58 research outputs found
TAVI: Simplification Is the Ultimate Sophistication
Since its introduction in 2002, TAVI has evolved dramatically and is now standard of care for intermediate risk patients when the femoral approach can be implemented safely. The development of innovative transcatheter heart valves (THVs) and refinement of technical skills have contributed to the decrease in complication rates associated with TAVI4. Increased experience, smaller sheaths, rigorous pre-procedural planning and improved vascular closing techniques have resulted in markedly lower rates of vascular complications. The next step is the simplification of the procedure, which should contribute to a further decrease in complications, and also reduce procedural time, hospital stay as well as staff workload and costs. Moving to conscious sedation, no predilatation, no temporary pace maker and use of the radial approach as the contralateral approach are all instrumental in achieving this ultimate refinement
Transcatheter heart valve commissural alignment: an updated review
Transcatheter aortic valve replacement (TAVR) indications recently extended to lower surgical risk patients with longer life expectancy. Commissural alignment (CA) is one of the emerging concepts and is becoming one of the cornerstones of the TAVR procedure in a patient with increased longevity. Indeed, CA may improve transcatheter heart valve (THV) hemodynamics, future coronary access, and repeatability. The definition of CA has been recently standardized by the ALIGN-TAVR consortium using a four-tier scale based on CT analysis. Progress has been made during the index TAVR procedure to optimize CA, especially with self-expandable platforms. Indeed, specific delivery catheter orientation, THV rotation, and computed-tomography-derived views have been proposed to achieve a reasonable degree of CA. Recent data demonstrate feasibility, safety, and a significant reduction in coronary overlap using these techniques, especially with self-expandable platforms. This review provides an overview of THV CA including assessment methods, alignment techniques during the index TAVR procedure with different THV platforms, the clinical impact of commissural misalignment, and challenging situations for CA
Marqueurs pronostiques biologiques et morphologiques du TAVI Ă lâĂšre de lâĂ©volution des pratiques
Management of aortic stenosis was revolutionized by the advent of transcatheter aortic valve replacement (TAVI). This technique, initially targeting patients at high surgical risk, was extended to lower risk patients regarding to improved outcomes and was accompanied, over the years, by a simplification at each step of the procedure. However, the careful selection of patients upstream of the procedure remains the key to success. Clinical and echographic factors are not sufficient to allow an accurate assessment of their risk profile. Thus, biomarkers and aortic valve calcifications evaluation may improve risk profile stratification. The objective of this thesis was to evaluate the prognostic value of troponin and aortic valve calcium score in patients undergoing TAVI in the era of TAVI simplificationThe first chapter of this thesis confirmed the prognostic value of pre- and post-procedure troponin (myocardial injury) in patients undergoing TAVI and of calcium score with previous generation prosthesis.The second chapter highlighted the impact of predilatation on this post-procedure troponin elevation with a potential prognostic impact.La prise en charge du rĂ©trĂ©cissement aortique a connu une vĂ©ritable rĂ©volution avec lâavĂšnement du remplacement valvulaire aortique percutanĂ© (TAVI). Cette technique, sâadressant initialement Ă des patients Ă haut risque chirurgical, a Ă©tĂ© Ă©tendue Ă des patients Ă moindre risque du fait de lâamĂ©lioration des rĂ©sultats et sâest accompagnĂ©e, au fil des annĂ©es, dâune simplification de la procĂ©dure. Cependant, la sĂ©lection rigoureuse des patients en amont de la procĂ©dure reste la clĂ© du succĂšs de cette technique. Les facteurs cliniques et Ă©chographiques sont insuffisants pour permettre une Ă©valuation prĂ©cise du profil de risque. Certains biomarqueurs et les calcifications de la valve aortique, permettraient dâamĂ©liorer la stratification du risque. Lâobjectif de ce travail Ă©tait dâĂ©valuer la valeur pronostique de la troponine et du score calcique valvulaire dans le TAVI Ă lâĂšre de lâĂ©volution des pratiques. Le premier chapitre de cette thĂšse a permis de confirmer la valeur pronostique de la troponine en prĂ© et post-procĂ©dure TAVI et celle du score calcique avec les valves de la prĂ©cĂ©dente gĂ©nĂ©ration. Le deuxiĂšme chapitre de ce travail a permis de mettre en Ă©vidence lâimpact de la prĂ©dilatation sur lâĂ©lĂ©vation de troponine post-procĂ©dure avec un rĂŽle pronostique potentiel
Biological and morphological prognostic markers in the era of TAVI simplification
