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Costa G, Pilgrim T, Amat Santos IJ, De Backer O, Kim WK, Barbosa Ribeiro H, Saia F, Bunc M, Tchetche D, Garot P, Ribichini FL, Mylotte D, Burzotta F, Watanabe Y, De Marco F, Tesorio T, Rheude T, Tocci M, Franzone A, Valvo R, Savontaus M, Wienemann H, Porto I, Gandolfo C, Iadanza A, Bortone AS, Mach M, Latib A, Biasco L, Taramasso M, Zimarino M, Tomii D, Nuyens P, Sondergaard L, Camara SF, Palmerini T, Orzalkiewicz M, Steblovnik K, Degrelle B, Gautier A, Del Sole PA, Mainardi A, Pighi M, Lunardi M, Kawashima H, Criscione E, Cesario V, Biancari F, Zanin F, Joner M, Esposito G, Adam M, Grube E, Baldus S, De Marzo V, Piredda E, Cannata S, Iacovelli F, Andreas M, Frittitta V, Dipietro E, Reddavid C, Strazzieri O, Motta S, Angellotti D, Sgroi C, Kargoli F, Tamburino C, Barbanti M. Management of Myocardial Revascularization in Patients With Stable Coronary Artery Disease Undergoing Transcatheter Aortic Valve Implantation. Circ Cardiovasc Interv 2022; 15:e012417. [PMID: 36538579 DOI: 10.1161/circinterventions.122.012417] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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] [Indexed: 12/24/2022]
Abstract
BACKGROUND The best management of stable coronary artery disease (CAD) in patients undergoing transcatheter aortic valve implantation (TAVI) is still unclear due to the marked inconsistency of the available evidence. METHODS The REVASC-TAVI registry (Management of Myocardial Revascularization in Patients Undergoing Transcatheter Aortic Valve Implantation With Coronary Artery Disease) collected data from 30 centers worldwide on patients undergoing TAVI who had significant, stable CAD at preprocedural work-up. For the purposes of this analysis, patients with either complete or incomplete myocardial revascularization were compared in a propensity score matched analysis, to take into account of baseline confounders. The primary and co-primary outcomes were all-cause death and the composite of all-cause death, stroke, myocardial infarction, and rehospitalization for heart failure, respectively, at 2 years. RESULTS Among 2407 patients enrolled, 675 pairs of patients achieving complete or incomplete myocardial revascularization were matched. The primary (21.6% versus 18.2%, hazard ratio' 0.88 [95% CI, 0.66-1.18]; P=0.38) and co-primary composite (29.0% versus 27.1%, hazard ratio' 0.97 [95% CI, 0.76-1.24]; P=0.83) outcome did not differ between patients achieving complete or incomplete myocardial revascularization, respectively. These results were consistent across different prespecified subgroups of patients (< or >75 years of age, Society of Thoracic Surgeons score > or <4%, angina at baseline, diabetes, left ventricular ejection fraction > or <40%, New York Heart Association class I/II or III/IV, renal failure, proximal CAD, multivessel CAD, and left main/proximal anterior descending artery CAD; all P values for interaction >0.10). CONCLUSIONS The present analysis of the REVASC-TAVI registry showed that, among TAVI patients with significant stable CAD found during the TAVI work-up, completeness of myocardial revascularization achieved either staged or concomitantly with TAVI was similar to a strategy of incomplete revascularization in reducing the risk of all cause death, as well as the risk of death, stroke, myocardial infarction, and rehospitalization for heart failure at 2 years, regardless of the clinical and anatomical situations.
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Affiliation(s)
- Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy (G.C., C.S., C.T., M.B.)
| | - Thomas Pilgrim
- Bern University Hospital, Inselspital, Switzerland (T.P., D.T.)
| | - Ignacio J Amat Santos
- Division of Cardiology, Hospital Clínico Universitario de Valladolid, Spain (I.J.A.C.)
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copehagen University Hospital, Denmark (O.D.B., P.N., L.S.)
| | - Won-Keun Kim
- Kerckhoff Heart Center, Bad Nauheim, Germany (W.-K.K.)
| | | | - Francesco Saia
- Dipartimento Cardiovascolare, Policlinico S. Orsola, University of Bologna, Italy (F.S., T.P., M.O.)
| | - Matjaz Bunc
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy (G.C., C.S., C.T., M.B.)
| | | | - Philippe Garot
- Institute cardiovasculaire Paris Sud, Massy, France (P.G., A.G.)
| | - Flavio Luciano Ribichini
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Italy (F.L.R., P.A.D.S., A.M., M.P., M.L.)
| | | | - Francesco Burzotta
- IRCSS Policlinico Universitario "Agostino Gemelli," Università Cattolica del Sacro Cuore, Roma, Italy (F.B.)
