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Henrique Barbosa Ribeiro,
Luis Nombela-Franco,
Marina Urena,
Michael Mok,
Sergio Pasian,
Daniel Doyle,
Robert Delarochellière,
Mélanie Côté,
Louis Laflamme,
Hugo Delarochellière,
Ricardo Allende, Eric Dumont,
Josep Rodés-Cabau
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ABSTRACT: OBJECTIVES: This study sought to evaluate, through a systematic review of the published data, the main baseline characteristics, management, and clinical outcomes of patients suffering coronary obstruction as a complication of transcatheter aortic valve implantation (TAVI). BACKGROUND: Very few data exist on coronary obstruction after TAVI. METHODS: Studies published between 2002 and 2012, with regard to coronary obstruction as a complication of TAVI, were identified with a systematic electronic search. Only the studies reporting data on the main baseline and procedural characteristics, management of the complication, and clinical outcomes were analyzed. RESULTS: A total of 18 publications describing 24 patients were identified. Most (83%) patients were women, with a mean age of 83 ± 7 years and a mean logistic European System for Cardiac Operative Risk Evaluation score of 25.1 ± 12%. Mean left coronary artery (LCA) ostium height and aortic root width were 10.3 ± 1.6 mm and 27.8 ± 2.8 mm, respectively. Most patients (88%) had received a balloon-expandable valve, and coronary obstruction occurred more frequently in the LCA (88%). Percutaneous coronary intervention was attempted in 23 cases (95.8%) and was successful in all but 2 patients (91.3%). At 30-day follow-up, there were no cases of stent thrombosis or repeat revascularization, and the mortality rate was 8.3%. CONCLUSIONS: Reported cases of coronary obstruction after TAVI occurred more frequently in women, in patients receiving a balloon-expandable valve, and the LCA was the most commonly involved artery. Percutaneous coronary intervention was a feasible and successful treatment in most cases. Continuous efforts should be made to identify the factors associated with this life-threatening complication to implement the appropriate measures for its prevention.
04/2013; · 1.07 Impact Factor
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ABSTRACT: A 26-year old female was hit in the cervical region by a large block of ice and admitted with stable vital signs and multiple fractures. Chest radiography demonstrated an enlarged mediastinum, and CT scan revealed a transection of the left common carotid artery at its origin, with a false aneurysm. The lesion was repaired using a median sternotomy, cardiopulmonary bypass, moderate hypothermia and cerebral antegrade perfusion through the right axillary artery. The bronchial lesion was diagnosed 2 days later and successfully treated with left posterolateral thoracotomy and the use of direct bronchial anastomosis.
Interactive cardiovascular and thoracic surgery 04/2013;
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Ronald K Binder,
Josep Rodés-Cabau,
David A Wood,
Michael Mok,
Jonathon Leipsic,
Robert De Larochellière,
Stefan Toggweiler, Eric Dumont,
Melanie Freeman,
Alexander B Willson,
John G Webb
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ABSTRACT: The aim of this study was to demonstrate the first-in-human feasibility and short-term clinical outcomes with a new balloon-expandable transcatheter heart valve (THV).
The SAPIEN 3 (S3) THV incorporates a paravalvular sealing system, an active 3-dimensional coaxial positioning catheter, and is compatible with a 14-F expandable sheath.
The S3 THV was implanted in 15 patients with symptomatic severe aortic stenosis via femoral arterial access. Multidetector computed tomography before and after valve implantation allowed assessment of a novel annular area sizing algorithm. Clinical and echocardiographic data were obtained at baseline, discharge, and 30 days.
All 15 device implants were successful. Multidetector computed tomography estimated an aortic annular area of 4.9 ± 0.4 cm(2), predicting 9.7 ± 6.9% THV oversizing. Post-transcatheter aortic valve replacement multidetector computed tomography showed consistently symmetrical and circular THVs. Aortic valve area increased from 0.7 ± 0.2 cm(2) to 1.5 ± 0.2 cm(2) (p < 0.001), and mean transaortic gradient decreased from 42.2 ± 10.3 mm Hg to 11.9 ± 5.3 mm Hg (p < 0.001). No patient had more than mild paravalvular aortic regurgitation. Hospital discharge occurred at a median of 3 (range 2 to 12) hospital days. At 30 days there were no deaths, strokes, vascular complications, bleeds, or transfusions, although 1 patient (6.7%) required a new pacemaker. All patients were in New York Heart Association functional class I or II.
