Idiopathic/Iatrogenic Left Bundle Branch Block-Induced Reversible Left Ventricle Dysfunction JACC State-of-the-Art Review

International audienceIdiopathic or iatrogenic left bundle branch block (LBBB) is a unique model of electro-mechanical ventricular dyssynchrony with concordant changes in electrical activation sequence and mechanical ventricle synchronization. In chronic animal models, isolated LBBB induces structural remodeling with progressive left ventricular (LV) dysfunction. Most abnormalities can be reverted after cardiac resynchronization therapy (CRT). In humans, 2 principal models of LBBB dyssynchronopathy can be observed the chronic model of isolated LBBB and an acute iatrogenic model of new-onset LBBB after aortic valve interventions. Although epidemiological evidence and clinical data need to be strengthened, there is a strong presumption that they may lead to LBBB-induced cardiomyopathy and benefit from CRT to prevent progression to heart failure. A large cohort study with prospective follow-up would be required to better define actual incidence, evolution over time, and predisposing factors. Parallel randomized CRT clinical trials should be conducted in selected at-risk populations namely, patients with persistent LBBB after transcatheter aortic valve replacement

171: Risk scores versus pragmatic clinical assessment to predict operative risk in aortic valve replacement for aortic stenosis

BackgroundPreoperative risk assessment of cardiac surgery is based on international validated scores. However their additional value above simple clinical assessment (CA) remains controversial. The aim of this study was to compare CA by cardiologists with the 5 most commonly used scores (additive and logistic EuroSCORE, EuroSCORE II, STS-score, Ambler-score) to predict perioperative mortality in patients undergoing aortic valve replacement for aortic stenosis.MethodsFrom October 2009 to November 2011, 314 consecutive patients (73±9,7 years; 29% octogenarians) were included. A surgical coronary revascularization was associated to aortic valve replacement in 22%. According to the expected mortality by CA, patients were split in 4 groups: “low” mortality risk [0–3.9%], “intermediate” [4–6.9%], “high” [7–9.9%] and “very high” ≥10%. The 5 scores were calculated for all the patients.ResultsObserved total operative mortality was 5,7%. The distribution of predicted mortality in the 4 groups was highly different according to the method. The positive predictive value (PPV) of each method was calculated for the 21% most at risk patients (corresponding to the 64 patients ranked in “high” and “very high” mortality risk groups by CA) resulting in PPV=17.2% for EuroSCORE II, 14.1% for CA and STS-score, 10.9% for additive EuroSCORE and logistic EuroSCORE and 10% for Ambler score. Predictive values of “low” and “intermediate” mortality risks were not significantly different depending on the methods (PPV between 2.8 and 4.4%).Conclusionpragmatic CA remains useful to predict operative risk in patients with surgical aortic valve replacement and to balance the different international scores

0418: Comparison of pre- and post-operative characteristics in octogenarians having isolated surgical aortic valve replacement before versus after introduction of transcatheter aortic valve implantation

International audience0418 – Figure Surgical aortic valve replacement (SAVR) is the reference treatment for severe aortic stenosis (AS). Transcatheter aortic valve implantation (TAVI) has emerged as an alternative treatment. The aim of the study was to assess if the clinical profile of octogenarian patients treated surgically before and after the TAVI program initiation has changed. We retrospectively included consecutive octogenarian patients, who underwent isolated SAVR, between January 2006 and December 2014 in a single high-volume center. We compared preoperative, peri-operative and postoperative characteristics before and after the initiation of TAVI (February 2009). 845 patients were included: 229 in the pre-TAVI group (2006-2008; 3 years), 616 in the post-TAVI group (2009-2014; 6 years). Over time, there was an increased rate of SAVR performed. The mean age was the same, 83.2±2.0 years in the pre-TAVI group, 83.5±2.1 years in the post-TAVI group (p=0.06). The preoperative characteristics were statistically comparable, except for history of heart failure (25% in the pre-TAVI group vs 18% in the post-TAVI group, p=0.04), coronary artery disease (22% in the pre-TAVI group vs 14% in the post-TAVI group, p=0.01), hypertension (59% in the pre-TAVI group vs 68% in the post-TAVI group, p=0.02) and obesity (18% in the pre-TAVI group vs 24% in the post-TAVI group, p=0.03). Peri-operative data and post-operative adverse events were comparable between both groups. The operative mortality (30-day) was similar, 5.2% in the pre-TAVI group, 5.5% in the post-TAVI group (p=0.87). In conclusion, with the emergence of TAVI, the number of octogenarian patients operated on continued to increase, their preoperative characteristics were clinically similar and the operative mortality was stabl

Comparison of Pre- and Post-Operative Characteristics in Octogenarians Having Isolated Surgical Aortic Valve Replacement Before versus After Introduction of Transcatheter Aortic Valve Implantation

