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Denimal T, Delhaye C, Piérache A, Robin E, Modine T, Moussa M, Sudre A, Koussa M, Debry N, Pamart T, Lamblin N, Lemesle G, Spillemaeker H, Verdier B, Porouchani S, Cosenza A, Bical A, Schurtz G, Labreuche J, Ternacle J, Balmette V, Aouate D, Denis T, Janah D, Sylla H, Roy B, Desbordes J, Van Belle E, Vincent F. Feasibility and safety of transfemoral transcatheter aortic valve implantation performed with a percutaneous coronary intervention-like approach. Arch Cardiovasc Dis 2021; 114:537-549. [PMID: 33895105 DOI: 10.1016/j.acvd.2020.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/05/2020] [Accepted: 12/22/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Transfemoral percutaneous transcatheter aortic valve implantation (TF-TAVI) is a safe, reproducible and established procedure, mainly performed under local anaesthesia, which is mostly administered and monitored by a dedicated anaesthesia team (regular approach). Our centre has developed a standardized pathway of care, and eligible patients are selected for a minimalist TF-TAVI, entirely managed by operators without the presence of the anaesthesia team in the operating room, like most interventional coronary procedures ("percutaneous coronary intervention-like" approach [PCI approach]). AIM To compare the safety and efficacy of TF-TAVI performed with the PCI approach versus the regular approach. METHODS The analysis population comprised all patients who underwent TF-TAVI with the PCI or regular approach in our institution from November 2016 to July 2019. The two co-primary endpoints were early safety composite and early efficacy composite at 30days as defined by the Valve Academic Research Consortium-2. The PCI (n=137) and Regular (n=221) approaches were compared using the propensity score based method of inverse probability of treatment weighting. RESULTS No differences were observed after comparison of TAVI performed with the PCI or regular approach regarding the composite safety endpoint (7.3% vs. 11.3%; odds ratio 0.63, 95% confidence interval 0.37 to 1.07; P=0.086) or the composite efficacy endpoint (4.4% vs. 6.3%; odds ratio 0.78, 95% confidence interval 0.41 to 1.49; P=0.45). CONCLUSIONS This study suggests that the efficacy and safety of TF-TAVI entirely managed by a PCI approach for selected patients are not different to those when TF-TAVI is performed with the attendance of a full anaesthesia care team. The PCI approach appears to be a safe and efficient clinical pathway, providing an appropriate and rational utilization of anaesthesiology resources, and could be used for the majority of TF-TAVI procedures.
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Affiliation(s)
- Tom Denimal
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Cardiology, Institut Cœur Poumon, CHU de Lille, Université Lille, 59037 Lille, France
| | - Cédric Delhaye
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Cardiology, Institut Cœur Poumon, CHU de Lille, Université Lille, 59037 Lille, France
| | - Adeline Piérache
- ULR 2694, METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Université de Lille, Département de Biostatistiques, CHU de Lille, 59000 Lille, France
| | - Emmanuel Robin
- Anesthésie et Réanimation Cardiovasculaire, CHU de Lille, 59037 Lille, France
| | - Thomas Modine
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, 33600 Pessac, France
| | - Mouhamed Moussa
- Anesthésie et Réanimation Cardiovasculaire, CHU de Lille, 59037 Lille, France
| | - Arnaud Sudre
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Cardiology, Institut Cœur Poumon, CHU de Lille, Université Lille, 59037 Lille, France
| | | | - Nicolas Debry
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Cardiology, Institut Cœur Poumon, CHU de Lille, Université Lille, 59037 Lille, France
| | - Thibault Pamart
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Cardiology, Institut Cœur Poumon, CHU de Lille, Université Lille, 59037 Lille, France
| | - Nicolas Lamblin
