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Hanet V, De Azevedo D, Krug P, Schafers HJ, Lansac E, De Kerchove L, El-Hamamsy I, Vojacek J, Contino M, Pouleur AC, Beauloye C, Pasquet A, Vanoverschelde JL, Vancraeynest D, Gerber B. Impact of recent 2021 ESC guideline changes on postoperative survival of patients with severe aortic regurgitation: insights from the AVIATOR registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.129] [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
Until 2021, the strongest guidelines on surgical correction of severe aortic regurgitation (AR) focused on the left ventricular systolic function (LVEF) and the presence of symptoms. However, those situations lead to an outcome penalty, even after surgical correction. Left ventricle end-systolic diameter (LVESD) gained in strength in 2021 European guidelines. Moreover, more inclusive cut-off values are now recommended (class IIb) in patients at low surgical risk, reflecting the will to recommend surgery before developing heart failure and its consequences on post-operative outcome.
Purpose
We sought to evaluate the impact of guidelines triggers and their recent changes on postoperative survival of patients with severe AR from a large multicentric international registry.
Method and results
Postoperative overall survival of 1899 patients operated for severe and chronic AR (mean age 49±15 years, 85% male) in the international multicenter surgery registry for aortic valve surgery, AVIATOR, was evaluated over a median of 37 months. Twelve patients (0.6%) died postoperatively, and 68 within 10 years. By multivariable Cox analysis, presence of heart failure symptoms (HR 2.60; 95% CI [1.20–5.66]; p=0; 016), and either LVESD >50 mm or >25 mm/m2 (HR 1.64; 95% CI [1.05–2.55]; p=0.029) predicted survival independently over and above age (HR 2.25 per SD, 95% CI [1.67–3.03], p<0.001), female gender and bicuspid phenotype. Therefore, patients operated on when meeting either old or new 2021 class I triggers had worse adjusted survival (respectively 86±2% and 87±2%) than patients operated on without meeting triggers (97±2%, p<0.01). However asymptomatic patients operated on while meeting new 2021 ESC class IIb triggers (ie LVESD >20 mm/m2 or LVEF between 50–55%, 10-year survival 97±3%). Moreover, the sub-group of patients having a dilated LVESD >50 mm or >25 mm/m2 but a preserved LVEF >50% had excellent survival (10-year survival 95±3%).
Conclusions
In severe AR, patients operated on when meeting any class I trigger have postoperative survival penalty. Asymptomatic patients operated on earlier have better survival. This supports early surgery in AR as encouraged by the recent ESC/EACTS guidelines.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Fondation Nationale de la Recherche Scientifique of the Belgian Government
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Affiliation(s)
- V Hanet
- Cliniques Saint-Luc UCL , Brussels , Belgium
| | | | - P Krug
- Cliniques Saint-Luc UCL , Brussels , Belgium
| | - H J Schafers
- Saarland University Hospital , Homburg , Germany
| | - E Lansac
- Institut Mutualiste Montsouris , Paris , France
| | | | | | - J Vojacek
- Charles University in Prague , Hradec Kralove , Czechia
| | - M Contino
- ASST Fatebenefratelli Sacco , Milano , Italy
| | - A C Pouleur
- Cliniques Saint-Luc UCL , Brussels , Belgium
| | - C Beauloye
- Cliniques Saint-Luc UCL , Brussels , Belgium
| | - A Pasquet
- Cliniques Saint-Luc UCL , Brussels , Belgium
| | | | | | - B Gerber
- Cliniques Saint-Luc UCL , Brussels , Belgium
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Ibrahim M, Stevens L, Ouzounian M, Hage A, Dagenais F, Peterson M, El-Hamamsy I, Boodhwani M, Bozinovski J, Moon M, Yamashita MH, Atoui R, Bittira B, Payne D, Lachapelle K, Chu M, Chung J. EVOLVING SURGICAL TECHNIQUES AND IMPROVING OUTCOMES FOR AORTIC ARCH SURGERY IN CANADA. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Heck R, Montagner M, Bozso SJ, Nagendran J, Chu MW, El-Hamamsy I, Ouzounian M, Kempfert J, Starck C, Moon MC. Acute and Midterm Results after AMDS (Ascyrus Medical Dissection Stent) Implantation for Arch Remodeling in the Treatment of Acute DeBakey-I Dissections: A Prospective International Trial. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705311] [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] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Hébert M, Cartier R, El-Hamamsy I, Dagenais F, Langlois Y, de Varennes B, Greentree D, Stevens L. AN ADAPTED CLAVIEN-DINDO CLASSIFICATION AND COMPREHENSIVE COMPLICATIONS INDEX RELIABLY REPRESENT EARLY POSTOPERATIVE OUTCOMES IN CARDIAC SURGERY. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.318] [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: 11/15/2022] Open
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St-Onge S, Bouhout I, Bouchard D, Carrier M, Cartier R, El-Hamamsy I, Jeanmart H, Lamarche Y, Pellerin M, Perrault L, Demers P. RE-EXPLORATION AND ECONOMIC JUSTIFICATION OF A CHEST DRAINAGE PROTOCOL IMPLEMENTING ACTIVE TUBE CLEARANCE AFTER CARDIAC SURGERY. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Ghoneim A, Bouhout I, Hage A, El-Hamamsy I, M Boodhwani, Bozinovski J, Dagenais F, Kumar K, Payne D, Moon M, Herman C, Ouzounian M, Peterson M, Chu M. CONTEMPORARY OUTCOMES OF AORTIC ARCH REPAIR WITH HYPOTHERMIC CIRCULATORY ARREST: THE IMPACT OF URGENCY STATUS EVIDENCE FROM THE CANADIAN THORACIC AORTIC COLLABORATIVE. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.594] [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: 11/15/2022] Open
