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International audience; Background. Heart transplantation is the gold-standard treatment for end-stage heart failure. However, the shortage of grafts has led to longer waiting times and increased mortality for candidates without priority. Aims. To study waiting-list and post-transplant mortality, and their risk factors among patients registered for heart transplantation without initial high emergency procedure. Methods. All patients registered on the heart transplantation waiting list (2004-2015) without initial high emergency procedure were included. Clinical, biological, echocardiographic and haemodynamic data were collected. Waiting list and 1-year post-transplant survival were analysed with a Kaplan-Meier model. Results. Of 221 patients enrolled, 168 (76.0%) were men. Mean age was 50.0 +/- 12.0 years. Forty-seven patients died on the waiting list, resulting in mortality rates of 11.2 +/- 2.7% at 1 year, 31.9 +/- 5.4% at 2 years and 49.4 +/- 7.1% at 3 years. Median survival was 36.0 +/- 4.6 months. In the multivariable analysis, left ventricular ejection fraction < 30% (hazard ratio [HR]: 3.76, 95% confidence interval [CI]: 1.38-10.24; P=0.010) and severe right ventricular systolic dysfunction (HR: 2.89, 95% CI: 1.41-5.92; P=0.004) were associated with increased waiting-list mortality. The post-transplant survival rate was 73.1 +/- 4.4% at 1 year. Pretransplant severe right ventricular dysfunction and age > 50 years were strong predictors of death after transplantation (HR: 5.38, 95% CI: 1.38-10.24 [P=0.020] and HR: 6.16, 95% CI: 1.62-9.32 [P=0.0130], respectively). Conclusions. Mortality among candidates for heart transplantation remains high. Patients at highest risk of waiting-list mortality have to be promoted, but without compromising post transplant outcomes. For this reason, candidates with severe right ventricular dysfunction are of concern, because, for them, transplantation is hazardous. (C) 2016 Elsevier Masson SAS. All rights reserved.

Background: Cardiac transplantation is an effective therapy for end-stage heart failure. Because cardiac allograft vasculopathy (CAV) is the major cause of late mortality after heart transplant (HT), there is a need to identify markers that reflect inflammatory or cytotoxic immune mechanisms contributing to its onset. Noninvasive and early stratification of patients at risk remains a challenge for adapting individualized therapy. The CD16 (Fc-gamma receptor 3A [FCGR3A]) receptor was recently identified as a major determinant of antibody-mediated natural killer (NK) cell activation in HT biopsies; however, little is known about the role of CD16 in promoting allograft vasculopathy. This study aimed to investigate whether markers that reflect CD16-dependent circulating NK cell activation may identify patients at higher risk of developing CAV after HT. Methods: Blood samples were collected from 103 patients undergoing routine coronarography angiography for CAV diagnosis (median 5 years since HT). Genomic and phenotypic analyses of FCGR3A/CD16 Fc-receptor profiles were compared in CAV-positive (n=52) and CAV-free patients (n=51). The levels of CD16 expression and rituximab-dependent cell cytotoxic activity of peripheral NK cells in HT recipients were evaluated using a noninvasive NK-cellular humoral activation test. Results: Enhanced levels of CD16 expression and antibody-dependent NK cell cytotoxic function of HT recipients were associated with the FCGR3A-VV genotype. The frequency of the FCGR3A-VV genotype was significantly higher in the CAV + group (odds ratio, 3.9; P =0.0317) than in the CAV - group. The FCGR3A-VV genotype was identified as an independent marker correlated with the presence of CAV at the time of coronary angiography by using multivariate logistic regression models. The FCGR3A-VV genotype was also identified as a baseline-independent predictor of CAV risk (odds ratio, 4.7; P =0.023). Conclusions: This study unravels a prominent role for the CD16-dependent NK cell activation pathway in the complex array of factors that favor the progression of transplant arteriosclerosis. It highlights the clinical potential of a noninvasive evaluation of FCGR3A/CD16 in the early stratification of CAV risk. The recognition of CD16 as a major checkpoint that controls immune surveillance may promote the design of individualized NK cell–targeted therapies to limit vascular damage in highly responsive sensitized patients. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01569334.

