Transcatheter Valve-in-Valve and Valve-in-Ring for Treating Aortic and Mitral Surgical Prosthetic Dysfunction

AbstractBioprosthetic valve use has increased significantly. Considering their limited durability, there will remain an ongoing clinical need for repairing or replacing these prostheses in the future. The current standard of care for treating bioprosthetic valve degeneration involves redo open-heart surgery. However, repeat cardiac surgery may be associated with significant morbidity and mortality. With the rapid evolution of transcatheter heart valve therapies, the feasibility and safety of implanting a transcatheter heart valve within a failed tissue valve has been established. We review the historical perspective of transcatheter valve-in-valve therapy, as well as the main procedural challenges and clinical outcomes associated with this new less invasive treatment option

The Canadian WATCHMAN Registry for Percutaneous Left Atrial Appendage Closure

BACKGROUND Access to left atrial appendage closure (LAAC) in Canada is limited, due to funding restrictions. This work aimed to assess Canadian clinical practice on patient selection, postprocedural antithrombotic therapy, and safety and/or efficacy with WATCHMAN device implantation. METHODS Seven Canadian centres implanting the WATCHMAN device participated in this prospective multicentre, observational registry. All procedures were done under general anesthesia with transesophageal echocardiography guidance. Patients were prospectively followed for 2years. The long-term stroke rate was compared with the expected rate based on the CHA$_{2}$DS$_{2}$-VASc score. RESULTS A total of 272 patients who underwent LAAC with the WATCHMAN device between December 2013 and August 2019 (mean age: 75.4 years [standard deviation {SD}: 8.75]; male, 63.2%; CHA$_{2}$DS$_{2}$-VASc score: 4.35 [SD: 1.64]; HAS-BLED score: 3.55 [SD: 0.94]) were included. Most patients (90.4%) had prior history of bleeding (major, 80.5%; minor, 21.7%). The WATCHMAN device was successfully implanted in 269 patients (98.9%), with a few procedure-related complications, including 5 pericardial effusions requiring drainage (1.8%), and 1 death (0.4%; 22 days post-LAAC from respiratory failure). Post-LAAC antithrombotic therapy included dual antiplatelet therapy in 70.6%, single antiplatelet therapy in 18.4%, and oral anticoagulation in 13.6%. During the follow-up period (mean: 709.7 days [SD: 467.2]), an 81.4% reduction of the ischemic stroke rate occurred, based on the expected rate from the CHA$_{2}$DS$_{2}$-VASc score (6.0% expected vs 1.1% observed). Device-related thrombus was detected in 1.8%. CONCLUSIONS The majority of Canadian patients who underwent LAAC had oral anticoagulation contraindication due to prior bleeding, and most were safely treated with antiplatelet therapy post-LAAC, with a low device-related thrombus incidence. Long-term follow-up demonstrated that LAAC achieved a significant reduction in ischemic stroke rate

Centre d’anthropologie sociale – CAS

Jean-Pierre Albert, directeur d’étudesAnne Bouchy, directrice d’études à l’EFEO La mort et les religions. Études comparatives Avec Marlène Albert-Llorca, Alain Ballabriga, Anny Bloch-Raymond, Marine Carrin, Patrizia Ciambelli, Jean-Louis Ormières, Valérle Robin, Guillaume Rozenberg, Harald Tambs-Lyche, Sébastien Tank-Storper, Claudine Vassas. Les séances ont été centrées sur le thème « Mort, religion et politique », avec deux orientations principales : Les enjeux des rites funéraires et de la..

Centre d’anthropologie sociale – CAS

Jean-Pierre Albert, directeur d’étudesAnne Bouchy, directrice d’études à l’EFEO La mort et les religions. Études comparatives Avec Marlène Albert-Llorca, Alain Ballabriga, Anny Bloch-Raymond, Marine Carrin, Patrizia Ciambelli, Jean-Louis Ormières, Valérle Robin, Guillaume Rozenberg, Harald Tambs-Lyche, Sébastien Tank-Storper, Claudine Vassas. Les séances ont été centrées sur le thème « Mort, religion et politique », avec deux orientations principales : Les enjeux des rites funéraires et de la..