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan (Y.W., H.K.)
| | - Federico De Marco
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese (MI), Italy (F.D.M., E.C., V.C.)
| | - Tullio Tesorio
- Clinica Montevergine, GVM Care & Research, Mercogliano (AV), Italy (T.T., F.B., F.Z.)
| | | | - Marco Tocci
- Division of Cardiology, Policlinico Umberto I, Roma, Italy (M.T.)
| | - Anna Franzone
- Division of Cardiology, AOU Federico II, Università di Napoli, Italy (A.F., G.E., D.A.)
| | - Roberto Valvo
- University of Catania, Italy (R.V., E.D., C.R., O.S., S.M.)
| | | | - Hendrik Wienemann
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Germany (H.W., M.A., E.G., S.B.)
| | - Italo Porto
- CardioThoracic and Vascular department, San Martino Policlinico Hospital, Genova, Italy (I.P., V.D.M., E.P.)
| | - Caterina Gandolfo
- Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, Italy (C.G., S.C.)
| | - Alessandro Iadanza
- Azienda Ospedaliera Universitaria Senese, UOSA Cardiologia Interventistica, Policlinico Le Scotte, Siena, Italy (A.I.)
| | - Alessandro Santo Bortone
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy (A.S.B., F.I.)
| | - Markus Mach
- Wien University Hospital, Austria (M.M., M.A.)
| | - Azeem Latib
- Montefiore Medical Center, New York (A.L., F.K.)
| | - Luigi Biasco
- Azienda sanitaria locale di Ciriè, Chivasso e Ivrea, ASLTO4, Italy (L.B.)
| | - Maurizio Taramasso
- Heart and Valve Center, University Hospital of Zurich, University of Zurich, Switzerland (M.T.)
| | | | - Daijiro Tomii
- Bern University Hospital, Inselspital, Switzerland (T.P., D.T.)
| | - Philippe Nuyens
- The Heart Center, Rigshospitalet, Copehagen University Hospital, Denmark (O.D.B., P.N., L.S.)
| | - Lars Sondergaard
- The Heart Center, Rigshospitalet, Copehagen University Hospital, Denmark (O.D.B., P.N., L.S.)
| | - Sergio F Camara
- Heart Institute of Sao Paulo (InCor), University of Sao Paulo, Brazil (H.B.R., S.F.C.)
| | - Tullio Palmerini
- Dipartimento Cardiovascolare, Policlinico S. Orsola, University of Bologna, Italy (F.S., T.P., M.O.)
| | - Mateusz Orzalkiewicz
- Dipartimento Cardiovascolare, Policlinico S. Orsola, University of Bologna, Italy (F.S., T.P., M.O.)
| | | | | | | | - Paolo Alberto Del Sole
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Italy (F.L.R., P.A.D.S., A.M., M.P., M.L.)
| | - Andrea Mainardi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Italy (F.L.R., P.A.D.S., A.M., M.P., M.L.)
| | - Michele Pighi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Italy (F.L.R., P.A.D.S., A.M., M.P., M.L.)
| | - Mattia Lunardi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Italy (F.L.R., P.A.D.S., A.M., M.P., M.L.).,Galway University Hospital, Ireland (D.M., M.L.)
| | - Hideyuki Kawashima
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan (Y.W., H.K.)
| | - Enrico Criscione
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese (MI), Italy (F.D.M., E.C., V.C.)
| | - Vincenzo Cesario
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese (MI), Italy (F.D.M., E.C., V.C.)
| | - Fausto Biancari
- Clinica Montevergine, GVM Care & Research, Mercogliano (AV), Italy (T.T., F.B., F.Z.)
| | - Federico Zanin
- Clinica Montevergine, GVM Care & Research, Mercogliano (AV), Italy (T.T., F.B., F.Z.)
| | | | - Giovanni Esposito
- Division of Cardiology, AOU Federico II, Università di Napoli, Italy (A.F., G.E., D.A.)
| | - Matti Adam
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Germany (H.W., M.A., E.G., S.B.)
| | - Eberhard Grube
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Germany (H.W., M.A., E.G., S.B.)
| | - Stephan Baldus
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Germany (H.W., M.A., E.G., S.B.)
| | - Vincenzo De Marzo
- CardioThoracic and Vascular department, San Martino Policlinico Hospital, Genova, Italy (I.P., V.D.M., E.P.)
| | - Elisa Piredda
- CardioThoracic and Vascular department, San Martino Policlinico Hospital, Genova, Italy (I.P., V.D.M., E.P.)