International audience; no abstract

International audience; no abstract

Objectives: In the last decade, cardiac surgery in octogenarians is becoming a routinely performed procedure in our Western countries. The functional benefit of this surgery had already been proved. The aim of this study was to evaluate operative mortality, to identify pre- and postoperative risk factors of early and late mortality, to assess the Euroscore count in this high-risk group of patient and to evaluate late results of this surgery. Methods: We reviewed 215 consecutive patients with a mean age of 83G2 years having undergone valvular surgery. There were 127 female patients (57.1%) and 88 males (42.9%). One hundred and fifty-nine patients (74%) underwent aortic valve replacement 42 (19.5%) mitral surgery and 14 (6.5%) double valve surgery. There were 32 (14.9%) re-operative cases. Twenty-seven patients (12.6%) were operated on in emergency. There were 32 re-operations (14%). The EuroSCORE was used to assess predicted operative risk. Mean Euroscore additive count was 9.5G2.3 and mean logistic Euroscore was 15.1%. Results: Operative mortality was 8.8% (19 patients). Left ventricular dysfunction was the only pre-operative significant risk factors of mortality (PZ0.05). Low cardiac output (P!0.001), gastrointestinal complications (PZ0.03) and surgical reexploration (PZ0.001) were significant risk factors of mortality. Mean survival was 84% after one year and 56% after 5 years. Conclusions: Valvular surgery in octogenarians is a safe and low risk procedure compared to functional benefit and long-term survival. Our data how that logistic Euroscore overestimates the mortality in this high-risk group of patients. q 2004 Elsevier B.V. All rights reserved.

In patients with CKD, not only renal but also, nonrenal clearance of drugs is altered. Uremic toxins could modify the expression and/or activity of drug transporters in the liver. We tested whether the uremic toxin indoxyl sulfate (IS), an endogenous ligand of the transcription factor aryl hydrocarbon receptor, could change the expression of the following liver transporters involved in drug clearance: SLC10A1, SLC22A1, SLC22A7, SLC47A1, SLCO1B1, SLCO1B3, SLCO2B1, ABCB1, ABCB11, ABCC2, ABCC3, ABCC4, ABCC6, and ABCG2. We showed that IS increases the expression and activity of the efflux transporter P-glycoprotein (P-gp) encoded by ABCB1 in human hepatoma cells (HepG2) without modifying the expression of the other transporters. This effect depended on the aryl hydrocarbon receptor pathway. Presence of human albumin at physiologic concentration in the culture medium did not abolish the effect of IS. In two mouse models of CKD, the decline in renal function associated with the accumulation of IS in serum and the specific upregulation of Abcb1a in the liver. Additionally, among 109 heart or kidney transplant recipients with CKD, those with higher serum levels of IS needed higher doses of cyclosporin, a P-gp substrate, to obtain the cyclosporin target blood concentration. This need associated with serum levels of IS independent of renal function. These findings suggest that increased activity of P-gp could be responsible for increased hepatic cyclosporin clearance. Altogether, these results suggest that uremic toxins, such as IS, through effects on drug transporters, may modify the nonrenal clearance of drugs in patients with CKD.

SummaryAuthors recently have suggested that family enrneshment is not synonymous with high levels of closeness or cohesion. A model proposed by Green and Werner clarifies the cohesion-enmeshment domain by distinguishing between closeness-caregiving and intrusiveness as separate relationship processes. This paper examines the cross-cultural applicability of this perspective through a study of 61 married couples in France. The French version of the California Inventory for Family Assessment (CIFA), a self-report measure designed to assess clinically relevant marital dimensions, was employed. In general, spouses' reports of their marital process demonstrated high internal consistency reliabilities. Factor analysis showed meaningful factor structures distinguishing closeness-caregiving and intrusiveness, as predicted, as well as openness of communication. Significant correlations were obtained between CIFA scales and scores on the Marital Adjustment Test. These results are similar for French and American couples. Research implications for studying relationships among French-speaking couples are underlined.

Background: Surgical procedures using the latissimus dorsi (LD) muscle to assist chronic heart failure inflict major trauma on severely sick patients. A less invasive approach may prove beneficial. The aim of this article is to review our clinical and experimental approaches of dynamic aortomyoplasty (AMP) and emphasize the necessity to reorient surgical technique towards new directions and a less invasive thoracoscopic approach. Materials and Methods: A clinical pilot study on dynamic descending AMP started in June 1995 and included four patients. Two of them could benefit from LD counterpulsation, surviving 6 months and 18 months. Following this clinical experience, we investigated, on an animal model, minimally invasive thoracoscopic surgery for this procedure. Twelve goats underwent endoscopic LD harvest and video-assisted aortic wrap, and were studied after surgical recovery from an anatomical and functional standpoint. Results: Clinical AMP using open techniques provided extraaortic counterpulsation in NYHA Class IV patients contraindicated for other surgical therapies. However, surgical technique and strategy needed improvements for optimal cardiac assistance and better patient outcome. Minimally invasive thoracoscopic surgery was feasible and reproducible in goats, achieving improved anatomy and physiology as compared to the open technique in humans. When appropriate the wrapping technique and stimulation protocol were used, an optimal counterpulsation was demonstrated. We concluded that thoracoscopic AMP may provide a minimally invasive approach to cardiac assistance and thus, a new surgical option for patients presenting with chronic heart failure. (J Card Surg 1998;13:60–69)

