1
|
Lievre L, Dupont V, Kanagaratnam L, Faroux L, Debrumetz A, Rieu P, Wynckel A. Urine-to-plasma creatinine ratio and fractional excretion of urea performance in acute-on-chronic kidney disease patients. J Nephrol 2023; 36:2661-2663. [PMID: 37402076 DOI: 10.1007/s40620-023-01700-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 06/09/2023] [Indexed: 07/05/2023]
Affiliation(s)
- Loïc Lievre
- Department of Nephrology, University Hospital of Reims, Reims, France.
- French Intensive Care Renal Network (FIRN), Reims, France.
| | - Vincent Dupont
- Department of Nephrology, University Hospital of Reims, Reims, France
- French Clinical Research Infrastructure Network, Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists (F-CRIN INI-CRCT), Reims, France
| | | | - Laurent Faroux
- Department of Cardiology, University Hospital of Reims, Reims, France
| | - Alexandre Debrumetz
- Department of Nephrology, University Hospital of Reims, Reims, France
- French Intensive Care Renal Network (FIRN), Reims, France
| | - Philippe Rieu
- Department of Nephrology, University Hospital of Reims, Reims, France
| | - Alain Wynckel
- Department of Nephrology, University Hospital of Reims, Reims, France
- French Intensive Care Renal Network (FIRN), Reims, France
| |
Collapse
|
2
|
Mesnier J, Simard T, Jung RG, Lehenbauer KR, Piayda K, Pracon R, Jackson GG, Flores-Umanzor E, Faroux L, Korsholm K, Chun JKR, Chen S, Maarse M, Montrella K, Chaker Z, Spoon JN, Pastormerlo LE, Meincke F, Sawant AC, Moldovan CM, Qintar M, Aktas MK, Branca L, Radinovic A, Ram P, El-Zein RS, Flautt T, Ding WY, Sayegh B, Benito-González T, Lee OH, Badejoko SO, Paitazoglou C, Karim N, Zaghloul AM, Agarwal H, Kaplan RM, Alli O, Ahmed A, Suradi HS, Knight BP, Alla VM, Panaich SS, Wong T, Bergmann MW, Chothia R, Kim JS, Pérez de Prado A, Bazaz R, Gupta D, Valderrábano M, Sanchez CE, El Chami MF, Mazzone P, Adamo M, Ling F, Wang DD, O'Neill W, Wojakowski W, Pershad A, Berti S, Spoon DB, Kawsara A, Jabbour G, Boersma LVA, Schmidt B, Nielsen-Kudsk JE, Freixa X, Ellis CR, Fauchier L, Demkow M, Sievert H, Main ML, Hibbert B, Holmes DR, Alkhouli M, Rodés-Cabau J. Persistent and Recurrent Device-Related Thrombus After Left Atrial Appendage Closure: Incidence, Predictors, and Outcomes. JACC Cardiovasc Interv 2023; 16:2722-2732. [PMID: 38030358 DOI: 10.1016/j.jcin.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/05/2023] [Accepted: 09/11/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Scarce data exist on the evolution of device-related thrombus (DRT) after left atrial appendage closure (LAAC). OBJECTIVES This study sought to assess the incidence, predictors, and clinical impact of persistent and recurrent DRT in LAAC recipients. METHODS Data were obtained from an international multicenter registry including 237 patients diagnosed with DRT after LAAC. Of these, 214 patients with a subsequent imaging examination after the initial diagnosis of DRT were included. Unfavorable evolution of DRT was defined as either persisting or recurrent DRT. RESULTS DRT resolved in 153 (71.5%) cases and persisted in 61 (28.5%) cases. Larger DRT size (OR per 1-mm increase: 1.08; 95% CI: 1.02-1.15; P = 0.009) and female (OR: 2.44; 95% CI: 1.12-5.26; P = 0.02) were independently associated with persistent DRT. After DRT resolution, 82 (53.6%) of 153 patients had repeated device imaging, with 14 (17.1%) cases diagnosed with recurrent DRT. Overall, 75 (35.0%) patients had unfavorable evolution of DRT, and the sole predictor was average thrombus size at initial diagnosis (OR per 1-mm increase: 1.09; 95% CI: 1.03-1.16; P = 0.003), with an optimal cutoff size of 7 mm (OR: 2.51; 95% CI: 1.39-4.52; P = 0.002). Unfavorable evolution of DRT was associated with a higher rate of thromboembolic events compared with resolved DRT (26.7% vs 15.1%; HR: 2.13; 95% CI: 1.15-3.94; P = 0.02). CONCLUSIONS About one-third of DRT events had an unfavorable evolution (either persisting or recurring), with a larger initial thrombus size (particularly >7 mm) portending an increased risk. Unfavorable evolution of DRT was associated with a 2-fold higher risk of thromboembolic events compared with resolved DRT.
Collapse
Affiliation(s)
- Jules Mesnier
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Trevor Simard
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Richard G Jung
- Capital Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Kyle R Lehenbauer
- Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Kerstin Piayda
- CardioVascular Center Frankfurt, Frankfurt, Germany; Department of Cardiology and Angiology, Universitätsklinikum Gießen und Marburg, Gießen, Germany
| | - Radoslaw Pracon
- Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland
| | | | - Eduardo Flores-Umanzor
- Department of Cardiology, Hospital Clínic of Barcelona, August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | - Laurent Faroux
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Kasper Korsholm
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Julian K R Chun
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markuskrankenhaus, Frankfurt, Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markuskrankenhaus, Frankfurt, Germany
| | - Moniek Maarse
- Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands; LB Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Kristi Montrella
- Heart and Vascular Institute, University of Pittsburgh Medical Center, University of Pittsburgh, Altoona, Pennsylvania, USA
| | - Zakeih Chaker
- Division of Cardiology, West Virginia School of Medicine, Morgantown, West Virginia, USA
| | - Jocelyn N Spoon
- International Heart Institute of Montana, Missoula, Montana, USA
| | - Luigi E Pastormerlo
- Fondazione Toscana Gabriele Monasterio Massa, Scuola Superiore Sant'Anna, Pisa, Italy
| | | | | | - Carmen M Moldovan
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Mohammed Qintar
- Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA; Department of Cardiology, Sparrow Hospital, Michigan State University, Lansing, Michigan
| | - Mehmet K Aktas
- Division of Cardiology, University of Rochester Medical Center, Rochester, New York, USA
| | - Luca Branca
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Andrea Radinovic
- Arrhythmology Department, San Raffaele University Hospital, Milan, Italy
| | - Pradhum Ram
- Emory University Hospital, Atlanta, Georgia, USA
| | - Rayan S El-Zein
- Division of Cardiology, OhioHealth Doctors Hospital/OhioHealth Riverside Methodist Hospital, Columbus, Ohio, USA
| | | | - Wern Yew Ding
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Bassel Sayegh
- Heart, Lung and Vascular Institute, Excela Health, Independence Health System, Pittsburgh, Pennsylvania, USA
| | | | - Oh-Hyun Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Solomon O Badejoko
- Division of Internal Medicine, St Joseph's Medical Center (Dignity Health), Stockton, California, USA
| | | | - Nabeela Karim
- Royal Brompton and Harefield Hospitals, Part of Guys' and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Ahmed M Zaghloul
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | | | - Rachel M Kaplan
- Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois, USA
| | - Oluseun Alli
- Division of Cardiology, Novant Health Heart and Vascular Institute, Charlotte, North Carolina, USA
| | - Aamir Ahmed
- Rush University Medical Center, Chicago, Illinois, USA
| | | | - Bradley P Knight
- Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois, USA
| | - Venkata M Alla
- Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Sidakpal S Panaich
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Tom Wong
- Royal Brompton and Harefield Hospitals, Part of Guys' and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | | | - Rashaad Chothia
- Division of Internal Medicine, St Joseph's Medical Center (Dignity Health), Stockton, California, USA
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | | | - Raveen Bazaz
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Dhiraj Gupta
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | | | - Carlos E Sanchez
- Division of Cardiology, OhioHealth Doctors Hospital/OhioHealth Riverside Methodist Hospital, Columbus, Ohio, USA
| | | | - Patrizio Mazzone
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Fred Ling
- Division of Cardiology, University of Rochester Medical Center, Rochester, New York, USA
| | - Dee Dee Wang
- Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - William O'Neill
- Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Wojtek Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Ashish Pershad
- Chandler Regional Medical Center, Chandler, Arizona, USA
| | - Sergio Berti
- Fondazione Toscana Gabriele Monasterio Massa, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Daniel B Spoon
- International Heart Institute of Montana, Missoula, Montana, USA
| | - Akram Kawsara
- Division of Cardiology, West Virginia School of Medicine, Morgantown, West Virginia, USA
| | - George Jabbour
- Heart and Vascular Institute, University of Pittsburgh Medical Center, University of Pittsburgh, Altoona, Pennsylvania, USA
| | - Lucas V A Boersma
- Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands; LB Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markuskrankenhaus, Frankfurt, Germany
| | | | - Xavier Freixa
- Department of Cardiology, Hospital Clínic of Barcelona, August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | | | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Faculté de Médecine, Université François Rabelais, Tours, France
| | - Marcin Demkow
- Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland
| | - Horst Sievert
- Heart, Lung and Vascular Institute, Excela Health, Independence Health System, Pittsburgh, Pennsylvania, USA
| | - Michael L Main
- Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Benjamin Hibbert
- Capital Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - David R Holmes
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota, USA.
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Department of Cardiology, Hospital Clínic of Barcelona, August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain.
| |
Collapse
|
3
|
Faroux L, Villecourt A, Metz D. The Management of Coronary Artery Disease in TAVR Patients. J Clin Med 2023; 12:7126. [PMID: 38002738 PMCID: PMC10672348 DOI: 10.3390/jcm12227126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/01/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
About half of the transcatheter aortic valve replacement (TAVR) recipients exhibit some degree of coronary artery disease (CAD), and controversial results have been reported regarding the impact of the presence and severity of CAD on clinical outcomes post-TAVR. In addition to coronary angiography, promising data has been recently reported on the use of both cardiac computed tomography angiography and the functional invasive assessment of coronary lesions whether by FFR or iFR in the work-up pre-TAVR. Despite mitigated available data, percutaneous revascularization of significant coronary lesions has been the routine strategy in TAVR candidates with CAD. Additionally, scarce data exists on the incidence, characteristics and management of coronary events post-TAVR, and increasing interest exists on the potential coronary access challenges in patients requiring coronary angiography/intervention post-TAVR. This review provides an updated overview of the knowledge of CAD in TAVR recipients, focusing on its prevalence, clinical impact, pre- and post-procedural evaluation and management.
Collapse
Affiliation(s)
- Laurent Faroux
- Cardiology Department, Reims University Hospital, 51100 Reims, France
| | | | | |
Collapse
|
4
|
Avvedimento M, Campelo-Parada F, Munoz-Garcia E, Nombela-Franco L, Fischer Q, Donaint P, Serra V, Veiga G, Gutiérrez E, Esposito G, Vilalta V, Alperi A, Regueiro A, Asmarats L, Ribeiro HB, Matta A, Munoz-Garcia A, Tirado-Conte G, Urena M, Metz D, Rodenas-Alesina E, de la Torre Hernandez JM, Fernandez-Nofrerias E, Pascual I, Vidal-Cales P, Arzamendi D, Campanha-Borges DC, Trinh KH, Côté M, Faroux L, Rodés-Cabau J. Late Bleeding Events in Patients Undergoing Percutaneous Coronary Intervention in the Workup Pre-TAVR. JACC Cardiovasc Interv 2023; 16:2153-2164. [PMID: 37704301 DOI: 10.1016/j.jcin.2023.06.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/20/2023] [Accepted: 06/27/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND In patients undergoing percutaneous coronary intervention (PCI) in the work-up pre-transcatheter aortic valve replacement (TAVR), the incidence and clinical impact of late bleeding events (LBEs) remain largely unknown. OBJECTIVES This study sought to determine the incidence, clinical characteristics, associated factors, and outcomes of LBEs in patients undergoing PCI in the work-up pre-TAVR. METHODS This was a multicenter study including 1,457 consecutive patients (mean age 81 ± 7 years; 41.5% women) who underwent TAVR and survived beyond 30 days. LBEs (>30 days post-TAVR) were defined according to the Valve Academic Research Consortium-2 criteria. RESULTS LBEs occurred in 116 (7.9%) patients after a median follow-up of 23 (IQR: 12-40) months. Late bleeding was minor, major, and life-threatening or disabling in 21 (18.1%), 63 (54.3%), and 32 (27.6%) patients, respectively. Periprocedural (<30 days post-TAVR) major bleeding and the combination of antiplatelet and anticoagulation therapy at discharge were independent factors associated with LBEs (P ≤ 0.02 for all). LBEs conveyed an increased mortality risk at 4-year follow-up compared with no bleeding (43.9% vs 36.0; P = 0.034). Also, LBE was identified as an independent predictor of all-cause mortality after TAVR (HR: 1.39; 95% CI: 1.05-1.83; P = 0.020). CONCLUSIONS In TAVR candidates with concomitant significant coronary artery disease requiring percutaneous treatment, LBEs after TAVR were frequent and associated with increased mortality. Combining antiplatelet and anticoagulation regimens and the occurrence of periprocedural bleeding determined an increased risk of LBEs. Preventive strategies should be pursued for preventing late bleeding after TAVR, and further studies are needed to provide more solid evidence on the most safe and effective antithrombotic regimen post-TAVR in this challenging group of patients.
Collapse
Affiliation(s)
- Marisa Avvedimento
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Erika Munoz-Garcia
- Cardiology Department, Hospital Universitario Virgen de la Victoria, Málaga, CIBERCV, Spain
| | - Luis Nombela-Franco
- Cardiology Department, Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico de San Carlos, Madrid, Spain
| | - Quentin Fischer
- Cardiology Department, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pierre Donaint
- Cardiology Department, Reims University Hospital, Reims, France
| | - Vicenç Serra
- Cardiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Gabriela Veiga
- Cardiology Department, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | | | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Victoria Vilalta
- Cardiology Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Alberto Alperi
- Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Ander Regueiro
- Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
| | - Lluis Asmarats
- Cardiology Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Henrique B Ribeiro
- Cardiology Department, Heart Institute, University of São Paulo, São Paulo, Brazil
| | - Anthony Matta
- Cardiology Department, Hôpital Rangueil, CHU Toulouse, Toulouse, France
| | - Antonio Munoz-Garcia
- Cardiology Department, Hospital Universitario Virgen de la Victoria, Málaga, CIBERCV, Spain
| | - Gabriela Tirado-Conte
- Cardiology Department, Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico de San Carlos, Madrid, Spain
| | - Marina Urena
- Cardiology Department, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Damien Metz
- Cardiology Department, Reims University Hospital, Reims, France
| | | | | | | | - Isaac Pascual
- Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Pablo Vidal-Cales
- Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
| | - Dabit Arzamendi
- Cardiology Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Kim Hoang Trinh
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Mélanie Côté
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Laurent Faroux
- Cardiology Department, Reims University Hospital, Reims, France
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain.
| |
Collapse
|
5
|
Benseba J, Mercier J, Couture T, Faroux L, Bernatchez L, Côté M, Panagides V, Mesnier J, Mohammadi S, Dumont É, Kalavrouziotis D, Hadjadj S, Beaudoin J, DeLarochellière R, Rodés-Cabau J, Paradis JM. Fractional Flow Reserve to Assess Coronary Artery Disease in Patients with Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation: Long-Term Outcomes. Struct Heart 2023; 7:100179. [PMID: 37520135 PMCID: PMC10382974 DOI: 10.1016/j.shj.2023.100179] [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] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/31/2023] [Accepted: 02/22/2023] [Indexed: 08/01/2023]
Abstract
Background The long-term outcomes of patients undergoing functional assessment of coronary lesions with fractional flow reserve (FFR) while awaiting transcatheter aortic valve implantation (TAVI) are unknown. Data on the safety of intracoronary adenosine use in this setting are scarce. The objectives of this study were to describe (1) the long-term outcomes based on the coronary artery disease (CAD) assessment strategy used and (2) the safety of intracoronary adenosine in patients with severe aortic stenosis (AS). Methods 1023 patients with severe AS awaiting TAVI were included. Patients were classified according to their CAD assessment strategy: angiography guided or FFR guided. Patients were further subdivided according to the decision to proceed with percutaneous coronary intervention (PCI): angiography-guided PCI (375/1023), angiography-guided no-PCI (549/1023), FFR-guided PCI (50/1023), and FFR-guided no-PCI (49/1023). Patients were followed up for the occurrence of major adverse cardiac and cerebrovascular events (MACCEs). Results At a mean follow-up of 33.7 months, we observed no significant differences in terms of major adverse cardiovascular and cerebrovascular events (MACCE) in the angiography-guided group (42.4%) compared with the FFR-guided group (37.4%) (p = 0.333). When comparing outcomes of the FFR-guided no-PCI group (32.7%) with the angiography-guided PCI group (46.4%), no significant difference was noted (p = 0.999). Following intracoronary adenosine, a single adverse event occurred. Conclusions In this population, intracoronary adenosine is safe and well tolerated. We found no significant benefit to an FFR-guided strategy compared with an angiography-guided strategy with respect to MACCEs. Although clinically compelling, avoiding the procedural risks of PCI by deferring the intervention in functionally insignificant lesions failed to show a statistically significant benefit.