The S3 THV and delivery system might facilitate fully percutaneous implantation in a broader range of patients with the potential for more accurate positioning and less paravalvular regurgitation.
03/2013; 6(3):293-300. · 1.07 Impact Factor
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Michael Mok,
Luis Nombela-Franco,
Marina Urena,
Robert Delarochellière,
Daniel Doyle,
Henrique Barbosa Ribeiro,
Mélanie Côté,
Philippe Pibarot,
Hugo Delarochellière,
Louis Laflamme,
Paul Poirier, Eric Dumont,
Josep Rodés-Cabau
Journal of the American College of Cardiology 02/2013; 61(8):897-8. · 14.16 Impact Factor
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Luis Nombela-Franco,
Marc Ruel,
Sam Radhakrishnan,
John G Webb,
Marc Hansen,
Marino Labinaz,
Chris Thompson,
Stephen Fremes, Eric Dumont,
Robert Delarochellière,
Daniel Doyle,
Marina Urena,
Michael Mok,
Henrique Barbosa Ribeiro,
Idan Roifman,
Stuart Watkins,
Jean G Dumesnil,
Philippe Pibarot,
Josep Rodés-Cabau
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ABSTRACT: Transcatheter aortic valve implantation with the self-expandable CoreValve (CV) and the balloon-expandable Edwards SAPIEN (ES) bioprostheses has been widely used for the treatment of severe aortic stenosis. However, a direct comparison of the hemodynamic results associated with these 2 prostheses is lacking. The aim of the present study was to compare the hemodynamic performance of both bioprostheses. A total of 41 patients who underwent transcatheter aortic valve implantation with the CV prosthesis were matched 1:1 for prosthesis size (26 mm), aortic annulus size, left ventricular ejection fraction, body surface area, and body mass index with patients who underwent transcatheter aortic valve implantation with the ES prosthesis. Doppler-echocardiographic data were prospectively collected before the intervention and at hospital discharge, and all examinations were sent to, and analyzed in, a central echocardiography core laboratory. The mean transprosthetic residual gradient was lower (p = 0.024) in the CV group (7.9 ± 3.1 mm Hg) than in the ES group (9.7 ± 3.8 mm Hg). The effective orifice area tended to be greater in the CV group (1.58 ± 0.31 cm(2) vs 1.49 ± 0.24 cm(2), p = 0.10). The incidence of severe prosthesis-patient mismatch was, however, similar between the 2 groups (effective orifice area indexed to the body surface area ≤0.65 cm(2)/m(2); CV 9.8%, ES 9.8%, p = 1.0). The incidence of paravalvular aortic regurgitation was greater with the CV (grade 1 or more in 85.4%, grade 2 or more in 39%) than with the ES (grade 1 or more in 58.5%, grade 2 or more in 22%; p = 0.001). The number and extent of paravalvular leaks were greater in the CV group (p <0.01 for both comparisons). In conclusion, transcatheter aortic valve implantation with the CV prosthesis was associated with a lower residual gradient but a greater rate of paravalvular aortic regurgitation compared to the ES prosthesis. The potential clinical consequences of the differences in hemodynamic performance between these transcatheter heart valves needs to be addressed in future studies.
The American journal of cardiology 01/2013; · 3.58 Impact Factor
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ABSTRACT: Atrial fibrillation (AF) is a common co-morbidity among patients undergoing Transcatheter Aortic Valve Implantation (TAVI). Only recently have the clinical outcomes of patients with chronic or new-onset AF after TAVI been reported. The absence of clinical trials focusing on this cohort of patients has resulted in the lack of evidence based clinical guidelines. We aim to review and discuss the current literature on AF in TAVI, its clinical implications and future perspectives.
