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ObjectivesThe TRI-SCORE reliably predicts in-hospital mortality after isolated tricuspid valve surgery (ITVS) on native valve but has not been tested in the setting of redo interventions. We aimed to evaluate the predictive value of the TRI-SCORE for in-hospital mortality in patients with redo ITVS and to compare its accuracy with conventional surgical risk scores.MethodsUsing a mandatory administrative database, we identified all consecutive adult patients who underwent a redo ITVS at 12 French tertiary centres between 2007 and 2017. Baseline characteristics and outcomes were collected from chart review and surgical scores were calculated.ResultsWe identified 70 patients who underwent a redo ITVS (54±15 years, 63% female). Prior intervention was a tricuspid valve repair in 51% and a replacement in 49%, and was combined with another surgery in 41%. A tricuspid valve replacement was performed in all patients for the redo surgery. Overall, in-hospital mortality and major postoperative complication rates were 10% and 34%, respectively. The TRI-SCORE was the only surgical risk score associated with in-hospital mortality (p=0.005). The area under the receiver operating characteristic curve for the TRI-SCORE was 0.83, much higher than for the logistic EuroSCORE (0.58) or EuroSCORE II (0.61). The TRI-SCORE was also associated with major postoperative complication rates and survival free of readmissions for heart failure.ConclusionRedo ITVS was rarely performed and was associated with an overall high in-hospital mortality and morbidity, but hiding important individual disparities. The TRI-SCORE accurately predicted in-hospital mortality after redo ITVS and may guide clinical decision-making process (www.tri-score.com).

[This corrects the article DOI: 10.3389/fcvm.2021.827515.].

OBJECTIVES Despite growing evidence that aortic valve repair improves long-term patient outcomes and quality of life, aortic valves are mostly replaced. We evaluate the effect of aortic valve repair versus replacement in patients with dystrophic aortic root aneurysm up to 4 years. METHODS The multicentric CAVIAAR (Conservation Aortique Valvulaire dans les Insuffisances Aortiques et les Anévrismes de la Racine aortique) prospective cohort study enrolled 261 patients: 130 underwent standardized aortic valve repair (REPAIR) consisting of remodelling root repair with expansible aortic ring annuloplasty, and 131 received mechanical composite valve and graft replacement (REPLACE). Primary outcome was a composite criterion of mortality, reoperation, thromboembolic or major bleeding events, endocarditis or operating site infections, pacemaker implantation and heart failure, analysed with propensity score-weighted Cox model analysis. Secondary outcomes included major adverse valve-related events and components of primary outcome. RESULTS The mean age was 56.1 years, and valve was bicuspid in 115 patients (44.7%). Up to 4 years, REPAIR did not significantly differ from REPLACE in terms of primary outcome [Hazard Ratio (HR) 0.66 (0.39; 1.12)] but showed significantly less valve-related deaths (HR 0.09 [0.02; 0.34]) and major bleeding events (HR 0.37 [0.16; 0.85]) without an increased risk of valve-related reoperation (HR 2.10 [0.64; 6.96]). When accounting for the occurrence of multiple events in a single patient, the REPAIR group had half the occurrence of major adverse valve-related events (HR 0.51 [0.31; 0.86]). CONCLUSIONS Although the primary outcome did not significantly differ between the REPAIR and REPLACE groups, the trend is in favour of REPAIR by a significant reduction of valve-related deaths and major bleeding events. Long-term follow-up beyond 4 years is needed to confirm these findings.

Veno-arterial extracorporeal membranous oxygenation (VA-ECMO) is a form of temporary mechanical circulatory support that is used as a salvage technique in cardiac arrest and cardiogenic shock. The setting up of an ECMO is often a difficult decision that is taken in an emergency environment, in hemodynamically unstable patients. Despite all advances that veno-arterial ECMO has witnessed over the past 50 years (1), its related mortality is still very high. Referring to the Extracorporeal Life Support Organization (ELSO) registry, VA-ECMO cardiac patients have overall survival to discharge of only 43% (2).

