One-year clinical outcomes following Edwards INSPIRIS RESILIA aortic valve implantation in 487 young patients with severe aortic stenosis: a single-center experience

IntroductionThe use of an aortic bioprosthesis is on the rise in younger patients with severe aortic stenosis despite the risk of accelerated structural valve degeneration (SVD). In the search for an optimal valve substitute that would not be prone to SVD, the INSPIRIS bioprosthesis represents a promising solution to lowering the risk of SVD. Here, we report the 1-year outcomes of the INSPIRIS RESILIA aortic bioprosthesis in a population of young patients who underwent aortic valve replacement.MethodsIn this prospective single-center study, we included all consecutive patients receiving INSPIRIS RESILIA bioprosthesis between June 2017 and July 2021. Patients with isolated severe aortic regurgitation were excluded. Clinical assessment and transthoracic echocardiography were performed preoperatively and at 1 year post-operatively. The primary outcome was overall mortality at one year.ResultsA total of 487 patients were included. The mean age was 58.2 ± 11.5 years, 75.2% were men. Most of the interventions were elective, with a mean EuroSCORE II of 4.8 ± 7.9. The valve annulus size in most cases was either 23 mm or 25 mm. Overall mortality at 1-year was 4.1%. At 1-year, 7 patients (1.4%) had a stroke, 4 patients (0.8%) had a myocardial infarction, and 20 patients (4.1%) were hospitalized for congestive heart failure. The Kaplan-Meier estimated survival rates and survival without major adverse cardiac events at 1-year were 96.4% and 96.7%, respectively. At 1-year follow-up, 10 patients (2.1%) had endocarditis and 1 patient (0.2%) had partial prosthetic thrombosis. Pacemaker implantation at 1-year post-operative was necessary in 27 patients (5.5%). Severe patient prosthesis mismatch and severe intra valvular regurgitation were 1.2% and 0.6%, respectively. The Kaplan-Meier estimated survival rates at 1-year of no infective endocarditis preoperative and infective endocarditis preoperative were 97.9 ± 0.7% and 89.5 ± 3.3%, respectively (P < 0.001). Excluding endocarditis-related complication, no structural valve deterioration and no valve failure requiring redo surgery were reported.ConclusionThis is the largest single-center descriptive study of the 1-year outcomes after INSPIRIS RESILIA bioprosthesis implantation. The EDWARDS INSPIRIS RESILIA bioprosthesis provides encouraging clinical outcomes with an excellent 1- year survival rates and good hemodynamic performance. Long-term studies are mandatory to assess valve durability

Durability of bioprosthetic aortic valve replacement in patients under the age of 60 years - 1-year follow-up from the prospective INDURE registry.

OBJECTIVES We report 1-year safety and clinical outcomes in patients <60 years undergoing bioprosthetic surgical aortic valve intervention. METHODS The INSPIRIS RESILIA Durability Registry (INDURE) is a prospective, multicentre registry to assess clinical outcomes of patients <60 years. Patients with planned SAVR with or without concomitant replacement of the ascending aorta and/or coronary bypass surgery were included. Time-related valve safety, haemodynamic performance, and quality of life (QoL) at 1 year were assessed. RESULTS 421 patients were documented with a mean age of 53.5 years, 76.5% being male, and 27.2% in NYHA class III/IV. Outcomes within 30 days included cardiovascular-related mortality (0.7%), time-related valve safety (VARC-2; 5.8%), thromboembolic events (1.7%), valve-related life-threatening bleeding (VARC-2; 4.3%), and permanent pacemaker implantation (3.8%). QoL was significantly increased at 6 months and sustained at 1 year. Freedom from all-cause mortality at 1 year was 98.3% (95%CI 97.1;99.6) and 81.8% were NYHA I vs. 21.9% at baseline. No patient developed structural valve deterioration Stage 3 (VARC-3). Mean aortic pressure gradient was 12.6 mmHg at 1 year and effective orifice area was 1.9 cm2. CONCLUSIONS The 1-year data from the INSPIRIS RESILIA valve demonstrate good safety and excellent haemodynamic performance as well as an early QoL improvement. CLINICALTRIALS NUMBER NCT03666741

Durability of bioprosthetic aortic valves in patients under the age of 60 years - Rationale and design of the international INDURE registry

Background: There is an ever-growing number of patients requiring aortic valve replacement (AVR). Limited data is available on the long-term outcomes and structural integrity of bioprosthetic valves in younger patients undergoing surgical AVR. Methods: The INSPIRIS RESILIA Durability Registry (INDURE) is a prospective, open-label, multicentre, international registry with a follow-up of 5 years to assess clinical outcomes of patients younger than 60 years who undergo surgical AVR using the INS

Three new brown dwarfs and a massive hot Jupiter revealed by TESS around early-type stars

