Recent publications : Previews

Letter by Fournier et al Regarding Article, “Functional Assessment of Coronary Artery Disease in Patients Undergoing Transcatheter Aortic Valve Implantation: Influence of Pressure Overload on the Evaluation of Lesions Severity”

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Fournier S, Harbaoui B, Muller O.Circ Cardiovasc Interv. 2017 Apr;10(4). We read with great interest the recent publication by Pesarini et al regarding the functional assessment of coronary artery disease in patients undergoing transcatheter aortic valve implantation (TAVI). The authors report that angiographically intermediate lesions may become functionally significant after TAVI, whereas variation in the fractional flow reserve (FFR) would not affect the diagnostic decision based on the 0.8 cutoff in patients at the extremes of the quantitative coronary angiography spectrum (unobstructed arteries or severe lesions). The authors should be commended for their work in a field where data are sparse; however, we think that a few significant points must be highlighted.

Entrapment of Rotational Atherectomy Burrs in Freshly Implanted Stents: First Illustration of the Rolled-Up Phenomenon

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J Invasive Cardiol. 2016 Nov;28(11):E132-E133Fournier S, Iglesias JF, Zuffi A, Eeckhout E, Tozzi P, Muller O. OBJECTIVES:We aimed to illustrate one of the mechanisms of rotational atherectomy burr entrapment in a coronary stent where the burr was rolled up in the stent’s struts.METHODS:We report a case where the treatment of a mid right coronary artery (RCA) lesion using a rotational atherectomy device was attempted. During the procedure, the burr suddenly got stuck in a freshly implanted stent in the distal RCA. Despite several attempts and maneuvers, we were unable to pull back the burr.RESULTS:The patient was transferred for emergency surgery. The length of the RCA from its proximal third to the crux, including the stuck burr and the freshly implanted stent, had to be extracted.CONCLUSIONS:Physicians…
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Recanalization of a Challenging Chronic Total Occlusion of the Superficial Femoral Artery through the Profunda Femoris Using a Pure Retrograde Technique.

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J Vasc Interv Radiol. 2016 Aug;27(8):1253-7.Zuffi A, Muller O, Biondi-Zoccai G, Turri M, Trana C, Iglesias JF, Fournier S  The transcollateral retrograde technique offers an alternative for increasing the success rates of SFA recanalization when standard antegrade approaches fail or other techniques—such as the use of rotational or directional atherectomy devices—are not feasible The use of low-profile 0.014-inch–compatible devices may allow higher crossing rates and greater safety. In summary, we describe successful recanalization of an SFA occlusion via a transcollateral approach with 0.014-inch low-profile coronary catheter and balloons.

Cardiac sarcoidosis with coeliac disease

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Cardiovascular Medicine. 2016;19(04):128-131. Fournier S, Regamey J, Rotman S, Pruvot E, Hullin R. This case of cardiac sarcoidosis started with manifestation of a complete AV block in a 42 years old female without other cardiac dysfunction. Two years later, the patients presented with acute heart failure symptoms at the Emergency Department. The echocardiography at admission showed thinning and hyperdensity of the basal interventricular septum which is a rare but typical echocardiographic sign of cardiac sarcoidosis. Endomyocardial biopsy, PET-CT, and transbronchial biopsy confirmed the clinical suspicion of sarcoidosis. Of note, the patient also had celiac disease which can occur conjoint with sarcoidosis. After 5 months of immunosuppressive treatment with methylprednisolone and azathioprine the burden of inflammatory lesions was significantly reduced and the patient had improved to…
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The impact of fractional flow reserve and iFr on current PCI strategies

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Cardiovascular Medicine. 2016;19(03):67-71. Fournier S, Muller O. Fractional flow reserve (FFR) measurement has become the gold standard for assessing myocardial ischemia and has been recommended to decide to perform or not a myocardial revascularization in both American and European guidelines. Indeed, large clinical trials have demonstrated that an evaluation of stenoses guided by FFR reduced death, nonfatal myocardial infarction and repeat revascularization (MACE) when compared to an evaluation guided by angiography only and that a percutaneous coronary intervention (PCI) with an optimal medical treatment was superior to an optimal medical treatment alone to reduce MACE in presence of pathological FFR. To measure a FFR, the use pharmacological vasodilator (usually adenosine) is necessary. To avoid its administration, iFR recently emerged with the identification of a “wave-free…
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Circadian aspects of myocardial infarction among young STEMI patients.

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Eur J Intern Med. 2016 Jan;27:e5-6. Fournier S, Muller O. We read with interest the recent publication of Rallidis et al [1] reporting the circadian pattern of symptoms onset in patients presenting with ST-segment elevation myocardial infarction (STEMI). Authors should be commended for their work where they succeed to report a total of 256 patients being < 35 years old.In this interesting study, the authors conclude that there is a significant circadian pattern in symptoms onset with an observed morning peak. They conclude that this information might be useful for a prompt diagnosis and aggressive treatment in this particular subgroup of very young STEMI patients where clinical presentation is frequently atypical. In this regard, we woud like to discuss a few points.  

Assessment of quality performance measures for primary percutaneous coronary intervention: A report from a tertiary referral centre in Switzerland.

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Eur Heart J Acute Cardiovasc Care. 2015 Oct 16. Haas C, Fournier S, Iglesias JF, Trana C, Roguelov C, Locca D, Lauriers N, Muller O, Eeckhout E. AIMS: The present study aimed to document a local pattern of care in consecutive patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction (STEMI) in a tertiary centre in Switzerland. METHODS:A retrospective study was conducted at the University Hospital of Lausanne, Switzerland. A total of 389 consecutive patients undergoing primary percutaneous coronary intervention for STEMI between 2009 and 2010 were studied. The audit focused on 14 items derived from the American College of Cardiology/American Heart Association 2008 quality performance measures position paper on STEMI management. These indicators all corresponded to a class 1 recommendation at the time…
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First Reported Successful Femoral Valve-in-Valve Transcatheter Aortic Valve Replacement Using the Edwards Sapien 3 Valve

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J Invasive Cardiol. 2015 Oct;27(10):E220-3. Fournier S, Monney P, Roguelov C, Zuffi A, Iglesias JF, Qanadli SD, Courbon C, Eeckhout E, Muller O. Management of degenerated aortic valve bioprosthesis classically requires redo surgery, but transcatheter aortic valve-in-valve implantation is becoming a valid alternative in selected cases. In the case of a degenerated Mitroflow bioprosthesis, TAVR is associated with an additional challenge due to a specific risk of coronary occlusion. We aimed to assess the safety and feasibility of transfemoral valve-in-valve implantation of the new Edwards Sapien 3 (Edwards Lifesciences) in a degenerated Mitroflow bioprosthesis (Sorin Group, Inc).

Transcatheter aortic valve implantation: update on indications

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Rev Med Suisse. 2015 May 27;11(476):1197-200, 1202. Fournier S, Monney P, Ferrari E, Lglesias JF, Roguelov C, Zuffi A, Eeckhout E, Muller O.Although surgical aortic valve replacement has been the standard of care for patient with severe aortic stenosis, transcatheter aortic valve implantation (TAVI) is now a fair standard of care for patients not eligible or high risk for surgical treatment. The decision of therapeutic choice between TAVI and surgery considers surgical risk (estimated by the Euro-SCORE and STS-PROM) as well as many parameters that go beyond the assessment of the valvular disease’s severity by echocardiography: a multidisciplinary assessment in “Heart Team” is needed to assess each case in all its complexity.