Personne :
Bertrand, Olivier

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Bertrand
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Olivier
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Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval
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  • Publication
    Restreint
    Usefulness of TEE as the primary imaging technique to guide transcatheter transapical aortic valve implantation
    (American College of Cardiology Foundation, 2011-02-01) Bertrand, Olivier; Lemieux, Jérôme; Dumont, Éric; De Larochellière, Robert; Côté, Mélanie; Villeneuve, Jacques; Rodés-Cabau, Josep; Bergeron, Sébastien; Bagur, Rodrigo Hernan; Doyle, Daniel; Pibarot, Philippe
    Objectives: The aim of this study was to: 1) determine the usefulness of transesophageal echocardiography (TEE) as the primary technique to guide transapical (TA) transcatheter aortic valve implantation (TAVI); and 2) to compare TEE with angiography as the primary imaging modality for TA-TAVI guidance. Background: TEE has been routinely used as an adjunct to angiography during TA-TAVI procedures, but very few data exist on the use of TEE as the primary imaging technique guiding TA-TAVI. Methods: One hundred consecutive high-risk patients (mean age 79 ± 9 years, mean logistic EuroSCORE: 25.8 ± 17.6%) who underwent TA-TAVI in our center were included. The Edwards valve was used in all cases, and all procedures were performed in an operating room without hybrid facilities. The TA-TAVI was primarily guided by angiography in the first 25 patients (A-TAVI group) and by TEE in the last 75 patients (TEE-TAVI group). Procedural, 30-day, and follow-up results were evaluated. Results: No differences were observed between groups at baseline except for a higher (p = 0.001) prevalence of moderate or severe mitral regurgitation in the TEE-TAVI group. The procedure was successful in 97.3% and 100% of the patients in the TEE-TAVI and A-TAVI groups, respectively (p = 1.0), and a lower contrast volume was used in the TEE-TAVI group (12 [5 to 20] ml vs. 40 [20 to 50] ml, p < 0.0001). There were no differences between groups in the occurrence of valve malposition needing a second valve (TEE-TAVI: 5.3%; A-TAVI: 4%; p = 1.0) or valve embolization (TEE-TAVI: 1.3%; A-TAVI: 4%; p = 0.44). The results regarding post-procedural valve hemodynamic status and aortic regurgitation were similar between groups. The survival rates at 30-day and 1-year follow-up were 87% and 75% in the TEE-group and 88% and 84% in the A-TAVI group, respectively (log-rank = 0.49). Conclusions: TEE-TAVI was associated with similar acute and midterm results as A-TAVI and significantly reduced contrast media use during the procedures. These results suggest the feasibility and safety of performing TA-TAVI procedures in an operating room without hybrid facilities, but larger studies are needed to confirm these findings.
