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Personne :
DeLarochellière, Hugo

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DeLarochellière

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Hugo

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Faculté de médecine, Université Laval,

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ncf11892746

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  • PublicationRestreint
    Significant 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; Amat Santos, Ignacio J.; Beaudoin, Jonathan; Laflamme, Jérôme; García, Eulogio; Doyle, Daniel; Macaya, Carlos; Urena Alcazar, Marina; Jiménez-Quevedo, Pilar; Pibarot, Philippe; Allende, Ricardo; Ribeiro, Henrique B.; De Larochellière, Robert
    Significant 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.
  • PublicationRestreint
    Chronic 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; Amat Santos, Ignacio J.; Laflamme, Jérôme; Mok, Michael; Doyle, Daniel; Maltais, François; Urena Alcazar, Marina; Pibarot, Philippe; Allende, Ricardo; Ribeiro, Henrique B.; De Larochellière, Robert
    OBJECTIVES: 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
  • PublicationRestreint
    Prognostic 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; Mok, Michael; Doyle, Daniel; Poirier, Paul; Urena Alcazar, Marina; Pibarot, Philippe; Ribeiro, Henrique B.; De Larochellière, Robert