Publications by authors named "Jean Porterie"

28 Publications

  • Page 1 of 1

Characteristics and outcome of ambulatory heart failure patients receiving a left ventricular assist device.

ESC Heart Fail 2021 Sep 7. Epub 2021 Sep 7.

Cardiac Surgery Department and Cardiology Department, Cardiac Intensive Care Unit, Tours University Hospital, Tours, France.

Aims: Despite regularly updated guidelines, there is still a delay in referral of advanced heart failure patients to mechanical circulatory support and transplant centres. We aimed to analyse characteristics and outcome of non-inotrope-dependent patients implanted with a left ventricular assist device (LVAD).

Methods And Results: The ASSIST-ICD registry collected LVAD data in 19 centres in France between February 2006 and December 2016. We used data of patients in Interagency Registry for Mechanically Assisted Circulatory Support Classes 4-7. The primary endpoint was survival analysis. Predictors of mortality were searched with multivariable analyses. A total of 303 patients (mean age 61.0 ± 9.9 years, male sex 86.8%) were included in the present analysis. Ischaemic cardiomyopathy was the leading heart failure aetiology (64%), and bridge to transplantation was the main implantation strategy (56.1%). The overall likelihood of being alive while on LVAD support or having a transplant at 1, 2, 3, and 5 years was 66%, 61.7%, 58.7%, and 55.1%, respectively. Age [hazard ratio (HR) 1.03, 95% confidence interval (CI) 1.00-1.05; P = 0.02], a concomitant procedure (HR 2.32, 95% CI 1.52-3.53; P < 0.0001), and temporary mechanical right ventricular support during LVAD implantation (HR 2.94, 95% CI 1.49-5.77; P = 0.002) were the only independent variables associated with mortality. Heart failure medications before or after LVAD implantation were not associated with survival.

Conclusion: Ambulatory heart failure patients displayed unsatisfactory survival rates after LVAD implantation. A better selection of patients who can benefit from LVAD may help improving outcomes.
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http://dx.doi.org/10.1002/ehf2.13592DOI Listing
September 2021

Commentary: Enhanced open transcatheter mitral valve replacement: The ultimate hybrid approach.

JTCVS Tech 2021 Feb 18;5:29-30. Epub 2020 Nov 18.

Department of Cardiac Surgery, Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada.

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http://dx.doi.org/10.1016/j.xjtc.2020.11.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8300021PMC
February 2021

Commentary: Early failure of the Trifecta GT bioprosthesis: Innovation is not always progress.

JTCVS Tech 2020 Dec 28;4:109-110. Epub 2020 Sep 28.

Division of Cardiac Surgery, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.

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http://dx.doi.org/10.1016/j.xjtc.2020.09.033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8307754PMC
December 2020

Commentary: Biologic mustache for the modified Cabrol technique.

JTCVS Tech 2020 Dec 14;4:68-69. Epub 2020 Sep 14.

Department of Cardiac Surgery, Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada.

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http://dx.doi.org/10.1016/j.xjtc.2020.08.070DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8306568PMC
December 2020

Commentary: Thoracoabdominal aneurysmectomy: Operative steps for Crawford extent II repair: The devil is in the detail.

JTCVS Tech 2020 Sep 19;3:41-42. Epub 2020 Aug 19.

Department of Cardiac Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Québec, Canada.

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http://dx.doi.org/10.1016/j.xjtc.2020.08.044DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8305245PMC
September 2020

Clinical impact of the heart team on the outcomes of surgical aortic valve replacement among octogenarians.

J Thorac Cardiovasc Surg 2021 Mar 11. Epub 2021 Mar 11.

Department of Cardiac Surgery, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada. Electronic address:

Objectives: The effectiveness of a multidisciplinary heart team in the management of patients with severe symptomatic aortic stenosis is unknown. This study evaluated the impact of a heart team on the outcomes of surgical aortic valve replacement in octogenarians.

Methods: Between May 2007 and January 2016, 528 patients aged 80 years or more were referred to our institutional heart team for a transcatheter aortic valve replacement. Among these, 101 were redirected to surgical aortic valve replacement (heart team group). These patients were compared with a surgical aortic valve replacement cohort (n = 506) without prior heart team screening (non-heart team group), taken from the same time period. Propensity score matching with bootstrap analysis was performed; 76 heart team patients were matched to 76 non-heart team patients. Early and late outcomes including survival and readmission for cardiovascular causes were compared.

