André Vincentelli - Academia.edu (original) (raw)

Papers by André Vincentelli

Research paper thumbnail of Platelet activation with the Aeson Bioprosthetic Total Artificial Heart: insight from aspirin treatment and outcomes

IntroductionThe Aeson bioprosthetic total artificial heart (A-TAH) is a pulsatile and autoregulat... more IntroductionThe Aeson bioprosthetic total artificial heart (A-TAH) is a pulsatile and autoregulated device. The aim of this study was to evaluate the level of platelet activation secondary to A-TAH implantation.MethodsWe examined the level of platelet activation markers in adult patients receiving A-TAH support (n=16) during clinical follow-up by quantifying sP-selectin (sP-sel) and sCD40L in plasma.ResultsThe cumulative duration of A-TAH support was 3587 days. Before implantation, sCD40L was 2684.6 pg/mL (954.0-16706.1) and remained steady after implantation [3305.8 pg/mL (1234.2-12327.5), 3300.5 pg/mL (1041.5-8370.1), and 2560.0 pg/mL (1325.5-14039.5), respectively, at <3 months, 3–6 months and >6 months; non-significant difference along time-period]. sP-sel was 33997.0 pg/mL (16019.6-73377.6) and remained steady after implantation [33580.1 pg/mL (13979.8-53395.2), 33204.9 pg/mL (15332.6-67263.4), and 34684.5 pg/mL (14084.9-49206.0), respectively, at <3 months, 3–6 months...

Research paper thumbnail of Platelet activation with the Aeson Bioprosthetic Total Artificial Heart: insight from aspirin treatment and outcomes

IntroductionThe Aeson bioprosthetic total artificial heart (A-TAH) is a pulsatile and autoregulat... more IntroductionThe Aeson bioprosthetic total artificial heart (A-TAH) is a pulsatile and autoregulated device. The aim of this study was to evaluate the level of platelet activation secondary to A-TAH implantation.MethodsWe examined the level of platelet activation markers in adult patients receiving A-TAH support (n=16) during clinical follow-up by quantifying sP-selectin (sP-sel) and sCD40L in plasma.ResultsThe cumulative duration of A-TAH support was 3587 days. Before implantation, sCD40L was 2684.6 pg/mL (954.0-16706.1) and remained steady after implantation [3305.8 pg/mL (1234.2-12327.5), 3300.5 pg/mL (1041.5-8370.1), and 2560.0 pg/mL (1325.5-14039.5), respectively, at <3 months, 3–6 months and >6 months; non-significant difference along time-period]. sP-sel was 33997.0 pg/mL (16019.6-73377.6) and remained steady after implantation [33580.1 pg/mL (13979.8-53395.2), 33204.9 pg/mL (15332.6-67263.4), and 34684.5 pg/mL (14084.9-49206.0), respectively, at <3 months, 3–6 months...

Research paper thumbnail of 804 Real-time three-dimensional echocardiography provides additional information but does not replace 2D echocardiography in the assessment of mitral regurgitation

European Journal of Echocardiography, 2005

Research paper thumbnail of Haemophilus parainfluenzae endocarditis in young adults

Médecine et Maladies Infectieuses, 2017

Research paper thumbnail of Post aortic dissection: Gap between activity recommendation and real life patients aerobic capacities

International Journal of Cardiology, 2016

Back ground: Regular exercise at a safe level, i.e. 3-5 metabolic equivalents, is recommended to ... more Back ground: Regular exercise at a safe level, i.e. 3-5 metabolic equivalents, is recommended to improve blood pressure control and quality of life even after aortic dissection, although aerobic exercise capacities in these patients are unexplored yet. Methods: We prospectively collected data from 105 patients with a history of post aortic dissection referred for a cardiopulmonary exercise testing (CPX) aiming to guide exercise rehabilitation. Results: The population was composed of 76% of male, with a mean age of 57.9 ± 12.4 years. There were an equal distribution between the two type of dissection (47% of type A and 53% of type B aortic dissection). No cardiac event occurred during or after CPX. One third of patients have normal aerobic exercise capacity defined as peak oxygen uptake upper than 85% of their predicted capacity. Mean oxygen uptake peak was quite low 19.2 ± 5.2 ml/kg/min (5.5 ± 1.5 metabolic equivalents). Aerobic capacity was limited by cardiac chronotropic incompetence in 42% or peripheral deconditioning in 45%. Blood pressure remained in an acceptable range during the exercise. Systolic and diastolic blood pressures were respectively 151 ± 20 and 77 ± 13 mm Hg at first ventilatory threshold. Conclusions: CPX is a safe exploration in patients with post aortic dissection syndrome. Given the fact that most of these patients are faced with significant aerobic capacities, the recommended daily practice of moderate exercise at 3-5 METS should be adapted and personalized to each patient thanks to CPX.