Aortic valve surgery in non-elderly patients represents a very challenging patient population. The younger the patient is at the point of aortic valve intervention, the longer their anticipated life expectancy will be, with longer exposure to valve-related complications and risk for re-operation. Although the latest international guidelines recommend aortic valve repair in patients with aortic valve insufficiency, what we see in the real world is that the vast majority of these aortic valves are replaced. However, current prosthetic valves has now been shown to lead to significant loss of life expectancy for non-elderly patients up to 50% for patients in their 40s undergoing mechanical aortic valve replacement. Bioprostheses carry an even worse long-term survival, with higher rates of re-intervention. The promise of trans-catheter valve-in-valve technology is accentuating the trend of bioprosthetic implantation in younger patients, without yet the appropriate evidence. In contrast, aortic valve repair has shown excellent outcomes in terms of quality of life, freedom from re-operation and freedom from major adverse valve-related events with similar life expectancy to general population as it is also found for the Ross procedure, the only available living valve substitute. We are at a time when the paradigm of aortic valve surgery needs to change for the better. To better serve our patients, we must acquire high quality real-world evidence from multiple centers globally - this is the vision of the AVIATOR registry and our common responsibility.

The routine use of mechanical circulatory support during lung transplantation (LTx) is still controversial. The use of prophylactic human albumin (HA) or hypertonic sodium lactate (HSL) prime in mechanical circulatory support during LTx could prevent ischemia–reperfusion (IR) injuries and pulmonary endothelial dysfunction and thus prevent the development of pulmonary graft dysfunction. The objective was to investigate the impact of cardiopulmonary bypass (CPB) priming with HA and HSL compared to a CPB prime with Gelofusine (GF) on pulmonary endothelial dysfunction in a lung IR rat model. Rats were assigned to four groups: IR-CPB-GF group, IR-CPB-HA group, IR-CPB-HSL group and a sham group. The study of pulmonary vascular reactivity by wire myograph was the primary outcome. Glycocalyx degradation (syndecan-1 and heparan) was also assessed by ELISA and electron microscopy, systemic and pulmonary inflammation by ELISA (IL-1β, IL-10, and TNF-α) and immunohistochemistry. Clinical parameters were evaluated. We employed a CPB model with three different primings, permitting femoral–femoral assistance with left pulmonary hilum ischemia for IR. Pulmonary endothelium-dependent relaxation to acetylcholine was significantly decreased in the IR-CPB-GF group (11.9 ± 6.2%) compared to the IR-CPB-HA group (52.8 ± 5.2%, p < 0.0001), the IR-CPB-HSL group (57.7 ± 6.3%, p < 0.0001) and the sham group (80.8 ± 6.5%, p < 0.0001). We did not observe any difference between the groups concerning glycocalyx degradation, and systemic or tissular inflammation. The IR-CPB-HSL group needed more vascular filling and developed significantly more pulmonary edema than the IR-CPB-GF group and the IR-CPB-HA group. Using HA as a prime in CPB during Ltx could decrease pulmonary endothelial dysfunction’s IR-mediated effects. No effects of HA were found on inflammation.

Background The ACURATE neo™ transcatheter heart valve (Boston Scientific, Marlborough, Massachusetts) is predominantly implanted via femoral access. Transcarotid use of this prothesis has never been reported. Case presentation We present the case of an 89-year-old woman referred to us for a transcatheter aortic valve replacement (TAVR). After apparatus imaging of the aortic annulus and the peripheral vascular pathway, the heart team was confronted with a triple challenge: (i) The preferable choice of a self-expanding valve because of a small aortic annulus in an obese woman. (ii) Gaining favorable access to the coronary ostia, considering multiple recent coronary stenting. (iii) Utilizing an alternative arterial access because of iliac and femoral severely calcified stenosis. Implanting the ACURATE neo™ transcatheter heart valve (THV) via carotidal access allowed us to overcome these challenges. The procedure was performed successfully without any short-term complications. Conclusion We report the first case of implantation of an ACURATE neo™ transcatheter heart valve (Boston Scientific, Marlborough, Massachusetts) via the right common carotid artery.

