Personne : Bagur, Rodrigo Hernan
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Université Laval. Département de médecine
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- PublicationAccès libreTranscatheter aortic valve implantation for the treatment of patients with severe symptomatic aortic stenosis(2012) Bagur, Rodrigo Hernan; Bertrand, Olivier; Rodés-Cabau, Josep; Pibarot, PhilippeL'implantation de valve aortique par cathéter (IVAC) a émergé comme une alternative thérapeutique pour les patients avec une sténose aortique (SA) sévère symptomatique considérée à haut risque pour le remplacement de valve aortique (RVA) chirurgicale. Nos objectifs étaient les suivants: 1) Déterminer l'incidence, les facteurs prédictifs et la valeur pronostique de l'insuffisance rénale aiguë (IRA) suite à l'IVAC, et de comparer l'incidence d'IRA chez les patients atteints d'insuffisance rénale chronique (IRC) pré-procédurale par rapport à un groupe ayant subi un RVA. 2) Évaluer l'utilité de l'échocardiographie transoesophagienne (ETO) pour guider l'IVAC par voie transapicale comme modalité d'imagerie primaire. 3) Comparer l'incidence et les facteurs prédictifs du bloc auriculo-ventriculaire (BAV) complet et d'implantation d'un pacemaker permanent (IPP) après l'IVAC par rapport au RVA. 4) Évaluer la faisabilité et la sécurité du test de marche de 6 minutes (6MWT) comme une mesure de la capacité d'exercice avant et après l'IVAC. 5) Évaluer le "Duke Activity Status Index" (DASI) comme une mesure de l'état fonctionnel/qualité de vie (QDV) pré-et post-IVAC, et de comparer l'état fonctionnel évalué par le DASI et la classification fonctionnelle de la "New York Heart Association" (NYHA) avec la capacité d'exercice, telle qu'évaluée par le 6MWT chez ces patients. Les résultats de notre premier travail ont montré que l'IRA s'est produite chez 11.7% des patients suite à l'IVAC et a été associée à un risque 4 fois supérieur de mortalité postopératoire. L'hypertension, la maladie pulmonaire obstructive chronique et les transfusions sanguines péri-opératoires étaient les facteurs prédictifs d'IRA. Chez les patients atteints d'IRC pré-procédurale, l'IVAC a été associée à une réduction significative d'IRA par rapport au RVA. Nous avons montré que l'ETO a été associée à une réduction significative de la quantité de produit de durant l'IVAC par voie transapicale. Suite à cela, nous avons démontré que l'IVAC avec la valve expansible par ballonnet a été associé à un taux plus élevé de BAV complet et IPP par rapport à le RVA. La présence du bloc de branche droite de base a montré une corrélation avec l'IPP dans le groupe IVAC. Nous avons démontré que l'IVAC a été associée à une amélioration significative de l'état fonctionnel/QDV ainsi que dans la distance parcourue lors du 6MWT après l'IVAC. Toutefois, une proportion substantielle de patients n'ont pas amélioré ou a même ont diminué leurs évaluations fonctionnelles après l'IVAC.
- PublicationAccès libreThe physiological burden of the 6-minute walk test compared with cardiopulmonary exercise stress test in patients with severe aortic atenosis(Elsevier, 2021-02-06) Rodés-Cabau, Josep; Auclair, Audrey; Bagur, Rodrigo Hernan; Nadreau, Éric; Poirier, Paul; Pibarot, Philippe; Clavel, Marie-Annick; Bastien, Marjorie; Forman, Daniel E.Background Management of aortic stenosis (AS) relies on symptoms. Exercise testing is recommended for asymptomatic patients with significant AS but is often experienced as forbidding and/or technically unrealistic for patients who are often frail, deconditioned, and intimidated by the exercise test. We compared the physiological burden assessed with gas exchange assessments to gauge and respiratory exchange ratio (RER) of a 6-minute walk test (6MWT) to a cardiopulmonary exercise stress test (CPET) in patients with severe AS. peak oxygen utilization Methods Adults with equivocal symptoms and severe AS (1-aortic valve area [AVA] ≤ 1.0 cm2 or AVA index ≤ 0.6 cm2/m2, 2-peak aortic jet velocity ≥ 4.0 m/sec, 3-mean transvalvular pressure gradient ≥ 40 mm Hg by rest or dobutamine stress echocardiography, or 4-aortic valve calcification ≥ 1200 in women or ≥ 2000 AU in men) were studied. All participants completed both a 6MWT and symptom-limited progressive bicycle exercise testing. Breath-by-breath gas analysis and 12-lead electrocardiography were completed during 6MWT and CPET. Results: Eleven patients were studied. Patients walked on average 330 ± 75 m during the 6MWT and achieved a maximal workload of 48 ± 14 watts during the CPET. During the 6MWT, peak maximal oxygen uptake (O2peak) was 12.8 ± 2.5 vs 10.8 ± 4.2 mL/kg/min during the CPET. Respiratory exchange ratio exceeded 1.1 in both the 6MWT and CPET indicating similarly high exertion. Compared with the CPET, a larger proportion of the 6MWT was performed at a high intensity level (78% ± 28% vs 33% ± 24% at > 85% V̇O2peak; P = 0.004). Conclusions The 6MWT with breath-by-breath gas analysis was well tolerated and able to achieve a physiological intense RER and O2peak that are similar to symptom-limited CPET in patients with severe AS.
