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Rodés-Cabau, Josep

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Josep

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Université Laval. Faculté de médecine

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Voici les éléments 1 - 10 sur 19
  • PublicationRestreint
    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.
  • PublicationRestreint
    Open issues in transcatheter aortic valve implantation. Part 1 : patient selection and treatment strategy for transcatheter aortic valve implantation
    (Oxford University Press, 2014-07-25) Bax, Jeroen J.; Rodés-Cabau, Josep; Delgado, Victoria; Pibarot, Philippe; Bapat, Vinayak; Baumgartner, Helmut; Collet, Jean P.; Erbel, Raimund; Hamm, Christian W.; Kappetein, A. P.; Leipsic, Jonathon; Leon, Martin B.; MacCarthy, Philip; Piazza, Nicolo; Roberts, William C. (William Clifford); Serruys, P. W.; Thomas, Martyn; Vahanian, Alec; Webb, John G. (John Graydon); Zamorano, José L. (José Luis); Windecker, Stephan
    An exponential increase in the use of transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis has been witnessed over the recent years. The current article reviews different areas of uncertainty related to patient selection. The use and limitations of risk scores are addressed, followed by an extensive discussion on the value of three-dimensional imaging for prosthesis sizing and the assessment of complex valve anatomy such as degenerated bicuspid valves. The uncertainty about valvular stenosis severity in patients with a mismatch between the transvalvular gradient and the aortic valve area, and how integrated use of echocardiography and computed tomographic imaging may help, is also addressed. Finally, patients referred for TAVI may have concomitant mitral regurgitation and/or coronary artery disease and the management of these patients is discussed.
  • PublicationRestreint
    Open issues in transcatheter aortic valve implantation. Part 2 : procedural issues and outcomes after transcatheter aortic valve implantation.
    (Academic Press, 2014-10-07) Bax, Jeroen J.; Rodés-Cabau, Josep; Delgado, Victoria; Pibarot, Philippe; Bapat, Vinayak; Baumgartner, Helmut; Collet, Jean-Philippe; Erbel, Raimund; Hamm, Christian W.; Kappetein, A. P.; Leipsic, Jonathon; Leon, Martin B.; MacCarthy, Philip; Piazza, Nicolo; Roberts, William C. (William Clifford); Serruys, P. W.; Thomas, Martyn; Vahanian, Alec; Webb, John G. (John Graydon); Zamorano, José L. (José Luis); Windecker, Stephan
    This article provides an overview on procedure-related issues and uncertainties in outcomes after transcatheter aortic valve implantation (TAVI). The different access sites and how to select them in an individual patient are discussed. Also, the occurrence and potential predictors of aortic regurgitation (AR) after TAVI are addressed. The different methods to quantify AR are reviewed, and it appears that accurate and reproducible quantification is suboptimal. Complications such as prosthesis-patient mismatch and conduction abnormalities (and need for permanent pacemaker) are discussed, as well as cerebrovascular events, which emphasize the development of optimal anti-coagulative strategies. Finally, recent registries have shown the adoption of TAVI in the real world, but longer follow-up studies are needed to evaluate the outcome (but also prosthesis durability). Additionally, future studies are briefly discussed, which will address the use of TAVI in pure AR and lower-risk patients.