Research paper thumbnail of Drug-induced aortic valve stenosis: An under recognized entity

International Journal of Cardiology, 2016

Background: We have been intrigued by the observation that aortic stenosis (AS) may be associated... more Background: We have been intrigued by the observation that aortic stenosis (AS) may be associated with characteristic features of mitral drug-induced valvular heart disease (DI-VHD) in patients exposed to valvulopathic drugs, thus suggesting that beyond restrictive heart valve regurgitation, valvulopathic drugs may be involved in the pathogenesis of AS. Methods: Herein are reported echocardiographic features, and pathological findings encountered in a series of patients suffering from both AS (mean gradient N 15 mm Hg) and mitral DI-VHD after valvulopathic drugs exposure. History of rheumatic fever, chest radiation therapy, systemic disease or bicuspid aortic valve disease were exclusion criteria. Results: Twenty-five (19 females, mean age 62 years) patients having both AS and typical features of mitral DI-VHD were identified. Mean transaortic pressure gradient was 32 +/− 13 mm Hg. Aortic regurgitation was ≥ mild in 24 (96%) but trivial in one. Known history of aortic valve regurgitation following drug initiation prior the development of AS was previously diagnosed in 17 patients (68%). Six patients underwent aortic valve replacement and 3 both aortic and mitral valve replacement. In the 9 patients with pathology analysis,

Research paper thumbnail of Ross procedure is a safe treatment option for aortic valve endocarditis: Long-term follow-up of 42 patients

International journal of cardiology, Jan 15, 2016

Aortic root replacement with a pulmonary autograft (Ross procedure) can be performed as a treatme... more Aortic root replacement with a pulmonary autograft (Ross procedure) can be performed as a treatment of aortic valve endocarditis, avoiding prosthetic valve implantation in septic context. We sought to assess long-term outcomes of the Ross procedure in this indication. From April 1992 to March 2009, the intervention was performed in 42 patients (mean age 34±8years) suffering from an active or ancient aortic valve endocarditis. 36% of the patients had extensive perivalvular involvement, and surgery was urgent in 18 patients (43%). We performed a prospective clinical and echocardiographic follow-up of this population. Median follow-up was 10years (4-21years). Overall survival at 10 and 15years was respectively 87±5% and 81±8%. Perioperative mortality was 4.7% (2 patients) and no late cardiac death was reported. Eight patients (19%) underwent repeat surgery for autograft and/or homograft dysfunction at a median time of 8.4years (3months-18years). Rate of recurrent endocarditis was low (...

Research paper thumbnail of Cardiopulmonary Bypass Circuit Comparison of Blood Activation in the Wound, Active Vent, and

Research paper thumbnail of Posterior Intercostal Hemorrhage Following Median Sternotomy

Journal of Cardiac Surgery, 2012

Inflammatory pseudotumor (also known as inflammatory myofibroblastic tumor) is an uncommon spindl... more Inflammatory pseudotumor (also known as inflammatory myofibroblastic tumor) is an uncommon spindle cell lesion that was initially recognized in the lung and is now known to occur in virtually every major organ of the body. We report a case of a seven-year-old male who had an inflammatory pseudotumor of the right ventricular outflow tract involving the pulmonary valve causing pulmonary stenosis.

Research paper thumbnail of Recommandations sur les indications de l’assistance circulatoire dans le traitement des arrêts cardiaques réfractaires

Annales Françaises d'Anesthésie et de Réanimation, 2009

Research paper thumbnail of When less is more: Go slowly when repopulating a decellularized valve in vivo!

The Journal of Thoracic and Cardiovascular Surgery, 2006

Research paper thumbnail of Does glutaraldehyde induce calcification of bioprosthetic tissues?

The Annals of Thoracic Surgery, Dec 1, 1998

Background. Glutaraldehyde has been said to be responsible in part for the calcification of gluta... more Background. Glutaraldehyde has been said to be responsible in part for the calcification of glutaraldehydetreated tissues after implantation in animals or humans. We investigated whether the origin of the tissue, autologous or heterologous, could have a more prominent role in the process of calcification. Methods. Three-month-old sheep received sheep pericardial samples (n ‫؍‬ 133) and human pericardial samples (n ‫؍‬ 123) implanted subcutaneously. Samples were treated with 0.6% glutaraldehyde for 5, 10, or 20 minutes or 7 days and then rinsed thoroughly before implantation. Samples were then retrieved after 3 months. Calcium content was assessed by spectrophometry. Results. The results show a low calcium content in the autologous group (mean 1.14 ؎ 2.07) and a high calcium content in the heterologous group (mean 38.97 ؎ 26). These results were the same regardless of the duration of the treatment. Conclusions. Glutaraldehyde treatment (0.6%) does not play a significant role in the calcification of glutaraldehyde-treated tissue regardless of the origin, autologous or heterologous, of the tissue. Glutaraldehyde-treated autologous tissues are associated with an incidence of calcification lower than heterologous tissues.

Research paper thumbnail of Mechanical modifications to human pericardium after a brief immersion in 0.625% glutaraldehyde

