BACKGROUND:The Sacubitril-Valsartan combination (SVC) has been gaining an important role in the treatment of heart failure with reduced ejection fraction. We aimed to evaluate the immediate postoperative hemodynamic profile of patients usually treated with the SVC and undergoing elective cardiac surgery. MATERIALS AND METHODS:This single-center retrospective study was conducted from January 2022 to March 2024 in cardiac surgery. All consecutive patients treated with SVC were compared to unexposed patients, selected by propensity score matching in a 1:2 ratio. The propensity score was estimated using a logistic regression adjusted for age, sex, creatinine clearance, preoperative critical illness, acute coronary syndrome < 90 days, left ventricular ejection fraction, surgery, and cardiopulmonary bypass time. The primary outcome was the Vasoactive-Inotropic Score (VIS) during the first 24 h postoperatively. RESULTS:We included 28 exposed and 56 non-exposed patients. We found no significant difference in 24-h VIS (Exposed: 21.5 ± 15; Non-exposed: 21.4 ± 18; p = 0.86). We found no significant difference in VIS during the first 5 days, norepinephrine duration, dobutamine duration, lactate change, vascular filling, fluid balance, the occurrence of acute renal failure, duration of mechanical ventilation, and length of stay in intensive care. These results were similar in the subgroup of patients undergoing off-pump coronary artery bypass surgery. However, a difference smaller than 10 VIS points cannot be excluded. CONCLUSION:In this exploratory study in cardiac surgery, preoperative treatment with SVC was not associated with increased vasoplegia and vasoactive drug consumption.

We report an unusual case of giant intracardiac medullary thyroid cancer metastasis. A 76-year-old woman with a 9-year history of medullary thyroid cancer presented an unexpected 7.5 cm mass in the right ventricle. Complete resection and tricuspid valve replacement led to 40 months survival.

BACKGROUND: Among patients with coronary artery disease (CAD), around 25% have multisite artery disease (MSAD). Patients with CAD and MSAD are at higher risk of peri-operative and long-term cardiovascular events. Whether off-pump coronary bypass grafting (CABG) can improve their prognosis is unknown. We aimed to assess the benefits of off- vs. on-pump cardiac surgery in patients undergoing CABG, according to coexistence of extra-cardiac artery disease. METHODS: Between April 1998 and September 2008, 1221 patients undergoing CABG without any other intervention were enrolled. Overall death and major cardiovascular events were recorded at 1-month and during long-term follow-up. A propensity score (PS), derived from all relevant variables (P<0.25) associated with on-pump as compared to off-pump CABG, and representing the likelihood for each individual patient to receive off-pump CABG, was calculated. RESULTS: MSAD was observed in 279 patients (23%). Off-pump CABG was performed in 208 (17%) patients. The median follow-up was 7.6 years. The 10-year mortality was significantly lower in off- vs. on-pump CABG group (74 +/- 4% vs. 68 +/- 2%, P=0.024). In patients with MSAD, there was a trend for better survival for off- vs. on-pump CABG (63 +/- 8% vs. 50 +/- 4%, P=0.078). After adjustment for PS, we found no further difference between on- and off-pump CABG both in the whole cohort (HR=1.30, P.10), as well as in MSAD patients (HR=1.51, P=0.14). CONCLUSIONS: Patients with MSAD receiving CABG are at worst prognostic than those with isolated CAD. In these patients, we found no significant difference in the long-term mortality and cardiovascular events between on- and off-pump CABG.