Introduction: Endoplasmic reticulum stress (ERS) is involved in inflammatory organ failure. Our objective was to describe ERS, its unfolded protein response (UPR) expression/kinetics during cardiac surgery with cardiopulmonary bypass (CPB) and its association with postoperative organ failure (OF).Methods: Prospective study conducted on patients undergoing cardiac surgery with CPB. Blood samples were taken before (Pre-CPB), 2 h (H2-CPB) and 24 h (H24-CPB) after CPB. Plasma levels of 78 kDa Glucose- Regulated Protein (GRP78, final effector of UPR) were evaluated by ELISA. The expression of genes coding for key elements of UPR (ATF6, ATF4, sXBP1, CHOP) was evaluated by quantitative PCR performed on total blood. OF was defined as invasive mechanical ventilation and/or acute kidney injury and/or hemodynamic failure requiring catecholamines.Results: We included 46 patients, GRP78 was decreased at H2-CPB [1,328 (878–1,730) ng/ml vs. 2,348 (1,655–3,730) ng/ml Pre-CPB; p < 0.001] but returned to basal levels at H24-CPB [2,068 (1,436–3,005) ng/ml]. The genes involved in UPR had increased expression at H2 and H24. GRP78 plasma levels in patients with OF at H24-CPB (n = 10) remained below Pre-CPB levels [−27.6 (−51.5; −24.2)%] compared to patients without OF (n = 36) in whom GRP78 levels returned to basal levels [0.6 (−28.1; 26.6)%; p < 0.01]. H24-CPB ATF6 and CHOP expressions were lower in patients with OF than in patients without OF [2.3 (1.3–3.1) vs. 3.0 (2.7–3.7), p < 0.05 and 1.3 (0.9–2.0) vs. 2.2 (1.7–2.9), p < 0.05, respectively].Conclusions: Low relative levels of GRP78 and weak UPR gene expression appeared associated with postoperative OF. Further studies are needed to understand ERS implication during acute organ failure in humans.

OBJECTIVES Endothelial dysfunction during ischaemia-reperfusion (IR) is a major cause of primary graft dysfunction during lung transplantation. The routine use of cardiopulmonary bypass (CPB) during lung transplantation remains controversial. However, the contribution of CPB to pulmonary endothelial dysfunction remains unclear. The objective was to investigate the impact of CPB on endothelial dysfunction in a lung IR rat model. METHODS Rats were allocated to 4 groups: (i) Sham, (ii) IR, (iii) CPB and (iv) IR-CPB. The primary outcome was the study of pulmonary vascular reactivity by wire myograph. We also assessed glycocalyx degradation by enzyme-linked immunosorbent assay and electron microscopy and both systemic and pulmonary inflammation by enzyme-linked immunosorbent assay and immunohistochemistry. Rats were exposed to 45 min of CPB and IR. We used a CPB model allowing femoro-femoral support with left pulmonary hilum ischaemia for IR. RESULTS Pulmonary endothelium-dependent relaxation to acetylcholine was markedly reduced in the IR-CPB group (10.7 ± 9.1%) compared to the IR group (50.5 ± 5.2%, P CONCLUSIONS CPB significantly increased the IR-mediated effects on pulmonary endothelial dysfunction. Therefore, the use of CPB during lung transplantation could be deleterious, by increasing endothelial dysfunction.