Journal of Thrombosis and Thrombolysis 12/2012; · 1.48 Impact Factor
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ABSTRACT: Cardiovascular risk profiles and adiposity assessment data in patients with thoracic aortic disease (TAD) are sparse.
Despite the fact that TAD patients are considered as a high-risk population, they will not be managed as aggressively as they should in terms of their cardiovascular risk profile.
Anthropometric, blood pressure (BP) data, and blood samples were collected prospectively from patients followed at our TAD dedicated clinic. The same measures have been taken in a control group initiating a cardiac rehabilitation program.
In all, 286 patients with TAD and 116 controls were recruited. BMI was higher among the controls than the patients with TAD (30.0±6.1 vs. 27.2±4.9 kg/m, respectively; P<0.001). We found no statistical difference between the groups for waist circumference (TAD: 93.1±15.2 and 103.6±14.5 cm, control: 95.0±13.4 and 106.3±14.8 cm, respectively, for women and men; P=0.06). In terms of lipid profile, low-density lipoprotein cholesterol was 2.44±0.88 in patients with TAD and 2.09±0.82 mmol/l in the controls (P<0.001). A higher percentage of patients with TAD had low-density lipoprotein cholesterol values that were beyond the target (63.3% in TAD vs. 46.1% in control; P<0.01). The values of apolipoprotein-B were similar between groups (P=0.41). BP was higher in patients with TAD (135±19/76±11 mmHg) versus the controls (129±17/71±11 mmHg; P<0.01). On the basis of ambulatory BP monitoring, 49.3% of patients with TAD were not well controlled for daytime and/or night-time BP.
Cardiovascular risk factors, particularly BP, are not well controlled in patients with TAD followed in a dedicated clinic when compared with another high-risk control group in a cardiac rehabilitation program.
Blood pressure monitoring 12/2012; 17(6):235-42. · 1.62 Impact Factor
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ABSTRACT: OBJECTIVE: The present study was undertaken to examine the incidence and management of surgical site infection (SSI) in patients submitted to transapical transcatheter aortic valve implantation (TA-TAVI). METHODS: From April 2007 to December 2011, 154 patients underwent TA-TAVI with an Edwards Sapien bioprosthesis (ES) at the Institut Universitaire de Cardiologie et Pneumologie de Quebec (IUCPQ) as part of a multidisciplinary program to prospectively evaluate percutaneous aortic valve implantation. Patient demographics, perioperative variables, and postoperative complications were recorded in a prospective registry. RESULTS: Five (3.2%) patients in the cohort presented with an SSI during the study period. The infections were all hospital-acquired (HAI) and were considered as organ/space SSI's based on Center for Disease Control criteria (CDC). Within the first few weeks of the initial procedure, these patients presented with an abscess or chronic draining sinus in the left thoracotomy incision and were re-operated. The infection spread to the apex of the left ventricle in all cases where pledgeted mattress sutures could be seen during debridement. Patients received multiple antibiotic regimens without success until the wound was surgically debrided and covered with viable tissue. The greater omentum was used in three patients and the pectoralis major muscle in the other two. None of the patients died or had a recurrent infection. Three of the patients were infected with Staphylococcus epidermidis, one with Staphylococcus aureus, and one with Enterobacter cloacae. Patients with surgical site infections were significantly more obese with higher BMI (31.4+/-3.1 vs 26.2+/-4.4 p=0.0099) than the other patients in the cohort. CONCLUSIONS: While TA-TAVI is a minimally invasive technique, SSIs, which are associated with obesity, remain a concern. Debridement and rib resection followed by wound coverage with the greater omentum and/or the pectoralis major muscle were used successfully in these patients.