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Cardiology, Institut Cœur Poumon, CHU de Lille, Université Lille, 59037 Lille, France; Unité de Soins Intensif Cardiologiques, CHU de Lille, 59037 Lille, France; Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, 33600 Pessac, France
| | - Gilles Lemesle
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Cardiology, Institut Cœur Poumon, CHU de Lille, Université Lille, 59037 Lille, France; Unité de Soins Intensif Cardiologiques, CHU de Lille, 59037 Lille, France
| | - Hugues Spillemaeker
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Cardiology, Institut Cœur Poumon, CHU de Lille, Université Lille, 59037 Lille, France
| | - Basile Verdier
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Cardiology, Institut Cœur Poumon, CHU de Lille, Université Lille, 59037 Lille, France
| | - Sina Porouchani
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Cardiology, Institut Cœur Poumon, CHU de Lille, Université Lille, 59037 Lille, France
| | - Alessandro Cosenza
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Cardiology, Institut Cœur Poumon, CHU de Lille, Université Lille, 59037 Lille, France
| | - Antoine Bical
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Cardiology, Institut Cœur Poumon, CHU de Lille, Université Lille, 59037 Lille, France
| | - Guillaume Schurtz
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Cardiology, Institut Cœur Poumon, CHU de Lille, Université Lille, 59037 Lille, France; Unité de Soins Intensif Cardiologiques, CHU de Lille, 59037 Lille, France
| | - Julien Labreuche
- ULR 2694, METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Université de Lille, Département de Biostatistiques, CHU de Lille, 59000 Lille, France
| | - Julien Ternacle
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, 33600 Pessac, France
| | - Vincent Balmette
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Cardiology, Institut Cœur Poumon, CHU de Lille, Université Lille, 59037 Lille, France
| | - David Aouate
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Cardiology, Institut Cœur Poumon, CHU de Lille, Université Lille, 59037 Lille, France
| | - Thomas Denis
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Cardiology, Institut Cœur Poumon, CHU de Lille, Université Lille, 59037 Lille, France
| | - Dany Janah
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Cardiology, Institut Cœur Poumon, CHU de Lille, Université Lille, 59037 Lille, France
| | - Habib Sylla
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Cardiology, Institut Cœur Poumon, CHU de Lille, Université Lille, 59037 Lille, France
| | - Benjamin Roy
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Cardiology, Institut Cœur Poumon, CHU de Lille, Université Lille, 59037 Lille, France
| | - Jacques Desbordes
- Anesthésie et Réanimation Cardiovasculaire, CHU de Lille, 59037 Lille, France
| | - Eric Van Belle
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Cardiology, Institut Cœur Poumon, CHU de Lille, Université Lille, 59037 Lille, France.
| | - Flavien Vincent
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Cardiology, Institut Cœur Poumon, CHU de Lille, Université Lille, 59037 Lille, France
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Van Belle E, Manigold T, Piérache A, Furber A, Debry N, Luycx-Bore A, Bauchart JJ, Nugue O, Huchet F, Bic M, Vinchon F, Sayah S, Fournier A, Decoulx E, Mouhammad U, Clerc J, Manchuelle A, Lazizi T, Chmait A, Jeannetteau J, Hénon P, Bonin M, Dupret-Minet M, Tirouvanziam A, Molcard D, Arabucki F, Py A, Prunier F, Delhaye C, Lemesle G, Schurtz G, Cosenza A, Spillemaeker H, Verdier B, Denimal T, Pamart T, Sylla H, Janah D, Aouate D, Porouchani S, Guillez V, Bonnet G, Ternacle J, Labreuche J, Cayla G, Vincent F. Myocardial Infarction incidence during national lockdown in two French provinces unevenly affected by COVID-19 outbreak: An observational study. Lancet Reg Health Eur 2021; 2:100030. [PMID: 34173627 PMCID: PMC7938895 DOI: 10.1016/j.lanepe.2021.100030] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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] [Indexed: 02/07/2023]