This case report is about a suspected interaction between argatroban, a direct thrombin inhibitor, and cyclosporine, which occurred in a 60-year-old patient after a second heart transplantation. We explored 4 possible mechanisms of interaction, which are an analytical interference, an idiopathic hemodilution, an increase of renal and hepatic clearance, and a metabolic drug-drug interaction.

Modifications of the diastolic parameters pressure half-time (PHT) and isovolumic relaxation time (IVRT), recorded using cardiac Doppler echocardiography (CDE), were studied in 23 heart transplant recipients and compared to the results of 345 endomyocardial biopsies (EMB) performed on the same day. Two different protocols, analyzing respectively (1) a decrease of 20% or more in IVRT and/or PHT with respect to the mean and (2) a decrease of 20% or more in IVRT and/ or PHT with respect to its preceding value, were used to evaluate the efficiency of CDE in diagnosing mild and moderate rejections. When a mild rejection was detected by EMB, a statistically significant decrease was found in the average CDE parameter values of the patient population. However, these variations were weak and did not differ from the spontaneous variations observed in each patient in the absence of rejection. Thus, it is not surprising that the sensitivity of CDE in the detection of mild rejections was very low (45%) using the most sensitive protocol (variations of the parameters from their preceding value). We conclude that CDE alone does not seem to be sufficient to perform the noninvasive diagnosis of low-grade rejections and must be complemented by other noninvasive methods.

The new-generation bioprostheses are associated with a longer lifespan, and therefore tend to be implanted in younger patients. However, with the increase in life expectancy, the trend is towards a higher rate of repeat valve replacement. Hence, the study aim was to evaluate the present mortality and risk factors for repeat valvular surgery.A total of 183 consecutive patients (87 males, 96 females; mean age 62 years; range: 28-88 years) who underwent repeat valve replacement at the authors' institution between 2001 and 2004 was reviewed. Reoperations in these patients were required due to structural degeneration of the bioprosthesis (50%), to paravalvular leak (20%), and to prosthetic endocarditis (14%), valve thrombosis (9%), and plasty failure (9%). In total, 105 patients (57%) had received at least one bioprosthesis during the previous operation, 58 (31%) had a mechanical valve, 15 (8%) had an isolated mitral plasty, and five (2%) hybrid procedures. All preoperative and operative risk factors were studied.The overall operative mortality rate was 6.6% (n = 12), but only 3.9% (n = 4) for the bioprosthesis reoperation. The risk factors for mortality included pulmonary hypertension (60 mmHg; p = 0.03), renal insufficiency (p = 0.02), more than one repeat valve replacement (p = 0.004), previous mechanical prosthesis (p = 0.02), previous mitral surgery (p = 0.019), and associated tricuspid surgery (p = 0.03).The data acquired tended to show that repeat valve replacement of bioprostheses may be carried out with an acceptable operative risk, in connection with the majority of operations on bioprostheses being secondary to structural degeneration of the implant. Hence, in most cases a well-controlled, programmed operation would lead to very low mortality (4%), despite a significant morbidity rate.