Collapse
Affiliation(s)
- Juva Benseba
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec, Canada
| | - Julien Mercier
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec, Canada
| | - Thomas Couture
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec, Canada
| | - Laurent Faroux
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec, Canada
| | | | - Mélanie Côté
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec, Canada
| | - Vassili Panagides
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec, Canada
| | - Jules Mesnier
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec, Canada
| | - Siamak Mohammadi
- Department of Cardiac Surgery, Quebec Heart and Lung Institute, Quebec, Canada
| | - Éric Dumont
- Department of Cardiac Surgery, Quebec Heart and Lung Institute, Quebec, Canada
| | | | - Sandra Hadjadj
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec, Canada
| | - Jonathan Beaudoin
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec, Canada
| | | | - Josep Rodés-Cabau
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec, Canada
| | | |
Collapse
|
6
|
Théry G, Faroux L, Boyer F, Nazeyrollas P, Chabert JP, Metz D, Lesaffre F. Relationship between Exercise Test Parameters, Device-Delivered Electric Shock and Adverse Clinical Events in Patients with an Implantable Cardioverter Defibrillator for Primary Prevention. J Pers Med 2023; 13:589. [PMID: 37108975 PMCID: PMC10143101 DOI: 10.3390/jpm13040589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/24/2023] [Accepted: 03/25/2023] [Indexed: 03/30/2023] Open
Abstract
(1) Background: Receiving the first internal electric shock is a turning point for patients with an implantable cardioverter defibrillator (ICD) for primary prevention. However, no study has investigated whether patients who receive a first device-delivered electric shock have a poor prognosis even at the time of ICD implantation. (2) Methods: We retrospectively identified 55 patients with ischemic (n = 31) or dilated (n = 24) cardiomyopathy who underwent ICD implantation for primary prevention with exercise test at the time of implantation. We recorded baseline characteristics, exercise test parameters, and clinical events. (3) Results: After a median follow-up of 5 years, we observed an association between an appropriate device-delivered electric shock, the occurrence of death or heart transplant, and the occurrence of the composite endpoint. There was also a significant relation between a VE/VCO2 slope >35 and the occurrence of the composite endpoint. Conversely, there was no significant association between negative outcomes on the exercise test and the occurrence of a device-delivered electric shock. (4) Conclusions: The exercise test performed at the time of ICD implantation do not predict the occurrence of device-delivered electric shock. The exercise test and the first electric shock are two independent markers of poor prognosis.
Collapse
Affiliation(s)
- Guillaume Théry
- Department of Cardiology, Reims University Hospital, 51100 Reims, France
- Intensive Care Unit, Reims University Hospital, 51100 Reims, France
| | - Laurent Faroux
- Department of Cardiology, Reims University Hospital, 51100 Reims, France
| | - Fanny Boyer
- Department of Cardiology, Reims University Hospital, 51100 Reims, France
| | - Pierre Nazeyrollas
- Department of Cardiology, Reims University Hospital, 51100 Reims, France
| | | | - Damien Metz
- Department of Cardiology, Reims University Hospital, 51100 Reims, France
| | - François Lesaffre
- Department of Cardiology, Reims University Hospital, 51100 Reims, France
| |
Collapse
|
7
|
Lérault A, Villecourt A, Decottignies-Dienne T, Tassan-Mangina S, Heroguelle V, Di Cesare A, Rubin S, Ruggieri VG, Metz D, Faroux L. Catheter versus surgical approach for the management of concomitant aortic stenosis and coronary artery disease: An inverse probability treatment weighting analysis. Arch Cardiovasc Dis 2023; 116:117-125. [PMID: 36702719 DOI: 10.1016/j.acvd.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Two therapeutic strategies are available when aortic stenosis and coronary artery disease coexist: a transcatheter approach, with percutaneous coronary intervention followed by transcatheter aortic valve replacement; and a surgical approach, consisting of surgical aortic valve replacement combined with coronary artery bypass graft. AIM We sought to compare the outcomes of these two strategies. METHODS The study population consisted of 241 patients who benefited from aortic valve replacement and coronary revascularization (transcatheter, n=150; surgery, n=91). RESULTS Patients in the transcatheter population were older (83.5 vs. 71.8years; P<0.001) and had a higher Logistic EuroSCORE (11.1% vs. 5.7%; P<0.001). At 30days postprocedure, patients who had surgery exhibited more life-threatening bleedings (12.1% vs 4.5%; P=0.034), acute kidney injury (12.1% vs. 1.3%; P<0.001) and atrial fibrillation (55.6% vs. 8.7%; P<0.001). After a median follow-up of 27months, the risk of major adverse cardiovascular or cerebrovascular events did not differ significantly between the two strategies (hazard ratio [HR] 1.41, 95% confidence interval [CI] 0.97-2.04; P=0.07), whereas estimated glomerular filtration rate<60mL/min (HR 2.22, 95% CI 1.58-3.12; P<0.001), peripheral artery disease (HR 2.00, 95% CI 1.37-2.91; P<0.001) and left ventricular ejection fraction<50% (HR 1.69, 95% CI 1.12-2.55; P=0.012) were associated with a negative prognosis. CONCLUSIONS In our study, patients with aortic stenosis and coronary artery disease treated by catheter were older and had a higher co-morbidity burden than those treated by surgery. The surgical strategy was associated with a higher rate of 30-day complications, but long-term outcomes were similar between the two strategies.
Collapse
Affiliation(s)
- Adèle Lérault
- Department of Cardiology, Reims University Hospital, 51092 Reims, France
| | | | | | | | | | | | - Sylvain Rubin
- Cardiac Surgery Department, Reims University Hospital, 51092 Reims, France
| | | | - Damien Metz
- Department of Cardiology, Reims University Hospital, 51092 Reims, France
| | - Laurent Faroux
- Department of Cardiology, Reims University Hospital, 51092 Reims, France; EA3801 HERVI, SFR CAP Santé, University of Reims Champagne Ardenne, 51100 Reims, France.
| |
Collapse
|
8
|
Bonnet G, Panagides V, Vincent F, Faroux L, Corona S, Modine T, Metz D, Van Belle E, Pibarot P, Leroux L, Rodes-Cabau J, Ternacle J. Bioprosthetic valve fracture during valve-in-valve transcatheter aortic valve replacement: multicenter propensity matched analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) can be completed by bioprosthetic valve fracture (BVF) to reduce final transvalvular gradients. The aim was to compare outcomes in ViV-TAVI patients with versus without BVF.
Methods
Consecutive patients undergoing ViV-TAVI procedure in four international centers were included, from 2010 to 2021. We used a 1:2 propensity score-matching method to compare postprocedural hemodynamic, complications, and long-term outcomes. Patients were matched for baseline characteristics, time since prior surgery, and characteristics of surgical bioprothesis (type and size).
Results
A total of 390 patients were analyzed, including 40 BVF. Propensity matching 1:2 yielded 38 patients in BVF group and 76 patients in no-BVF group. There was no difference in procedural complications rate and in-hospital deaths (5.1%) between the two groups. Post-procedural hemodynamic parameters significantly improved using BVF: aortic valve area (1.4 cm2 [IQR: 1.23 to 2.3] vs. 1.3 cm2 [IQR: 1.05 to 1.61], p=0.008), mean aortic gradient (12mmHg [IQR: 7.5 to 16.5] vs. 17mmHg [IQR: 11 to 22], p=0.008) and peak velocity (2.2m/s [IQR: 1.8 to 2.7] vs. 2.6m/s [IQR: 2.2 to 3.1], p=0.027). BVF had an additional benefit in the smallest surgical valve (≤21 mm). The use of BVF was independently associated with improved hemodynamic parameters. Overall survival in the matched cohort was 87.8±3.7% at 2-year follow-up, without difference between groups (87.5±6.9% in the BVF group vs. 88.4±4.2% in the no-BVF group, p=0.85).
Conclusion
Compared to ViV-TAVI alone, BVF was safe and improved immediate hemodynamic and long-term outcomes, especially in patients with small surgical aortic bioprosthesis.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- G Bonnet
- Hospital Haut Leveque , Bordeaux , France
| | - V Panagides
- Quebec Heart and Lung Institute , Quebec , Canada
| | - F Vincent
- Chru De Lille - Institut Coeur-Poumons , Lille , France
| | - L Faroux
- Hospital Robert Debre - University Hospital Centre of Reims , Reims , France
| | - S Corona
- Hospital Haut Leveque , Bordeaux , France
| | - T Modine
- Hospital Haut Leveque , Bordeaux , France
| | - D Metz
- Hospital Robert Debre - University Hospital Centre of Reims , Reims , France
| | - E Van Belle
- Chru De Lille - Institut Coeur-Poumons , Lille , France
| | - P Pibarot
- Quebec Heart and Lung Institute , Quebec , Canada
| | - L Leroux
- Hospital Haut Leveque , Bordeaux , France
| | | | - J Ternacle
- Hospital Haut Leveque , Bordeaux , France
| |
Collapse
|
9
|
Bouchiat L, Faroux L, Chabert JP, Mauran P, Blanpain T, Metz D, Lesaffre F. Transseptal versus retrograde approach for ablation of left-sided accessory pathways: impact on radiation exposure. J Radiol Prot 2022; 42:031509. [PMID: 35901783 DOI: 10.1088/1361-6498/ac84e5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/28/2022] [Indexed: 06/15/2023]
Abstract
Management of left-sided accessory pathways (APs) is based on catheter ablation through an antegrade or retrograde approach. Both are safe and effective but are associated with exposure to x-rays; however, recipients of ablation are generally young. We sought to evaluate the impact of the approach chosen on dose-area product (DAP). A total of 95 patients who underwent radiofrequency ablation of a left-sided AP between January 2011 and January 2020 were included. The primary endpoint was the radiation dose received by the patient. Secondary endpoints were procedural success and complication and recurrence rates. The mean age of the study population was 34.3 ± 16.6 years. The antegrade transseptal approach was used in 63.5% of cases. By multivariate analysis, the antegrade transseptal approach was associated with a 53% reduction in DAP (p< 0.001). The radiation dose received was also significantly associated with body mass index and total fluoroscopy time (p< 0.001). There was no significant difference in other secondary endpoints between approaches. The use of an antegrade transseptal approach is associated with a significant reduction in DAP compared with the retrograde approach, and procedural success and complication and recurrence rates are similar.
Collapse
Affiliation(s)
| | - Laurent Faroux
- Department of Cardiology, Reims University Hospital, Reims, France
- EA3801 HERVI, SFR CAP Santé, Université Reims Champagne Ardenne, Reims, France
| | | | - Pierre Mauran
- Pediatric and Congenital Cardiology Unit, American Memory Hospital, Reims, France
| | - Thierry Blanpain
- Department of Cardiology, Reims University Hospital, Reims, France
| | - Damien Metz
- Department of Cardiology, Reims University Hospital, Reims, France
| | | |
Collapse
|
10
|
Faroux L, Nombela-Franco L, Têtu-Couture M, Romero-Delgado T, Mohammadi S, Tirado-Conte G, Paradis JM, Jimenez-Quevedo P, Kalavrouziotis D, McInerney A, Delarochelliere R, Marroquin L, Dumont E, Alperi A, Muntane-Carol G, Macaya C, Rodés-Cabau J. Unplanned Hospital Readmissions After Transcatheter Aortic Valve Replacement in the Era of New-Generation Devices. J Invasive Cardiol 2022; 34:E299-E309. [PMID: 35343916] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Unplanned hospital readmissions after transcatheter aortic valve replacement (TAVR) are frequent and have been associated with a poor prognosis. We sought to determine the trends in the incidence and causes of unplanned hospital readmission after TAVR in patients receiving new-generation devices (NGDs) vs early-generation devices (EGDs). METHODS The study population consisted of 1802 consecutive TAVR recipients (863 EGDs and 939 NGDs). Early and late readmissions were defined as those occurring ≤30 days and >30 days to 1-year post TAVR, respectively. RESULTS A total of 986 unplanned hospital readmissions (cardiac cause, 38.4%; non-cardiac cause, 61.6%) were recorded at a median time of 110 days (interquartile range [IQR], 37-217) post TAVR. The rates of early (12.3% vs 9.4%; P=.046) and late (39.1% vs 31.6%; P<.01) readmission were lower in the NGD population. In the NGD group, major/life-threatening periprocedural bleeding (hazard ratio [HR], 2.40, 95% confidence interval [CI], 1.06-5.42; P=.04) and estimated glomerular filtration rate (eGFR) <60 mL/min at hospital discharge (HR, 1.80; 95% CI, 1.15-2.83; P=.01) were associated with an increased risk of early readmission post TAVR. Chronic obstructive pulmonary disease (HR, 1.42; 95% CI, 1.07-1.88; P=.02), eGFR <60 mL/min (HR, 1.43; 95% CI, 1.11-1.84; P<.01), and combining antiplatelet and anticoagulation therapy (HR, 1.37; 95% CI, 1.01-1.85; P=.04) determined an increased risk of late readmission. CONCLUSIONS TAVR recipients receiving NGDs exhibited a significant but modest reduction in unplanned hospital readmissions, with about one-third of patients still requiring rehospitalization at 1-year follow-up in the contemporary TAVR era. Non-cardiac comorbidities, periprocedural bleeding events, and intensive antithrombotic therapy determined an increased risk.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, 2725 chemin Ste-Foy. G1V4G5, Quebec City, Quebec, Canada.
| |
Collapse
|
11
|
Benseba J, Rodés-Cabau J, Beaudoin J, Hadjadj S, Kalavrouziotis D, Dumont E, Mohammadi S, Mesnier J, Panagides V, Cote M, Couture T, Mercier J, Faroux L, Bernatchez L, Robert D, Paradis JM. LONG TERM OUTCOMES FOLLOWING THE USE OF FRACTIONAL FLOW RESERVE TO ASSESS CORONARY ARTERY DISEASE IN PATIENTS WITH SEVERE AORTIC STENOSIS UNDERGOING TRANSCATHETER AORTIC VALVE IMPLANTATION. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01757-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
12
|
Faroux L, Rodés-Cabau J. Response to: Antithrombotic regimes in patients with prior gastrointestinal bleeding undergoing left atrial appendage closure. Pacing Clin Electrophysiol 2021; 45:440. [PMID: 34897746 DOI: 10.1111/pace.14427] [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] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 11/09/2021] [Accepted: 11/28/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Laurent Faroux
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| |
Collapse
|
13
|
Dognin N, Salaun E, Champagne C, Domain G, O'Hara G, Philippon F, Paradis JM, Faroux L, Beaudoin J, O'Connor K, Bernier M, Rodés-Cabau J, Champagne J. Percutaneous left atrial appendage closure in patients with primary hemostasis disorders and atrial fibrillation. J Interv Card Electrophysiol 2021; 64:497-509. [PMID: 34822043 DOI: 10.1007/s10840-021-01073-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 10/04/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND OR PURPOSE We report our single-center experience with percutaneous left atrial appendage closure (LAAC) in patients with non-valvular atrial fibrillation (NVAF) and primary hemostasis disorders (HD). METHODS Consecutive patients with primary HD who underwent a percutaneous LAAC were included. Baseline characteristics, procedural data, and clinical outcomes were prospectively collected and compared with the overall LAAC cohort without HD. RESULTS Since 2013, among 229 LAAC, 17 patients (7%) had a primary HD: thrombocytopenia (n = 5), myelodysplastic syndrome (n = 6), von Willebrand syndrome (n = 4), type A hemophilia (n = 1), and dysfibrinogenemia (n = 1). The HD population's age ranged from 61 to 87 years, and the median CHA2DS2VASc was 5. Periprocedural plasmatic management was required in 47% of patients. The immediate LAAC implantation success rate was 100%. Patients received a direct oral anticoagulant (DOA) (n = 9), dual antiplatelet (n = 6), aspirin (n = 1), or no therapy (n = 1) during the first six postoperative weeks, followed with single antiplatelet (n = 16) or no therapy (n = 1) during lifelong. After 20 months, the technical success rate and procedural success rate were 100% and 94%. Zero device-/procedure-related complication and only one life-threatening bleeding occurred. Compared to patients without HD (n = 212), a baseline history of bleeding was less frequent (53% vs 91%, p < 0.001), and more patients received a perioperative blood transfusion (47% vs 4%, p < 0.001) in the HD group. The efficacy and safety outcomes did not differ between HD and non-HD cohorts. CONCLUSIONS Percutaneous LAAC in primary HD carriers appeared as safe and as effective as in overall LAAC population for stroke and bleeding prevention at midterm follow-up. Percutaneous left atrial appendage closure in patients with atrial fibrillation and primary hemostasis disorders. The percutaneous LAAC in primary hemostasis disorders and AF carriers requires a multidisciplinary approach. Cardiologist, anesthesiologist, and hematologist discussion is a cornerstone to assess anticoagulant contraindication, LAAC feasibility, periprocedural management, and follow-up (high). This multidisciplinary care is illustrated by the case of a 61-year-old male with hemophilia type A and recurrent hemarthrosis. Pre-LAAC assessment confirmed procedural indication and cactus LAA anatomy (left). After plasmatic management with factor VIII infusion, a WATCHMAN™ no. 21 was successfully implanted (middle). During follow-up, without antithrombotic regime, no ischemic or hemorrhagic complication occurred (right). LAA, left atrial appendage; LAAC, left atrial appendage closure; TEE, transesophageal echocardiography. Percutaneous LAAC in primary HD carriers appeared as safe and as effective as in overall LAAC population for stroke and bleeding prevention at midterm follow-up.
