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Kikoïne J, Kilani N, Pitta-Gros B, Yerly P. Remote haemodynamic monitoring in patients with heart failure. Lancet 2024; 403:808. [PMID: 38431346 DOI: 10.1016/s0140-6736(23)02679-x] [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: 07/10/2023] [Accepted: 11/24/2023] [Indexed: 03/05/2024]
Affiliation(s)
- John Kikoïne
- Department of Cardiology, Lausanne University Hospital, Lausanne 1003, Switzerland.
| | - Nadia Kilani
- Department of Cardiology, Lausanne University Hospital, Lausanne 1003, Switzerland
| | - Barbara Pitta-Gros
- Department of Cardiology, Lausanne University Hospital, Lausanne 1003, Switzerland
| | - Patrick Yerly
- Department of Cardiology, Lausanne University Hospital, Lausanne 1003, Switzerland
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Abdurashidova T, Müller M, Schukraft S, Soborun N, Pitta‐Gros B, Kikoïne J, Lu H, Chazymova Z, Dzhorupbekova K, Beishenkulov M, Tzimas G, Kirsch M, Vollenweider P, Mean M, Monney P, Hullin R. European Society of Cardiology guidelines and 1 year outcomes of acute heart failure treatment in Central Asia and Europe. ESC Heart Fail 2024; 11:483-491. [PMID: 38059306 PMCID: PMC10804142 DOI: 10.1002/ehf2.14591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/07/2023] [Indexed: 12/08/2023] Open
Abstract
AIMS Outcomes reported for patients with hospitalization for acute heart failure (AHF) treatment vary worldwide. Ethnicity-associated characteristics may explain this observation. This observational study compares characteristics and 1-year outcomes of Kyrgyz and Swiss AHF patients against the background of European Society of Cardiology guidelines-based cardiovascular care established in both countries. METHODS AND RESULTS The primary endpoint was 1 year all-cause mortality (ACM); the secondary endpoint was 1 year ACM or HF-related rehospitalization. A total of 538 Kyrgyz and 537 Swiss AHF patients were included. Kyrgyz patients were younger (64.0 vs. 83.0 years, P < 0.001); ischaemic or rheumatic heart disease and chronic obstructive pulmonary disease were more prevalent (always P < 0.001). In Swiss patients, smoking, dyslipidaemia, hypertension, and atrial flutter/fibrillation were more frequent (always P ≤ 0.035); moreover, left ventricular ejection fraction (LVEF) was higher (47% vs. 36%; P < 0.001), and >mild aortic stenosis was more prevalent (P < 0.001). Other valvular pathologies were more prevalent in Kyrgyz patients (P < 0.001). At discharge, more Swiss patients were on vasodilatory treatment (P < 0.006), while mineralocorticoid receptor antagonists (P = 0.001), beta-blockers (P = 0.001), or loop diuretics (P < 0.001) were less often prescribed. In Kyrgyz patients, unadjusted odds for the primary and secondary endpoints were lower [odds ratio (OR) 0.68, 95% confidence interval (CI): 0.51-0.90, P = 0.008; OR 0.72, 95% CI: 0.56-0.91, P = 0.006, respectively]. After adjustment for age and LVEF, no difference remained (primary endpoint: OR 1.03, 95% CI: 0.71-1.49, P = 0.894; secondary endpoint: OR 0.82, 95% CI: 0.60-1.12, P = 0.206). CONCLUSIONS On the background of identical guidelines, age- and LVEF-adjusted outcomes were not different between Central Asian and Western European AHF patients despite of large ethnical disparity.