Aims To identify determinants of in-hospital and mid-term outcomes after isolated tricuspid valve surgery (ITVS) as little is known regarding the impact of tricuspid regurgitation (TR) mechanism and clinical presentation. Methods and results Among 5661 consecutive adult patients who underwent a tricuspid valve surgery at 12 French tertiary centers in 2007-2017 collected from a mandatory administrative database, we identified 466 patients (8% of all tricuspid surgeries) who underwent an ITVS. Most patients presented with advanced disease (47% in NYHA III/IV, 57% with right-sided heart failure (HF) signs). TR was functional in 49% (22% with prior left-sided heart valve surgery and 27% isolated) and organic in 51% (infective endocarditis in 31% and other causes in 20%). In-hospital mortality and major complications rates were 10% and 31% respectively. Rates of survival and survival free of HF readmission were 75% and 62% at 5 years. Patients with functional TR incurred a worse in-hospital mortality than those with organic TR (14.4% vs. 6.3%, P = 0.004) but presentation was more severe. Independent determinants of outcomes were NYHA class III/IV (OR = 2.7[1.2–6.1], P = 0.01), moderate/severe right ventricular dysfunction (OR = 2.6[1.2–5.8], P = 0.02), lower prothrombin time (OR = 0.98[0.96–0.99], P = 0.008) and with borderline statistical significance, right-sided HF signs (OR = 2.4[0.9–6.5], P = 0.06) while TR mechanism was not (OR = 0.7[0.3–1.8], P = 0.88). Conclusion ITVS was associated with high mortality and morbidity, both in-hospital and during follow-up, predicted by the severity of the presentation but not by TR mechanism. Our results suggest that TV intervention should be performed earlier in the course of the disease.

Background Surgical site complications represent major concerns in many surgical specialties and lead to an increased length of hospital stay and the need for additional treatments and care. This investigation aimed to report survey data from the introduction of the PICO negative pressure wound therapy system (Smith & Nephew, Hull, United Kingdom) in a single hospital in France regarding cardiac surgical procedures through standard median sternotomy. Methods The patients in this study were at high risk of developing surgical site infections. PICO was used immediately postoperatively on the closed incision sites in all patients undergoing cardiac surgical procedures. Data were compared with a retrospective cohort of patients in whom PICO had not been used postoperatively. In total, 233 anonymized patient records were reviewed, 142 of which used the PICO device and 91 of which did not. Results PICO was shown to provide both clinical and economic benefits over standard care across a range of different cardiac surgical patients. The rates of complications, including deep surgical wound infections and mediastinitis, were reduced. Conclusions As noted, PICO had advantages over standard care in these patients, and complication rates decreased. This study demonstrated cost savings and an increase in available surgical and hospital capacity related to PICO use.

PURPOSE Veno-arterial Extracoporeal Membrane Oxygenation (VA-ECMO) provides circulatory assistance for patients in cardiogenic shock. Large quantities of fluids are often required, especially during the early stages, but can result in a potentially harmful fluid-overload. The objective was to determine the association of early fluid-balance and mortality. METHODS Retrospective single-center study in 101 VA-ECMO patients between 2013 and 2016. Daily fluid-balance and weight changes over the 5 first days were observed. Analyses between survivors and non-survivors were conducted using Mann-Whitney tests and logistic regression multivariable and Cox hazard-proportional analyses to determine any association with 28-days mortality. RESULTS Mortality was 47.5%. The fluid-balance was higher in non-survivors at day-1 (47.3[18.1-71.9] vs. 19.3[1.5-36.2] mL/kg, P

Interest is growing in the clinical use of sutureless (SU) valves. However, indications in some anatomical sub-settings, like bicuspid aortic valves (BAV), have been so far limited. We discuss herein our initial experience with the implantation of the 3f Enable SU bioprosthesis in patients with a BAV. Patients with a BAV were selected in our unit between March 2011 and September 2014 for a SU 3f Enable valve implantation. Twenty of the 198 patients who underwent a 3f Enable valve implantation in our unit had a BAV. Procedural success was 100 %, but reclamping was necessary in one (5 %) case. Median size of implanted bioprosthesis was 23 mm. After a mean follow-up of 13.8 ± 10.7 months, survival was 100 %. Two patients (10 %) showed an immediate grade 1 paravalvular leak (PVL) that progressed to grade 2 and 3+ (moderate/severe), respectively, during follow-up. Type of bicuspidy (Sievers classification) in these two patients was 0 and intraoperatively aortic annuli admitted the 25 mm calibrator. Among the 18 patients without PVL, no one had a type 0 large BAV. At 1 year, implantation of the 3f Enable SU bioprosthesis appears to be safe in patients with BAV type I and II, while in type 0 use of the SU valve seems to be safe only if the annular diameter is