Results: Matched subgroups were largely comparable; congestive heart failure and echocardiographic pulmonary hypertension were more prevalent in the heart team group. In-hospital mortality was significantly lower in the matched heart team group (0% vs 6.0%, bootstrap mean difference 6.0%, 95% confidence interval, 2.2-9.8). The risk of stroke, low cardiac output state, reexploration for bleeding, pneumonia, and prolonged ventilation was also significantly lower in the heart team group. There was no significant between-group difference regarding late survival (hazard ratio, 0.86, 95% confidence interval, 0.55-1.33, P = .49) or readmission for cardiovascular reasons (hazard ratio, 0.70, 95% confidence interval, 0.41-1.20, P = .19).

Conclusions: Preoperative multidisciplinary assessment of octogenarians by a heart team was associated with lower in-hospital mortality and adverse events after surgical aortic valve replacement.
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http://dx.doi.org/10.1016/j.jtcvs.2021.03.030DOI Listing
March 2021

Comparison of Outcomes and Mortality in Patients Having Left Ventricular Assist Device Implanted Early -vs- Late After Diagnosis of Cardiomyopathy.

Am J Cardiol 2021 05 4;146:82-88. Epub 2021 Feb 4.

Department of Cardiology and Cardiac Surgery, AP-HP CHU Henri Mondor, Créteil, France.

LVAD implantation in patients with a recently diagnosed cardiomyopathy has been poorly investigated. This work aims at describing the characteristics and outcomes of patients receiving a LVAD within 30 days following the diagnosis of cardiomyopathy. Patients from the ASSIST-ICD study was divided into recently and remotely diagnosed cardiomyopathy based on the time from initial diagnosis of cardiomyopathy to LVAD implantation using the cut point of 30 days. The primary end point of the study was all-cause mortality at 30-day and during follow-up. A total of 652 patients were included and followed during a median time of 9.1 (2.5 to 22.1) months. In this population, 117 (17.9%) had a recently diagnosed cardiomyopathy and had LVAD implantation after a median time of 15.0 (9.0 to 24.0) days following the diagnosis. This group of patients was significantly younger, with more ischemic cardiomyopathy, more sudden cardiac arrest (SCA) events at the time of the diagnosis and were more likely to receive temporary mechanical support before LVAD compared with the remotely diagnosed group. Postoperative in-hospital survival was similar in groups, but recently diagnosed patients had a better long-term survival after hospital discharge. SCA before LVAD and any cardiac surgery combined with LVAD implantation were identified as 2 independent predictors of postoperative mortality in recently diagnosed patients. In conclusion, rescue LVAD implantation for recently diagnosed severe cardiomyopathy is common in clinical practice. Such patients experience a relatively low postoperative mortality and have a better long-term survival compared with remotely diagnosed patients.
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http://dx.doi.org/10.1016/j.amjcard.2021.01.027DOI Listing
May 2021

Postoperative Delirium is a Risk Factor of Poor Evolution Three Years After Cardiac Surgery: An Observational Cohort Study.

Clin Interv Aging 2020 18;15:2375-2381. Epub 2020 Dec 18.

Anesthesiology and Intensive Care Department, CHU Toulouse, Toulouse, France.

Background: After cardiac surgery, postoperative delirium (POD) is common and is associated with long-term changes in cognitive function. Impact on health-related quality of life (QOL) and long-term dependence are not well known. This aim of this study is to evaluate the role of POD in poor evolution at three years after surgery including poor QOL and dependence and mortality.

Patients And Methods: We enrolled and followed 173 patients 60 years of age or older who were planning to undergo cardiac surgery with cardiopulmonary bypass. The primary composite outcome was death of any causes, or patients with either a loss of QOL (evaluated with of EuroQuol verbal 5D EQ5D less than 50), or a loss of two points on the instrumental activities of daily living occurring three years after surgery. POD was diagnosed with the use of Confusion Assessment Method. Multivariate logistic regression was performed.

Results: At three years, 74 patients (42.8%) had a poor evolution. Independent risk factors in poor patient evolution were sex (female gender; OR: 3.6; 95%CI: 1.45-8.7; =0.006), metabolic status (diabetic patients; OR: 4; 95%CI: 1.6-10.2; =0.002), Euroscore 2 (Euroscore 2 >1.5; OR: 5.2; 95%CI: 1.7-15.4; =0.003) and POD (OR: 3.3; 95%CI 1.4-7.8; =0.006). Coronary disease was protective (OR: 0.3; 95%CI: 0.14-0.71; =0.006).

Conclusion: After cardiac surgery, POD significantly altered patient evolution and increased risk of dependence and loss of QOL.
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http://dx.doi.org/10.2147/CIA.S265797DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7755370PMC
April 2021

Early Evaluation of Patients on Axial Flow Pump Support for Refractory Cardiogenic Shock is Associated with Left Ventricular Recovery.

J Clin Med 2020 Dec 21;9(12). Epub 2020 Dec 21.

Intensive Cardiac Care Unit, Department of Cardiology, Rangueil University Hospital, 31059 Toulouse, France.

