Personne : DeLarochellière, Hugo
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Faculté de médecine, Université Laval,
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- PublicationRestreintChronic obstructive pulmonary disease in patients undergoing transcatheter aortic valve implantation : insights on clinical outcomes, prognostic markers, and functional status changes.(2013-08-01) DeLarochellière, Hugo; Laflamme, Louis; Dumont, Éric; Côté, Mélanie; Villeneuve, Jacques; Nombela-Franco, Luis; Rodés-Cabau, Josep; DeLarochellière, Robert; Amat Santos, Ignacio J.; Laflamme, Jérôme; Mok, Michael; Doyle, Daniel; Maltais, François; Urena Alcazar, Marina; Pibarot, Philippe; Allende, Ricardo; Barbosa Ribeiro, HenriqueOBJECTIVES: This study sought to determine the effects of chronic obstructive pulmonary disease (COPD) on clinical outcomes in patients undergoing transcatheter aortic valve implantation (TAVI) and to determine the factors associated with worse outcomes in COPD patients. BACKGROUND: No data exist on the factors determining poorer outcomes in COPD patients undergoing TAVI. METHODS: A total of 319 consecutive patients (29.5% with COPD) who underwent TAVI were studied. Functional status was evaluated by New York Heart Association (NYHA) functional class, Duke Activity Status Index, and the 6-min walk test (6MWT) at baseline and at 6 to 12 months. The TAVI treatment was considered futile if the patient either died or did not improve in NYHA functional class at 6-month follow-up. RESULTS: Survival rates at 1 year were 70.6% in COPD patients and 84.5% in patients without COPD (p = 0.008). COPD was an independent predictor of cumulative mortality after TAVI (hazard ratio: 1.84; 95% confidence interval: 1.08 to 3.13; p = 0.026). Improvement in functional status was observed after TAVI (p < 0.001 for NYHA functional class, Duke Activity Status Index, and 6MWT), but COPD patients exhibited less (p = 0.036) improvement in NYHA functional class. Among COPD patients, a shorter 6MWT distance predicted cumulative mortality (p = 0.013), whereas poorer baseline spirometry results (FEV1 [forced expiratory volume in the first second of expiration]) determined a higher rate of periprocedural pulmonary complications (p = 0.040). The TAVI treatment was futile in 40 COPD patients (42.5%) and a baseline 6MWT distance <170 m best determined the lack of benefit after TAVI (p = 0.002). CONCLUSIONS: COPD was associated with a higher rate of mortality at mid-term follow-up. Among COPD patients, a higher degree of airway obstruction and a lower exercise capacity determined a higher risk of pulmonary complications and mortality, respectively. TAVI was futile in more than one-third of the COPD patients, and a shorter distance walked at the 6MWT predicted the lack of benefit after TAVI. These results may help to improve the clinical decision-making process in this challenging group of patients
- PublicationAccès libreIncidence, predictive factors and haemodynamic consequences of acute stent recoil following transcatheter aortic valve implantation with a balloon-expandable valve(Europa Edition, 2014-04-01) DeLarochellière, Hugo; Laflamme, Louis; Dumont, Éric; Larose, Éric; Côté, Mélanie; Nombela-Franco, Luis; Rodés-Cabau, Josep; DeLarochellière, Robert; Laflamme, Jérôme; Pasian, Sergio; Doyle, Daniel; Urena Alcazar, Marina; Pibarot, Philippe; Allende, Ricardo; Barbosa Ribeiro, Henrique; Jerez-Valero, MiguelAims: The elastic behaviour (acute recoil) of a valve prosthesis stent following transcatheter aortic valve implantation (TAVI) is unknown. This study sought to determine the occurrence, severity, predictive factors and haemodynamic consequences of acute recoil following TAVI. Methods and results : A prospective angiographic analysis of the stent frame dimensions in 111 consecutive patients who underwent TAVI with a balloon-expandable valve (36 Edwards SAPIEN; 75 SAPIEN XT) was performed. Acute recoil was defined as the difference between minimal lumen diameter (MLD) at full balloon expansion and immediately after balloon deflation. MLD during balloon inflation was significantly larger than MLD after balloon deflation (23.40±2.31 mm vs. 22.29±2.21 mm, p<0.001), which represented an absolute and percent decrease in stent dimension of 1.10±0.40 mm and 4.70±1.76%, respectively. In the multivariate analysis, the predictors of larger recoil were a higher prosthesis/annulus ratio (r²=0.0624, p=0.015) and the SAPIEN XT prosthesis (r²=0.1276, p=0.001). No significant changes in haemodynamic performance were observed at discharge and follow-up in patients with larger recoil. Conclusions : TAVI with a balloon-expandable valve was systematically associated with a certain degree of valve stent recoil after balloon deflation. A higher degree of valve oversizing and the SAPIEN XT prosthesis predicted a larger degree of stent recoil.
