A new approach: Left atrial appendage occlusion, as an alternative to anticoagulant, to treat patient who suffered of atrial fibrillation, acute coronary syndrome and clopidogrel resistance.

International audienc

A new approach: Left atrial appendage occlusion, as an alternative to anticoagulant, to treat patient who suffered of atrial fibrillation, acute coronary syndrome and clopidogrel resistance.

International audienc

Great expectations

International audienc

Initial experience with the WATCHMAN™ left atrial appendage system for stroke prevention in atrial fibrillation: A single-centre registry.

International audienceLeft atrial appendage (LAA) closure using the WATCHMAN™ device (WM) may be considered in patients with non-valvular atrial fibrillation (AF) and a high-risk of stroke who are ineligible for long-term oral anticoagulation (OAC).To report our single-centre preliminary experience, focusing on feasibility, safety and short-term efficacy of this procedure.Patients implanted from December 2013 to February 2014 were included. The procedure, performed under general anaesthesia, was guided by fluoroscopy and transoesophageal echocardiography (TOE). Efficacy was defined as the ability to implant the WM with no peridevice leak; safety was defined as the occurrence of in-hospital and 45-day events, including stroke, pericardial effusion and device migration.Twenty-three patients (mean age: 77.6 years; 16 men [69.6%]; mean CHA2DS2-VASc score: 5) underwent WM implantation. The indication was gastrointestinal bleeding in 14 (60.9%) patients, cerebral haemorrhage in eight (34.8%) and need for long-term ticagrelor after stent thrombosis on clopidgrel in one (4.3%). Procedural success was 95.7% (95% confidence interval: 77.3-100.0); efficacy was 90.9% (95% confidence interval: 71.0-98.7). The size of the implanted WATCHMAN™ device was in agreement with the prespecified size, based on measurement of the LAA, in 56.5% of cases. In five cases, the criteria were not met, but the device was successfully implanted in four of these, with a good result (80.0%). Treatment at discharge was a reduced dose of anticoagulant plus aspirin in three cases (13.0%) or antiplatelet therapy alone in 20 cases (90.9%). No adverse event occurred during the index hospitalization or at 45 days. At 45 days, the LAA was sealed in 18/19 patients (94.7%) on TOE, with no difference between those who did or did not have an implanted device of the prespecified size.When performed by an operator trained in the procedure, WM implantation appears to be safe and effective. This procedure may be considered in patients at high-risk of stroke who are ineligible for long-term OAC

0230: Effectiveness of switching Prasugrel's ‘low responders’ to ticagrelor after acute coronary syndrome

AimsThis study aimed to assess the effectiveness and safety of switching from Prasugrel to Ticagrelor patients identified as Prasugrel low-responders one month after ACS.Methods and results540 patients admitted for ACS with coronary stent implantation and discharged on Prasugrel 10mg were screened. Prasugrel response was assessed one month after discharge using Platelet Reactivity Index Vasodilatator Stimulated Phosphoprotein (PRI VASP). High on-Treatment Platelet Reactivity (HTPR) was defined as VASP>50%. Patients with HTPR were enrolled and switched to Ticagrelor 90 mg twice a day. They were re-tested a month later. Primary endpoint was defined as: comparison of degree of platelet inhibition and incidence of HTPR one month after switching to Ticagrelor in patients with HTPR on Prasugrel therapy. The safety endpoint was the incidence of bleedings under Ticagrelor as compared with Prasugrel therapy, using the Bleeding Academic Research Consensus definition.Between March 2010 and November 2013, 19 patients were defined as HTPR on Prasugrel 10 mg one month after ACS, with a mean VASP of 59,3%. Among these patients, 14 were switched to Ticagrelor 180 mg daily and, at one month, we observed a significant decrease in PRI VASP, with a mean value at 19.6% (p<0.001). No patients remained HTPR and 4 patients (28.4%) were identified as Very Low on-Treatment Platelet Reactivity (VLTPR) (VASP<10%). No ischemic events were reported after switching, while 3 patients (21%) suffered from bleeding complications (2 BARC1 and 1 BARC2 bleedings) during Ticagrelor therapy.ConclusionSwitch to Ticagrelor in Prasugrel's “low responders” patients is an effective strategy, leading to an adequate platelet inhibition in a large majority of patients. This biological tailored approach could be useful in preventing ischemic complications, in this specific high risk population, potentially increasing bleeding risk. This hypothesis needs to be confirmed in large clinical studies.Abstract 0230 – Figur

Chronic heart failure in heart transplant recipients: Presenting features and outcome

International audienceBackground. - The ageing graft frequently shows coronary lesions and a restrictive physiology. Aims. - To determine the presenting features and outcome of chronic heart failure in heart transplant recipients. Methods. - In this cohort study, we compared 44 consecutive heart transplant recipients who developed chronic heart failure more than 1 year after heart transplantation with 44 control heart transplant recipients who did not develop heart failure. Results. - We found that patients who developed heart failure had more frequently a history of hypertension or diabetes before transplantation. During the 12 months after transplantation, significantly more patients had moderate-to-severe acute rejections (>= grade 2R) in the heart failure group than in the control group. At the time of heart failure diagnosis, systolic left ventricular function was preserved in 50% of patients and coronary angiography was normal or near normal in 36% of patients. Half of the 44 patients in the heart failure group died within 2 years of heart failure diagnosis. Ascites and end-stage renal failure requiring dialysis were significantly more frequent during follow-up in the heart failure group than in the control group (respectively, 10/44 vs 0/44 [P=0.001] and 18/44 vs 5/44 [P=0.003]). Conclusion. - In heart transplant recipients presenting with heart failure, systolic left ventricular function is frequently preserved and coronary angiography is frequently abnormal, but may be normal or near normal. During follow-up, the main features of these patients are a high mortality rate after heart failure diagnosis, a frequent need for renal dialysis and frequent ascites. (C) 2016 Elsevier Masson SAS. All rights reserved