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Laurin C, Chauvette V, El-Hamamsy I, Dumont É, Demers P, Dagenais F, Rahmouni K. OUTCOMES AFTER THORACIC AORTIC REPLACEMENT FOR GIANT CELL AORTITIS ANEURYSM: A MULTICENTER RETROSPECTIVE STUDY. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Bouhout I, Rong W, Poirier N, Dahdah N, El-Hamamsy I, Raboisson M, Poirier N. THE NORMAL AORTIC ROOT AND CUSP CONFIGURATION IN PEDIATRIC PATIENTS: GUIDE TO A SUCCESSFUL AORTIC VALVE REPAIR. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.216] [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: 11/26/2022] Open
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Labombarda F, Lenoir M, Aslam S, Marcotte F, El-Hamamsy I, Mongeon FP. 276Non contrast 3D steady-state free-precession magnetic resonance angiography: the more relevant magnetic resonance technique for the assessment prior to Ross procedure? Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez121.001] [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: 11/13/2022] Open
Affiliation(s)
- F Labombarda
- Montreal Heart Institute, Adult Congenital Heart Disease, Montreal, Canada
| | - M Lenoir
- Montreal Heart Institute, Heart surgery, Montreal, Canada
| | - S Aslam
- Montreal Heart Institute, Adult Congenital Heart Disease, Montreal, Canada
| | - F Marcotte
- Montreal Heart Institute, Adult Congenital Heart Disease, Montreal, Canada
| | - I El-Hamamsy
- Montreal Heart Institute, Heart surgery, Montreal, Canada
| | - F P Mongeon
- Montreal Heart Institute, Adult Congenital Heart Disease, Montreal, Canada
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Sibilio S, Koziarz A, McClure G, Alsagheir A, Alradaddi H, Lengyel A, Reza S, Um K, MacIsaac S, Mendoza P, Paparella D, El-Hamamsy I, Parry D, Belley-Côté E, Whitlock R. OUTCOME AFTER ROSS PROCEDURE IN ADULT PATIENTS: A SYSTEMATIC REVIEW, META-ANALYSIS AND MICROSIMULATION. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Calin E, Dionne P, Demers P, Lamarche Y, El-Hamamsy I, Pagé P, Jeanmart H. AN EVALUATION OF THE SAFETY OF NEW ORAL ANTICOAGULANTS FOLLOWING CARDIAC SURGERY. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.293] [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: 12/01/2022] Open
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Elbatarny M, Tam D, Edelman J, Rocha R, Chu M, Peterson M, El-Hamamsy I, Apoo J, Friedrich J, Boodhwani M, Yanagawa B, Ouzounian M. VALVE-SPARING ROOT REPLACEMENT VERSUS COMPOSITE VALVE GRAFT PROCEDURES IN THE MANAGEMENT OF AORTIC ROOT DILATION. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.238] [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: 11/16/2022] Open
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Bouhout I, Aly G, Tousch M, Poirier N, Cartier R, Demers P, Chu M, El-Hamamsy I. CAN PULMONARY AUTOGRAFT DILATATION BE PREVENTED IN PATIENTS WITH AORTIC REGURGITATION UNDERGOING THE ROSS PROCEDURE? IMPACT OF A TAILORED SURGICAL APPROACH. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Simard F, O'Meara E, Ducharme A, Racine N, White M, Asgar A, Ibrahim R, Dorval JF, Bonan R, Rouleau JL, Cartier R, El-Hamamsy I, Basmadjian A, Henri C. P5356Left atrial deformation in patients with moderate to severe aortic stenosis and heart failure. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5356] [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: 11/13/2022] Open
Affiliation(s)
- F Simard
- Montreal Heart Institute, Montreal, Canada
| | - E O'Meara
- Montreal Heart Institute, Montreal, Canada
| | - A Ducharme
- Montreal Heart Institute, Montreal, Canada
| | - N Racine
- Montreal Heart Institute, Montreal, Canada
| | - M White
- Montreal Heart Institute, Montreal, Canada
| | - A Asgar
- Montreal Heart Institute, Montreal, Canada
| | - R Ibrahim
- Montreal Heart Institute, Montreal, Canada
| | - J F Dorval
- Montreal Heart Institute, Montreal, Canada
| | - R Bonan
- Montreal Heart Institute, Montreal, Canada
| | | | - R Cartier
- Montreal Heart Institute, Montreal, Canada
| | | | | | - C Henri
- Montreal Heart Institute, Montreal, Canada
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Sibilio S, Koziarz A, McClure G, Alsagheir A, Alraddadi H, Lengyel A, Reza S, Um K, Mendoza P, Mclsaac S, Paparella D, El-Hamamsy I, Parry D, Belley-Cote E, Whitlock R. P3524Outcome after ross procedure in adult patients: a systematic review, meta-analysis and microsimulation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3524] [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: 11/14/2022] Open
Affiliation(s)
- S Sibilio
- University of Bari, Hospital Policlinico, Bari, Italy
| | - A Koziarz
- McMaster University, Department of Health Research Methods, Evidence, and Impact, Hamilton, Canada
| | - G McClure
- McMaster University, Michael G. DeGroote School of Medicine, Hamilton, Canada
| | - A Alsagheir
