Institute Cardiovasculaire Paris Sud

Saint-Lambert-du-Lattay, France

Institute Cardiovasculaire Paris Sud

Saint-Lambert-du-Lattay, France
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Lefevre T.,Institute Cardiovasculaire Paris Sud | Girasis C.,Onassis Cardiac Surgery Center | Lassen J.F.,Copenhagen University
EuroIntervention | Year: 2015

The left main is the largest bifurcation of the coronary tree and is, therefore, easier to access. Nevertheless, the risks of untoward consequences associated with the loss of the side branch are much higher. Although the usual technical strategies implemented in coronary bifurcations can generally be applied to left main lesions, several inherent characteristics (the ostial position of the main branch, the size of the side branch, the amount of calcification, the angle which is often in a T shape, the use of stents of variable suitability, the crucial role of POT) need to be taken into account in order to achieve optimal acute and long-term results. © 2015 Europa Digital & Publishing. All rights reserved.


Morice M.-C.,Institute Cardiovasculaire Paris Sud | Serruys P.W.,Erasmus University Rotterdam | Kappetein A.P.,Erasmus University Rotterdam | Feldman T.E.,Evanston Hospital | And 11 more authors.
Circulation | Year: 2014

Background-Current guidelines recommend coronary artery bypass graft surgery (CABG) when treating significant de novo left main coronary artery (LM) stenosis; however, percutaneous coronary intervention (PCI) has a class IIa indication for unprotected LM disease in selected patients. This analysis compares 5-year clinical outcomes in PCI- and CABG-treated LM patients in the Synergy Between PCI With Taxus and Cardiac Surgery (SYNTAX) trial, the largest trial in this group to date. Methods and Results-The SYNTAX trial randomly assigned 1800 patients with LM or 3-vessel disease to receive either PCI (with TAXUS Express paclitaxel-eluting stents) or CABG. The unprotected LM cohort (N=705) was predefined and powered. Major adverse cardiac and cerebrovascular event rates at 5 years was 36.9% in PCI patients and 31.0% in CABG patients (hazard ratio, 1.23 [95% confidence interval, 0.95-1.59]; P=0.12). Mortality rate was 12.8% and 14.6% in PCI and CABG patients, respectively (hazard ratio, 0.88 [95% confidence interval, 0.58-1.32]; P=0.53). Stroke was significantly increased in the CABG group (PCI 1.5% versus CABG 4.3%; hazard ratio, 0.33 [95% confidence interval, 0.12-0.92]; P=0.03) and repeat revascularization in the PCI arm (26.7% versus 15.5%; hazard ratio, 1.82 [95% confidence interval, 1.28-2.57]; P<0.01). Major adverse cardiac and cerebrovascular events were similar between arms in patients with low/intermediate SYNTAX scores but significantly increased in PCI patients with high scores (=33). Conclusions-At 5 years, no difference in overall major adverse cardiac and cerebrovascular events was found between treatment groups. PCI-treated patients had a lower stroke but a higher revascularization rate versus CABG. These results suggest that both treatments are valid options for LM patients. The extent of disease should accounted for when choosing between surgery and PCI, because patients with high SYNTAX scores seem to benefit more from surgery compared with those in the lower tertiles. Clinical Trial Registration-URL: http://www.clinicaltrials. gov. Unique identifier: NCT00114972. (Circulation. 2014;129:2388-2394.) © 2014 American Heart Association, Inc.


