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4. Current treatment of symptomatic aortic stenosis in elderly patients: Do risk scores really matter after 80 years of age?

Author

Bouleti, Claire, Michel, Morgane, Jobbe Duval, Antoine, Hemery, Thibaut, Nicol, Pierre-Philippe, Didier, Romain, Zeyons, Floriane, Zouaghi, Oualid, Tchetche, Didier, Delon, Clémence, Delomez, Maxence, Dibie, Alain, Attias, David, Le Breton, Hervé, Cormier, Bertrand, Obadia, Jean-François, Tribouilloy, Christophe, Lansac, Emmanuel, Chevreul, Karine, Naccache, Nicole, Eltchaninoff, Hélène, Gilard, Martine, and Iung, Bernard

Published
2021
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5. Septuagenarian population has similar survival and outcomes to younger patients after left ventricular assist device implantation

Author

Galand, Vincent, Flécher, Erwan, Chabanne, Céline, Lelong, Bernard, Goéminne, Céline, Vincentelli, André, Delmas, Clément, Dambrin, Camille, Nubret, Karine, Pernot, Mathieu, Kindo, Michel, Hoang Minh, Tam, Gaudard, Philippe, Frapier, Jean Marc, Michel, Magali, Sénage, Thomas, Boignard, Aude, Chavanon, Olivier, Verdonk, Constance, Para, Marylou, Pelcé, Edeline, Gariboldi, Vlad, Pozzi, Matteo, Obadia, Jean-François, Litlzer, Pierre Yves, Anselme, Frédéric, Babatasi, Gerard, Plane, Anne Flore, Garnier, Fabien, Bielefeld, Marie, Hamon, David, Radu, Costin, Bourguignon, Thierry, Genet, Thibaud, Eschalier, Romain, D’Ostrevy, Nicolas, Bories, Marie-Cécile, Marijon, Eloi, Vanhuyse, Fabrice, Blangy, Hugues, Leclercq, Christophe, and Martins, Raphaël P.

Published
2020
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8. Position paper for management of elderly patients with pacemakers and implantable cardiac defibrillators: Groupe de Rythmologie et Stimulation Cardiaque de la Société Française de Cardiologie and Société Française de Gériatrie et Gérontologie

Author

Fauchier, Laurent, Alonso, Christine, Anselme, Frederic, Blangy, Hugues, Bordachar, Pierre, Boveda, Serge, Clementy, Nicolas, Defaye, Pascal, Deharo, Jean-Claude, Friocourt, Patrick, Gras, Daniel, Halimi, Franck, Klug, Didier, Mansourati, Jacques, Obadia, Benjamin, Pasquié, Jean-Luc, Pavin, Dominique, Sadoul, Nicolas, Taieb, Jerome, Piot, Olivier, and Hanon, Olivier

Published
2016
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14. Impact of procedural success on clinical outcome after MitraClip: Results from the MITRA-FR trial

Author

Messika-Zeitoun, David, Attias, David, Piriou, Nicolas, Iung, Bernard, Armoiry, Xavier, Trochu, Jean-Noël, Donal, Erwan, Habib, Gilbert, Cormier, Bertrand, Guerin, Patrice, Lefèvre, Thierry, Maucort-Boulch, Delphine, Boutitie, Florent, Vahanian, Alec, Riche, Benjamin, Obadia, Jean-François, University of Ottawa [Ottawa], Centre cardiologique du Nord (CCN), Centre hospitalier universitaire de Nantes (CHU Nantes), Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Matériaux, ingénierie et science [Villeurbanne] (MATEIS), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Centre National de la Recherche Scientifique (CNRS), Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Assistance Publique - Hôpitaux de Marseille (APHM), Microbes évolution phylogénie et infections (MEPHI), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Hôpital Privé Jacques Cartier [Massy], Regenerative Medicine and Skeleton (RMeS), École nationale vétérinaire, agroalimentaire et de l'alimentation Nantes-Atlantique (ONIRIS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Nantes Université - UFR Odontologie (Nantes Univ – UFR Odonto), Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ), Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Hôpital Louis Pradel [CHU - HCL], This trial was funded by the French Ministry of Health and Research National Programme and Abbott Vascular. Abbott Vascular provided the devices and the support for the investigators’ meetings. Neither Abbott Vascular nor any other commercial entity had a role in trial design, participating centre selection, centre monitoring and oversight, data collection, patient enrolment, patient management, data storage, data analysis, data interpretation, the writing of the manuscript or the decision to submit the manuscript., and Service de Biostatistiques [Lyon]