PubMed, 1998

Background and aims of the study: The use of human pericardium pretreated for 10 min with 0.625% ... more Background and aims of the study: The use of human pericardium pretreated for 10 min with 0.625% glutaraldehyde (GLUT) in valvular repair or intracardiac reconstruction has produced good results. However, to date, no investigations have been made to determine the mechanical changes that occur in the tissue following such pretreatment. Methods: Human pericardial samples were harvested from 25 patients and immersed in GLUT for increasing times (5, 10, 30, 60 min and 6 months). Either untreated human pericardium or bovine pericardium treated for six months with GLUT served as controls. Tensile tests were performed with a uniaxial load machine and a pulsative bench. Fatigue testing was for 14 days; each sample was tested at 1,200 cycles/min at a controlled pressure of 90-120 mmHg. Results: Untreated tissue thickness was 0.44+/-0.16 mm, but after six months GLUT treatment it was 0.53+/-0.15 mm (p<0.001). There was a 13.7% shrinkage of tissue after six months immersion. Strain was significantly greater in treated tissue than in untreated tissue, while stiffness decreased with the duration of GLUT immersion. Young's modulus was significantly lower after six months GLUT treatment (0.26+/-0.06 MPa) compared with untreated, and 5-, 10- and 30-min GLUT treatment (0.32+/-0.15, 0.35+/-0.09, 0.32+/-0.09 and 0.36+/-0.10 MPa (p<0.05)), respectively. Creep was greater after six months GLUT treatment (0.5+/-0.03%) than in untreated and 10-, 30- and 60-min treatments (0.3+/-0.50, 0.27+/-0.01, 0.27+/-0.02, 0.3+/-0.01% (p<0.05)), respectively. Ultimate tensile stress (UTS) was greater in 10-min treated pericardium than in untreated tissue: 38.46+/-11.75 versus 22.17+/-8.30 MPa (p<0.05) respectively. Strain at rupture was greater in the 6-month group (30.62+/-2.54%) than for untreated and 10-, 30- and 60-min GLUT immersion 16.3+/-0.73, 21.85+/-0.75, 20.12+/-1.04 and 18.87+/-0.86% (p<0.05), respectively. Fatigue testing showed an increased length after five and 10 min, and six months, with a lengthening of 14.66, 12.53, 7.66%, respectively compared with 3.5% for untreated tissue (p<0.05). There were three failures in the untreated group (n = 5), none in the 5- and 10-min groups, and one in the 6-month group (p<0.05). Conclusion: Brief immersion of human pericardial tissue in 0.625% glutaraldehyde reduces the tissue's stiffness and improves its durability for use in cardiac surgery.

Research paper thumbnail of Right heart catheterization in advanced systolic heart failure. What are the most useful haemodynamic parameters for risk stratification?

Archives of Cardiovascular Diseases, Mar 1, 2022

BACKGROUND Previous studies have shown that pulmonary hypertension is a predictor of mortality in... more BACKGROUND Previous studies have shown that pulmonary hypertension is a predictor of mortality in patients with systolic heart failure (SHF). Persistent pulmonary hypertension after a reactivity test is associated with a worse outcome after transplantation. Recent studies have shown the utility of different haemodynamic parameters. AIMS To define best haemodynamic parameters for risk stratification in patients with advanced systolic heart failure. METHODS We included 425 consecutive patients who underwent a right heart catheterization with an inotropic challenge if indicated. RESULTS During a median (interquartile range) follow-up of 1.67 (0.49-4.49) years, there were 151 major cardiac events (126 cardiovascular deaths and 25 postoperative deaths after ventricular assist device implantation or heart transplantation). The most powerful independent predictors of major cardiac events were baseline right atrial pressure (RAP) (hazard ratio [HR]: 1.09, 95% confidence interval [CI]: 1.06-1.12; P<0.0001) and baseline pulmonary vascular resistance (PVR) (HR: 1.10; 95% CI: 1.03-1.17; P=0.002). After inotropic challenge, the only independent predictor was mean pulmonary arterial pressure (mPAP) (HR: 1.06; 95% CI: 1.03-1.09; P<0.0001). The combination of PVR (≤or>3 Wood units), RAP (30mmHg) was the best predictor of major events. CONCLUSION We suggest using a simple algorithm based on baseline PVR, baseline RAP and mPAP after the inotropic challenge for the risk stratification of stable patients with advanced systolic heart failure.

Research paper thumbnail of Clinical and Echocardiographic Correlates of Plasma B-type Natriuretic Peptide Levels in Patients with Aortic Valve Stenosis and Normal Left Ventricular Ejection Fraction

Echocardiography-a Journal of Cardiovascular Ultrasound and Allied Techniques, May 12, 2011

Several studies suggest that BNP testing may help define the timing of aortic valve surgery in pa... more Several studies suggest that BNP testing may help define the timing of aortic valve surgery in patients with aortic valve stenosis (AVS) prior onset of overt LV systolic dysfunction. The aim of this study was to identify clinical and echocardiographic correlates of plasma BNP levels in a large cohort of patients with AVS and preserved LV ejection fraction. One hundred thirty-five consecutive patients were prospectively included in the present study (Mean age 73 ± 13 years old, 66 (49%) male). Eighty-nine patients (66%) had severe AVS (aortic valve area &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.6 cm(2) /m(2) BSA). Plasma BNP levels, clinical and comprehensive Doppler echocardiography evaluation was performed in all patients. Independent clinical correlates of plasma BNP levels (R(2) = 0.19) were older age (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001) and presence of AVS symptoms (P = 0.004). Independent echocardiographic correlates of plasma BNP levels (R(2) = 0.38) were E/Ea ratio (P = 0.01), LV mass index (P = 0.018), left atrial surface (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001) and systolic pulmonary artery pressure (sPAP; P = 0.004). Overall, independent correlates of plasma BNP levels (R(2) = 0.47) were older age (P = 0.001), known coronary artery disease (P = 0.047), increased LV mass index (P = 0.001), left atrial enlargement (P = 0.002), and increased sPAP (P = 0.003). In patients with AVS and normal LV ejection fraction, plasma BNP predominantly reflects the clinical and echocardiographic consequences of afterload burden imposed on the left ventricle rather than the severity of valve stenosis, per se.