Despite large randomized controlled trials demonstrating similar outcomes for of-pump or on-pump coronary artery bypass grafting, the debate between proponents of each technique remains current.1Shaefi S. Mittel A. Loberman D. et al.Off-pump versus on-pump coronary artery bypass grafting-a systematic review and analysis of clinical outcomes.J Cardiothorac Vasc Anesth. 2019; 33: 232-244Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar On-pump technique improves surgical exposure on a nonbeating heart but exposes the patient to a powerful inflammatory response and to ischemic stroke owing to cross clamping and cannulation. Off-pump coronary artery bypass (OPCAB) may reduce blood transfusion, postoperative length of hospital stay, postoperative neurocognitive decline, and systemic anticoagulation, but heart repositioning may be associated with hemodynamic instability; thus, this technique requires a learning curve for the surgeons and increases the incidence of ineffective revascularization. In brief, all trials failed to identify a difference between the surgical techniques, especially for neurocognitive outcomes. A 2012 Cochrane review2Møller C.H. Penninga L. Wetterslev J. et al.Off-pump versus on-pump coronary artery bypass grafting for ischaemic heart disease.Cochrane Database Syst Rev. 2012; 14CD007224Google Scholar concluded that there was no benefit of OPCAB over on-pump technique with respect to mortality, stroke, and myocardial infarction. However, OPCAB seems to be a safe alternative to on-pump technique for patients with low risks of perioperative complication and for patients with anatomic limitations for extracorporeal circulation. Elderly patients may benefit more from OPCAB than a younger population. First, they have less physiologic reserve and they are less resistant to the complications of cardiopulmonary bypass. Age increases the risk of aortic injury or plaque disruption. However, a composite outcome (mortality, stroke, and myocardial infarction) was not different between OPCAB and on-pump technique in a cohort of 900 patients older than 70 years of age (Danish on-pump versus off-pump randomization study (DOORS)), despite fewer grafts per patient in the OPCAB group.3Houlind K. Kjeldsen B.J. Madsen S.N. et al.On-pump versus off-pump coronary artery bypass surgery in elderly patients: Results from the Danish on-pump versus off-pump randomization study.Circulation. 2012; 125: 2431-2439Crossref PubMed Scopus (125) Google Scholar Likewise, in 2,539 patients 75 years of age or older, there was no significant difference between OPCAB and on-pump coronary artery bypass grafting, and the OPCAB group was more likely to require repeat revascularization for 1 year after the procedure.4Diegeler A. Börgermann J. Kappert U. et al.Off-pump versus on-pump coronary-artery bypass grafting in elderly patients.N Engl J Med. 2013; 368: 1189-1198Crossref PubMed Scopus (354) Google Scholar Finally, in spite of more perioperative complications in on-pump procedures, Parmeshwar et al., in a retrospective study of 555 patients,5Parmeshwar N. Fero K.E. Manecke G. et al.Off-pump versus on-pump: Long-term outcomes after coronary artery bypass in a veteran population.J Cardiothorac Vasc Anesth. 2019; 33: 1187-1194Abstract Full Text Full Text PDF Scopus (4) Google Scholar did not find a difference in overall survival, reintervention, or postoperative myocardial infarction between patients who underwent bypass grafting on-pump or off-pump over an extended follow-up averaging 10 years. However, we have 2 comments about these different studies. First, the definition of a cohort of elderly people is suggestive. A 70-year-old limit, as in the DOORS study, seems low. It allows the inclusion of many patients, but the cohort is less representative. It might therefore be relevant for the specific study of elderly patients to raise the age threshold. Second, the ten-year outcome is a primary endpoint of interest when the life expectancy of the population allows a long-term follow-up. The life expectancy of a, 80-year-old man is 8.8 years in France, which means that a significant portion of the population may die of a noncardiac cause. This, therefore, decreases the statistical power of the analysis at 10 years and increases type II errors. We therefore conducted a retrospective study in our unit to test whether there appeared to be a short-term difference between the 2 surgical procedures in a population of people over 80 years of age. According to French law (L.1121-1 paragraph 1 and R1121-3 Public Health Code), neither informed consent nor approval by an ethics committee is necessary for the extraction of anonymous data or for the analysis of patients’ medical files. Quantitative variables were expressed as median and first and third quartiles. Percentages were compared using the chi-square test or Fisher exact test, as appropriate, and quantitative variables were compared using the Mann-Whitney test. All statistical tests were conducted at the 2-tailed level of 5%. A total of 43 octogenarian patients were hospitalized in our unit for a single procedure of coronary artery bypass grafting from January 2016 to October 2018, including 27 patients in the on-pump group and 16 in the off-pump group. The number of grafts performed per patient (3 [2;3] in both groups) and Logistic Euroscore II (2.16 [1.75;3.64] in on-pump group v 2.74 [1.80;4.39] in off-pump group) were similar between groups (Table 1). The preoperative left ventricular ejection fraction was not statistically significant. In our cohort, kidney damage appeared similar (Table 2) between the two surgical techniques. The increase in postoperative creatinine in the off-pump group may be explained by a higher preoperative creatinine and the ratio of pre- and postoperative creatinine was identical. In addition, the number of patients presenting an acute kidney injury according to the KDIGO (Kidney Disease Improving Global Outcomes) classification is identical. Cardioplegia induced an increase in troponin, but the size effect on serum potassium was low. There was no difference in acid base characteristics and chloremia. Surprisingly, although preoperative hemoglobin and transfusions were comparable in both groups, postoperative hemoglobin appeared lower in the off-pump group. Finally, there was no difference in postoperative management in both groups (Table 3): transfusion (number of transfused patients and unit of red cells), postoperative length of stay in critical care, and new renal replacement therapy.Table 1Characteristics of 43 Octogenarian Patients Underwent Revascularization With and Without Use of Cardiopulmonary BypassVariablesOn-Pump Coronary Artery Bypass Grafting n = 27Off-Pump Coronary Artery Bypass Grafting n = 16p ValueAge (y)81 (80;82)83 (80;84)0.13Female Sex, n (%)5 (19)4 (25)0.61Emergency9 (33)4 (25)0.56Diabetes mellitus5 (19)1 (6)0.26Preoperative creatinine (µmol/L)86 (66;104)102.5 (91;118)0.02Preoperative Hemoglobin (g/dL)14 (12;15.5)13 (11;15)0.34Logistic Euroscore 22.16 (1.75;3.64)2.74 (1.80;4.39)0.39Preoperative left ventricular ejection fraction60 (48;66)60 (40;60)0.49Preoperative left ventricular ejection fraction <50%9 (35)5 (33)0.95NOTE. Quantitative variables were expressed as median and first and thirrd quartiles and qualitative variables in frequency and percentage. Open table in a new tab Table 2Laboratory Findings of 43 Octogenarian Patients With Isolated First-Time Coronary Artery Bypass GraftingVariablesOn-Pump Coronary Artery Bypass Grafting n = 27Off-Pump Coronary Artery Bypass Grafting n = 16p ValuePreoperative creatinine (µmol/L)86 (66;104)102.5 (91;118)0.02Postoperative creatinine (µmol/L)89 (82;109)110 (97;182)0.02Pre- and post-creatinine ratio1.13 (0.96;1.30)1.10 (1.02;1.33)0.97New renal failure*Indicates new renal failure was considered in the presence of 50% increase in creatinine with respect to baseline (KDIGO at least 1). n (%)3 (11)3 (19)0.48Early postoperative potassium level (mmol/L)4.5 (4.3;4.9)4.1 (3.7;4.9)0.04Early postoperative chloride level (mmol/L)105 (104;107)102.5 (102;106)0.06Early postoperative pH7.36 (7.31;7.41)7.38 (7.32;7.4)0.74Early postoperative base deficit3.9 (3.1;5.6)3.9 (2.7;5.2)0.79Early postoperative lactate1.62 (1.05;2.01)1.46 (1.07;2.13)0.96Postoperative high sensitive troponine T724 (240;1,280)207 (149;190)<0.01Maximal high sensitive troponine T727 (386;1,300)266 (169;433)<0.01Early postoperative hemoglobin (g/dL)12.9 (11.6;13.8)11.1 (9.8;13.9)<0.05Early postoperative Hematocrit (%)38 (34;42)32.5 (28;40)<0.05Early postoperative platelets (G/L)169 (148;209)172 (135;229)0.85Early postoperative fibrinogen3.16 (2.55;3.78)3.12 (2.71;3.61)0.84NOTE. Quantitative variables were expressed as median and 1st and 3rd quartiles and qualitative variables in frequency and percentage. Indicates new renal failure was considered in the presence of 50% increase in creatinine with respect to baseline (KDIGO at least 1). Open table in a new tab Table 3Operative Variables and Use of ResourcesVariablesOn-Pump Coronary Artery Bypass Grafting n = 27Off-Pump Coronary Artery Bypass Grafting n = 16p ValueGrafts per patient3 (2;3)3 (2;3)0.85Patients receiving any packed red blood cells during surgery and intensive care unit stay12 (44)8 (50)0.72Units of transfused packed red cells0 (0;2)0.5 (0;2)0.98Patients receiving fresh frozen plasma6 (22)3 (19)0.79Patients receiving fibrinogen5 (19)1 (6)0.26New renal replacement therapy2 (7)1 (6)0.89Postoperative length of stay in intensive and intermediate care unit5 (4;7)5 (4;7)0.98Death (at 30 d)0 (0)0 (0)1NOTE. Quantitative variables were expressed as median and 1st and 3rd quartiles and qualitative variables in frequency and percentage. Open table in a new tab NOTE. Quantitative variables were expressed as median and first and thirrd quartiles and qualitative variables in frequency and percentage. NOTE. Quantitative variables were expressed as median and 1st and 3rd quartiles and qualitative variables in frequency and percentage. NOTE. Quantitative variables were expressed as median and 1st and 3rd quartiles and qualitative variables in frequency and percentage. In conclusion, it is difficult to show a relevant difference in patient outcomes between the 2 techniques. The choice may therefore depend directly on the practice of the team of surgeons and anesthesiologists. There are no conflicts of interest for any of the authors. On Pump or Off: Is There a Difference?Journal of Cardiothoracic and Vascular AnesthesiaVol. 33Issue 7PreviewI read with interest the letter to the editor written by Dr. Tiquet and colleagues. They performed a retrospective study of 43 patients over 80 years of age undergoing either on-pump or off-pump coronary artery bypass. The letter does not provide details about how the patients were selected for either procedure, but the 2 groups were very similar at baseline. There was no difference in the number of bypass grafts per patient between the 2 groups. Measured 30-day outcomes also were similar, specifically preoperative and postoperative creatinine ratios, need for blood product transfusions, length of intensive care unit stay, and death at 30 days (0 in both groups). Full-Text PDF