Journal of Cardiothoracic Surgery 11/2012; 7(1):122. · 1.19 Impact Factor
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Luis Nombela-Franco,
John G Webb,
Peter de Jaegere,
Stefan Toggweiler,
Rutger-Jan Nuis,
Antonio E Dager,
Ignacio J Amat-Santos,
Anson Cheung,
Jian Ye,
Ronald K Binder, [......],
Luis M Benitez,
Sergio Pérez,
Javier Lopez,
José A San Roman,
Daniel Doyle,
Robert Delarochellière,
Marina Urena,
Jonathon Leipsic, Eric Dumont,
Josep Rodés-Cabau
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ABSTRACT: BACKGROUND: The objective of this study was to evaluate the timing, predictive factors and prognostic value of cerebrovascular events (CVEs) following transcatheter aortic valve implantation (TAVI). METHODS AND RESULTS: The study included 1061 consecutive patients who underwent TAVI with a balloon- (64%) or a self- (36%) expandable valve. CVEs were classified as acute (≤24 hours), subacute (1-30 days), and late (>30 days). CVEs occurred in 54 patients (5.1%; stroke:4.2%) within 30 days following TAVI (acute in 54% of cases). The predictors of acute CVEs were balloon postdilation of the valve prosthesis (OR:2.46, 95% CI:1.07-5.67) and valve dislodgment/embolization (OR:4.36, 95%CI:1.21-15.69); new-onset atrial fibrillation [NOAF] (OR:2.76, 95%CI:1.11-6.83) was the predictor of subactute CVEs. Late CVEs occurred in 35 patients (3.3%; stroke:2.1%) at a median follow-up of 12 (3-23) months. The predictors of late CVEs were chronic AF (HR:2.84, 95%CI:1.46-5.53), peripheral vascular disease (HR: 2.02, 95%CI:1.02-3.97) and prior cerebrovascular disease (HR:2.04, 95%CI:1.01-4.15). Major stroke was associated with 30-day (OR 7.43, 95%CI:2.45-22.53) and late (HR:1.75, 95%CI:1.01-3.04) mortality. CONCLUSIONS: In a large cohort of patients undergoing TAVI, the rate of acute and subacute CVEs was 2.7% and 2.4%, respectively. While balloon postdilation and valve dislodgment/embolization were the predictors of acute CVEs, NOAF determined a higher risk for subacute events. Late events were mainly determined by a history of chronic AF, peripheral and cerebrovascular disease. The occurrence of major stroke was associated with an increased early and late mortality. These results provide important insights for the implementation of preventive measures for CVEs following TAVI.
Circulation 11/2012; · 14.74 Impact Factor
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Josep Rodés-Cabau,
John G Webb,
Anson Cheung,
Jian Ye, Eric Dumont,
Mark Osten,
Christopher M Feindel,
Madhu K Natarajan,
James L Velianou,
Giussepe Martucci, [......],
Robert Delarochellière,
Kevin Teoh,
Victor Chu,
Kevin Bainey,
Kevin Lachapelle,
Asim Cheema,
David Latter,
Jean G Dumesnil,
Philippe Pibarot,
Eric Horlick
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ABSTRACT: OBJECTIVES: This study sought to evaluate the long-term outcomes after transcatheter aortic valve implantation (TAVI) in the Multicenter Canadian Experience study, with special focus on the causes and predictors of late mortality and valve durability. BACKGROUND: Very few data exist on the long-term outcomes associated with TAVI. METHODS: This was a multicenter study including 339 patients considered to be nonoperable or at very high surgical risk (mean age: 81 ± 8 years; Society of Thoracic Surgeons score: 9.8 ± 6.4%) who underwent TAVI with a balloon-expandable Edwards valve (transfemoral: 48%, transapical: 52%). Follow-up was available in 99% of the patients, and serial echocardiographic exams were evaluated in a central echocardiography core laboratory. RESULTS: At a mean follow-up of 42 ± 15 months 188 patients (55.5%) had died. The causes of late death (152 patients) were noncardiac (59.2%), cardiac (23.0%), and unknown (17.8%). The predictors of late mortality were chronic obstructive pulmonary disease (hazard ratio [HR]: 2.18, 95% confidence interval [CI]: 1.53 to 3.11), chronic kidney disease (HR: 1.08 for each decrease of 10 ml/min in estimated glomerular filtration rate, 95% CI: 1.01 to 1.19), chronic atrial fibrillation (HR: 1.44, 95% CI: 1.02 to 2.03), and frailty (HR: 1.52, 95% CI: 1.07 to 2.17). A mild nonclinically significant decrease in valve area occurred at 2-year follow-up (p < 0.01), but no further reduction in valve area was observed up to 4-year follow-up. No changes in residual aortic regurgitation and no cases of structural valve failure were observed during the follow-up period. CONCLUSIONS: Approximately one-half of the patients who underwent TAVI because of a high or prohibitive surgical risk profile had died at a mean follow-up of 3.5 years. Late mortality was due to noncardiac comorbidities in more than one-half of patients. No clinically significant deterioration in valve function was observed throughout the follow-up period.