La prise en charge du rĂ©trĂ©cissement aortique a connu une vĂ©ritable rĂ©volution avec lâavĂšnement du remplacement valvulaire aortique percutanĂ© (TAVI). Cette technique, sâadressant initialement Ă des patients Ă haut risque chirurgical, a Ă©tĂ© Ă©tendue Ă des patients Ă moindre risque du fait de lâamĂ©lioration des rĂ©sultats et sâest accompagnĂ©e, au fil des annĂ©es, dâune simplification de la procĂ©dure. Cependant, la sĂ©lection rigoureuse des patients en amont de la procĂ©dure reste la clĂ© du succĂšs de cette technique. Les facteurs cliniques et Ă©chographiques sont insuffisants pour permettre une Ă©valuation prĂ©cise du profil de risque. Certains biomarqueurs et les calcifications de la valve aortique, permettraient dâamĂ©liorer la stratification du risque. Lâobjectif de ce travail Ă©tait dâĂ©valuer la valeur pronostique de la troponine et du score calcique valvulaire dans le TAVI Ă lâĂšre de lâĂ©volution des pratiques. Le premier chapitre de cette thĂšse a permis de confirmer la valeur pronostique de la troponine en prĂ© et post-procĂ©dure TAVI et celle du score calcique avec les valves de la prĂ©cĂ©dente gĂ©nĂ©ration. Le deuxiĂšme chapitre de ce travail a permis de mettre en Ă©vidence lâimpact de la prĂ©dilatation sur lâĂ©lĂ©vation de troponine post-procĂ©dure avec un rĂŽle pronostique potentiel.Management of aortic stenosis was revolutionized by the advent of transcatheter aortic valve replacement (TAVI). This technique, initially targeting patients at high surgical risk, was extended to lower risk patients regarding to improved outcomes and was accompanied, over the years, by a simplification at each step of the procedure. However, the careful selection of patients upstream of the procedure remains the key to success. Clinical and echographic factors are not sufficient to allow an accurate assessment of their risk profile. Thus, biomarkers and aortic valve calcifications evaluation may improve risk profile stratification. The objective of this thesis was to evaluate the prognostic value of troponin and aortic valve calcium score in patients undergoing TAVI in the era of TAVI simplificationThe first chapter of this thesis confirmed the prognostic value of pre- and post-procedure troponin (myocardial injury) in patients undergoing TAVI and of calcium score with previous generation prosthesis.The second chapter highlighted the impact of predilatation on this post-procedure troponin elevation with a potential prognostic impact
Does ivabradine balance dobutamine effects in cardiogenic shock? A promising new strategy
International audienc
Reply concerning âColchicine in coronary artery disease: Role of anti-inflammatory medications redefinedâ: Prime time for anti-inflammatory agents for the management of cardiovascular diseases
International audienc
Management of valvulopathies with acute severe heart failure and cardiogenic shock
International audienc
Anti-inflammatory drugs as promising cardiovascular treatments
International audienceInflammation is a well-known powerful effector of atherosclerosis development. Cell infiltration induces inflammatory signal increasing plaque formation as well as its destabilization, leading to cardiovascular disease including myocardial infarction. During ischemia, necrotic cardiomyocytes stimulate the inflammatory storm into the myocardium (by chemokines, vascular adhesion molecules, interleukins action) promoting cardiac repair but also remodeling. Areas covered: Herein the authors present each condition (atherosclerosis and myocardial infarction) in two separate parts. Pathophysiology is briefly presented and focused on its implication in inflammation. Non-invasive techniques are presented, which explore inflammation in vivo. Several anti-inflammatory drugs are presented (mechanism of action, already published studies and ongoing trials are summarized). Expert commentary: Whereas atherosclerosis, regarding both the step-by-step pathophysiology and the acute plaque destabilization, is widely recognized as involving inflammatory pathways, the current translations in clinical practice remain poor. However, both basic and clinical research are active in the field, and the first large trials should soon be available, corroborating or not whether modulating inflammatory processes could be of interest in clinical practice
Intraâaortic balloon pump: is the technique really outdated?
International audienceAims: Intra-aortic balloon pump (IABP) utilization was expected to be quickly abandoned following the IABP-shock trial and its class III, level B recommendation in the 2016 European Society of Cardiology (ESC) guidelines. The aim of this study was to evaluate the use of IABP compared with other mechanical support devices in a nationwide approach.Methods and results:We conducted a retrospective study based on the French national hospital discharge database. All patients undergoing assist device implantation by IABP, extracorporeal membrane oxygenation (ECMO), or IMPELLAÂź from 2014 to 2018 (2 years before/2 years after the 2016 guidelines) were included. The primary endpoint was the incidence of IABP implantation over the years. Secondary endpoints were incidence of total assist device, ECMO, and IMPELLAÂź implantations. From 2014 to 2018, a total of 18 940 patients benefited from mechanical support by IABP (n = 6657, 35.2%), ECMO (n = 11 881, 62.7%), or IMPELLAÂź (n = 402, 2.1%) in France. The incidence of total mechanical support implantations (ECMO and IABP) was constant over the years. IABP implantations decreased progressively from 1725 implantations in 2014 to 996 in 2018 (â42%). By contrast, ECMO implantations increased progressively from 1919 implantations in 2014 to 2763 implantations in 2018 (+44%). IMPELLAÂź implantations remained stable over the years from 63 (1.7%) implantations in 2014 to 83 (2.1%) in 2018.Conclusions: In this nationwide realâlife study, despite a significant decline in IABP implantations over the years since the ESC guidelines, this device remained used in clinical practice with around 1000 implantations in 2018. The size of centres was not strictly correlated with this use, suggesting differential uses depending on the local background
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