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Affiliation(s)
- Tamila Abdurashidova
- Division of Cardiology, Cardiovascular DepartmentLausanne University Hospital, University of LausanneRue du Bugnon 461001LausanneSwitzerland
| | - Martin Müller
- Department of Emergency MedicineUniversity Hospital of Bern, University of BernBernSwitzerland
| | - Sara Schukraft
- Division of Cardiology, Cardiovascular DepartmentLausanne University Hospital, University of LausanneRue du Bugnon 461001LausanneSwitzerland
| | - Nisha Soborun
- Division of Cardiology, Cardiovascular DepartmentLausanne University Hospital, University of LausanneRue du Bugnon 461001LausanneSwitzerland
| | - Barbara Pitta‐Gros
- Division of Cardiology, Cardiovascular DepartmentLausanne University Hospital, University of LausanneRue du Bugnon 461001LausanneSwitzerland
| | - John Kikoïne
- Division of Cardiology, Cardiovascular DepartmentLausanne University Hospital, University of LausanneRue du Bugnon 461001LausanneSwitzerland
| | - Henri Lu
- Division of Cardiology, Cardiovascular DepartmentLausanne University Hospital, University of LausanneRue du Bugnon 461001LausanneSwitzerland
| | - Zalina Chazymova
- Cardiac Care UnitNational Center of Cardiology and Internal MedicineBishkekKyrgyzstan
| | - Kanzaada Dzhorupbekova
- Department of StatisticsNational Center of Cardiology and Internal MedicineBishkekKyrgyzstan
| | - Medet Beishenkulov
- Cardiac Care UnitNational Center of Cardiology and Internal MedicineBishkekKyrgyzstan
| | - Georgios Tzimas
- Division of Cardiology, Cardiovascular DepartmentLausanne University Hospital, University of LausanneRue du Bugnon 461001LausanneSwitzerland
| | - Matthias Kirsch
- Division of Cardiac Surgery, Cardiovascular DepartmentLausanne University Hospital, University of LausanneLausanneSwitzerland
| | - Peter Vollenweider
- Department of Internal MedicineLausanne University Hospital, University of LausanneLausanneSwitzerland
| | - Marie Mean
- Department of Internal MedicineLausanne University Hospital, University of LausanneLausanneSwitzerland
| | - Pierre Monney
- Division of Cardiology, Cardiovascular DepartmentLausanne University Hospital, University of LausanneRue du Bugnon 461001LausanneSwitzerland
| | - Roger Hullin
- Division of Cardiology, Cardiovascular DepartmentLausanne University Hospital, University of LausanneRue du Bugnon 461001LausanneSwitzerland
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El Bèze N, Himbert D, Suc G, Brochet E, Ajzenberg N, Cailliau A, Kikoïne J, Delhomme C, Carrasco JL, Ou P, Iung B, Urena M. Comparison of Direct Oral Anticoagulants vs Vitamin K Antagonists After Transcatheter Mitral Valve Replacement. J Am Coll Cardiol 2024; 83:334-346. [PMID: 38199711 DOI: 10.1016/j.jacc.2023.10.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 09/08/2023] [Accepted: 10/13/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND There is currently no established recommendation for antithrombotic treatment following transcatheter mitral valve replacement (TMVR). However, based on the analogy with surgical mitral bioprosthesis, vitamin K antagonists (VKAs) are predominantly used. OBJECTIVES The purpose of this study was to compare bleeding and thrombotic events associated with direct oral anticoagulants (DOACs) or VKAs in a prospective cohort of TMVR patients. METHODS We enrolled consecutive patients who underwent transseptal TMVR using a SAPIEN family prosthesis at our center between 2011 and 2023. The primary outcome was the occurrence of bleeding. VKAs were administered to patients until October 2019, after which DOACs were prescribed. The median follow-up was 4.7 months (Q1-Q3: 2.6-6.7 months). RESULTS A total of 156 patients were included. The mean age was 65 ± 18.5 years, and 103 patients (66%) were women. The median EuroSCORE II was 7.48% (Q1-Q3: 3.80%-12.97%). Of the participants, 20.5% received DOACs and 79.5% were treated with VKAs. The primary outcome was observed in 50 (40%) patients in the VKA group and 3 (9%) patients in the DOAC group (adjusted HR: 0.21; 95% CI: 0.06-0.74; P = 0.02). Treatment with DOAC was associated with a shorter length of hospital stay. No significant differences were found in terms of thrombotic events, major vascular complications, stroke, or death. CONCLUSIONS The use of DOACs after TMVR, compared with VKAs, appears to reduce the risk of bleeding complications and decrease the length of hospital stay for patients, without a significant increase in the risk of thrombotic events.