Background Sutureless valves have recently enabled closed chest aortic valve replacement. This paper evaluates the feasibility of a robotic telemanipulation during thoracoscopic sutureless aortic valve implantation in cadavers. Methods Cadavers were prepared with a five thoracosopic trocar setting, with a transthoracic clamp inserted in the first right intercostal space and the optics inserted in the second. Seven sutureless valve implantations were scheduled using 5 Sorin Perceval and 2 Medtronic 3f Enable valves. Results In all cases performance of pericardial suspension, aortotomy and root exposure required less than 20 min. Native valve excision and sutureless bioprosthesis implantation was technically feasible in all cases. A satisfactory prosthesis sealing was ascertained visually and the absence of paravalvular leakages was assessed with a nerve hook test around the prosthetic flange. Conclusions Closed chest and robot assisted sutureless valve implantation is feasible in cadavers. Robotic technology can enhance reproducibility of the technique. Copyright © 2015 John Wiley & Sons, Ltd.

Summary Background The long-term survival of patients treated from descending thoracic aneurysm (DTA) is well known, more than those treated from a thoracoabdominal aortic aneurysm (TAAA). Moreover, studies are rarely focused on the aneurysmal etiology and include both degenerative and post dissecting aneurysms. The aim of this study is to compare the long-term survival of patients operated from DTA or TAAA due to degenerative atherosclerosis. Methods Thirty-nine atherosclerotic aneurysm patients were operated between January 2007 and July 2015 at Rouen University Hospital. Eighteen DTA patients were operated by TEVAR and 21 TAAA patients (8 type I and 13 type III) by open approach. The main endpoint was remote survival patients. Results Overall, the initial population was similar in the two groups. However, one third of DTA were treated in context of emergency for painful aneurysm versus 9.5% of patients with TAAA (P = 0.066). Survival median of 18 DTA was 18 months (1–68). Survival median of 21 TAAA followed was 66 months (1–91). Survival in both groups was statistically different with the log-rank test (P = 0.044). Conclusions Long-term prognosis of atherosclerotic DTA may be worse than that of TAAA's. This retrospective study reflects experience in the management of DTA and TAAA in a single-center. Prospective data in patients treated with endovascular procedures for DTA or TAAA, with fenesterated or branched endoprosthesis, are warranted to confirm these results.

The aim of this study was to investigate the potential anti-inflammatory and endothelial protective properties of albumin during cardiopulmonary bypass (CPB) in an experimental porcine model. Two groups underwent CPB for 90 min (n = 7 in each group), and a baseline (BL) control group did not undergo CPB (n = 7). Priming consisted of a gelatin solution (4% gelofusine, CPBG group) or colloid solution (5% albumin, CPBA group). Mesenteric arterial segments were isolated and exposed in vitro to phenylephrine (with or without nitric oxide synthase inhibition) to assess contractility, and exposed to acetylcholine and sodium nitroprusside to assess relaxation. Plasma tumor necrosis factor (TNF)-α levels, intestinal and pulmonary TNF-α and heme oxygenase (HO)-1 mRNA expression, and organ injury were studied. Upon sacrifice, TNF-α levels were significantly higher in the CPBG group than in the CPBA and BL groups. The contractile response was significantly higher in the CPBG group, whereas the response to acetylcholine was significantly lower in the CPBG group than in the other groups. HO-1 mRNA expression was significantly higher in intestine samples in the CPBA group than in the CPBG and BL groups. HO-1 mRNA expression was significantly higher in lung samples in the CPBA group than in the CPBG group. Leukocyte infiltration was significantly higher in intestine and lung samples in the CPBG group than in the CPBA and BL groups. Albumin priming reduced CPB-induced mesenteric vascular dysfunction and prevented the development of a systemic inflammatory response by modeling HO-1 expression in target organs.