| | - Stefano Cannata
- Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, Italy (C.G., S.C.)
| | - Fortunato Iacovelli
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy (A.S.B., F.I.)
| | | | | | - Elena Dipietro
- University of Catania, Italy (R.V., E.D., C.R., O.S., S.M.)
| | | | | | - Silvia Motta
- University of Catania, Italy (R.V., E.D., C.R., O.S., S.M.)
| | - Domenico Angellotti
- Division of Cardiology, AOU Federico II, Università di Napoli, Italy (A.F., G.E., D.A.)
| | - Carmelo Sgroi
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy (G.C., C.S., C.T., M.B.)
| | | | - Corrado Tamburino
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy (G.C., C.S., C.T., M.B.)
| | - Marco Barbanti
- University Medical Centre Ljubljana, Slovenia (M.B., K.S.)
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Abdelshafy M, Soliman O, Kim W, Ruck A, Elkoumy A, Elzomor H, Wang R, Tao L, Garg S, Mylotte D, Onuma Y, Serruys P. Quantitative angiographic assessment of aortic regurgitation post 11 different types of TAVI devices a multicentre pooled analysis of 2665 valves. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2078] [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
Regurgitation following TAVR impacts all-cause mortality. So far, no quantitative comparison of regurgitation by the same core lab has been performed among the various commercially available transcatheter heart valves (THV) We aimed to compare quantitative angiographic aortic regurgitation (AR) of 11 different types of THVs.
Method
This is a multicentre retrospective corelab pooled analysis of aortograms from 2704 consecutive patients treated with 11 different THV devices. Analysis was done by quantitative videodensitometric aortography (LVOT-AR), which is an objective, accurate, and reproducible tool for assessment of AR following TAVR. This method relies on time density changes in contrast medium after injection in the ascending aorta and its regurgitation (and subsequent density increase) in the LVOT. The ratio between the areas under the two-time density curves of these regions quantifies the AR in absolute percentage. The valves evaluated include ACURATE neo2 (n=120), Lotus (n=546), Myval (n=108), VitaFlow (n=105), Evolut PRO (n=95), SAPIEN 3 (n=397), Evolut R (n=295), SAPIEN XT (n=239), ACURATE neo (n=120), Venus-A (n=113) and CoreValve (n=532). Stratification of continuous variable regurgitation into categorical variables was performed according to the following pre-determined threshold criteria: 1) none/trace regurgitation (LVOT-AR<6%); 2) mild (6%≤ LVOT-AR ≤17%); and 3) moderate or severe (LVOT-AR >17%).
Results
The addition of anti PVR sealing features to the new generations ACURATE neo2 THV proved to be effective in reduction the incidence of significant PVR In comparison with the first generation ACURATE neo.
Myval, VitaFlow and Venus-A THVs are showing promising results.
Although the incidence of moderate/severe AR has regressed over time with new generations of THVs, the incidence of mild AR is still prominent with all THVs still exhibiting mild AR with an incidence ranging between 30% and 50% with the exception of the Lotus valve that had an 19% incidence of mild AR
Conclusion
ACURATE neo2 had the lowest severe/moderate percentage of AR showing significant improvements in comparison to ACURATE neo. Myval, VitaFlow and Venus-A are promising options in the THV armamentarium. These results should be confirmed in prospective randomized, head-to-head comparisons between THVs.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Abdelshafy
- National University of Ireland , Galway , Ireland
| | - O Soliman
- National University of Ireland , Galway , Ireland
| | - W Kim
- Kerckhoff Heart and Thorax Center , Bad Nauheim , Germany
| | - A Ruck
- Karolinska Institute , Stockholm , Sweden
| | - A Elkoumy
- National University of Ireland , Galway , Ireland
| | - H Elzomor
- National University of Ireland , Galway , Ireland
| | - R Wang
- Xijing Hospital of the Fourth Military Medical University , Xi'an , China
| | - L Tao
- Xijing Hospital of the Fourth Military Medical University , Xi'an , China
| | - S Garg
- Royal Blackburn Hospital , Blackburn , United Kingdom
| | - D Mylotte
- National University of Ireland , Galway , Ireland
| | - Y Onuma
- National University of Ireland , Galway , Ireland
| | - P Serruys
- National University of Ireland , Galway , Ireland