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Affiliation(s)
- Nathan El Bèze
- Department of Cardiology, Bichat Claude Bernard Hospital-Paris City University, Paris, France
| | - Dominique Himbert
- Department of Cardiology, Bichat Claude Bernard Hospital-Paris City University, Paris, France; INSERM UMRS1148, INSERM, Paris, France
| | - Gaspard Suc
- Department of Cardiology, Bichat Claude Bernard Hospital-Paris City University, Paris, France; INSERM UMRS1148, INSERM, Paris, France
| | - Eric Brochet
- Department of Cardiology, Bichat Claude Bernard Hospital-Paris City University, Paris, France
| | - Nadine Ajzenberg
- INSERM UMRS1148, INSERM, Paris, France; Department of Hematology, Bichat Claude Bernard Hospital-Paris City University, Paris, France
| | - Audrey Cailliau
- Department of Cardiology, Bichat Claude Bernard Hospital-Paris City University, Paris, France
| | - John Kikoïne
- Department of Cardiology, Bichat Claude Bernard Hospital-Paris City University, Paris, France
| | - Clemence Delhomme
- Department of Cardiology, Bichat Claude Bernard Hospital-Paris City University, Paris, France
| | - Jose Luis Carrasco
- Department of Anesthesiology, Bichat Claude Bernard Hospital-Paris City University, Paris, France
| | - Phalla Ou
- Department of Radiology, Bichat Claude Bernard Hospital-Paris City University, Paris, France
| | - Bernard Iung
- Department of Cardiology, Bichat Claude Bernard Hospital-Paris City University, Paris, France; INSERM UMRS1148, INSERM, Paris, France
| | - Marina Urena
- Department of Cardiology, Bichat Claude Bernard Hospital-Paris City University, Paris, France; INSERM UMRS1148, INSERM, Paris, France.
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Kikoïne J, Himbert D, Chong-Nguyen C, Suc G, Brochet E, Cailliau A, Delhomme C, Iung B, Urena M. Incidence and Predictors of Early Major Bleeding After Transseptal Transcatheter Mitral Valve Replacement Using TAV. JACC Cardiovasc Interv 2023; 16:2337-2339. [PMID: 37758391 DOI: 10.1016/j.jcin.2023.07.030] [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] [Received: 06/09/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 10/03/2023]
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Affiliation(s)
- Philippe Gabriel Steg
- Université Paris-Cité, France (P.G.S., J.K.).,Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, France (P.G.S., J.K.).,French Alliance for Cardiovascular Trials, Institut National de la Santé et de la Recherche Médicale U-1148, Paris (P.G.S.).,Institut Universitaire de France, Paris (P.G.S.)
| | - John Kikoïne
- Université Paris-Cité, France (P.G.S., J.K.).,Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, France (P.G.S., J.K.)
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Mesnier J, Urena M, Chong-Nguyen C, Fischer Q, Kikoïne J, Carrasco JL, Terzian Z, Brochet E, Iung B, Himbert D. Impact of Mitral Annular Calcium and Mitral Stenosis on Outcomes After Transcatheter Aortic Valve Implantation. Am J Cardiol 2021; 155:103-112. [PMID: 34284866 DOI: 10.1016/j.amjcard.2021.06.017] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/06/2021] [Accepted: 06/14/2021] [Indexed: 11/24/2022]
Abstract
Mitral annular calcium (MAC) is a common finding in patients undergoing transcatheter aortic valve implantation (TAVI) and may be associated with mitral stenosis (MAC-MS). Their impact on post-TAVI outcomes remains controversial. We sought to assess the impact of MAC and MAC-MS on clinical outcomes following TAVI. We included 1,177 patients who consecutively underwent TAVI in our institution between January 2008 and May 2018. MAC diagnosis reposed on echocardiogram and computed tomography. The combination of MAC and a mean transmitral gradient ≥ 5 mmHg defined MAC-MS. The study included 1,177 patients, of whom 504 (42.8%) had MAC and 85 (7.2%) had MAC-MS. Patients with and without MAC had similar outcomes except for a higher rate of pacemaker implantation in MAC patients (adjusted HR: 1.32, 95% CI: 1.03-1.69, p = 0.03). The subgroup of patients with severe MAC had similar outcomes. However, MAC-MS was an independent predictor of all-cause mortality at 30 days (adjusted HR: 2.30, 95% CI: 1.08-4.86, p = 0.03) and 1 year (adjusted HR: 1.73, 95% CI: 1.04-2.89, p = 0.04). In conclusion, MAC is present in nearly half of the patients treated with TAVI but MAC-MS is far less frequent. In itself, even severe, MAC does not influence outcomes while MAC-MS is an independent predictor of all-cause 1-year mortality. Measurement of mean transmitral gradient identifies patients with MAC at high risk after TAVI.