Background: Diabetes is a risk factor for perioperative complications after cardiac surgery. We studied its effects on mesenteric endothelial function in a cardiopulmonary bypass (CPB) model. Methods: Forty Wistar rats were divided into four groups: sham (D-CPB-), cardiopulmonary bypass (D-CPB+), diabetic (D+CPB-) and diabetic that have undergone CPB (D+CPB+). Two samples of mesenteric artery were used for nitric oxide synthase (NOS) Western blot analysis, and two others for assessing contractile response and endothelium relaxations. Nitrite products and tumour necrosis factor-alpha (TNF-α) were assessed as markers of inflammatory response. Results: We observed an enhanced contractile response to the α-adrenergic agonist associated with impairment of mesenteric vasorelaxation in D+CPB+ rats. Western immunoblot analysis of D+CPB+ highlighted an additive effect of hyper-expression of inducible NOS. A significantly increased inflammatory response was observed after CPB in diabetic animals. Conclusions: This work confirms the potential deleterious impact of diabetes on the mesenteric endothelium during CPB in cardiac surgery.

Cardiac surgery can relieve symptoms and improve the prognosis of patients with aortic stenosis. However, surgery-related morbidity and mortality are high when severe cardiac or extracardiac factors co-exist. We report the outcome of percutaneous balloon aortic valvuloplasty (BAV) as a bridge to aortic valve replacement (AVR) in temporarily inoperable patients in our institution.All patients who, between January 2002 and December 2006, underwent a bridging percutaneous BAV and had an AVR performed 8-14 weeks later, were included in the study. Clinical and investigational data were collected retrospectively from the patients' files. Follow-up was performed by telephonic interview.Twenty-five patients were included in the analysis (median age 71.9 years). Operative risk decreased from 18.6% before BAV to less than 13% before AVR, according to the logistical European System for Cardiac Operative Risk Evaluation (EuroSCORE). Median ejection fraction (EF) was 40% before dilation compared with 44% after BAV. The necessity for BAV included acute pulmonary oedema (8%), cardiac failure (64%), cardiogenic shock (16%), syncope (8%) and EF10% (4%). Complications included low output (28%), renal failure (20%), septic shock (4%) and cerebrovascular accident (8%). One postoperative hospital death was observed. The median length of stay in the intensive care unit (ICU) was 44 days, and the median total hospital stay was 10 days.BAV used as a bridging procedure to improve cardiovascular function prior to AVR is an interesting therapeutic approach in patients with aortic stenosis and haemodynamic failure. The postoperative course after AVR was also improved in our patients.

Sutureless valves have recently enabled closed chest aortic valve replacement. This paper evaluates the feasibility of a robotic telemanipulation during thoracoscopic sutureless aortic valve implantation in cadavers.Cadavers were prepared with a five thoracosopic trocar setting, with a transthoracic clamp inserted in the first right intercostal space and the optics inserted in the second. Seven sutureless valve implantations were scheduled using 5 Sorin Perceval and 2 Medtronic 3f Enable valves.In all cases performance of pericardial suspension, aortotomy and root exposure required less than 20 min. Native valve excision and sutureless bioprosthesis implantation was technically feasible in all cases. A satisfactory prosthesis sealing was ascertained visually and the absence of paravalvular leakages was assessed with a nerve hook test around the prosthetic flange.Closed chest and robot assisted sutureless valve implantation is feasible in cadavers. Robotic technology can enhance reproducibility of the technique. Copyright © 2015 John WileySons, Ltd.

Background Mesenteric ischemia and acidosis leading to intestinal ischemia has been observed during cardiopulmonary bypass (CPB) despite normal flow in the mesenteric vessels. The aim of this study was to assess mesenteric endothelium-dependent reactivity and vasoconstrictor responses of small mesenteric arteries in a rat model of CPB without aortic cross-clamping. Methods After femoral cannulation a partial 90 minutes CPB was performed with hemodynamics and blood gas parameters monitoring. Blood samples and segments of small mesenteric arteries were obtained in rats sacrificed 2.5 hours (CPBH2.5) or 6 hours (CPBH6) after femoral cannulation. Sham surgery (sham H2.5, sham H6) was performed with femoral cannulation only. Segments of small mesenteric arteries were placed in a myograph in order to assess the contractile response to phenylephrine (with or without NO synthase inhibitor) or the endothelium-dependent relaxation to acetylcholine. Systemic inflammation was evaluated by measuring plasma concentrations of TNFα. Pulmonary and intestinal infiltration of activated leukocytes was assessed by immunohistochemistry. Results CPB induced increased contractile response to phenylephrine which persisted after blockade of NO synthesis as well as transient impairment of endothelium-dependent relaxations. CPB also led to early and marked release of TNFα. Conclusions CPB was responsible for mesenteric endothelial dysfunction and direct increase in the contractile response to α1-adrenergic agonist with increased systemic inflammatory response. This phenomenon might contribute to an increase in the risk of mesenteric ischemic events during cardiac surgery especially when vasopressor agents are used.

