Aims:Cardiac surgery may induce abrupt changes in pre-load, afterload, and right ventricular contractility. The ability of the right ventricle to maintain systolic performance in the presence of increased afterload is referred to as right ventricular-pulmonary artery (RV-PA) coupling. To assess RV-PA coupling in patients undergoing surgery for severe mitral regurgitation (MR), to identify a tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP) threshold for RV-PA uncoupling, and to evaluate its prognostic value for early mortality, right heart failure (RHF), post-operative course, and late mortality. Methods and results:This retrospective single-centre observational study included 277 patients who underwent surgery for severe MR between January 2018 and March 2023. RV-PA coupling was assessed using the ratio of TAPSE/PASP derived from pre-operative transthoracic echocardiography. The primary endpoint was early all-cause mortality within 30 days. Secondary endpoints included mortality from RHF, length of intensive care unit (ICU) stay, length of hospital stay, and late all-cause mortality.Receiver operating characteristic analysis identified an optimal TAPSE/PASP cut-off of 0.30 mm/mmHg to define RV-PA uncoupling. Patients with TAPSE/PASP ≤0.30 mm/mmHg had significantly higher early mortality and worse post-operative outcomes. In multivariable logistic regression, TAPSE/PASP remained an independent predictor of early mortality together with EuroSCORE II, cardiopulmonary bypass time, and weaning from bypass requiring ECMO or inotropic support. In a sensitivity analysis restricted to isolated mitral valve (MV) surgery, TAPSE/PASP remained the only independent predictor of early mortality. RV-PA uncoupling was also associated with excess early mortality from RHF and longer ICU and hospital stay, but not with late mortality. Conclusion:Pre-operative RV-PA uncoupling assessed by TAPSE/PASP is strongly associated with early mortality and post-operative RHF after MV surgery for severe MR and may help refine perioperative risk stratification.

Introduction: Currently, there are 2 types of third generation bioprostheses that can be used in patients with aortic stenosis with a large aortic annulus (LAA): the 29-mm Sapien 3 (S3; Edwards Lifesciences LLC, Irvine, CA) and the 34-mm Evolut-R (ER; Medtronic, Inc, Dublin, Ireland). The objective of this trial was to compare long-term hemodynamic and clinical outcomes of these two valves in patients with LAA and to determine the effect of aortic annulus size on these two outcomes. Method: We conducted a retrospective, monocentric study (CHU Rangueil-Toulouse) in patients who underwent transcatheter aortic valve implantation (TAVI) for aortic stenosis between 04/01/2018 and 31/12/2020. We included all patients with severe aortic stenosis (SAS) who were diagnosed based on clinical and echocardiographic criteria. All clinical, anatomical, and procedural characteristics were recorded. Results: We included 172 patients: 110 received a 29-mm S3 prosthesis and 62 patients a 34-mm ER prosthesis. The average area of the aortic annulus was 595 +/- 67 mm(2). The average aortic perimeter was 87.5 +/- 5.1 cm for the S3 and 584 +/- 72 mm(2) and 86.4 +/- 6.3 cm for the ER. The aortic regurgitation (AR) rate was higher with the ER than with the S3 (18.3% vs. 3.9%; p = 0.002) but the mean transvalvular gradient was lower with the ER (7.1 +/- 2.8 mmHg vs. 9.9 +/- 3.8 mmHg; p < 0.001). At Day 30, there were 4 deaths in the S3 group and 1 death in the ER group. The mean duration of follow-up was 22.7 months. No differences in cardiovascular mortality were observed between the two devices, with a rate of 2.7 deaths per 100 person-years for the ER vs. 3.9 deaths per person-years for the S3 group (p = 0.208). Subgroup analysis according to the LAA size showed a higher rate of AR in patients with the largest annulus dimensions. Conclusion: In patients with a LAA who require a TAVI, the 34-mm ER and 29-mm S3 prostheses demonstrate significant differences in hemodynamics with no impact on cardiovascular mortality.

