Papers by Arsène Basmadjian
Journal of Interventional Cardiology, Sep 5, 2013
ObjectivesTo describe the particular assessment and closure strategy that was followed in patient... more ObjectivesTo describe the particular assessment and closure strategy that was followed in patients with left atrial appendages (LAA) with an early and severe bend.BackgroundThe presence of a chicken‐wing morphology with an early and severe bend constitutes one of the most difficult anatomical settings for transcatheter LAA occlusion.MethodsBetween November 2009 and December 2012, patients who presented chicken‐wing LAA with an early (&lt;20 mm from the ostium) and severe bend (&lt;180°) were identified and included in the analysis. A particular implanting strategy consisting of deploying the distal lobe of the device inside the chicken‐wing bend was used in all cases.ResultsAmong 42 patients who underwent LAA occlusion during the study period, 5 (12%) presented the pre‐specified anatomy. Following the mentioned implanting strategy, all patients underwent successful LAA occlusion using the Amplatzer Cardiac Plug (n = 2) and the Amplatzer Amulet (n = 3). Successful occlusion was achieved in all patients. None of them presented any procedural complication. Follow‐up transesophageal echocardiography at 3 months showed successful LAA sealing in all patients and no device embolization or thrombosis.ConclusionsAccording to our results, the pre‐specified closing implantation technique for chicken‐wing LAAs with an early and severe bend might be a valid strategy for this challenging anatomical setting. Further cases will be necessary to confirm the results. (J Interven Cardiol 2013;26:509‐514)
Background: Significant paravalvular leak (PVL) after prosthetic replacement can result in hemoly... more Background: Significant paravalvular leak (PVL) after prosthetic replacement can result in hemolysis and/or congestive heart failure (CHF). Percutaneous PVL reduction (PPVR) represents an alternative to repeat surgery for a selected population. The purpose of this study was to assess the procedural and long-term clinical efficacy of percutaneous PPVR and its effect on survival free of rehospitalization for CHF, surgical reintervention, and death. Methods: We analyzed a cohort of 56 consecutive patients who underwent 61 PPVRs in our institution between June 2001 and December 2010. Procedural success was defined as a reduction in regurgitation severity free from procedural complications. Patients were followed-up for vital status, clinical events, and symptoms. Results: Patients were aged 65 � 11 years, with an average logistic EuroSCORE of 19 � 14%. Indications for PPVR included CHF (61%), hemolysis (9%), or both (30%), caused by mitral (n ¼ 44) or aortic (n ¼ 12) PVL. Procedural success was achieved in 75% of cases. Three major complications, including 2 deaths, occurred during the initial 30-day follow-up in the 42 patients who were treated with a device. After adjusting for the logistic EuroSCORE, prosthesis type (mitral vs aortic), and time interval since the last valve surgery,
Frontiers in Cardiovascular Medicine, Feb 8, 2022
Bicuspid aortic valve (BAV) is the most frequent congenital anomaly and has a natural evolution t... more Bicuspid aortic valve (BAV) is the most frequent congenital anomaly and has a natural evolution toward aortic regurgitation or stenosis due to the asymmetrical valve function associated with an evolutive ascending aortopathy. Several BAV classifications exist describing the presence and number of raphe, amount and location of calcium, and the symmetry of the functional cusps. The impact of BAV morphology on transcatheter aortic valve implantation (TAVI) outcomes still remains little investigated. Pivotal randomized trials comparing TAVI with surgery have excluded BAV until yet. However, data from registries and observational studies including highly selected patients have shown promising results of TAVI in BAV. With this review, we aimed at describing anatomical and pathophysiological characteristics of BAV, discussing the main aspects to assess diagnostic imaging modalities, and giving an overview of TAVI outcomes and technical considerations specific to BAV morphology.