Collapse
Affiliation(s)
- Nicolas Dognin
- Service de Cardiologie, Institut Universitaire de Cardiologie Et de Pneumologie de Québec, 2725 Chemin de Sainte-Foy, Québec City, Québec, G1V 4G5, Canada.
| | - Erwan Salaun
- Service de Cardiologie, Institut Universitaire de Cardiologie Et de Pneumologie de Québec, 2725 Chemin de Sainte-Foy, Québec City, Québec, G1V 4G5, Canada
| | - Catherine Champagne
- Service de Cardiologie, Institut Universitaire de Cardiologie Et de Pneumologie de Québec, 2725 Chemin de Sainte-Foy, Québec City, Québec, G1V 4G5, Canada
| | - Guillaume Domain
- Service de Cardiologie, Institut Universitaire de Cardiologie Et de Pneumologie de Québec, 2725 Chemin de Sainte-Foy, Québec City, Québec, G1V 4G5, Canada
| | - Gilles O'Hara
- Service de Cardiologie, Institut Universitaire de Cardiologie Et de Pneumologie de Québec, 2725 Chemin de Sainte-Foy, Québec City, Québec, G1V 4G5, Canada
| | - François Philippon
- Service de Cardiologie, Institut Universitaire de Cardiologie Et de Pneumologie de Québec, 2725 Chemin de Sainte-Foy, Québec City, Québec, G1V 4G5, Canada
| | - Jean-Michel Paradis
- Service de Cardiologie, Institut Universitaire de Cardiologie Et de Pneumologie de Québec, 2725 Chemin de Sainte-Foy, Québec City, Québec, G1V 4G5, Canada
| | - Laurent Faroux
- Service de Cardiologie, Institut Universitaire de Cardiologie Et de Pneumologie de Québec, 2725 Chemin de Sainte-Foy, Québec City, Québec, G1V 4G5, Canada
| | - Jonathan Beaudoin
- Service de Cardiologie, Institut Universitaire de Cardiologie Et de Pneumologie de Québec, 2725 Chemin de Sainte-Foy, Québec City, Québec, G1V 4G5, Canada
| | - Kim O'Connor
- Service de Cardiologie, Institut Universitaire de Cardiologie Et de Pneumologie de Québec, 2725 Chemin de Sainte-Foy, Québec City, Québec, G1V 4G5, Canada
| | - Mathieu Bernier
- Service de Cardiologie, Institut Universitaire de Cardiologie Et de Pneumologie de Québec, 2725 Chemin de Sainte-Foy, Québec City, Québec, G1V 4G5, Canada
| | - Josep Rodés-Cabau
- Service de Cardiologie, Institut Universitaire de Cardiologie Et de Pneumologie de Québec, 2725 Chemin de Sainte-Foy, Québec City, Québec, G1V 4G5, Canada
| | - Jean Champagne
- Service de Cardiologie, Institut Universitaire de Cardiologie Et de Pneumologie de Québec, 2725 Chemin de Sainte-Foy, Québec City, Québec, G1V 4G5, Canada
| |
Collapse
|
14
|
Alperi A, Mohammadi S, Campelo-Parada F, Munoz-Garcia E, Nombela-Franco L, Faroux L, Veiga G, Serra V, Fischer Q, Pascual I, Asmarats L, Gutiérrez E, Regueiro A, Vilalta V, Ribeiro HB, Matta A, Munoz-Garcia A, Armijo G, Metz D, De la Torre Hernandez JM, Rodenas-Alesina E, Urena M, Moris C, Arzamendi D, Perez-Fuentes P, Fernandez-Nofrerias E, Campanha-Borges DC, Mesnier J, Voisine P, Dumont E, Kalavrouziotis D, Rodés-Cabau J. Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Complex Coronary Artery Disease. JACC Cardiovasc Interv 2021; 14:2490-2499. [PMID: 34794656 DOI: 10.1016/j.jcin.2021.08.073] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 08/31/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this study was to compare, in a cohort of patients with complex coronary artery disease (CAD) and severe aortic stenosis (AS), the clinical outcomes associated with transfemoral transcatheter aortic valve replacement (TAVR) (plus percutaneous coronary intervention [PCI]) versus surgical aortic valve replacement (SAVR) (plus coronary artery bypass grafting [CABG]). BACKGROUND Patients with complex CAD were excluded from the main randomized trials comparing TAVR with SAVR, and no data exist comparing TAVR + PCI vs SAVR + CABG in such patients. METHODS A multicenter study was conducted including consecutive patients with severe AS and complex CAD (SYNTAX [Synergy Between PCI with Taxus and Cardiac Surgery] score >22 or unprotected left main disease). A 1:1 propensity-matched analysis was performed to account for unbalanced covariates. The rates of major adverse cardiac and cerebrovascular events (MACCE), including all-cause mortality, nonprocedural myocardial infarction, need for new coronary revascularization, and stroke, were evaluated. RESULTS A total of 800 patients (598 undergoing SAVR + CABG and 202 undergoing transfemoral TAVR + PCI) were included, and after propensity matching, a total of 156 pairs of patients were generated. After a median follow-up period of 3 years (interquartile range: 1-6 years), there were no significant differences between groups for MACCE (HR for transfemoral TAVR vs SAVR: 1.33; 95% CI: 0.89-1.98), all-cause mortality (HR: 1.25; 95% CI: 0.81-1.94), myocardial infarction (HR: 1.16; 95% CI: 0.41-3.27), and stroke (HR: 0.42; 95% CI: 0.13-1.32), but there was a higher rate of new coronary revascularization in the TAVR + PCI group (HR: 5.38; 95% CI: 1.73-16.7). CONCLUSIONS In patients with severe AS and complex CAD, TAVR + PCI and SAVR + CABG were associated with similar rates of MACCE after a median follow-up period of 3 years, but TAVR + PCI recipients exhibited a higher risk for repeat coronary revascularization. Future trials are warranted.
Collapse
Affiliation(s)
- Alberto Alperi
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Siamak Mohammadi
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | | | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | | | | | - Vicenç Serra
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Quentin Fischer
- Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - Isaac Pascual
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | | | | | - Henrique B Ribeiro
- Instituto do Coração (InCor), Heart Institute, University of Sao Paulo, Sao Paulo, Brazil
| | | | | | - German Armijo
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | | | | | | | - Marina Urena
- Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - Cesar Moris
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | | | | | - Jules Mesnier
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Pierre Voisine
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Eric Dumont
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Hospital Clinic de Barcelona, Barcelona, Spain.
| |
Collapse
|
15
|
Dognin N, Salaun E, Champagne C, O'Hara G, Paradis J, Faroux L, Philippon F, Beaudoin J, O'Connor K, Bernier M, Rodès-Cabau J, Champagne J. PERCUTANEOUS LEFT ATRIAL APPENDAGE CLOSURE IN PATIENTS WITH HEMOSTASIS DISORDERS AND ANTICOAGULANT CONTRAINDICATION. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.100] [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: 11/30/2022] Open
|
16
|
Junquera L, Urena M, Muñoz-Garcia A, Nombela-Franco L, Faurie B, Veiga-Fernandez G, Alperi A, Serra V, Fischer Q, Himbert D, Muñoz-García E, Vera-Urquiza R, Jiménez-Quevedo P, de la Torre Hernandez JM, Pascual I, Garcia Del Blanco B, Mohammadi S, Faroux L, Couture T, Côté M, Rodés-Cabau J. Secondary Femoral Access Hemostasis During Transcatheter Aortic Valve Replacement: Impact of Vascular Closure Devices. J Invasive Cardiol 2021; 33:E604-E613. [PMID: 34338651] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Vascular and bleeding complications related to secondary femoral access site are frequent in patients undergoing transcatheter aortic valve replacement (TAVR), and their occurrence is associated to poorer outcomes. We aimed to evaluate the clinical impact of vascular closure devices (VCDs) for secondary femoral access hemostasis in TAVR procedures. METHODS This was a multicenter study including 4031 patients who underwent TAVR (mean age, 81 ± 8 years; mean Society of Thoracic Surgeons [STS] score, 4.9 [interquartile range, 3.3-7.6]), and had a secondary femoral access. The 30-day clinical outcomes were analyzed according to femoral access-site hemostasis (manual compression vs VCD), and according to the type of VCD (Perclose [Abbott Cardiovascular] vs Angio-Seal [Terumo Interventional Systems]) using a propensity-matched, multivariable, logistic regression model. RESULTS Manual compression was used in 941 patients (23.3%) and VCDs were used in 3090 patients (76.7%; Perclose in 1549 patients [38.4%] and Angio-Seal in 1541 patients [38.2%]) for secondary femoral access hemostasis. Vascular complications related to secondary access site occurred in 162 patients (4%), and were more frequent in patients who underwent manual compression (7.2%) compared with VCD hemostasis (3%; adjusted P<.001). In the VCD group, the use of Angio-Seal (vs Perclose) was associated with a higher rate of vascular complications (3.7% vs 2.4%, respectively; adjusted P=.02), femoral artery pseudoaneurysm (1.3% vs 0.4%, respectively; adjusted P<.01), invasive treatment requirement for treating vascular complications (surgery: 0.8% vs 0.3%, respectively [adjusted P=.03]; and thrombin injection: 0.9% vs 0%, respectively [adjusted P<.001]). CONCLUSION VCDs represented a safer and more effective alternative compared with manual compression for secondary femoral access-site hemostasis in patients undergoing TAVR procedures, and the Perclose VCD was associated with the lowest risk of vascular complications. Future randomized studies are warranted.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, 2725 Ch Ste-Foy, Québec, QC G1V 4G5, Canada.
| |
Collapse
|
17
|
Simard T, Jung RG, Lehenbauer K, Piayda K, Pracoń R, Jackson GG, Flores-Umanzor E, Faroux L, Korsholm K, Chun JKR, Chen S, Maarse M, Montrella K, Chaker Z, Spoon JN, Pastormerlo LE, Meincke F, Sawant AC, Moldovan CM, Qintar M, Aktas MK, Branca L, Radinovic A, Ram P, El-Zein RS, Flautt T, Ding WY, Sayegh B, Benito-González T, Lee OH, Badejoko SO, Paitazoglou C, Karim N, Zaghloul AM, Agrawal H, Kaplan RM, Alli O, Ahmed A, Suradi HS, Knight BP, Alla VM, Panaich SS, Wong T, Bergmann MW, Chothia R, Kim JS, Pérez de Prado A, Bazaz R, Gupta D, Valderrabano M, Sanchez CE, El Chami MF, Mazzone P, Adamo M, Ling F, Wang DD, O'Neill W, Wojakowski W, Pershad A, Berti S, Spoon D, Kawsara A, Jabbour G, Boersma LVA, Schmidt B, Nielsen-Kudsk JE, Rodés-Cabau J, Freixa X, Ellis CR, Fauchier L, Demkow M, Sievert H, Main ML, Hibbert B, Holmes DR, Alkhouli M. Predictors of Device-Related Thrombus Following Percutaneous Left Atrial Appendage Occlusion. J Am Coll Cardiol 2021; 78:297-313. [PMID: 34294267 DOI: 10.1016/j.jacc.2021.04.098] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [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: 02/01/2021] [Revised: 04/05/2021] [Accepted: 04/29/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Device-related thrombus (DRT) has been considered an Achilles' heel of left atrial appendage occlusion (LAAO). However, data on DRT prediction remain limited. OBJECTIVES This study constructed a DRT registry via a multicenter collaboration aimed to assess outcomes and predictors of DRT. METHODS Thirty-seven international centers contributed LAAO cases with and without DRT (device-matched and temporally related to the DRT cases). This study described the management patterns and mid-term outcomes of DRT and assessed patient and procedural predictors of DRT. RESULTS A total of 711 patients (237 with and 474 without DRT) were included. Follow-up duration was similar in the DRT and no-DRT groups, median 1.8 years (interquartile range: 0.9-3.0 years) versus 1.6 years (interquartile range: 1.0-2.9 years), respectively (P = 0.76). DRTs were detected between days 0 to 45, 45 to 180, 180 to 365, and >365 in 24.9%, 38.8%, 16.0%, and 20.3% of patients. DRT presence was associated with a higher risk of the composite endpoint of death, ischemic stroke, or systemic embolization (HR: 2.37; 95% CI, 1.58-3.56; P < 0.001) driven by ischemic stroke (HR: 3.49; 95% CI: 1.35-9.00; P = 0.01). At last known follow-up, 25.3% of patients had DRT. Discharge medications after LAAO did not have an impact on DRT. Multivariable analysis identified 5 DRT risk factors: hypercoagulability disorder (odds ratio [OR]: 17.50; 95% CI: 3.39-90.45), pericardial effusion (OR: 13.45; 95% CI: 1.46-123.52), renal insufficiency (OR: 4.02; 95% CI: 1.22-13.25), implantation depth >10 mm from the pulmonary vein limbus (OR: 2.41; 95% CI: 1.57-3.69), and non-paroxysmal atrial fibrillation (OR: 1.90; 95% CI: 1.22-2.97). Following conversion to risk factor points, patients with ≥2 risk points for DRT had a 2.1-fold increased risk of DRT compared with those without any risk factors. CONCLUSIONS DRT after LAAO is associated with ischemic events. Patient- and procedure-specific factors are associated with the risk of DRT and may aid in risk stratification of patients referred for LAAO.