Phrenic Nerve Isolation in Cardiac Resynchronization. Left phrenic nerve stimulation is a well-known complication of cardiac resynchronization therapy (CRT). We report a case where electronic or anatomical repositioning of the left ventricular (LV) electrode (within the coronary sinus tributaries) was not feasible/effective. Surgical graft interpositioning was performed to successfully isolate the phrenic nerve from the previously implanted coronary sinus epicardial LV lead. (J Cardiovasc Electrophysiol, Vol. 23, pp. 778-780, July 2012)

Numerous cardiopulmonary bypass (CPB) models in the rat have already been described, but these models often have an important mortality and differ a lot from human clinical conditions thus making them hardly usable. The CPB model in the rat we describe allows a femoro-femoral support CPB with a low priming volume, minimal surgical approach and excellent peroperative survival. This CPB model in the rat allows evaluating extracorporeal circulation effects.

Intraoperative aortic dissection is a rare but potentially fatal complication of cardiac surgery. In this report, we present a case of intraoperative aortic dissection that was complicated by intestinal ischaemia. The aorta was successfully repaired using both open and endovascular techniques.

The durability of a Starr-Edwards valve implanted in the tricuspid position in 1967 to treat Ebstein's disease with tricuspid valve regurgitation. At surgery, cardiac permanent pacing for postoperative complete atrioventricular block was achieved using a nuclear-powered pacemaker (NP). Although the 43rd year of cardiologic follow up was free from complications, the patient--a 74-year-old woman--suffered symptomatic mitral regurgitation and underwent a redo mitral valve replacement, during which the Starr-Edwards valve and NP were left in place.

The aim of this study was to investigate the potential anti-inflammatory and endothelial protective properties of albumin during cardiopulmonary bypass (CPB) in an experimental porcine model. Two groups underwent CPB for 90 min (n = 7 in each group), and a baseline (BL) control group did not undergo CPB (n = 7). Priming consisted of a gelatin solution (4% gelofusine, CPBG group) or colloid solution (5% albumin, CPBA group). Mesenteric arterial segments were isolated and exposed in vitro to phenylephrine (with or without nitric oxide synthase inhibition) to assess contractility, and exposed to acetylcholine and sodium nitroprusside to assess relaxation. Plasma tumor necrosis factor (TNF)-α levels, intestinal and pulmonary TNF-α and heme oxygenase (HO)-1 mRNA expression, and organ injury were studied. Upon sacrifice, TNF-α levels were significantly higher in the CPBG group than in the CPBA and BL groups. The contractile response was significantly higher in the CPBG group, whereas the response to acetylcholine was significantly lower in the CPBG group than in the other groups. HO-1 mRNA expression was significantly higher in intestine samples in the CPBA group than in the CPBG and BL groups. HO-1 mRNA expression was significantly higher in lung samples in the CPBA group than in the CPBG group. Leukocyte infiltration was significantly higher in intestine and lung samples in the CPBG group than in the CPBA and BL groups. Albumin priming reduced CPB-induced mesenteric vascular dysfunction and prevented the development of a systemic inflammatory response by modeling HO-1 expression in target organs.

Background The role of cryoballoon pulmonary vein isolation for the treatment of atrial fibrillation (AF) is unclear. Methods and results In a 61-year-old man with persistent AF and severe mitral valve regurgitation, surgical cryoballoon pulmonary vein isolation was performed during open-heart surgery, without complication. Conclusion Surgical cryoballoon ablation is feasible and can effectively isolate PV.