We investigated prognostic factors associated with refractory left ventricle (LV) failure leading to LV assist device (LVAD), heart transplant or death in patients on an axial flow pump support for cardiogenic shock (CS). Sixty-two CS patients with an Impella CP or 5.0 implant were retrospectively enrolled, and clinical, biological, echocardiographic, coronarographic and management data were collected. They were compared according to the 30-day outcome. Patients were mainly male ( = 55, 89%), 58 ± 11 years old and most had no history of heart failure or coronary artery disease (70%). The main etiology of CS was acute coronary syndrome ( = 57, 92%). They presented with severe LV failure (LV ejection fraction (LVEF) 22 ± 9%), organ malperfusion (lactate 3.1 ± 2.1 mmol/L), and frequent use of inotropes, vasopressors, and mechanical ventilation (59, 66 and 30%, respectively). At 24 h, non-recovery was associated with higher total bilirubin (odds ratios (OR) 1.07 (1.00-1.14); = 0.039), lower LVEF (OR 0.89 (0.81-0.96); = 0.006) and the number of administrated amines (OR 4.31 (1.30-14.30); = 0.016). Early evaluation in patients with CS with an axial flow pump implant may enable the identification of factors associated with an unlikely recovery and would call for early screening for LVAD or heart transplant.
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http://dx.doi.org/10.3390/jcm9124130DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7767477PMC
December 2020

Commentary: Preoperative Screening CT: Not Ready for Primetime in The COVID-19 Era.

Semin Thorac Cardiovasc Surg 2021 7;33(2):425-426. Epub 2020 Nov 7.

Department of Cardiac Surgery, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada. Electronic address:

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http://dx.doi.org/10.1053/j.semtcvs.2020.10.035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7834735PMC
May 2021

The frozen elephant trunk technique in an emergency: THORAFLEX French National Registry offers new insights.

Eur J Cardiothorac Surg 2020 Nov 3. Epub 2020 Nov 3.

Federation of Heart, Lung and Vessels, University Hospital Amiens-Picardie, Amiens, France.

Objectives: Our goal was to study the immediate outcome after an emergency frozen elephant trunk procedure with a Thoraflex™ Hybrid prosthesis (THP) in patients included in the EPI-Flex national registry and operated on in 21 French centres.

Methods: All patients operated on in France between April 2016 and April 2019 for acute aortic syndromes and who had an frozen elephant trunk procedure with a THP were included in the study. The main end point was in-hospital mortality. The secondary end point was neuromorbidity, including paraplegia. The evolution of the main end point was monitored using a variable life-adjusted display graph with cumulative sum derivatives in order to stop inclusions in case the observed mortality became out of range compared to an expected mortality between 15% and 20%.

Results: Enrolment ended on the scheduled date and included 109 patients. Most cases (54%) were performed at 3 centres, where more than 10 THP each were implanted (10-26). The observed mortality in the large-volume centres (22%) was comparable to that observed in the low-volume centres (20%). The individually risk-adjusted cumulative sum revealed that observed in-hospital mortality was statistically in line with that predicted by the log EuroSCORE. Analysis of the secondary end point revealed 8% cases of paraplegia, all of which appeared after treatment of the thoracic type A aortic dissection.

Conclusions: In France, THP for emergency frozen elephant trunk surgery outside high-volume centres did not result in excessive in-hospital deaths. However, a word of caution must be expressed regarding the prevention of medullar ischaemia even in emergency aortic surgery.
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http://dx.doi.org/10.1093/ejcts/ezaa325DOI Listing
November 2020

Renal Artery Outcomes After Open Repair of Suprarenal or Type IV Thoraco-abdominal Aortic Aneurysms.

Eur J Vasc Endovasc Surg 2020 11 1;60(5):678-686. Epub 2020 Sep 1.

Department of Vascular Surgery, Rangueil University Hospital, Toulouse, France. Electronic address:

Objective: The aim of this study was to evaluate the mid and long term patency of elective renal artery reconstructions during open surgical repair of suprarenal aortic aneurysms (SRAA) and type 4 thoraco-abdominal aortic aneurysms (T4AAA).

Methods: This retrospective, single centre study included all consecutive patients who underwent surgery for SRAA or T4AAA between January 2009 and December 2019 at Toulouse University Hospital. All patients underwent strict pre-operative planning with computed tomography angiography (CTA) and 3D reconstruction of the aortic aneurysm, visceral and renal artery anatomy to choose the most appropriate surgical technique for each case. Primary patency, primary assisted patency, and rates of re-intervention were calculated using the Kaplan-Meier method.

