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Management of mitral regurgitation (MR) recurrence after failed surgical mitral annuloplasty with ring implantation (SMARI) is controversial. Transcatheter edge-to-edge mitral valve repair (TEER) is one option, but rings increase the procedural' difficulty. To evaluate the results of TEER in patients with SMARI. The Clip-in-Ring registry is a multicenter registry conducted in 11 centers in France, approved by local institutional review boards, of consecutive TEER following SMARI. Outcomes were the Mitral Valve Academic Research Consortium (MVARC) technical, modified 30-days device and procedural successes (where 10 mmHg is considered as a cut-off for significant mitral stenosis) and MVARC-complications. Twenty three patients were studied: age: 69 ± 10; male: 74%; STS score: 3.0 [2.0–5.8], EuroScore II: 12.0 [6.4–18.5]; left ventricle ejection fraction: 53 ± 12%; complete rings: 60%; MR grade 3+/4+: 17/78%; NYHA class III/IV: 47/22%; median surgery-TEER delay: 23 [6–94] months. Technical success of the TEER was 100%. At discharge, residual MR grade was ≤ 2+ in 87% and median trans-mitral gradient was 4 [3–5] mmHg. Thirty days modified MVARC-device success device and procedural success were 82%: 4 patients (17%) had residual MR grade > 2+, including 2 patients who needed a complementary surgery. No patient had a 30-days trans-mitral gradient > 7 mmHg. No patient died or suffered a stroke or any life-threatening complications. One patient presented vascular access complication requiring transfusion. No other MVARC-2 adverse event was reported (Fig. 1). TEER in patients with failed mitral ring is feasible, and safe. Larger registries should delineate its exact role in the therapeutic armamentarium for this medical issue. [ABSTRACT FROM AUTHOR]

Objectives: To identify predictors of operative and postoperative mortalily and of functional reversibility after aortic valve replacement (AVR) in patients with aortic stenosis (AS) and severe left ventricular (LV) systolic dysfunction. Methods and results: Between 1990 and 2000, 155 consecutive patients (mean (SD) age 72 (9) years) in New York Heart Association (NYHA) heart failure functional class III or IV (n = 138) and with LV ejection fraction (LVEF) ⩽ 30% underwent AVR for critical AS (mean (SD) valve area index 0.35 (0.09) cm²/m²). Thirty day mortality was 12%. NYHA class (3.7 (0.6) v 3.2 (0.7), p = 0.004), cardiothoracic ratio (CR) (0.63 (0.07) v 0.56 (0.06), p < 0.0001), pulmonary artery systolic pressure (63 (25) v 50 (19) mm Hg, p = 0.03), and prevalence of complete left bundle branch block (22% v 8%, p = 0.03) and of renal insufficiency (p = 0.001) were significantly higher in 18 non-survivors than in 137 survivors. In multivariate analysis, the only independent predictor of operative mortality was a CTR ⩾ 0.6 (odds ratio (OR) 12.2, 95% confidence interval (CI) 5.4 to 27.4, p = 0.002). The difference between preoperative and immediate postoperative LVEF (early-ΔEF) was > 10 ejection fraction units (EFU) in 55 survivors. In multivariate analysis, CTR (OR 5.95, 95% CI 3.0 to 11.6, p = 0.006) and mean transaortic gradient (OR 1.05, 95% CI 1.0 to 1.1, p < 0.05) were independent predictors of an early-ΔEF > 10 EFU. During a mean (SD) follow up of 4.6 (3) years, 50 of 137 (36%) 30 day survivors died, 31 of non-cardiac causes. Diabetes (OR 3.8, 95% CI 2.4 to 6.0, p = 0.003), age ⩾ 75 years (OR 2.6, 95% CI 2.1 to 4.5, p = 0.004), and early-ΔEF ⩽ 10 EFU (OR 0.96, 95% CI 0.94 to 0.97, p = 0.01) were independent predictors of long term mortality. Among 127 survivors, the percentage of patients in NYHA functional class III or IV decreased from 89% preoperatively to 3% at one year. The decrease in functional class was significantly greater in patients with an early-ΔEF ⩾ 10 EFU than patients with an early-ΔEF ⩽ 10 EU (p = 0,02). In addition, the mean (SD) LVEF at one year was 53 (11 )% in patients with an early-ΔEF > 10 EFU and 42 (11)% in patients with early-ΔEF ⩽ 10 EFU (p < 0.001). Conclusions: Despite a relatively high operative mortality, AVR for AS and severely depressed IVEF was beneficial in the majority of patients. Early postoperative recovery of LV function was associated with significantly greater relief of symptoms and longer survival. [ABSTRACT FROM AUTHOR]

The article offers information on the model based on the analogy with electrical networks that stimulate the occlusion of the right coronary artery (RCA) and the influence of bypass grafts. The study shows that the presence of right graft improves the perfusion of the right distal territory. The study emphasizes that the revascularisation of the occluded RCA is justified.

Secondary mitral regurgitation (MR) is associated with poor outcome in systolic heart failure (HF-) patients. Percutaneous edge-to-edge mitral valve repair (PMVR) recently failed to prove any beneficial effect over optimal medical treatment (OMT). Nevertheless, little is known about the effect of PMVR on LV performance and mechanics in HF-patients with severe secondary MR. Thirty-seven patients with severe secondary MR treated by PMVR were included and compared (according to indices of LV myocardial function) to nineteen patients with treated by OMT. Both groups were clinically comparable. At 6-month follow-up, only LV constructive work improve significantly in both groups (977 vs. 1101 mmHg%, P = 0,003, 967 vs. 1110 mmHg%, P = 0,002 for PMVR and OMT groups, respectively) whereas left ventricular (LV) end-systolic volume index, LV ejection fraction and global longitudinal strain were not different. Compared to MITRA-FR and COAPT studies, our population had a proportionate MR (blue point in Fig. 1 , panel A). Fig. 1 , panel B demonstrate that only five patients of PMVR group had disproportionate MR. Interestingly, these patients hadn't any major event during 6 months FU (Table 1). Echocardiographic characteristics at 6-month follow-up are not different when compare PMVR and OMT for HF- patients with a severe proportionate secondary MR. [ABSTRACT FROM AUTHOR]

The article focuses on the study of drug-eluting stents (DES) on the coronary hydrodynamic parameters. Topics discussed include the myocardial infarction in three-vessel disease including percutaneous coronary revascularisation (PCI), the left anterior descending artery (LAD), and the right coronary artery (RCA).