Subjects
Heart Valve Prosthesis Implantation, Heart Failure, Mitral Valve Insufficiency, Stroke Volume, General Medicine, Outcomes, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, Ventricular Function, Left, Treatment Outcome, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Humans, Transcatheter mitral valve therapy, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Cardiology and Cardiovascular Medicine, Mitral regurgitation
Abstract

International audience; BACKGROUND: Differences in procedural success rates have been proposed to explain the divergent results between the MITRA-FR trial (Percutaneous Repair with the MitraClip Device for Severe Functional/Secondary Mitral Regurgitation) and the COAPT trial (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation). AIM: To examine whether MITRA-FR patients who had successful clip implantation achieved a better outcome than the control group.METHODS: Based on the per protocol population of MITRA-FR, we compared the outcome in 71 patients in whom optimal clip implantation was achieved (group 1: mitral regurgitation grade ≤ 1 + at discharge) with that in 23 patients with non-optimal clip implantation (group 2: mitral regurgitation grade ≥ 2 + at discharge) and that in 137 patients in the control group (group 3). The primary endpoint was all-cause death or unplanned hospitalization for heart failure at 24 months.RESULTS: Event-free survival was not different across the groups (42±6% in group 1, 30±10% in group 2 and 31±4% in group 3; log-rank P=0.32). In multivariable analyses, after adjustment for age, sex, rhythm, aetiology, left ventricular ejection fraction and mitral regurgitation severity, group was not associated with variations in outcome: using Group 3 as reference, hazard ratio 0.86, 95% confidence interval 0.58-1.27 (P=0.43) in group 1; and hazard ratio 0.98 95% confidence interval 0.54-1.76 (P=0.94) in group 2.CONCLUSIONS: The clinical outcome of patients in whom optimal procedural result was achieved at discharge was not different compared with the control group. Our results do not support the hypothesis that the differences in rates of residual mitral regurgitation at discharge between MITRA-FR and COAPT explain the divergent results between the two trials.

Published
2021
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15. Prognostic impact of mitral valve geometry in patients with secondary mitral regurgitation: A secondary analysis of the MITRA-FR trial.

Author

Ng, P., Riche, B., Le Ruz, R., Le Carpentier, A., Samson, G., Trochu, J.-N., Mewton, N., Guérin, P., Iung, B., Messika-Zeitoun, D., Obadia, J.-F., Capoulade, R., and Piriou, N.

Abstract

Mitral valve (MV) transcatheter edge-to-edge repair (TEER) has emerged as a second line therapy on top of guidelines-directed medical treatment (GDMT) in heart failure (HF) patients with severe secondary mitral regurgitation (SMR). Following the disparate results of the COAPT and MITRA-FR pivotal trials, echocardiographic markers of LV remodeling and MR severity have been proposed to select patients most likely to benefit from MV-TEER. The characterization of MV geometry in MITRA-FR patients could be an additional tool to predict patients prognosis and may help to improve understanding of patient selection for MV-TEER. To evaluate the association between MV geometry and outcomes of HF patients with SMR in the MITRA-FR trial, as well as the impact of SMR treatment modality. Thirteen MV geometry parameters were assessed from baseline transthoracic echocardiograms in patients from the MITRA-FR trial. The prognostic impact of MV geometry parameters was studied on top of the baseline clinical variables used in the primary analysis of MITRA-FR (i.e. age, atrial fibrillation [AF], ischemic cardiomyopathy, myocardial infarction, left ventricular ejection fraction [LVEF] and effective regurgitant orifice area [EROA]). The primary endpoint was the composite of all-cause mortality or HF hospitalization (HFH) within 2 years. The effect of treatment arms (MV-TEER plus GDMT vs. GDMT alone) on this association was also evaluated. Among the 307 patients included in the pivotal trial, 272 were analyzed in the present study (135 from the GDMT group and 137 from the GDMT + MV-TEER group). Mean age was 70 ± 10, 74% male. 50% had ischemic cardiomyopathy and 34% AF. LVEF was 33 ± 7% and EROA was 31 ± 11 mm2. Among mitral geometry parameters, only MV tenting area remained independently associated with the primary endpoint (hazard ratio (HR) = 1.22 per 1 cm2, confidence interval (CI) = 1.01–1.47; P = 0.041) after multivariate analysis (Fig. 1). These findings remained consistent in both treatment arms (P > 0.20 for interaction). In HF patients with SMR included in the MITRA-FR trial, MV tenting area was independently associated with the risk of HFH or all-cause mortality, without any difference according to treatment arms. These data suggest that MV tethering provides an incremental prognostic value beyond classical echocardiographic variables, including EROA, and then should be considered in the risk stratification of patients with HF and SMR. [ABSTRACT FROM AUTHOR]