Uterine transplantation from a deceased donor could become an available option for widely treating uterine infertility. However, this procedure requires more precise knowledge about the graft's tolerance to extended cold ischemia. Here, we sought to assess the uterine metabolic alterations after extended cold ischemic storage in a model of auto-transplantation in ewe. A total of 14 uterine auto-transplantations were performed, divided into 2 groups: 7 after 3 h of cold ischemia time (CIT) and 7 after 24 h. Venous uterine blood was collected before uterus retrieval and during reperfusion (30, 60 and 90 min); thereafter, blood gases, lactate, glucose and amino acids (AAs) were analyzed. Apoptosis analyses were performed before uterus retrieval and following reperfusion in uterus biopsies. A total of 12 uterine auto-transplantations were successfully performed and 7 ewes were alive >= 8 days after transplantation. After reperfusion, a decrease in pH, a rise of lactate and lactate/glucose ratio and a delayed decrease of pO(2) were found in the 3 h CIT group. No significant variation of these parameters was observed in the 24 h CIT group. Significant decreases of AAs were observed during reperfusion and these decreases were more pronounced and concerned a larger number of compounds in the 24 h CIT group than in the 3 h CIT group. There was no significant uterine apoptotic signal in either group. Overall, these results suggest that extended CIT storage delayed restoration of aerobic glycolysis and induced an increase in AA requirements of the uterus after reperfusion. However, this biochemical alteration did not reduce success rate for uterine transplantation.