Collapse
Affiliation(s)
- Trevor Simard
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota, USA. https://twitter.com/tjsimard
| | - Richard G Jung
- Capital Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Kyle Lehenbauer
- Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Kerstin Piayda
- CardioVascular Center Frankfurt, Frankfurt, Germany; Heinrich-Heine-University, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - Radoslaw Pracoń
- Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland
| | | | - Eduardo Flores-Umanzor
- Department of Cardiology, Hospital Clinic of Barcelona, August Pi I Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | - Laurent Faroux
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Kasper Korsholm
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Julian K R Chun
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markuskrankenhaus, Frankfurt, Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markuskrankenhaus, Frankfurt, Germany
| | - Moniek Maarse
- Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands; LB Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Kristi Montrella
- University of Pittsburgh Medical Center Heart and Vascular Institute, University of Pittsburgh, Altoona, Pennsylvania, USA
| | - Zakeih Chaker
- Division of Cardiology, West Virginia School of Medicine, Morgantown, West Virginia, USA
| | - Jocelyn N Spoon
- International Heart Institute of Montana, Missoula, Montana, USA
| | - Luigi E Pastormerlo
- Fondazione Toscana Gabriele Monasterio Massa, Scuola Superiore Sant'Anna, Pisa, Italy
| | | | | | - Carmen M Moldovan
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Mohammed Qintar
- Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Mehmet K Aktas
- Division of Cardiology, University of Rochester Medical Center, Rochester, New York, USA
| | - Luca Branca
- Catheterization Laboratory, Cardiothoracic Department, Spedali Civili of Brescia, Brescia, Italy
| | - Andrea Radinovic
- Arrhythmology Department, San Raffaele University Hospital, Milan, Italy
| | - Pradhum Ram
- Emory University Hospital, Atlanta, Georgia, USA
| | - Rayan S El-Zein
- Division of Cardiology, OhioHealth Doctors Hospital/OhioHealth Riverside Methodist Hospital, Columbus, Ohio, USA
| | | | - Wern Yew Ding
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Bassel Sayegh
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; The Heart, Lung and Vascular Institute, Excela Health, Pittsburgh, Pennsylvania, USA
| | | | - Oh-Hyun Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Solomon O Badejoko
- Division of Internal Medicine, St Joseph's Medical Center (Dignity Health), Stockton, California, USA
| | | | - Nabeela Karim
- Royal Brompton and Harefield Hospitals, Part of Guys' and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Ahmed M Zaghloul
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | | | - Rachel M Kaplan
- Northwestern University, Bluhm Cardiovascular Institute, Chicago, Illinois, USA
| | - Oluseun Alli
- Division of Cardiology, Novant Health Heart and Vascular Institute, Charlotte, North Carolina, USA
| | - Aamir Ahmed
- Rush University Medical Center, Chicago, Illinois, USA
| | | | - Bradley P Knight
- Northwestern University, Bluhm Cardiovascular Institute, Chicago, Illinois, USA
| | - Venkata M Alla
- Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Sidakpal S Panaich
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Tom Wong
- Royal Brompton and Harefield Hospitals, Part of Guys' and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | | | - Rashaad Chothia
- Division of Internal Medicine, St Joseph's Medical Center (Dignity Health), Stockton, California, USA
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | | | - Raveen Bazaz
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Dhiraj Gupta
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | | | - Carlos E Sanchez
- Division of Cardiology, OhioHealth Doctors Hospital/OhioHealth Riverside Methodist Hospital, Columbus, Ohio, USA
| | | | - Patrizio Mazzone
- Arrhythmology Department, San Raffaele University Hospital, Milan, Italy
| | - Marianna Adamo
- Catheterization Laboratory, Cardiothoracic Department, Spedali Civili of Brescia, Brescia, Italy
| | - Fred Ling
- Division of Cardiology, University of Rochester Medical Center, Rochester, New York, USA
| | - Dee Dee Wang
- Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - William O'Neill
- Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Wojtek Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | - Sergio Berti
- Fondazione Toscana Gabriele Monasterio Massa, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Daniel Spoon
- International Heart Institute of Montana, Missoula, Montana, USA
| | - Akram Kawsara
- Division of Cardiology, West Virginia School of Medicine, Morgantown, West Virginia, USA
| | - George Jabbour
- University of Pittsburgh Medical Center Heart and Vascular Institute, University of Pittsburgh, Altoona, Pennsylvania, USA
| | - Lucas V A Boersma
- Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands; LB Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markuskrankenhaus, Frankfurt, Germany
| | | | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Xavier Freixa
- Department of Cardiology, Hospital Clinic of Barcelona, August Pi I Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | | | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Faculté de Médecine, Université François Rabelais, Tours, France
| | - Marcin Demkow
- Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland
| | | | - Michael L Main
- Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Benjamin Hibbert
- Capital Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - David R Holmes
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota, USA.
| |
Collapse
|
18
|
Faroux L, Cruz-González I, Arzamendi D, Freixa X, Nombela-Franco L, Peral V, Caneiro-Queija B, Mangieri A, Trejo-Velasco B, Asmarats L, Regueiro A, McInerney A, Morcuende Gonzalez A, Estevez-Loureiro R, Laricchia A, O'Hara G, Rodés-Cabau J. Incidence, predictors, and clinical impact of bleeding recurrence in patients with prior gastrointestinal bleeding undergoing LAAC. Pacing Clin Electrophysiol 2021; 44:1216-1223. [PMID: 34110038 DOI: 10.1111/pace.14293] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/20/2021] [Accepted: 06/06/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Gastrointestinal bleeding (GIB) is associated with a high recurrence rate and a prior GIB episode is common in real-world left atrial appendage closure (LAAC) recipients. The present study sought to evaluate the clinical characteristics and outcomes of patients with prior GIB undergoing LAAC, and to determine the factors associated with and clinical impact of GIB recurrence. METHODS Multicenter study including 277 consecutive patients who underwent percutaneous LAAC and had prior GIB. All-cause death, all bleeding, GIB recurrence, and clinical ischemic stroke were recorded. RESULTS After a median follow-up of 17 (interquartile range: 6-37) months post-LAAC, the rates of death, bleeding, GIB recurrence, and ischemic stroke were 14.0 per 100 person-year (PY), 29.3 per 100 PY, 17.7 per 100 PY, and 1.1 per 100 PY, respectively. GIB recurrence occurred within 3 months post-LAAC in 55.8% of patients. A previous lower GIB (vs. upper or unclassified) (HR: 1.76; 95% CI: 1.09-2.82; p = .020) and eGFR < 45 mL/min (HR: 1.70; 95% CI:1.04-2.67; p = .033) determined an increased risk of GIB recurrence. By multivariable analysis, eGFR < 45 mL/min (HR: 2.72; 95% CI: 1.70-4.34; p < .001), GIB recurrence following LAAC (HR: 2.15; 95% CI: 1.33-3.46; p = .002), diabetes mellitus (HR: 1.77; 95% CI: 1.10-2.84; p = .018), and age (HR: 1.06; 95% CI: 1.03-1.10; p < .001) were associated with an increased mortality. CONCLUSIONS Patients with prior GIB undergoing LAAC exhibited a relatively low rate of GIB recurrence, and prior lower GIB and moderate-to-severe chronic kidney disease determined an increased risk. GIB recurrence was associated with an increased mortality.
Collapse
Affiliation(s)
- Laurent Faroux
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | | | - Xavier Freixa
- Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Vicente Peral
- Cardiology Department, Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, Palma, Spain
| | | | | | | | | | - Ander Regueiro
- Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Angela McInerney
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Antonio Morcuende Gonzalez
- Cardiology Department, Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, Palma, Spain
| | | | | | - Gilles O'Hara
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| |
Collapse
|
19
|
Lu H, Monney P, Hullin R, Fournier S, Roguelov C, Eeckhout E, Rubimbura V, Faroux L, Barrier A, Muller O, Kirsch M. Transcarotid Access Versus Transfemoral Access for Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2021; 8:687168. [PMID: 34124210 PMCID: PMC8190826 DOI: 10.3389/fcvm.2021.687168] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/12/2021] [Indexed: 01/15/2023] Open
Abstract
Background: The transfemoral (TF) route is the gold-standard access for transcatheter aortic valve replacement (TAVR). In 10–15% of patients, alternative accesses are needed, such as the transcarotid (TC) access. We performed a meta-analysis to compare 30-day mortality and complications between TC-TAVR and TF-TAVR. Methods: We searched PubMed/MEDLINE and EMBASE from inception to January 2021 to identify articles comparing TC-TAVR and TF-TAVR. Patients' baseline characteristics, procedural outcomes, and clinical 30-day outcomes were extracted. Results: We identified 9 studies, among which 2 used propensity-score matching, including 1,374 TC patients and 3,706 TF patients. TC-TAVR was associated with significantly higher EuroSCORE II and Logistic EuroSCORE values (respectively 8.0 ± 6.7 vs. 6.3 ± 5.4, p = 0.002 and 20.8 ± 14.2% vs. 20.0 ± 13.4%, p = 0.04), a higher prevalence of peripheral artery disease (52.6 vs. 32.8%, p = 0.001), previous cardiac surgery (26.3 vs. 22.4%, p = 0.008) and coronary artery disease (64.6 vs. 60.5%, p = 0.020). The pooled results found TC-TAVR to be associated with a significantly higher 30-day mortality risk (RR, 1.41, 95% CI, 1.02–1.96, p = 0.040), and a lower rate of 30-day major vascular complications (RR, 0.48, 95% CI, 0.25–0.92, p = 0.030). No significant difference was found regarding permanent pacemaker implantation, major bleeding and acute kidney injury. A subgroup analysis of the two propensity-score matched studies found a statistically increased risk of 30-day neurovascular complications (RR, 1.61, 95% CI, 1.02–2.55, p = 0.040). Conclusion: Compared with TF-TAVR, TC-TAVR was associated with an increased risk of 30-day mortality, likely related to a higher surgical risk and comorbidity burden, and with an increased risk of 30-day neurovascular complications. Careful preprocedural patient selection and close periprocedural neurological monitoring are paramount.
Collapse
Affiliation(s)
- Henri Lu
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Pierre Monney
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Roger Hullin
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Stephane Fournier
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Christian Roguelov
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Eric Eeckhout
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Vladimir Rubimbura
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Laurent Faroux
- Cardiology Department, Reims University Hospital, Reims, France
| | - Adelin Barrier
- Service of Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Olivier Muller
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Matthias Kirsch
- Service of Cardiovascular Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
20
|
Oudin V, Marcus C, Faroux L, Espinosa M, Metz D, Lesaffre F. Impact of epicardial fat on the duration of radiofrequency energydelivery during catheter ablation of atrial fibrillation. Europace 2021. [DOI: 10.1093/europace/euab116.555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Aims
This study aimed to determine the impact of the volume of epicardial fat on the duration of radiofrequency (RF) energy delivery during the procedure of ablation of atrial fibrillation (AF).
Methods
The volume of epicardial fat was measured from spiral computerized tomography scan. The primary endpoint was the duration of RF delivery for pulmonary vein isolation (PVI), and the overall total duration of RF application. Secondary endpoint was conversion of AF to sinus rhythm or organisation of the arrhythmia after PVI.
Results
From March 2015 to May 2018, 222 patients (45,5% with persistent AF) underwent a first RF catheter ablation procedure for AF. The total duration of RF delivery, and the duration of RF delivery specifically for PVI were significantly associated with higher total volume of epicardial fat (p = 0,0002; p = 0,009 respectively), periatrial (p = 0,003; p = 0,045) and periventricular epicardial fat (p = 0,001; p = 0,012). In multivariate analysis, total epicardial fat volume was not significantly associated with total RF delivery duration (p = 0,743). For patients with arrhythmia at the time of the procedure, patients who achieved conversion or organisation of their arrhythmia after PVI had similar levels of total epicardial fat to those whose arrhythmia persisted (65 ± 35,2 vs 74,5 ± 31,2 ml ; p = 0,192).
Conclusion We observed a significant relation between total, periatrial, and periventricular epicardial fat, and the duration of RF delivery during ablation of AF. This relation was not significant by multivariate analysis meaning that epicardial fat maybe a marker, but not an independent factor,of ablation complexity.
Collapse
Affiliation(s)
- V Oudin
- HOSPITAL ROBERT DEBRE - UNIVERSITY HOSPITAL CENTRE OF REIMS, Reims, France
| | - C Marcus
- HOSPITAL ROBERT DEBRE - UNIVERSITY HOSPITAL CENTRE OF REIMS, Reims, France
| | - L Faroux
- HOSPITAL ROBERT DEBRE - UNIVERSITY HOSPITAL CENTRE OF REIMS, Reims, France
| | - M Espinosa
- HOSPITAL ROBERT DEBRE - UNIVERSITY HOSPITAL CENTRE OF REIMS, Reims, France
| | - D Metz
- HOSPITAL ROBERT DEBRE - UNIVERSITY HOSPITAL CENTRE OF REIMS, Reims, France
| | - F Lesaffre
- HOSPITAL ROBERT DEBRE - UNIVERSITY HOSPITAL CENTRE OF REIMS, Reims, France
| |
Collapse
|
21
|
Faroux L, Mohammadi S, Rodés-Cabau J. Transcarotid TAVR: Towards a Better Understanding of Cerebral Embolic Events. Ann Thorac Surg 2021; 113:1752. [PMID: 33974894 DOI: 10.1016/j.athoracsur.2021.04.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 04/22/2021] [Indexed: 11/01/2022]
Affiliation(s)
- Laurent Faroux
- Quebec Heart & Lung Institute, Laval University, 2725 Chemin Ste-Foy, G1V4G5, Quebec City, Quebec, Canada
| | - Siamak Mohammadi
- Quebec Heart & Lung Institute, Laval University, 2725 Chemin Ste-Foy, G1V4G5, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, 2725 Chemin Ste-Foy, G1V4G5, Quebec City, Quebec, Canada.
| |
Collapse
|
22
|
Faroux L, Lhermusier T, Vincent F, Nombela-Franco L, Tchétché D, Barbanti M, Abdel-Wahab M, Windecker S, Auffret V, Campanha-Borges DC, Fischer Q, Muñoz-Garcia E, Trillo-Nouche R, Jorgensen T, Serra V, Toggweiler S, Tarantini G, Saia F, Durand E, Donaint P, Gutierrez-Ibanes E, Wijeysundera HC, Veiga G, Patti G, D'Ascenzo F, Moreno R, Hengstenberg C, Chamandi C, Asmarats L, Hernandez-Antolin R, Gomez-Hospital JA, Cordoba-Soriano JG, Landes U, Jimenez-Diaz VA, Cruz-Gonzalez I, Nejjari M, Roubille F, Van Belle É, Armijo G, Siddiqui S, Costa G, Elsaify S, Pilgrim T, le Breton H, Urena M, Muñoz-Garcia AJ, Sondergaard L, Bach-Oller M, Fraccaro C, Eltchaninoff H, Metz D, Tamargo M, Fradejas-Sastre V, Rognoni A, Bruno F, Goliasch G, Santaló-Corcoy M, Jimenez-Mazuecos J, Webb JG, Muntané-Carol G, Paradis JM, Mangieri A, Ribeiro HB, Campelo-Parada F, Rodés-Cabau J. ST-Segment Elevation Myocardial Infarction Following Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2021; 77:2187-2199. [PMID: 33926655 DOI: 10.1016/j.jacc.2021.03.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [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: 01/19/2021] [Revised: 03/08/2021] [Accepted: 03/11/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Among patients with acute coronary syndrome following transcatheter aortic valve replacement (TAVR), those presenting with ST-segment elevation myocardial infarction (STEMI) are at highest risk. OBJECTIVES The goal of this study was to determine the clinical characteristics, management, and outcomes of STEMI after TAVR. METHODS This was a multicenter study including 118 patients presenting with STEMI at a median of 255 days (interquartile range: 9 to 680 days) after TAVR. Procedural features of STEMI after TAVR managed with primary percutaneous coronary intervention (PCI) were compared with all-comer STEMI: 439 non-TAVR patients who had primary PCI within the 2 weeks before and after each post-TAVR STEMI case in 5 participating centers from different countries. RESULTS Median door-to-balloon time was higher in TAVR patients (40 min [interquartile range: 25 to 57 min] vs. 30 min [interquartile range: 25 to 35 min]; p = 0.003). Procedural time, fluoroscopy time, dose-area product, and contrast volume were also higher in TAVR patients (p < 0.01 for all). PCI failure occurred more frequently in patients with previous TAVR (16.5% vs. 3.9%; p < 0.001), including 5 patients in whom the culprit lesion was not revascularized owing to coronary ostia cannulation failure. In-hospital and late (median of 7 months [interquartile range: 1 to 21 months]) mortality rates were 25.4% and 42.4%, respectively (20.6% and 38.2% in primary PCI patients), and estimated glomerular filtration rate <60 ml/min (hazard ratio [HR]: 3.02; 95% confidence interval [CI]: 1.42 to 6.43; p = 0.004), Killip class ≥2 (HR: 2.74; 95% CI: 1.37 to 5.49; p = 0.004), and PCI failure (HR: 3.23; 95% CI: 1.42 to 7.31; p = 0.005) determined an increased risk. CONCLUSIONS STEMI after TAVR was associated with very high in-hospital and mid-term mortality. Longer door-to-balloon times and a higher PCI failure rate were observed in TAVR patients, partially due to coronary access issues specific to the TAVR population, and this was associated with poorer outcomes.