Le diagnostic des épanchements péricardiques chroniques peut être difficile [1], [2]. Les caractéristiques biochimiques et cytologiques du liquide permettent de s’orienter à travers les multiples causes potentielles. Nous rapportons le cas d’une patiente présentant un chylopéricarde, forme exceptionnelle d’épanchement péricardique. Une patiente de 72 ans était adressée en 2022 pour une péricardite chronique non constrictive diagnostiquée en 2019. Ses antécédents se résumaient à une hypertension artérielle traitée par ler canidipine et une chirurgie des varices. Le diagnostic était porté devant une dyspnée NYHA II isolée d’apparition progressive, et un épanchement péricardique circonférentiel jusqu’à 20 mm prédominant en regard des cavités droites. La patiente n’avait pas d’autres doléances, notamment pas de douleur thoracique, d’altération de l’état général ni de fièvre. Entre 2019 et 2022, les échographies montraient une stabilité de l’épanchement. L’examen clinique était normal. Il n’existait pas de syndrome inflammatoire biologique, la fonction rénale était normale tout comme la TSH. Des antinucléaires à 1/160 sans spécificité n’étaient associés à aucune autre anomalie immunologique. Le bilan microbiologique était négatif. Malgré un traitement par colchicine (1 mg/j) introduit en 2021 et dispensé pendant 1 an, aucune amélioration n’était observée. Lors de son hospitalisation en médecine interne en 2022, l’IRM cardiaque ne montrait aucune autre anomalie, mais le scanner thoraco-abdominopelvien révélait des épaississements septaux et péribronchovasculaires associés à des nodules < 7 mm et micronodules périlymphatiques prédominant sur le poumon droit, sans calcifications. Un drainage péricardique avec réalisation d’une fenêtre péricardopleurale gauche était décidé compte-tenu d’une gêne fonctionnelle importante, et ramenait un liquide lactescent avec 660 éléments nucléés dont 93 % de lymphocytes, des triglycérides à 23 mmol/L et un cholestérol total à 2,7 mmol/L. La microbiologie restait négative. La biopsie péricardique ne rapportait que de discrets remaniements fibreux sans inflammation. L’évolution clinique était favorable et la patiente retrouvait une autonomie normale. Un régime adapté était prescrit. En 2023, la patiente était asymptomatique et l’échocardiographie ne montrait pas de nouvel épanchement. Les lésions scanographiques pulmonaires étaient stables. Une lymphoscintigraphie est envisagée en cas de récidive. Le chylopéricarde est un épanchement péricardique rare composé de chyle normalement drainé par les vaisseaux lymphatiques3). La richesse en triglycéride lui donne son aspect lactescent. Le chylopéricarde est le plus souvent primaire, mais il peut être secondaire à une lésion du canal thoracique, par exemple dans le cadre d’un traumatisme, d’une chirurgie, d’une radiothérapie, d’une infection ou d’une néoplasie [2], [3]. L’histoire de la patiente était en faveur d’un chylopéricarde primaire. Les épaississements septaux et péribronchovasculaires, ainsi que les micronodules périlymphatiques, évoquaient une surcharge lymphatique. Une revue systématique de la littérature de 1965 à 2020 a récemment permis de décrire 98 patients adultes avec un chylopéricarde (moyenne d’âge de 65 ans, 55 % d’hommes) [3]. Trois quarts des patients étaient symptomatiques et la dyspnée était le signe le plus fréquent. L’épanchement était abondant (> 20 mm) dans 80 % des cas. Plus d’un tiers des patients avaient présenté une tamponnade. La prise en charge du chylopéricarde repose sur le traitement de la cause sous-jacente lorsqu’elle est retrouvée, la diminution du flux du chyle thoracique (régime à base de triglycérides à chaînes moyennes, nutrition parentérale, octréotide) et fréquemment un geste chirurgical [2], [3]. Le chylopéricarde est un épanchement péricardique rare qui doit être évoqué devant un épanchement abondant, des signes de surcharge lymphatique associés, et l’absence de syndrome inflammatoire et de prise de contraste des feuillets péricardiques. Le diagnostic de chylopéricarde primaire peut être retenu en dehors d’un traumatisme, d’une chirurgie ou d’une radiothérapie après avoir éliminé une infection et une néoplasie.