International Journal of Cardiology, Sep 1, 2013
The Amplatzer Cardiac Plug (ACP) is a relatively new system for left atrial appendage (LAA) closu... more The Amplatzer Cardiac Plug (ACP) is a relatively new system for left atrial appendage (LAA) closure. In general, the particular design of the device and the variability of the LAA anatomy make the sizing process challenging. The objective of our study was to analyze the impact of the shape and sizing of the device on the presence of follow-up leaks. The shape was evaluated by angiography and classified as &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;strawberry-like&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;, &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;square-like&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;tire-like&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;. The presence of peri-device leaks was assessed by transesophageal echocardiography (TEE) and graded as: 1) severe, 2) major, 3) moderate, 4) minor and 5) absent. Twenty five patients were included. Overall, the device was oversized by 3.38 ± 2.26 mm and 1.58 ± 2.75 mm in relation to the largest angiographic and TEE diameter respectively. None of the patients presented any intra-procedural complication. After discharge, one patient was admitted for cardiac tamponade and another for stroke. In both, the device was optimally deployed. Follow-up TEE was done after a mean time of 7.9 ± 5.9 months. The presence of a leak was associated with a lower degree of device over-sizing by TEE (0.06 ± 3.31 mm if leak vs. 2.73 ± 1.85 mm if no leak; p=0.04) and a trend towards by angiography (2.39 ± 3.06 mm if leak vs. 3.98 ± 1.57 mm if no leak; p=0.16). The shape of the device was not associated with the presence of TEE leaks. Neither the shape nor the presence of leaks was associated with worse clinical outcomes. Although the shape and sizing of the device were not linked to any particular clinical outcome, we found an association between a lower degree of over-sizing and the presence of follow-up leaks.
Canadian Journal of Cardiology, Sep 1, 2011
Circulation, May 30, 2006
Canadian Journal of Cardiology, Sep 1, 2012
Revista española de cardiología, Nov 1, 2009
Transcatheter Closure of Coronary Artery Fistulas USA), using an arteriovenous circuit, which inv... more Transcatheter Closure of Coronary Artery Fistulas USA), using an arteriovenous circuit, which involved antegrade insertion of the guide in the fistula and exteriorization through the right internal jugular vein (RIJV) following placement of the loop in the inferior vena cava (IVC) (Figure ). Complete occlusion of the fistula was documented by color Doppler 15 min after implantation of the device. Although implantation was carried out adjacent to an obtuse marginal (OM) coronary branch, there were no complications during the procedure. The patient was treated with acetylsalicylic acid and warfarin for 6 months to prevent the formation of a large thrombus. At 6 months of follow-up, the patient remained asymptomatic and TTE documented a decrease in size of the RV and CS. This case shows that percutaneous closure of coronary fistulas is a feasible and safe alternative to surgical ligation in anatomically appropriate vessels.
Canadian Journal of Cardiology, May 1, 2011
Cardiovascular complications are the second leading cause of late mortality in survivors of Hodgk... more Cardiovascular complications are the second leading cause of late mortality in survivors of Hodgkin's lymphoma (HL) exposed to mediastinal radiotherapy. Symptomatic cardiac disease following classic thoracic irradiation for HL is reported in 10%-30% of patients at 5-10 years of follow-up. We present the case of a 44-year-old man with a history of left cervical nodular lymphocyte predominant HL treated at childhood with 40 Gy extended field thoracic irradiation (Mantle) who presented with mixed aortic and mitral valve disease, coronary artery stenosis, myocardial and aortic calcifications, and mediastinal fibrosis. Despite extensive cardiac surgery, the postoperative course was complicated and resulted in the patient's death. We review herein the typical cardiac involvement related to mediastinal radiotherapy and the controversies surrounding its surgical approach.
European Heart Journal, 2018
who did not attain the LA volume within the normal range. During the successive follow-up periods... more who did not attain the LA volume within the normal range. During the successive follow-up periods (30±15 m), very late AF recurrence was reported in 12 patients (11%), and all recurrence episodes were detected in the patients who could not achieve the LA volume within the normal range (Figure). Although the decline in the LA volume led to the improvement of the LA function, the LA functional parameters did not normalize despite maintaining the sinus rhythm (Table). Additionally, we investigated echocardiographic studies at 2 years after PVI in selected 63 patients who maintained the sinus rhythm. Of these, 31 patients (49%) achieved the LA volume within the normal range, and no very late recurrence was subsequently reported in these patients. However, the LA functional parameters in these patients (pump strain:-8.9±3.0%, reservoir strain: 20±5.8%) did not achieve the normal level of the control subjects. Conclusion: PVI exerts beneficial effects on the LA structure and function. However, the LA function did not normalize even in patients with the normal LA volume after successful PVI. Thus, physicians should consider the underlying LA dysfunction and residual AF risks despite sinus rhythm restoration by PVI.
Archivos de cardiología de México
The purpose of this paper is to review the usefulness of multiplanar transesophageal echocardiogr... more The purpose of this paper is to review the usefulness of multiplanar transesophageal echocardiography before, during and after percutaneous transcatheter closure of secundum atrial septal defects. Transesophageal echocardiography imaging techniques,including their role in patient selection, procedural guidance and immediate assessment of technical success and complications are described and discussed in this review. Percutaneous transcatheter closure is indicated for ostium secundum atrial septal defects of less than 40 mm in maximal diameter. The defect must have a favorable anatomy, with adequate rims of at least 5 mm to anchor the prosthesis. Transesophageal echocardiography plays a critical role before the procedure in identifying potential candidates for percutaneous closure and to exclude those with unfavorable anatomy or associated lesions, which could not be addressed percutaneously. Transesophageal echocardiography is also important during the procedure to guide the deploym...