- Population Health Research Institute, Cardiac surgery, Hamilton, Canada
| | - H Alraddadi
- McMaster University, Department of surgery, Hamilton, Canada
| | - A Lengyel
- McMaster University, Undergraduate Faculty of Health Sciences, Hamilton, Canada
| | - S Reza
- Waterloo University, Undergraduate Faculty of Health Sciences, Waterloo, Canada
| | - K Um
- McMaster University, Michael G. DeGroote School of Medicine, Hamilton, Canada
| | - P Mendoza
- McMaster University, Undergraduate Faculty of Health Sciences, Hamilton, Canada
| | - S Mclsaac
- Population Health Research Institute, Cardiac surgery, Hamilton, Canada
| | - D Paparella
- University of Bari, Hospital Policlinico, Bari, Italy
| | - I El-Hamamsy
- Montreal Heart Institute, Department of surgery, Montreal, Canada
| | - D Parry
- McMaster University, Department of surgery, Hamilton, Canada
| | - E Belley-Cote
- Population Health Research Institute, Cardiac surgery, Hamilton, Canada
| | - R Whitlock
- Population Health Research Institute, Cardiac surgery, Hamilton, Canada
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Mazine A, Rocha RV, El-Hamamsy I, Ouzounian M, Yanagawa B, Bhatt DL, Verma S, Friedrich JO. P760The Ross procedure versus mechanical aortic valve replacement in adults: a systematic review and meta-analysis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p760] [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: 11/12/2022] Open
Affiliation(s)
- A Mazine
- University of Toronto, Cardiac Surgery, Toronto, Canada
| | - R V Rocha
- University of Toronto, Cardiac Surgery, Toronto, Canada
| | - I El-Hamamsy
- Montreal Heart Institute, Cardiac Surgery, Montreal, Canada
| | - M Ouzounian
- Toronto General Hospital, Cardiac Surgery, Toronto, Canada
| | - B Yanagawa
- St. Michael's Hospital, Cardiac Surgery, Toronto, Canada
| | - D L Bhatt
- Brigham and Women's Hospital, Heart & Vascular Center, Boston, United States of America
| | - S Verma
- St. Michael's Hospital, Cardiac Surgery, Toronto, Canada
| | - J O Friedrich
- St. Michael's Hospital, Critical Care Medicine, Toronto, Canada
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St-Onge S, Lemoine É, Bouhout I, Rochon A, El-Hamamsy I, Lamarche Y, Demers P. Evaluation of the real-world impact of rotational thromboelastometry-guided transfusion protocol in patients undergoing proximal aortic surgery. J Thorac Cardiovasc Surg 2018; 157:1045-1054.e4. [PMID: 30195598 DOI: 10.1016/j.jtcvs.2018.07.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 06/12/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Complex aortic procedures are potentially associated with important blood loss and coagulopathy. The aim of this study was to assess the impact of rotational thromboelastometry (ROTEM, Tem International GmBH, Munich, Germany) on transfusion requirements after proximal aortic operations in a real-world setting. METHODS This single-center retrospective analysis based on 385 consecutive patients undergoing cardiac surgeries involving the aortic root, ascending aorta, or aortic arch compared 197 controls managed according to routine transfusion protocol before the introduction of the ROTEM in 2012 with 188 patients operated afterward. With the use of a 1:1 propensity score match, 224 patients were included in paired analysis (112 in each group). The primary end point was erythrocytes transfusion rate. The secondary end points comprised the transfusion of other allogeneic blood products, number of units transfused, postoperative blood loss, massive transfusion rate, and use of other hemostatic products. RESULTS ROTEM implementation was associated with a trend toward reduction in the rate of erythrocytes transfusion (57% vs 46%, P = .08) and a decreased median number of units transfused for erythrocytes (1.0 [0.0-4.0] unit vs 0.0 [0.0-2.0] unit, P = .03) and plasma (0.0 [0.0-4.0] unit vs 0.0 [0.0-2.0] unit, P = .04). After sensitivity analysis, ROTEM displayed a comparable rate of erythrocytes transfusion (58% vs 47%, P = .15). CONCLUSIONS In a real-world setting, ROTEM-based algorithm implementation could help reduce excess erythrocytes transfusion for complex aortic procedures. We advocate for a strict adherence and concerted team effort to maximize the benefits of such addition to patients' management.
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Affiliation(s)
- Samuel St-Onge
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal School of Medicine, Montreal, Quebec, Canada
| | - Émile Lemoine
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal School of Medicine, Montreal, Quebec, Canada
| | - Ismail Bouhout
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal School of Medicine, Montreal, Quebec, Canada
| | - Antoine Rochon
- Department of Anesthesia, Montreal Heart Institute, Université de Montréal School of Medicine, Montreal, Quebec, Canada
| | - Ismaïl El-Hamamsy
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal School of Medicine, Montreal, Quebec, Canada
| | - Yoan Lamarche
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal School of Medicine, Montreal, Quebec, Canada
| | - Philippe Demers
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal School of Medicine, Montreal, Quebec, Canada.