Journal of the American College of Cardiology 09/2012; · 14.16 Impact Factor
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ABSTRACT: Abstract Acute coronary obstruction is one of the most feared complications associated with transcatheter aortic valve-in-valve implantation. Strategies for assessing the risk of coronary occlusion during these procedures as well as preventive measures are discussed. (J Card Surg 2012;**:1-4).
Journal of Cardiac Surgery 09/2012; · 0.87 Impact Factor
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Marina Urena,
Michael Mok,
Vicenç Serra, Eric Dumont,
Luis Nombela-Franco,
Robert Delarochellière,
Daniel Doyle,
Albert Igual,
Eric Larose,
Ignacio Amat-Santos,
Mélanie Côté,
Hug Cuéllar,
Philippe Pibarot,
Peter de Jaegere,
François Philippon,
Bruno Garcia Del Blanco,
Josep Rodés-Cabau
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ABSTRACT: This study evaluated the predictive factors and prognostic value of new-onset persistent left bundle branch block (LBBB) in patients undergoing transcatheter aortic valve implantation (TAVI) with a balloon-expandable valve.
The predictors of persistent (vs. transient or absent) LBBB after TAVI with a balloon-expandable valve and its clinical consequences are unknown.
A total of 202 consecutive patients with no baseline ventricular conduction disturbances or previous permanent pacemaker implantation (PPI) who underwent TAVI with a balloon-expandable valve were included. Patients were on continuous electrocardiographic (ECG) monitoring during hospitalization and 12-lead ECG was performed daily until hospital discharge. No patient was lost at a median follow-up of 12 (range: 6 to 24) months, and ECG tracing was available in 97% of patients. The criteria for PPI were limited to the occurrence of high-degree atrioventricular block (AVB) or severe symptomatic bradycardia.
New-onset LBBB was observed in 61 patients (30.2%) after TAVI, and had resolved in 37.7% and 57.3% at hospital discharge and 6- to 12-month follow-up, respectively. Baseline QRS duration (p = 0.037) and ventricular depth of the prosthesis (p = 0.017) were independent predictors of persistent LBBB. Persistent LBBB at hospital discharge was associated with a decrease in left ventricular ejection fraction (p = 0.001) and poorer functional status (p = 0.034) at 1-year follow-up. Patients with persistent LBBB and no PPI at hospital discharge had a higher incidence of syncope (16.0% vs. 0.7%; p = 0.001) and complete AVB requiring PPI (20.0% vs. 0.7%; p < 0.001), but not of global mortality or cardiac mortality during the follow-up period (all, p > 0.20). New-onset LBBB was the only factor associated with PPI following TAVI (p < 0.001).
Up to 30% of patients with no prior conduction disturbances developed new LBBB following TAVI with a balloon-expandable valve, although it was transient in more than one third. Longer baseline QRS duration and a more ventricular positioning of the prosthesis were associated with a higher rate of persistent LBBB, which in turn determined higher risks for complete AVB and PPI, but not mortality, at 1-year follow-up.