Published
2025
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17. Current treatment of symptomatic aortic stenosis in elderly patients: Do risk scores really matter after 80 years of age?

Author

Claire Bouleti, Emmanuel Lansac, C. Delon, Bernard Iung, Nicole Naccache, Maxence Delomez, Martine Gilard, Alain Dibie, Oualid Zouaghi, Morgane Michel, Antoine Jobbe Duval, Karine Chevreul, Hervé Le Breton, Jean-François Obadia, Pierre-Philippe Nicol, Bertrand Cormier, Christophe Tribouilloy, T. Hémery, David Attias, Didier Tchetche, Hélène Eltchaninoff, Romain Didier, Floriane Zeyons, Centre hospitalier universitaire de Poitiers (CHU Poitiers), Université de Poitiers - Faculté de Médecine et de Pharmacie, Université de Poitiers, CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables (ECEVE (U1123 / UMR_S_1123)), Institut National de la Santé et de la Recherche Médicale (INSERM)-AP-HP Hôpital universitaire Robert-Debré [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPC), Endothélium, valvulopathies et insuffisance cardiaque (EnVI), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Rouen, Normandie Université (NU), Hôpital de la Cavale Blanche, Service de cardiologie [Brest], Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Les Hôpitaux Universitaires de Strasbourg (HUS), Clinique Pasteur [Toulouse], Institut Mutualiste de Montsouris (IMM), Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Privé Jacques Cartier [Massy], Hospices Civils de Lyon (HCL), Université de Picardie Jules Verne (UPJV), Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, Département de la Recherche Clinique et du Développement [AP-HP Hôtel Dieu] (DRCD-URC Eco), Unité de Recherche Clinique en Economie de la Santé d'Ile-de-France, Hôpital Hôtel-Dieu [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Hôtel-Dieu [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Optimisation des régulations physiologiques (ORPHY (EA 4324)), Université de Brest (UBO)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPC)-Université Sorbonne Paris Nord, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, and ANR-16-RHUS-0003,STOP-AS,STOP-AS(2016)

Subjects
Male, medicine.medical_specialty, [SDV]Life Sciences [q-bio], Risk Assessment, Severity of Illness Index, Euroscore ii, Aortic valve replacement, Risque opératoire, Risk Factors, medicine, Clinical endpoint, Humans, In patient, Prospective Studies, Symptomatic aortic stenosis, Remplacement valvulaire aortique percutané, Aged, Aged, 80 and over, Heart Valve Prosthesis Implantation, Transcatheter aortic valve implantation, Medical treatment, business.industry, Aortic stenosis, Surgical aortic valve replacement, EuroSCORE, General Medicine, Therapeutic decision making, Aortic Valve Stenosis, Rétrécissement aortique, medicine.disease, Surgery, Remplacement valvulaire aortique chirurgical, Female, Cardiology and Cardiovascular Medicine, business
Abstract