BACKGROUND:Vascular complications (VCs) are commonly observed after transfemoral transcatheter aortic valve implantation (TAVI) procedures. Closure devices for the access site were developed to reduce their incidence. We aim to evaluate the prevalence, predictors, and outcomes of the occurrence of post-TAVI VCs.MATERIALS AND METHODS:A retrospective study was conducted on 1336 consecutive patients who underwent TAVI at the University Hospital of Toulouse, France, between January 2016 and March 2020. All included procedures were performed through the common femoral artery, and ProGlide® was the used closure device. The studied population was divided into two groups depending on the occurrence of VCs defined according to Valve Academic Research Consortium-2 criteria.RESULTS:The mean age of the studied population was 84.4 ± 6.9, and 48% were male. 90% of TAVI interventions were performed through the right femoral artery. The prevalence of VCs was 18.8%, and 3.7% were major. Prolonged procedure duration was an independent predictor of VCs. Using the right access site and smaller introducer size (14 Fr) were preventive factors. No significant difference in mortality rate was detected between the two groups.CONCLUSION:This study showed a low prevalence for post-TAVI VCs, especially for the major type. An increase in bleeding events and prolonged cardiac care unit stay were the common adverse outcomes.

Acute type A aortic dissection is one of the most hazardous acute vascular pathology. To investigate trends in the management of acute type A aortic dissections on the last 15 years. All consecutive patients who were operated on for an acute type A aortic dissection at the CHU of Toulouse, France, between 2005 and 2019 were retrospectively included. We compared demographics, diagnostic methods and surgical techniques between 3 periods: 2005–2009, 2010–2014 and 2015–2019 (Table 1). A total of 507 patients were included, mean age was 63 ± 12 years, 354 (70%) were male and 299 (59%) had hypertension. Demographics were similar across periods. About clinical presentation, the proportion of patients admitted to the operating room with cardiac arrest has increased between the 3 periods (12% vs 5% vs7%; P < 0.01). Regarding diagnostic, CT was the cornerstone (90%) and the use of TEE has increased (26% vs 10% vs 10%, P < 0.01). Regarding surgical management, we observed a decrease of the use of mechanical prosthesis (6% vs 17% vs 12%; P < 0.01), an increase of the use of hybrid prosthesis (10% vs 2% vs 0%; P < 0.01), of valve sparing (6% vs 0% vs 0%; P < 0.01) and of Bentall (29% vs 25% vs 13%; P < 0.01) (Fig. 1). Over a 15-years period, the demographics of patients operated on for type A aortic dissection has not significantly changed. However, there is a trend towards the management of patients in a more life-threatening condition. Most of the shifts relate to surgical techniques, with a more proactive approach to the treatment of associated aortic regurgitation.

Infective endocarditis (IE) after Transcatheter aortic-valve implantation (TAVI) is rare but severe complication. The primary aim of this study was to evaluate incidence, micro-organisms, clinical characteristics, outcomes and management of IE after TAVI. In a single-center, 996 patients were follow-up after TAVI between 2008 and 2018. By appling modified Duke criteria we perform diagnosis of IE. We identified 11 cases with « definite diagnosis » representing 1,1% of incidence. Patients characterised by a mean age of 79,6 years. Chronic kidney (5 patients) and diabet (4 patients) was frequent. IE appared after a median of 23,8 months after implantation. Reasons for initial diagnosis was fever (7 patients), heart failure (4 patients), poor condition (4 patients) and septic choc (1 patient). The most frequent causal micro-organisms were Staphylococcus aureus (3 patients) and coagulase-negative staphyloccoci (3 patients). Only one blood culture was negative. Vegetations were demonstrated in 8 cases. Only one patient developed a severe aortic regurgitation. There were no cases of embolism. Five patients had an indication for valve intervention according to the guidelines. After multidisciplinary assessment, medical treatment was the only way in this frailty population. Two patients had a persitent infection. At one year follow-up 7 patients were alive. IE is rare but severe complication. In our popultation rate was 1,1% of patients. Staphylococcus aureus and coagulase-negative staphyloccoci were the most represented micro-organisms. Even if valve intervention was necessary, antibiotic treatment was only performed.