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Kikoïne J, Hauguel-Moreau M, Hergault H, Aidan V, Ouadahi M, Dubourg O, Szymanski C, Mansencal N. Screening of Native Valvular Heart Disease Using a Pocket-Sized Transthoracic Echocardiographic Device. J Am Soc Echocardiogr 2021; 35:196-202. [PMID: 34461249 DOI: 10.1016/j.echo.2021.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 08/09/2021] [Accepted: 08/18/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The authors assessed the performance of pocket-sized transthoracic echocardiography (pTTE) compared with standard transthoracic echocardiography (sTTE) and auscultation for early screening of valvular heart disease (VHD). Early diagnosis of significant VHD is a challenge, but it enables appropriate follow-up and implementation of the best therapeutic strategy. METHODS sTTE, pTTE, and auscultation were performed by three different experienced physicians on 284 unselected patients. All cases of VHD detected by each of these three techniques were noted. sTTE was the gold standard. Each physician performed one examination and was blinded to the results of other examinations. RESULTS We diagnosed a total of 301 cases of VHD, with a large predominance of regurgitant lesions: 269 cases (89.3%) of regurgitant VHD and 32 (10.7%) of stenotic VHD. pTTE was highly sensitive (85.7%) and specific (97.9%) for screening for VHD, while auscultation detected only 54.1%. All significant cases of VHD (at least mild severity) were detected on pTTE. The weighted κ coefficient between pTTE and sTTE for the assessment of mitral regurgitation was 0.71 (95% CI, 0.70-0.72), indicating good agreement. The weighted κ coefficients between pTTE and sTTE for the assessment of aortic regurgitation and aortic stenosis were 0.97 (95% CI, 0.96-0.98) and 0.98 (95% CI, 0.97-0.99), respectively, indicating excellent agreement. CONCLUSIONS pTTE performed by physicians with level III competency in echocardiography is reliable for identifying significant VHD and should be proposed as a new screening tool.
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Affiliation(s)
- John Kikoïne
- Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris, Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, Université de Versailles-Saint Quentin, Boulogne, France
| | - Marie Hauguel-Moreau
- Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris, Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, Université de Versailles-Saint Quentin, Boulogne, France; INSERM U-1018, CESP, Clinical Epidemiology, UVSQ, Villejuif, France
| | - Hélène Hergault
- Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris, Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, Université de Versailles-Saint Quentin, Boulogne, France; INSERM U-1018, CESP, Clinical Epidemiology, UVSQ, Villejuif, France
| | - Vincent Aidan
- Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris, Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, Université de Versailles-Saint Quentin, Boulogne, France
| | - Mounir Ouadahi
- Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris, Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, Université de Versailles-Saint Quentin, Boulogne, France
| | - Olivier Dubourg
- Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris, Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, Université de Versailles-Saint Quentin, Boulogne, France; INSERM U-1018, CESP, Clinical Epidemiology, UVSQ, Villejuif, France
| | - Catherine Szymanski
- Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris, Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, Université de Versailles-Saint Quentin, Boulogne, France; INSERM U-1018, CESP, Clinical Epidemiology, UVSQ, Villejuif, France
| | - Nicolas Mansencal
- Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris, Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, Université de Versailles-Saint Quentin, Boulogne, France; INSERM U-1018, CESP, Clinical Epidemiology, UVSQ, Villejuif, France.