  • Publication
    Restreint
    Predicting late myocardial recovery and outcomes in the early hours of ST-segment elevation myocardial infarction : traditional measures compared with microvascular obstruction, salvaged myocardium, and necrosis characteristics by cardiovascular magnetic resonance
    (Elsevier, 2010-06-01) Bertrand, Olivier; Noël, Bernard; Woerly, Stéphane; De Larochellière, Robert; Boudreault, Jean-Roch; Larose, Éric; Rodés-Cabau, Josep; Barbeau, Gérald; Nguyen, Can Manh; Rouleau, Jacques; Proulx, Guy; Amyot, Marc; Déry, Jean-Pierre; Pibarot, Philippe; Roy, Louis; Gleeton, Onil
    Objectives : The aim of this study was to determine whether a very early imaging strategy improves the prediction of late systolic dysfunction and poor outcomes in ST-segment elevation myocardial infarction (STEMI) compared with traditional predictors. Background : Earlier prediction of poor outcomes after STEMI is desirable, because it will allow tailored therapy at the earliest possible time, when benefits might be greatest. Methods : One hundred and three patients with acute STEMI were studied by contrast-enhanced cardiovascular magnetic resonance within 12 h of primary angioplasty and at 6 months and followed >2 years. The primary end point was left ventricular (LV) dysfunction, whereas poor outcomes were a key secondary end point. Results : Traditional risk factors were only modest predictors of late LV dysfunction. Late gadolinium enhancement (LGE) volume maintained a stronger association to LV ejection fraction change than infarct transmurality, microvascular obstruction, or myocardial salvage during STEMI (p = 0.02). Multivariable logistic regression identified LGE volume during STEMI as the best predictor of late LV dysfunction (odds ratio: 1.36, p = 0.03). An LGE =23% of LV during STEMI accurately predicted late LV dysfunction (sensitivity 89%, specificity 74%). The LGE volume provided important incremental benefit for predicting late dysfunction (area under the curve = 0.92, p = 0.03 vs. traditional risk factors). Twenty-three patients developed poor outcomes (1 death, 2 myocardial infarctions, 5 malignant arrhythmias, 4 severe LV dysfunction <35%, 11 hospital stays for heart failure) over 2.6 ± 0.9 years; LGE volume remained a strong independent predictor of poor outcomes, whereas LGE =23% carried a hazard ratio of 6.1 for adverse events (p < 0.0001). Conclusions : During the hyperacute phase of STEMI, LGE volume provides the strongest association and incremental predictive value for late systolic dysfunction and discerns poor late outcomes.
  • Publication
    Restreint
    Images in cardiovascular medicine: transapical aortic valve implantation in a patient with severe aortic stenosis and Pott disease
    (American Heart Association, 2009-10-20) Bertrand, Olivier; Lemieux, Jérôme; Dumont, Éric; De Larochellière, Robert; Gingras, Luc; Rodés-Cabau, Josep; Bergeron, Sébastien; Bagur, Rodrigo Hernan; Doyle, Daniel; Pibarot, Philippe
  • Publication
    Restreint
    Atherosclerotic burden findings in young cryptogenic stroke patients with and without a patent foramen ovale
    (Elsevier Biomedical, 2009-02-01) Bertrand, Olivier; Noël, Martin; Marrero, Alier; Larose, Éric; Rivest, Donald; Rodés-Cabau, Josep; Couture, Ariane; Bédard, Élisabeth; Bogaty, Peter; Pibarot, Philippe; Verreault, Steve; Houde, Christine; Petitclerc, Marc
    BACKGROUND AND PURPOSE: To further determine the mechanisms of cryptogenic stroke or transient ischemic attack in young patients, we evaluated indices of atherosclerosis in patients
  • Publication
    Restreint
    Characteristics of trabeculated myocardium burden in young and apparently healthy adults
    (American College of Cardiology, 2014-07-18) Bertrand, Olivier; Paz Ricapito, Maria de la; Tizón-Marcos, Helena; Larose, Éric; Bibeau, Karine; Le Ven, Florent; Bédard, Élisabeth; Sinha, Swapnil; Pasian, Sergio; Engert, James; Pibarot, Philippe; Deschepper, Christian