BACKGROUND:Hybrid ablation for the treatment of atrial fibrillation is a single combined procedure consisting in a minimally thoracoscopic surgical ablation followed by a catheter ablation. This promising technique is recommended in persistent atrial fibrillation according to the current guidelines but is not routinely performed in France, mainly due to the absence of reimbursement by the French National Health Insurance. AIMS:The aim of this prospective and single-centre study was to analyse, for the first time in France, the feasibility, efficacy and complication rates of hybrid ablation in patients with persistent atrial fibrillation. METHODS:Hybrid ablation was performed in 15 consecutive patients (13 men, mean age 61±6 years) with persistent (7 patients) or long standing persistent (8 patients) atrial fibrillation. RESULTS:Hybrid ablation was completed in 14/15 patients. Eleven patients returned in sinus rhythm during the procedure. Two patients (13%) had major per-procedural complications and 2 had minor complications. During an average follow-up of 25±6 months, 6 patients (40%) underwent a redo catheter ablation because of atrial tachycardia, mainly peri-mitral atrial flutter. At 1 year follow up, 14/15 patients were in sinus rhythm, including 11 free of antiarrhythmic drugs.

Despite a considerable improvement in TAVR devices and procedures, together with a reduction in procedural complications, the rate of conduction disturbances (CD) remained stable over the years. Indeed, the CD rate is still significantly higher than in surgical aortic valve replacement, and represents one of the main limitations to the expansion of TAVR to younger low-risk patients. The aim of the present study was to assess the incidence and predictors of CD in low-risk patients undergoing TAVR. Among 637 patients without preexisting CD who underwent TAVR, 116 (18.2%) were considered at low surgical risk. Up to 25% of low-risk patients presented with persistent CD at discharge. The pacemaker implantation rate was similar in the low-risk group compared to the intermediate-/high-risk group (8.7% vs 10.6%, p = 0.55). Moreover, the rate of new persistent left bundle branch block (LBBB) following TAVR was also similar between both groups (18.1% vs 22.1%, p = 0.34). At 1-year follow-up, LBBB was persistent in 62.5% of patients and 3 of them required a pacemaker implantation. Depth of valve implantation, baseline QRS duration and mean aortic transvalvular gradient were identified as independent predictors of CD in low-risk patients. Patients at low surgical risk showed an equivalent CD rate than intermediate-/high-risk patients. The depth of valve implantation was the main predictor of CD in low-risk patients undergoing TAVR. Baseline QRS duration and mean aortic transvalvular gradient were also associated with increased CD.

Lung diseases are associated with higher mortality on patients undergoing on Tanscatheter aortic-valve implantation (TAVI). Impact of lung diseases are poorly investigated on alternative access. His study aim to compare 30-day and 1-year mortality after transaortic (TA) or transfemoral (TF) TAVI on patients with chronic lung diseases. All patients with symptomatic aortic stenosis were consecutively included between January 2012 and January 2016. Spirometry was performed and interpreted by a pneumologyst. Pulmonary diseases were defined according based on spirometric results. The allocation strategy for SAVR or TAVI, the way, the valve selection, was at the discretion of our local multidisciplinary Heart Team. Clinical follow-up was performed by clinical visit or phone consultation. The primary end point was the death from any cause after TAVI. A total of 164 patients were analysed. Comparing 82 TA to 82 TF patients mortality was similar at 30 day (RR = 1.24 (0.52–2.92) P = 0.692). Mortality rates after 1 year was also similar (RR = 1.35 (0.76–2.42), P = 0.308). There was no impact in lenght of hospitalisation (TF: n = 7.2 ± 2 days, TA n = 8 ± 3.3 days P = 0.108) (Fig. 1). In patients undergoing on TAVI, these results suggest that compared with the TF in TA approach lung diseases do not impact mortality. Access selection should not be impact by a lung dieases.

