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BACKGROUND Transcatheter aortic valve replacement (TAVR) has revolutionized management of high-risk patients with severe aortic stenosis. However, survival and the incidence of severe complications have been assessed in relatively small populations and/or with limited follow-up. OBJECTIVES This report details late clinical outcome and its determinants in the FRANCE-2 (FRench Aortic National CoreValve and Edwards) registry. METHODS The FRANCE-2 registry prospectively included all TAVRs performed in France. Follow-up was scheduled at 30 days, at 6 months, and annually from 1 to 5 years. Standardized VARC (Valve Academic Research Consortium) outcome definitions were used. RESULTS A total of 4,201 patients were enrolled between January 2010 and January 2012 in 34 centers. Approaches were transarterial (transfemoral 73%, transapical 18%, subclavian 6%, and transaortic or transcarotid 3%) or, in 18% of patients, transapical. Median follow-up was 3.8 years. Vital status was available for 97.2% of patients at 3 years. The 3-year all-cause mortality was 42.0% and cardiovascular mortality was 17.5%. In a multivariate model, predictors of 3-year all-cause mortality were male sex (p = 2 of 4 (p < 0.001). Severe events according to VARC criteria occurred mainly during the first month and subsequently in < 2% of patients/year. Mean gradient, valve area, and residual aortic regurgitation were stable during follow-up. CONCLUSIONS The FRANCE-2 registry represents the largest database available on late results of TAVR. Late mortality is largely related to noncardiac causes. Incidence rates of severe events are low after the first month. Valve performance remains stable over time. (J Am Coll Cardiol 2016; 68: 1637-47) (C) 2016 by the American College of Cardiology Foundation.

Henoch-Schonlein purpura (HSP) is a common autoimmune vasculitis in childhood. The detailed pathogenesis of HSP is still unclear, whereas several types of predisposing factors have been proved to be the initial step. The objectives of present study were to analyze the distribution of predisposing factors, association of the predisposing factors with clinical manifestations and HSP relapse/recurrence. 1200 children with HSP were recruited between January 2015 and December 2017. We reviewed their laboratory tests and medical histories associated with HSP onset. The annual incidence of HSP was 8.13–9.17 per 100 000 in Anhui province. HSP occurred more commonly in spring and winter than in summer with an obvious west-to-east gradient. Cutaneous purpura was the most prevalent manifestation (100%), followed by arthritis/arthralgias (43.67%), abdominal pain (40.17%) and renal involvement (18.17%). On admission, series of potential infections were identified in 611 patients (50.92%). The histories of allergy, injury, surgery, vaccination and tick bite were declared by 231 patients (19.25%), 15 patients (1.25%), 12 patients (1.00%), 4 patients (0.33%) and 3 patients (0.25%), respectively. However, predisposing factors could not be identified in 521 children with HSP (43.42%) yet. 123 cases (10.25%) relapsed or recurred more than one time; the mean number was 2.92, and the mean interval was 11.4 weeks. The infection is the most frequent predisposing factor regardless of clinical phenotypes and relapse/recurrence, whereas the clinical manifestations exhibit an obvious heterogenicity according to different predisposing factors.

Objectives We evaluated a large multicenter series of patients operated on for low-flow/low-gradient aortic stenosis (LF/ LGAS) to stratify the operative risk, assess whether perioperative mortality has decreased over recent years, and analyze the post-operative outcome. Background Although LF/LGAS is classically associated with a high operative risk, few data are available concerning the results of surgery in this setting. Methods A total of 217 consecutive patients (168 men, 77%) with severe aortic stenosis (area

Antithrombotic therapy after bioprosthetic aortic valve replacement (AVR) is a debated issue. AVR is frequent given the high prevalence of aortic stenosis. The absence of consensus highlights the need for an evaluation of clinical practices. Antithrombotic therapy after bioprosthetic AVR was

[Figure][1] ![Figure][1] [Video 1][2] Direct vision of the atrial cyst under cardiopulmonary bypass. ![Figure][1] [Video 2][3] Macroscopic aspect immediately after surgical excision. A 43-year-old woman with a prior history of isolated cutaneous erythematosus lupus

We evaluated a large multicenter series of patients operated on for low-flow/low-gradient aortic stenosis (LF/LGAS) to stratify the operative risk, assess whether perioperative mortality has decreased over recent years, and analyze the post-operative outcome.Although LF/LGAS is classically associated with a high operative risk, few data are available concerning the results of surgery in this setting.A total of 217 consecutive patients (168 men, 77%) with severe aortic stenosis (area1 cm(2)), low ejection fraction (EF) (or=35%), and low mean gradient (MG) (or=30 mm Hg) who underwent aortic valve replacement (AVR) between 1990 and 2005 were included.Perioperative mortality was 16% and decreased dramatically from 20% in the 1990 to 1999 period to 10% in the 2000 to 2005 period. Higher European System for Cardiac Operative Risk Evaluation score (EuroSCORE), very low MG and EF, New York Heart Association functional class III or IV, history of congestive heart failure, and multivessel coronary artery disease (MVD) were associated with perioperative mortality. On multivariate analysis, very low pre-operative MG and MVD were predictors of excess perioperative mortality. In the subgroup of patients with dobutamine stress echocardiography, the absence of contractile reserve was a strong predictor of perioperative mortality. Overall 5-year survival rate was 49 +/- 4%. Lower MG, higher EuroSCORE, prior atrial fibrillation, and MVD were identified as independent predictors of overall long-term mortality.In view of the very poor prognosis of unoperated patients, the current operative risk, and the long-term outcome after surgery, AVR is the treatment of choice in the majority of cases of LF/LGAS.

Transcatheter aortic valve implantation (TAVI) was first performed under general anesthesia (GA) but evidence is growing that TAVI can be done using local anesthesia (LA) when using the transfemoral approach. We compared VARC-defined outcomes between patients with LA and those with GA for

ObjectivesWe evaluated a large multicenter series of patients operated on for low-flow/low-gradient aortic stenosis (LF/LGAS) to stratify the operative risk, assess whether perioperative mortality has decreased over recent years, and analyze the post-operative outcome.BackgroundAlthough LF/LGAS is classically associated with a high operative risk, few data are available concerning the results of surgery in this setting.MethodsA total of 217 consecutive patients (168 men, 77%) with severe aortic stenosis (area

A significant perivalvular aortic regurgitation (AR) is observed in 10-20% after a successful TAVI procedure. The prognostic value and the predictors of such complication in Balloon-expendable (BE) and Self-expendable (SE) TAVI procedures remain unclear. 2,769 patients consecutive with a successful