The article presents a study which examines the simulations of the influence of the stenoses, severity and revascularisation status on the right territory perfusion in patients with severe coronary disease and occlusion of the right artery. It points on the difficulty in determining the collateral circulation to the occluded artery through preoperative measurements. The study used model parameters taken from the patient and a computational tool that may help surgeons in their decision-making.

The article reports on results of a study which proposes a model based on the analogy with electrical networks in order to assess quantitative evaluation of pressure and flows inside the native arteries, the collateral networks and the bypass grafts A description of the experimental set-up and measurement method is presented. The study concluded that the model provides a computational tool to evaluate therapeutic strategies for an individual patient.

The article provides a biomechanical analysis of per-operative hemodynamic data (pressure and flow rates) in order to assess quantitative evaluation of the collateral flow rate in patients with three vessels disease. The study involving patients with a proximal lesion occluding the right posterior descending coronary artery and severe stenosis narrowing the left coronary arteries is described. A theoretical expression for the pressure-derived index used in clinical routine is deduced and is called the collateral fractional flow reserve.

Introduction: Plusieurs études ont montré que la revascularisation coronarienne par pontage est préférable chez le patient diabétique (PD). Cette chirurgie améliore le pronostic vital à long terme mais la morbi-mortalité postopératoire reste élevée. Le but de notre travail a été d’évaluer chez les PD l’incidence des complications et de la mortalité après pontage coronarien dans un même centre entre 2001 et 2007. Nous avons étudié l’évolution de l’incidence après instauration fin 2004 d’un protocole de contrôle strict des glycémies en péri-opératoire en comparant les 2 périodes. Patients et méthodes: Il s’agit d’une étude longitudinale ayant inclus 3 941 patients consécutifs, dont 655 diabétiques (16,6 %) opérés au CHU de Rennes entre 2001 et 2007. L’incidence des complications à 30 jours chez les PD a été comparée à celle des patients non-diabétiques (PND) avec une analyse séparée pour chaque période encadrant l’instauration du contrôle des glycémies (2001-2004 : 2 100 sujets dont 341 PD et 2005 à 2007 : 1 841 sujets dont 314 PD). Résultats: Les PD étaient d’âge comparable (68±8 ans) mais avaient des comorbidités associées plus fréquentes par rapport aux PND (obésité : 48,7 versus 23,2 %) sans différences pour la fonction VG ou le nombre de lésions coronariennes. La mortalité à 1 mois a augmenté plus fortement entre les 2 périodes chez les PD (2,1 % à 4,7 %) que chez les PND (2,6 % à 3,2 %). La médiastinite était la complication sévère la plus fréquente chez les PD ; son incidence a fortement augmenté (3,5 % à 9,8 % chez les PD versus 1,9 % à 3 % chez les PND, p=0,01). Les PD avec médiastinite présentaient davantage de FRCV, notamment l’obésité (61 versus 49 %, p=0,03). Conclusion: L’incidence des complications précoces et en particulier des médiastinites après pontage coronarien reste importante chez les PD. Ceci est probablement lié à l’utilisation préférentielle des artères mammaire internes. L’instauration d’un protocole de contrôle strict des glycémies en péri-opératoire n’a pas eu d’impact bénéfique sur l’incidence des complications. [Copyright &y& Elsevier]

The goal of multiple organ procurement is to retrieve intact organs fully. This goal can only be reached if the organ dissection and preservation are optimal. [Copyright &y& Elsevier]

The Ratio of pulmonary artery diameter to ascending aortic diameter (PA:Ao ratio) on computed tomography (CT) is a recent predictive tool known to be associated with severity of heart failure and right heart failure after left ventricular assist device implantation. We searched for a predictive use of PA:Ao ratio in heart transplanted patients We collected extensive data from heart transplanted patients in our institution from 2012 to 2018. The diameters of the ascending aorta and the pulmonary artery were defined as the diameter at the level of the artery pulmonary bifurcation in a transaxial slice. Patients were separated into two groups: those with a PA:Ao ratio <1 and those with a PA:Ao ratio >1. We compared the incidence of severe primary graft dysfunction and early ICU death between these two groups. Secondary endpoint was the rate of high pulmonary vascular resistance in both groups. Between 2012 and 2018, 144 consecutive patients were heart transplanted. 50 had a PA:Ao ratio >1 (34,7%) and 94 had a PA:Ao ratio <1 (65,2%). Incidence of severe primary graft dysfunction was significantly higher in patients who had larger pulmonary arteries (48% Vs 15,9% p< 0,0001), mortality in ICU however did not differ (16% Vs 13,8%, p=0,919). Pulmonary vascular resistance superior to 2 woods was significantly associated with PA:Ao Ratio >1 compared to PA:Ao Ratio <1 (54% Vs 37,2 % p=0,047) but was less predictive for severe PGD (38,6% Vs 48% p=0, 246). PA:Ao ratio is a robust tool for prediction of severe primary graft failure in heart transplantation. Further studies should explore our findings for external validation. [ABSTRACT FROM AUTHOR]