Pericardial effusion can be a life-threatening condition when fluid accumulation is fast and large. Emergency drainage is then life saving but no consensus exists as to the preferential use of a percutaneous or surgical approach. To compare complications during follow-up and length of stay, one and six-months mortality and recurrences. All patients admitted for symptomatic pericardial effusion in 2017 in our tertiary Intensive Cardiac Care Center were prospectively included. Patients were analyzed depending on the type of drainage used: surgical of percutanous. A total of 129 patients were admitted for pericardial effusion and 92 were drained: 54 (58.7%) by a surgical and 38 (41.3%) by a percutanous way. At 6-months, no mortality or recurrences between groups were observed (12 (22.2%) versus 14 (36.9%) deaths; P = 0.12 and 6 (11.1%) versus 9 recurrences (23.7%); P = 0.11, respectively in the surgical and percutanous group). No in-hospital complications were found (4 (7.4%) for the surgical group, 1 (5.3%) for percutanous group; P = 0.39). length of in-hospital stay was shorter for patients treated by percutaneous drainage (5.9 days (±4.4) versus 8.2 days (±4.9); P = 0.02). Percutaneous drainage appears to be a reliable approach to treat symptomatic percicardial effusions without differences in terms of complications, recurrences or mortality compared to surgical drainage. Length of stay is shorter that may justify to use it at first line therapy.

We present a case of an 80-year-old woman with severe aortic insufficiency due to a degenerated 21-mm biological prosthetic aortic valve implanted 9 years earlier, treated by using a transcatheter aortic valve replacement valve-in-valve procedure and who experienced a delayed right coronary obstruction. (Level of Difficulty: Beginner.).

Background: Pericardial effusion can be a life-threatening condition and urgent drainage is then life-saving but no consensus exists as to the preferential use of a percutaneous drainage (PCD) or a surgical drainage (SD) approach. Method and Results: All patients admitted for symptomatic pericardial effusion in 2018 in our tertiary Intensive Cardiac Care Unit (Toulouse, France) were prospectively included. In- hospital complications, length of stay, 6-months mortality and recurrences have been collected and compared according to the procedure (PCD vs. SD). One hundred and twenty nine patients were admitted for pericardial effusion and 92 were drained: 54 (59%) and 38 (41%) by a surgical and percutaneous procedure, respectively. In- hospital complications were the same between the 2 procedures (7% for SD group and 15% for PCD; p = 0.39). However, duration of hospitalization was shorter for patients treated by PCD (5.9±4.4 versus 8.2±4.9 days; p = 0.02). Six-month mortality (22% for SD versus 37% for PCD; p = 0.12) or recurrences (11% for PCD versus 24% for SD; p = 0.11) were not different. Conclusion: In case of symptomatic non-iatrogenic pericardial effusions, PCD is an efficient and reliable less invasive technique. Its possible and wide availability, and its shorter length of hospitalization justifies its use as first line therapy in trained team especially for cancer patients.