Research paper thumbnail of Clinical implications of left ventricular assist device implantation in implantable cardioverter-defibrillator patients

European Heart Journal, Aug 2, 2013

Patients and methods: During the period 2010-2012, 11 patients were implanted with the Excor BiVA... more Patients and methods: During the period 2010-2012, 11 patients were implanted with the Excor BiVAD-system (Berlin Heart Excor) at the University Hospital (mean age 39 years, 73% male). All patients were in severe biventricular heart failure (mean CI 1,5 l/min x sqm, RAP 14 mmHg, PCWP 27 mmHg) and either on waiting list for transplantation or considered suitable for heart transplantation later on. BiVAD patients were compared to the contemporary 12 LVAD patients. Two different RV risk failure scores have also been calculated for each patient and will be discussed. Results: 10/11 patients (91%) survived to HTx. The mean time of stay in the ICU after BiVAD implantation was 10 days and the mean time on assist 148 days. 9/11 patients were in INTERMACS class 1 or 2, 2/11 were in INTERMACS class 3. None of them had ischemic heart disease as the cause of heart failure. In comparison, LVAD patients (Heart Mate II, Thoratec) were older (mean age 56 years), had more ischemic heart disease (50%) and were all male. The survival rate was similar (10/12 patients, 83%) and so was the mean time of stay in the ICU (15 days). The LVAD patients had significantly better RV longitudinal function (measured by tissue Doppler), higher right ventricular stroke work index (RVSWI), higher cardiac index (1,9 l/min x sqm) and lower risk score for RV failure. Three patients had significant RV failure after LVAD implantation and two of those had to be bridged with RVAD. Conclusion: Biventricular assist device is a good treatment option in selected patients with advanced biventricular heart failure. Although our population is small the results in this very sick group of patients are much more encouraging than earlier described. Our results also suggest that the use of BiVAD has been reasonable in relation to the characteristics of our patients.

Research paper thumbnail of Response to Letter Regarding Article, “Functional Impairment of von Willebrand Factor in Hypertrophic Cardiomyopathy: Relation to Rest and Exercise Obstruction”

Circulation, Jun 16, 2009

Research paper thumbnail of 234-I * Cardiac Surgery and Repair of Pectus Deformities: When and How?

Interactive Cardiovascular and Thoracic Surgery, Sep 23, 2014

Research paper thumbnail of Oral Abstract Session * New insights into primary mitral regurgitation: Valvular heart disease associated with systemic conditions and others

European Journal of Echocardiography, Dec 1, 2012

Purpose: Epidemiology of mitral valve prolapse (MVP) has been described in different ethnic group... more Purpose: Epidemiology of mitral valve prolapse (MVP) has been described in different ethnic groups with controversy data on prevalence depending on age, sex, echocardiographic criteria and ethnicity itself. We studied prevalence of MVP in russian population using a large echocardiographic database. Methods: We retrospectively analyzed 16.185 echocardiograms performed between 2008 and 2011 in outpatient department of Almazov Federal Heart, Blood and Endocrinology Centre for different clinical reason. The all echocardiograms were performed by 6 experienced echocardiographers on commercially available system (Vivid 7 Dimension, GE). MVP was diagnosed by billowing of 1 or both mitral leaflets .2 mm above the mitral annulus in the long-axis parasternal view. By maximal leaflets thickness ≥5 mm MVP defined as classic, otherwise as nonclassic. Results: The echocardiographic prevalence of MVP was 1.3% (213 subjects). 118 (0.7%) of them had classic and 95 (0.6%) nonclassic MVP (see picture). Estimated prevalence of MVP in this sample of urban Russian population was lower than previously reported in Framingham Heart Study (2.4% vs. 1.3%, x 2 =22.4, p,0.0001) and local single-center studies (10-38%). The prevalence of MVP was similar in female (1.3%) and male (1.2%) patients (p=0,67). The mean age of patients with MVP was 50.1+19.5 versus 51.6+18.9 years in those without MVP (p=0,25). Subjects with MVP had a significant longer and thicker leaflets and larger mitral annulus diameter (anterior leaflet (AL) length: 24.

Research paper thumbnail of Bleeding and thrombotic events in patients with severe COVID-19 supported with extracorporeal membrane oxygenation: a nationwide cohort study

Intensive Care Medicine

To describe bleeding and thrombotic events and their risk factors in patients receiving extracorp... more To describe bleeding and thrombotic events and their risk factors in patients receiving extracorporeal membrane oxygenation (ECMO) for severe coronavirus disease 2019 (COVID-19) and to evaluate their impact on inhospital mortality. Methods: The ECMOSARS registry included COVID-19 patients supported by ECMO in France. We analyzed all patients included up to March 31, 2022 without missing data regarding bleeding and thrombotic events. The association of bleeding and thrombotic events with in-hospital mortality and pre-ECMO variables was assessed using multivariable logistic regression models. Results: Among 620 patients supported by ECMO, 29% had only bleeding events, 16% only thrombotic events and 20% both bleeding and thrombosis. Cannulation site (18% of patients), ear nose and throat (12%), pulmonary bleeding (9%) and intracranial hemorrhage (8%) were the most frequent bleeding types. Device-related thrombosis and pulmonary embolism/thrombosis accounted for most of thrombotic events. In-hospital mortality was 55.7%. Bleeding events were associated with in-hospital mortality (adjusted odds ratio (adjOR) = 2.91[1.94-4.4]) but not thrombotic events (adjOR = 1.02[0.68-1.53]). Intracranial hemorrhage was strongly associated with in-hospital mortality (adjOR = 13.5[4.4-41.5]). Ventilation duration before ECMO ≥ 7 days and length of ECMO support were associated with bleeding. Thrombosis-associated factors were fibrinogen ≥ 6 g/L and length of ECMO support.