Abstract
Background A reduction of admission for MI has been reported in most countries affected by COVID-19. No clear explanation has been provided. Methods To report the incidence of myocardial infarction (MI) admission during COVID-19 pandemic and in particular during national lockdown in two unequally affected French provinces (10-million inhabitants) with a different media strategy, and to describe the magnitude of MI incidence changes relative to the incidence of COVID-19-related deaths. A longitudinal study to collect all MIs from January 1 until May 17, 2020 (study period) and from the identical time period in 2019 (control period) was conducted in all centers with PCI-facilities in northern "Hauts-de-France" province and western "Pays-de-la-Loire" Province. The incidence of COVID-19 fatalities was also collected. Findings In "Hauts-de-France", during lockdown (March 18-May 10), 1500 COVID-19-related deaths were observed. A 23% decrease in MI-IR (IRR=0.77;95%CI:0.71-0.84, p<0.001) was observed for a loss of 272 MIs (95%CI:-363,-181), representing 18% of COVID-19-related deaths. In "Pays-de-la-Loire", 382 COVID-19-related deaths were observed. A 19% decrease in MI-IR (IRR=0.81; 95%CI=0.73-0.90, p<0.001) was observed for a loss of 138 MIs (95%CI:-210,-66), representing 36% of COVID-19-related deaths. While in "Hauts-de-France" the MI decline started before lockdown and recovered 3 weeks before its end, in "Pays-de-la-Loire", it started after lockdown and recovered only by its end. In-hospital mortality of MI patients was increased during lockdown in both provinces (5.0% vs 3.4%, p=0.02). Interpretation It highlights one of the potential collateral damages of COVID-19 outbreak on cardiovascular health with a dramatic reduction of MI incidence. It advocates for a careful and weighted communication strategy in pandemic crises. Funding The study was conducted without external funding.
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Affiliation(s)
- Eric Van Belle
- CHU Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Inserm, U1011, Institut Pasteur de Lille, EGID, Université de Lille, Lille 59037, France
| | | | - Adeline Piérache
- Département de Biostatistiques, Univ. Lille, CHU Lille, ULR 2694 - METRICS: évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Akram Chmait
- Clinique Côte d'Opale, Saint-Martin Boulogne, France
| | | | | | | | | | | | | | | | | | | | - Cédric Delhaye
- CHU Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Inserm, U1011, Institut Pasteur de Lille, EGID, Université de Lille, Lille 59037, France
| | - Gilles Lemesle
- CHU Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Inserm, U1011, Institut Pasteur de Lille, EGID, Université de Lille, Lille 59037, France
| | - Guillaume Schurtz
- CHU Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Inserm, U1011, Institut Pasteur de Lille, EGID, Université de Lille, Lille 59037, France
| | - Alessandro Cosenza
- CHU Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Inserm, U1011, Institut Pasteur de Lille, EGID, Université de Lille, Lille 59037, France
| | - Hugues Spillemaeker
- CHU Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Inserm, U1011, Institut Pasteur de Lille, EGID, Université de Lille, Lille 59037, France
| | - Basile Verdier
- CHU Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Inserm, U1011, Institut Pasteur de Lille, EGID, Université de Lille, Lille 59037, France
| | - Tom Denimal
- CHU Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Inserm, U1011, Institut Pasteur de Lille, EGID, Université de Lille, Lille 59037, France
| | - Thibault Pamart
- CHU Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Inserm, U1011, Institut Pasteur de Lille, EGID, Université de Lille, Lille 59037, France
| | - Habib Sylla
- CHU Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Inserm, U1011, Institut Pasteur de Lille, EGID, Université de Lille, Lille 59037, France