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Kikoïne J, Urena M, Chong Nguyen C, Fischer Q, Carrasco J, Brochet E, Ducrocq G, Vahanian A, Iung B, Himbert D. Predictors and clinical impact of thrombosis after transcatheter mitral valve implantation using balloon-expandable bioprostheses. EUROINTERVENTION 2021; 16:1455-1462. [PMID: 33226001 PMCID: PMC9724835 DOI: 10.4244/eij-d-20-00991] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 11/23/2022]
Abstract
AIMS The aim of this study was to report the predictors and clinical impact of transcatheter heart valve (THV) thrombosis in patients undergoing transcatheter mitral valve implantation (TMVI). METHODS AND RESULTS We included 130 patients who consecutively underwent TMVI. Transoesophageal echocardiography (TOE) and/or computed tomography (CT) were performed in 91.7% of patients at discharge, in 73.3% at three months and in 72% beyond three months. THV thrombosis was defined as the presence of at least one thickened leaflet with restricted motion confirmed by TOE or contrast CT and classified as immediate, early, or late according to the timing of diagnosis. THV thrombosis was observed in 16 (12.3%) patients: immediate in 43.7%, early in 37.5% and late in 18.8%. Most of these thromboses were subclinical (93.7%) and non-obstructive (87.5%). No thromboembolic event occurred. After optimisation of antithrombotic treatment, THV thromboses resolved in all but one patient. Predictors were shock for immediate (p<0.001), male sex for early (p=0.045) and absence of anticoagulation for both early (p=0.018) and late (p=0.023) THV thromboses. CONCLUSIONS THV thrombosis is frequent after TMVI, occurs mainly within the first three months, is mostly subclinical and resolves after optimisation of antithrombotic treatment. An anticoagulation therapy for at least three months after the procedure is mandatory.
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Affiliation(s)
- John Kikoïne
- Department of Cardiology, Bichat Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Marina Urena
- Department of Cardiology, Bichat Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris, Paris, France,University of Paris, Paris, France,INSERM U1148, Paris, France
| | - Caroline Chong Nguyen
- Department of Cardiology, Bichat Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Quentin Fischer
- Department of Cardiology, Bichat Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Jose Carrasco
- Department of Anesthesiology, Bichat Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Eric Brochet
- Department of Cardiology, Bichat Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Gregory Ducrocq
- Department of Cardiology, Bichat Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris, Paris, France,University of Paris, Paris, France,INSERM U1148, Paris, France
| | | | - Bernard Iung
- Department of Cardiology, Bichat Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris, Paris, France,University of Paris, Paris, France,INSERM U1148, Paris, France
| | - Dominique Himbert
- Department of Cardiology, CHU Bichat Claude Bernard, APHP, 46 rue Henri Huchard, 75018 Paris, France
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Fuchs A, Urena M, Chong-Nguyen C, Kikoïne J, Brochet E, Abtan J, Fischer Q, Ducrocq G, Vahanian A, Iung B, Himbert D. Valve-in-Valve and Valve-in-Ring Transcatheter Mitral Valve Implantation in Young Women Contemplating Pregnancy. Circ Cardiovasc Interv 2020; 13:e009579. [DOI: 10.1161/circinterventions.120.009579] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Transcatheter mitral valve implantation (TMVI) is emerging as an alternative to surgical mitral valve replacement in selected high-risk patients. Delaying definitive mechanical mitral valve replacement and the constraints of anticoagulation thanks to TMVI may be an attractive option in young women contemplating pregnancy and suffering from failure of mitral bioprosthesis or annuloplasty. The aim of the study was to evaluate the possibility, safety, and outcomes of pregnancy after TMVI in this population.
Methods:
From 2013 to 2019, 12 young women contemplating pregnancy underwent transseptal valve-in-valve or valve-in-ring TMVI using the Edwards SAPIEN XT/3 valves and were prospectively followed up at 1 month, 6 months, 1 year, and yearly thereafter.