- PublicationRestreintCerebral embolism following transcatheter aortic valve implantation : comparison of transfemoral and transapical approaches.(Elsevier Biomedical, 2011-01-04) Bédard, Fernand; Dumont, Éric; Boone, Robert H.; De Larochellière, Robert; Larose, Éric; Côté, Mélanie; Gurvitch, Ronen; Villeneuve, Jacques; Rodés-Cabau, Josep; Bagur, Rodrigo Hernan; Doyle, Daniel; Jayasuria, Cleonie; Pibarot, Philippe; Marrero, Alier; Webb, John G. (John Graydon)OBJECTIVES: The objective of this study was to compare the incidence of cerebral embolism (CE) as evaluated by diffusion-weighted magnetic resonance imaging (DW-MRI) following transapical (TA) transcatheter aortic valve implantation (TAVI) versus transfemoral (TF) TAVI. BACKGROUND: The TA-TAVI approach avoids both the manipulation of large catheters in the aortic arch/ascending aorta and the retrograde crossing of the aortic valve, and this avoidance might lead to a lower rate of CE. METHODS: This was a prospective multicenter study including 60 patients who underwent cerebral DW-MRI the day before and within the 6 days following TAVI (TF approach: 29 patients; TA approach: 31 patients). Neurologic and cognitive function assessments were performed at DW-MRI time points. RESULTS: The TAVI procedure was performed with the Edwards valve and was successful in all cases but one (98%). A total of 41 patients (68%) had 251 new cerebral ischemic lesions at the DW-MRI performed 4 ± 1 days after the procedure, 19 patients in the TF group (66%) and 22 patients in the TA group (71%; p = 0.78). Most patients (76%) with new ischemic lesions had multiple lesions (median number of lesions per patient: 3, range 1 to 31). There were no differences in lesion number and size between the TF and TA groups. No baseline or procedural factors were found to be predictors of new ischemic lesions. The occurrence of CE was not associated with a measurable impairment in cognitive function, but 2 patients (3.3%) had a clinically apparent stroke within the 24 h following the procedure (1 patient in each group). CONCLUSIONS: TAVI is associated with a high rate of silent cerebral ischemic lesions as evaluated by DW-MRI, with no differences between the TF and TA approaches. These results provide important novel insight into the mechanisms of CE associated with TAVI and support the need for further research to both reduce the incidence of CE during these procedures and better determine their clinical relevance
- PublicationRestreintIncidence, predictive factors, and prognostic value of new-onset atrial fibrillation following transcatheter aortic valve implantation(Elsevier, 2012-01-10) Dumont, Éric; Côté, Mélanie; Villeneuve, Jacques; Nombela-Franco, Luis; Rodés-Cabau, Josep; Amat Santos, Ignacio J.; Bagur, Rodrigo Hernan; Doyle, Daniel; Philippon, François; Urena Alcazar, Marina; Pibarot, Philippe; De Larochellière, RobertObjectives: This study sought to evaluate the incidence, predictive factors, and prognostic value of new-onset atrial fibrillation (NOAF) following transcatheter aortic valve implantation (TAVI). Background: Very few data exist on the occurrence of NOAF following TAVI. Methods: A total of 138 consecutive patients with no prior history of atrial fibrillation (AF) underwent TAVI with a balloon-expandable valve. Patients were on continuous electrocardiogram monitoring until hospital discharge, and NOAF was defined as any episode of AF lasting >30 s. All clinical, echocardiographic, procedural, and follow-up data were prospectively collected. Results: NOAF occurred in 44 patients (31.9%) at a median time of 48 h (interquartile range: 0 to 72 h) following TAVI. The predictive factors of NOAF were left atrial (LA) size (odds ratio [OR]: 1.21 for each increase in 1 mm/m2, 95% confidence interval [CI]: 1.09 to 1.34, p < 0.0001) and transapical approach (OR: 4.08, 95% CI: 1.35 to 12.31, p = 0.019). At 30-day follow-up, NOAF was associated with a higher rate of stroke/systemic embolism (13.6% vs. 3.2%, p = 0.021, p = 0.047 after adjustment for baseline differences between groups), with no differences in mortality rate between groups (NOAF: 9.1%, no-NOAF: 6.4%, p = 0.57). At a median follow-up of 12 months (interquartile range: 5 to 20 months), a total of 27 patients (19.6%) had died, with no differences between the NOAF (15.9%) and no-NOAF (21.3%) groups, p = 0.58. The cumulative rate of stroke and stroke/systemic embolism at follow-up were 13.6% and 15.9%, respectively, in the NOAF group versus 3.2% in the no-NOAF group (p = 0.039, adjusted p = 0.037 for stroke; p = 0.020, adjusted p = 0.023 for stroke/systemic embolism). Conclusions: NOAF occurred in about one-third of the patients with no prior history of AF undergoing TAVI and its incidence was increased in patients with larger LA size and those undergoing transapical TAVI. NOAF was associated with a higher rate of stroke/systemic embolism, but not a higher mortality, at 30 days and at 1-year follow-up.