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Vistarini N, Nguyen A, White M, Racine N, Perrault LP, Ducharme A, Bouchard D, Demers P, Pellerin M, Lamarche Y, El-Hamamsy I, Giraldeau G, Pelletier G, Carrier M. Changes in patient characteristics following cardiac transplantation: the Montreal Heart Institute experience. Can J Surg 2017; 60:305-310. [PMID: 28805187 DOI: 10.1503/cjs.005716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Heart transplantation is no longer considered an experimental operation, but rather a standard treatment; nevertheless the context has changed substantially in recent years owing to donor shortage. The aim of this study was to review the heart transplant experience focusing on very long-term survival (≥ 20 years) and to compare the initial results with the current era. METHODS From April 1983 through April 1995, 156 consecutive patients underwent heart transplantation. Patients who survived 20 years or longer (group 1) were compared with patients who died within 20 years after surgery (group 2). To compare patient characteristics with the current era, we evaluated our recent 5-year experience (group 3; patients who underwent transplantation between 2010 and 2015), focusing on differences in terms of donor and recipient characteristics. RESULTS Group 1 (n = 46, 30%) included younger patients (38 ± 11 v. 48 ± 8 yr, p = 0.001), a higher proportion of female recipients (28% v. 8%, p = 0.001) and a lower prevalence of ischemic heart disease (42% v. 65%, p = 0.001) than group 2 (n = 110, 70%). Patients in group 3 (n = 54) were older (52 ± 12 v. 38 ± 11 yr, p = 0.001), sicker (rate of hospital admission at transplantation 48% v. 20%, p = 0.001) and transplanted with organs from older donors (42 ± 15 v. 29 ± 11 yr, p = 0.001) than those in group 1. CONCLUSION Very long-term survival ( ≥ 20 yr) was observed in 30% of patients transplanted during the first decade of our experience. This outcome will be difficult to duplicate in the current era considering our present population of older and sicker patients transplanted with organs from older donors.
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Affiliation(s)
- Nicola Vistarini
- From the Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Que. (Vistarini, Nguyen, Perrault, Bouchard, Demers, Pellerin, Lamarche, El-Hamamsy, Carrier); and the Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Que. (White, Racine, Ducharme, Giraldeau, Pelletier)
| | - Anthony Nguyen
- From the Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Que. (Vistarini, Nguyen, Perrault, Bouchard, Demers, Pellerin, Lamarche, El-Hamamsy, Carrier); and the Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Que. (White, Racine, Ducharme, Giraldeau, Pelletier)
| | - Michel White
- From the Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Que. (Vistarini, Nguyen, Perrault, Bouchard, Demers, Pellerin, Lamarche, El-Hamamsy, Carrier); and the Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Que. (White, Racine, Ducharme, Giraldeau, Pelletier)
| | - Normand Racine
- From the Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Que. (Vistarini, Nguyen, Perrault, Bouchard, Demers, Pellerin, Lamarche, El-Hamamsy, Carrier); and the Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Que. (White, Racine, Ducharme, Giraldeau, Pelletier)
| | - Louis P Perrault
- From the Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Que. (Vistarini, Nguyen, Perrault, Bouchard, Demers, Pellerin, Lamarche, El-Hamamsy, Carrier); and the Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Que. (White, Racine, Ducharme, Giraldeau, Pelletier)
| | - Anique Ducharme
- From the Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Que. (Vistarini, Nguyen, Perrault, Bouchard, Demers, Pellerin, Lamarche, El-Hamamsy, Carrier); and the Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Que. (White, Racine, Ducharme, Giraldeau, Pelletier)
| | - Denis Bouchard
- From the Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Que. (Vistarini, Nguyen, Perrault, Bouchard, Demers, Pellerin, Lamarche, El-Hamamsy, Carrier); and the Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Que. (White, Racine, Ducharme, Giraldeau, Pelletier)
| | - Philippe Demers
- From the Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Que. (Vistarini, Nguyen, Perrault, Bouchard, Demers, Pellerin, Lamarche, El-Hamamsy, Carrier); and the Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Que. (White, Racine, Ducharme, Giraldeau, Pelletier)
| | - Michel Pellerin
- From the Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Que. (Vistarini, Nguyen, Perrault, Bouchard, Demers, Pellerin, Lamarche, El-Hamamsy, Carrier); and the Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Que. (White, Racine, Ducharme, Giraldeau, Pelletier)
| | - Yoan Lamarche
- From the Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Que. (Vistarini, Nguyen, Perrault, Bouchard, Demers, Pellerin, Lamarche, El-Hamamsy, Carrier); and the Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Que. (White, Racine, Ducharme, Giraldeau, Pelletier)
| | - Ismaïl El-Hamamsy
- From the Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Que. (Vistarini, Nguyen, Perrault, Bouchard, Demers, Pellerin, Lamarche, El-Hamamsy, Carrier); and the Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Que. (White, Racine, Ducharme, Giraldeau, Pelletier)
| | - Geneviève Giraldeau
- From the Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Que. (Vistarini, Nguyen, Perrault, Bouchard, Demers, Pellerin, Lamarche, El-Hamamsy, Carrier); and the Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Que. (White, Racine, Ducharme, Giraldeau, Pelletier)
| | - Guy Pelletier
- From the Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Que. (Vistarini, Nguyen, Perrault, Bouchard, Demers, Pellerin, Lamarche, El-Hamamsy, Carrier); and the Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Que. (White, Racine, Ducharme, Giraldeau, Pelletier)
| | - Michel Carrier
- From the Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Que. (Vistarini, Nguyen, Perrault, Bouchard, Demers, Pellerin, Lamarche, El-Hamamsy, Carrier); and the Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Que. (White, Racine, Ducharme, Giraldeau, Pelletier)
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Emmott A, El-Hamamsy I, Leask RL. Histopathological and biomechanical properties of the aortic wall in 2 patients with chronic type A aortic dissection. Cardiovasc Pathol 2017; 29:48-52. [PMID: 28601673 DOI: 10.1016/j.carpath.2017.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 04/10/2017] [Revised: 05/25/2017] [Accepted: 05/25/2017] [Indexed: 11/19/2022] Open
Abstract
Type A aortic dissection is an acute condition that requires urgent surgical intervention. However, in a subset of patients, aortic dissections go undiagnosed and become chronic, thereby allowing the dissected wall to undergo a distinct remodeling process from that of the surrounding intact wall. Here, we observe the biomechanical and histological changes in the aortic wall of two patients with chronic Type A aortic dissection. Partial or complete disruption of the elastic structure of the medial layer was observed in the dissected wall of both patients; however, aortic stiffness in the region of dissection covaried with a change in collagen content. A ~50% increase in viscous energy loss was observed in the region of dissection of both patients which suggests an impaired elastic recoil and Windkessel function of the proximal aorta. MMP expression (2 and 9) differed between the dissected and intact wall and was distinct between the two patients. Our observations suggest that an active remodeling process occurs in the dissected aortic wall resulting in a vastly different biomechanical behavior.