Background Conventional antibody induction therapy is currently used in heart transplantation despite safety concerns. This 6-month, prospective, randomized, multicenter, open-label study examined whether basiliximab offers a tolerability benefit compared with anti-thymocyte globulin (ATG) while maintaining similar efficacy in de novo heart transplant recipients. Methods Adult heart transplant recipients were randomized to receive basiliximab (20 mg on Day 0 and Day 4) or ATG (2.5 mg/kg/day for 3 to 5 days) with cyclosporine, mycophenolate mofetil and steroids. The primary safety end-point was a composite of serum sickness, fever, cutaneous rash, anaphylaxis, infection, thrombocytopenia, leukopenia and post-transplant proliferative disease. Efficacy was assessed by a composite end-point of death, graft loss, acute rejection Grade >1B, acute rejection associated with hemodynamic compromise or treated with antibody therapy, or loss to follow-up, whichever occurred first. Results Eighty patients were randomized and analyzed. By Month 6, the incidence of the composite safety end-point was significantly lower with basiliximab than with ATG (50.0% vs 78.6%, p = 0.01), and infectious death was less frequent in the basiliximab group (0 of 38 vs 6 of 42, p = 0.027). The composite efficacy end-point occurred in 24 patients (63.2%) in the basiliximab arm vs 28 patients (66.7%, p = not significant [NS]) receiving ATG. Acute rejection episodes of Grade ≥1B were reported with similar frequency (50% with basiliximab vs 45.2% with ATG, p = NS); 7 patients (18.4%) in the basiliximab group and 3 (7.1%) in the ATG group had rejection Grade ≥3A. Conclusions These results suggest that basiliximab offers improved tolerability with similar efficacy compared with current polyclonal antibody induction therapy in de novo heart transplant patients.

s S61 Methods: 117 patients undergoing HTx at IKEM were prospectively enrolled. AKI was defined as an increase of serum creatinine level by ≥ 50% or worsening of renal function requiring renal replacement therapy (RRT) during 1st week postHTx. Serum Cystatin-C and urinary Neutrophil gelatinase-associated lipocalin (NGAL), alpha-1-microglobulin (A1M) or albumin were serially sampled. Results: 30 patients (25.6% of total) fulfilled the criteria of AKI. Preoperative renal function, demographics and comorbidities were similar between AKI and non-AKI groups. Cystatin-C displayed earliest and the most robust separation between AKI and non-AKI group, with significant difference present already 3 hours after surgery (figure left, arrow) and persisting on day 7 and 10. The increase in Cystatin-C preceded the serum creatinine elevation by 4 days. In univariate analysis, Cystatin-C> 1.6 mg/L at 3-hours after HTx predicted AKI with OR 5.1 (95%CI: 2.2-13) and in multivariate analysis (adjustment to presence of sepsis, bleeding or need of RVAD) with OR 4.4 (95% CI:1.7-12). Urinary NGAL raised significantly only on day 3 in AKI group (p= 0.003). Differences in ACR and A1M values between groups did not reach significance. Interestingly, elevated Cystatin-C (≥ 2.5mg/L at day 7) predicted also long-term mortality after HTx (figure right). Conclusion: Cystatin-C was the most useful for evaluation and prediction of AKI. Measurement of serum Cystatin-C in patients early after HTx (3h after surgery) may help to promptly identify the patients with high risk for renal complications. Elevated cystatin-C also predicts long-term outcome. (Grant NT/11269 5 and NT/ 11262-6 and Institutional support 00023001) ascending aortic diameter was also a predictor and may reflect the risks associated with an undersized allograft. The final predictor was total ischemic time emphasizing the need for improvements in allograft preservation and storage.

Objective: Systemic inflammatory response (SIRS) and severe SIRS (SIRS with organ dysfunction) occurring after cardiopulmonary bypass (CPB) are common causes of morbidity and mortality among cardiac surgical patients. These syndromes are often preceded by a profound vasodilation, characterized by vasoplegia occurring during surgery. Many substances have been implicated in their pathophysiology. Adenosine is a strong endogenous vasodilating agent released by endothelial cells and myocytes under metabolic stress and may be involved in blood pressure failure during CPB induced by severe SIRS. Design: A prospective comparative observational study. Setting: The operating room and intensive care unit of a tertiary care university hospital. Patients: Adenosine plasma levels (mean ± so; APLs) were measured before (baseline), during, and immediately after surgery in 35 patients who underwent aortic valve replacement involving CPB. APLs were correlated to operative and postoperative clinical courses. Measurements and Main Results: APLs were significantly higher in seven patients with vasoplegia and postoperative severe SIRS (1.6 μmol·L -1 [0.2-2.6] vs. 0.4 μmol·L -1 [0.1-1.0]) at baseline and during surgery. The duration of mechanical ventilation and stay in the intensive care unit were significantly longer for patients with higher APLs. Mean arterial pressure was inversely correlated with mean arterial APLs (Pearson's correlation coefficient: R = -0.66; p

