Jean Michel Juliard

First-in-man implantation of a tricuspid annular remodeling device for functional tricuspid regurgitation

Tricuspid regurgitation (TR) is a common finding in patients with left-sided disease, and is associated with poor outcome and predicts poor survival, heart failure, and reduced functional capacity [(1)][1]. It is common after mitral valve treatment in rheumatic or ischemic mitral regurgitation, if

Closure of ostium secundum atrial septum defect with the atriasept occluder: Early European experience

Objectives: This multicentre study sought to report the safety and efficacy of the ATRIASEPT septal occluder to repair atrial septal defect (ASD). Background: The ATRIASEPT is a low profile, flexible, double disk occluder with centering system specifically designed for closure of ostium secundum ASD. Method: Patients were enrolled from four participating European sites and followed up for 12 months post procedure. Outcomes were evaluated, including closure success and incidence of adverse events. Results: Seventy‐six patients received the ATRIASEPT device. Mean size of the defect was 15 ± 4 mm. Closure success was observed in 69 patients (89%) at the end of the procedure. Sixty‐four patients had a six‐month follow up with a complete closure by 58 patients (90%). Minor adverse events occurred in two patients. Significant functional improvement was reported by all symptomatic patients. Conclusion: Percutaneous closure of ASD ostium secundum type defects with the ATRIASEPT is safe and effective with high success rate and excellent mid‐term outcome.

Delayed reopening of a hemodynamically significant patent foramen ovale after left lung transplantation: Emergency management

We report the case of a man who underwent a left-lung transplantation for pulmonary fibrosis and who developed deterioration of his respiratory condition at Day 16 post-operatively, with marked hypoxemia not explained by the usual early respiratory complications of lung transplantation. Contrast-enhanced transthoracic echocardiography identified a patent foramen ovale with massive spontaneous right-to-left shunting. As for the pathogenesis of this right-to-left shunting, we found no evidence supporting an elevation of right-side pressures, with the redirection of the inferior vena cava flow toward the patent foramen ovale being the suspected mechanism. We conclude that delayed reopening of the patent foramen ovale leading to massive right-to-left shunting is a possible complication after lung transplantation.

TCT-88 Innovative Transcatheter Tricuspid Valve Repair System. Initial Outcomes from the First in Human Multi-Centre Study