Thrombocytopenia after transcatheter aortic valve implantation (TAVI) is common and has been related to worse clinical outcomes. Comparison of platelet kinetics among different types of valves is limited. Our objectives were to analyze the differences in drop platelet count (DPC) between balloon-expandable valves (BEVs) and self-expanding valves and their prognostic implications after TAVI. Patients who underwent transfemoral TAVI from 2008 to 2016 were included. Exclusion criteria were severe baseline thrombocytopenia and periprocedural death. Postprocedural platelet counts were collected. Two groups were created: DPC <= 30 and DPC >30%. Valve Academic Research Consortium-2 criteria were used to define outcomes. Study population included 609 patients (age 84.7 +/- 6.0, 46.6% males). The mean DPC was 32.5 +/- 13.9%. The DPC was higher in the BEV arm (33.9 +/- 14.2 vs 30.7 +/- 13.4%, p = 0.006), and the nadir was reached later in comparison to the self-expanding valve arm (3.0 +/- 1.3 vs 2.5 +/- 1.1 days, p < 0.001). After multivariable analysis, the use of BEV, known coronary artery disease, and left ventricle ejection fraction were the factors associated with a higher rate of DPC >30%. At 30 days, the DPC >30% was related with a higher rate of life-threatening and/or major bleeding (6.8 vs 2.1%, p = 0.009) and death (3.5 vs 0.8%, p = 0.036). At 1 year, the difference in mortality disappeared. In conclusion, in this cohort of patients, the use of BEV seems to be associated with a higher risk of DPC after TAVI. A DPC >= 30% was related with increased risk of life-threatening and/or major bleeding and death at 30 days. Larger and prospective studies are needed to understand this phenomenon. (C) 2019 Published by Elsevier Inc.

Objective: Participating in either competitive or leisure sports is restrictive after surgical mitral valve repair (MVR). In this study, we examine the impact of sports on outcomes after MVR. Design: Retrospective cohort study. Setting: Patients aged 18 to 65 years who underwent a first-time MVR for primary mitral regurgitation (MR) in a tertiary care center. Patients: One hundred twenty-one consecutive patients were included in the study. The exclusion criteria were as follows: other concomitant procedures, early perioperative death or repeat intervention, noncardiac death or endocarditis during follow-up, and general contraindications for normal physical activity. Assessment of Risk Factors: Participation in sports was quantified by the number of hours per week during the past 6 months, classified according to the Mitchell classification and assessed with the International Physical Activity Questionnaire (IPAQ) short form. Main Outcome Measures: The primary composite endpoint was MVR failure defined as MR grade ≥2 or mean transmitral gradient ≥8 mm Hg, signs and symptoms of heart failure, or late-onset postoperative AF (>3 months). Results: The mean age was 50 ± 11 years, and there were 85 (71%) men. The median follow-up was 34 months [interquartile range (IQR): 20-50]. Fifty-six (46%) patients participated in sports regularly (median of 3 h/wk; IQR: 2-5). Twenty (17%) patients reached the primary composite endpoint with no correlation with participation in sports (P = 0.537), IPAQ categories (P = 0.849), in any of the Mitchell classification subgroups and a high level of participation in sports ≥6 hours (P = 0.679). Conclusions: Sports seem to be unrelated to the worst outcome after MVR.

Neurological complications of infective endocarditis (IE) concerns 20–40% of cases when symptomatic and 70% when asymptomatic. It is a well-identified gravity factor. Surgical indications in IE are larges and usual in emergency situations. However, neurological event, symptomatic or not, counts in surgical discussion. Sub-groups of patients with real risk of neurological deterioration during extracorporeal circulation are difficult to identify. The purpose of this study was to identify the risk factors of death and handicap in patients operated for infective endocarditis with neurological complications. Retrospective monocentric study realized in CHU of Toulouse from October 2014 to March 2017. We included 78 patients treated by cardiac surgery in a context of infective endocarditis complicated by neurological event (ischemic or hemorrhagic stroke, meningitis or mycotic aneurysm). The primary endpoint was mortality and Rankins score greater than or equal to 2, at six month. Primary endpoint occurred in 21 patients (26%). Risk factors were anteriority of mechanical valve replacement (P = 0,004), pejorative SOFA score (P < 0,0001), diabetes (P = 0,005), high Euroscore (P = 0,0004), infection by methicillin-sensitive Staphylococcus aureus (P = 0,033), oral streptococcus (P = 0,037) initial hemodynamic instability (P = 0,005), aminoside treatment (P = 0,001), duration of reanimation (P = 0,004), vasopressive drugs use and mechanical ventilation pre and post-surgery. However, we did not find significative results to several variables as hemorrhagic stroke (P = 0,69), surgery delay (P = 0,324), neurological symptoms (P = 0,120), Glasgow score (P = 0,146) and oral anticoagulation (P = 0,211) (Fig. 1). Main risk factors of death or handicap at six month, after a cardiac surgery in context of IE with neurological complication were hemodynamic presentation, micro organism and diabetes.