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Affiliation(s)
- Alexander Emmott
- Department of Chemical Engineering, McGill University, Montreal, Quebec, Canada; Research Center, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Ismaïl El-Hamamsy
- Research Center, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada; Division of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Canada
| | - Richard L Leask
- Department of Chemical Engineering, McGill University, Montreal, Quebec, Canada; Research Center, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
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Noly PE, Legris-Falardeau V, Ibrahim R, El-Hamamsy I, Cartier R, Lamarche Y, Bouchard D, Dorval JF, Poirier N, Demers P. Results of a multimodal approach for the management of aortic coarctation and its complications in adults. Interact Cardiovasc Thorac Surg 2017; 25:335-342. [DOI: 10.1093/icvts/ivx039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 01/23/2017] [Indexed: 01/23/2023] Open
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21
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St-Onge S, Ben Ali W, Bouhout I, Bouchard D, Carrier M, Cartier R, El-Hamamsy I, Lamarche Y, Perrault L, Pellerin M, Demers P. CHEST DRAINAGE USING ACTIVE CLEARANCE TECHNOLOGY REDUCES THE INCIDENCE OF POSTOPERATIVE ATRIAL FIBRILLATION. Can J Cardiol 2016. [DOI: 10.1016/j.cjca.2016.07.315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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22
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Ben Ali W, Ducruet T, El-Hamamsy I, Bouchard D, Poirier N. LONG TERM RESULTS OF PAEDIATRIC ROSS PROCEDURE: A NEW METHODOLOGY OF TIME-TO-EVENT DATA META-ANALYSIS. Can J Cardiol 2016. [DOI: 10.1016/j.cjca.2016.07.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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23
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Ghoneim A, Bouhout I, Demers P, Bouchard D, Poirier N, Perrault L, Lamarche Y, Carrier M, Pellerin M, Cartier R, El-Hamamsy I. AORTIC VALVE SURGERY IN PATIENTS WITH PREVIOUS MEDIASTINAL RADIATION THERAPY. Can J Cardiol 2016. [DOI: 10.1016/j.cjca.2016.07.378] [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: 11/25/2022] Open
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24
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Morgant M, Bouhout I, Amr G, Poirier N, Bouchard D, Demers P, Cartier R, Pellerin M, Perrault L, Carrier M, Hebert Y, Lamarche Y, El-Hamamsy I. IMPACT OF PROSTHESIS-PATIENT MISMATCH AFTER MECHANICAL AORTIC VALVE REPLACEMENT ON MIDTERM SURVIVAL IN YOUNG ADULTS. Can J Cardiol 2016. [DOI: 10.1016/j.cjca.2016.07.167] [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: 11/25/2022] Open
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25
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Dionne P, Poulin F, Généreux P, Carrier M, Cartier R, Bouchard D, El-Hamamsy I, Pellerin M, Ibrahim R, Asgar A, Lamarche Y, Demers P. EARLY HEMODYNAMIC RESULTS IN PATIENTS WITH SMALL AORTIC ANNULUS UNDERGOING SURGICAL SUTURELESS AORTIC VALVE REPLACEMENT (PERCEVAL) AND BALLOON-EXPANDABLE TRANSCATHETER AORTIC VALVE IMPLANTATION. Can J Cardiol 2016. [DOI: 10.1016/j.cjca.2016.07.504] [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] Open
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26
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Vistarini N, Laliberté E, Beauchamp P, Bouhout I, Lamarche Y, Cartier R, Carrier M, Perrault L, Bouchard D, El-Hamamsy I, Pellerin M, Demers P. Del Nido cardioplegia in the setting of minimally invasive aortic valve surgery. Perfusion 2016; 32:112-117. [DOI: 10.1177/0267659116662701] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study is to report our experience with del Nido cardioplegia (DNC) in the setting of minimally invasive aortic valve surgery. Forty-six consecutive patients underwent minimally invasive aortic valve replacement (AVR) through a “J” ministernotomy: twenty-five patients received the DNC (Group 1) and 21 patients received standard blood cardioplegia (SBC) (Group 2). The rate of ventricular fibrillation at unclamping was significantly lower in the DNC group (12% vs 52%, p=0.004), as well as postoperative creatinine kinase-MB (CK-MB) values (11.4±5.2 vs 17.7±6.9 µg/L, p=0.004). There were no deaths, myocardial infarctions or major complications in either group. Less postoperative use of intravenous insulin (28% vs 81%, p<0.001) was registered in the DNC group. In conclusion, the DNC is easy to use and safe during minimally invasive AVR, providing a myocardial protection at least equivalent to our SBC, improved surgical efficiency, minimal cost and less blood glucose perturbations.