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Lunardi M, Mylotte D, Serruys P, Wijns W. The global effect of Covid-19 on acute coronary syndromes management. Eur Heart J 2021. [PMCID: PMC8524632 DOI: 10.1093/eurheartj/ehab724.1361] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aim Covid-19 has had a dramatic impact on the healthcare systems globally. Despite efforts to maintain systems of cardiovascular care during the pandemic, public health responses to the virus have contributed to adverse cardiovascular outcomes. Herein, we summarize current evidence detailing the impact of Covid-19 on interventional cardiology. Methods According to PRISMA criteria, a systematic review was performed through Medline, Embase, and Cochrane databases, to identify reports on the impact of Covid-19 on interventional cardiovascular procedures. We identified 50 published studies that met the prespecified inclusion and exclusion criteria. Results In the acute setting, several datasets report a reduction of acute coronary syndrome (ACS) admission by 40% globally (−40%, 95% CI 37–43 from the National Health Service hospital trusts in England). Most surveys and registries reported a numerically higher impact on NSTEMI/unstable angina cases compared to STEMI (−42%, 95% CI 38–46 and −23%, 95% CI 16–30 respectively, from the National Health Service hospital trusts in England). In STEMI care pathways, several studies report increased delays between symptom onset and first medical contact (105 min, 95% CI 45–222 during the pandemic vs 71 min, 95% CI 30–180 before it, p<0.001, from the National STEMI registry in Spain), with a subsequent increased duration of the ischaemic period (200 min, 95% CI 140–332 during the pandemic vs 233 min, 95% CI 150–375 before it, p<0.001, from the National STEMI registry in Spain). Importantly, hospital “door-to-balloon” times were unchanged. Most studies suggest similar in-hospital mortality for STEMI during the pandemic compared to historic controls (1.7% vs 1.8%, p=0.67 from British National Institute of Cardiovascular Outcomes Research database). An increased incidence of mechanical complications were observed (41.2% vs 19.6%, p=0.030, from an Italian monocentric experience). In the United States (New York city), overall mortality from ischemic heart diseases depicted a 2-fold increase during the pandemic (relative change 2.39, 95% CI 1.39–4.09). Of note, in the same city home deaths increased from 35/day in 2013–2017 to 200/day during the pandemic. These data suggest that ACS incidence has not decreased, but more likely patients presenting ischemic symptoms may have not contacted health care services, and have died at home. Conclusions The Covid-19 pandemic has adversely impacted outcomes in patients with ischemic heart disease (IHD). The diagnosis and treatment of IHD should be designated a health system priority that remains intact during pandemic events as the magnitude of harm induced by its interruption is substantial. FUNDunding Acknowledgement Type of funding sources: None.
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Affiliation(s)
- M Lunardi
- National University of Ireland Galway, Division of Cardiology, Galway, Ireland
| | - D Mylotte
- National University of Ireland Galway, Division of Cardiology, Galway, Ireland
| | - P Serruys
- Imperial College London, Department of Cardiology, London, United Kingdom
| | - W Wijns
- National University of Ireland Galway, Division of Cardiology, Galway, Ireland
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Ben-Ali W, Ibrahim R, Rodès-Cabeau J, von Bardeleben RS, Mylotte D, Granada J, Modine T. Correction to: Transcatheter Mitral Valve Implantation Systematic Review: Focuson Transseptal Approach and Mitral Annulus Calcification. Curr Cardiol Rep 2021; 23:51. [PMID: 33811516 DOI: 10.1007/s11886-021-01502-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- W Ben-Ali
- Service Médico-Chirurgical: Valvulopathies- Chirurgie Cardiaque-Cardiologie Interventionelle Structurelle, Hôpital Cardiologique de Haut Lévèque, CHU-Bordeaux, Bordeaux, France
- Structural Valve Program, Montreal Heart Institute, Montréal, Canada
- Service de Chirurgie, Cardio-vasculaire Hôpital haut Leveque, CHU-Bordeaux, Avenue de Magellan 33604, Pessac Cedex, France
| | - R Ibrahim
- Structural Valve Program, Montreal Heart Institute, Montréal, Canada
| | - J Rodès-Cabeau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | | | - D Mylotte
- Department of Cardiology, University Hospital of Galway, Galway, Ireland
| | - J Granada
- Cardiovascular Research Foundation, CRF Skirball Center for Innovation, Columbia University Medical Center, New York, USA
| | - T Modine
- Service Médico-Chirurgical: Valvulopathies- Chirurgie Cardiaque-Cardiologie Interventionelle Structurelle, Hôpital Cardiologique de Haut Lévèque, CHU-Bordeaux, Bordeaux, France.
- Service de Chirurgie, Cardio-vasculaire Hôpital haut Leveque, CHU-Bordeaux, Avenue de Magellan 33604, Pessac Cedex, France.