Les tumeurs du rein avec thrombus tumoral sont peu fréquentes (2 à 10 %), avec des chirurgies invasives le plus souvent multidisciplinaires et surtout une mortalité et une morbidité importantes. L’objectif était d’évaluer les résultats de morbidité périopératoires et oncologiques des patients opérés d’une tumeur rénale avec thrombus tumoral envahissant la veine cave inférieure (VCI) à plus de 2 cm de la veine rénale. Entre 1988 et 2018, 97 patients ont été opérés dans un centre universitaire expert de haut volume. Les données préopératoires [insuffisance rénale (< 60 mL/min), facteurs de risque cardiovasculaires, cTNM, classification de Mayo, peropératoires (voie d’abord, circulation extracorporelle [CEC], saignement, durée opératoire) et postopératoires (anatomopathologie, complications, traitement complémentaire, progression, décès) ont été analysées. Les taux de survie globale (SG) et sans progression (SSP) ont été estimés selon la méthode de Kaplan–Meier. L’impact du niveau du thrombus a été étudié par des analyses univariées et multivariées à l’aide du test du Log rank et du modèle de Cox, des tests de corrélations de Spearman ont été effectués. L’âge médian était de 64 ans (34–85 ans). Soixante-quinze pour cent présentaient une tumeur rénale droite, classée cT3b-c dans 95 % des cas, 15,7 % présentaient une atteinte ganglionnaire(cN1-2), 30 % étaient d’emblée métastatiques, 14,4 % avaient présenté une embolie pulmonaire préopératoire. 39,2 % des patients présentaient un thrombus intracardiaque (Mayo 4), 36,1 % infradiaphragmatique en regard des veines hépatiques (Mayo 3) et 21,6 % sous hépatiques (Mayo 2). Au total, 27,8 % des patients présentaient au moins une complication Clavien > 2, 3 patients décédaient en périopératoire. Soixante-sept pour cent avaient un traitement adjuvant (Tableau 1). La médiane de SG était de 25,2 mois, la SSP de 6,3 mois [IC 4,30–8,44] (Fig. 1). Le Mayo était un facteur prédictif péjoratif de SSP (p = 0,0123). On retrouve une corrélation positive entre la classification de Mayo et les complications, la durée d’hospitalisation et le grade de Fuhrman (Tableau 2). La chirurgie des cancers du rein avec thrombus tumoral concerne une population jeune avec peu de comorbidité. Il s’agit d’une chirurgie morbide, avec une médiane de SSP faible. Malgré l’association chirurgie multidisciplinaire et traitement adjuvant, cette maladie reste de mauvais pronostic. L’extension veineuse du thrombus tumoral est corrélée au grade de Fuhrman, aux complications périopératoires et à la durée d’hospitalisation.