Objective: To assess the performance of transthoracic echocardiographic parameters to predict operative mortality and morbidity in patients undergoing coronary artery bypass grafting, and to assess its incremental prognostic value as compared to the Society of Thoracic Surgeons (STS) score. Materials and methods: We prospectively collected the clinical and biological data required to calculate the STS score in patients hospitalised for coronary artery bypass grafting. Preoperative transthoracic echocardiography was performed for each patient. The primary endpoint was 30-day mortality or major morbidity (i.e. stroke, renal failure, prolonged ventilation, deep sternal wound infection, reoperation) as defined by the STS. The secondary endpoint was prolonged hospitalisation for over 14 days. Results: A total of 172 patients was included (mean age 66.1±10.2 years, 12.2% were women). The primary endpoint occurred in 33 patients (19.2%), and 28 patients (16.3%) had a prolonged hospital stay. Independent predictive factors for the primary endpoint were an increased left atrial volume (>31 mL/m²; odds ratio (OR) 3.55, 95% confidence interval (CI) 1.38–9.12; P=0.004) and a decreased tricuspid annular plane systolic excursion (<20 mm; OR 3.45, 95% CI 1.47–8.21; P=0.008). The predictive value of the multivariate model increased when the two echocardiographic parameters were added to the STS score (area under the curve 0.598 vs. 0.695, P=0.001; integrated discrimination improvement 7.44%). Conclusion: In patients undergoing coronary artery bypass grafting, preoperative assessment of left atrial size and tricuspid annular plane systolic excursion should be performed systematically, as it provides additional prognostic information to the STS score.