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Armario X, Rosseel L, Banning A, Khogali S, Blackman D, Abdel-Wahab M, Tchetche D, Hildick-Smith D, Van Mieghem N, Spence M, Frerker C, Nickenig G, Pilgrim T, Sondergaard L, Mylotte D. Transcatheter aortic valve implantation with the LOTUS Edge system: early European experience. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Aims
To evaluate the clinical outcomes of transcatheter aortic valve implantation (TAVI) with the recently commercialised LOTUS EdgeTM system.
Methods and results
We performed a multicentre, single-arm, retrospective registry to generate early information on patients undergoing TAVI with the LOTUS EdgeTM system following its commercial release in July 2019. Novel features of this second-generation device include increased flexibility of the delivery catheter, enhanced visualisation of the locking mechanism and the depth guard technology to reduce left ventricular outflow tract interaction and, potentially, reduce the risk of permanent pacemaker (PPM) implantation. All endpoints were defined according to the VARC-2 definitions and were reported by the treating site.
A total of 286 consecutive patients from 18 participating centres were included. The mean age and STS score were 81.2±6.9 years and 5.2±5.4%, respectively. Most procedures were performed under local anaesthesia (97.2%) via transfemoral access (98.6%).
Successful vascular access, valve delivery and deployment and system retrieval were achieved in 97.6% of cases. 30-day rates of all-cause mortality (2.1%, N=6) and stroke (3.5%, N=10) were acceptable. Disabling, life-threatening or major bleeding occurred in 3.8% and major vascular complications in 2.1%. The incidence of new PPM implantation was 27.1% among all patients and 32.2% among pacemaker-naive patients. After TAVI, the mean transvalvular pressure gradient was 11.9±5.6 mmHg and the mean aortic valve area was 1.9±0.9 cm2. The rate of moderate paravalvular leak was 2.1% with no cases of severe paravalvular leak.
Conclusions
Early experience with the LOTUS EdgeTM system demonstrated acceptable 30-day clinical outcomes with impressively low rates of paravalvular leak. The requirement for new PPM remained high in this early experience. Further study is required to understand if improving operator experience with the device can reduce PPM rates.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- X Armario
- Galway University Hospital, Galway, Ireland
| | - L Rosseel
- Galway University Hospital, Galway, Ireland
| | - A Banning
- John Radcliffe Hospital, Oxford, United Kingdom
| | - S.S Khogali
- New Cross Hospital, Wolverhampton, United Kingdom
| | - D.J Blackman
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | | | | | | | - N.M Van Mieghem
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - M.S Spence
- Belfast City Hospital Trust, Belfast, United Kingdom
| | - C Frerker
- Cologne University Hospital - Heart Center, Cologne, Germany
| | | | - T Pilgrim
- University of Bern, Bern, Switzerland
| | - L Sondergaard
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - D Mylotte
- Galway University Hospital, Galway, Ireland
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Dowling C, Bavo A, Faquir NE, Mortier P, de Jaegere P, De Backer O, Sondergaard L, Ruile P, Mylotte D, McConkey H, Rajani R, Laborde J, Brecker S. Patient-Specific Computer Simulation of Transcatheter Aortic Valve Implantation in Bicuspid Aortic Valve Morphology. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Overtchouk P, Sudre A, Delhaye C, Juthier F, Van Belle E, Coisne A, Koussa M, Mylotte D, Modine T. P3598Advanced image processing with fusion and calcification enhancement in transcatheter aortic valve implantation: impact on radiation exposure. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - A Sudre
- CHRU Lille, 59000, Lille, France
| | | | | | | | - A Coisne
- CHRU Lille, 59000, Lille, France
| | - M Koussa
- CHRU Lille, 59000, Lille, France
| | - D Mylotte
- Galway University Hospital, Galway, Ireland
| | - T Modine
- CHRU Lille, 59000, Lille, France