Results: In total, 103 patients, having undergone 159 renal artery revascularisation procedures, were enrolled in the study. Fifty-five patients presented with a type T4AAA and 48 patients with a SRAA. In hospital mortality was 2.9%. In association with aortic surgery, 100 direct re-implantation (62.8%), 48 retrograde bypasses (30.1%), and 11 anterograde bypasses (6.9%) of the renal arteries were performed. Median follow up was 45.9 ± 36 months. Renal artery primary patency rates were 99.4%, 96.4%, and 93.1% at one, three, and five years, respectively. Assisted primary patency rates were 99.4%, 97.7%, and 97.7% at one, three, and five years, respectively, with five cases of renal stenosis > 70% successfully treated by renal stenting. No significant difference in patency was found regarding the type of renal revascularisation.

Conclusion: This retrospective study suggests that the mid term patency of elective open renal artery reconstruction during SRAA and type T4AAA surgery preceded by pre-operative planning with 3D-CTA reconstruction, yields excellent outcomes whatever the technique used.
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http://dx.doi.org/10.1016/j.ejvs.2020.07.052DOI Listing
November 2020

Relation of Body Mass Index to Outcomes in Patients With Heart Failure Implanted With Left Ventricular Assist Devices.

Am J Cardiol 2020 10 6;133:81-88. Epub 2020 Aug 6.

Department of Cardiology and cardiac surgery, University Hospital, Dijon, France.

We aimed at characterizing the impact of low and high body mass index (BMI) on outcomes after left-ventricular assist device (LVAD) surgery and define the predictors of mortality in patients with abnormal BMI (low/high). This study was conducted in 19 centers from 2006 to 2016. Patients were divided based on their baseline BMI into 3 groups of BMI: low (BMI ≤18.5 kg/m²); normal (BMI = 18.5 to 24.99 kg/m²) and high (BMI ≥25 kg/m²) (including overweight (BMI = 25 to 29.99 kg/m²), and obesity (BMI ≥30 Kg/m²)). Among 652 patients, 29 (4.4%), 279 (42.8%) and 344 (52.8%) had a low-, normal-, and high BMI, respectively. Patients with high BMI were significantly more likely men, with more co-morbidities and more history of ventricular/supra-ventricular arrhythmias before LVAD implantation. Patients with abnormal BMI had significantly lower survival than those with normal BMI. Notably, those with low BMI experienced the worst survival whereas overweight or obese patients had similar survival. Four predictors of mortality for LVAD candidates with abnormal BMI were defined: total bilirubin ≥16 µmol/L before LVAD, hypertension, destination therapy, and cardiac surgery with LVAD. Depending on the number of predictor per patients, those with abnormal BMI may be divided in 3 groups of 1-year mortality risk, i.e., low (0 to 1 predictor: 29% and 31%), intermediate (2 to 3 predictors, 51% and 52%, respectively), and high (4 predictors: 83%). In conclusion, LVAD recipients with abnormal BMI experience lower survival, especially underweight patients. Four predictors of mortality have been identified for LVAD population with abnormal BMI, differentiating those a low-, intermediate-, and high risks of death.
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http://dx.doi.org/10.1016/j.amjcard.2020.07.045DOI Listing
October 2020

Commentary: Rheumatic valve surgery in emerging countries: New insights for an old disease.

J Thorac Cardiovasc Surg 2021 Dec 11;162(6):1728-1729. Epub 2020 Apr 11.

Division of Cardiac Surgery, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada. Electronic address:

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http://dx.doi.org/10.1016/j.jtcvs.2020.03.126DOI Listing
December 2021

Influence of extracorporeal membrane oxygenation on the pharmacokinetics of ceftolozane/tazobactam: an ex vivo and in vivo study.

J Transl Med 2020 05 27;18(1):213. Epub 2020 May 27.

Pharmacokinetics and Toxicology Laboratory, Toulouse University Hospital, Toulouse, France.

Background: Extracorporeal membrane oxygenation (ECMO) is increasingly used in intensive care units and can modify drug pharmacokinetics and lead to under-exposure associated with treatment failure. Ceftolozane/tazobactam is an antibiotic combination used for complicated infections in critically ill patients. Launched in 2015, sparse data are available on the influence of ECMO on the pharmacokinetics of ceftolozane/tazobactam. The aim of the present study was to determine the influence of ECMO on the pharmacokinetics of ceftolozane-tazobactam.

Methods: An ex vivo model (closed-loop ECMO circuits primed with human whole blood) was used to study adsorption during 8-h inter-dose intervals over a 24-h period (for all three ceftolozane/tazobactam injections) with eight samples per inter-dose interval. Two different dosages of ceftolozane/tazobactam injection were studied and a control (whole blood spiked with ceftolozane/tazobactam in a glass tube) was performed. An in vivo porcine model was developed with a 1-h infusion of ceftolozane-tazobactam and concentration monitoring for 11 h. Pigs undergoing ECMO were compared with a control group. Pharmacokinetic analysis of in vivo data (non-compartmental analysis and non-linear mixed effects modelling) was performed to determine the influence of ECMO.