Journal of the American College of Cardiology, 2012
echocardiography (TEE). After confirming the position by TEE and multi-angle fluoroscopy, the occ... more echocardiography (TEE). After confirming the position by TEE and multi-angle fluoroscopy, the occluder was released to seal the LAA ostium. Local and systemic histopathology was assessed 30 days after device implantation. Results: By pre-implant angiography and TEE, the mean diameter of LAA ostium was 15.9Ϯ2.5mm and15.8Ϯ2.5mm, respectively. LAA occlusion devices, clinically indicated for 14ϳ20mm human LAA ostial diameter, were successfully implanted in 6 animals without pericardial effusion or other procedure-or device-related complications. Postoperative TEE showed all devices in the intended positions achieving successful closure of all LAA ostia (Figure a). Minimal peri-device leaks (Ͻ 3mm jet) were noted in 2/6 cases. Animals experienced no adverse events over 30 days post-implant. Histological analysis showed adequate deployment and complete circumferential occlusion of all 6 appendages after 30 days. Full endothelial coverage of the luminal aspect of the occluder was found with no surface thrombosis (Figure b). No adverse histology findings were noted in the myocardia, mitral valves, kidneys or brains. Conclusions: In a 30-day canine study the Coherex WaveCrest TM demonstrated safe deployment, durable LAA occlusion and favorable biocompatibility.
Journal of the American College of Cardiology, 2013
Results: Maximal diameter of ASD in "multiple" group was larger than "sufficient" or "single" gro... more Results: Maximal diameter of ASD in "multiple" group was larger than "sufficient" or "single" group (29 mm, 16 mm, 19 mm, p<0.01). Procedural success rate was 98% with no in-hospital death. One cardiac erosion occurred in "single" group and 1 device embolization occurred in "multiple" group. In 6 patients, stable device deployment was not achieved. Although procedural success rate in "multiple" group was significantly lower than "sufficient" or "single" group, >80% of patients having multiple rim deficiencies completed the procedure (Figure). Conclusions: Even for ASD patients with multiple rim deficiencies, device closure has the validity to be considered as an initial therapeutic option.
Journal of Interventional Cardiology, 2013
ObjectivesTo describe the particular assessment and closure strategy that was followed in patient... more ObjectivesTo describe the particular assessment and closure strategy that was followed in patients with left atrial appendages (LAA) with an early and severe bend.BackgroundThe presence of a chicken‐wing morphology with an early and severe bend constitutes one of the most difficult anatomical settings for transcatheter LAA occlusion.MethodsBetween November 2009 and December 2012, patients who presented chicken‐wing LAA with an early (<20 mm from the ostium) and severe bend (<180°) were identified and included in the analysis. A particular implanting strategy consisting of deploying the distal lobe of the device inside the chicken‐wing bend was used in all cases.ResultsAmong 42 patients who underwent LAA occlusion during the study period, 5 (12%) presented the pre‐specified anatomy. Following the mentioned implanting strategy, all patients underwent successful LAA occlusion using the Amplatzer Cardiac Plug (n = 2) and the Amplatzer Amulet (n = 3). Successful occlusion was achie...
Journal of Cardiac Surgery, 2010
Mitral valve repair is the procedure of choice for severe degenerative mitral regurgitation (MR).... more Mitral valve repair is the procedure of choice for severe degenerative mitral regurgitation (MR). The objective of this study was to review prospectively gathered echocardiographic and clinical results with mitral valve repair for degenerative disease. Between May 1995 and July 2004, 403 patients underwent mitral valve repair for degenerative disease (mean age 63 +/- 12 years, 72% males). Concomitant procedures included CABG (29%), radiofrequency left-sided maze procedure (8%), aortic valve replacement (6%), and tricuspid valve repair (4%). Thirty-day mortality was 0.4% for patients with isolated mitral valve repair and 5.1% for patients with mitral valve repair and concomitant procedure (p = 0.003). Five-year survival was higher for isolated mitral valve repair compared to mitral valve repair with a combined procedure (92 +/- 2% vs. 76 +/- 5%; 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;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Pulmonary artery pressure and left atrial and left ventricular end-diastolic diameters were significantly improved following mitral valve repair (all 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;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;or= 0.005) and this was sustained afterward. The freedom from severe (3+ or 4+) and moderate-severe (2+, 3+, or 4+) MR was 95% and 77% at 5 years, respectively, whereas the freedom from reoperation was 96 +/- 1% at 5 years. Significant predictors of moderate-severe MR recurrence were cardiac dilatation, anterior leaflet prolapse, and concomitant procedure, whereas mitral valve disease amenable to posterior leaflet resection had a lower risk of MR recurrence. Excellent clinical outcomes can be obtained using standard techniques of mitral valve repair of the degenerative valve. MR recurrence is low but nonnegligible, emphasizing the necessity for long-term postoperative echocardiographic follow-up in these patients.