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Mandes LA, Sedky Y, Aguiar Rosa S, Militaru C, Kalcik M, Cuddy S, Ciudin R, Platon P, Gurzun M, Mateescu AD, Lacau S, Ginghina C, Coman I, Popescu BA, Romeih S, Simary W, Van Doorn C, Agapito A, Antonio M, Branco L, Sousa L, Oliveira JA, Laranjo S, Martins S, Jalles Tavares N, Cruz Ferreira R, Popara A, Beyer R, Gurzun MM, Zarma L, Popescu BA, Ginghina C, Jurcut R, Dogan T, Yetim M, Bekar L, Karaarslan O, Celik O, Cicek M, Camkiran V, Karavelioglu Y, Kolcow W, Da Costa M, Mylotte D, Smyth Y. Clinical Cases: Congenital heart disease800Late diagnosis of double chambered right ventricle in an adult: diagnostic pitfalls and the role of multimodality imaging801Anomalous origin of left pulmonary artery from ascending aorta: an unusual cause of cardiac failure802An uncommon cause of right ventricular failure803Staged severe evolution and treatment dilemmas in a patient with Marfan syndrome804A rare presentation of coarctation of the aorta: transient ischemic attack due to thrombus formation in the coarcted segment which was treated with oral anticogulation805Penetrating cardiac trauma resulting in a ventricular septal defect, a flail mitral valve leaflet and a right middle cerebral artery infarct, with percutaneous closure of the ventricular septal defect. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew253] [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: 11/13/2022] Open
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Cuddy S, Yearoo I, Walsh R, Mylotte D, Sharif F, Bynes B, MacNeill B, Crowley J, Nash P, Daly K. 48 Thrombolysis in STEMI: are the correct patients being identified for routine angiography versus rescue PCI, the west of Ireland experience. Heart 2015. [DOI: 10.1136/heartjnl-2015-308621.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mylotte D, Andalib A, Theriault-Lauzier P, Dorfmeister M, Girgis M, Alharbi W, Chetrit M, Galatas C, Mamane S, Sebag I, Buithieu J, Bilodeau L, de Varennes B, Lachapelle K, Lange R, Martucci G, Virmani R, Piazza N. Transcatheter heart valve failure: a systematic review. Eur Heart J 2014; 36:1306-27. [DOI: 10.1093/eurheartj/ehu388] [Citation(s) in RCA: 153] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 08/28/2014] [Indexed: 11/14/2022] Open
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Benamer H, Mylotte D, Garcia-Alonso C, Unterseeh T, Garot P, Louvard Y, Lefevre T, Morice MC. [Renal denervation a treatment for resistant hypertension: a French experience]. Ann Cardiol Angeiol (Paris) 2013; 62:384-391. [PMID: 24182849 DOI: 10.1016/j.ancard.2013.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Arterial hypertension is the largest single contributor to global mortality, and is poorly controlled in approximately 50% of patients despite lifestyle and pharmacologic interventions. Randomized clinical trials have demonstrated that catheter-based renal sympathetic denervation reduces blood pressure (BP) in patients with resistant hypertension. We sought to evaluate the efficacy of this novel therapy in "Real World" clinical practice. Consecutive patients with treatment-resistant primary hypertension, as defined as home BP>160 mmHg despite treatment with ≥3 antihypertensive drugs, were selected for denervation following renal artery screening. Ambulatory and home BP monitoring was performed in all patients prior to and following percutaneous renal sympathetic denervation. In total, 35 patients were selected for catheter-based renal sympathetic denervation. The mean age was 63.6 ± 11.7 years, 37.1% were women, 37.1% were diabetic, and 11.4% had renal impairment (GFR<45 mL/min). The basal BP (home or ambulatory) was 179.1 ± 20.75/99.66 ± 19.76 mmHg, despite an average of 4.91 ± 0.98 medications per patient. Successful bilateral sympathetic denervation was performed in 33/35 patients (1 renal artery stenosis on angiography [not ablated], 1 patient with renal artery spasm [unilateral denervation]), with an average 5.9 ± 1.6 ablations per renal artery. No procedural complications occurred. At 6 months, blood pressure was 15.5 ± 22.37/87.76 ± 13.97 mmHg (P<0.01). At 2 years follow-up, systolic blood pressure (ABPM or Home BP) was 143.8 ± 15.30 mmHg (P<0.0001) and diastolic 83.42 ± 12.80 mmHg (P=0.0004). There were no adverse events during follow-up, and no deterioration in renal function was observed. Catheter-based renal denervation is safe and efficacious treatment, which results in significant reductions in blood pressure in patients with treatment-resistant hypertension, stable at 2 years follow-up. These results are applicable to real-world patient populations.
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Affiliation(s)
- H Benamer
- ICV-GVM la Roseraie, 120, avenue de la République, 93300 Aubervilliers, France; ICPS, 6, avenue du Noyer-Lambert, 91300 Massy, France.