- PublicationRestreintPrognostic value of exercise capacity as evaluated by the 6-minute walk test in patients undergoing transcatheter aortic valve implantation(Elsevier, 2013-02-26) DeLarochellière, Hugo; Laflamme, Louis; Dumont, Éric; Côté, Mélanie; Nombela-Franco, Luis; Rodés-Cabau, Josep; DeLarochellière, Robert; Mok, Michael; Doyle, Daniel; Poirier, Paul; Urena Alcazar, Marina; Pibarot, Philippe; Barbosa Ribeiro, Henrique
- PublicationRestreintIncidence and risk factors of hemolysis after transcatheter aortic valve implantation with a balloon-expandable valve(Elsevier, 2015-06-01) Campelo-Parada, Francisco; Laroche, Vincent; DeLarochellière, Hugo; Laflamme, Louis; Dumont, Éric; Abdul-Jawad Altisent, Omar; Côté, Mélanie; Rodés-Cabau, Josep; DeLarochellière, Robert; Mohammadi, Siamak; Paradis, Jean-Michel; Laflamme, Jérôme; Doyle, Daniel; Del Trigo, Maria; Urena Alcazar, Marina; Pibarot, Philippe; Puri, RishiThere are currently no data evaluating the hematologic and biocompatibility profile of transcatheter aortic valves in vivo. We evaluated the incidence, predictive factors, and clinical consequences associated with hemolysis post-transcatheter aortic valve implantation (TAVI). A total of 122 patients who underwent TAVI with a balloon-expandable valve were included. Baseline blood sampling and echocardiography, followed by early post-TAVI echocardiography and repeat blood sampling, at 6 to 12 months post-TAVI were performed. Hemolysis post-TAVI was defined according to the established criteria. The incidence of hemolysis post-TAVI was 14.8% yet no patient experienced severe hemolytic anemia requiring transfusion. Compared with the nonhemolysis group, those with hemolysis demonstrated significant reductions in hemoglobin (p = 0.012), were more frequently women (67% vs 34%, p = 0.016), and had a higher incidence of post-TAVI severe prosthesis-patient mismatch (PPM) (44% vs 17%, p = 0.026). The rate of mild or more prosthetic valve regurgitation did not significantly differ between those patients with and without hemolysis (56% vs 37%, p = 0.44). Wall shear rate (WSR) and energy loss index (ELI), both indirect measures of shear stress, were higher (p = 0.039) and lower (p = 0.004), respectively, in those patients with hemolysis. Increasing PPM severity was also associated with significant stepwise WSR increments and ELI decrements (p <0.01 for both). In conclusion, subclinical hemolysis occurred in 15% of patients following TAVI. Although prosthetic valve regurgitation had no impact on hemolysis, a novel association between PPM and hemolysis was found, likely driven by higher shear stress as determined by WSR and ELI. These hematologic and biomechanical findings may have long-term clinical implications and could affect future transcatheter aortic valve design.