    Increased myocardial trabeculations define noncompaction cardiomyopathy (NCC). Imaging advancements have led to increasingly common identification of prominent trabeculations with unknown implications. We quantified and determined the impact of trabeculations’ burden on cardiac function and stretch in a population of healthy young adults. One hundred adults aged 18 to 35 years (28 – 4 years, 55% women) without known cardiovascular disease were prospectively studied by cardiovascular magnetic resonance. Left ventricular (LV) volumes, segmental function, and ejection fraction (EF) and left atrial volumes were determined. Thickness and area of trabeculated (T) and dense (D) myocardium were measured for each standardized LV segment. N-terminal pro-brain natriuretic peptide (Nt-pro-BNP) was measured. Eighteen percent of the subjects had ‡1 positive traditional criteria for NCC, and 11% meet new proposed NCC cardiovascular magnetic resonance criteria. Trabeculated over dense myocardium ratio (T/D) ratios were uniformly greater at end-diastole versus end-systole (0.90 – 0.25 vs 0.42 – 0.13, p <0.0001), in women versus men (0.85 – 0.24 vs 0.72 – 0.19, p [ 0.006), at anterior versus nonanterior segments (1.41 – 0.59 vs 0.88 – 0.35, p <0.0001), and at apical versus nonapical segments (1.31 – 0.56 vs 0.87 – 0.38, p <0.0001). The largest T/D ratios were associated with lower LVEF (57.0 – 5.3 vs 62 – 5.5, p [ 0.0001) and greater Nt-pro-BNP (203 – 98 vs 155 – 103, p [ 0.04). Multivariable regression identified greater end-systolic T/D ratios as the strongest independent predictor of lower LVEF, beyond age and gender, left atrial or LV volumes, and Nt-pro-BNP (b [ L9.9, 95% CI L15 to 4.9, p <0.001). In conclusion, healthy adults possess variable amounts of trabeculations that regularly meet criteria for NCC. Greater trabeculations are associated with decreased LV function. Apparently healthy young adults with increased trabecular burden possess evidence of mildly impaired cardiac function.
  • Publication
    Restreint
    Incidence, predictive factors, and prognostic value of myocardial injury following uncomplicated transcatheter aortic valve implantation.
    (Elsevier Biomedical, 2011-05-17) Bertrand, Olivier; Gutiérrez, Marcos; Dumont, Éric; De Larochellière, Robert; Larose, Éric; Côté, Mélanie; Villeneuve, Jacques; Rodés-Cabau, Josep; Bagur, Rodrigo Hernan; Doyle, Daniel; Manazzoni, Juan; Pibarot, Philippe
    OBJECTIVES: This study sought to: 1) determine the incidence, degree, and timing of the rise in serum cardiac markers of myocardial injury associated with uncomplicated transcatheter aortic valve implantation (TAVI); and 2) evaluate the predictive factors and prognostic value of myocardial injury associated with TAVI. BACKGROUND: Very few data exist on the occurrence and clinical relevance of myocardial injury during TAVI procedures. METHODS: A total of 101 patients who underwent successful TAVI (transfemoral [TF] approach, n = 38; transapical [TA] approach, n = 63) were included. Creatine kinase-MB (CK-MB) and cardiac troponin T (cTnT) levels were determined at baseline and at 6 to 12, 24, 48, and 72 h following TAVI. RESULTS: TAVI was associated with some degree of myocardial injury in 99% of the patients (TF: 97%, TA: 100%) as determined by a rise in cTnT (maximal value, 0.48 µg/l, interquartile range [IQR]: 0.24 to 0.82 µg/l) and in 77% of the patients (TF: 47%, TA: 95%) as determined by a rise in CK-MB (maximal value, 18.6 µg/l; IQR: 11.0 to 27.4 µg/l). TA approach and baseline renal dysfunction were associated with a higher increase in biomarkers of myocardial injury (p < 0.01 for both). A larger myocardial injury was associated with a smaller improvement of left ventricular ejection fraction (LVEF) (p < 0.01). The degree of rise in cTnT was an independent predictor of cardiac mortality at 9 ± 10 months of follow-up (hazard ratio: 1.14 per each increase of 0.1 µg/l, 95% confidence interval: 1.02 to 1.28, p = 0.028). CONCLUSIONS: TAVI was systematically associated with some degree of myocardial injury, with TA approach and baseline renal dysfunction determining a higher increase in biomarkers of myocardial injury. A greater degree of myocardial injury was associated with less improvement in LVEF and a higher cardiac mortality at follow-up.
