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Dumesnil, Jean G.

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Dumesnil

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Jean G.

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Université Laval. Faculté de médecine

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ncf10485729

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Voici les éléments 1 - 10 sur 26
  • PublicationRestreint
    Prevalence and long-term outcome of aortic prosthesis-patient mismatch in patients with paradoxical low-flow severe aortic stenosis
    (American Heart Association, 2014-09-09) Magne, Julien; Boulogne, Cyrille; Mohty, Dania; Pibarot, Philippe; Dumesnil, Jean G.; Echahidi, Najmeddine; Cornu, Elisabeth; Laskar, Marc; Virot, Patrice; Aboyans, Victor
    Background—Patients with severe aortic stenosis (AS) and paradoxical low flow (PLF) have worse outcome compared with those with normal flow. Furthermore, prosthesis–patient mismatch (PPM) after aortic valve replacement is a predictor of reduced survival. However, the prevalence and prognostic impact of PPM in patients with PLF-AS are unknown. We aimed to analyze the prevalence and long-term survival of PPM in patients with PLF-AS. Methods and Results—Between 2000 and 2010, 677 patients with severe AS, preserved left ventricular ejection fraction, and aortic valve replacement were included (74±8 years; 42% women; aortic valve area, 0.69±0.16 cm2). A PLF (indexed stroke volume =35 mL/m2) was found in 26%, and after aortic valve replacement, 54% of patients had PPM, defined as an indexed effective orifice area =0.85 cm2/m2 . The combined presence of PLF and PPM was found in 15%. Compared with patients with noPLF/noPPM, those with PLF/PPM were significantly older, with more comorbidities. They also received smaller and biological bioprosthesis more often (all P<0.01). Although early mortality was not significantly different between groups, the 10-year survival rate was significantly reduced in case of PLF/PPM compared with noPLF/noPPM (38±9% versus 70±5%; P=0.002), even after multivariable adjustment (hazard ratio, 2.58; 95% confidence interval, 1.5–4.45; P=0.0007). Conclusions—In this large catheterization-based study, the coexistence of PLF-AS before surgery and PPM after surgery is associated with the poorest outcome
  • PublicationRestreint
    Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its prevention
    (Elsevier Biomedical, 2000-10-01) Pibarot, Philippe; Dumesnil, Jean G.
    Prosthesis-patient mismatch is present when the effective orifice area of the inserted prosthetic valve is less than that of a normal human valve. This is a frequent problem in patients undergoing aortic valve replacement, and its main hemodynamic consequence is the generation of high transvalvular gradients through normally functioning prosthetic valves. The purposes of this report are to present an update on the concept of aortic prosthesis-patient mismatch and to review the present knowledge with regard to its impact on hemodynamic status, functional capacity, morbidity and mortality. Also, we propose a simple approach for the prevention and clinical management of this phenomenon because it can be largely avoided if certain simple factors are taken into consideration before the operation
  • PublicationRestreint
    The problem of severe valve prosthesis-patient mismatch in aortic bioprostheses : near extinction?
    (C.V. Mosby, 2014-06-01) Pibarot, Philippe; Dumesnil, Jean G.
  • PublicationRestreint
    Invited commentary
    (Elsevier, 2014-03-30) Pibarot, Philippe; Dumesnil, Jean G.
  • PublicationRestreint
    Impact of valve prosthesis-patient mismatch on short-term mortality after aortic valve replacement
    (American Heart Association, 2003-08-26) Baillot, Richard; Doyle, Daniel; Blais, Claudia; Pibarot, Philippe; Dumesnil, Jean G.; Simard, Serge
    Background— The prosthesis used for aortic valve replacement (AVR) can be too small in relation to body size, thus causing valve prosthesis-patient mismatch (PPM) and abnormally high transvalvular pressure gradients. This study examined if there is a relation between PPM and short-term mortality after operation. Methods and Results— The indexed valve effective orifice area (EOA) was estimated for each type and size of prosthesis being implanted in 1266 consecutive patients and used to define PPM as not clinically significant if 0.85 cm2/m2, as moderate if 0.65 cm2/m2 and 0.85 cm2/m2, and as severe if 0.65 cm2/m2; it was correlated with 30-day mortality and compared with other relevant variables. Moderate or severe PPM was present in 38% of patients. Thirty-day mortality was 4.6% (58/1266 patients) and the strongest independent predictors in multivariate analysis were left ventricular ejection fraction 40% (P 0.007), infectious endocarditis (P 0.002), emergent/salvage operation (P 0.002), cardiopulmonary bypass time 120 minutes (P 0.001), and PPM (P 0.003). Relative risk of mortality was increased 2.1-fold (95% confidence interval, 1.2 to 3.7) in patients with moderate PPM and 11.4-fold (4.4 to 29.5) in those with severe PPM. Moreover, risk of mortality for every category of PPM was higher in patients with a left ventricular ejection fraction 40% as compared with 40% (nonsignificant PPM, 2.7 versus 1.0; moderate PPM, 7.1 versus 1.8; severe PPM, 77.1 versus 11.3). Conclusion— PPM is a strong and independent predictor of short-term mortality among patients undergoing AVR, and its impact is related both to its degree of severity and the status of left ventricular function. In contrast to other risk factors, moderate-severe PPM can be largely avoided with the use of a prospective strategy at the time of operation.
