5.7% vs 1 % [P = .01], respectively). The combined safety end point dropped from 31.3% in tertile (T) (T1) to 17.8% in T3 (P < .001). By multivariable analysis, the last cohort as compared with the initial cohort was associated with significant reductions in 30-day mortality (odds ratio [OR] 0.35, 95% CI 0.12-0.96), stage 3 AKI (OR 0.12, 95% CI 0.29-0.93), and the combined safety end point (OR 0.52, 95% CI 0.29-0.93). One-year survival improved significantly (T1 79% vs T3 86%, P = .016). CONCLUSIONS Over time, TAVI is performed with significant reductions in major vascular complications, life-threatening bleedings, and the combined clinical safety end point and improved 1-year survival.
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van der Boon RM, Chieffo A, Dumonteil N, Tchetche D, Van Mieghem NM, Buchanan GL, Vahdat O, Marcheix B, Serruys PW, Fajadet J, Colombo A, Carrié D, van Domburg RT, de Jaegere PP. Effect of body mass index on short- and long-term outcomes after transcatheter aortic valve implantation. Am J Cardiol 2013; 111:231-6. [PMID: 23102879 DOI: 10.1016/j.amjcard.2012.09.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 09/18/2012] [Accepted: 09/18/2012] [Indexed: 12/20/2022]
Abstract
Better outcomes have been reported after percutaneous cardiac intervention in obese patients ("obesity paradox"). However, limited information is available on the effect of the body mass index on the outcomes after transcatheter aortic valve implantation (TAVI). We, therefore, sought to determine the effect of the body mass index on the short- and long-term outcomes in patients who underwent TAVI. The population consisted of 940 patients, of whom 25 (2.7%) were underweight, 384 had a (40.9%) normal weight, 372 (39.6%) were overweight, and 159 (16.9%) were obese. Overall, the obese patients were younger (79.7 ± 6.4 years vs 81.7 ± 7.3 and 80.8 ± 7.0 years, p = 0.008) and had a greater prevalence of preserved left ventricular and renal function. On univariate analysis, obese patients had a greater incidence of minor stroke (1.3% vs 0 and 0.3%, p = 0.03), minor vascular complications (15.7% vs 9.1% and 11.6%, p = 0.028) and acute kidney injury stage I (23.3% vs 10.7% and 16.1%, p <0.001). After adjustment, body mass index, as a continuous variable, was associated with a lower risk of mortality at 30 days (odds ratio 0.93, 95% confidence interval 0.86 to 0.98, p = 0.023) and no effect on survival after discharge (hazard ratio 1.01, 95% confidence interval 0.96 to 1.07, p = 0.73). In conclusion, obesity was associated with a greater incidence of minor, but no major, perioperative complications after TAVI. After adjustment, obesity was associated with a lower risk of 30-day mortality and had no adverse effect on mortality after discharge, underscoring the "obesity paradox" in patients undergoing TAVI.
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Bennadji A, Marcheix B, Cron C, Alexandre D, Mondoly P, Delay M, Rollin A, Cardin C, Glock Y, Maury P. 191: Acute rate of transmural lesions induced by the Epicor system® during peri-operative left atrial ablation for atrial fibrillation. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2013. [DOI: 10.1016/s1878-6480(13)71121-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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