The True Role of Accelerometer Feedback in Quadrotor Control

A revisited quadrotor model is proposed, including in particular the so-called rotor drag. It differs from the model usually considered, even at first order, and much better explains the role of accelerometer feedback in control algorithms. The theoretical derivation is supported by experimental data

A Separation Principle on Lie Groups

For linear time-invariant systems, a separation principle holds: stable observer and stable state feedback can be designed for the time-invariant system, and the combined observer and feedback will be stable. For non-linear systems, a local separation principle holds around steady-states, as the linearized system is time-invariant. This paper addresses the issue of a non-linear separation principle on Lie groups. For invariant systems on Lie groups, we prove there exists a large set of (time-varying) trajectories around which the linearized observer-controler system is time-invariant, as soon as a symmetry-preserving observer is used. Thus a separation principle holds around those trajectories. The theory is illustrated by a mobile robot example, and the developed ideas are then extended to a class of Lagrangian mechanical systems on Lie groups described by Euler-Poincare equations.Comment: Submitted to IFAC 201

Prosthesis-patient mismatch after aortic valve replacement in the PARTNER 2 trial and registry

Objectives This study aimed to compare incidence and impact of measured prosthesis-patient mismatch (PPMM) versus predicted PPM (PPMP) after surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). Background TAVR studies have used measured effective orifice area indexed (EOAi) to body surface area (BSA) to define PPM, but most SAVR series have used predicted EOAi. This difference may contribute to discrepancies in incidence and outcomes of PPM between series. Methods The study analyzed SAVR patients from the PARTNER (Placement of Aortic Transcatheter Valves) 2A trial and TAVR patients from the PARTNER 2 SAPIEN 3 Intermediate Risk registry. PPM was classified as moderate if EOAi ≤0.85 cm2/m2 (≤0.70 if obese: body mass index ≥30 kg/m2) and severe if EOAi ≤0.65 cm2/m2 (≤0.55 if obese). PPMM was determined by the core lab–measured EOAi on 30-day echocardiogram. PPMP was determined by 2 methods: 1) using normal EOA reference values previously reported for each valve model and size (PPMP1; n = 929 SAVR, 1,069 TAVR) indexed to BSA; and 2) using normal reference EOA predicted from aortic annulus size measured by computed tomography (PPMP2; n = 864 TAVR only) indexed to BSA. Primary endpoint was the composite of 5-year all-cause death and rehospitalization. Results The incidence of moderate and severe PPMP was much lower than PPMM in both SAVR (PPMP1: 28.4% and 1.2% vs. PPMM: 31.0% and 23.6%) and TAVR (PPMP1: 21.0% and 0.1% and PPMP2: 17.0% and 0% vs. PPMM: 27.9% and 5.7%). The incidence of severe PPMM and severe PPMP1 was lower in TAVR versus SAVR (P < 0.001). The presence of PPM by any method was associated with higher transprosthetic gradient. Severe PPMP1 was independently associated with events in SAVR after adjustment for sex and Society of Thoracic Surgeons score (hazard ratio: 3.18;95% CI: 1.69-5.96; P < 0.001), whereas no association was observed between PPM by any method and outcomes in TAVR. Conclusions EOAi measured by echocardiography results in a higher incidence of PPM following SAVR or TAVR than PPM based on predicted EOAi. Severe PPMP is rare (<1.5%), but is associated with increased all-cause death and rehospitalization after SAVR, whereas it is absent following TAVR

Standardized Definitions for Bioprosthetic Valve Dysfunction Following Aortic or Mitral Valve Replacement: JACC State-of-the-Art Review.

peer reviewedBioprosthetic valve dysfunction (BVD) and bioprosthetic valve failure (BVF) may be caused by structural or nonstructural valve dysfunction. Both surgical and transcatheter bioprosthetic valves have limited durability because of structural valve deterioration. The main objective of this summary of experts participating in a virtual workshop was to propose standardized definitions for nonstructural and structural BVD and BVF following aortic or mitral biological valve replacement with the goal of facilitating research reporting and implementation of these terms in clinical practice. Definitions of structural BVF, based on valve reintervention or death, underestimate the true incidence of BVF. However, definitions solely based on the presence of high transprosthetic gradient at a given echocardiogram during follow-up overestimate the incidence of structural BVD and BVF. Definitions of aortic or mitral structural BVD must therefore include the confirmation by imaging of permanent structural changes to the leaflets alongside evidence of deterioration in valve hemodynamic function at echocardiography follow-up

Multimodality imaging in cardiology : application to the assessment of aortic bioprostheses