Results: With the ex vivo model, variations in concentration ranged from - 5.73 to 1.26% and from - 12.95 to - 2.89% respectively for ceftolozane (concentrations ranging from 20 to 180 mg/l) and tazobactam (concentrations ranging from 10 to 75 mg/l) after 8 h. In vivo pharmacokinetic exploration showed that ECMO induces a significant decrease of 37% for tazobactam clearance without significant modification in the pharmacokinetics of ceftolozane, probably due to a small cohort size.

Conclusions: Considering that the influence of ECMO on the pharmacokinetics of ceftolozane/tazobactam is not clinically significant, normal ceftolozane and tazobactam dosing in critically ill patients should be effective for patients undergoing ECMO.
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http://dx.doi.org/10.1186/s12967-020-02381-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7251674PMC
May 2020

Complete aortic replacement in aortitis due to aseptic abscess syndrome.

J Vasc Surg Cases Innov Tech 2020 Jun 23;6(2):216-220. Epub 2020 Apr 23.

Department of Vascular Surgery, Rangueil University Hospital, Toulouse, France.

A 36-year-old man was admitted for a tender inflammatory type IV thoracoabdominal aortic aneurysm with multiple aortic dilations. After open repair, he remained frail, but results of all infectious and inflammatory investigations were negative. Hypermetabolic intrasplenic collections were discovered on postoperative computed tomography, and aortitis with aseptic abscess syndrome was strongly suggested. Immunosuppressive therapy was undertaken, and his health improved dramatically. After 7 years of treatment, however, the initial aortic dilations had developed in size, necessitating multiple surgical procedures leading to complete aortic replacement. The postoperative course was uneventful with a satisfactory final computed tomography scan. Subsequent to immunotherapy, no new aneurysm developed.
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http://dx.doi.org/10.1016/j.jvscit.2020.02.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7184059PMC
June 2020

Infective Endocarditis in a Third Trimester Pregnant Woman: Team Work Is the Best Option.

JACC Case Rep 2020 Apr 15;2(4):521-525. Epub 2020 Apr 15.

Department of Cardiology, Rangueil University Hospital, Toulouse, France.

Infective endocarditis in pregnancy may have a misleading presentation and carries a high-risk of complications for both the mother and her infant. When urgent valve surgery is required, the fetal risk relative to cardiopulmonary bypass is challenging requiring a multidisciplinary management. We report the case of a pregnant woman with infective endocarditis on a bicuspid aortic valve who was successfully treated by a 2-step strategy including cardiac surgery. ().
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http://dx.doi.org/10.1016/j.jaccas.2020.02.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8298775PMC
April 2020

Commentary: Subclinical valve thrombosis: A game-changer issue in transcatheter aortic valve replacement?

J Thorac Cardiovasc Surg 2021 11 21;162(5):1500-1501. Epub 2020 Feb 21.

Department of Cardiac Surgery, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada. Electronic address:

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http://dx.doi.org/10.1016/j.jtcvs.2020.02.064DOI Listing
November 2021

Post-kyphoplasty cement embolism migrating to the peritoneum through the right ventricle.

J Cardiovasc Comput Tomogr 2020 Nov - Dec;14(6):e159-e160. Epub 2020 Feb 13.

Cardio-thoracic Surgery Department, Dupuytren Teaching Hospital, Limoges, France.

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http://dx.doi.org/10.1016/j.jcct.2020.02.003DOI Listing
February 2021

Contribution and performance of multimodal imaging in the diagnosis and management of cardiac masses.

Int J Cardiovasc Imaging 2020 May 10;36(5):971-981. Epub 2020 Feb 10.

Department of Cardiology, Rangueil University Hospital, Toulouse, France.

To evaluate the contribution and performance of multimodal imaging in the diagnostic and therapeutic management of cardiac masses. We carried out a monocentric retrospective study on patients referred for cardiac mass assessment between 2006 and 2019, and analyzed the respective contribution of transesophageal echocardiography (TEE), cardiac computed tomography (CT), cardiac magnetic resonance (CMR) and F-fluorodeoxyglucose positron emission tomography coupled with CT (F-FDG PET-CT). For each test, we determined strategy before and after its completion (need for another imaging or decision-making) as well as result on benign, malignant or indeterminate nature. For the 119 patients included, all imaging modalities increased decision-making rates, which rose from 2 to 54%, 23 to 62%, 31 to 85% and 49 to 100% before and after TEE, CT, CMR and F-FDG PET-CT, respectively (P < 0.001 before vs. after). TEE was particularly efficient for atrial masses, especially for the left atrium, with a decision rate rising from 0 to 74% (P < 0.001). F-FDG PET-CT was the most efficient to differentiate benign and malignant etiologies (area under the curve 0.89 ± 0.06 and 0.94 ± 0.05 for benign and malignant, respectively, P < 0.001). A benign or undetermined result on each modality was associated with a good prognosis, compared to malignant. All modalities studied are useful for cardiac mass decision-making. First-line TEE is particularly efficient for atrial masses, whereas CT and CMR are useful for ventricular masses or suspicion of malignancy. A benign or malignant result for each modality is correlated to survival and F-FDG PET-CT is the most effective to define it.
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http://dx.doi.org/10.1007/s10554-020-01774-zDOI Listing
May 2020