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Affiliation(s)
- Nicola Vistarini
- Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Pavia University School of Medicine, Pavaia, Italy
| | - Eric Laliberté
- Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Philippe Beauchamp
- Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Ismail Bouhout
- Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Yoan Lamarche
- Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Raymond Cartier
- Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Michel Carrier
- Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Louis Perrault
- Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Denis Bouchard
- Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Ismaïl El-Hamamsy
- Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Michel Pellerin
- Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Philippe Demers
- Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
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Emmott A, Garcia J, Chung J, Lachapelle K, El-Hamamsy I, Mongrain R, Cartier R, Leask RL. Biomechanics of the Ascending Thoracic Aorta: A Clinical Perspective on Engineering Data. Can J Cardiol 2016; 32:35-47. [DOI: 10.1016/j.cjca.2015.10.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 10/17/2015] [Accepted: 10/18/2015] [Indexed: 12/14/2022] Open
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Dionne P, Pagé P, Lamarche Y, Demers P, El-Hamamsy I, Jeanmart H. POST-OPERATIVE USE OF NEW ORAL ANTICOAGULANTS IN CARDIAC SURGERY, EXPERIENCE IN 51 PATIENTS. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Legris-Falardeau V, Noly P, Ibrahim R, Poirier N, El-Hamamsy I, Lamarche Y, Bouchard D, Cartier R, Dorval J, Demers P. CONTEMPORARY MANAGEMENT OF AORTIC COARCTATION IN ADULTS: MID-TERM RESULTS. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.357] [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: 11/27/2022] Open
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30
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Vistarini N, Nguyen A, Perrault L, Bouchard D, Cartier R, Demers P, Pellerin M, Lamarche Y, El-Hamamsy I, Carrier M. LONG-TERM SURVIVAL AFTER CARDIAC TRANSPLANTATION: PAST, PRESENT AND FUTURE. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.425] [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: 11/25/2022] Open
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31
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Tarola C, Losenno K, Peterson M, El-Hamamsy I, Chu M. VALVE SPARING AORTIC ROOT RECONSTRUCTION: DOES GRAFT SIZING MATTER? Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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32
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Bouhout I, Semplonius T, Cartier R, Poirier N, El-Hamamsy I. EARLY CHANGES IN AUTOGRAFT ROOT DIMENSIONS FOLLOWING THE ROSS PROCEDURE: ROLE OF SURGICAL ETIOLOGY. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.384] [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: 11/16/2022] Open
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33
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Ghoneim A, Bouhout I, Fortin W, Mazine A, El-Hamamsy I, Jeanmart H, Pellerin M, Bouchard D. BEATING HEART MINIMALLY INVASIVE MITRAL VALVE SURGERY IN PATIENTS WITH PATENT CORONARY BYPASS GRAFTS. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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34
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Trapeaux J, Busseuil D, Shi Y, Nobari S, Shustik D, Mecteau M, El-Hamamsy I, Lebel M, Mongrain R, Rhéaume E, Tardif JC. Improvement of aortic valve stenosis by ApoA-I mimetic therapy is associated with decreased aortic root and valve remodelling in mice. Br J Pharmacol 2014; 169:1587-99. [PMID: 23638718 DOI: 10.1111/bph.12236] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 04/10/2013] [Accepted: 04/18/2013] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND AND PURPOSE We have shown that infusions of apolipoprotein A-I (ApoA-I) mimetic peptide induced regression of aortic valve stenosis (AVS) in rabbits. This study aimed at determining the effects of ApoA-I mimetic therapy in mice with calcific or fibrotic AVS. EXPERIMENTAL APPROACH Apolipoprotein E-deficient (ApoE(-/-) ) mice and mice with Werner progeria gene deletion (Wrn(Δhel/Δhel) ) received high-fat diets for 20 weeks. After developing AVS, mice were randomized to receive saline (placebo group) or ApoA-I mimetic peptide infusions (ApoA-I treated groups, 100 mg·kg(-1) for ApoE(-/-) mice; 50 mg·kg(-1) for Wrn mice), three times per week for 4 weeks. We evaluated effects on AVS using serial echocardiograms and valve histology. KEY RESULTS Aortic valve area (AVA) increased in both ApoE(-/-) and Wrn mice treated with the ApoA-I mimetic compared with placebo. Maximal sinus wall thickness was lower in ApoA-I treated ApoE(-/-) mice. The type I/III collagen ratio was lower in the sinus wall of ApoA-I treated ApoE(-/-) mice compared with placebo. Total collagen content was reduced in aortic valves of ApoA-I treated Wrn mice. Our 3D computer model and numerical simulations confirmed that the reduction in aortic root wall thickness resulted in improved AVA. CONCLUSIONS AND IMPLICATIONS ApoA-I mimetic treatment reduced AVS by decreasing remodelling and fibrosis of the aortic root and valve in mice.