Objectives:To date, no "gold standard" technique has been developed for sternum replacement in cases of radioinduced sarcoma, which is a rare and aggressive disease. Current techniques rely on metallic prostheses, meshes, or bone grafts-procedures that that are associated with several complications. We therefore tried a new solution that might simplify and optimize this surgery.Methods:We used a porous alumina ceramic prosthesis (Ceramil: i.ceram, Limoges, France) that has several interesting characteristics, such as osseointegration, biocompatibility, radiolucency, and high mechanical strength.Results:We report the first case of sternal replacement surgery involving the implantation of a ceramic prosthesis after radio-induced sternal sarcoma. In 2005, a 54-year-old woman was diagnosed with local breast cancer for which she underwent all appropriate treatment. Ten years later, she developed radio-induced sarcoma of the sternum. A complete sternal replacement was performed on 24 April 2015, with no postoperative complications. Imaging by 18F-flurodeoxyglucose positron-emission tomography-computed tomography performed 26 months after the surgery showed no local recurrence. The patient seems to have fully recovered and has resumed normal activity.Conclusions:This new technique is promising. For the first time, we highlight the feasibility, safety, and efficacy of sternal replacement using a porous alumina ceramic prosthesis.

CONTEXT: To date, there is no gold standard technique for sternum replacement. Current techniques rely on metallic prosthesis, meshes and bars, or bone grafts. However, they have several pitfalls. AIMS: The aim of this article is to report the results of sternal replacement with a porous alumina ceramic sternum. SETTINGS AND DESIGN: Surgeries were performed in two teaching hospitals in France. METHODS: We designed a porous alumina ceramic prosthesis which possesses interesting characteristics for this surgery such as great biocompatibility, a certain level of bacterial resistance, radiolucency, and compatibility with radiotherapy. The implant is stitched to the ribs with suture thread and does not require osteosynthesis material. RESULTS: Six patients with a mean age of 60.6 years received this prosthesis. Indication was tumor in five cases and mediastinitis in one case. The mean follow-up is 20 months (3–37 months). No major complication occurred and healing was fine for all patients. Patients did not complain of breathing discomfort or pain related to the prosthesis. CONCLUSIONS: This new technique is promising even if there are only six patients in this study.

BackgroundSimilarly, to sepsis, cardiac surgery with cardiopulmonary bypass (CPB) induces major changes in leukocyte subsets. Immature granulocytes (IGs) increase both in sepsis and after open‐heart surgery. Secondary infections are a major complication of cardiac surgery with CPB. We hypothesized that the assessment of leukocyte subsets with multicolor flow cytometry (FCM) could help the front‐line clinician to better identify patients at high risk of infectious complications in this clinical setting.MethodsIn this single‐center observational pilot study, we identified 26 leukocyte subsets using three combinations of antibodies (from 5 to 10 colors per combinations): one devoted to granulocytes, one to lymphocyte subpopulations and one for rare cells (plasma cells and dendritic cells). Blood samples were obtained preoperatively and immediately after open‐heart surgery under CPB in 59 patients without immuno‐depression, chronic or neoplastic inflammatory disease, and immunosuppressive treatment. Secondary infections during hospital stay were recorded.ResultsPatients exhibited postoperative NK and T‐cell lymphopenia, increased levels of IGs and monocytes with low levels of surface HLA DR. Twelve patients developed secondary infectious complications. Only immediate postoperative IG levels were significantly higher in these patient (6.6 [6; 7.39] G/L vs. 3.8 [2.67; 5.72] G/L, P = 0.01). Patients with immediate postoperative increase of IGs developed more frequently infectious complication (10/22 [46%] vs. 2/37 [5%]: P < 0.001).ConclusionsThis study suggests that postoperative increase of IGs is related to postoperative organ failure and promises to help in early identification of patients at risk of infectious complications after open‐heart surgery under CPB. © 2018 International Clinical Cytometry Society