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Mylotte D, Rushani D, Guo L, Kaouache M, Guo K, Therrien J, Martucci G, Mackie A, Marelli A. Bacterial Endocarditis in Patients With Adult Congenital Heart Disease. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Mylotte D, Osnabrugge RL, Windecker S, Lefevre T, Martucci G, Van Mieghem NM, Kappetein AP, Serruys PW, Lange R, Piazza N. Implant dynamics of transcatheter aortic valve implantation in Europe. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5421] [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: 11/14/2022] Open
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Mylotte D, Osnabrugge RL, Windecker S, Lefevre T, Martucci G, Van Mieghem NM, Kappetein AP, Serruys PW, Lange RL, Piazza N. National economic indices and reimbursement systems determine transcatheter aortic valve implantation use in Western Europe. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.2579] [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: 11/14/2022] Open
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Mylotte D, Sheahan RG, Nolan PG, Neylon MA, McArdle B, Constant O, Diffley A, Keane D, Nash PJ, Crowley J, Daly K. The implantable defibrillator and return to operation of vehicles study. Europace 2012; 15:212-8. [DOI: 10.1093/europace/eus254] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Mylotte D, Kavanagh GF, Peace AJ, Tedesco AF, Carmody D, O'Reilly M, Foley DP, Thompson CJ, Agha A, Smith D, Kenny D. Platelet reactivity in type 2 diabetes mellitus: a comparative analysis with survivors of myocardial infarction and the role of glycaemic control. Platelets 2011; 23:439-46. [PMID: 22150374 DOI: 10.3109/09537104.2011.634932] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
UNLABELLED Patients with type 2 diabetes mellitus exhibit considerable platelet dysfunction, though this is poorly characterized in patients with diabetes taking aspirin for the primary prevention of cardiovascular events. We sought to compare platelet function in this patient population with that of a high-risk group of non-diabetic subjects with a history of previous myocardial infarction (MI), and to assess whether glycaemic control impacts on platelet function. METHODS Platelet aggregation was measured in response to incremental concentrations of five platelet agonists using light transmission aggregometry. All patients were taking aspirin, and aspirin insensitivity was defined as ≥ 20% arachidonic acid (AA) mediated aggregation. Patients with diabetes were divided according to glycaemic control (HbA(1c)): optimal ≤ 6.5, good 6.6-7.4 and suboptimal ≥ 7.5%. RESULTS In total, 85 patients with type 2 diabetes and 35 non-diabetic patients with previous MI were recruited. Compared to MI patients, diabetes patients had increased aggregation in response to multiple concentrations of epinephrine, collagen, adenosine diphosphate and AA. Aspirin insensitivity was more common in type 2 diabetes (15% vs. 0%, p=0.037). Platelet aggregation was increased in response to several agonists patients with suboptimal glycaemic control compared to patients with optimal control. Aspirin insensitivity was also more common in patients with suboptimal glycaemic control compared to those with good or optimal control (26.0% vs. 8.3% vs. 4%, p=0.04). CONCLUSION Patients with type 2 diabetes mellitus, without proven vascular disease, exhibit platelet dysfunction and have increased platelet aggregation and aspirin insensitivity compared to non-diabetic patients with previous MI. Platelet dysfunction in diabetes is more severe in patients with suboptimal glycaemic control.
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Affiliation(s)
- D Mylotte
- Department of Molecular and Cellular Therapeutics, The Royal College of Surgeons in Ireland , Dublin , Ireland.
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Mylotte D, Peace AJ, Tedesco AT, Mangiacapra F, Dicker P, Kenny D, Foley DP. Clopidogrel discontinuation and platelet reactivity following coronary stenting. J Thromb Haemost 2011; 9:24-32. [PMID: 20961396 DOI: 10.1111/j.1538-7836.2010.04121.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS Antiplatelet therapy with aspirin and clopidogrel is recommended for 1 year after drug-eluting stent (DES) implantation or myocardial infarction. However, the discontinuation of antiplatelet therapy has become an important issue as recent studies have suggested a clustering of ischemic events within 90 days of clopidogrel withdrawal. The objective of this investigation was to explore the hypothesis that there is a transient 'rebound' increase in platelet reactivity within 3 months of clopidogrel discontinuation. METHODS AND RESULTS In this prospective study, platelet function was assessed in patients taking aspirin and clopidogrel for at least 1 year following DES implantation. Platelet aggregation was measured using a modification of light transmission aggregometry in response to multiple concentrations of adenosine diphosphate (ADP), epinephrine, arachidonic acid, thrombin receptor activating peptide and collagen. Clopidogrel was stopped and platelet function was reassessed 1 week, 1 month and 3 months later. Thirty-two patients on dual antiplatelet therapy were recruited. Discontinuation of clopidogrel increased platelet aggregation to all agonists, except arachidonic acid. Platelet aggregation in response to ADP (2.5, 5, 10, and 20 μm) and epinephrine (5 and 20 μm) was significantly increased at 1 month compared with 3 months following clopidogrel withdrawal. Thus, a transient period of increased platelet reactivity to both ADP and epinephrine was observed 1 month after clopidogrel discontinuation. CONCLUSIONS This study demonstrates a transient increase in platelet reactivity 1 month after clopidogrel withdrawal. This phenomenon may, in part, explain the known clustering of thrombotic events observed after clopidogrel discontinuation. This observation requires confirmation in larger populations.