| | - Dany Janah
- CHU Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Inserm, U1011, Institut Pasteur de Lille, EGID, Université de Lille, Lille 59037, France
| | - David Aouate
- CHU Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Inserm, U1011, Institut Pasteur de Lille, EGID, Université de Lille, Lille 59037, France
| | - Sina Porouchani
- CHU Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Inserm, U1011, Institut Pasteur de Lille, EGID, Université de Lille, Lille 59037, France
| | - Valérie Guillez
- CHU Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Inserm, U1011, Institut Pasteur de Lille, EGID, Université de Lille, Lille 59037, France
| | - Guillaume Bonnet
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, 33600 Pessac, France
| | - Julien Ternacle
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, 33600 Pessac, France
| | - Julien Labreuche
- Département de Biostatistiques, Univ. Lille, CHU Lille, ULR 2694 - METRICS: évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France
| | | | - Flavien Vincent
- CHU Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Inserm, U1011, Institut Pasteur de Lille, EGID, Université de Lille, Lille 59037, France
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3
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Vincent F, Spillemaeker H, Kyheng M, Belin-Vincent C, Delhaye C, Piérache A, Denimal T, Verdier B, Debry N, Moussa M, Schurtz G, Porouchani S, Cosenza A, Juthier F, Pamart T, Richardson M, Coisne A, Hertault A, Sobocinski J, Modine T, Pontana F, Duhamel A, Labreuche J, Van Belle E. Ultrasound Guidance to Reduce Vascular and Bleeding Complications of Percutaneous Transfemoral Transcatheter Aortic Valve Replacement: A Propensity Score-Matched Comparison. J Am Heart Assoc 2020; 9:e014916. [PMID: 32172643 PMCID: PMC7335526 DOI: 10.1161/jaha.119.014916] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [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] [Indexed: 01/08/2023]
Abstract
Background Ultrasound (US) guidance provides the unique opportunity to control the puncture zone of the artery during transfemoral transcatheter aortic valve replacement and may decrease major vascular complications (VC) and life-threatening or major bleeding complications. This study aimed to evaluate the clinical impact of US guidance using a propensity score-matched comparison. Methods and Results US guidance was implemented as the default approach for all transfemoral transcatheter aortic valve replacement cases in our institution in June 2013. We defined 3 groups of consecutive patients according to the method of puncture (fluoroscopic/US guidance) and the use of a transcatheter heart valve. Patients in the US-guided second-generation group (Sapien XT [Edwards Lifesciences, Irvine, CA], Corevalve [Medtronic, Dublin, Ireland]) were successfully 1:1 matched with patients in the fluoroscope-guided second-generation group (n=95) with propensity score matching. In a second analysis we described the consecutive patients of the US-guided third-generation group (Evolut-R [Medtronic], Sapien 3 [Edwards Lifesciences], n=308). All vascular and bleeding complications were reduced in the US-guided second-generation group compared with the fluoroscope-guided second-generation group: VC (16.8% versus 6.3%; P=0.023); life-threatening or major bleeding (22.1% versus 6%; P=0.004); and VC related to vascular access (12.6% versus 4.2%; P=0.052). In the US-guided third-generation group the rates of major VC and life-threatening or major bleeding were 3.2% (95% CI, 1.6% to 5.9%) and 3.6% (95% CI, 1.8% to 6.3%). In the overall population (n=546), life-threatening or major bleeding was associated with a 1.7-fold increased mortality risk (P=0.02). Conclusions We demonstrated that US guidance effectively reduced VC and bleeding complications for transfemoral transcatheter aortic valve replacement and should be considered the standard puncture method. Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02628509.