Background: Coronary angiography is still the gold standard for the diagnosis of cardiac allograft vasculopathy (CAV) for which alternative noninvasive diagnostic approaches are currently investigated. In this study, we assessed whether 31 P magnetic resonance chemical shift imaging can diagnose CAV by studying variations in cardiac high-energy phosphates in a population of adult heart transplant recipients. Methods and results: CAV was defined by coronary angiography as the presence of diffuse coronary irregularities with significant concentric narrowing on epicardial or distalcoronaryarteries.EightpatientswithCAV(groupA),and18patientswithoutCAV(groupB)wereincludedinthisstudyandcomparedto nine healthy volunteers (group C). Patients and volunteers underwent 31 P three-dimensional chemical shift imaging to determine the ratio of phosphocreatine (PCr) and adenosine tri-phosphate (ATP). PCr/ATP was significantly lower in group A (1.51 0.50) than in groups B and C (1.98 0.53 (p = 0.003) and 2.14 0.31 (p = 0.001)), respectively. Time from transplant, number of episodes of acute rejection, and left ventricular ejection fraction (LVEF) were not significantly different between patient groups. A PCr/ATP value of 1.59 was the optimal cut-off value to predict CAV (specificity and sensitivity of 100% and 72%, respectively). Conclusion: Clinically, in vivo 31 P chemical shift imaging is a promising, non-invasive method to detect the potential modifications of high-energy phosphates related to CAVand to better screen indications for coronary angiograms. This may be relevant for coronary angiography follow-up and adjustments of immunotherapy regimen. # 2005 Elsevier B.V. All rights reserved.

Cardiac surgery in octogenarians is now performed routinely, and generally results in a good improvement in functional capacity. The study aim was to evaluate operative mortality and to identify preoperative and postoperative risk factors of mortality.A total of 200 consecutive patients (79 males, 121 females; mean age 83 years; range: 80-90 years) who underwent valvular surgery at the authors' institution between 1991 and 2002 was reviewed. Among patients, 154 underwent aortic valve replacement (77.0%), 35 mitral surgery (17.5%), and 11 aortic and mitral valve surgery (5.5%). Forty-five patients (22.5%) had concomitant myocardial revascularization, and 23 (11.5%) were operated on in an emergency setting. Preoperative risk factors studied included endocarditis (2.0%), ventricular dysfunction (22.5%), pulmonary hypertension (33.5%), renal dysfunction (31.5%), chronic obstructive pulmonary disease (7.0%) and arteriopathy (9.0%). The mean EuroSCORE, which was used to assess predicted operative risk, was 9.1; the score was9 in 104 patients (52%) and9 in 96 (48%).Hospital mortality was 7% (n = 14). There were no significant preoperative risk factors of mortality. Postoperative complications occurred in 115 patients (57.5%), including low cardiac output (16.0%), supraventricular arrhythmia (29.5%), pulmonary complications (9.5%), gastrointestinal ischemia (2.0%), wound infection (2.0%) and surgical re-exploration (5.5%). Low cardiac output (p0.001), gastrointestinal ischemia (p = 0.03) and surgical reexploration (p = 0.004) were significant risk factors of mortality.Valvular surgery in octogenarians is a safe and low-risk procedure. The present data tended to show that the EuroSCORE overestimates mortality in this group of patients.

International audience; OBJECTIVE: Early graft failure (EGF) is a life-threatening event still accounting for a significant percentage of early deaths after heart transplantation. We tested whether selected metabolic markers, including high-energy phosphate concentrations measured ex vivo in pre-transplant heart grafts by (31)P magnetic resonance spectroscopy (MRS) are related with early post-transplant outcome. METHODS: During a 3-year period, 26 heart grafts harvested in the vicinity of the transplantation centre were studied. Evaluation of transplantability was done conventionally. (31)P MRS was performed ex vivo approximately 60min after aortic cross-clamp to quantify ATP, P(i) and PCr concentration ratios. A MRS-score was defined as a combination of intracellular pH (pHi) and the PCr/P(i) ratio. EGF was defined as the need to abnormally extend circulatory support or to use more than two inotropes before weaning the patient from CPB after transplantation. The grafts were attributed to three groups as follows: A1, transplanted with uneventful outcome (n=14); A2, transplanted with subsequent EGF (n=3) and B, not suitable for transplantation (n=9). RESULTS: Significant differences between groups existed for the following metabolic markers: PCr/ATP (P=0.013), PCr/P(i) (P=0.0004), pHi (P=0.0016) and MRS-score (P=0.0001). The sensitivity, specificity and positive likelihood ratio for EGF with a MRS-score\textlessor=1.95 were, respectively, 100%, 86% and 7. CONCLUSIONS: In the setting of this study, post-transplant outcome was related to the pre-transplant MRS-score of grafts evaluated ex vivo. This result might help to more securely use grafts from marginal donors.