Kappetein A.P.,Erasmus Medical Center | Feldman T.E.,NorthShore University Health System | MacK M.J.,Baylor Healthcare System | Morice M.-C.,Institute Cardiovasculaire Paris Sud | And 6 more authors.
European Heart Journal | Year: 2011

Aims Long-term randomized comparisons of percutaneous coronary intervention (PCI) to coronary artery bypass grafting (CABG) in left main coronary (LM) disease and/or three-vessel disease (3VD) patients have been limited. This analysis compares 3-year outcomes in LM and/or 3VD patients treated with CABG or PCI with TAXUS Express stents. Methods and resultsSYNTAX is an 85-centre randomized clinical trial (n 1800). Prospectively screened, consecutive LM and/or 3VD patients were randomized if amenable to equivalent revascularization using either technique; if not, they were entered into a registry. Patients in the randomized cohort will continue to be followed for 5 years. At 3 years, major adverse cardiac and cerebrovascular events [MACCE: death, stroke, myocardial infarction (MI), and repeat revascularization; CABG 20.2 vs. PCI 28.0, P< 0.001], repeat revascularization (10.7 vs. 19.7, P< 0.001), and MI (3.6 vs. 7.1, P 0.002) were elevated in the PCI arm. Rates of the composite safety endpoint (death/stroke/MI 12.0 vs. 14.1, P 0.21) and stroke alone (3.4 vs. 2.0, P 0.07) were not significantly different between treatment groups. Major adverse cardiac and cerebrovascular event rates were not significantly different between arms in the LM subgroup (22.3 vs. 26.8, P 0.20) but were higher with PCI in the 3VD subgroup (18.8 vs. 28.8, P< 0.001). Conclusion sAt 3 years, MACCE was significantly higher in PCI-compared with CABG-treated patients. In patients with less complex disease (low SYNTAX scores for 3VD or low/intermediate terciles for LM patients), PCI is an acceptable revascularization, although longer follow-up is needed to evaluate these two revascularization strategies. © 2011 The Author.


Head S.J.,Erasmus Medical Center | Holmes Jr. D.R.,Mayo Medical School | Serruys P.W.,Erasmus Medical Center | Mohr F.W.,University of Leipzig | And 3 more authors.
JACC: Cardiovascular Interventions | Year: 2012

Background: The aim of this study was to evaluate the use of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in "real-world" patients unsuitable for the alternative treatment. No data are available on the risk profile and outcomes of patients that can only undergo PCI or CABG. Methods: In the SYNTAX (Synergy between PCI with TAXUS and Cardiac Surgery) trial, a multidisciplinary Heart Team reached a consensus on whether PCI and CABG could result in clinical equipoise; if so, the patient was randomized. If not, the patient was enrolled in a CABG-ineligible PCI registry or PCI-ineligible CABG registry. A proportion (60%) of patients in the CABG registry was randomly assigned to be followed up for 5 years. No statistical comparisons were performed between randomized and registry patients. Major adverse cardiac or cerebrovascular event (MACCE) rates are presented as observational only. Results: A total of 3,075 patients were treated in the SYNTAX trial; 198 (6.4%) and 1,077 (35.0%) patients were included in PCI and CABG registries, respectively. The main reason for inclusion in the CABG registry was too complex coronary anatomy (70.9%), and the main reason for inclusion in the PCI registry was too high-risk for surgery (70.7%). Three-year MACCE was 38.0% after PCI and 16.4% after CABG. Stratification by SYNTAX score terciles demonstrated a step-wise increase of MACCE rates in both PCI and CABG registries. Conclusions: The SYNTAX Heart Team concluded that PCI and CABG remained the only treatment options for 6.4% and 35.0% of patients, respectively. Inoperable patients with major comorbidities that underwent PCI had high MACCE rates. In patients not suitable for PCI, surgical results were excellent. (SYNTAX Study: TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries, NCT00114972). © 2012 American College of Cardiology Foundation.