Collapse
Affiliation(s)
- Laurent Faroux
- Quebec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | | | - Flavien Vincent
- CHU Lille, Institut Coeur et Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Inserm U1011, Institut Pasteur de Lille, EGID, Université de Lille, Lille, France
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | | | - Marco Barbanti
- A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | | | | | - Vincent Auffret
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR1099, Rennes, France
| | | | - Quentin Fischer
- Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - Erika Muñoz-Garcia
- Hospital Universitario Virgen de la Victoria, Málaga, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, Spain
| | | | | | - Vicens Serra
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | - Francesco Saia
- Institute of Cardiology, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Eric Durand
- Normandie Univ, UNIROUEN, U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000, Rouen, France
| | - Pierre Donaint
- Centre Hospitalier Universitaire de Reims, Service de Cardiologie, Reims, France
| | | | | | - Gabriela Veiga
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Giuseppe Patti
- Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Science, Citta' della Salute e Della Scienza, University of Turin, Turin, Italy
| | - Raul Moreno
- Hospital Universitario La Paz, Madrid, Spain
| | | | | | | | | | | | | | - Uri Landes
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | - Ignacio Cruz-Gonzalez
- University Hospital Salamanca, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain
| | | | - François Roubille
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Cardiology Department, INI-CRT, CHU de Montpellier, France
| | - Éric Van Belle
- CHU Lille, Institut Coeur et Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Inserm U1011, Institut Pasteur de Lille, EGID, Université de Lille, Lille, France
| | - German Armijo
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | | | - Giuliano Costa
- A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Sameh Elsaify
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | | | - Hervé le Breton
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR1099, Rennes, France
| | - Marina Urena
- Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - Antonio Jesus Muñoz-Garcia
- Hospital Universitario Virgen de la Victoria, Málaga, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, Spain
| | | | | | | | - Hélène Eltchaninoff
- Normandie Univ, UNIROUEN, U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000, Rouen, France
| | - Damien Metz
- Centre Hospitalier Universitaire de Reims, Service de Cardiologie, Reims, France
| | | | | | - Andrea Rognoni
- Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Francesco Bruno
- Division of Cardiology, Department of Medical Science, Citta' della Salute e Della Scienza, University of Turin, Turin, Italy
| | | | | | | | - John G Webb
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | - Jean-Michal Paradis
- Quebec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Antonio Mangieri
- Invasive Cardiology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy and Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | | | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Québec City, Québec, Canada; Hospital Clínic de Barcelona, Barcelona, Spain.
| |
Collapse
|
23
|
Faroux L, Junquera L, Mohammadi S, Kalavrouziotis D, Dumont E, Paradis JM, Delarochellière R, del Val D, Muntané-Carol G, Pasian S, Ferreira-Neto AN, Pelletier-Beaumont E, Rodés-Cabau J. Cerebral Embolism After Transcarotid Transcatheter Aortic Valve Replacement: Factors Associated With Ipsilateral Ischemic Burden. Ann Thorac Surg 2021; 111:951-957. [DOI: 10.1016/j.athoracsur.2020.05.139] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/07/2020] [Accepted: 05/13/2020] [Indexed: 11/28/2022]
|
24
|
Muntané-Carol G, Philippon F, Nault I, Faroux L, Alperi A, Mittal S, Rodés-Cabau J. Ambulatory Electrocardiogram Monitoring in Patients Undergoing Transcatheter Aortic Valve Replacement: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 77:1344-1356. [PMID: 33706878 DOI: 10.1016/j.jacc.2020.12.062] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/15/2020] [Accepted: 12/18/2020] [Indexed: 12/29/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) has changed the treatment of patients with severe aortic stenosis. However, the occurrence of conduction disturbances has not decreased significantly over time and remains the main drawback of the procedure. In addition, new-onset atrial fibrillation is the most frequent tachyarrhythmia during the hospitalization period and is associated with worse clinical outcomes. However, little is known regarding the incidence and clinical impact of arrhythmic events beyond the periprocedural TAVR period. Ambulatory electrocardiogram (AECG) monitoring has recently emerged as a tool to unravel the complex issue of arrhythmic disorders (bradyarrhythmias and tachyarrhythmias) before and after TAVR. To date, the preliminary results from the initial experience using AECG monitoring systems showed the safety, usefulness, and potential clinical implications of this diagnostic tool in TAVR recipients. This review provides an overview of the current status, clinical implications, and future perspectives of AECG monitoring in the TAVR setting.
Collapse
Affiliation(s)
- Guillem Muntané-Carol
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada. https://twitter.com/MuntaneCarol
| | - François Philippon
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Isabelle Nault
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Laurent Faroux
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Alberto Alperi
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Suneet Mittal
- Snyder Center for Comprehensive Atrial Fibrillation and Department of Cardiology at Valley Health System, Ridgewood, New Jersey, USA
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada; Hospital Clínic de Barcelona, Barcelona, Spain.
| |
Collapse
|
25
|
Faroux L, Cruz-González I, Arzamendi D, Freixa X, Nombela-Franco L, Peral V, Caneiro-Queija B, Mangieri A, Trejo-Velasco B, Asmarats L, Regueiro A, McInerney A, Mas-Lladó C, Estevez-Loureiro R, Laricchia A, O'Hara G, Rodés-Cabau J. Short-term direct oral anticoagulation or dual antiplatelet therapy following left atrial appendage closure in patients with relative contraindications to chronic anticoagulation therapy. Int J Cardiol 2021; 333:77-82. [PMID: 33647365 DOI: 10.1016/j.ijcard.2021.02.054] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/04/2021] [Accepted: 02/19/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Biological data suggest that short-term anticoagulation would be more effective than dual antiplatelet therapy (DAPT) to reduce the thrombotic risk following left atrial appendage closure (LAAC). This study sought to assess the safety and efficacy of direct oral anticoagulation (DOAC) versus DAPT immediately post-LAAC. METHODS Multicenter study including 592 consecutive patients with relative contraindication to chronic anticoagulation who underwent LAAC and received either DAPT or DOAC for 1-3 months. Each patient receiving DOAC was matched with 2 patients on DAPT based on propensity-score (propensity-matched population of 285 patients). Outcomes recorded were death, stroke, non-procedural related severe bleeding, serious adverse event (SAE: composite of death, stroke, bleeding) and early (within 3 months post-LAAC) device-related thrombosis (DRT). RESULTS Early outcomes (within 3-month post-LAAC) did not significantly differ between groups, but a numerically higher rate of early death (3.7% vs. 1.1%), non-procedural related severe bleeding (7.4% vs. 3.2%), and SAE (11.1% vs. 5.3%) were observed in patients receiving DAPT. After a median follow-up of 22 (8-38) months, similar outcomes were observed in DAPT and DOAC groups regarding death (HR: 1.18; 95% CI: 0.58-2.37; p = 0.652), stroke (HR: 1.01; 95% CI: 0.22-5.45; p = 0.908), non-procedural related severe bleeding (HR: 1.68; 95% CI: 0.69-4.12; p = 0.257), and SAE (HR: 1.28; 95% CI: 0.73-2.24; p = 0.383). DRT was identified in 4 patients (2.6%) receiving DAPT versus 0 patient receiving DOAC (p = 0.162). CONCLUSIONS Short-term DOAC following LAAC in patients with contraindications to chronic anticoagulation was safe and tended to associate with a lower rate of SAE and DRT compared to DAPT.
Collapse
Affiliation(s)
- Laurent Faroux
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | | | - Xavier Freixa
- Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Vicente Peral
- Department of Cardiology, Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, Palma, Spain
| | | | | | | | | | - Ander Regueiro
- Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Angela McInerney
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Caterina Mas-Lladó
- Department of Cardiology, Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, Palma, Spain
| | | | | | - Gilles O'Hara
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
| |
Collapse
|
26
|
Alperi A, Faroux L, Muntané-Carol G, Rodés-Cabau J. Meta-analysis Comparing Early Outcomes Following Transcatheter Aortic Valve Implantation With the Evolut Versus Sapien 3 Valves. Am J Cardiol 2021; 139:87-96. [PMID: 33190806 DOI: 10.1016/j.amjcard.2020.10.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/17/2020] [Accepted: 10/21/2020] [Indexed: 12/17/2022]
Abstract
We aimed to compare the early (in-hospital/30-day) outcomes (major periprocedural complications, device success/valve performance, and mortality) following transcatheter aortic valve implantation with the Sapien 3 versus Evolut transcatheter valve systems. This was a systematic review from PubMed and EMBASE databases for studies reporting raw data or estimates. The outcomes analyzed were (1) in-hospital/30-day major periprocedural complications, (2) device success and valve performance, and (3) mortality. The outcomes were defined according to VARC-2 criteria. A total of 24,628 transcatheter aortic valve implantation patients from 9 studies (1 randomized, 8 observational [5 case- or propensity-matched analyses]) were included: 12,411 and 12,217 patients had Sapien 3 and Evolut valve implantation, respectively. There were no differences between devices regarding in-hospital/30-day stroke (risk ratio [RR] 0.95, 95% confidence interval [CI] 0.34 to 2.66), major vascular complications (RR 1.03, 95% CI 0.63 to 1.68), acute kidney injury (RR 1.17, 95% CI 0.78 to 1.77), device success (RR 1.00, 95% CI 0.97 to 1.04) and moderate-severe residual aortic regurgitation (RR 0.49, 95% CI 0.20 to 1.17). Sapien 3 recipients exhibited lower risk of permanent pacemaker implantation (RR 0.66, 95% CI 0.55 to 0.80), a higher risk of life-threatening bleeding (RR 1.82, 95% CI 1.18 to 2.80), and higher residual transvalvular gradients (mean difference 3.95 mmHg, 95% CI 3.37 to 4.56). A lower risk of in-hospital/30-day mortality was observed for Sapien 3 (RR 0.79, 95% CI 0.69 to 0.90). In conclusion, the similarities in device success rate and major periprocedural complications (except for a higher and lower risk of permanent pacemaker implantation and life-threatening bleeding, respectively, with the Evolut system) support the lack of a valve type effect accounting for the increased mortality risk observed with the Evolut valve.
Collapse
|
27
|
Freitas-Ferraz AB, Bernier M, O'Connor K, Beaudoin J, Champagne J, Paradis JM, O'Hara G, Muntané-Carol G, Alperi A, Faroux L, Junquera L, Rodés-Cabau J. Safety and effects of volume loading during transesophageal echocardiography in the pre-procedural work-up for left atrial appendage closure. Cardiovasc Ultrasound 2021; 19:3. [PMID: 33388071 PMCID: PMC7778814 DOI: 10.1186/s12947-020-00230-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/03/2020] [Indexed: 12/05/2022] Open
Abstract
Background In patients undergoing left atrial appendage (LAA) closure, an accurate sizing of the LAA is key to optimize device sizing, procedural success and reduce complications. Previous studies have shown that intraprocedural volume loading increases LAA dimensions and improves device sizing. However, the safety and effects on LAA and device sizing of administering a fluid bolus during pre-procedural transesophageal echocardiography (TEE) are unknown. The aim of this study was to determine the safety and impact on LAA dimensions and device sizing of an intravenous (IV) fluid bolus administered during TEE in the setting of the pre-procedural work-up for LAA closure. Methods The study included a total of 72 patients who underwent TEE to assess suitability for LAAC and received a 500 ml IV bolus of normal saline. The LAA landing zone (LZ) and depth were measured by TEE before and after volume loading, and these measurements were used to predict the device size implanted during a subsequent percutaneous LAAC procedure. Results There were no complications associated with volume loading. The baseline mean LZ was 19.6 ± 3.6 mm at 90o, and 20.2 ± 4.1 mm at 135o. Following fluid bolus, the maximum diameter increased 1.5 ± 1.0 mm at 90o (p<0.001), and 1.3 ± 1.0 mm at 135o (p<0.001). The baseline mean depth of the LAA was 26.5 ± 5.5 mm at 90o, and 23.9 ± 5.8 mm at 135o. After fluid bolus, the mean depth increased by 1.5 ± 1.8 mm (p<0.001) and 1.6 ± 2.0 (p<0.001), at 90o and 135o, respectively. Sizing based on post-bolus measurements of the LZ significantly improved the agreement with the final device size selection during the procedure in 71.0% of cases (vs. 42.0% with pre-bolus measurements). Conclusions Volume loading during ambulatory TEE as part of the pre-procedural work-up of LAAC is safe and significantly increases LAA dimensions. This strategy may become the new standard, particularly in centers performing LAAC with no TEE guidance, as it improves LAA sizing and more accurately predicts the final device size.
Collapse
Affiliation(s)
- Afonso B Freitas-Ferraz
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, 2725, chemin Sainte-Foy, Quebec City, G1V 4G5, Quebec, Canada
| | - Mathieu Bernier
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, 2725, chemin Sainte-Foy, Quebec City, G1V 4G5, Quebec, Canada.
| | - Kim O'Connor
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, 2725, chemin Sainte-Foy, Quebec City, G1V 4G5, Quebec, Canada
| | - Jonathan Beaudoin
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, 2725, chemin Sainte-Foy, Quebec City, G1V 4G5, Quebec, Canada
| | - Jean Champagne
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, 2725, chemin Sainte-Foy, Quebec City, G1V 4G5, Quebec, Canada
| | - Jean-Michel Paradis
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, 2725, chemin Sainte-Foy, Quebec City, G1V 4G5, Quebec, Canada
| | - Gilles O'Hara
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, 2725, chemin Sainte-Foy, Quebec City, G1V 4G5, Quebec, Canada
| | - Guillem Muntané-Carol
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, 2725, chemin Sainte-Foy, Quebec City, G1V 4G5, Quebec, Canada
| | - Alberto Alperi
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, 2725, chemin Sainte-Foy, Quebec City, G1V 4G5, Quebec, Canada
| | - Laurent Faroux
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, 2725, chemin Sainte-Foy, Quebec City, G1V 4G5, Quebec, Canada
| | - Lucia Junquera
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, 2725, chemin Sainte-Foy, Quebec City, G1V 4G5, Quebec, Canada
| | - Josep Rodés-Cabau
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, 2725, chemin Sainte-Foy, Quebec City, G1V 4G5, Quebec, Canada.
| |
Collapse
|
28
|
Faroux L, Alperi A, Muntané-Carol G, Rodes-Cabau J. Safety and efficacy of repeat transcatheter aortic valve replacement for the treatment of transcatheter prosthesis dysfunction. Expert Rev Med Devices 2020; 17:1303-1310. [PMID: 33196328 DOI: 10.1080/17434440.2020.1848540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction: Transcatheter aortic valve replacement (TAVR) has recently expanded toward the treatment of younger patients with lower surgical risk and longer life expectancy. Thus, transcatheter heart valve (THV) durability has become a central issue, and an important increase in the number of TAVR-in-TAVR is expected in the coming years. Areas covered: Overview of the current status of TAVR-in-TAVR for the treatment of THV dysfunction, focusing on safety and efficacy of repeat TAVR procedures. Expert opinion: An accurate analysis of the pre-procedure cardiac computed tomography, incorporating new parameters such as the position of the top of the first THV in relation to the sinotubular-junction, will be necessary to assess the risk of coronary occlusion. Subsequent coronary angiography will be necessary in a proportion of TAVR-in-TAVR patients, but coronary access may be very difficult or even impossible in some of them. Therefore, the choice between TAVR and SAVR in young low-risk patients should incorporate the potential need for treating coronary events at mid- to long-term follow-up. Likewise, the choice of the valve type and the implantation position at the time of the first TAVR procedure should take into account the possibility of TAVR-in-TAVR in the future.Abbreviations ACS: acute coronary syndrome; CO: coronary obstruction; EOA: effective orifice area; SAVR: surgical aortic valve replacement; SVD: structural valve degenerationTAVR: transcatheter aortic valve replacement; THV: transcatheter heart valve.