Participating in Sports After Mitral Valve Repair for Primary Mitral Regurgitation: A Retrospective Cohort Study.

Clin J Sport Med 2021 09;31(5):414-422

Department of Cardiology, University Hospital of Rangueil, Toulouse, France.

Objective: Participating in either competitive or leisure sports is restrictive after surgical mitral valve repair (MVR). In this study, we examine the impact of sports on outcomes after MVR.

Design: Retrospective cohort study.

Setting: Patients aged 18 to 65 years who underwent a first-time MVR for primary mitral regurgitation (MR) in a tertiary care center.

Patients: One hundred twenty-one consecutive patients were included in the study. The exclusion criteria were as follows: other concomitant procedures, early perioperative death or repeat intervention, noncardiac death or endocarditis during follow-up, and general contraindications for normal physical activity.

Assessment Of Risk Factors: Participation in sports was quantified by the number of hours per week during the past 6 months, classified according to the Mitchell classification and assessed with the International Physical Activity Questionnaire (IPAQ) short form.

Main Outcome Measures: The primary composite endpoint was MVR failure defined as MR grade ≥2 or mean transmitral gradient ≥8 mm Hg, signs and symptoms of heart failure, or late-onset postoperative AF (>3 months).

Results: The mean age was 50 ± 11 years, and there were 85 (71%) men. The median follow-up was 34 months [interquartile range (IQR): 20-50]. Fifty-six (46%) patients participated in sports regularly (median of 3 h/wk; IQR: 2-5). Twenty (17%) patients reached the primary composite endpoint with no correlation with participation in sports (P = 0.537), IPAQ categories (P = 0.849), in any of the Mitchell classification subgroups and a high level of participation in sports ≥6 hours (P = 0.679).

Conclusions: Sports seem to be unrelated to the worst outcome after MVR.
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http://dx.doi.org/10.1097/JSM.0000000000000769DOI Listing
September 2021

Predictive factors for long-term mortality in miscellaneous cardiogenic shock: Protective role of beta-blockers at admission.

Arch Cardiovasc Dis 2019 Dec 31;112(12):738-747. Epub 2019 May 31.

Department of cardiology, Rangueil university hospital, 31059 Toulouse, France; Rangueil medical school, university Paul Sabatier, 31059 Toulouse, France; Cardiac imaging centre, Toulouse university hospital, 31059 Toulouse, France; Department of nuclear medicine, Rangueil university hospital, 31059 Toulouse, France.

Background: Despite advances in intensive care medicine, management of cardiogenic shock (CS) remains difficult and imperfect, with high mortality rates, regardless of aetiology. Predictive data regarding long-term mortality rates in patients presenting CS are sparse.

Aim: To describe prognostic factors for long-term mortality in CS of different aetiologies.

Methods: Two hundred and seventy-five patients with CS admitted to our tertiary centre between January 2013 and December 2014 were reviewed retrospectively. Mortality was recorded in December 2016. A Cox proportional-hazards model was used to determine predictors of long-term mortality.

Results: Most patients were male (72.7%), with an average age of 64±16 years and a history of cardiomyopathy (63.5%), mainly ischaemic (42.3%). Leading causes of CS were myocardial infarction (35.3%), decompensated heart failure (34.2%) and cardiac arrest (20.7%). Long-term mortality was 62.5%. After multivariable analysis, previous use of beta-blockers (hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.41-0.89; P=0.02) and coronary angiography exploration at admission (HR 0.57, 95% CI 0.38-0.86; P=0.02) were associated with a lower risk of long-term mortality. Conversely, age (HR 1.02 per year, 95% CI 1.01-1.04; P<0.001), catecholamine support (HR 1.45 for each additional agent, 95% CI 1.20-1.75; P<0.001) and renal replacement therapy (HR 1.66, 95% CI 1.09-2.55; P=0.02) were associated with an increased risk of long-term mortality.