  • Publication
    Restreint
    Comparison of the hemodynamic performance of percutaneous and surgical bioprostheses for the treatment of severe aortic stenosis
    (Elsevier Biomedical, 2009-05-19) Bertrand, Olivier; Webb, John G. (John Graydon); Rodés-Cabau, Josep; Bergeron, Sébastien; Altwegg, Lukas; Pibarot, Philippe; Dumont, Éric; Clavel, Marie-Annick; Thompson, Chris; De Larochellière, Robert; Doyle, Daniel; Masson, Jean-Bernard
    Objectives : This study was undertaken to compare the hemodynamic performance of a percutaneous bioprosthesis to that of surgically implanted (stented and stentless) bioprostheses for the treatment of severe aortic stenosis. Methods : Fifty patients who underwent percutaneous aortic valve implantation (PAVI) with the Cribier-Edwards or Edwards SAPIEN bioprosthetic valve (Edwards Lifesciences, Inc., Irvine, California) were matched 1:1 for sex, aortic annulus diameter, left ventricular ejection fraction, body surface area, and body mass index, with 2 groups of 50 patients who underwent surgical aortic valve replacement (SAVR) with a stented valve (Edwards Perimount Magna [SAVR-ST group]), or a stentless valve (Medtronic Freestyle, Medtronic, Minneapolis, Minnesota [SAVR-SL group]). Doppler echocardiographic data were prospectively obtained before the intervention, at discharge, and at 6- to 12-month follow-up. Results : Mean transprosthetic gradient at discharge was lower (p < 0.001) in the PAVI group (10 ± 4 mm Hg) compared with the SAVR-ST (13 ± 5 mm Hg) and SAVR-SL (14 ± 6 mm Hg) groups. Aortic regurgitation (AR) occurred more frequently in the PAVI group (mild: 42%, moderate: 8%) compared with the SAVR-ST (mild: 10%, moderate: 0%) and SAVR-SL (mild: 12%, moderate: 0%) groups (p < 0.0001). At follow-up, the mean gradient in the PAVI group remained lower (p < 0.001) than that of the SAVR-ST group, but was similar to that of the SAVR-SL group. The incidence of severe prosthesis-patient mismatch was significantly lower (p = 0.007) in the PAVI group (6%) compared with the SAVR-ST (28%) and SAVR-SL (20%) groups. However, the incidence of AR remained higher (p < 0.0001) in the PAVI group compared with the 2 other groups. Conclusions : PAVI provided superior hemodynamic performance compared with the surgical bioprostheses in terms of transprosthetic gradient and prevention of severe prosthesis-patient mismatch, but was associated with a higher incidence of AR.
  • Publication
    Restreint
    Feasibility and initial results of percutaneous aortic valve implantation including selection of the transfemoral or transapical approach in patients with severe aortic stenosis
    (Elsevier, 2008-11-01) Bertrand, Olivier; Dumont, Éric; Villeneuve, Jacques; De Larochellière, Robert; Rodés-Cabau, Josep; Doyle, Daniel; Bergeron, Sébastien; Lemieux, Jerome; Pibarot, Philippe; Clavel, Marie-Annick; Raby, Kathlee
  • Publication
    Restreint
    Exercise capacity in patients with severe symptomatic aortic stenosis before and six months after transcatheter aortic valve implantation
    (Elsevier, 2011-07-15) Bertrand, Olivier; Dumont, Éric; De Larochellière, Robert; Côté, Mélanie; Rodés-Cabau, Josep; Bagur, Rodrigo Hernan; Doyle, Daniel; Poirier, Paul; Pibarot, Philippe
    Few data exist on the use of the 6-minute walk test (6MWT) to measure the exercise capacity of patients with severe symptomatic aortic stenosis considered at very high surgical risk. The objectives of the present prospective study were (1) to determine the feasibility and safety of the 6MWT as a measure of exercise capacity before and after transcatheter aortic valve implantation (TAVI), and (2) to determine the clinical and hemodynamic parameters associated with the exercise capacity changes in such patients. A total of 64 patients (age 80 8 years, logistic European System for Cardiac Operative Risk Evaluation score 21 15%, Society of Thoracic Surgeons’ score 7.5 3.9%) who had undergone successful