  • 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
    Infective endocarditis after transcatheter aortic valve implantation : results from a large multicenter registry
    (American Heart Association, 2015-03-09) Dumont, Éric; Messika-Zeitoun, David; Nombela-Franco, Luis; Eltchaninoff, Hélène; Rodés-Cabau, Josep; Kapadia, Samir R.; Amat Santos, Ignacio J.; Lerakis, Stamatios A.; Urena Alcazar, Marina; Cheema, Asim; Pibarot, Philippe; Gutiérrez-Ibañes, Enrique; Ribeiro, Henrique B.; Muñoz, Antonio; Pan, Manuel; Webb, John G. (John Graydon); Herrmann, Howard C.; Kodali, Susheel; Tamburino, Corrado; Jilaihawi, Hasan; Masson, Jean-Bernard; Brito, Fabio Sandoli de; Ferreira, Maria Cristina; Lima, Valter Correa; Mangione, José Armando; Iung, Bernard; Vahanian, Alec; Durand, Éric; Tuzcu, Murat; Hayek, Salim; Angulo-Llanos, Rocio; Gómez-Doblas, Juan José; Castillo Dominguez, Juan Carlos; Dvir, Danny; Leon, Martin B.; Garcia, Eulogio; Cobiella Carnicer, Javier; Vilacosta, Isidre; Barbanti, Marco; Makkar, Rajendra; López Diez, Javier; San Román, Alberto
    Background— We aimed to determine the incidence, predictors, clinical characteristics, management, and outcomes of infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI). Methods and Results— This multicenter registry included 53 patients (mean age, 79±8 years; men, 57%) who suffered IE after TAVI of 7944 patients after a mean follow-up of 1.1±1.2 years (incidence, 0.67%, 0.50% within the first year after TAVI). Mean time from TAVI was 6 months (interquartile range, 1–14 months). Orotracheal intubation (hazard ratio, 3.87; 95% confidence interval, 1.55–9.64; P=0.004) and the self-expandable CoreValve system (hazard ratio, 3.12; 95% confidence interval, 1.37–7.14; P=0.007) were associated with IE (multivariate analysis including 3067 patients with individual data). The most frequent causal microorganisms were coagulase-negative staphylococci (24%), followed by Staphylococcus aureus (21%) and enterococci (21%). Vegetations were present in 77% of patients (transcatheter valve leaflets, 39%; stent frame, 17%; mitral valve, 21%). At least 1 complication of IE occurred in 87% of patients (heart failure in 68%). However, only 11% of patients underwent valve intervention (valve explantation and valve-in-valve procedure in 4 and 2 patients, respectively). The mortality rate in hospital was 47.2% and increased to 66% at the 1-year follow-up. IE complications such as heart failure (P=0.037) and septic shock (P=0.002) were associated with increased in-hospital mortality. Conclusions— The incidence of IE at 1 year after TAVI was 0.50%, and the risk increased with the use of orotracheal intubation and a self-expandable valve system. Staphylococci and enterococci were the most common agents. Although most patients presented at least 1 complication of IE, valve intervention was performed in a minority of patients, and nearly half of the patients died during the hospitalization period.
  • PublicationRestreint
    Clinical impact of aortic regurgitation after transcatheter aortic valve replacement : insights into the degree and acuteness of presentation
    (Elsevier, 2014-09-01) Dumont, Éric; Nombela-Franco, Luis; Webb, John G. (John Graydon); Rodés-Cabau, Josep; Tamburino, Corrado; Bergeron, Sébastien; Muñoz, Antonio; Amat Santos, Ignacio J.; Cheema, Asim; Urena Alcazar, Marina; Dager, Antonio; Pibarot, Philippe; Serra, Vicenç; Ribeiro, Henrique B.; Jerez-Valero, Miguel; Barbanti, Marco; Immè, Sebastiano; Alonso-Briales, Juan H.; Al Lawati, Hatim; Benitez, Luis Miguel; Cucalon, Angela Maria; García del Blanco, Bruno; Revilla, Ana
    OBJECTIVES: The aim of this study was to determine the impact of the degree of residual aortic regurgitation (AR) and acuteness of presentation of AR after transcatheter aortic valve replacement (TAVR) on outcomes. BACKGROUND: The degree of residual AR after TAVR leading to excess mortality remains controversial, and little evidence exists on the impact of the acuteness of presentation of AR. METHODS: A total of 1,735 patients undergoing TAVR with balloon-expandable or self-expanding valves were included. The presence and degree of AR were evaluated by transthoracic echocardiography; acute AR was defined as an increase in AR severity of =1 degree compared with pre-procedural echocardiography. RESULTS: Residual AR was classified as mild in 761 patients (43.9%) and moderate to severe in 247 patients (14.2%). The presence of moderate to severe AR was an independent predictor of mortality at a mean follow-up of 21 ± 17 months compared with none to trace (adjusted hazard ratio [HR]: 1.81, 95% confidence interval [CI]: 1.32 to 2.48; p < 0.001) and mild AR (adjusted HR: 1.68, 95% CI: 1.27 to 2.24; p < 0.001) groups. There was no increased risk in patients with mild AR compared with those with none to trace AR (p = 0.393). In patients with moderate to severe AR, acute AR was observed in 161 patients (65%) and chronic AR in 86 patients (35%). Acute moderate to severe AR was independently associated with increased risk of mortality compared with none/trace/mild AR (adjusted HR: 2.37, 95% CI: 1.53 to 3.66; p < 0.001) and chronic moderate to severe AR (adjusted HR: 2.24, 95% CI: 1.17 to 4.30; p = 0.015) [corrected]. No differences in survival rate were observed between patients with chronic moderate to severe and none/trace/mild AR (p > 0.50). CONCLUSIONS: AR occurred very frequently after TAVR, but an increased risk of mortality at ~2-year follow-up was observed only in patients with acute moderate to severe AR.