Collapse
Affiliation(s)
- Laurent Faroux
- Cardiology Department, Quebec Heart and Lung Institute, Laval University , Quebec City, Quebec, Canada
| | - Alberto Alperi
- Cardiology Department, Quebec Heart and Lung Institute, Laval University , Quebec City, Quebec, Canada
| | - Guillem Muntané-Carol
- Cardiology Department, Quebec Heart and Lung Institute, Laval University , Quebec City, Quebec, Canada
| | - Josep Rodes-Cabau
- Cardiology Department, Quebec Heart and Lung Institute, Laval University , Quebec City, Quebec, Canada
| |
Collapse
|
29
|
Del Val D, Trottier M, Alperi A, Muntané-Carol G, Faroux L, Delarochellière R, Paradis JM, Dumont E, Kalavrouziotis D, Mohammadi S, Tessier M, Gervais P, Côté M, Rodés-Cabau J. 18F-Fluorodeoxyglucose Uptake Pattern in Noninfected Transcatheter Aortic Valves. Circ Cardiovasc Imaging 2020; 13:e011749. [PMID: 33167679 DOI: 10.1161/circimaging.120.011749] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- David Del Val
- Department of Cardiology (D.d.V., A.A., G.M.-C., L.F., R.D., J.-M.P., M.C., J.R.-C.), Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Mikaël Trottier
- Department of Nuclear Medicine (M. Trottier, M. Tessier), Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Alberto Alperi
- Department of Cardiology (D.d.V., A.A., G.M.-C., L.F., R.D., J.-M.P., M.C., J.R.-C.), Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Guillem Muntané-Carol
- Department of Cardiology (D.d.V., A.A., G.M.-C., L.F., R.D., J.-M.P., M.C., J.R.-C.), Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Laurent Faroux
- Department of Cardiology (D.d.V., A.A., G.M.-C., L.F., R.D., J.-M.P., M.C., J.R.-C.), Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Robert Delarochellière
- Department of Cardiology (D.d.V., A.A., G.M.-C., L.F., R.D., J.-M.P., M.C., J.R.-C.), Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Jean-Michel Paradis
- Department of Cardiology (D.d.V., A.A., G.M.-C., L.F., R.D., J.-M.P., M.C., J.R.-C.), Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Eric Dumont
- Department of Cardiac Surgery (E.D., D.K., S.M.), Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Dimitri Kalavrouziotis
- Department of Cardiac Surgery (E.D., D.K., S.M.), Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Siamak Mohammadi
- Department of Cardiac Surgery (E.D., D.K., S.M.), Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Michel Tessier
- Department of Nuclear Medicine (M. Trottier, M. Tessier), Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Philippe Gervais
- Department of Infectious Diseases (P.G.), Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Mélanie Côté
- Department of Cardiology (D.d.V., A.A., G.M.-C., L.F., R.D., J.-M.P., M.C., J.R.-C.), Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Department of Cardiology (D.d.V., A.A., G.M.-C., L.F., R.D., J.-M.P., M.C., J.R.-C.), Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| |
Collapse
|
30
|
Ternacle J, Faroux L, Alperi A, Muntané-Carol G, Delarochellière R, Paradis JM, Kalavrouziotis D, Mohammadi S, Dumont E, Beaudoin J, Bernier M, Côté N, Côté M, Vincent F, Clavel MA, Rodés-Cabau J, Pibarot P. Impact of Left-Ventricular Dysfunction in Patients With High- and Low- Gradient Severe Aortic Stenosis Following Transcatheter Aortic Valve Replacement. Can J Cardiol 2020; 37:1103-1111. [PMID: 33161147 DOI: 10.1016/j.cjca.2020.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/14/2020] [Accepted: 10/30/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Outcomes of transcatheter aortic valve replacement (TAVR) in patients with high-gradient (HG) severe aortic stenosis (AS) and reduced left-ventricular (LV) ejection fraction (EF) are unknown. METHODS Patients undergoing TAVR for native severe AS between 2009 and 2018 were retrospectively included and classified into 3 groups: HG (≥ 40 mm Hg) and preserved EF (≥ 50%), HG low EF (< 50%), and low gradient (LG < 40 mm Hg) low EF. The primary endpoint was a composite of cardiovascular mortality and readmission for heart failure at 1 year after TAVR. RESULTS Of the 526 patients included, 323 (61%) had HG preserved EF, 69 (13%) had HG low EF, and 134 (26%) had LG low EF. HG low EF group had higher prevalence of atrial fibrillation and heart failure and higher Society of Thoracic Surgeons score compared with the HG preserved EF group. Patients in the LG low EF group were older and had higher prevalence of coronary artery disease compared with those in the HG groups. All-cause mortality at 30 days (4.0%) was similar across the 3 groups. After adjustment, the risk of primary endpoint was similar in the HG low-EF vs preserved EF groups. Conversely, the risk of primary endpoint was higher in the LG low EF group vs the HG preserved EF group (hazard ratio [HR], 2.24; 95% confidence interval [CI],1.36-3.70; P = 0.002) and vs HG low EF group (HR, 3.50; 95% CI, 1.55-7.90; P = 0.003), whereas the risk of all-cause mortality was similar across the 3 groups. CONCLUSIONS The outcome of patients with HG low EF severe AS following TAVR is as good as that of patients with HG preserved EF.
Collapse
Affiliation(s)
- Julien Ternacle
- Institut universitaire de cardiologie et de pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Laurent Faroux
- Institut universitaire de cardiologie et de pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Alberto Alperi
- Institut universitaire de cardiologie et de pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Guillem Muntané-Carol
- Institut universitaire de cardiologie et de pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Robert Delarochellière
- Institut universitaire de cardiologie et de pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Jean-Michel Paradis
- Institut universitaire de cardiologie et de pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Dimitri Kalavrouziotis
- Institut universitaire de cardiologie et de pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Siamak Mohammadi
- Institut universitaire de cardiologie et de pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Eric Dumont
- Institut universitaire de cardiologie et de pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Jonathan Beaudoin
- Institut universitaire de cardiologie et de pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Mathieu Bernier
- Institut universitaire de cardiologie et de pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Nancy Côté
- Institut universitaire de cardiologie et de pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Mélanie Côté
- Institut universitaire de cardiologie et de pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Flavien Vincent
- Institut universitaire de cardiologie et de pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Marie-Annick Clavel
- Institut universitaire de cardiologie et de pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Josep Rodés-Cabau
- Institut universitaire de cardiologie et de pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Philippe Pibarot
- Institut universitaire de cardiologie et de pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada.
| |
Collapse
|
31
|
Villecourt A, Faroux L, Muneaux A, Tassan-Mangina S, Heroguelle V, Poncet A, Nazeyrollas P, Ruggieri V, Metz D. Comparison of clinical outcomes after transcarotid and transsubclavian versus transfemoral TAVI: a propensity-matched analysis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Transcarotid (TC) and transsubclavian (TSc) accesses are increasingly used as alternative approaches for TAVI when the transfemoral (TF) access is not suitable. However, concerns remain about the risk of peri-procedural stroke and long-term outcomes following TC or TSc TAVI.
The present study sought to compare early- and long-term outcomes of TC/TSc vs. TF TAVI after propensity-score matching.
260 patients who underwent TAVI through a TF (n=220), TC (n=32) or TSc (n=8) approach at our institution during a 4 years period were identified. A 1:1 matching based on the propensity-score was performed, leading to a population of 40 TF and 40 TC/TSc. Primary endpoints were early complications whereas secondary endpoints were long-term outcomes.
There was no difference in the baseline characteristics. At 30-day post-TAVI, there was no difference in mortality and stroke rates between TF and TC/TSc TAVI (5% vs. 5% mortality, p=1.0 and 2 vs. 1 stroke, p=1.0). After a median follow-up of 21 months, the risk of death (p=0.950), stroke (p=0.817) and myocardial infarction (p=0.155) did not differ between the 2 groups.
After propensity-score matching, no significant difference in early and long-term outcomes was observed between TF and TSc/TSc TAVI. These findings should encourage Heart-Teams to consider a TC or TSc approach when TF access is not available.
Table 1. 30-day and 1-year outcomes according to the arterial access (TF vs. TC/TSc) Variables TF-TAVI (n=40) TC/TSc-TAVI (n=40) p-value 30-day outcomes All-cause mortality 2 (5.0) 2 (5.0) 1.000 All-stroke 2 (5.0) 1 (2.5) 1.000 Life-threatening bleeding 4 (10.0) 1 (2.5) 0.375 Acute kidney injury stage 2 or 3 2 (5.0) 1 (2.5) 1.000 Major vascular complication 6 (15.0) 6 (15.0) 1.000 Coronary obstruction 0 0 – Early safety composite endpoint (VARC-2) 10 (25.0) 8 (20.0) 0.804 1-year outcomes All-cause mortality 6 (15.0) 7 (17.5) 1.000 Cardiovascular mortality 5 (12.5) 3 (7.5) 0.727 Stroke 3 (7.5) 2 (5.0) 1.000 Myocardial infarction 0 (0) 2 (5) 0.500 MACCE 8 (20.0) 9 (22.5) 1.000 Readmission for heart failure 6 (15.0) 2 (5) 0.219
Figure 1
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
| | - L Faroux
- University Hospital of Reims, Reims, France
| | - A Muneaux
- University Hospital of Reims, Reims, France
| | | | | | - A Poncet
- University Hospital of Reims, Reims, France
| | | | | | - D Metz
- University Hospital of Reims, Reims, France
| |
Collapse
|
32
|
Alperi A, Muntané-Carol G, Freitas-Ferraz AB, Junquera L, Del Val D, Faroux L, Philippon F, Rodés-Cabau J. Overcoming the transcatheter aortic valve replacement Achilles heel: conduction abnormalities-a systematic review. Ann Cardiothorac Surg 2020; 9:429-441. [PMID: 33312901 DOI: 10.21037/acs-2020-av-40] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Transcatheter aortic valve replacement (TAVR) has been shown to be a good alternative to surgery for treating severe symptomatic aortic stenosis (AS) across the whole range of surgical risk patients. Whereas most periprocedural TAVR complications have significantly decreased over time, conduction disturbances remain high. Approaches to decrease this shortcoming are under continuous investigation. Methods We conducted a systematic review focusing on modifiable factors impacting post-TAVR conduction disturbances, such as balloon aortic valvuloplasty (BAV), type of new-generation transcatheter valve and implantation depth (ID). Search strategies were based on the best available evidence from each study. Primary endpoints were post-TAVR need of permanent pacemaker implantation (PPI) and new onset left bundle branch block (NOLBBB). Results Data from 35 studies with a total of 29,982 patients were analyzed. BAV did not negatively impact PPI rates after TAVR. In propensity-matched and randomized trials, the Evolut R valve was associated with higher rates of PPI compared to the Sapien 3 valve (25% vs. 19.2% in propensity-matched studies; 22.9% vs. 19% in a randomized trial). The Acurate Neo valve was associated with the lowest PPI rate in observational studies (10.4%), but a PPI rate similar to Sapien 3 was reported in a randomized trial (10% vs. 9%). The Portico valve system was associated with a higher PPI risk (PPI rate of 21.9% and 27.7% in propensity-matched and randomized studies, respectively). ID and its relation with the membranous septum (MS) length predicted post-TAVR conduction disturbances, particularly with Evolut R and Sapien 3 valves. Conclusions Pre-TAVR BAV did not increase the risk of conduction disturbances post-TAVR. Among the new-generation transcatheter valve systems, Sapien 3 and Acurate Neo valves were associated with the lowest PPI rates followed by the Evolut and Portico valves. A deeper valve implantation and a shorter MS length determined an increased risk of conduction disturbances post-TAVR.
Collapse
Affiliation(s)
- Alberto Alperi
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | | | - Lucia Junquera
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - David Del Val
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Laurent Faroux
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - François Philippon
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| |
Collapse
|
33
|
Faroux L, Campelo-Parada F, Munoz-Garcia E, Nombela-Franco L, Fischer Q, Donaint P, Serra V, Veiga G, Gutiérrez E, Vilalta V, Alperi A, Regueiro A, Asmarats L, Ribeiro HB, Matta A, Munoz-Garcia A, Armijo G, Urena M, Metz D, Rodenas-Alesina E, de la Torre Hernandez JM, Fernandez-Nofrerias E, Pascual I, Perez-Fuentes P, Arzamendi D, Campanha-Borges DC, Del Val D, Couture T, Rodés-Cabau J. Procedural Characteristics and Late Outcomes of Percutaneous Coronary Intervention in the Workup Pre-TAVR. JACC Cardiovasc Interv 2020; 13:2601-2613. [PMID: 33069647 DOI: 10.1016/j.jcin.2020.07.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/23/2020] [Accepted: 07/07/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study sought to determine, in patients undergoing percutaneous coronary intervention (PCI) during the work-up pre-transcatheter aortic valve replacement (TAVR): 1) the clinical and peri-procedural PCI characteristics; 2) the long-term outcomes; and 3) the clinical events in those patients with complex coronary features. BACKGROUND A PCI is performed in about 25% of TAVR candidates, but procedural features and late outcomes of pre-TAVR PCI remain largely unknown. METHODS Multicenter study including 1197 consecutive patients who had PCI in the work-up pre-TAVR. A total of 1,705 lesions (1.5 ± 0.7 lesions per patient) were included. Death, stroke, myocardial infarction, and major adverse cardiovascular and cerebrovascular events (MACCE) were recorded, as well as target lesion failure (TLF) and target vessel failure (TVF). RESULTS One-half of patients exhibited a multivessel disease and the mean SYNTAX (SYNergy between PCI with TAXUS and Cardiac Surgery) score was 12.1 ± 9.1. The lesions were of B2/C type, calcified, bifurcation, and ostial in 49.9%, 45.8%, 21.4%, and 19.3% of cases, respectively. After a median follow-up of 2 (interquartile range: 1 to 3) years, a total of 444 (37.1%) patients presented an MACCE. Forty patients exhibited TVF (3.3%), with TLF identified in 32 (2.7%) patients. By multivariable analysis, previous peripheral artery disease (p < 0.001), chronic obstructive pulmonary disease (p = 0.002), atrial fibrillation (p = 0.003), diabetes mellitus (p = 0.012), and incomplete revascularization (p = 0.014) determined an increased risk of MACCE. In patients with unprotected left main or SYNTAX score >32 (n = 128), TLF, TVF, and MACCE rates were 3.9%, 6.3%, and 35.9%, respectively (p = 0.378; p = 0.065, and p = 0.847, respectively, vs. the rest of the population). CONCLUSIONS Patients undergoing PCI in the work-up pre-TAVR frequently exhibited complex coronary lesions and multivessel disease. PCI was successful in most cases, and TLF and TVF rates at 2-year follow-up were low, also among patients with high-risk coronary features. However, overall MACCE occurred in about one-third of patients, with incomplete revascularization determining an increased risk. These results should inform future studies to better determine the optimal revascularization strategy pre-TAVR.