Research paper thumbnail of Platelet activation with the Aeson Bioprosthetic Total Artificial Heart: insight from aspirin treatment and outcomes

IntroductionThe Aeson bioprosthetic total artificial heart (A-TAH) is a pulsatile and autoregulat... more IntroductionThe Aeson bioprosthetic total artificial heart (A-TAH) is a pulsatile and autoregulated device. The aim of this study was to evaluate the level of platelet activation secondary to A-TAH implantation.MethodsWe examined the level of platelet activation markers in adult patients receiving A-TAH support (n=16) during clinical follow-up by quantifying sP-selectin (sP-sel) and sCD40L in plasma.ResultsThe cumulative duration of A-TAH support was 3587 days. Before implantation, sCD40L was 2684.6 pg/mL (954.0-16706.1) and remained steady after implantation [3305.8 pg/mL (1234.2-12327.5), 3300.5 pg/mL (1041.5-8370.1), and 2560.0 pg/mL (1325.5-14039.5), respectively, at <3 months, 3–6 months and >6 months; non-significant difference along time-period]. sP-sel was 33997.0 pg/mL (16019.6-73377.6) and remained steady after implantation [33580.1 pg/mL (13979.8-53395.2), 33204.9 pg/mL (15332.6-67263.4), and 34684.5 pg/mL (14084.9-49206.0), respectively, at <3 months, 3–6 months...

Research paper thumbnail of Platelet activation with the Aeson Bioprosthetic Total Artificial Heart: insight from aspirin treatment and outcomes

IntroductionThe Aeson bioprosthetic total artificial heart (A-TAH) is a pulsatile and autoregulat... more IntroductionThe Aeson bioprosthetic total artificial heart (A-TAH) is a pulsatile and autoregulated device. The aim of this study was to evaluate the level of platelet activation secondary to A-TAH implantation.MethodsWe examined the level of platelet activation markers in adult patients receiving A-TAH support (n=16) during clinical follow-up by quantifying sP-selectin (sP-sel) and sCD40L in plasma.ResultsThe cumulative duration of A-TAH support was 3587 days. Before implantation, sCD40L was 2684.6 pg/mL (954.0-16706.1) and remained steady after implantation [3305.8 pg/mL (1234.2-12327.5), 3300.5 pg/mL (1041.5-8370.1), and 2560.0 pg/mL (1325.5-14039.5), respectively, at <3 months, 3–6 months and >6 months; non-significant difference along time-period]. sP-sel was 33997.0 pg/mL (16019.6-73377.6) and remained steady after implantation [33580.1 pg/mL (13979.8-53395.2), 33204.9 pg/mL (15332.6-67263.4), and 34684.5 pg/mL (14084.9-49206.0), respectively, at <3 months, 3–6 months...

Research paper thumbnail of 804 Real-time three-dimensional echocardiography provides additional information but does not replace 2D echocardiography in the assessment of mitral regurgitation

European Journal of Echocardiography, 2005

Research paper thumbnail of Haemophilus parainfluenzae endocarditis in young adults

Médecine et Maladies Infectieuses, 2017

Research paper thumbnail of Post aortic dissection: Gap between activity recommendation and real life patients aerobic capacities

International Journal of Cardiology, 2016

Back ground: Regular exercise at a safe level, i.e. 3-5 metabolic equivalents, is recommended to ... more Back ground: Regular exercise at a safe level, i.e. 3-5 metabolic equivalents, is recommended to improve blood pressure control and quality of life even after aortic dissection, although aerobic exercise capacities in these patients are unexplored yet. Methods: We prospectively collected data from 105 patients with a history of post aortic dissection referred for a cardiopulmonary exercise testing (CPX) aiming to guide exercise rehabilitation. Results: The population was composed of 76% of male, with a mean age of 57.9 ± 12.4 years. There were an equal distribution between the two type of dissection (47% of type A and 53% of type B aortic dissection). No cardiac event occurred during or after CPX. One third of patients have normal aerobic exercise capacity defined as peak oxygen uptake upper than 85% of their predicted capacity. Mean oxygen uptake peak was quite low 19.2 ± 5.2 ml/kg/min (5.5 ± 1.5 metabolic equivalents). Aerobic capacity was limited by cardiac chronotropic incompetence in 42% or peripheral deconditioning in 45%. Blood pressure remained in an acceptable range during the exercise. Systolic and diastolic blood pressures were respectively 151 ± 20 and 77 ± 13 mm Hg at first ventilatory threshold. Conclusions: CPX is a safe exploration in patients with post aortic dissection syndrome. Given the fact that most of these patients are faced with significant aerobic capacities, the recommended daily practice of moderate exercise at 3-5 METS should be adapted and personalized to each patient thanks to CPX.