Journal of the American College of Cardiology 09/2012; 60(18):1743-52. · 14.16 Impact Factor
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Ignacio J Amat-Santos, Eric Dumont,
Marina Urena,
Luis Nombela-Franco,
Robert Delarochellière,
Daniel Doyle,
Rodrigo Bagur,
Jacques Villeneuve,
Mélanie Côté,
François Philippon,
Philippe Pibarot,
Josep Rodés-Cabau
Journal of the American College of Cardiology 07/2012; 60(3):238. · 14.16 Impact Factor
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Ignacio J Amat-Santos, Eric Dumont,
Jacques Villeneuve,
Daniel Doyle,
Michel Rheault,
Dominique Lavigne,
Jerôme Lemieux,
André St-Pierre,
Michael Mok,
Marina Urena,
Luis Nombela-Franco,
Steve Blackburn,
Mathieu Simon,
Christine Bourgault,
José Luis Carrasco,
Philippe Pibarot,
Melanie Côté,
Robert Delarochellière,
David J Cohen,
Josep Rodés-Cabau
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ABSTRACT: To determine the impact of perioperative thoracic epidural analgesia (TEA) on acute and late outcomes following transapical transcatheter aortic valve implantation (TA-TAVI).
A total of 135 consecutive patients who underwent TA-TAVI were included. All patients received catheter-based pain control, either via TEA (TEA group, n=74) or intercostal local analgesia with a catheter placed at the surgical incision site (non-TEA group, n=61), depending on the preference of the anaesthesiologist responsible for the case.
Pain level during early postoperative period (verbal rating scale from 1 to 10), 30-day/in-hospital complications and mortality, and 1-year mortality.
There were no differences in baseline or procedural characteristics between groups except for a lower left ventricular ejection fraction in the TEA group. The maximal pain score related to thoracotomy in the postoperative period was higher in the non-TEA group as compared with the TEA group (4 (IQR: 3-5)) vs 2 (IQR: 1-3), p<0.001). Non-TEA was associated with a higher rate of pulmonary complications (p<0.05 for nosocomial pneumonia, reintubation and tracheostomy). The 30-day/in-hospital mortality rate was higher in the non-TEA group (22.9% vs 2.7% in the TEA group, p<0.001). At 1-year follow-up, overall mortality remained higher in the non-TEA group (31.1%) compared with the TEA group (10.8%), p=0.005. Similar periprocedural and late results were obtained in a propensity score-matched analysis that included 100 matched patients. In the multivariable analysis, STS score (p=0.027) and absence of TEA (p=0.039) were independent predictors of increased cumulative late mortality.
TEA provided superior analgesia following TA-TAVI, and was associated with a dramatic reduction in periprocedural respiratory complications, and both, short- and long-term mortality. These results highlight the importance of obtaining optimal analgesia following TA-TAVI to improve the results associated with this procedure.
Heart (British Cardiac Society) 07/2012; 98(21):1583-90. · 4.22 Impact Factor
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Karin H Humphries,
Stefan Toggweiler,
Josep Rodés-Cabau,
Luis Nombela-Franco, Eric Dumont,
David A Wood,
Alexander B Willson,
Ronald K Binder,
Melanie Freeman,
May K Lee,
Min Gao,
Mona Izadnegahdar,
Jian Ye,
Anson Cheung,
John G Webb
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ABSTRACT: The aim of this study was to examine sex differences in outcome after transcatheter aortic valve replacement (TAVR) with real-world data from 2 large centers in Canada.
Transcatheter aortic valve replacement is an effective alternative to surgical valve replacement in symptomatic patients with severe aortic stenosis, but the impact of sex on outcomes remains unclear. The PARTNER (Placement of Aortic Transcatheter Valves) 1A trial demonstrated greater benefit of TAVR over surgery in women, but whether this was due to the poorer surgical outcome of women or better TAVR outcome, compared with men, is unknown.
Consecutive patients (n = 641) undergoing TAVR in Vancouver and Quebec City, Canada, were evaluated. Differences in all-cause mortality were examined with Kaplan-Meier estimates, adjusted logistic regression, and proportional hazards models.