Results:
Mean age of the patients was 30±6 years. Bioprosthesis degeneration was observed in 7 cases and annuloplasty failure in 5. Three valve-in-ring patients required the implantation of a second valve, which led to an overall procedural success rate of 75%. One delayed left ventricular outflow tract obstruction required elective surgical mitral valve replacement. At 6 months/1 year, 83% of the patients were in New York Heart Association classes I/II. Mitral regurgitation was ≤2+ in all the cases and mean gradient was 7±2 mm Hg. Four patients could complete 6 full-term pregnancies. One symptomatic thrombosis occurred and resolved under aspirin and anticoagulation therapy. All others pregnancies were uneventful. Predelivery mean gradient was 11 mm Hg, and systolic pulmonary artery pressure was 32 mm Hg. There were 4 vaginal deliveries and 2 cesarians. Newborns were alive and healthy. At last follow-up, there was no death, and 3 patients required elective surgical mitral valve replacement at 6- to 54-month follow-up.
Conclusions:
Our study suggests that, in young women, transseptal TMVI to treat failing bioprostheses may result in good short-term outcomes that allow uneventful pregnancies. The results are less favorable in women with failed annuloplasty rings.
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Affiliation(s)
- Adeline Fuchs
- Department of Cardiology, Bichat Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, France (A.F., M.U., C.C.-N., J.K., E.B., J.A., Q.F., G.D., B.I., D.H.)
| | - Marina Urena
- Department of Cardiology, Bichat Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, France (A.F., M.U., C.C.-N., J.K., E.B., J.A., Q.F., G.D., B.I., D.H.)
- University of Paris, France (M.U., C.C.-N., Q.F., G.D., B.I.)
- INSERM U 1148, France (M.U., C.C.-N., G.D., A.V., B.I., D.H.)
| | - Caroline Chong-Nguyen
- Department of Cardiology, Bichat Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, France (A.F., M.U., C.C.-N., J.K., E.B., J.A., Q.F., G.D., B.I., D.H.)
- University of Paris, France (M.U., C.C.-N., Q.F., G.D., B.I.)
- INSERM U 1148, France (M.U., C.C.-N., G.D., A.V., B.I., D.H.)
| | - John Kikoïne
- Department of Cardiology, Bichat Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, France (A.F., M.U., C.C.-N., J.K., E.B., J.A., Q.F., G.D., B.I., D.H.)
| | - Eric Brochet
- Department of Cardiology, Bichat Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, France (A.F., M.U., C.C.-N., J.K., E.B., J.A., Q.F., G.D., B.I., D.H.)
| | - Jérémie Abtan
- Department of Cardiology, Bichat Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, France (A.F., M.U., C.C.-N., J.K., E.B., J.A., Q.F., G.D., B.I., D.H.)
| | - Quentin Fischer
- Department of Cardiology, Bichat Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, France (A.F., M.U., C.C.-N., J.K., E.B., J.A., Q.F., G.D., B.I., D.H.)
- University of Paris, France (M.U., C.C.-N., Q.F., G.D., B.I.)
| | - Grégory Ducrocq
- Department of Cardiology, Bichat Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, France (A.F., M.U., C.C.-N., J.K., E.B., J.A., Q.F., G.D., B.I., D.H.)
- University of Paris, France (M.U., C.C.-N., Q.F., G.D., B.I.)
- INSERM U 1148, France (M.U., C.C.-N., G.D., A.V., B.I., D.H.)
| | - Alec Vahanian
- INSERM U 1148, France (M.U., C.C.-N., G.D., A.V., B.I., D.H.)
| | - Bernard Iung
- Department of Cardiology, Bichat Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, France (A.F., M.U., C.C.-N., J.K., E.B., J.A., Q.F., G.D., B.I., D.H.)
- University of Paris, France (M.U., C.C.-N., Q.F., G.D., B.I.)