  • PublicationRestreint
  • PublicationRestreint
    Impact of prosthesis-patient mismatch on survival after mitral valve replacement
    (American Heart Association, etc., 2007-03-05) Tanné, David; Magne, Julien; Doyle, Daniel; Pibarot, Philippe; Dumesnil, Jean G.; Dagenais, François; Mathieu, Patrick
    Background — We recently reported that valve prosthesis-patient mismatch (PPM) is associated with persisting pulmonary hypertension after mitral valve replacement. Thus, the objective of this study was to evaluate the impact of PPM on mortality in patients undergoing mitral valve replacement. Methods and Results— The indexed valve effective orifice area was estimated for each type and size of prosthesis being implanted in 929 consecutive patients and used to define PPM as not clinically significant if >1.2 cm2/m2, as moderate if >0.9 and =1.2 cm2/m2, and as severe if =0.9 cm2/m2. Moderate PPM was present in 69% of patients; severe PPM was seen in 9%. For patients with severe PPM, 6-year survival (74±5%) and 12-year survival (63±7%) were significantly less than for patients with moderate PPM (84±1% and 76±2%; P=0.027) or nonsignificant PPM (90±2% and 82±4%; P=0.002). On multivariate analysis, severe PPM was associated with higher mortality (hazard ratio, 3.2; 95% confidence interval, 1.5 to 6.8; P=0.003). Conclusions— Severe PPM is an independent predictor of mortality after mitral valve replacement. As opposed to other independent risk factors, PPM may be avoided or its severity may be reduced with the use of a prospective strategy at the time of operation. For patients identified as being at risk for severe PPM, every effort should be made to implant a prosthesis with a larger effective orifice area.
  • PublicationRestreint
    Prothesis-patient mismatch in the mitral position : old concept, new evidences
    (Elsevier, 2007-06-01) Pibarot, Philippe; Dumesnil, Jean G.
  • PublicationRestreint
    Impact of valve prosthesis-patient mismatch on pulmonary arterial pressure after mitral valve replacement
    (American College of Cardiology, 2005-03-30) Pibarot, Philippe; Dumesnil, Jean G.; Li, Mingzhou; Mathieu, Patrick
    Objectives: We sought to determine the impact of valve prosthesis-patient mismatch (PPM) on pulmonary arterial (PA) pressure after mitral valve replacement (MVR). Background: Pulmonary arterial hypertension is a serious complication of mitral valve disease, and it is a major risk factor for poor outcome after MVR. We hypothesized that valve PPM might be a determinant of PA hypertension after MVR. Methods: Systolic PA pressure was measured by Doppler echocardiography in 56 patients with normally functioning mitral prosthetic valves. Mitral valve effective orifice area (EOA) was determined by the continuity equation and indexed for body surface area. Results: Thirty patients (54%) had PA hypertension defined as systolic PA pressure >40 mm Hg, whereas 40 patients (71%) had PPM defined as an indexed EOA =1.2 cm2/m2. There was a significant correlation (r = 0.64) between systolic PA pressure and indexed EOA. The average systolic PA pressure and prevalence of PA hypertension were 34 ± 8 mm Hg and 19% in patients with no PPM versus 46 ± 8 mm Hg and 68% in patients with PPM (p < 0.001). In multivariate analysis, the indexed EOA was by far the strongest predictor of systolic PA pressure. Conclusions: Persistent PA hypertension is frequent after MVR and strongly associated with the presence of PPM. The clinical implications of these findings are important given that PPM can largely be avoided by using a simple prospective strategy at the time of operation.
  • PublicationRestreint
    Prosthesis-patient mismatch : an update
    (Current Science, 2011-02-25) Pibarot, Philippe; Dumesnil, Jean G.
    Prosthesis-patient mismatch (PPM) is present when the effective orifice area of the inserted prosthetic valve is too small in relation to body size. Its main hemodynamic consequence is to generate higher than expected gradients through normally functioning prosthetic valves. The purpose of this review is to present an update on the present state of knowledge with regard to diagnosis, prognosis, and prevention of PPM. PPM is a frequent occurrence (20% to 70% of aortic valve replacements) that has been shown to be associated with worse hemodynamics, less regression of left ventricular hypertrophy, more cardiac events, and lower survival. Moreover, as opposed to most other risk factors, PPM can largely be prevented by using a prospective strategy at the time of operation.