  • PublicationRestreint
    Acute kidney injury following transcatheter aortic valve implantation : predictive factors, prognostic value, and comparison with surgical aortic valve replacement
    (European Society of Cardiology, 2009-12-27) Bertrand, Olivier; Webb, John G. (John Graydon); Dumont, Éric; Nietlispach, Fabian; De Larochellière, Robert; Rodés-Cabau, Josep; Bagur, Rodrigo Hernan; Doyle, Daniel; Masson, Jean-Bernard; Pibarot, Philippe; Gutiérrez-Marcos, José; Clavel, Marie-Annick
    Aims: Very few data exist on the occurrence of acute kidney injury (AKI) associated with transcatheter aortic valve implantation (TAVI). The objectives of the present study were (i) to determine the incidence, predictive factors, and prognostic value of AKI following TAVI, and (ii) to compare the occurrence of AKI in TAVI vs. surgical aortic valve replacement (SAVR) in patients with pre-procedural chronic kidney disease (CKD). Methods and results: A total of 213 patients (mean age 82 ± 8 years) undergoing TAVI for the treatment of severe aortic stenosis were included in the study. Acute kidney injury was defined as a reduction of >25% in estimated glomerular filtration rate (eGFR) within 48 h following the procedure or the need for haemodialysis during index hospitalization. Those patients with pre-procedural CKD (eGFR <60 mL/min/1.73 m2, n = 119) were compared with 104 contemporary patients with CKD who underwent isolated SAVR. The incidence of AKI following TAVI was 11.7%, with 1.4% of the patients requiring haemodialysis. Predictive factors of AKI were hypertension (OR: 4.66; 95% CI: 1.04–20.87), chronic obstructive pulmonary disease (OR: 2.64, 95% CI: 1.10–6.36), and peri-operative blood transfusion (OR: 3.47, 95% CI: 1.30–9.29). Twenty-one patients (9.8%) died during index hospitalization, and the logistic EuroSCORE (OR: 1.03 for each increase of 1%; 95% CI: 1.01–1.06) and occurrence of AKI (OR: 4.14, 95% CI: 1.42–12.13) were identified as independent predictors of postoperative mortality. Patients with CKD who underwent TAVI were older, had a higher logistic EuroSCORE and lower pre-procedural eGFR values compared with those who underwent SAVR (P < 0.0001 for all). The incidence of AKI was lower (P = 0.001; P = 0.014 after propensity score adjustment) in CKD patients who underwent TAVI (9.2%, need for haemodialysis: 2.5%) compared with those who underwent SAVR (25.9%, need for haemodialysis: 8.7%). Conclusion: Acute kidney injury occurred in 11.7% of the patients following TAVI and was associated with a greater than four-fold increase in the risk of postoperative mortality. Hypertension, chronic obstructive pulmonary disease, and blood transfusion were predictive factors of AKI. In those patients with pre-procedural CKD, TAVI was associated with a significant reduction of AKI compared with SAVR.