Yamamoto M.,Henri Mondor University Hospital | Hayashida K.,Institute Cardiovasculaire Paris Sud | Mouillet G.,Henri Mondor University Hospital | Hovasse T.,Institute Cardiovasculaire Paris Sud | And 8 more authors.
Journal of the American College of Cardiology | Year: 2013

Objectives This study sought to assess the influence of chronic kidney disease (CKD) classification on clinical outcomes in patients undergoing transcatheter aortic valve implantation (TAVI). Background The prognostic value of impaired renal function according to CKD classification has not been thoroughly investigated in very elderly TAVI cohorts. Methods Data from 642 consecutive patients who underwent TAVI were prospectively collected. Clinical outcomes were compared in enrolled patients, divided into CKD stage 1+2, CKD stage 3a, CKD stage 3b, and CKD stage 4 on the basis of estimated glomerular filtration rate ≥60, 45 to 59, 30 to 44, and 15 to 29 ml/min/1.73 m 2, respectively. Results Among the study patients (mean age: 83.5 ± 6.5 years, logistic European System for Cardiac Operative Risk Evaluation score 20.0% [range: 13.6% to 28.8%]), 34% were categorized as CKD stage 1+2 (n = 218), 28.3% as CKD stage 3a (n = 182), 28.2% as CKD stage 3b (n = 181), and 9.5% as CKD stage 4 (n = 61). Thirty-day and cumulative 1-year mortality rates increased significantly across the 4 groups (6.9% vs. 8.8% vs. 13.3% vs. 26.2%, p = 0.002, and 17.2% vs. 23.4% vs. 29.2% vs. 47.8%, p < 0.001, respectively). After adjustment for considerable influential confounders in a Cox multivariate regression model, CKD stage 4 was associated with increased risk for 30-day mortality (hazard ratio: 3.04; 95% confidence interval [CI]: 1.43 to 6.49; p = 0.004), and CKD stages 3b and 4 were related to increased cumulative 1-year mortality (hazard ratios: 1.71 and 2.91; 95% CI: 1.09 to 2.68 and 1.73 to 4.90; p = 0.020 and p < 0.001, respectively) compared with CKD stage 1+2 as the referent. Conclusions Classification of CKD stages before TAVI allows risk stratification for early and midterm clinical outcomes. TAVI for patients with CKD stage 4 is still considered challenging because of high mortality rates after the procedure. © 2013 by the American College of Cardiology Foundation.


Sgueglia G.A.,Interventional Cardiology | Chevalier B.,Institute Cardiovasculaire Paris Sud
JACC: Cardiovascular Interventions | Year: 2012

Bifurcation lesions are the most frequently approached complex coronary lesions in everyday interventional practice. Bifurcations complexity relies essentially on their very specific anatomy that is imperfectly handled by current coronary devices and, despite dedicated techniques and drug-eluting stents, percutaneous coronary interventions directed toward the treatment of bifurcations are technically demanding and require proper execution. Kissing balloon (KB) inflation was the first specific bifurcation technique to have been developed for percutaneous bifurcation interventions and continues to currently play an important role. Indeed, KB has been proposed to optimize stent apposition, improve side branch access while correcting stent deformation or distortion. Over the years, the KB technique has been deeply investigated by many different methods, from bench testing and computer simulations to in vivo intravascular imaging and clinical studies, producing a large amount of data pointing out the benefits and limitations of the technique. We sought to provide here a comprehensive overview of all those aspects. © 2012 American College of Cardiology Foundation.


Hayashida K.,Institute Cardiovasculaire Paris Sud
EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology | Year: 2012

Significant aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) has been shown to be associated with worse mid-term outcome. The two-year follow-up results of the PARTNER US trial showed that not only ≥3/4 AR grade, but also grade 2 had a significant impact on mortality. Thus, prevention and treatment of significant AR after TAVI is of great importance. Usually, AR after TAVI consists mostly of paravalvular leak and significant central AR is uncommon. Here we describe measures to decrease the risk of AR after TAVI which are currently available.


Arai T.,Institute Cardiovasculaire Paris Sud | Lefevre T.,Institute Cardiovasculaire Paris Sud
Journal of Cardiology | Year: 2014

Transcatheter aortic valve implantation (TAVI) has rapidly emerged as a valid therapeutic option for patients with severe symptomatic aortic stenosis who are high risk or ineligible for conventional surgical aortic valve replacement. Despite its minimally invasive nature, TAVI is invariably associated with complications in these old patients that may affect outcomes. Although the success of TAVI is determined by multiple factors, good screening and appropriate patient selection is crucial. Selection of the right patient includes the determination of risk levels and feasibility of a safe procedure in each individual case. Here, we describe below our critical appraisal of patient selection for TAVI. © 2013.