Research paper thumbnail of Drug-induced aortic valve stenosis: An under recognized entity

International Journal of Cardiology, 2016

Background: We have been intrigued by the observation that aortic stenosis (AS) may be associated... more Background: We have been intrigued by the observation that aortic stenosis (AS) may be associated with characteristic features of mitral drug-induced valvular heart disease (DI-VHD) in patients exposed to valvulopathic drugs, thus suggesting that beyond restrictive heart valve regurgitation, valvulopathic drugs may be involved in the pathogenesis of AS. Methods: Herein are reported echocardiographic features, and pathological findings encountered in a series of patients suffering from both AS (mean gradient N 15 mm Hg) and mitral DI-VHD after valvulopathic drugs exposure. History of rheumatic fever, chest radiation therapy, systemic disease or bicuspid aortic valve disease were exclusion criteria. Results: Twenty-five (19 females, mean age 62 years) patients having both AS and typical features of mitral DI-VHD were identified. Mean transaortic pressure gradient was 32 +/− 13 mm Hg. Aortic regurgitation was ≥ mild in 24 (96%) but trivial in one. Known history of aortic valve regurgitation following drug initiation prior the development of AS was previously diagnosed in 17 patients (68%). Six patients underwent aortic valve replacement and 3 both aortic and mitral valve replacement. In the 9 patients with pathology analysis,

Research paper thumbnail of Ross procedure is a safe treatment option for aortic valve endocarditis: Long-term follow-up of 42 patients

International journal of cardiology, Jan 15, 2016

Aortic root replacement with a pulmonary autograft (Ross procedure) can be performed as a treatme... more Aortic root replacement with a pulmonary autograft (Ross procedure) can be performed as a treatment of aortic valve endocarditis, avoiding prosthetic valve implantation in septic context. We sought to assess long-term outcomes of the Ross procedure in this indication. From April 1992 to March 2009, the intervention was performed in 42 patients (mean age 34±8years) suffering from an active or ancient aortic valve endocarditis. 36% of the patients had extensive perivalvular involvement, and surgery was urgent in 18 patients (43%). We performed a prospective clinical and echocardiographic follow-up of this population. Median follow-up was 10years (4-21years). Overall survival at 10 and 15years was respectively 87±5% and 81±8%. Perioperative mortality was 4.7% (2 patients) and no late cardiac death was reported. Eight patients (19%) underwent repeat surgery for autograft and/or homograft dysfunction at a median time of 8.4years (3months-18years). Rate of recurrent endocarditis was low (...

Research paper thumbnail of Cardiopulmonary Bypass Circuit Comparison of Blood Activation in the Wound, Active Vent, and

Research paper thumbnail of Posterior Intercostal Hemorrhage Following Median Sternotomy

Journal of Cardiac Surgery, 2012

Inflammatory pseudotumor (also known as inflammatory myofibroblastic tumor) is an uncommon spindl... more Inflammatory pseudotumor (also known as inflammatory myofibroblastic tumor) is an uncommon spindle cell lesion that was initially recognized in the lung and is now known to occur in virtually every major organ of the body. We report a case of a seven-year-old male who had an inflammatory pseudotumor of the right ventricular outflow tract involving the pulmonary valve causing pulmonary stenosis.

Research paper thumbnail of Recommandations sur les indications de l’assistance circulatoire dans le traitement des arrêts cardiaques réfractaires

Annales Françaises d'Anesthésie et de Réanimation, 2009

Research paper thumbnail of When less is more: Go slowly when repopulating a decellularized valve in vivo!

The Journal of Thoracic and Cardiovascular Surgery, 2006

Research paper thumbnail of Does glutaraldehyde induce calcification of bioprosthetic tissues?

The Annals of Thoracic Surgery, Dec 1, 1998

Background. Glutaraldehyde has been said to be responsible in part for the calcification of gluta... more Background. Glutaraldehyde has been said to be responsible in part for the calcification of glutaraldehydetreated tissues after implantation in animals or humans. We investigated whether the origin of the tissue, autologous or heterologous, could have a more prominent role in the process of calcification. Methods. Three-month-old sheep received sheep pericardial samples (n ‫؍‬ 133) and human pericardial samples (n ‫؍‬ 123) implanted subcutaneously. Samples were treated with 0.6% glutaraldehyde for 5, 10, or 20 minutes or 7 days and then rinsed thoroughly before implantation. Samples were then retrieved after 3 months. Calcium content was assessed by spectrophometry. Results. The results show a low calcium content in the autologous group (mean 1.14 ؎ 2.07) and a high calcium content in the heterologous group (mean 38.97 ؎ 26). These results were the same regardless of the duration of the treatment. Conclusions. Glutaraldehyde treatment (0.6%) does not play a significant role in the calcification of glutaraldehyde-treated tissue regardless of the origin, autologous or heterologous, of the tissue. Glutaraldehyde-treated autologous tissues are associated with an incidence of calcification lower than heterologous tissues.

Research paper thumbnail of Mechanical modifications to human pericardium after a brief immersion in 0.625% glutaraldehyde