Complications after ventricular assist devices placement most frequently consist of bleeding, infection, and thromboembolic events. We describe a late complication after transplantation caused by transdiaphragmatic connection of the device placed in the abdominal position that presented as an acute pulmonary syndrome, misleading initial diagnosis.

Q fever endocarditis caused by Coxiella burnetii is the most important etiology of negative blood culture endocarditis. Without specific clinical findings, diagnosis is difficult and prevalence of this life-threatening disease is underestimated.Q fever endocarditis was assessed in 19 patients (15 men, four women; age range: 36-79 years) by evaluating clinical and echocardiographic criteria and specific serology. All patients had evidence of pre-existing valvular disease, and 10 had a valvular prosthesis. Diagnosis was assessed in: the presence of unexplained fever (n = 5), heart failure with valvular dysfunction (n = 10), hemolysis (n = 1), glomerulonephritis (n = 1) and stroke (n = 2). A late diagnosis was made in eight patients, either during or after surgery.In all cases, usual blood cultures remained negative, despite specific serology being positive. Transthoracic and transesophageal echocardiography were conclusive in only six cases (four vegetations, two periannular abscesses). Surgery was indicated in 15 patients for heart failure or valvular dysfunction (n = 12), hemolysis (n = 1) and periannular abscess (n = 2). Intraoperative findings were suggestive of endocarditis in seven cases; valvular cultures were positive in 92% of cases. All patients were treated with combined doxycycline/ hydrochloroquine or quinolone, for a mean of 24 months (range: 6-60 months). Mean follow up was 40 months (range: 6-144 months). Two patients died from heart failure, one patient was lost to follow up, and 16 patients had no late relapses.Q fever is an underestimated cause of endocardititis, and early diagnosis is the key to good prognosis. The need for systematic serologic examination in case of valvular dysfunction, with or without endocarditis symptoms, is emphasized.

We have developed a low-cost and minimally-invasive MRS CDE combined procedure to diagnose routinely low grade rejection, allowing to eliminate systematic biopsies after the first year and to reduce the number of biopsies to the minimum required by the occurrence of immunological and or functional perturbations. The MRS CDE approach is also used to finetune the immunosuppressive treatment.

We describe 7 transplanted heart recipients from a single family with limb-girdle muscular dystrophy type 1B linked to a mutation of the LMNA gene in the splice donor site of the exon 9 (IVS 9+1:g>a). These patients did not display higher early postoperative or late complications than other heart transplant recipients at a mean follow-up of 8 years (range 1–17 years). Noticeably, there was no case of rhabdomyolysis and skeletal muscle symptoms were not markedly impaired.

A 52-year-old man, living at home, had been on left ventricular assistance for 15 months with a Novacor pump (Worldheart, Ottawa, ON, Canada). Following the onset of effort dyspnea that had recently become worse, he was admitted to the hospital. A review of the pump showed that its flow rate had significantly decreased. An electrocardiogram showed a third-degree atrioventricular block. A pacemaker was implanted and the patient became asymptomatic immediately afterwards. This clinical case report shows the importance of satisfactory right ventricle filling in these patients. Right ventricle filling can be impaired by conduction disorders.

Use of cardiopulmonary support (CPS) by peripheral access with a membrane oxygenator has made considerable progress as a result of the development of centrifugal pumps, percutaneous cannulation, and pre-heparinized circuits. We have used CPS for resuscitation in 3 cases, for recovery after cardiotomy in 6 cases (myo-cardial insufficiency, 4; pulmonary arterial hypertension, 1; respiratory insufficiency, 1), and after heart transplantation in 1 case. Of these 10 patients, 3 died during CPS, 5 were successfully weaned, and 2 underwent heart transplantation. Use of CPS is expanding for emergency cardiac assistance. Installation is simple and rapid. It allows recovery of organs pending more invasive and costly techniques.

In conjunction with biopsy and Doppler studies, we analysed by high resolution proton NMR spectroscopy the blood plasma of 22 heart transplant recipients. There was a significant variation in the glycosylated residues of proteins with the development of acute cardiac rejection. A more extensive study is underway to assess the sensitivity and specificity of this approach for the early diagnosis of acute cardiac rejection.