TAVI were included. The 6MWT was performed within the month before TAVI and at the 6-month follow-up visit. The mean distance walked increased from 165.3 79.7 to 231.7 88.9 m (p <0.0001); however, up to 25% of the patients did not improve or even decreased their exercise capacity. After adjustment for the baseline distance walked, multilinear regression analysis showed that a greater degree of renal dysfunction, as evaluated by the serum creatinine levels (r 2 0.05, p 0.03), lower postprocedural hemoglobin values (r 2 0.13, p 0.0012), and a longer hospitalization length (r 2 0.08, p 0.007) were associated with lower improvement in exercise capacity. In conclusion, exercise capacity, as evaluated by the 6MWT, was very poor in patients with severe symptomatic aortic stenosis considered at very high surgical risk. TAVI was associated with a significant increase in exercise capacity, although no improvement was observed in 1/4 of the patients. A greater degree in renal dysfunction, lower postprocedural hemoglobin values, and longer hospitalization stay were predictors of lower improvement in exercise capacity after TAVI. These results suggest that the 6MWT might become an important tool as a part of the evaluation process for TAVI candidates. © 2011 Elsevier Inc. All rights reserved. (Am J Cardiol 2011;108:258–264)
  • Publication
    Restreint
    Performance-based functional assessment of patients undergoing transcatheter aortic valve implantation
    (Elsevier, 2011-04-01) Bertrand, Olivier; Dumont, Éric; De Larochellière, Robert; Villeneuve, Jacques; Rodés-Cabau, Josep; Bagur, Rodrigo Hernan; Côté, Mélanie; Doyle, Daniel; Poirier, Paul; Pibarot, Philippe; Gutiérrez-Marcos, José; Clavel, Marie-Annick
    Background: Very few data exist on the functional evaluation of patients with severe symptomatic aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). The aims of this prospective study were (1) to evaluate the Duke Activity Status Index (DASI) as a measure of functional status pre-TAVI and post-TAVI, (2) to determine the clinical parameters associated with DASI changes after TAVI, and (3) to compare functional status as evaluated by DASI and the New York Heart Association (NYHA) class with exercise capacity as evaluated by the 6-minute walk test (6MWT) in such patients. Methods: A total of 76 patients (80 ± 8 years old) who underwent successful TAVI were included. All patients completed the DASI self-questionnaire at baseline and at 6 months after TAVI, and 46 patients also performed a 6MWT. Results: The mean DASI increased from 10.3 ± 5.4 to 16.3 ± 8.3 at 6 months after TAVI (P b .0001). However, the DASI did not change or even decreased to some extent in 30% of patients after TAVI. Renal dysfunction as evaluated by the estimated glomerular filtration rate was identified as the independent predictor of DASI impairment after TAVI (OR 1.7 for each decrease in estimated glomerular filtration rate of 10 mL/min/1.73 m2, 95% CI 1.3-2.3, P = .005). The mean distance walked increased from 165.9 ± 77.6 to 211.8 ± 78.7 m (P = .0001) at follow-up. The DASI showed a good correlation with the distance walked at baseline (r = 0.55, P b .0001) and at follow-up (r = 0.66, P b .0001). The NYHA class improved to some degree in all but 5 patients; however, the NYHA class did not correlate with the results of DASI and the 6MWT. Conclusions: Transcatheter aortic valve implantation was associated with a significant increase in functional status at 6-month follow-up as evaluated by the DASI, although no improvement was observed in about one third of patients. The presence of baseline renal dysfunction better determined this lack of improvement in functional status. The DASI, but not the NYHA class, correlated with distance walked in the 6MWT. These results suggest that the DASI might become a useful tool for evaluating both candidates for and the impact of TAVI procedures. (Am Heart J 2011;161:726-34.)