Hayashida K.,Institute Cardiovasculaire Paris Sud | Morice M.-C.,Institute Cardiovasculaire Paris Sud | Chevalier B.,Institute Cardiovasculaire Paris Sud | Hovasse T.,Institute Cardiovasculaire Paris Sud | And 7 more authors.
Journal of the American College of Cardiology | Year: 2012

Objectives: The purpose of this study was to clarify the impact of sex-related differences in transcatheter aortic valve implantation (TAVI) for high-risk patients with severe aortic stenosis. Background: Although TAVI is becoming a mature technique, the impact of sex differences remains unclear. Methods: The TAVI patients were included prospectively in a dedicated database from October 2006. The proportion of women (n = 131) was similar to that of men (n = 129). The Edwards valve (85.4%) and CoreValve (14.6%) were used through the transfemoral (65.0%), subclavian (3.1%), or transapical (31.9%) approach. All events were defined according to Valve Academic Research Consortium criteria. Results: Age was similar (83.1 ± 6.3 years), but women had less coronary and peripheral disease, less previous cardiac surgery, higher ejection fraction, and lower EuroSCORE (European System for Cardiac Operative Risk Evaluation [22.3 ± 9.0% vs. 26.2 ± 13.0%, p = 0.005]). Minimal femoral size (7.74 ± 1.03 mm vs. 8.55 ± 1.34 mm, p < 0.001), annulus size (20.9 ± 1.4 vs. 22.9 ± 1.7 mm, p < 0.001), and valve size (23.9 ± 1.6 mm vs. 26.3 ± 1.5 mm, p < 0.001) were smaller in women. Device success was similar (90.8% vs. 88.4%, p = 0.516) despite more frequent iliac complications (9.0% vs. 2.5%, p = 0.030). Residual mean aortic pressure gradient (11.6 ± 4.9 vs. 10.9 ± 4.9, p = 0.279) was also similar. The 1-year survival rate was higher for women, 76% (95% confidence interval: 72% to 80%), than for men, 65% (95% confidence interval: 60% to 69%); and male sex (hazard ratio: 1.62, 95% confidence interval: 1.03 to 2.53, p = 0.037) was identified as a predictor of midterm mortality by Cox regression analysis. Conclusions: Female sex is associated with better baseline clinical characteristics and improved survival, and is identified as a predictor of midterm survival after TAVI. © 2012 American College of Cardiology Foundation.


Kassab G.S.,Indiana University | Bhatt D.L.,Harvard University | Lefevre T.,Institute Cardiovasculaire Paris Sud | Louvard Y.,Institute Cardiovasculaire Paris Sud
EuroIntervention | Year: 2013

Elevation of biomarkers and ischaemia after coronary stenting of a bifurcation is not uncommon due to side branch (SB) occlusion. Hence, it is important to understand the relation between the lumen calibre of the SB and the myocardial mass affected. The objective of this proof of concept perspective is to provide a formulation for the relation between the SB calibre and perfused myocardial mass based on experimentally-validated scaling laws. A lumen calibre-mass scaling law provides a nearly linear relation between cross-sectional area of SB and the myocardial mass at risk. It is clinically known that the larger the diameter of the SB the more myocardial mass is at risk. The present analysis formulates this notion quantitatively and provides a simple relation where the %infarct can be determined directly from the angiographic cross-sectional area of SB. This relation can help guide the decision for bifurcation stenting where the SB may be at risk for occlusion. This brief proof of concept perspective provides a basis for future human studies that may demarcate the calibre (and hence myocardial mass) in relation to cardiac biomarkers as a cut-off for treatment of SB.

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