Women comprised 51.3% of the cohort. Balloon-expandable valves were used in 97% of cases, with transapical approach in 51.7 % women and 38.1% men. Women had more major vascular complications (12.4% vs. 5.4%, p = 0.003) and borderline significantly more major/life-threatening bleeds (21.6% vs. 15.8%, p = 0.08). At baseline, women had higher aortic gradients and worse renal function but better ejection fractions. Men had more comorbidities: prior myocardial infarction, prior revascularization, and chronic obstructive pulmonary disease. The adjusted odds ratio for 30-day all-cause mortality favored women, 0.39 (95% confidence interval: 0.19 to 0.80; p = 0.01), and this benefit persisted for 2 years, hazard ratio 0.60 (95% confidence interval: 0.41 to 0.88; p = 0.008).
Female sex is associated with better short- and long-term survival after TAVR. Added to the PARTNER 1A findings, these results suggest TAVR might be the preferred treatment option for elderly women with symptomatic severe aortic stenosis.
Journal of the American College of Cardiology 07/2012; 60(10):882-6. · 14.16 Impact Factor
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ABSTRACT: Abstract In transcatheter aortic valve implantation procedures using balloon-expandable valves, the valve is deployed by rapid balloon inflation within a short period of rapid ventricular pacing. This system and deployment technique is generally considered to be nonrepositionable. We illustrate with two cases (transapical and transfemoral) the possibility to partially reposition the valve during its deployment if a slow balloon inflation technique were employed-a technique that may minimize the risk of valve mal-positioning and its attendant complications. (J Card Surg 2012;27:546-548).
Journal of Cardiac Surgery 07/2012; 27(5):546-8. · 0.87 Impact Factor
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Melanie Freeman,
Josep Rodés-Cabau,
Marina Urena,
Robert Delarochelliere, Eric Dumont,
Jean-Bernard Masson,
Alexander B Willson,
Ronald K Binder,
Stefan Toggweiler,
Jonathon Leipsic,
David A Wood,
John G Webb
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ABSTRACT: OBJECTIVES: To demonstrate the feasibility of transfemoral Transcatheter Aortic Valve Replacement (TAVR) with the 29mm Edwards SAPIEN XT Valve and Novaflex +™ delivery system through a 20F expandable sheath (eSheath™, Edwards Lifesciences Inc., USA). Additionally, to describe the use of the Novaflex + delivery system and expandable sheath. BACKGROUND: TAVR has undergone significant advances in device technology resulting in smaller profile sheaths and delivery systems, allowing transfemoral delivery of a 29mm valve. METHODS: Twelve patients underwent transfemoral TAVR with the 29mm Edwards SAPIEN XT Valve and Novaflex + delivery system through a 20F expandable sheath. Baseline clinical and procedural characteristics are evaluated. In-hospital and 30-day outcomes are reported according to Valve Academic Research Consortium criteria. RESULTS: All patients were male with a mean aortic annulus diameter of 25.0 ± 1.1mm and 25.9 ± 1.2mm, on TEE and MDCT respectively. Mean iliofemoral minimal luminal diameter (MLD) was 8.0 ± 0.8mm. Successful deployment of the valve occurred in 11 out of 12 patients. Valve embolization occurred in one patient. Aortic valve area increased from 0.7 ± 0.2 to 2.0 ± 0.5 cm(2) (p<0.001). There were two major vascular complications, however there were no in-hospital or 30-day neurological events, need for pacemaker insertion, or mortality. CONCLUSIONS: Transfemoral TAVR with the 29mm Edwards SAPIEN XT Valve and Novaflex + delivery system through a 20F expandable sheath was feasible with acceptable short term outcomes. © 2012 Wiley Periodicals, Inc.
Catheterization and Cardiovascular Interventions 06/2012; · 2.29 Impact Factor
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Nicolas Girerd,
Julien Magne,
Muriel Rabilloud,
Eric Charbonneau,
Siamak Mohamadi,
Philippe Pibarot,
Pierre Voisine,
Richard Baillot,
Daniel Doyle, Eric Dumont,
François Dagenais,
Patrick Mathieu
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ABSTRACT: Complete revascularization during coronary artery bypass grafting (CABG) has been reported to be associated with better short-term and long-term outcomes. We hypothesized that the survival benefit of complete revascularization would be less in old patients than in young patients.