- INSERM U 1148, France (M.U., C.C.-N., G.D., A.V., B.I., D.H.)
| | - Dominique Himbert
- Department of Cardiology, Bichat Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, France (A.F., M.U., C.C.-N., J.K., E.B., J.A., Q.F., G.D., B.I., D.H.)
- INSERM U 1148, France (M.U., C.C.-N., G.D., A.V., B.I., D.H.)
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Kikoïne J, Hauguel M, Lannou S, Mallet S, Dubourg O, Szymanski C, Mansencal N. Screening of valvular heart disease using pocket-sized transthoracic echocardiography device. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.118] [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]
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Kikoïne J, Hauguel-Moreau M, Lannou S, Dubourg O, Szymanski C, Mansencal N. Screening of valvular heart disease using pocket-sized transthoracic echocardiography device. Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2019.04.021] [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: 10/26/2022]
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Kikoïne J, Lebon M, Gouffran G, Millischer D, Cattan S, Nallet O. [Not Available]. Ann Cardiol Angeiol (Paris) 2016; 65:375. [PMID: 27968759 DOI: 10.1016/j.ancard.2016.09.019] [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] [Indexed: 06/06/2023]
Affiliation(s)
- J Kikoïne
- Service de cardiologie, GHI Le-Raincy, 93370 Montfermeil, France
| | - M Lebon
- Service de cardiologie, GHI Le-Raincy, 93370 Montfermeil, France
| | - G Gouffran
- Service de cardiologie, GHI Le-Raincy, 93370 Montfermeil, France
| | - D Millischer
- Service de cardiologie, GHI Le-Raincy, 93370 Montfermeil, France
| | - S Cattan
- Service de cardiologie, GHI Le-Raincy, 93370 Montfermeil, France
| | - O Nallet
- Service de cardiologie, GHI Le-Raincy, 93370 Montfermeil, France.
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Kikoïne J, Lebon M, Gouffran G, Millischer D, Cattan S, Nallet O. [Measurement of fractional flow reserve in patients with severe aortic stenosis: A valid test?]. Ann Cardiol Angeiol (Paris) 2016; 65:366-369. [PMID: 27692748 DOI: 10.1016/j.ancard.2016.09.010] [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: 06/29/2016] [Accepted: 09/02/2016] [Indexed: 10/20/2022]
Abstract
A 54-year-old woman was hospitalized for an acute pulmonary oedema revealing a severe aortic stenosis (AS) associated with an aortic aneurysm and a left ventricular hypertrophy (LVH). The coronary angiography found an equivocal left main lesion. Fractional flow reserve (FFR) showed hemodynamic significance (FFR=0.78) and optical coherence tomography confirmed this result with a minimal lumen area of 4.9mm2. FFR-guided percutaneous intervention is reported to improve outcome in patients with stable coronary disease. However, only few data are available in cases of AS. In this condition, secondary LVH is associated with microcirculatory dysfunction, which interferes with optimal hyperemia. An elevated right atrial pressure could also modify FFR measurement. This risk of underestimation of a coronary lesion in patients with severe AS has to be taken into consideration in clinical practice.
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Affiliation(s)
- J Kikoïne
- Service de cardiologie, centre hospitalier intercommunal Le Raincy Montfermeil, rue du Général-Leclerc, 93370 Montfermeil, France
| | - M Lebon
- Service de cardiologie, centre hospitalier intercommunal Le Raincy Montfermeil, rue du Général-Leclerc, 93370 Montfermeil, France
| | - G Gouffran
- Service de cardiologie, centre hospitalier intercommunal Le Raincy Montfermeil, rue du Général-Leclerc, 93370 Montfermeil, France
| | - D Millischer
- Service de cardiologie, centre hospitalier intercommunal Le Raincy Montfermeil, rue du Général-Leclerc, 93370 Montfermeil, France
| | - S Cattan
- Service de cardiologie, centre hospitalier intercommunal Le Raincy Montfermeil, rue du Général-Leclerc, 93370 Montfermeil, France
| | - O Nallet
- Service de cardiologie, centre hospitalier intercommunal Le Raincy Montfermeil, rue du Général-Leclerc, 93370 Montfermeil, France.
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