Objective: Postoperative atrial fibrillation is a major complication following coronary artery bypass graft. We hypothesized that, beyond clinical and electrocardiogram (ECG) data, transthoracic echocardiography could improve the prediction of postoperative atrial fibrillation. Methods: We prospectively studied 169 patients in sinus rhythm who underwent isolated coronary artery bypass graft in our institution. Clinical, biological, ECG and transthoracic echocardiography data were collected within 24 h before surgery. The patients were continuously monitored during the first five days, and then had daily 12-lead ECG afterwards until discharge. Postoperative atrial fibrillation was defined by any episode >10 min. Results: Postoperative atrial fibrillation was found in 65 patients (38%). Compared with those without, patients with postoperative atrial fibrillation were significantly older ( p=0.008), had more frequently a history of hypertension ( p=0.009), history of atrial fibrillation ( p<0.001) and New York Heart Association class ⩾III ( p=0.004). They also had longer PR interval ( p=0.005), higher preoperative NT-pro brain natriuretic peptide level ( p=0.006), left ventricle end-diastolic volume ( p=0.002), indexed left ventricle mass ( p<0.0001), indexed maximal left atrial volume ( p<0.0001), maximal right atrial area ( p<0.001) and lower left ventricle ejection fraction ( p=0.04). In multivariate analysis, history of atrial fibrillation (odds ratio =6.1, 95% confidence interval: 1.4–26.0, p=0.02) and indexed maximal left atrial volume (odds ratio =1.13, 95% confidence interval: 1.1–1.2, p=0.001) were the only two independent predictive factors of postoperative atrial fibrillation. The addition of echocardiographic parameters improved the predictive value (χ2) of the model, from 34 to 57. Conclusion: A history of atrial fibrillation and indexed left atrial maximal volume are the best predictors of the occurrence of postoperative atrial fibrillation following coronary artery bypass graft. The identification of high risk population of postoperative atrial fibrillation using these two factors could lead to the development of targeted strategies to limit this frequent complication in these patients.

The prognostic impact of elevated pulmonary arterial pressure (PAP) remains controversial in aortic stenosis (AS) and few studies focused on patients with preserved left ventricular ejection fraction (LVEF). We aimed to investigate the impact of pulmonary hypertension (PH), invasively derived, on survival in severe AS with preserved LVEF.

Background: Angiotensin receptors blockers (ARB) and angiotensin conversion enzyme inhibitors (ACEi) are effective for cardiac remodeling, but their clinical interest after isolated aortic valve replacement (AVR) for aortic stenosis (AS) is unclear. We studied the impact of renin-angiotensin

was lung cancer in 3 patients, pulmonary tuberculosis in 5. Chest tube drainage or open window thoracostomy were used for empyema treatment in 2 and 6 cases respectively.Unsuccessful surgical attempts to close BPF were undertaken in 4 cases.Measurement under C-arm was carried out by balloon insertion into the fistula to measure its size.The procedure was performed by flexible bronchoscope under local anaesthesia.The guide was inserted into the pleural cavity via the fistula.Two thoracoscopic ports were performed, and the guide was pulled out of the pleural space through the port.The plug was fixed to the guide and inserted into the fistula.The outcome of the treatment was followed up from 2 months to 2 years.Results: No complications followed the procedures.Repeated insertion of the plug became necessary in one case.Granulomatous tissue growth and scarring around the plug provided reliable occlusion.Successful PP-BPF closure was achieved in 7 cases.In one patient the PP-BPF enlarged and the plug was dropped out on the progression of tuberculosis.Conclusions: Endoscopic PP-BPF closure is a safe, well tolerated and promising technique with good results.Stabilization of the underlying disease is an important prerequisite for the success of the treatment.

Electrocardiographic (ECG) strain has been reported as a specific marker of midwall left ventricular (LV) myocardial fibrosis, predictive of adverse clinical outcomes in aortic stenosis (AS), but its prognostic impact after aortic valve replacement (AVR) is unknown. We aimed to assess the impact of ECG strain on long-term mortality after surgical AVR for AS. From January 2005 to January 2014, patients with interpretable preoperative ECG who underwent isolated AVR for AS were included. ECG strain was defined as >= 1.-mm concave downslopping ST-segment depression with asymmetrical T- wave inversion in lateral leads. Mortality was assessed over a follow-up period of 4.8 +/- 2.7 years. Among the 390 patients included, 110 had ECG strain (28%). They had significantly lower body mass index, higher mean transaortic pressure gradient and Cornell-product ECG LV hypertrophy than in those without ECG strain. There was also a trend for lower LV ejection fraction in patients with ECG strain as compared with those without. Patients with ECG strain had significantly lower 8-year survival than those without. ECG strain remained associated with reduced survival both in patients with and without LV hypertrophy (p <0.0001 for both). After adjustment, ECG strain remained a strong and independent determinant of long-term survival (hazard ratio 4.4, p <0.0001). Similar results were found in patients with LV hypertrophy or without LV hypertrophy. In the multivariate model, the addition of ECG strain provided incremental prognostic value (p <0.0001). In conclusion, in patients with AS, ECG strain is associated with 4-fold increased risk of long-term mortality after isolated AVR, regardless of preoperative LV hypertrophy. (C) 2017 Elsevier Inc. All rights reserved.