We analyzed data from 6,539 consecutive patients who had undergone a first isolated on-pump CABG procedure between 2000 and 2008. We investigated the impact of complete revascularization and its interaction with age on operative and long-term survival using propensity-score-based analyses.
Patients with incomplete (versus complete) revascularization (n = 318 [4.9%]) were sicker overall. During a mean follow-up of 5.8 ± 2.2 years, 909 patients died. In the propensity-score-matched analysis, operative mortality was not significantly different between patients with complete revascularization and those with incomplete revascularization (1.9% versus 2.8%; odds ratio [OR], 1.46; 95% confidence interval [CI], 0.56-3.46; p = 0.48). In contrast, incomplete revascularization had an independent negative impact on long-term survival, which was strongly age dependent (hazard ratio [HR] for interaction, 0.96 per year increment; p = 0.02). In a propensity-score-matched analysis, incomplete revascularization was independently associated with higher long-term mortality in patients younger than 60 years (HR, 3.27; 95% CI, 1.21-8.86; p = 0.02), whereas it was not in patients 60 to 70 years and 70 years of age and older (p = 0.87 and p = 0.24, respectively).
Contrary to what is observed in patients younger than 60 years, complete revascularization does not seem to improve long-term survival in older patients. This suggests that elderly patients at high operative risk may be considered, when deemed clinically appropriate, for limited coronary revascularization.
The Annals of thoracic surgery 06/2012; 94(4):1166-72. · 3.74 Impact Factor
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ABSTRACT: Transaortic transcatheter aortic valve implantation (TAo-TAVI) has been recently proposed as an alternative to transapical (TA) and transfemoral (TF) approach. We now discuss a technical issue associated with TAo-TAVI related to the use of a delivery system dedicated to the antegrade TA approach. The potential solutions to this issue as well as the potential advantages of the TAo approach are discussed.
Journal of Cardiac Surgery 05/2012; 27(4):438-40. · 0.87 Impact Factor
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Alexander B Willson,
Josep Rodès-Cabau,
David A Wood,
Jonathon Leipsic,
Anson Cheung,
Stefan Toggweiler,
Ronald K Binder,
Melanie Freeman,
Robert DeLarochellière,
Robert Moss,
Luis Nombela-Franco, Eric Dumont,
Karolina Szummer,
Gregory P Fontana,
Raj Makkar,
John G Webb
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ABSTRACT: The purpose of this study was to demonstrate the feasibility and procedural outcomes with a new self-expanding and repositionable transcatheter heart valve.
Transcatheter aortic valve replacement is a viable option for selected patients with severe symptomatic aortic stenosis. However, suboptimal prosthesis positioning may contribute to paravalvular regurgitation, atrioventricular conduction block, and mitral or coronary compromise.
The repositionable Portico valve (St. Jude Medical, Minneapolis, Minnesota) was implanted in 10 patients with severe aortic stenosis utilizing percutaneous femoral arterial access. Patients underwent transthoracic and transesophageal echocardiography and multidetector computed tomography before and after valve implantation. Clinical and echocardiographic follow-up was obtained at 30 days.
Device implantation was successful in all patients. Prosthesis recapture and repositioning was performed in 4 patients. Intermittent prosthetic leaflet dysfunction in 1 patient required implantation of a second transcatheter valve. There was 1 minor stroke. At 30-day follow-up, echocardiographic mean transaortic gradient was reduced from 44.9 ± 16.7 mm Hg to 10.9 ± 3.8 mm Hg (p < 0.001), and valve area increased from 0.6 ± 0.1 cm(2) to 1.3 ± 0.2 cm(2) (p < 0.001). Paravalvular regurgitation was mild or less in 9 patients (90%) and moderate in 1 patient (10%). There were no major strokes, major vascular complications, major bleeds, or deaths. No patient required pacemaker implantation. All patients were in New York Heart Association functional class II or less.
Transcatheter aortic valve replacement with the repositionable Portico transcatheter heart valve is feasible, with good short-term clinical and hemodynamic outcomes.
Journal of the American College of Cardiology 05/2012; 60(7):581-6. · 14.16 Impact Factor
