Impact of Direct Transcatheter Aortic Valve Replacement Without Balloon Aortic Valvuloplasty on Procedural and Clinical Outcomes: Insights From the FRANCE TAVI Registry.

OBJECTIVES: This study sought to describe the current practices and compare outcomes according to the use of balloon aortic valvuloplasty (BAV) or not during transcatheter aortic valve replacement (TAVR). BACKGROUND: Since its development, aortic valve pre-dilatation has been an essential step of TAVR procedures. However, the feasibility of TAVR without systematic BAV has been described. METHODS: TAVR performed in 48 centers across France between January 2013 and December 2015 were prospectively included in the FRANCE TAVI (Registry of Aortic Valve Bioprostheses Established by Catheter) registry. We compared outcomes according to BAV during the TAVR procedure. RESULTS: A total of 5,784 patients have been included in our analysis, corresponding to 2,579 (44.6%) with BAV avoidance and 3,205 (55.4%) patients with BAV performed. We observed a progressive decline in the use of BAV over time (78% of procedures in 2013 and 49% in the last trimester of 2015). Avoidance of BAV was associated with similar device implantation success (97.3% vs. 97.6%; p = 0.40). TAVR procedures without BAV were quicker (fluoroscopy 17.2 ± 9.1 vs. 18.5 ± 8.8 min; p < 0.01) and used lower amounts of contrast (131.5 ± 61.6 vs. 141.6 ± 61.5; p < 0.01) and radiation (608.9 ± 576.3 vs. 667.0 ± 631.3; p < 0.01). The rates of moderate to severe aortic regurgitation were lower with avoidance of BAV (8.3% vs. 12.2%; p < 0.01) and tamponade rates (1.5% vs. 2.3%; p = 0.04). CONCLUSIONS: We confirmed that TAVR without BAV is frequently performed in France with good procedural results. This procedure is associated with procedural simplification and lower rates of residual aortic regurgitation.

Bilateral leg oedema after bariatric surgery: A selenium-deficient cardiomyopathy.

This report describes a case of selenium-deficient cardiomyopathy secondary to bariatric surgery (Roux-en-Y gastric bypass surgery). A 40 year-old woman presented with bilateral leg oedema nine months after the surgical procedure. Timely diagnosis of selenium-deficient cardiomyopathy was due to the recognition of symptoms of heart failure, increased NT pro-BNP level, detection of myocardial diastolic dysfunction and impaired left ventricular global longitudinal strain by echocardiography, and early identification of selenium deficiency. Symptoms resolution, cardiac biomarkers and echocardiographic abnormalities normalization were observed after 3 months of oral selenium supplementation and conventional heart failure therapy. Any sign of heart failure after bariatric surgery should require screening for a nutrient-deficient cardiomyopathy.

Comparison of drug release from poly(lactide-co-glycolide) microspheres and novel fibre formulations.

Intraperitoneal cisplatin delivery has recently been shown to benefit ovarian cancer patients. Cisplatin-containing poly(lactide-co-glycolide) (PLGA) microspheres have been proposed for cisplatin delivery. The drug loading of cisplatin containing microspheres produced elsewhere is 3-10%w. Similar microspheres are reported here with a mean diameter of 38.8 µm, and a drug loading of 11.7%w, but using ethyl acetate as a safer solvent. In addition, novel formulations of cisplatin-containing solid and hollow PLGA 65:35 (lactide:glycolide) fibres were prepared and are reported here for the first time. PLGA hollow fibres were produced by phase inversion with a high drug loading of 27%w. Mechanistic mathematical models were applied to the cisplatin release profiles to allow quantitative comparison of microsphere, solid fibre and hollow fibre formulations. The diffusion coefficient of cisplatin eluting from a typical batch of PLGA microspheres was 4.8 × 10(-13) cm(2) s(-1); this low diffusivity of cisplatin in microspheres was caused by the low porosity of the polymer matrix. The diffusion coefficients of cisplatin eluting from a batch of PLGA solid fibres and hollow fibres were 6.1 × 10(-10) and 3.3 × 10(-10) cm(2) s(-1), respectively. These fibres allowed the controlled release of high doses of cisplatin over four days and may represent an improvement in slow release technology for treatment of ovarian cancer.

[Cardiac disease at risk in the young athlete]. / Pathologies cardiaques à risque chez le jeune sportif.

Physical training significantly reduces all cause mortality in the general population. Eligibility for competitive sport participation in athletes with cardiovascular diseases is based on recommendations. Incidence of sudden cardiac death in young athletes is low (0.5 to 2/100,000 athletes/year). The most common cardiac diseases at risk are hypertrophic cardiomyopathies, congenital coronary arteries abnormalities, arrhythmogenic right ventricular cardiomyopathy and acute myocarditis. Pre-participation screening is based on the cardiovascular evaluation, including ECG (repeated every 3years since the age of 12 and every 5years since the age of 20 to the age of 35). Some events are unpredictable (idiopathic ventricular fibrillation, sudden death related to congenital coronary arteries abnormalities or commotio cordis). A better access to public defibrillation is needed.