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The TAPIR Registry was established to evaluate the outcomes of transcatheter aortic valve implantation (TAVI) in patients who had previously undergone surgical mitral valve repair or replacement (SMVR). The study included 365 patients from 16 European centers and compared their outcomes with a control group of 4,832 patients who had not undergone prior mitral valve surgery. Results showed that TAVI in patients with prior SMVR was safe and feasible, with no significant increase in 5-year mortality compared to those without prior mitral valve surgery, although there was a higher incidence of mild paravalvular regurgitation in the former group. [Extracted from the article]

Objectives To assess the long term clinical impact of coronary artery disease (CAD) distribution in patients undergoing transcatheter aortic valve replacement (TAVR) using the FRench Aortic National CoreValve and Edwards (FRANCE-2) registry. Background CAD is common in patients undergoing TAVR. However, the impact of CAD distribution before TAVR on short and long-term prognosis remains unclear. Methods FRANCE-2 is a national French registry including all consecutive TAVR performed between 2010 and 2012 in 34 centres. Three-year mortality was assessed in relation to CAD status. CAD was define as at least one coronary stenosis > 50%. Results A total of 4201 patients were enrolled in the registry. For the present analysis, we excluded patients with a history of coronary artery bypass. CAD was reported in 1252 patients (30%). Half of patient presented with coronary multivessel disease. CAD extent was associated with an increase in cardiovascular risk-profile and in Logistic Euroscore (from 19.3 ± 12.8% to 21.9 ± 13.5%, P < 0.001). Mortality at 30 days and 3 years was 9% and 44% respectively in the overall population. In multivariate analyses, neither the presence nor the extent of CAD was associated with mortality at 3 years (presence of CAD: HR 0.90; 95% CI 0.78 to 1.07). Significant lesion of the left anterior descending (LAD) was associated with higher 3-year mortality (HR 1.42; 95% CI 1.10 to 1.87). Similar results were found after propensity score matching (428 patients per group). Conclusions CAD is not associated with decreased short and long-term survival in patients undergoing TAVR. The potential deleterious effect of LAD disease on long-term survival suggests the need for revascularization before or at the time of TAVR. [ABSTRACT FROM AUTHOR]

Introduction La présence d’anticorps circulants dirigés contre les principaux pathogènes parodontaux a été associée à l’incidence d’événements coronariens chez des sujets sains. En revanche, l’impact de la présence de ces anticorps en prévention secondaire de la maladie coronarienne n’est pas connu. Matériels et méthodes La cohorte nationale FAST-MI a pour objectif d’évaluer la prise en charge des patients admis en unité de soins intensifs pour un syndrome coronaire aigu avec ou sans sus-décalage du segment ST, et d’évaluer son impact sur le devenir à moyen et à long terme des patients. Les taux d’immunoglobulines G et d’immunoglobulines A (IgG et IgA) dirigés contre Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Prevotella intermedia et Tannerella forsythia ont été mesurés par ELISA parmi les 992 patients qui avaient donné leur consentement pour la constitution d’une collection plasmatique. L’impact des taux de chaque anticorps en continu et en tertiles, et le risque de survenue d’un décès ou d’une récidive d’infarctus du myocarde à 1 an, a été évalué par des modèles de Cox. Résultats Aucune association significative n’a été trouvée entre le risque d’un événement secondaire à 1 an et les taux d’IgG et d’IgA- anti-P. gingivalis (HR ; IC95 %: 0,96 ; 0,78-1,18 et 1,13 ; 0,90-1,42). De même, les taux d’IgG et d’IgA dirigés contre P. intermedia, A. actinomycetemcomitans et T. forsythia n’étaient pas corrélés aux événements secondaires. Le statut diabétique ne modifiait pas ces relations. Conclusion Contrairement à la valeur prédictive retrouvée en prévention pri-maire, les taux d’anticorps circulants dirigés contre les principaux pathogènes parodontaux ne sont pas associés à un événement secondaire. Les taux d’anti-corps mesurant l’exposition passée aux pathogènes, une étude s’intéressant aux variables cliniques parodontales est nécessaire pour mesurer l’importance de l’hygiène bucco-dentaire dans les programmes de réadaptation car-diaque. Déclaration d’intérêt Les auteurs déclarent ne pas avoir d’intérêt direct ou indirect (financier ou en nature) avec un organisme privé, industriel ou commercial en relation avec le sujet présenté. [ABSTRACT FROM AUTHOR]

Purpose: transcatheter aortic valve implantation (TAVI), performed either by transfemoral (TF) or transapical (TA) approach, is an emerging technique for the treatment of severe aortic stenosis (AS) in high-risk patients. It is unclear whether TF- or TA-TAVI compares favourably with modern conventional surgical aortic valve replacement (SAVR) in a high-risk population. Methods: we conducted a two-centre observational prospective cohort study. High-risk patients (Logistic EuroScore 15% and/or STS Score>10%) with symptomatic severe AS were treated either by SAVR or by TAVI. TF approach was the first choice for TAVI, using both the balloon-expandable or the self-expandable available bioprostheses. TA approach was used when TF approach was contra-indicated. Baseline characteristics, 30-day functional status, prostheses mean gradient (MG) (efficacy endpoint), and 30-day allcause mortality (safety endpoint) were compared. Results: 143 patients were included: 58 underwent SAVR, 60 underwent TF-TAVI and 25 TA-TAVI. Mean age, aortic valve area and left ventricular ejection fraction were the same in the 3 groups. Patients undergoing TF- and TA-TAVI had higher Logistic EuroScore (24.0% [20.0–29.0], 25.2% [20.0–29.8] vs 18.6% [15.8–23.8] respectively, p=0.001) and worse functional status (NYHA class>or = III: 98%, 100% vs 50% respectively, p<0.0001) than those treated by SAVR. 30-day functional status and final prostheses MG were the same in all groups. 30-day all-cause mortality was 17% in the SAVR group, 5% in the TF-TAVI group, and 16% in the TA-TAVI group (TF-TAVI vs SAVR: p=0.05, TA-TAVI vs SAVR: p=0.999). Conclusions: These observational data suggest that, in this high-risk population, SAVR and TAVI 30-day effectiveness are equivalent. Only TF-TAVI, whereas no TA-TAVI when reserved to contraindications of TF approach, seems to improve the 30-day mortality in comparison with SAVR. [ABSTRACT FROM AUTHOR]