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Affiliation(s)
- Flavien Vincent
- Cardiology Department of Interventional Cardiology for Coronary, Valves, and Structural Heart Diseases Institut Coeur Poumon CHU Lille Lille France.,Inserm U1011 Institut Pasteur de Lille EGID Lille France.,Université de Lille France
| | - Hugues Spillemaeker
- Cardiology Department of Interventional Cardiology for Coronary, Valves, and Structural Heart Diseases Institut Coeur Poumon CHU Lille Lille France.,Inserm U1011 Institut Pasteur de Lille EGID Lille France.,Université de Lille France
| | - Maéva Kyheng
- EA 2694-Santé Publique: Épidémiologie et Qualité des Soins CHU Lille University of Lille France
| | - Cassandre Belin-Vincent
- Cardiology Department of Interventional Cardiology for Coronary, Valves, and Structural Heart Diseases Institut Coeur Poumon CHU Lille Lille France
| | - Cédric Delhaye
- Cardiology Department of Interventional Cardiology for Coronary, Valves, and Structural Heart Diseases Institut Coeur Poumon CHU Lille Lille France
| | - Adeline Piérache
- EA 2694-Santé Publique: Épidémiologie et Qualité des Soins CHU Lille University of Lille France
| | - Tom Denimal
- Cardiology Department of Interventional Cardiology for Coronary, Valves, and Structural Heart Diseases Institut Coeur Poumon CHU Lille Lille France.,Inserm U1011 Institut Pasteur de Lille EGID Lille France.,Université de Lille France
| | - Basile Verdier
- Cardiology Department of Interventional Cardiology for Coronary, Valves, and Structural Heart Diseases Institut Coeur Poumon CHU Lille Lille France.,Inserm U1011 Institut Pasteur de Lille EGID Lille France.,Université de Lille France
| | - Nicolas Debry
- Cardiology Department of Interventional Cardiology for Coronary, Valves, and Structural Heart Diseases Institut Coeur Poumon CHU Lille Lille France.,Inserm U1011 Institut Pasteur de Lille EGID Lille France.,Université de Lille France
| | - Mouhamed Moussa
- Anesthésie et Réanimation Cardio-Vasculaire CHU Lille Lille France.,Inserm U1011 Institut Pasteur de Lille EGID Lille France.,Université de Lille France
| | - Guillaume Schurtz
- Cardiology Department of Interventional Cardiology for Coronary, Valves, and Structural Heart Diseases Institut Coeur Poumon CHU Lille Lille France
| | - Sina Porouchani
- Cardiology Department of Interventional Cardiology for Coronary, Valves, and Structural Heart Diseases Institut Coeur Poumon CHU Lille Lille France
| | - Alessandro Cosenza
- Cardiology Department of Interventional Cardiology for Coronary, Valves, and Structural Heart Diseases Institut Coeur Poumon CHU Lille Lille France
| | - Francis Juthier
- Chirurgie Cardiaque CHU Lille Lille France.,Inserm U1011 Institut Pasteur de Lille EGID Lille France.,Université de Lille France
| | - Thibault Pamart
- Cardiology Department of Interventional Cardiology for Coronary, Valves, and Structural Heart Diseases Institut Coeur Poumon CHU Lille Lille France.,Inserm U1011 Institut Pasteur de Lille EGID Lille France.,Université de Lille France
| | - Marjorie Richardson
- Cardiology Department of Interventional Cardiology for Coronary, Valves, and Structural Heart Diseases Institut Coeur Poumon CHU Lille Lille France
| | - Augustin Coisne
- Cardiology Department of Interventional Cardiology for Coronary, Valves, and Structural Heart Diseases Institut Coeur Poumon CHU Lille Lille France.,Inserm U1011 Institut Pasteur de Lille EGID Lille France.,Université de Lille France
| | | | | | - Thomas Modine
- Chirurgie Cardiaque CHU Lille Lille France.,Inserm U1011 Institut Pasteur de Lille EGID Lille France.,Université de Lille France
| | | | - Alain Duhamel
- EA 2694-Santé Publique: Épidémiologie et Qualité des Soins CHU Lille University of Lille France
| | - Julien Labreuche
- EA 2694-Santé Publique: Épidémiologie et Qualité des Soins CHU Lille University of Lille France
| | - Eric Van Belle
- Cardiology Department of Interventional Cardiology for Coronary, Valves, and Structural Heart Diseases Institut Coeur Poumon CHU Lille Lille France.,Inserm U1011 Institut Pasteur de Lille EGID Lille France.,Université de Lille France
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