- PublicationRestreintImages 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
- PublicationRestreintValidation and characterization of transcatheter aortic valve effective orifice area measured by Doppler echocardiography(American College of Cardiology, 2011-10-04) Larose, Éric; Rodés-Cabau, Josep; Dumont, Éric; Bergeron, Sébastien; Bagur, Rodrigo Hernan; Pibarot, Philippe; De Larochellière, Robert; Dumesnil, Jean G.; Doyle, Daniel; Clavel, Marie-AnnickObjectives : The objectives were to compare different Doppler echocardiographic methods for the measurement of prosthetic valve effective orifice area (EOA) following transcatheter aortic valve implantation (TAVI) and to determine the factors influencing the EOA of transcatheter balloon expandable valves.
- PublicationRestreintComparison between transcatheter and surgical prosthetic valve implantation in patients with severe aortic stenosis and reduced left ventricular ejection fraction(American Heart Association, 2010-11-09) Rodés-Cabau, Josep; Webb, John G. (John Graydon); Bergeron, Sébastien; Bagur, Rodrigo Hernan; Masson, Jean-Bernard; Pibarot, Philippe; Dumont, Éric; Dumesnil, Jean G.; De Larochellière, Robert; Clavel, Marie-Annick; Doyle, Daniel; Mathieu, Patrick; Baumgartner, Helmut; Burwash, Ian; Mundigler, Gerald; Moss, Robert; Kempny, Aleksander; Bergler-Klein, Jutta; Gurvitch, RonenBackground—Patients with severe aortic stenosis and reduced left ventricular ejection fraction (LVEF) have a poor prognosis with conservative therapy but a high operative mortality when treated surgically. Recently, transcatheter aortic valve implantation (TAVI) has emerged as an alternative to surgical aortic valve replacement (SAVR) for patients considered at high or prohibitive operative risk. The objective of this study was to compare TAVI and SAVR with respect to postoperative recovery of LVEF in patients with severe aortic stenosis and reduced LV systolic function.Methods and Results—Echocardiographic data were prospectively collected before and after the procedure in 200 patients undergoing SAVR and 83 patients undergoing TAVI for severe aortic stenosis (aortic valve area =1 cm2) with reduced LV systolic function (LVEF =50%). TAVI patients were significantly older (81±8 versus 70±10 years; P<0.0001) and had more comorbidities compared with SAVR patients. Despite similar baseline LVEF (34±11% versus 34±10%), TAVI patients had better recovery of LVEF compared with SAVR patients (¿LVEF, 14±15% versus 7±11%; P=0.005). At the 1-year follow-up, 58% of TAVI patients had a normalization of LVEF (>50%) as opposed to 20% in the SAVR group. On multivariable analysis, female gender (P=0.004), lower LVEF at baseline (P=0.005), absence of atrial fibrillation (P=0.01), TAVI (P=0.007), and larger increase in aortic valve area after the procedure (P=0.01) were independently associated with better recovery of LVEF. Conclusion—In patients with severe aortic stenosis and depressed LV systolic function, TAVI is associated with better LVEF recovery compared with SAVR. TAVI may provide an interesting alternative to SAVR in patients with depressed LV systolic function considered at high surgical risk.
- PublicationRestreintExercise 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, PhilippeFew 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.
- PublicationRestreintPerformance-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-AnnickBackground: 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 < .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 m(2), 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 < .0001) and at follow-up (r = 0.66, P < .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.
- PublicationRestreintAcute 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-AnnickAims: 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.