Context. The detection and characterization of exoplanets and brown dwarfs around massive AF-type stars is essential to investigate and constrain the impact of stellar mass on planet properties. However, such targets are still poorly explored in radial velocity (RV) surveys because they only feature a small number of stellar lines and those are usually broadened and blended by stellar rotation as well as stellar jitter. As a result, the available information about the formation and evolution of planets and brown dwarfs around hot stars is limited. Aims. We aim to increase the sample and precisely measure the masses and eccentricities of giant planets and brown dwarfs transiting early-type stars detected by the Transiting Exoplanet Survey Satellite (TESS). Methods. We followed bright (V 6200 K that host giant companions (R > 7 R⊕) using ground-based photometric observations as well as high precision radial velocity measurements from the CORALIE, CHIRON, TRES, FEROS, and MINERVA-Australis spectrographs. Results. In the context of the search for exoplanets and brown dwarfs around early-type stars, we present the discovery of three brown dwarf companions, TOI-629b, TOI-1982b, and TOI-2543b, and one massive planet, TOI-1107b. From the joint analysis of TESS and ground-based photometry in combination with high precision radial velocity measurements, we find the brown dwarfs have masses between 66 and 68 MJup, periods between 7.54 and 17.17 days, and radii between 0.95 and 1.11 RJup. The hot Jupiter TOI-1107b has an orbital period of 4.08 days, a radius of 1.30 RJup, and a mass of 3.35 MJup. As a by-product of this program, we identified four low-mass eclipsing components (TOI-288b, TOI-446b, TOI-478b, and TOI-764b). Conclusions. Both TOI-1107b and TOI-1982b present an anomalously inflated radius with respect to the age of these systems. TOI-629 is among the hottest stars with a known transiting brown dwarf. TOI-629b and TOI-1982b are among the most eccentric brown dwarfs. The massive planet and the three brown dwarfs add to the growing population of well-characterized giant planets and brown dwarfs transiting AF-type stars and they reduce the apparent paucity

Genetics and pathophysiology of bicuspid aortic valve

La bicuspidie aortique représente la malformation cardiaque congénitale la plus fréquente, affectant environ 2% de la population. Paradoxalement, le mécanisme de dégénérescence accélérée d’une valve bicuspide n’est pas encore élucidé. Ce travail s’appuie sur l’analyse de modèles animaux et sur l’analyse d’une cohorte prospective de 300 patients porteurs d’une valve aortique bicuspide.Notre cohorte de 300 patients nous a permis de chercher à identifier de nouveaux gènes impliqués dans la bicuspidie aortique par des approches de séquençage nouvelle génération, mais aussi par une approche de gène candidat. La comparaison des données cliniques et échographiques des patients porteurs de bicuspidie aortique avec et sans dysfonctionnement nous a permis d’établir une corrélation entre le phénotype de la bicuspidie et fonction valvulaire.Ce travail a eu pour objectif d’améliorer la compréhension de la physiopathologie de la bicuspidie aortique en identifiant de nouveaux gènes candidats et d’acquérir une meilleure connaissance du processus de dégénérescence valvulaire accélérée par le biais de modèles murins et d’études cliniques.Bicuspid Aortic Valve (BAV) is the most common congenital heart defect, affecting about 2% of the population. BAV is a heritable trait, but the genetic basis underlying this defect remains unclear. BAV is associated with an excess of morbidity and mortality related to several complications such as accelerated valve degeneration that required earlier and more frequent referral for surgery. Despite its burden, the mechanism underlying BAV degeneration has not been elucidated. Aortic valve replacement constitutes a late response to a disease whose diagnosis is often carried out earlier, at the stage of non-severity. My thesis aims to identify the pathophysiology of BAV and to investigate the mechanisms involved in BAV degeneration. Thus, this study was based on the analysis of animal models and on the examination of a prospective cohort of 300 patients with BAV. Three hundred patients with BAV were prospectively included in our cohort to identify new genes involved in BAV by next generation sequencing and candidate-gene approach. The objective of this thesis was to improve our understanding of the pathophysiology of BAV and to assess the mechanisms underlying BAV degeneration by analyzing animal and clinical models

Traitement chirurgical de l'insuffisance mitrale fonctionnelle chronique (étude pronostique comparée de l'annuloplastie et du remplacement valvulaire)

AIX-MARSEILLE2-BU Méd/Odontol. (130552103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

An uncommon cause of tricuspid regurgitation: three-dimensional echocardiographic incremental value, surgical and genetic insights

International audienceCongenital tricuspid valve disease is a rare defect that includes regurgitation, stenosis and Ebstein's anomaly. We report a case of severe tricuspid regurgitation associated with functional mitral regurgitation in a 47-year-old man with congestive heart failure. Transthoracic echocardiography (TTE) ruled out any Ebstein's anomaly. Three-dimensional TTE revealed a `tricuspid hole' into the anterior leaflet that was only attached to the tricuspid annulus next to both anteroseptal and anteroposterior commissures. There was no sign of leaflet tear or perforation. The surgical repair of the tricuspid and mitral valves was performed with an optimal result. No sign of endocarditis or rheumatic disease was observed during the intervention. Sequence analysis of GATA4, HEY2 and ZFPM2 genes was performed, but no causative mutation was identified

Open-heart transcatheter aortic valve replacement in complex aortic valve reoperation: about a case series

International audienc

Genetic and phenotypic continuum of HOXA genes: A case with double HOXA9/HOXA13 mutations

International audienceThe HOXA genes cluster plays a key role in embryologic development. Mutations in HOXA genes have been linked to different human phenotypes, including developmental delay, limb anomalies, and urogenital malformations. The present study reported a clinical and genetic investigation of a female patient with polymalformative syndrome including left arm agenesis, bicornuate uterus and bicuspid aortic valve. using whole exome sequencing, two heterozygous missense variants were identified. Of these, one was a novel variant in the HOXA13 gene [p.(Tyr290Ser)] and the second a heterozygous variant in the HOXA9 gene [p.(ala102Pro)]. To the best of our knowledge, this is the first association of HOXA9/HOXA13 point mutations linked to a syndromic case. in conclusion, the present study suggested that the phenotypic spectrum of vertebral anomalies, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies and limb abnormalities/hand-foot-genital syndrome may be attributable to the combination of different HOXA variants, particularly in patients with a severe clinical presentation. The current report contributed as well to the molecular understanding of HOXA genes-related phenotypes via the identification of novel variant and genes associations