Objective: To report our experience in aortic valve replacement with the Mitroflow (Sorin, Vancouver, Canada) aortic bioprosthesis.Methods: We retrospectively reviewed all patients who underwent aortic valve replacement with a Mitroflow bioprosthesis at our institution from January 1994 to December 2011. No exclusion criteria were retained. Patients were followed yearly. Echocardiography follow-up was performed systematically before the hospital discharge and annually by patients' cardiologists.Results: Seven hundred twenty-eight patients (mean age, 76 +/- 6 years; range, 33-91 years) underwent aortic valve replacement with Mitroflow 12A or LX model and were included in this analysis. 30-day mortality for nonemergent isolated aortic valve replacement was 5.5%. Eight patients (1%) underwent reoperation for structural valve deterioration (SVD) and 30 patients (5.8%) presented echocardiographic signs of SVD. Actuarial freedom from reoperation for SVD was 99% +/- 0.5% and 95% +/- 5% at 10 and 15 years. Actuarial freedom from echocardiographic signs of SVD was 77% +/- 5% and 56% +/- 11% at 10 and 15 years, respectively. At the univariate analysis, only the mean gradient at discharge (P = .0200), the prevalence of size 19 (P = .0273), and severe patient-prosthesis mismatch (P = .0384) were significantly different in patients developing SVD at follow-up. Freedom from echocardiographic signs of SVD at 8 years were 88% +/- 4% and 64% +/- 13% in patients with a Mitroflow > 19 and Mitroflow 19, respectively (log-rank test, P = .0056; Wilcoxon test, P = .0589).Conclusions: Overall outcomes were satisfactory. However the risk of early SVD seems higher for the Mitroflow size 19. This size should be reserved for applications when annulus enlargement is risky or there is an anatomic contraindication to sutureless or stentless valve.

Objective: To assess how the uterus tolerates extended cold ischemic storage before auto-transplantation in ewes.Study design: Fourteen uterine auto-transplantations were performed in ewes from November 2014 to June 2015 at the Analysis and Research Laboratory of Limoges, France. The animals were divided into 2 groups: 7 after 3 h of cold ischemia timeand 7 after 24 h. Transplant was assessed >= 8 days after transplantation. Histology and apoptosis analyses (TUNEL method and indirect immunohistochemistry of cleaved Caspase 3) were performed before uterus retrieval (control), after 90 min following reperfusion and >= 8 days after transplantation.Results: Twelve uterine auto-transplantations were successfully performed. The histological analysis at 90 min following reperfusion revealed a moderate inflammation of the endometrium and serosa in the 3-h group and severe inflammation in the 24-h group, but no significant apoptotic signal was found in either group. Seven ewes were alive at >= 8 days after transplantation: the macroscopic and histological analyses revealed two viable uteri in the 3-h group and three in the 24-h group. In each group one uterus was necrotic.Conclusion: These first results in ewes suggest that the uterus is an organ with a good tolerance to extended cold ischemic storage before transplantation. (C) 2017 Published by Elsevier Ireland Ltd.

OBJECTIVE:Uterine infertility (UI), which can be caused by a variety of congenital or acquired factors, affects several thousand women in Europe. Uterus transplantation (UTx), at the current stage of research, offers hope for these women to be both the biological mother and the carrier of their child. However, the indications of UTx still need to be defined. The main aim of the study was to describe the different etiologies of UI and other data as marital and parental status from women requesting UTx who contacted us in the framework of a UTx clinical trial. Secondarily, we discussed the potential indications of UTx and their feasibility.STUDY DESIGN:This is an observational study.RESULTS:Of a total of 139 patients with UI, 105 patients (75.5%) had uterine agenesis, making it the leading cause of UI in this sample. Among the patients with uterine agenesis, 25% had a solitary kidney and 44.7% had undergone vaginal reconstruction. Peripartum hysterectomy, hysterectomy for cancer, and hysterectomy for benign pathologies accounted for 9.4%, 7.2% and 5% of cases, respectively. Less common causes of UI included complete androgen insensitivity syndrome (2.2% of patients) and prenatal diethylstilbestrol exposure (0.7%). Approximately 14% of the women already had at least one child and 66% were in a couple living together for at least 2 years.CONCLUSION:UTx is still under evaluation and further research is under way. Nulliparous patients with no major medical or surgical history and with normal ovarian function, who meet the legal criteria for medically assisted reproduction, represent the best indications for UTx at this stage of its development.