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Affiliation(s)
- J Trapeaux
- Montreal Heart Institute, Montreal, QC, Canada
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35
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Dionne P, Poirier N, Cartier R, Mongeon F, Dore A, Deschamps A, El-Hamamsy I. EARLY OUTCOMES FOLLOWING THE FIRST 100 ROSS PROCEDURES IN A STARTING PROGRAM: WHAT IS THE LEARNING CURVE? Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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36
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Forcillo J, Poirier N, El-Hamamsy I. A NOVEL APPROACH FOR THE SURGICAL MANAGEMENT OF UNICUSPID AORTIC VALVES: TECHNICAL FEASIBILITY AND EARLY ECHOCARDIOGRAPHIC Results. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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37
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Saydy N, Mazine A, Stevens L, Jeanmart H, Demers P, Pagé P, Lamarche Y, El-Hamamsy I. PREDICTORS OF POSTOPERATIVE ACUTE KIDNEY INJURY IN YOUNG ADULTS UNDERGOING CARDIAC SURGERY. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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38
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Dionne P, Wener E, Leask R, Mongrain R, Cartier R, Poirier N, El-Hamamsy I. BIOMECHANICAL PROPERTIES OF PATIENT-SPECIFIC AORTAS AND PULMONARY ARTERIES ACCORDING TO AORTIC VALVE PHENOTYPE: RELEVANCE TO THE ROSS PROCEDURE. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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39
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Badrudin D, Moss E, Bouchard D, Carrier M, Cartier R, El-Hamamsy I, Lamarche Y, Pellerin M, Perrault L, Demers P. 160 Surgery For Type A Aortic Dissection: Results Over 15 Years. Can J Cardiol 2012. [DOI: 10.1016/j.cjca.2012.07.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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40
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Bouhout I, Poirier N, Mercier L, Dore A, Leduc L, El-Hamamsy I. 795 Pregnancy Following Aortic Valve Replacement - Cardiac, Maternal and Fetal Outcomes. Can J Cardiol 2012. [DOI: 10.1016/j.cjca.2012.07.715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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41
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Bouhout I, Stevens L, Cartier R, Carrier M, Pellerin M, Perrault L, Bouchard D, Demers P, Poirier N, El-Hamamsy I. 141 Long-Term Outcomes Following Isolated Mechanical Aortic Valve Replacement In Young Adults. Can J Cardiol 2012. [DOI: 10.1016/j.cjca.2012.07.146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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42
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Lamarche Y, Pagé M, Laflamme M, El-Hamamsy I, Bouchard D, Bernatchez J, Noel L, Laflamme J, Cartier R. 699 Cardiac Arrest After Cardiac Surgery : Role of Simulation for the Intensive Care Team Performance. Can J Cardiol 2012. [DOI: 10.1016/j.cjca.2012.07.633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Pagé M, Mongeon F, Stevens L, Dore A, Mercier L, Khairy P, Garceau P, Marcotte F, El-Hamamsy I. 797 Cusp Fusion Phenotype is a Determinant of Ascending Aorta Dilation Rate and Pattern Among Patients With Isolated Bicuspid Aortic Valve. Can J Cardiol 2012. [DOI: 10.1016/j.cjca.2012.07.717] [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: 11/26/2022] Open
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Bertazzo S, Cloyd K, Gentleman E, El-Hamamsy I, Chester A, Yacoub M, Stevens M. 285 NANO- AND MICRO-STRUCTURE OF CALCIFICATION IN HUMAN AORTIC VALVE, AORTA AND CORONARY WALL. ATHEROSCLEROSIS SUPP 2011. [DOI: 10.1016/s1567-5688(11)70286-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Vanden Eynden F, Bouchard D, El-Hamamsy I, Butnaru A, Demers P, Carrier M, Perrault LP, Tardif JC, Pellerin M. Effect of Aortic Valve Replacement for Aortic Stenosis on Severity of Mitral Regurgitation. Ann Thorac Surg 2007; 83:1279-84. [PMID: 17383327 DOI: 10.1016/j.athoracsur.2006.12.076] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2006] [Revised: 12/22/2006] [Accepted: 12/27/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Surgically addressing moderate mitral regurgitation (MR) at the time of aortic valve replacement (AVR) for aortic stenosis remains uncertain. The purpose of this study was to examine the change in moderate (2+) or moderate-severe (3+) MR after isolated AVR for aortic stenosis to determine preoperative factors predictive of improvement in MR. METHODS Using an institutional databank of prospectively collected data, all patients undergoing isolated AVR for aortic stenosis with moderate (2+) to moderate-severe (3+) MR between 1994 and 1996 at the Montreal Heart Institute were evaluated. RESULTS Eighty patients with preoperative and postoperative transthoracic echocardiographic follow-up were identified. Preoperative MR was moderate (2+) in 78 patients (97.5%) and moderate-severe (3+) in 2 patients (2.5%). Mitral regurgitation was classified as rheumatic (32%), ischemic (32%), functional (21%), and myxomatous (15%). At 1-year follow-up transthoracic echocardiography, MR improved by 1 or 2 grades in 29 patients (35%), was unchanged in 44 (55%), and worsened in 7 (10%). On multivariate analysis, isolated ischemic and functional MR were the only preoperative factors predictive of MR improvement after AVR (p = 0.01): 54% of ischemic and 44% of functional MR patients showed improvement in MR after AVR compared with 23% of rheumatic and 17% of myxomatous MR patients. CONCLUSIONS Etiology of MR was a significant prognostic factor for improvement in MR grade. Since there was little improvement in the rheumatoid and myxomatous group, replacement or repair should strongly be considered. For functional and ischemic mitral regurgitation, a surgical correction should be performed on an individual basis.
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El-Hamamsy I, White M, Pellerin M, Demers P, Bouchard D, Leung TK, Perrault LP, Carrier M. Successful explantation of a left ventricular assist device following acute fulminant myocarditis. Can J Cardiol 2006; 22:507-8. [PMID: 16685316 PMCID: PMC2560553 DOI: 10.1016/s0828-282x(06)70269-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
A left ventricular (LV) assist device was implanted in a 53-year-old woman in cardiogenic shock secondary to fulminant myocarditis. LV function recovered to normal after one week of support from an LV assist device. The device was explanted and the patient is showing a good outcome with a normalized LV function.