L’incidence et la prévalence des maladies valvulaires sont en augmentation, l’épidémiologie de ces maladies se modifie avec une prépondérance des maladies dégénératives, et le traitement considéré est le plus souvent le remplacement valvulaire prothétique, notamment dans le cadre de la sténose aortique qui est la maladie valvulaire la plus fréquente. Les techniques de remplacement valvulaire et les prothèses valvulaires ont grandement évolué ces dernières années, notamment avec le développement des implantations de prothèses par voie percutanée. Cependant les substituts valvulaires aortiques biologiques sont exposés à des complications diverses mettant en jeu la fonction de la prothèse : fuite péri-prothétique, endocardite infectieuse, dégénérescence des tissus biologiques. Ces complications restent des challenges diagnostiques et l’échographie est l’imagerie de référence. Cependant, l’imagerie cardiaque et valvulaire a réalisé de grands progrès, et l’utilisation d’autres techniques ou modalités d’imagerie peut être une alternative ou un complément à l’exploration par échocardiographie : imagerie par scanner, imagerie par résonance magnétique, imagerie nucléaire. Le recours et la combinaison de ces différentes techniques s’intègrent dans une approche globale, nommée imagerie multimodale. L’objectif général de ce projet de doctorat a été d’étudier l’apport de l’imagerie multimodale dans la surveillance des bioprothèses aortiques et l’évaluation des complications et de la dégénérescence structurelle qui peuvent survenir.The incidence and prevalence of heart valve diseases are increasing worldwide. Their epidemiology also changes, and the required treatment is most often a prosthetic valve replacement, especially for aortic stenosis that is the most frequent heart valve disease. Techniques of valve replacement as well as prosthesis themselves have dramatically evolved in recent years, especially with the development of percutaneous transcatheter procedures. However, biologic aortic valve substitutes are at risk of several complications including prosthetic valve dysfunction, paravalvular regurgitation, infective endocarditis and structural valve deterioration. Correctly diagnose any of these complications still is a challenge but echocardiography plays a pivotal role and remains the gold-standard as per diagnostic imaging. Nonwithsanding the fact that echocardiography is the main imaging modality for valvular anomalies, great progress has been made in cardiac imaging and modalities like CT-Scan, MRI and nuclear imaging are nowadays regularly used along with echocardiography. The use and combination of these different techniques are part of a global approach, entitled multi-modality imaging.The general objective of this doctoral project was to study the contribution of the multi-imaging approach in the assessment of the bioprosthesis function and screening for complications and structural valve deterioration that may occur

Quantification des fuites péri-prothétiques post TAVI (apport de l'imagerie par résonnance magnétique)

INTRODUCTION: L'implantation de valve prothétique par voie percutanée est devenue une alternative au traitement des sténoses aortiques serrées chez les patients à haut risque chirurgical. Les fuites péri-prothéiques surviennent fréquemment, elles sont majoritairement minimes. Les fuites modérées sont présentes jusqu'à 27% des cas et sont un facteur indépendant de mortalité. L'impact des fuites minimes reste discuté et se pose la problématique de possible sous estimation par la classification actuelle échographique. OBJECTIF: Comparer l'évaluation des fuites péri-prothétiques par l'utilisation de séquences d'imagerie de phase en IRM à celle obtenue par la technique de référence actuelle: l'Echographie Trans-Thoracique (ETT). Intégrer secondairement l'Index de Régurgitation aortique (IR) pour affiner l'évaluation des fuites péri-prothétiques et du pronostic. METHODES: Tous les patients bénéficiant d'un TAVI (COREVALVE et EDWARDS SAPIEN XT) dans notre centre et non contre indiqués à la réalisation d'une IRM ont été inclus. La mesure de l'IR a été réalisée en fin de procédure TAVI, ainsi qu'une ETT concomitante à l'IRM au 5ème jours post-TAVI. RESULTATS/DISCUSSION: 30 patients ont pu bénéficié d'une IRM. Les coupes passant par le stent de la prothèse présentent toutes des artefacts et le niveau de coupe doit être placé le plus proche du bord supérieur ou inférieur de la prothèse. Les volumes régurgités et les fractions de régurgitation étaient significativement croissants avec la sévérité de la fuite évaluée en ETT. 3 cas de FR élevées et d'IR abs chez des patients classé en fuite minime par l'ETT, sont suspectées d'être de sous estimation de la technique échographique. CONCLUSION: L'IRM par l'intermédiaire des séquences de phase permet une évaluation des fuites péri-prothétiques. Dans certains cas, elle permettrait de corriger une sous estimation de la technique échographique. Une analyse combinée ETT-IRM-IR paraît la plus aprte à évaluer la réelle sévérité de la fuite et à envisager le pronostic post TAVIAIX-MARSEILLE2-BU Méd/Odontol. (130552103) / SudocSudocFranceF

Beyond Standard Echocardiography in Infective Endocarditis Computed Tomography, 3-Dimensional Imaging, and Multi-Imaging

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

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

Biomarkers of aortic bioprosthetic valve structural degeneration

Purpose of review: Bioprosthetic valves are now used for the majority of surgical aortic valve replacements and for all transcatheter aortic valve replacements. However, bioprostheses are subject to structural valve deterioration (SVD) and have, therefore limited durability. Recent findings: Clinical, imaging, and circulating biomarkers may help to predict or indicate the presence of bioprosthetic valve SVD. The most important biomarkers of SVD includes: patient-related clinical biomarkers, such as diabetes and renal failure; valve-related biomarkers, such as absence of antimineralization process and severe prosthesis-patient mismatch; imaging biomarkers: the presence of valve leaflet mineralization on multidetector computed tomography or sodium fluoride uptake on positron emission tomography; and circulating biomarkers including: increased levels of HOMA index, ApoB/ApoA-I ratio, PCSK9, Lp-PLA2, phosphocalcic product. The assessment of these biomarkers may help to enhance risk stratification for SVD following AVR and may contribute to open novel pharmacotherapeutic avenues for the prevention of SVD. Summary: SVD may affect all bioprostheses after aortic valve replacement, and is the main cause of bioprosthetic valve failure and reintervention during the follow-up. Comprehensive assessment of clinical, imaging, and circulating biomarkers associated with earlier SVD could help strengthen the follow-up in high-risk patients and provide novel pharmacologic therapeutic strategies