Long-term survival and risk of reoperation in "non-Marfan syndrome" patients with a long life expectancy who undergo emergency surgery for acute type A aortic dissection (aTAAD) are not well known. To analyse survival, risk of reoperation and quality of life in this population. From 1990 to 2010, all patients aged ≤ 50 years and not affected by Marfan syndrome, who underwent emergency surgery for aTAAD at two institutions, were included in this analysis. Patients were categorized into four groups according to the extension of the aortic replacement: SUPRACORONARY, ROOT, ARCH and EXTENSIVE. Sixty-six patients (mean age 45 ± 4 years; range 34–50 years) were considered eligible for this analysis. Overall in-hospital mortality was 24% (16/66 patients); and 25%, 23%, 20.5% and 43% in the SUPRACORONARY, ROOT, ARCH and EXTENSIVE groups, respectively. Mean follow-up among survivors was 10.5 ± 7.2 years (range: 0.1–24.7 years). Overall 10-year survival was 55 ± 6%; and 75 ± 12%, 69 ± 13%, 47 ± 8% and 28 ± 17% in the SUPRACORONARY, ROOT, ARCH and EXTENSIVE groups, respectively. Overall freedom from reoperation on the aorta was 73 ± 7.5%; and 40 ± 20%, 75 ± 21%, 78 ± 8% and 100% in the SUPRACORONARY, ROOT, ARCH and EXTENSIVE groups, respectively. In our experience, patients who underwent isolated supracoronary ascending aorta or root replacement showed the most satisfactory late survival. However, because the risk of reoperation is low when the replacement is extended to the root, our data suggest that root replacement could represent a good compromise between operative mortality and long-term survival. Les résultats à très long terme après chirurgie pour dissection aortique aiguë de type A chez le patient avec une longue espérance de vie non atteint du syndrome de Marfan sont peu connus. Nous analysons la survie et le risque de réintervention dans cette population. Nous avons analysé rétrospectivement tous les patients âgés de moins de 50 ans, non atteints du syndrome de Marfan et opérés d'une dissection aortique aiguë de type A dans deux hôpitaux, entre 1990 et 2010. Les patients ont été repartis en 4 groupes selon l'extension du remplacement aortique : SUS-CORONAIRE, RACINE (étendu que à la racine), ARCHE (étendu que à l'arche) et ETENDU (de la racine à l'arche). Soixante-six patients (âge moyen : 45 ± 4 ans; de 34 à 50 ans) ont été inclus dans cette analyse. La mortalité hospitalière globale était de 24 % (16/66 patients) et de 25 %, 23 %, 20,5 % et 43 % dans les groupes SUS-CORONAIRE, RACINE, ARCHE et ETENDU, respectivement. Le suivi moyen parmi les survivants était de 10,5 ± 7,2 ans (de 0,1 à 24,7 ans). La survie à 10 ans (mortalité hospitalière incluse) était de 55 ± 6 %, 75 ± 12 %, 69 ± 13 %, 47 ± 8 % et 28 ± 17 %, dans les groupes SUS-CORONAIRE, RACINE, ARCHE et ETENDU, respectivement. La liberté d'une réintervention sur l'aorte à 10 ans était de 73 ± 7,5 %, 40 ± 20 %, 75 ± 21 %, 78 ± 8 %, dans les groupes SUS-CORONAIRE, RACINE, ARCHE et ETENDU, respectivement. Dans notre série, les patients qui ont bénéficié d'un remplacement de l'aorte sus-coronaire ou d'un remplacement de la racine aortique présentent la meilleure survie au long terme. Toutefois, puisque le risque de réintervention est faible après remplacement de la racine aortique, nos données suggèrent que le remplacement de la racine aortique semble être un bon compromis entre la mortalité hospitalière et la survie au long terme.