Conclusions: Long-term mortality rates in CS remain high, reaching 60% at 1-year follow-up. Previous use of beta-blockers and coronary angiography exploration at admission were associated with better long-term survival, while age, renal replacement therapy and the use of catecholamines appeared to worsen the prognosis, and should lead to intensification of CS management.
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http://dx.doi.org/10.1016/j.acvd.2019.04.004DOI Listing
December 2019

Transaortic Left Ventricular Unloading in VA-ECMO: The Transsubclavian Route.

Ann Thorac Surg 2019 10 13;108(4):e269-e270. Epub 2019 Mar 13.

Department of Cardiac Surgery, CHU Clermont-Ferrand, Clermont-Ferrand, France.

Left ventricular unloading during extracorporeal life support aims to minimize potential side effects of increased left ventricular afterload. A transaortic catheter vent implanted through a subclavian approach was used in 2 patients. Patient 1 was a 48-year-old man with a recent history of ST-elevation myocardial infarction who developed refractory cardiogenic shock due to severe biventricular dysfunction. Patient 2 was a 56-year-old man admitted for severe flu. The unloading procedure was successful in both patients, with bridge to heart transplantation in the first case and bridge to recovery in the other.
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http://dx.doi.org/10.1016/j.athoracsur.2019.01.080DOI Listing
October 2019

Comparison of the Frequency of Thrombocytopenia After Transfemoral Transcatheter Aortic Valve Implantation Between Balloon-Expandable and Self-Expanding Valves.

Am J Cardiol 2019 04 4;123(7):1120-1126. Epub 2019 Jan 4.

Cardiology Department, Rangueil University Hospital, Toulouse, France. Electronic address:

Thrombocytopenia after transcatheter aortic valve implantation (TAVI) is common and has been related to worse clinical outcomes. Comparison of platelet kinetics among different types of valves is limited. Our objectives were to analyze the differences in drop platelet count (DPC) between balloon-expandable valves (BEVs) and self-expanding valves and their prognostic implications after TAVI. Patients who underwent transfemoral TAVI from 2008 to 2016 were included. Exclusion criteria were severe baseline thrombocytopenia and periprocedural death. Postprocedural platelet counts were collected. Two groups were created: DPC ≤30 and DPC >30%. Valve Academic Research Consortium-2 criteria were used to define outcomes. Study population included 609 patients (age 84.7 ± 6.0, 46.6% males). The mean DPC was 32.5 ± 13.9%. The DPC was higher in the BEV arm (33.9 ± 14.2 vs 30.7 ± 13.4%, p = 0.006), and the nadir was reached later in comparison to the self-expanding valve arm (3.0 ± 1.3 vs 2.5 ± 1.1 days, p <0.001). After multivariable analysis, the use of BEV, known coronary artery disease, and left ventricle ejection fraction were the factors associated with a higher rate of DPC >30%. At 30 days, the DPC >30% was related with a higher rate of life-threatening and/or major bleeding (6.8 vs 2.1%, p = 0.009) and death (3.5 vs 0.8%, p = 0.036). At 1 year, the difference in mortality disappeared. In conclusion, in this cohort of patients, the use of BEV seems to be associated with a higher risk of DPC after TAVI. A DPC ≥30% was related with increased risk of life-threatening and/or major bleeding and death at 30 days. Larger and prospective studies are needed to understand this phenomenon.
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http://dx.doi.org/10.1016/j.amjcard.2018.12.036DOI Listing
April 2019

Aortic and innominate routes for transcatheter aortic valve implantation.

J Thorac Cardiovasc Surg 2019 04 31;157(4):1393-1401.e7. Epub 2018 Aug 31.

Department of Cardiovascular Surgery, Rangueil University Hospital, Toulouse, France.

Objectives: This study aimed at evaluating the efficacy and safety of the transaortic approach for the transcatheter aortic valve implantation procedure using balloon-expandable and self-expanding devices.

Methods: From January 2012 to December 2016, the transaortic-transcatheter aortic valve implantation procedure was performed in 206 consecutive patients at the Rangueil University Hospital. All procedures were performed by a multidisciplinary heart team. The ascending aorta (27%) or innominate artery (73%) was exposed through a J-type manubriotomy. Events were adjudicated according to Valve Academic Research Consortium-2 criteria.

Results: Mean age and logistic European System for Cardiac Risk Evaluation II were 83.9 ± 6.7 years and 16.8% ± 10.8%, respectively. Balloon-expandable and self-expanding valves were implanted in 59.7% and 40.3% of patients, respectively. Device success rate was 98.1%. Thirty-day overall mortality, cardiovascular mortality, cerebrovascular event, myocardial infarction, and permanent pacemaker implantation rates were 5.3%, 4.4%, 1.5%, 1.0%, and 9.7%, respectively (1-year rates: 15.5%, 9.2%, 3.9%, 3.4%, and 10.2%, respectively). Life-threatening bleeding and major vascular complications (7.3% and 3.9%, respectively) were not related to the central access site in approximately half of the cases. Multivariable Cox regression analysis identified preoperative renal failure as an independent predictor of overall mortality (odds ratio, 2.82; 95% confidence interval, 1.73-4.59; P < .0001). At the 1-year follow-up, most patients had experienced improved functional status and 98.4% of them were free of moderate to severe paravalvular leak.