International audienceAortic stenosis (AS) is the most frequent heart valve disease. Surgical aortic valve replacement (SAVR) is the reference treatment. Transcatheter aortic valve implantation (TAVI) has emerged as an alternative treatment. New strategies for treating the AS are upcoming. The aim of the study was to assess if the clinical profile of octogenarian patients treated surgically before and after the TAVI program initiation has changed. We retrospectively included consecutive octogenarian patients, who underwent isolated SAVR, between January 2006 and December 2011 in a single high-volume center. We compared preoperative and postoperative characteristics before and after the initiation of TAVI (February 2009). 517 patients were included: 229 in the "before TAVI" group (2006-2008), 288 in the "after TAVI" group (2009-2011). The mean age was 83.2±2.0 in the "before TAVI" group, 83.5 ± 2.1 in the "after TAVI" group (p=0.106). There were no significant differences in preoperative characteristics: NYHA class (p=0.374), history of heart failure (p=0.680), left ventricular ejection fraction (59.8±12.2% in the "before TAVI" group, 59.9±11.3% in the "after TAVI" group, p=0.922), coronary artery disease (p=0.431), chronic pulmonary disease (p=0.363), previous cardiac surgery (p=0.085). The logistic EuroSCORE was 7.78±4.60% in the "before TAVI" group and 7.33±3.96% in the "after TAVI" group (p=0.236). The operative mortality (30-day) was comparable: 5.2% in the "before TAVI" group, 6.9% in the "after TAVI" group (p=0.424). Thus, with the emergence of TAVI, the number of octogenarian patients operated on, their preoperative characteristics and the operative mortality remained comparable

Totally implanted venous access-associated adverse events in oncology: Results from a prospective 1-year surveillance programme

International audienceDuring the last decade, most studies on totally implanted venous access-associated adverse events (TIVA-AE) were conducted retrospectively and/or were based on a limited sample size. The aim of our survey was two-fold: to estimate the incidence of TIVA-AE and to identify risk factors in patients with cancer

High-degree atrioventricular block complicating ST segment elevation myocardial infarction in the contemporary era

International audienceBackground High-degree atrioventricular block (HAVB) is a common complication of ST segment elevation myocardial infarction (STEMI). HAVB in STEMI is historically considered as a marker of worse outcome but overall data about HAVB in the contemporary era of mechanical reperfusion and potent antiplatelet therapies are scarce. Aim Analysing incidence, clinical correlates and impact on inhospital outcomes of HAVB in a large prospective registry (Observatoire Régional Breton sur l'Infarctus, ORBI) of modern management of STEMI with a special focus on potential differences between patients with HAVB on admission and those who developed HAVB during hospitalisation. Methods All patients enrolled in ORBI between June 2006 and December 2013 were included in the present analysis and were divided into 3 groups: patients without HAVB at any time, patients with HAVB on admission and those who developed HAVB during hospitalisation. Results A total of 6662 patients (age: 62.0 (52.0–74.0) years; male: 76.3%) were included in the present analysis. HAVB was documented in 3.5% of patients, present on admission in 63.7% of patients and occurring during hospitalisation in 36.3%. Patients with HAVB on admission or occurring during the first 24 h of hospitalisation had higher inhospital mortality rates (18.1% and 28.6%, respectively) than patients without (4.5%) or with HAVB occurring beyond the first 24 h of hospitalisation (8.0%). However by multivariable analysis, HAVB was not independently associated with inhospital mortality contrarily to age, presentation as cardiac arrest, anterior STEMI location, reperfusion therapy, cardiogenic shock, mechanical ventilation and occurrence of sustained ventricular tachyarrhythmias or mechanical complication. Conclusions Patients with HAVB had a higher mortality rate than patients without. However HAVB is not an independent predictor of inhospital mortalit

0019: High-degree atrioventricular block complicating ST-segment elevation myocardial infarction in the contemporary era: data from the ORBI prospective French regional registry

International audienceBackground High-degree atrioventricular block (HAVB) is a common complication of ST-segment elevation myocardial infarction (STEMI). HAVB in STEMI is historically considered as a marker of worse outcome but overall data about HAVB in the contemporary era of mechanical reperfusion and potent antiplatelet therapies are scarce. Aim We aimed at analyzing incidence, clinical correlates and impact on inhospital outcomes of HAVB in a large prospective registry (ORBI) of modern management of STEMI with a special focus on potential differences between patients with HAVB on admission and those who developed HAVB during hospitalization. Methods All patients enrolled in ORBI between June 2006 and December 2013 were included in the present analysis and were divided into 3 groups: patients without HAVB at any time, patients with HAVB on admission and those who developed HAVB during hospitalization. Results 6662 patients (age: 62.0 [52.0-74.0]; male: 76.3%) were included in the present analysis. HAVB was documented in 3.5% of patients, present on admission in 63.7% of patients and occurring during hospitalization in 36.3%. Patients with HAVB on admission or occurring during the first 24h of hospitalization had higher in-hospital mortality rates (18.1% and 28.6% respectively) than patients without (4.5%) or with HAVB occurring beyond the first 24h of hospitalization (8.0%). However by multivariable analysis, HAVB was not independently associated with in-hospital mortality. Conclusion Patients with HAVB had a higher mortality rate than patients without. However HAVB is not an independent predictor of in-hospital mortality. Abstract 0019 – Figure: Multivariable analysi