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Affiliation(s)
- D Mylotte
- Department of Molecular and Cellular Therapeutics, The Royal College of Surgeons in Ireland, Dublin, Ireland
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Mylotte D, Byrne RA, Iijima R, Kastrati A. Multivessel percutaneous coronary intervention: a review of the literature and fallacies in its interpretation. Minerva Cardioangiol 2008; 56:493-510. [PMID: 18813185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Since its inception in the 1960s, coronary revascularization has established itself as a fundamental therapy for treating the acute and chronic manifestations of atherosclerotic coronary disease. Catheter-based techniques were realized in the late 1970s and have evolved from balloon dilatation of simple, discrete stenoses to complex, multivessel interventions across the spectrum of coronary disease presentations. In retrospect, there were two defining technological developments the introduction of coronary stenting which enabled more stable acute outcomes and the evolution of drug-eluting stents which ameliorated the effect of neointimal hyperplasia the dominant cause of delayed loss of efficacy. The role of catheter-based intervention in multivessel disease is well established in the treatment of ST-elevation myocardial infarction and acute coronary syndromes. On the contrary, in the arena of in stable coronary disease, its utility is keenly debated. The pace of development in cardiovascular pharmacology has rendered early investigation of best treatment strategies largely obsolete, while newer revascularization techniques have successfully extended the remit of catheter-based multivessel intervention strategies to include left main stem disease, bifurcation stenosis and chronic occlusions. Consequently complete revascularization is now available via a percutaneous approach and conventional beliefs relating to choice of revascularization strategy deserve re-assessment. The authors present a contemporary review of the literature and a challenge against fallacies in its interpretation.
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Affiliation(s)
- D Mylotte
- Deutsches Herzzentrum, Technische Universität Munich, Germany
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Sherlock M, Mylotte D, Mac Mahon J, Moore KB, Thompson CJ. Lipid lowering targets are easier to attain than those for treatment of hypertension in type 2 diabetes. Ir J Med Sci 2006; 175:36-41. [PMID: 17312827 DOI: 10.1007/bf03167965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM To assess the impact of therapeutic strategies to reduce cardiovascular risk in patients with type 2 diabetes. METHODS Five-hundred patients with type 2 diabetes were studied, using retrospective case note analysis in 1997 (followed by a unit policy targeting vascular risk) and again in 2001. RESULTS The mean BP of the hypertensive patients was unchanged, 151/83 +/- 23/12 mmHg (1997) and 149/84 +/- 19.1/9.8 mmHg (P=0.2) (2001) (despite increase in patients receiving 23 antihypertensives (4.2% to 18.0%, P<0.01). The mean cholesterol improved from 5.34 +/- 1.1 mmol/L to 4.72 +/- 0.94 mmol/L (P<0.01). 2.9% compared with 44.6% (P<0.01) of hypercholesterolaemic patients, achieved target cholesterol. Antiplatelet therapy increased from 27.6% to 61.2% (P<0.01). Reduced mean HbA1c, 7.91 +/- 1.61% to 7.12 +/- 1.41% (P<0.01). CONCLUSION Improved lipid profiles, aspirin uptake and glycaemic control, but no improvement in blood pressure targets were achieved. Additional strategies are required to achieve cardiovascular risk factor targets.
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Affiliation(s)
- M Sherlock
- Dept of Diabetes and Endocrinology, Beaumont Hospital Dublin
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Russo TA, Mylotte D. Expression of the K54 and O4 specific antigen has opposite effects on the bactericidal activity of squalamine against an extraintestinal isolate of Escherichia coli. FEMS Microbiol Lett 1998; 162:311-5. [PMID: 9627966 DOI: 10.1111/j.1574-6968.1998.tb13014.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Squalamine is a novel cationic steroid that possesses potent, broad spectrum, antimicrobial activity. Recent data suggests that squalamine or related compounds may be present and important in host resistance to infection in the urinary tract. Therefore, the role of the K54 capsule and the O4 specific antigen moiety of the lipopolysaccharide in protecting an extraintestinal isolate of Escherichia coli against the bactericidal activity of this novel antimicrobial compound was studied. The O4 specific antigen was important for protection against squalamine. Surprisingly, in contrast, the presence of the K54 antigen enhanced the bactericidal activity of squalamine. This is the first example, to our knowledge, in which an established virulence trait, the K54 capsule, may be detrimental to an infecting pathogen under certain circumstances.
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Affiliation(s)
- T A Russo
- Department of Medicine, SUNY at Buffalo 14214, USA.
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