PubMed, 1998

Background and aims of the study: The use of human pericardium pretreated for 10 min with 0.625% ... more Background and aims of the study: The use of human pericardium pretreated for 10 min with 0.625% glutaraldehyde (GLUT) in valvular repair or intracardiac reconstruction has produced good results. However, to date, no investigations have been made to determine the mechanical changes that occur in the tissue following such pretreatment. Methods: Human pericardial samples were harvested from 25 patients and immersed in GLUT for increasing times (5, 10, 30, 60 min and 6 months). Either untreated human pericardium or bovine pericardium treated for six months with GLUT served as controls. Tensile tests were performed with a uniaxial load machine and a pulsative bench. Fatigue testing was for 14 days; each sample was tested at 1,200 cycles/min at a controlled pressure of 90-120 mmHg. Results: Untreated tissue thickness was 0.44+/-0.16 mm, but after six months GLUT treatment it was 0.53+/-0.15 mm (p<0.001). There was a 13.7% shrinkage of tissue after six months immersion. Strain was significantly greater in treated tissue than in untreated tissue, while stiffness decreased with the duration of GLUT immersion. Young's modulus was significantly lower after six months GLUT treatment (0.26+/-0.06 MPa) compared with untreated, and 5-, 10- and 30-min GLUT treatment (0.32+/-0.15, 0.35+/-0.09, 0.32+/-0.09 and 0.36+/-0.10 MPa (p<0.05)), respectively. Creep was greater after six months GLUT treatment (0.5+/-0.03%) than in untreated and 10-, 30- and 60-min treatments (0.3+/-0.50, 0.27+/-0.01, 0.27+/-0.02, 0.3+/-0.01% (p<0.05)), respectively. Ultimate tensile stress (UTS) was greater in 10-min treated pericardium than in untreated tissue: 38.46+/-11.75 versus 22.17+/-8.30 MPa (p<0.05) respectively. Strain at rupture was greater in the 6-month group (30.62+/-2.54%) than for untreated and 10-, 30- and 60-min GLUT immersion 16.3+/-0.73, 21.85+/-0.75, 20.12+/-1.04 and 18.87+/-0.86% (p<0.05), respectively. Fatigue testing showed an increased length after five and 10 min, and six months, with a lengthening of 14.66, 12.53, 7.66%, respectively compared with 3.5% for untreated tissue (p<0.05). There were three failures in the untreated group (n = 5), none in the 5- and 10-min groups, and one in the 6-month group (p<0.05). Conclusion: Brief immersion of human pericardial tissue in 0.625% glutaraldehyde reduces the tissue's stiffness and improves its durability for use in cardiac surgery.

Research paper thumbnail of Right heart catheterization in advanced systolic heart failure. What are the most useful haemodynamic parameters for risk stratification?

Archives of Cardiovascular Diseases, Mar 1, 2022

BACKGROUND Previous studies have shown that pulmonary hypertension is a predictor of mortality in... more BACKGROUND Previous studies have shown that pulmonary hypertension is a predictor of mortality in patients with systolic heart failure (SHF). Persistent pulmonary hypertension after a reactivity test is associated with a worse outcome after transplantation. Recent studies have shown the utility of different haemodynamic parameters. AIMS To define best haemodynamic parameters for risk stratification in patients with advanced systolic heart failure. METHODS We included 425 consecutive patients who underwent a right heart catheterization with an inotropic challenge if indicated. RESULTS During a median (interquartile range) follow-up of 1.67 (0.49-4.49) years, there were 151 major cardiac events (126 cardiovascular deaths and 25 postoperative deaths after ventricular assist device implantation or heart transplantation). The most powerful independent predictors of major cardiac events were baseline right atrial pressure (RAP) (hazard ratio [HR]: 1.09, 95% confidence interval [CI]: 1.06-1.12; P<0.0001) and baseline pulmonary vascular resistance (PVR) (HR: 1.10; 95% CI: 1.03-1.17; P=0.002). After inotropic challenge, the only independent predictor was mean pulmonary arterial pressure (mPAP) (HR: 1.06; 95% CI: 1.03-1.09; P<0.0001). The combination of PVR (≤or>3 Wood units), RAP (30mmHg) was the best predictor of major events. CONCLUSION We suggest using a simple algorithm based on baseline PVR, baseline RAP and mPAP after the inotropic challenge for the risk stratification of stable patients with advanced systolic heart failure.

Research paper thumbnail of Clinical and Echocardiographic Correlates of Plasma B-type Natriuretic Peptide Levels in Patients with Aortic Valve Stenosis and Normal Left Ventricular Ejection Fraction

Echocardiography-a Journal of Cardiovascular Ultrasound and Allied Techniques, May 12, 2011

Several studies suggest that BNP testing may help define the timing of aortic valve surgery in pa... more Several studies suggest that BNP testing may help define the timing of aortic valve surgery in patients with aortic valve stenosis (AVS) prior onset of overt LV systolic dysfunction. The aim of this study was to identify clinical and echocardiographic correlates of plasma BNP levels in a large cohort of patients with AVS and preserved LV ejection fraction. One hundred thirty-five consecutive patients were prospectively included in the present study (Mean age 73 ± 13 years old, 66 (49%) male). Eighty-nine patients (66%) had severe AVS (aortic valve area &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.6 cm(2) /m(2) BSA). Plasma BNP levels, clinical and comprehensive Doppler echocardiography evaluation was performed in all patients. Independent clinical correlates of plasma BNP levels (R(2) = 0.19) were older age (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001) and presence of AVS symptoms (P = 0.004). Independent echocardiographic correlates of plasma BNP levels (R(2) = 0.38) were E/Ea ratio (P = 0.01), LV mass index (P = 0.018), left atrial surface (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001) and systolic pulmonary artery pressure (sPAP; P = 0.004). Overall, independent correlates of plasma BNP levels (R(2) = 0.47) were older age (P = 0.001), known coronary artery disease (P = 0.047), increased LV mass index (P = 0.001), left atrial enlargement (P = 0.002), and increased sPAP (P = 0.003). In patients with AVS and normal LV ejection fraction, plasma BNP predominantly reflects the clinical and echocardiographic consequences of afterload burden imposed on the left ventricle rather than the severity of valve stenosis, per se.