International Journal of Cardiology, 2014
The Amplatzer™ Amulet™ (Amulet) is the evolution of the Amplatzer™ Cardiac Plug, a dedicated devi... more The Amplatzer™ Amulet™ (Amulet) is the evolution of the Amplatzer™ Cardiac Plug, a dedicated device for percutaneous left atrial appendage (LAA) occlusion. The new device has been designed to facilitate the implantation process, improve the sealing performance and further reduce the risk of complications. The objective of the study was to describe the initial experience with the Amplatzer Amulet for percutaneous LAA occlusion. This was a prospective single-center study of patients undergoing percutaneous LAA occlusion. The indication for LAA closure was a formal contraindication for oral anticoagulation or previous history of stroke due to INR lability. All procedures were done under general anesthesia and transesophageal echocardiography (TEE) guidance. Transthoracic echocardiography was performed 24h after the procedure in order to rule out procedural complications before discharge. Further follow-up was done with a clinical visit and TEE at 1-3 months. Between July-2012 and June-2013, 25 patients with a mean CHA2DS2-VASC of 4.3 ± 1.7 underwent LAA occlusion with the Amplatzer Amulet. The device was successfully implanted in 24 patients (96%) without any procedural stroke, pericardial effusion or device embolization. None of the patients presented any clinical event at follow-up. Follow-up TEE showed complete LAA sealing in all patients with no residual leaks &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;3mm and no device embolization. One patient (4.1%) presented a device thrombosis at follow-up without clinical expression. In this initial series of patients, the Amulet showed a remarkable acute and short-term performance in terms of feasibility and safety as depicted by the high successful implantation rate and the low incidence of complications.
Canadian Journal of Cardiology, 2014
We analyzed 193 patients who underwent transcatheter PFO closure using four different PFO closure... more We analyzed 193 patients who underwent transcatheter PFO closure using four different PFO closure devices: 48 GSO (24.8%), 34 Helex (17.6%), 74 APO (38.3%) and 37 Biostar (19.1%). There were no significant differences in clinical outcomes among devices. Transesophageal echocardiography at 4 months revealed higher closure rates with GSO (92.6%) than with Helex (74.2%; p=0.031) and APO (76.4%; p=0.036) and no significant differences compared to Biostar (93.7%).
Canadian Journal of Cardiology, 2013
Canadian Journal of Cardiology, 2013
Significant paravalvular leak (PVL) after prosthetic replacement can result in hemolysis and/or c... more Significant paravalvular leak (PVL) after prosthetic replacement can result in hemolysis and/or congestive heart failure (CHF). Percutaneous PVL reduction (PPVR) represents an alternative to repeat surgery for a selected population. The purpose of this study was to assess the procedural and long-term clinical efficacy of percutaneous PPVR and its effect on survival free of rehospitalization for CHF, surgical reintervention, and death. We analyzed a cohort of 56 consecutive patients who underwent 61 PPVRs in our institution between June 2001 and December 2010. Procedural success was defined as a reduction in regurgitation severity free from procedural complications. Patients were followed-up for vital status, clinical events, and symptoms. Patients were aged 65 ± 11 years, with an average logistic EuroSCORE of 19 ± 14%. Indications for PPVR included CHF (61%), hemolysis (9%), or both (30%), caused by mitral (n = 44) or aortic (n = 12) PVL. Procedural success was achieved in 75% of cases. Three major complications, including 2 deaths, occurred during the initial 30-day follow-up in the 42 patients who were treated with a device. After adjusting for the logistic EuroSCORE, prosthesis type (mitral vs aortic), and time interval since the last valve surgery, a successful PPVR was associated with a better survival free of rehospitalisation for CHF, need for surgical reintervention, and death compared with patients with a failed PPVR. (hazard ratio = 0.34; 95% confidence interval, 0.17-0.71). PPVR is associated with a reasonable rate of procedural success and favourable cardiovascular outcomes, and represents an appropriate option when technically possible.
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Papers by Arsène Basmadjian