nos: 89 92 TCT-89 Balloon pulmonary angioplasty for chronic thromboembolic hypertension: report of a two-year experience in a surgical center Philippe Brenot, Carlos Garcia Alonso, Benoit Gerardin, Ryad Bourkaib, Xavier Jais, Gerald Simonneau, Elie Fadel Minneapolis Heart Institute Foundation; Hôpital Marie Lannelongue, Le Plessis Robinson, France; Hôpital Marie Lannelongue; Evecquemont, Evcequemont, France; Hôpital Bicêtre; Hôpital Bicêtre; Hôpital Marie Lannelongue BACKGROUND Balloon pulmonary angioplasty (BPA) has emerged as a new therapy (beside surgery and medical treatment) for patients suffering of chronic thromboembolic pulmonary hypertension (CTEPH). We describe herein our single-center experience in our first 113 patients. METHODS Patients were selected for BPA at weekly multidisciplinary meetings in collaboration with the national reference center for pulmonary hypertension. Patients underwent functional evaluation (NYHA class and 6 minutes walking test), as well as right heart catheterization and pulmonary artery imaging before BPA and systematically 3 months after the last session. BPA was performed via femoral vein under local anesthesia. Balloon diameter ranged from 1.5 to 9 mm. Several sessions were required to reach our goal of mean PAP < 30 mmHg. RESULTS From February 2014 to May 2016, 113 patients (64 males, 57%), mean age 62 15, underwent BPA. Reasons to perform BPA were: non-surgical distal disease in 82, comorbidities in 22, persistent high pulmonary artery pressure (PAP) after surgery in 7 and refusal to surgery in 2. The mean number of sessions was 5.5 (range 1 to 10). After 620 sessions we deplore 29 hemoptysis (4.5% of procedures), none of which was life threatening, 11 pulmonary artery dissections (1.7%), 5 of which were treated by stent implantation, and 46 reperfusion pulmonary injuries (7,4%), 2 of which required mechanical ventilation. 3 patients died (2.7%), 2 because of reperfusion injury and 1 of an infectious complication. Follow up has been completed for the first 79 patients (mean FU of 8 months, range 3 to 20). 3 patients died (1 sudden death, 1 recurrence of pulmonary embolism and 1 road accident). NYHA status improved from 2.91 to 1.77 (p<0.01). Mean PAP improved from 44.5 to 31.2 mmHg (p<0.01). Cardiac output increased from 2.59 L/min/m2 to 2.95 (p<0.01). Pulmonary vascular resistance (PVR) went down from 7.77 UW to 3.92 UW (p<0.01). CONCLUSION Our short term BPA results confirm the usefulness of this technique to improve hemodynamics and more importantly quality of life in well selected patients. Future analysis should help us select responsive patients while diminishing procedure related complications. To our knowledge this series is one of the largest currently available. CATEGORIES STRUCTURAL: Heart Failure TCT-90 Efficacy and safety of sequential hybrid therapy with pulmonary endarterectomy and additional balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension Kenichi Yanaka, Kazuhiko Nakayama, Toshiro Shinke, Hiromasa Otake, Takayoshi Toba, Hachidai Takahashi, Daisuke Terashita, Yuto Shinkura, Koji Kuroda, Kenzo Uzu, Natsuko Tahara, Yoshinori Nagasawa, Yuichiro Nagano, Naoki Tamada, yoshiro tsukiyama, Hiroyuki Yamamoto, Noriaki Emoto, Ken-ichi Hirata University of Michigan Health System, Kobe city, Japan; CVPath Institute, Inc; Kobe University Hospital, Kobe, Japan; National Institute of Cardiovascular Diseases, Dhaka, Bangladesh; Himeji Cardiovascular Center, Himeji, Japan; Kobe University, Himeji, Japan; Kobe University Hospital; City Clinic, Kobe, Japan; Kobe University

When Transcatheter Therapy Moves to the “Forgotten Valve”∗

Tricuspid regurgitation (TR) is very frequent in the population. More than 80% of TR is secondary to left-sided heart disease that causes right ventricular (RV) volume or pressure overload. As an illustration, >20% of patients undergoing cardiac surgery for left-sided valvular disease present with

Percutaneous Edge-to-Edge Mitral Valve Repair for Functional Mitral Regurgitation in a High-Surgical-Risk Patient

This case describes the use of the MitraClip to treat severe functional MR in an acutely decompensated high-surgical-risk patient.

Exclusion percutanée de l’auricule gauche : perspectives

With its high prevalence and well-known thromboembolic risk, atrial fibrillation (AF) is a crucial component of the 2010-2014 actions plan, ongoing in France to reduce the annual incidence of stroke. The stroke risk is stratified well with the CHA(2)DS(2)-VASc score. With the current guidelines, most patients with AF should be on oral anticoagulant regimen, a treatment recognized as effective but whose bleeding risks limit its use. In clinical practice, warfarin is often not prescribed in patients with high risk of stroke. Thus, the exploration of new ways in preventing thromboembolic events in patients with AF is needed. Beside new more convenient anticoagulant agents, the exclusion of the left atrial appendage recognized as main source of thrombi, may be an alternative in patients with both high risk of thrombotic and haemorrhagic events. Surgical experience showed that the results depend on the quality of the exclusion. For over the past 10 years, several percutaneous exclusion systems of the left atrial appendage have been developed. A randomized study (PROTECT AF) demonstrated the non-inferiority of the percutaneous exclusion in comparison with the warfarin. However, the place of this interventional therapy remains to be clarified, particularly the definition of the target population. This often multidisciplinary approach will have to be accompanied by a reduction of periprocedural complications, increase in rate of complete occlusion, and enough long clinical follow-up to assess the efficiency of this strategy.