Conclusions: In a higher-risk subgroup within the patient population receiving transcatheter aortic valve implantation, transaortic-transcatheter aortic valve implantation was successfully performed in 98.1% of cases, with high functional improvement and low rates of mortality and adverse events, especially neurologic complications.
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http://dx.doi.org/10.1016/j.jtcvs.2018.07.098DOI Listing
April 2019

Propensity-matched comparison of clinical outcomes after transaortic versus transfemoral aortic valve replacement.

EuroIntervention 2018 Sep;14(7):750-757

Department of Cardiology, Rangueil University Hospital, Toulouse, France.

Aims: We aimed to compare the long-term outcomes of transaortic (TAo-AVR) and transfemoral (TF-AVR) transcatheter aortic valve replacement.

Methods And Results: Between January 2012 and December 2015, consecutive TAo-AVR and TF-AVR cases were compared using a propensity score-matching analysis. Primary endpoints were 30-day and one-year mortality; 644 TAVR patients were included (163 TAo-AVR and 481 TF-AVR). Peripheral artery disease (31.9% vs. 5%, p<0.001) and coronary artery disease (50.0% vs. 39.3%, p=0.009) were more frequent in TAo-AVR patients. The Society of Thoracic Surgeons scores were not different (6.9% vs. 6.5%, p=0.243). Propensity matching identified 124 well-matched patient pairs. Thirty-day and one-year mortality rates were similar in the overall population of TAo-AVR and TF-AVR patients (7.3% vs 7.6%, p=0.8 and 18.4% vs. 15.8%, p=0.6, respectively), and in the matched cohort (7.3% vs. 6.5%, p=0.8 and 15.3% vs. 16.1%, p=0.8, respectively). Transaortic access was associated with higher risk of new onset of atrial fibrillation (NOAF) (24.4% vs. 9.6%, p=0.012), life-threatening bleedings (6.5% vs. 0.8%, p=0.036) and transfusion (41% vs. 16.7%, p<0.001).

Conclusions: No significant differences were observed between the respective 30-day and one-year mortality rates of TAo-AVR and TF-AVR patients. The transaortic approach thus constitutes a valid alternative to TF-AVR, but is associated with higher rates of NOAF, bleedings, and transfusion.
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http://dx.doi.org/10.4244/EIJ-D-18-00168DOI Listing
September 2018

Anatomical basis of the risk of injury to the right laryngeal recurrent nerve during thoracic surgery.

Surg Radiol Anat 2012 Aug 25;34(6):509-12. Epub 2012 Feb 25.

Laboratory of Human Anatomy, Purpan Medical University, Université Paul Sabatier, 133 route de Narbonne, 31062, Toulouse, France.

Purpose: Despite the intrathoracic part being short, the right laryngeal recurrent nerve is often injured during thoracic surgery. The aim of this cadaver study was to understand the mechanisms of right laryngeal recurrent nerve injuries during thoracic surgery and to describe anatomical landmarks for its preservation.

Methods: Dissections were performed on 10 fresh human cadavers. A right anterolateral thoracic wall segment was removed, preserving the first rib. Dissections were carried out to identify the following structures: first rib, esophagus, trachea, right main bronchus, right brachiocephalic and subclavian vessels, azygos vein, phrenic nerve, vagus nerve, and right laryngeal recurrent nerve.

Results: The distance between the origin of the right laryngeal recurrent nerve and its adjacent structures was assessed. Moderate traction of the thoracic part of the vagus nerve resulted in a downward translation of the right laryngeal recurrent nerve's origin. In such conditions, the right laryngeal recurrent nerve's origin was distant of 14.8 mm (±2.89 mm) from the subclavian artery.

Conclusions: Intraoperative incidence of right laryngeal recurrent nerve direct injury could be decreased by understanding the detailed course of its intrathoracic part. Moreover, traction on the intrathoracic part of the right vagus nerve may result in indirect lesions of the right laryngeal recurrent nerve: stretch induced lesions and nerve vasculature's lesions.
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http://dx.doi.org/10.1007/s00276-012-0946-7DOI Listing
August 2012

Commentary: Endovascular treatment of residual aortic dissection.

J Endovasc Ther 2011 Jun;18(3):374-5

Department of Cardiovascular, University Hospital of Rangueil, Toulouse, France.

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http://dx.doi.org/10.1583/11-3397C.1DOI Listing
June 2011
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