- PublicationRestreintSignificant mitral regurgitation left untreated at the time of aortic valve replacement : a comprehensive review of a frequent entity in the transcatheter aortic valve replacement era.(Elsevier Biomedical, 2014-06-24) DeLarochellière, Hugo; Laflamme, Louis; Dumont, Éric; Côté, Mélanie; Nombela-Franco, Luis; Rodés-Cabau, Josep; Bergeron, Sébastien; DeLarochellière, Robert; Amat Santos, Ignacio J.; Beaudoin, Jonathan; Laflamme, Jérôme; García, Eulogio; Doyle, Daniel; Macaya, Carlos; Urena Alcazar, Marina; Jiménez-Quevedo, Pilar; Pibarot, Philippe; Allende, Ricardo; Barbosa Ribeiro, HenriqueSignificant mitral regurgitation (MR) is frequent in patients with severe aortic stenosis (AS). In these cases, concomitant mitral valve repair or replacement is usually performed at the time of surgical aortic valve replacement (SAVR). Transcatheter aortic valve replacement (TAVR) has recently been considered as an alternative for patients at high or prohibitive surgical risk. However, concomitant significant MR in this setting is typically left untreated. Moderate to severe MR after aortic valve replacement is therefore a relevant entity in the TAVR era. The purpose of this review is to present the current knowledge on the clinical impact and post-procedural evolution of concomitant significant MR in patients with severe AS who have undergone aortic valve replacement (SAVR and TAVR). This information could contribute to improving both the clinical decision-making process in and management of this challenging group of patients.
- PublicationRestreintLong-term prognostic value and serial changes of plasma N-terminal prohormone B-type natriuretic peptide in patients undergoing transcatheter aortic valve implantation.(Elsevier, etc., 2014-03-01) DeLarochellière, Hugo; Dahou, Abdellaziz; Dumont, Éric; Côté, Mélanie; Nombela-Franco, Luis; Rodés-Cabau, Josep; Le Ven, Florent; Bergeron, Sébastien; DeLarochellière, Robert; Ribeiro, Henrique Barbosa; Laflamme, Jérôme; Doyle, Daniel; Urena Alcazar, Marina; Pibarot, Philippe; Allende, Ricardo; Clavel, Marie-AnnickLittle is known about the usefulness of evaluating cardiac neurohormones in patients undergoing transcatheter aortic valve implantation (TAVI). The objectives of this study were to evaluate the baseline values and serial changes of N-terminal prohormone B-type natriuretic peptide (NT-proBNP) after TAVI, its related factors, and prognostic value. A total of 333 consecutive patients were included, and baseline, procedural, and follow-up (median 20 months, interquartile range 9 to 36) data were prospectively collected. Systematic NT-proBNP measurements were performed at baseline, hospital discharge, 1, 6, and 12 months, and yearly thereafter. Baseline NT-proBNP values were elevated in 86% of the patients (median 1,692 pg/ml); lower left ventricular ejection fraction and stroke volume index, greater left ventricular mass, and renal dysfunction were associated with greater baseline values (p <0.01 for all). Higher NT-proBNP levels were independently associated with increased long-term overall and cardiovascular mortalities (p <0.001 for both), with a baseline cut-off level of w2,000 pg/ml best predicting worse outcomes (p <0.001). At 6- to 12-month follow-up, NT-proBNP levels had decreased (p <0.001) by 23% and remained stable up to 4-year follow-up. In 39% of the patients, however, there was a lack of NT-proBNP improvement, mainly related to preprocedural chronic atrial fibrillation, lower mean transaortic gradient, and moderate-to-severe mitral regurgitation (p <0.01 for all). In conclusion, most patients undergoing TAVI presented high NT-proBNP levels, and a lack of improvement was observed in >1/3 of the patients after TAVI. Also, higher NT-proBNP levels predicted greater overall and cardiac mortalities at a median follow-up of 2 years. These findings support the implementation of NT-proBNP measurements for the clinical decision-making process and follow-up of patients undergoing TAVI.