  • PublicationAccès libre
    Myocardial injury following transcatheter aortic valve implantation : insights from delayed-enhancement cardiovascular magnetic resonance
    (CongrHealth.com, 2015-06-01) Dahou, Abdellaziz; Dumont, Éric; Paz Ricapito, Maria de la; De Larochellière, Robert; Larose, Éric; Nombela-Franco, Luis; Rodés-Cabau, Josep; Le Ven, Florent; Mohammadi, Siamak; Paradis, Jean-Michel; Capoulade, Romain; Amat Santos, Ignacio J.; Doyle, Daniel; Urena Alcazar, Marina; Pibarot, Philippe; Allende, Ricardo; Clavel, Marie-Annick; Ribeiro, Henrique B.
    Aims: The aim of this study was to evaluate the presence, localisation and extent of myocardial injury as determined by late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR) imaging in patients undergoing transcatheter aortic valve implantation (TAVI). Methods and results: A total of 37 patients, who underwent successful TAVI with a balloon-expandable valve (transapical [TA], n=11; non-TA, n=26), were included. Cardiac biomarker (CK-MB and cTnT) levels were determined at baseline and following TAVI. CMR was performed within a week before and within 30 days following TAVI. Some increase in cardiac biomarkers was detected in 97% of the patients as determined by a rise in cTnT, and in 49% of the patients as determined by a rise in CK-MB. Following TAVI, no new myocardial necrosis defects were observed with the non-TA approach. Nonetheless, all patients who underwent TAVI through the TA approach had new focal myocardial necrosis in the apex, with a median myocardial extent and necrotic mass of 5% [2.0-7.0] and 3.5 g [2.3-4.5], respectively. Conclusions: Although some increase in cardiac biomarkers of myocardial injury was systematically detected following TAVI, new myocardial necrosis as evaluated by CMR was observed only in patients undergoing the procedure through the TA approach, involving ~5% of the myocardium in the apex.
  • PublicationRestreint
    Impact of valvuloarterial impedance on 2-year outcome of patients undergoing transcatheter aortic valve implantation
    (C.V. Mosby, 2013-05-11) Katsanos, Spyridon; Rodés-Cabau, Josep; Clavel, Marie-Annick; Pibarot, Philippe; Yiu, Kai Hang; Leong, Leong; Van der kley, Frank; Ajmone Marsan, Nina; Bax, Jeroen J.; Delgado, Victoria
    Background: Elderly patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) often have increased calcification and fibrosis of the aorta. Indices that account for the severity of valvular obstruction and systemic vascular impedance may better assess total left ventricular afterload. The aims of the present study were to evaluate changes in valvuloarterial impedance (Zva), systemic arterial compliance, and systemic vascular resistance after TAVI and to investigate the prognostic value of these parameters. Methods: A total of 116 patients (49% men; mean age, 81 ± 8 years) with symptomatic severe aortic stenosis underwent TAVI. Zva, systemic arterial compliance, and systemic vascular resistance were measured at baseline and 1 and 12 months after TAVI. The primary end point was all-cause mortality. Results: After TAVI, there was a significant reduction in Zva (from 5.40 ± 1.52 mm Hg/mL/m(2) at baseline to 4.13 ± 1.17 mm Hg/mL/m(2) at 1 month and 4.35 ± 1.38 mm Hg/mL/m(2) at 1 year, P < .001). Systemic arterial compliance (from 0.57 ± 0.27 to 0.57 ± 0.28 and 0.53 ± 0.27 mL/m(2)/mm Hg, P = .408) and systemic vascular resistance (from 1,938 ± 669 to 1,856 ± 888 and 1,871 ± 767, dyne·s·cm(-5), P = .697) did not change significantly over time. During a median follow-up period of 25 months, survival rates of patients with baseline Zva ≥ 5 mm Hg/mL/m(2) were lower compared with those with Zva < 5 mm Hg/mL/m(2) (82% vs 91%, respectively, log-rank P = .04). On multivariate Cox proportional-hazards analysis, baseline Zva was independently associated with all-cause mortality (hazard ratio, 1.48; 95% confidence interval, 1.05-2.07; P = .025). Conclusions: In patients undergoing TAVI, there is a significant postprocedural reduction in Zva, but there is no reduction in systemic arterial compliance or vascular resistance. Baseline Zva is an independent predictor of overall mortality at 2-year follow-up.
  • 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