Sport practice for competitive and leisure athlete is restrictive after mitral valve repair (MVR) despite excellent long-term results with mortality rate similar to that of the general population. We hypothesized that sport and a high level of physical activity have no impact on surgical outcome after MVR. Patients aged from 18 to 65 years undergoing single MVR for primary mitral regurgitation (MR) at CHU de Toulouse were included from January 2010 to March 2017. Exclusion criteria were previous cardiac surgery, other concomitant procedure except tricuspid annuloplasty or atrial fibrillation (AF) ablation, death or reoperation, contraindication to normal activity. Primary endpoint was: tardive post-operative AF (TAF) (> 3 month); mitral valve failure (VF) defined as MR >1 or average gradient (AG) >8 mmHg; heart failure (HF). Practice of sport was assessed in hour per week during last 6 month and classified according to Mitchell classification; physical activity was assessed by IPAQ (International physical Activity questionnaire) short form. Among 196 procedures during this period, 61 patients were excluded, 14 lost to follow up and 121 patients included. Medium age was 50 ± 11. Median follow up was 33.9 (19.7–49.8) months. 56 patients practice regular sport activity with median 3 (1.9–5) hours per week and 11 (19.6%) at least 6 hours. IPAQ continuous score was 1674 met.min.week (792–3572) and 42 (34.7%) reached IPAQ 3 very active group. Twenty events occurred: 7 TAF (5.8%); 13 VF (10.7%; 5 MR > 1 and 8 AG > 8 mmHg), 0 HF. There was no relation between primary endpoint and practice of sport (P = 0.54), all Mitchel classification sub-groups, high sport practice (> 6 hours) (P = 0.49), IPAQ 1 (P = 0.94), IPAQ 2 (P = 0.59), IPAQ 3 (P = 0.63) and IPAQ continuous score (P = 0.4). None of 4 death and 3 reoperations were related to sport (Table 1). Sport or high physical activity seems not related to primary endpoint in this very active cohort.

L’insuffisance rénale aiguë (IRA) est une complication fréquente (20 à 30 %) des chirurgies cardiaques avec circulation extracorporelle (CEC). Elle augmente de manière significative la morbimortalité postopératoire immédiate et le risque d’évolution vers la maladie rénale chronique (MRC), avec une physiopathologie complexe et multifactorielle. L’objectif de notre étude a été d’identifier les facteurs préopératoires (biologiques, cliniques et peptidomiques) prédictifs d’IRA postopératoires afin de stratifier les patients en amont de la chirurgie en fonction de leur risque d’IRA. Étude prospective, observationnelle, monocentrique, incluant tous les patients majeurs ayant bénéficié d’une chirurgie cardiaque programmée avec CEC entre mars 2016 et janvier 2017. La survenue d’une IRA était définie selon la classification KDIGO et les patients ont été séparés en 2 groupes : IRA stade 0–1 vs. IRA stade 2–3. Une analyse du peptidome urinaire était réalisée avant la chirurgie (score de prédiction du risque de MRC CKD273). Parmi les 509 patients inclus, 120 (24 %) ont développé une IRA, dont 41 (8 %) une IRA sévère (KDIGO 2 et 3). Dix-huit patients (3,5 %) ont nécessité une épuration extrarénale. La mortalité hospitalière globale (n = 15) était de 3 % (27 % dans le groupe IRA sévère; n = 11/41 [27 %]). En préopératoire, les facteurs prédictifs d’IRA sévère étaient un DFGe de base < 60 mL/min/1,73 m2 et une HTAP échographique. En période postopératoire, les facteurs prédictifs indépendants d’IRA sévère incluaient un DFGe de base < 60 mL/min/1,73 m2, une durée de CEC élevée et une transfusion érythrocytaire peropératoire. Le score CKD273, mesuré avant la chirurgie, augmentait significativement selon la sévérité de l’IRA. La survenue d’une IRA stade 2–3 en postopératoire est associée à une forte mortalité (> 25 %). Les facteurs de risques identifiés permettent de stratifier en amont de la chirurgie les patients à risque d’IRA sévère et d’optimiser la gestion périopératoire de ces patients. L’analyse du peptidome urinaire à l’aide d’un panel reconnu (CKD273) permet également de stratifier les patients en pré-chirurgie ce qui pourrait à l’avenir permettre de proposer des études interventionnelles ciblant les patients les plus à risques de développer une IRA postopératoire.