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Affiliation(s)
- Ismaïl El-Hamamsy
- Department of Cardiovascular Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec
| | - Michel White
- Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Quebec
| | - Michel Pellerin
- Department of Cardiovascular Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec
| | - Philippe Demers
- Department of Cardiovascular Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec
| | - Denis Bouchard
- Department of Cardiovascular Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec
| | - Tack Ki Leung
- Department of Medical Biology (Pathology), Montreal Heart Institute and Université de Montréal, Montreal, Quebec
| | - Louis P Perrault
- Department of Cardiovascular Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec
| | - Michel Carrier
- Department of Cardiovascular Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec
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47
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El-Hamamsy I, Stevens L, White M, Perrault L, Pellerin M, Carrier M. 221. J Heart Lung Transplant 2006. [DOI: 10.1016/j.healun.2005.11.230] [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: 11/16/2022] Open
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48
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El-Hamamsy I, Stevens LM, Carrier M, Pelletier G, White M, Tremblay F, Perrault LP. Incidence and prognosis of cancer following heart transplantation using RATG induction therapy. Transpl Int 2005; 18:1280-5. [PMID: 16221159 DOI: 10.1111/j.1432-2277.2005.00203.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cancer limits survival following heart transplantation. The study's objectives were to evaluate the incidence and risk factors for cancers after heart transplantation and to assess the association between i.v. thymoglobuline induction therapy [rabbit antithymocyte immunoglobulin, (RATG)] and neoplasia. From 1982 to 2002, prospective data were gathered for 207 heart transplant recipients. Except from 1982 to 1987, all patients received a 3-day course of i.v. RATG following transplantation. Forty-three malignant neoplasms (21%) were diagnosed. The most common were: skin (42%), lung (12%), prostate (9%), genitourinary (9%) and lymphoma (5%). Mean length of follow-up after transplantation was 99 +/- 57 months. Mean survival after diagnosis was 52 +/- 44 months. Multivariate analysis showed no significant increase in the incidence of cancer with recipient age, sex, number of rejection episodes, the type of immunosuppression or the use of RATG. Patients receiving RATG developed their malignancies significantly earlier after transplantation (P =0.007) and succumbed faster after the diagnosis (P = 0.06). Cancer is a limiting event for long-term survival after heart transplantation. No individual risk factors allow predicting its development. In the present cohort, RATG does not have carcinogenic effects following transplantation, but is associated with a more precocious development of malignancies.
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Affiliation(s)
- Ismaïl El-Hamamsy
- Department of Cardiovascular Surgery, Montreal Heart Institute and University of Montreal, Quebec, Canada
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El-Hamamsy I, Dürrleman N, Stevens LM, Perrault LP, Carrier M. Aspergillus Endocarditis After Cardiac Surgery. Ann Thorac Surg 2005; 80:359-64. [PMID: 15975413 DOI: 10.1016/j.athoracsur.2004.08.070] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2004] [Revised: 08/28/2004] [Accepted: 08/30/2004] [Indexed: 10/25/2022]
Abstract
Aspergillus species infections are an increasingly common occurrence in hospital wards. Aspergillus endocarditis constitutes one of the manifestations of the disease, which bears a poor prognosis in cardiac surgery patients. A review of the literature on fungal and Aspergillus endocarditis was undertaken. Valvular risk factors, indwelling intravenous catheters, prolonged antibiotics, malignancy, and intravenous drug use increase the risk. Clinical presentation is insidious, with embolic complications often representing the first manifestation of the disease. Blood cultures are typically negative. The mortality rate is almost 100%. Amphotericin B represents the mainstay of medical therapy with several possible adjuncts. Surgery is an essential part of therapy in Aspergillus endocarditis after cardiac surgery and should be undertaken as soon as the diagnosis is made. Aspergillus endocarditis is an ominous complication after cardiac surgery. A high suspicion index, early administration of appropriate antibiotics, and prompt surgical intervention should improve the prognosis, which remains dismal.
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Affiliation(s)
- Ismaïl El-Hamamsy
- Department of Surgery, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
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Perrault LP, El-Hamamsy I, Dumont E, Malo O, Carrier M. Effects of Crystalloid, Blood and Celsior Solutions on Porcine Coronary Endothelial Function After Heart Transplantation. J Heart Lung Transplant 2005; 24:912-20. [PMID: 15982622 DOI: 10.1016/j.healun.2004.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2004] [Revised: 04/26/2004] [Accepted: 05/09/2004] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Coronary endothelial dysfunction occurs early after heart transplantation and predicts the development of cardiac allograft vasculopathy. Cardioplegic solutions may cause endothelial injury. The present study aimed to assess the effects of cardioplegic solutions (crystalloid, blood and Celsior) used at the time of graft harvesting on endothelial function and intimal hyperplasia 1 month after heart transplantation. METHODS A porcine heterotopic heart transplantation model was used. Three experimental groups were studied: crystalloid, blood and Celsior solutions were used for induction of cardiac arrest. Epicardial coronary arteries of native and allograft hearts were studied 1 month after transplantation in organ chambers. Endothelium-dependent relaxations to serotonin, bradykinin and calcium ionophore were assessed. Coronary neointimal proliferation was evaluated using histomorphometric studies. RESULTS Endothelium-dependent relaxations to serotonin and to calcium ionophore were significantly decreased in all 3 experimental groups vs controls (p<0.05). Endothelium-dependent relaxations to bradykinin were significantly reduced in the crystalloid group compared with the Celsior and blood groups and controls (p<0.05). There was a significantly lower rate of severe intimal hyperplasia in the Celsior group compared to the crystalloid and blood groups (p<0.05). CONCLUSION Celsior cardioplegic solution represents the solution of choice in terms of preservation of endothelial function and lower incidence of severe coronary intimal hyperplasia following transplantation compared with crystalloid and blood cardioplegia solutions. These early results could translate into a reduction of the long-term incidence of cardiac allograft vasculopathy and improve graft survival.
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Affiliation(s)
- Louis P Perrault
- Department of Surgery and Research Center, Montreal Heart Institute, Montreal, Quebec, Canada.
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