International audience; Background. - According to the guidelines, surgical aortic valve replacement (SAVR) is recommended in patients at low surgical risk (EuroSCORE II < 4%), whereas for other patients, the decision between transcatheter aortic valve implantation (TAVI) and surgery should be made by the Heart Team, with TAVI being favoured in elderly patients. Aim. - The RAC prospective multicentre survey assessed the respective contributions of age and surgical risk scores in therapeutic decision making in elderly patients with severe symptomatic aortic stenosis. Methods. - In September and October 2016, 1049 consecutive patients aged >= 75 years were included in 32 centres with on-site TAVI and surgical facilities. The primary endpoint was the decision between medical management, TAVI or SAVR. Results. - Mean age was 84 +/- 5 years and 53% of patients were female. The surgical risk was classified as high (EuroSCORE II > 8%) in 18% of patients, intermediate (EuroSCORE II 4-8%) in 34% and low (EuroSCORE II = 80 years were referred for TAVI, despite a low estimated surgical risk. Conclusions. - The impact of risk scores depends strongly on age, and decreases considerably after 80 years, most patients being referred for TAVI, independent of their estimated surgical risk. Despite medical advancements, 10% of patients were still denied any intervention. (C) 2021 Elsevier Masson SAS. All rights reserved.

Published
2021
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19. Choice of echocardiography method for postoperative evaluation of mitral valve replacement with a mechanical prosthesis

Author

Martine Barthelet, J. Nloga, O. Metton, Jean Ninet, J. Robin, Roland Henaine, Geneviève Derumeaux, J.-F. Obadia, G. Greffe, C. Saroul, and P. Wautot

Subjects
Male, Reoperation, medicine.medical_specialty, medicine.medical_treatment, Embolism, Prosthesis, Postoperative Complications, Mechanical prosthesis, Mitral valve, medicine, Humans, International Normalized Ratio, Heart valve, Aged, Postoperative Care, business.industry, Mitral valve replacement, Thrombosis, General Medicine, Guideline, Middle Aged, medicine.disease, Surgery, Stroke, medicine.anatomical_structure, Thrombose, Echocardiography, Heart Valve Prosthesis, Infective endocarditis, Rheumatic fever, Female, business, Cardiology and Cardiovascular Medicine, Echocardiographie, Prothèse mécanique, Valve mitrale, Follow-Up Studies
Abstract

SummaryObjectThe French Cardiology Society (SFC) systematically recommends (Class I) transesophageal echocardiography (TEE) after any mitral valve replacement with a mechanical prosthesis (MMVR). Taking into account the increasing workload of echocardiography laboratories, our attitude was to propose that only post-operative transthoracic echocardiography (TTE) is performed. The purpose of this study was to evaluate the possible risks of this simplified procedure.MethodsWe performed a precise analysis of one full year of practice of MMVR with exhaustive follow-up for the first 2 years concentrating on thromboembolic complications.ResultsFrom January to December 2003, 84MMVRs (46 after rheumatic fever, 22 degenerative disease, 11 infective endocarditis (IE) and 5 ischemia) were conducted in 45 women and 39 men of average age 61 years. Early mortality (< 30 days) concerned 5 patients (5.9%). A control TTE to determine normal prosthetic function was performed 7±2 days after surgery and this revealed 2 cases of nonobstructive thrombosis which were treated medically, 3 cases of paraprosthetic regurgitation, and 1 vegetation due to underlying IE. Actuarial survival was 90.5% at 1 year and 83.3% at 2 years. After a mean follow-up of 179.3 patient-years, 5 patients were reoperated (5.9%): 1 for IE, 1 for paravalvular regurgitation, 1 for mitral valve insufficiency with haemolysis, and 2 for obstructive prosthetic valve thromboses. In addition there were 2 cases of prosthetic valve thrombosis, 8 ischemic strokes (2 ministrokes, 6 sequelar strokes), and 1 peripheral embolism. The global thromboembolic complication rate was therefore 6.1 per 100 patient-years (n=11). There were 4 hemorrhagic events, i.e. a rate of 2.2 events per 100 patient-years. 63% of the 1193 INR conducted were within the target range (3-4.5), 26% were below 3 and 11% were greater than 4.5. 35 % of patients with thromboembolic complications had an INR < 3.ConclusionMorbidity and mortality during the first 2 years after MMVR were relatively high but equivalent to the values of comparable series in the literature. These complications would not have been reduced by a more precise screening based on early TEE. Despite the increasingly litigious nature of the doctor-patient relationship, it would probably be excessive to oppose that this guideline was not followed in a dispute; in particular as it is difficult to apply this measure as echocardiography departments are overworked.

Published
2008
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