Research paper thumbnail of Clinical implications of left ventricular assist device implantation in implantable cardioverter-defibrillator patients

European Heart Journal, Aug 2, 2013

Patients and methods: During the period 2010-2012, 11 patients were implanted with the Excor BiVA... more Patients and methods: During the period 2010-2012, 11 patients were implanted with the Excor BiVAD-system (Berlin Heart Excor) at the University Hospital (mean age 39 years, 73% male). All patients were in severe biventricular heart failure (mean CI 1,5 l/min x sqm, RAP 14 mmHg, PCWP 27 mmHg) and either on waiting list for transplantation or considered suitable for heart transplantation later on. BiVAD patients were compared to the contemporary 12 LVAD patients. Two different RV risk failure scores have also been calculated for each patient and will be discussed. Results: 10/11 patients (91%) survived to HTx. The mean time of stay in the ICU after BiVAD implantation was 10 days and the mean time on assist 148 days. 9/11 patients were in INTERMACS class 1 or 2, 2/11 were in INTERMACS class 3. None of them had ischemic heart disease as the cause of heart failure. In comparison, LVAD patients (Heart Mate II, Thoratec) were older (mean age 56 years), had more ischemic heart disease (50%) and were all male. The survival rate was similar (10/12 patients, 83%) and so was the mean time of stay in the ICU (15 days). The LVAD patients had significantly better RV longitudinal function (measured by tissue Doppler), higher right ventricular stroke work index (RVSWI), higher cardiac index (1,9 l/min x sqm) and lower risk score for RV failure. Three patients had significant RV failure after LVAD implantation and two of those had to be bridged with RVAD. Conclusion: Biventricular assist device is a good treatment option in selected patients with advanced biventricular heart failure. Although our population is small the results in this very sick group of patients are much more encouraging than earlier described. Our results also suggest that the use of BiVAD has been reasonable in relation to the characteristics of our patients.

Research paper thumbnail of Response to Letter Regarding Article, “Functional Impairment of von Willebrand Factor in Hypertrophic Cardiomyopathy: Relation to Rest and Exercise Obstruction”

Circulation, Jun 16, 2009

Research paper thumbnail of 234-I * Cardiac Surgery and Repair of Pectus Deformities: When and How?

Interactive Cardiovascular and Thoracic Surgery, Sep 23, 2014

Research paper thumbnail of Oral Abstract Session * New insights into primary mitral regurgitation: Valvular heart disease associated with systemic conditions and others

European Journal of Echocardiography, Dec 1, 2012

Purpose: Epidemiology of mitral valve prolapse (MVP) has been described in different ethnic group... more Purpose: Epidemiology of mitral valve prolapse (MVP) has been described in different ethnic groups with controversy data on prevalence depending on age, sex, echocardiographic criteria and ethnicity itself. We studied prevalence of MVP in russian population using a large echocardiographic database. Methods: We retrospectively analyzed 16.185 echocardiograms performed between 2008 and 2011 in outpatient department of Almazov Federal Heart, Blood and Endocrinology Centre for different clinical reason. The all echocardiograms were performed by 6 experienced echocardiographers on commercially available system (Vivid 7 Dimension, GE). MVP was diagnosed by billowing of 1 or both mitral leaflets .2 mm above the mitral annulus in the long-axis parasternal view. By maximal leaflets thickness ≥5 mm MVP defined as classic, otherwise as nonclassic. Results: The echocardiographic prevalence of MVP was 1.3% (213 subjects). 118 (0.7%) of them had classic and 95 (0.6%) nonclassic MVP (see picture). Estimated prevalence of MVP in this sample of urban Russian population was lower than previously reported in Framingham Heart Study (2.4% vs. 1.3%, x 2 =22.4, p,0.0001) and local single-center studies (10-38%). The prevalence of MVP was similar in female (1.3%) and male (1.2%) patients (p=0,67). The mean age of patients with MVP was 50.1+19.5 versus 51.6+18.9 years in those without MVP (p=0,25). Subjects with MVP had a significant longer and thicker leaflets and larger mitral annulus diameter (anterior leaflet (AL) length: 24.

Research paper thumbnail of Bleeding and thrombotic events in patients with severe COVID-19 supported with extracorporeal membrane oxygenation: a nationwide cohort study

Intensive Care Medicine

To describe bleeding and thrombotic events and their risk factors in patients receiving extracorp... more To describe bleeding and thrombotic events and their risk factors in patients receiving extracorporeal membrane oxygenation (ECMO) for severe coronavirus disease 2019 (COVID-19) and to evaluate their impact on inhospital mortality. Methods: The ECMOSARS registry included COVID-19 patients supported by ECMO in France. We analyzed all patients included up to March 31, 2022 without missing data regarding bleeding and thrombotic events. The association of bleeding and thrombotic events with in-hospital mortality and pre-ECMO variables was assessed using multivariable logistic regression models. Results: Among 620 patients supported by ECMO, 29% had only bleeding events, 16% only thrombotic events and 20% both bleeding and thrombosis. Cannulation site (18% of patients), ear nose and throat (12%), pulmonary bleeding (9%) and intracranial hemorrhage (8%) were the most frequent bleeding types. Device-related thrombosis and pulmonary embolism/thrombosis accounted for most of thrombotic events. In-hospital mortality was 55.7%. Bleeding events were associated with in-hospital mortality (adjusted odds ratio (adjOR) = 2.91[1.94-4.4]) but not thrombotic events (adjOR = 1.02[0.68-1.53]). Intracranial hemorrhage was strongly associated with in-hospital mortality (adjOR = 13.5[4.4-41.5]). Ventilation duration before ECMO ≥ 7 days and length of ECMO support were associated with bleeding. Thrombosis-associated factors were fibrinogen ≥ 6 g/L and length of ECMO support.