Collapse
Affiliation(s)
- Laurent Faroux
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Erika Munoz-Garcia
- Cardiology Department, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - Luis Nombela-Franco
- Cardiology Department, Instituto Cardiovascular, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Quentin Fischer
- Cardiology Department, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pierre Donaint
- Cardiology Department, Reims University Hospital, Reims, France
| | - Vicenç Serra
- Cardiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Gabriela Veiga
- Cardiology Department, Hospital Marques de Valdecilla, Santander, Spain
| | | | - Victoria Vilalta
- Cardiology Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Alberto Alperi
- Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Ander Regueiro
- Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Lluis Asmarats
- Cardiology Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Henrique B Ribeiro
- Cardiology Department, Heart Institute, University of São Paulo, São Paulo, Brazil
| | - Anthony Matta
- Cardiology Department, Hôpital Universitaire de Toulouse, Toulouse, France
| | - Antonio Munoz-Garcia
- Cardiology Department, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - German Armijo
- Cardiology Department, Instituto Cardiovascular, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Marina Urena
- Cardiology Department, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Damien Metz
- Cardiology Department, Reims University Hospital, Reims, France
| | | | | | | | - Isaac Pascual
- Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Pedro Perez-Fuentes
- Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Dabit Arzamendi
- Cardiology Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | | | - David Del Val
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Thomas Couture
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
| |
Collapse
|
34
|
Faroux L, Parada FC, Munoz-Garcia E, Nombela-Franco L, Fischer Q, Donaint P, Serra V, Fernández GV, Ibanes EG, Vilalta V, Alperi A, Regueiro A, Asmarats L, Ribeiro H, Matta A, Munoz-Garcia A, Ortiz GA, Urena M, Metz D, Rodenas-Alesina E, Hernandez JMDLT, Fernandez-Nofrerias E, Pascual I, Fuentes PP, Arzamendi D, Borges DCC, Val DD, Couture T, Rodés-Cabau J. TCT CONNECT-90 Procedural Characteristics and Late Outcomes of Percutaneous Coronary Intervention in the Workup Pre-TAVR. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
35
|
Faroux L, Junquera L, Mohammadi S, Del Val D, Muntané-Carol G, Alperi A, Kalavrouziotis D, Dumont E, Paradis JM, Delarochellière R, Rodés-Cabau J. Femoral Versus Nonfemoral Subclavian/Carotid Arterial Access Route for Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2020; 9:e017460. [PMID: 32990146 PMCID: PMC7792420 DOI: 10.1161/jaha.120.017460] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Some concerns remain regarding the safety of transcarotid and transsubclavian approaches for transcatheter aortic valve replacement. We aimed to compare the risk of 30‐day complications and death in transcarotid/transsubclavian versus transfemoral transcatheter aortic valve replacement recipients. Methods and Results Data from 20 studies, including 79 426 patients (16 studies) and 3992 patients (4 studies) for the evaluation of the unadjusted and adjusted impact of the arterial approach were sourced, respectively. The use of a transcarotid/transsubclavian approach was associated with an increased risk of stroke when using unadjusted data (risk ratio [RR], 2.28; 95% CI, 1.90–2.72) as well as adjusted data (odds ratio [OR], 1.53; 95% CI, 1.05–2.22). The pooled results deriving from unadjusted data showed an increased risk of 30‐day death (RR, 1.46; 95% CI, 1.22–1.74) and bleeding (RR, 1.53; 95% CI, 1.18–1.97) in patients receiving transcatheter aortic valve replacement through a transcarotid/transsubclavian access (compared with the transfemoral group), but the associations between the arterial access and death (OR, 1.22; 95% CI, 0.89–1.69), bleeding (OR, 1.05; 95% CI, 0.68–1.61) were no longer significant when using adjusted data. No significant effect of the arterial access on vascular complication was observed in unadjusted (RR, 0.84; 95% CI, 0.66–1.06) and adjusted (OR, 0.79; 95% CI, 0.53–1.17) analyses. Conclusions Transcarotid and transsubclavian approaches for transcatheter aortic valve replacement were associated with an increased risk of stroke compared with the transfemoral approach. However, these nonfemoral arterial alternative accesses were not associated with an increased risk of 30‐day death, bleeding, or vascular complication when taking into account the confounding factors.
Collapse
Affiliation(s)
- Laurent Faroux
- Quebec Heart and Lung InstituteLaval University Quebec City Quebec Canada
| | - Lucia Junquera
- Quebec Heart and Lung InstituteLaval University Quebec City Quebec Canada
| | - Siamak Mohammadi
- Quebec Heart and Lung InstituteLaval University Quebec City Quebec Canada
| | - David Del Val
- Quebec Heart and Lung InstituteLaval University Quebec City Quebec Canada
| | | | - Alberto Alperi
- Quebec Heart and Lung InstituteLaval University Quebec City Quebec Canada
| | | | - Eric Dumont
- Quebec Heart and Lung InstituteLaval University Quebec City Quebec Canada
| | | | | | - Josep Rodés-Cabau
- Quebec Heart and Lung InstituteLaval University Quebec City Quebec Canada
| |
Collapse
|
36
|
Faroux L, Villecourt A, Guimaraes L, Wintzer-Wehekind J, Junquera L, Arsenault J, Blanpain T, Tassan-Mangina S, Heroguelle V, Ruggieri VG, Metz D, Kalavrouziotis D, Dumont E, Paradis JM, Delarochellière R, Del Val D, Muntané-Carol G, Mohammadi S, Rodés-Cabau J. Radiation Exposure During Transcatheter Aortic Valve Replacement: Impact of Arterial Approach and Prosthesis Type. Ann Thorac Surg 2020; 111:1601-1606. [PMID: 32950489 DOI: 10.1016/j.athoracsur.2020.06.114] [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] [Received: 02/20/2020] [Revised: 06/03/2020] [Accepted: 06/29/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The impact of novel alternative access and valve type on radiation exposure during transcatheter aortic valve replacement (TAVR) has not yet been evaluated. This study sought to determine the impact of a transarterial approach and prosthesis type on physician and patient exposure to radiation during TAVR. METHODS This was a prospective study including 140 consecutive patients undergoing TAVR by transfemoral (n = 102) or transcarotid (TC) (n = 38) access at 2 centers. Implanted valves were the self-expanding Evolut R/PRO system (Medtronic, Minneapolis, MN; n = 38) and the balloon-expandable SAPIEN 3 valve (Edwards Lifesciences, Irvine, CA; n = 102). The primary endpoint was first operator radiation exposure. The secondary endpoint was patient radiation exposure. RESULTS First operator radiation exposure was 4-fold greater during TC TAVR (P < .001). The use of a self-expanding valve was associated with a longer x-ray time (P = .015) and a 2-fold greater first operator radiation dose (P = .018). Patient radiation dose was not significantly affected by arterial approach (P = .055) or valve type (P = .095). After adjustment for potential confounders, the TC approach remained associated with a 174.8% (95% confidence interval, 80.6-318.3, P < .001) increase in first operator radiation dose, whereas the use of a self-expanding valve no longer influenced the first operator dose (P = .630). CONCLUSIONS TC access and the use of a self-expanding valve were associated with a 4- and 2-fold greater first operator radiation exposure during TAVR procedures, respectively. Unlike the arterial approach, the effect of bioprosthesis type on radiation exposure was mainly related to x-ray time and was no longer significant after adjustment.
Collapse
Affiliation(s)
- Laurent Faroux
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Department of Cardiology, Reims University Hospital, Reims, France; EA3797 VieFra, University of Reims Champagne-Ardenne, Reims, France
| | | | - Leonardo Guimaraes
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Lucia Junquera
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Jean Arsenault
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Thierry Blanpain
- Department of Cardiology, Reims University Hospital, Reims, France
| | | | | | | | - Damien Metz
- Department of Cardiology, Reims University Hospital, Reims, France
| | | | - Eric Dumont
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Jean-Michel Paradis
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - David Del Val
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Siamak Mohammadi
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
| |
Collapse
|
37
|
Faroux L, Kalavrouziotis D, Rodés-Cabau J, Mohammadi S. Commentary: Coronary revascularization following aortic valve replacement: More than just a trivial event? JTCVS Open 2020; 3:104-105. [PMID: 36003861 PMCID: PMC9390426 DOI: 10.1016/j.xjon.2020.05.006] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 05/17/2020] [Accepted: 05/20/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Laurent Faroux
- Division of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Dimitri Kalavrouziotis
- Division of Cardiac Surgery, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Division of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Siamak Mohammadi
- Division of Cardiac Surgery, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
- Address for reprints: Siamak Mohammadi, MD, Department of Cardiac Surgery, Quebec Heart and Lung Institute, 2725 Chemin Sainte-Foy, Quebec City, Quebec, Canada, G1V 4G5.
| |
Collapse
|
38
|
Muntané-Carol G, del Val D, Junquera L, Faroux L, Delarochellière R, Paradis JM, Mohammadi S, Kalavrouziotis D, Dumont E, Philippon F, Rodés-Cabau J. Timing and evolution of advanced conduction disturbances in patients with right bundle branch block undergoing transcatheter aortic valve replacement. Europace 2020; 22:1537-1546. [DOI: 10.1093/europace/euaa149] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/25/2020] [Accepted: 05/13/2020] [Indexed: 12/29/2022] Open
Abstract
Abstract
Aims
This study sought to determine the timing and evolution over time of advanced conduction disturbances (CDs) in patients with baseline right bundle branch block (RBBB) undergoing transcatheter aortic valve replacement (TAVR).
Methods and results
One hundred and ten consecutive patients with pre-existing RBBB were included (out of 1341, 8.2%). All arrhythmias during the hospitalization period were recorded. Follow-up was performed at 30 days, 1 year, and yearly thereafter. Conduction recovery and ventricular pacing percentage (VPP) was evaluated at 30 days in those patients with permanent pacemaker implantation (PPMI). Sixty-one (55.5%) patients suffered advanced CDs [97% complete or high-degree atrioventricular block (CHB/HAVB)], and the vast majority (98%) occurred within the first 3 days post-procedure (intraprocedural: 85%). Fifty-two (47.3%) patients had PPMI (vs. 11.0% in non-RBBB patients, P < 0.001). Ventricular pacing percentage at 1 month was higher in patients with persistent-intraprocedural CHB/HAVB compared to those with transient-intraprocedural or post-procedural CHB/HAVB [99 (interquartile range, IQR 97–100)% vs. 72 (IQR 30–99)%, P = 0.02]. Complete recovery (VPP < 1%) was observed in only one patient (2%) with CHB/HAVB. After hospital discharge, no symptomatic bradyarrhythmias or sudden death occurred within 30 days. Patients with pre-existing RBBB exhibited a higher risk of PPMI at 4-year follow-up (26% vs. 8% in non-RBBB patients, P < 0.001).
Conclusion
In patients with pre-existing RBBB, the vast majority of advanced CDs occurred within the 3 days following TAVR, and most did not recover at 1-month, particularly those with intra-procedural persistent CHB/HAVB. These results should help to determine the hospitalization length and timing of PPMI in RBBB patients undergoing TAVR.
Collapse
Affiliation(s)
| | - David del Val
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - Lucía Junquera
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - Laurent Faroux
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | | | | | - Siamak Mohammadi
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | | | - Eric Dumont
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - François Philippon
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| |
Collapse
|
39
|
Muntané-Carol G, Alperi A, Faroux L, Bédard E, Philippon F, Rodés-Cabau J. Transcatheter Tricuspid Valve Intervention: Coaptation Devices. Front Cardiovasc Med 2020; 7:139. [PMID: 32903754 PMCID: PMC7438895 DOI: 10.3389/fcvm.2020.00139] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 06/30/2020] [Indexed: 11/13/2022] Open
Abstract
Transcatheter tricuspid valve intervention (TTVI) has recently emerged as an alternative for the treatment of severe tricuspid regurgitation (TR). Multiple percutaneous devices have been developed in the last decade with promising early results. Among them, the coaptation devices are designed to reduce TR severity by valve leaflet plication or occupying the regurgitant orifice with a spacer. To date, the MitraClip/TriClip devices (Abbott, Santa Clara, CA, USA), the PASCAL system (Edwards Lifesciencies, Irvine, CA, USA), and the FORMA device (Edwards Lifesciencies, Irvine, CA, USA) have been used as coaptation devices for treating severe TR. The present document aimed to review the clinical evidence on coaptation devices in the field of TTVI, describing its design characteristics, main procedural steps, and early and mid-term outcomes.
Collapse
Affiliation(s)
| | - Alberto Alperi
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - Laurent Faroux
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - Elisabeth Bédard
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - François Philippon
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| |
Collapse
|
40
|
Oudin V, Marcus C, Faroux L, Espinosa M, Metz D, Lesaffre F. Impact of epicardial fat on the duration of radiofrequency energy delivery during catheter ablation of atrial fibrillation. IJC Heart & Vasculature 2020; 29:100555. [PMID: 32551360 PMCID: PMC7292915 DOI: 10.1016/j.ijcha.2020.100555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 05/20/2020] [Accepted: 05/31/2020] [Indexed: 12/03/2022]
Abstract
Aims This study aimed to determine the impact of the volume of epicardial fat on the duration of radiofrequency (RF) energy delivery during the procedure of ablation of atrial fibrillation (AF). Methods The volume of epicardial fat was measured from spiral computerized tomography scan. The primary endpoint was the duration of RF delivery for pulmonary vein isolation (PVI), and the overall total duration of RF application. Secondary endpoint was conversion of AF to sinus rhythm or organisation of the arrhythmia after PVI. Results From March 2015 to May 2018, 222 patients (45.5% with persistent AF) underwent a first RF catheter ablation procedure for AF. The total duration of RF delivery, and the duration of RF delivery specifically for PVI were significantly associated with higher total volume of epicardial fat (p = 0.0002; p = 0.009 respectively), periatrial (p = 0.003; p = 0.045) and periventricular epicardial fat (p = 0.001; p = 0.012). In multivariate analysis, total epicardial fat volume was not significantly associated with total RF delivery duration (p = 0.743). For patients with arrhythmia at the time of the procedure, patients who achieved conversion or organisation of their arrhythmia after PVI had similar levels of total epicardial fat to those whose arrhythmia persisted (65 ± 35.2 vs 74.5 ± 31.2 ml; p = 0.192). Conclusion We observed a significant relation between total, periatrial, and periventricular epicardial fat, and the duration of RF delivery during ablation of AF. This relation was not significant by multivariate analysis meaning that epicardial fat may be a marker, but not an independent factor, of ablation complexity.
Collapse
|
41
|
Théry G, Faroux L, Deleuze P, Metz D. Idiopathic endomyocardial fibrosis in a Western European: a case report. Eur Heart J Case Rep 2020; 4:1-5. [PMID: 32617477 PMCID: PMC7319822 DOI: 10.1093/ehjcr/ytaa104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 01/22/2020] [Accepted: 04/09/2020] [Indexed: 11/14/2022]
Abstract
Background Endomyocardial fibrosis (EMF) is a rare cause of restrictive cardiomyopathy, mainly found in tropical/subtropical country. Endomyocardial fibrosis causes severe congestive symptoms and may lead to end-stage heart failure. Case summary A French Caucasian 44-year-old man without noticeable medical history and who had never travelled outside of France was hospitalized for a first episode of acute heart failure revealing an atypical appearance of the left ventricle. Cardiac magnetic resonance (CMR) identified EMF, but investigations did not identify any aetiology (no eosinophilia). Despite optimal management of chronic heart failure, functional class declined rapidly resulting in several hospitalizations for heart failure. The patient finally underwent an elective heart transplantation with good results at 6-month follow-up. Discussion Endomyocardial fibrosis exact physiopathology remains unclear, although association with eosinophilia has been reported. Diagnosis is challenging and is based on multi-modal imagery with a central role of CMR. There is no consensus on optimal management, medical therapy having poor outcomes and rate of peri-operative complications being high. Heart transplantation should be considered for eligible patients.
Collapse
Affiliation(s)
- Guillaume Théry
- Cardiology Department, Reims University Hospital, Avenue du Général Koenig, 51092 Reims, France
| | - Laurent Faroux
- Cardiology Department, Reims University Hospital, Avenue du Général Koenig, 51092 Reims, France
| | - Philippe Deleuze
- Cardiac Surgery Department, Marie-Lannelongue Hospital, 133 Avenue de la Résistance, 92350 Le Plessis-Robinson, France
| | - Damien Metz
- Cardiology Department, Reims University Hospital, Avenue du Général Koenig, 51092 Reims, France
| |
Collapse
|
42
|
Faroux L, Kalavrouziotis D, Mohammadi S. Commentary: Transcatheter therapies for tricuspid regurgitation: The rise of a new standard? JTCVS Open 2020; 2:20-21. [PMID: 36003680 PMCID: PMC9390353 DOI: 10.1016/j.xjon.2020.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 04/19/2020] [Accepted: 04/22/2020] [Indexed: 11/25/2022]
|
43
|
Faroux L, Couture T, Guimaraes C, Junquera L, Del Val D, Muntané-Carol G, Wintzer-Wehekind J, Mohammadi S, Paradis JM, Delarochellière R, Kalavrouziotis D, Dumont E, Pasian S, Rodés-Cabau J. Interaction Between Balloon-Expandable Valves and Coronary Ostia: Angiographic Analysis and Impact on Coronary Access. J Invasive Cardiol 2020; 32:235-242. [PMID: 32428866] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVES We sought to evaluate the position of balloon-expandable valves in relation to the coronary ostia using an angiographic- and computed tomography (CT)-based analysis, and to determine the impact of valve position on coronary angiography (CA)/percutaneous coronary intervention (PCI) feasibility and results. METHODS A total of 533 patients who received a Sapien XT or Sapien 3 valve were included in the angiographic analysis. Of these, 49 benefited from an opportunistic electrocardiography-gated CT after transcatheter aortic valve replacement (TAVR) and were included in the CT analysis. RESULTS Regarding the left coronary artery (LCA) ostium, the top of the transcatheter heart valve (THV) frame was infraostial in 49% of cases, and the valve totally covered the LCA ostium in 27% of patients. The stent frame of the Sapien 3 valve completely covered the LCA ostium more frequently than the Sapien XT valve (43% vs 12%, respectively; P<.001) and the relative implantation depth was significantly less ventricular in the Sapien 3 group than in the Sapien XT group (28.0 ± 12.3% vs 36.8 ± 12.6%, respectively; P<.001). The CT evaluation found similar results to angiographic evaluation. A total of 53 patients (10%) underwent CA (± PCI) following TAVR, and valve position did not influence CA performance/quality and PCI results. CONCLUSIONS The stent frame of balloon-expandable Sapien valves exceeded the coronary ostia in about one-fourth of patients, and this percentage was >40% with the new-generation Sapien 3 valve. However, THV position did not affect the feasibility, quality, and results of CA/PCI post TAVR.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, 2725 Chemin Ste-Foy, G1V4G5, Quebec City, Quebec, Canada.
| |
Collapse
|
44
|
Couture T, Faroux L, Junquera L, Del Val D, Muntané-Carol G, Wintzer-Wehekind J, Alperi A, Mohammadi S, Paradis JM, Delarochellière R, Kalavrouziotis D, Dumont E, Rodés-Cabau J. Interaction Between Self-Expanding Transcatheter Heart Valves and Coronary Ostia: An Angiographically Based Analysis of the Evolut R/Pro Valve System. J Invasive Cardiol 2020; 32:123-128. [PMID: 32160151] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES We sought to assess the position of the CoreValve Evolut R/Pro (Medtronic) with respect to the left coronary artery (LCA) ostium and evaluate the impact of implantation depth on this relationship. METHODS One hundred consecutive patients who received an Evolut R/Pro valve and had an adequate angiography following valve implantation were included. Angiographic measurements included valve implantation depth, the position of the Evolut R/Pro with respect to the LCA, and the distance between the neo-valve cusp and the LCA ostium. Coronary access issues following TAVR were also recorded. RESULTS Regarding the LCA ostium, the neo-valve of the Evolut R/Pro was supraostial, at the ostial level, and infraostial in 3%, 12%, and 85% of cases, respectively. When beneath the LCA ostium, the mean distance between the neo-valve and the floor of the LCA ostium was 4.1 ± 5.2 mm. An implantation depth ≤6 mm was associated with a higher rate of neo-valve at the ostial level or above (25% vs 4% for implantation depth >6 mm; P=.01). Accessing the coronary arteries was required in 10% of the patients at 12 ± 8 months post TAVR, and selective coronary angiography of the left and right coronary arteries was achieved in 60% and 40% of the cases, respectively. CONCLUSIONS The Evolut R/Pro neo-valve was positioned below the LCA ostium in the vast majority of cases (85%), but an implantation depth ≤6mm was associated with a higher rate of neo-valve positioning at or above the coronary ostia level. Considering the current tendency of very high (aortic) valve implants to avoid conduction disturbances, future studies should determine the impact of high Evolut R/Pro positioning on coronary access issues post TAVR.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, 2725 Chemin Ste-Foy, G1V4G5, Quebec City, Quebec, Canada.
| |
Collapse
|
45
|
Alperi Garcia A, Muntané-Carol G, Junquera L, del Val D, Faroux L, Philippon F, Rodés-Cabau J. Can we reduce conduction disturbances following transcatheter aortic valve replacement? Expert Rev Med Devices 2020; 17:309-322. [DOI: 10.1080/17434440.2020.1741349] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
| | | | - Lucia Junquera
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | - David del Val
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | - Laurent Faroux
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | - François Philippon
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| |
Collapse
|
46
|
Faroux L, Muntané-Carol G, Urena M, Nombela-Franco L, Amat-Santos I, Kleiman N, Munoz-Garcia A, Atienza F, Serra V, Deyell MW, Veiga-Fernandez G, Masson JB, Canadas-Godoy V, Himbert D, Fischer Q, Castrodeza J, Elizaga J, Pascual JF, Webb JG, de la Torre JM, Asmarats L, Pelletier-Beaumont E, Alméndarez M, Couture T, Philippon F, Rodes-Cabau J. Late Electrocardiographic Changes in Patients With New-Onset Left Bundle Branch Block Following Transcatheter Aortic Valve Implantation. Am J Cardiol 2020; 125:795-802. [PMID: 31889524 DOI: 10.1016/j.amjcard.2019.11.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/20/2019] [Accepted: 11/22/2019] [Indexed: 12/29/2022]
Abstract
This study sought to determine, in patients with new-onset persistent left bundle branch block (NOP-LBBB) after transcatheter aortic valve implantation (TAVI), the incidence and factors associated with (i) LBBB recovery and (ii) permanent pacemaker implantation (PPI) at 1-year follow-up. This was a multicenter study including 153 patients (mean age: 81 ± 5 years, 56% of women) with NOP-LBBB post-TAVI (balloon-expandable valve in 112 patients). Delta PR (ΔPR) and delta QRS (ΔQRS) were defined as the difference in PR and QRS length between baseline and hospital discharge ECG, and the relative ΔPR and ΔQRS as absolute ΔPR and ΔQRS divided by baseline PR and QRS length, respectively. The patients had a clinical visit and 12-lead ECG at 1-year follow-up. LBBB recovery was observed in 50 patients (33%), and 14 patients (9%) had advanced conduction disturbances requiring PPI during the follow-up period. No clinical or ECG variables were associated with LBBB recovery, including prosthesis type (self- or balloon-expandable valve, p = 0.563), QRS width at baseline/discharge or absolute/relative ΔQRS (p >0.10 for all). The presence of atrial fibrillation at baseline (0.026), a longer PR interval at discharge (0.009), and a longer absolute and relative ΔPR (p = 0.002 and p = 0.004, respectively) were associated with an increased risk of PPI at 1-year follow-up. In conclusion, NOP-LBBB post-TAVI resolved in one-third of patients at 1-year follow-up, but no clinical or ECG variables were associated with LBBB recovery. Conversely, a nonsinus rhythm at baseline and a longer ΔPR were associated with an increased risk of PPI within the year after TAVI.
Collapse
Affiliation(s)
- Laurent Faroux
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Marina Urena
- Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Paris, France
| | - Luis Nombela-Franco
- Instituto Cardiovascular, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | | | - Neal Kleiman
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | | | - Felipe Atienza
- Hospital General Universitario Gregorio Maranon, Madrid, Spain
| | - Vicenç Serra
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Marc W Deyell
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | | | | | - Dominique Himbert
- Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Paris, France
| | - Quentin Fischer
- Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Paris, France
| | | | - Jaime Elizaga
- Hospital General Universitario Gregorio Maranon, Madrid, Spain
| | | | - John G Webb
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | - Lluis Asmarats
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Marcel Alméndarez
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Thomas Couture
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Francois Philippon
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodes-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
| |
Collapse
|
47
|
Kinnel M, Faroux L, Villecourt A, Tassan-Mangina S, Heroguelle V, Nazeyrollas P, Poncet A, Ruggieri VG, Metz D. Abdominal aorta tortuosity on computed tomography identifies patients at risk of complications during transfemoral transcatheter aortic valve replacement. Arch Cardiovasc Dis 2020; 113:159-167. [DOI: 10.1016/j.acvd.2019.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 10/02/2019] [Accepted: 10/15/2019] [Indexed: 12/20/2022]
|
48
|
Faroux L, Munoz-Garcia E, Serra V, Alperi A, Nombela-Franco L, Fischer Q, Veiga G, Donaint P, Asmarats L, Vilalta V, Chamandi C, Regueiro A, Gutiérrez E, Munoz-Garcia A, Garcia Del Blanco B, Bach-Oller M, Moris C, Armijo G, Urena M, Fradejas-Sastre V, Metz D, Castillo P, Fernandez-Nofrerias E, Sabaté M, Tamargo M, Del Val D, Couture T, Rodes-Cabau J. Acute Coronary Syndrome Following Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2020; 13:e008620. [PMID: 31992059 DOI: 10.1161/circinterventions.119.008620] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Scarce data exist on coronary events following transcatheter aortic valve replacement (TAVR), and no study has determined the factors associated with poorer outcomes in this setting. This study sought to determine the clinical characteristics, outcomes, and prognostic factors of acute coronary syndrome (ACS) events following TAVR. METHODS Multicenter cohort study including a total of 270 patients presenting an ACS after a median time of 12 (interquartile range, 5-17) months post-TAVR. Post-ACS death, myocardial infarction, stroke, and overall major adverse cardiovascular or cerebrovascular events were recorded. RESULTS The ACS clinical presentation consisted of non-ST-segment-elevation myocardial infarction (STEMI) type 2 (31.9%), non-STEMI type 1 (31.5%), unstable angina (28.5%), and STEMI (8.1%). An invasive strategy was used in 163 patients (60.4%), and a percutaneous coronary intervention was performed in 97 patients (35.9%). Coronary access issues were observed in 2.5% and 2.1% of coronary angiography and percutaneous coronary intervention procedures, respectively. The in-hospital mortality rate was 10.0%, and at a median follow-up of 17 (interquartile range, 5-32) months, the rates of death, stroke, myocardial infarction, and major adverse cardiovascular or cerebrovascular events were 43.0%, 4.1%, 15.2%, and 52.6%, respectively. By multivariable analysis, revascularization at ACS time was associated with a reduction of the risk of all-cause death (hazard ratio, 0.54 [95% CI, 0.36-0.81] P=0.003), whereas STEMI increased the risk of all-cause death (hazard ratio, 2.06 [95% CI, 1.05-4.03] P=0.036) and major adverse cardiovascular or cerebrovascular events (hazard ratio, 1.97 [95% CI, 1.08-3.57] P=0.026). CONCLUSIONS ACS events in TAVR recipients exhibited specific characteristics (ACS presentation, low use of invasive procedures, coronary access issues) and were associated with a poor prognosis, with a very high in-hospital and late death rate. STEMI and the lack of coronary revascularization determined an increased risk. These results should inform future studies to improve both the prevention and management of ACS post-TAVR.
Collapse
Affiliation(s)
- Laurent Faroux
- Quebec Heart and Lung Institute, Laval University, Canada (L.F., D.d.V., T.C., J.R.-C.)
| | - Erika Munoz-Garcia
- Hospital Universitario Virgen de la Victoria, Málaga, Spain (E.M.-G., A.M.-G.)
| | - Vicenç Serra
- Hospital Universitari Vall d'Hebron, Barcelona, Spain (V.S., B.G.d.B., M.B.-O.)
| | - Alberto Alperi
- Hospital Universitario Central de Asturias, Oviedo, Spain (A.A., C.M.)
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Universitario Clínico San Carlos, Madrid, Spain (L.N.-F., G.A.)
| | - Quentin Fischer
- Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France (Q.F., M.U.)
| | - Gabriela Veiga
- Hospital Marques de Valdecilla, Santander, Spain (G.V., V.F.-S.)
| | | | - Lluis Asmarats
- Hospital Santa Creu i Sant Pau, Barcelona, Spain (L.A., P.C.)
| | | | | | - Ander Regueiro
- Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain (A.R., M.S.)
| | - Enrique Gutiérrez
- Instituto de Investigación Sanitaria Gregorio Marañon, Madrid, Spain (E.G., M.T.)
| | | | | | | | - Cesar Moris
- Hospital Universitario Central de Asturias, Oviedo, Spain (A.A., C.M.)
| | - German Armijo
- Cardiovascular Institute, Hospital Universitario Clínico San Carlos, Madrid, Spain (L.N.-F., G.A.)
| | - Marina Urena
- Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France (Q.F., M.U.)
| | | | - Damien Metz
- Reims University Hospital, Reims, France (P.D., D.M.)
| | - Pablo Castillo
- Hospital Santa Creu i Sant Pau, Barcelona, Spain (L.A., P.C.)
| | | | - Manel Sabaté
- Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain (A.R., M.S.)
| | - Maria Tamargo
- Instituto de Investigación Sanitaria Gregorio Marañon, Madrid, Spain (E.G., M.T.)
| | - David Del Val
- Quebec Heart and Lung Institute, Laval University, Canada (L.F., D.d.V., T.C., J.R.-C.)
| | - Thomas Couture
- Quebec Heart and Lung Institute, Laval University, Canada (L.F., D.d.V., T.C., J.R.-C.)
| | - Josep Rodes-Cabau
- Quebec Heart and Lung Institute, Laval University, Canada (L.F., D.d.V., T.C., J.R.-C.)
| |
Collapse
|
49
|
Faroux L, Chen S, Muntané-Carol G, Regueiro A, Philippon F, Sondergaard L, Jørgensen TH, Lopez-Aguilera J, Kodali S, Leon M, Nazif T, Rodés-Cabau J. Clinical impact of conduction disturbances in transcatheter aortic valve replacement recipients: a systematic review and meta-analysis. Eur Heart J 2020; 41:2771-2781. [DOI: 10.1093/eurheartj/ehz924] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [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] [Received: 07/27/2019] [Revised: 09/26/2019] [Accepted: 12/11/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
The clinical impact of new-onset persistent left bundle branch block (NOP-LBBB) and permanent pacemaker implantation (PPI) on transcatheter aortic valve replacement (TAVR) recipients remains controversial. We aimed to evaluate the impact of (i) periprocedural NOP-LBBB and PPI post-TAVR on 1-year all-cause death, cardiac death, and heart failure hospitalization and (ii) NOP-LBBB on the need for PPI at 1-year follow-up.
Methods and results
We performed a systematic search from PubMed and EMBASE databases for studies reporting raw data on 1-year clinical impact of NOP-LBBB or periprocedural PPI post-TAVR. Data from 30 studies, including 7792 patients (12 studies) and 42 927 patients (21 studies) for the evaluation of the impact of NOP-LBBB and PPI after TAVR were sourced, respectively. NOP-LBBB was associated with an increased risk of all-cause death [risk ratio (RR) 1.32, 95% confidence interval (CI) 1.17–1.49; P < 0.001], cardiac death (RR 1.46, 95% CI 1.20–1.78; P < 0.001), heart failure hospitalization (RR 1.35, 95% CI 1.05–1.72; P = 0.02), and PPI (RR 1.89, 95% CI 1.58–2.27; P < 0.001) at 1-year follow-up. Periprocedural PPI after TAVR was associated with a higher risk of all-cause death (RR 1.17, 95% CI 1.11–1.25; P < 0.001) and heart failure hospitalization (RR 1.18, 95% CI 1.03–1.36; P = 0.02). Permanent pacemaker implantation was not associated with an increased risk of cardiac death (RR 0.84, 95% CI 0.67–1.05; P = 0.13).
Conclusion
NOP-LBBB and PPI after TAVR are associated with an increased risk of all-cause death and heart failure hospitalization at 1-year follow-up. Periprocedural NOP-LBBB also increased the risk of cardiac death and PPI within the year following the procedure. Further studies are urgently warranted to enhance preventive measures and optimize the management of conduction disturbances post-TAVR.
Collapse
Affiliation(s)
- Laurent Faroux
- Quebec Heart and Lung Institute, Laval University, 2725 chemin Ste-Foy, Quebec City, Quebec G1V4G5, Canada
| | - Shmuel Chen
- Columbia University Medical Center, New York-Presbyterian Hospital, 177 Fort Washington Avenue, New York, NY 10032, USA
| | - Guillem Muntané-Carol
- Quebec Heart and Lung Institute, Laval University, 2725 chemin Ste-Foy, Quebec City, Quebec G1V4G5, Canada
| | - Ander Regueiro
- Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Carrer de Villaroel, 170, 08036 Barcelona, Spain
| | - Francois Philippon
- Quebec Heart and Lung Institute, Laval University, 2725 chemin Ste-Foy, Quebec City, Quebec G1V4G5, Canada
| | - Lars Sondergaard
- Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Troels H Jørgensen
- Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - José Lopez-Aguilera
- Hospital Reina Sofia of Cordoba, Avenida Menendez Pidal, 14004 Cordoba, Spain
| | - Susheel Kodali
- Columbia University Medical Center, New York-Presbyterian Hospital, 177 Fort Washington Avenue, New York, NY 10032, USA
| | - Martin Leon
- Columbia University Medical Center, New York-Presbyterian Hospital, 177 Fort Washington Avenue, New York, NY 10032, USA
| | - Tamim Nazif
- Columbia University Medical Center, New York-Presbyterian Hospital, 177 Fort Washington Avenue, New York, NY 10032, USA
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, 2725 chemin Ste-Foy, Quebec City, Quebec G1V4G5, Canada
| |
Collapse
|
50
|
Oudin V, Metz D, Marcus C, Faroux L, Lesaffre F. Impact of epicardial fat on the duration of endocavitary radiofrequency during atrial fibrillation ablation. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.252] [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]
|