Tachycardia-mediated cardiomyopathy associated with cardiogenic shock is a rare but well-known entity. We report an unusual case of cardiogenic shock with atrial tachycardia in postpartum; the patient underwent successful radiofrequency ablation under extracorporeal membrane oxygenation (ECMO). Radiofrequency ablation is usually used to treat this clinical situation. The use of ECMO has been described only in pediatric case. (J Card Surg 2012;27:647-649)

Objective Cardiopulmonary bypass (CPB) is responsible for an inflammatory response that can lead to postoperative organ dysfunction. Undernutrition increases the risk of organ failure. We investigated the effect of undernutrition on the inflammatory response and mesenteric vascular reactivity induced by CPB in rats. Methods CPB was performed in Wistar rats given normal nutrition or protein undernutrition. Mesenteric artery contractility was determined in the presence of increasing concentrations of phenylephrine with or without nitric oxide synthase blockade. Relaxation was assessed in the presence of acetylcholine or sodium nitroprusside. The inflammatory response was evaluated by the measurement of systemic tumor necrosis factor-α at cannulation and after 150 min and by a histologic study of pulmonary and gut leukocyte infiltration. Results CPB and protein undernutrition induced hypercontractility to phenylephrine and early relaxation defects in the mesenteric arteries. CPB caused endothelial dysfunction with early impairment of endothelium-dependent relaxation. Protein undernutrition led to an impaired relaxation of the mesenteric arteries, which was in part endothelium independent. Concomitantly, a significant inflammatory response was observed. Conclusion CPB and undernutrition induce mesenteric hypercontractility to α1-adrenergics and impair vascular relaxation, without any additive effect of CPB on undernutrition. Undernutrition causes inflammation and a lack of vascular relaxation, probably involving smooth muscle contractile mechanisms.

A ventricular septal rupture (VSR) is a rare complication of blunt chest trauma. We describe the case of a 25-year-old man who developed a VSR as a result of a high-speed road accident. The rupture was closed by left ventricular remodeling and replacement of the diseased myocardium with a Dacron patch. The patch sutures were reinforced with glue. Redo surgery was necessary at nine months due to patch detachment and embolization of the glue in the right lower lobe. The patient is asymptomatic, at 13-month follow-up. Keywords: Trauma; Blunt; Myocardial injury; Cardiac intervention; Shunts (cardiac); Wound closure. Language: en

Coronary artery dissection (CAD) is a rare but serious complication of type A aortic dissection (AD) which may be discovered preoperatively in the presence of clinical or ECG signs of ischemia, or intraoperatively after dissection of the coronary ostium. Treatment of CAD consists of surgical repair with glue and, if necessary, coronary artery bypass graft. No case of AD with CAD complicated by major arrhythmias treated by assisted circulation has been reported in the literature. We report the first case of AD with implementation of extracorporeal membranous oxygenation following cardiotomy with a favorable outcome.

Acute aortic syndrome (AAS) (aortic dissection, intramural aortic haematoma, or penetrating atherosclerotic ulcer) is a surgical emergency. Computed tomography (CT) is the reference technique for the diagnosis of this critical situation. However, a few reports of false-positive images leading to unnecessary interventions have been published. It is important to recognize and understand the pitfalls in the CT diagnosis of AAS. We describe the case of a 76-year-old man with clinical signs of AAS and a CT-scan compatible with a diagnosis of aortic intra-mural haematoma, leading to emergency surgery. The peroperative findings revealed a normal aortic wall with the presence of an unusual pericardial recess at the right side of the aorta.

Cryoablation can be used to treat atrial fibrillation (AF) surgically. We describe a 71-year-old woman who underwent cryoablation after 6 months of AF. Four hours post-surgery, electrocardiographic changes were observed in the circumflex artery territory associated with hemodynamic instability, which responded to inotropic agents. Angiography revealed a diffuse circumflex artery spasm with a heterogeneous aspect of the posterior branch evoking a dissection. Platelet anti-aggregant and trinitrine therapy were started. Recovery was uneventful and the patient was discharged on day 13. Cryoablation-associated circumflex artery dissection is rare. Caution is required when locating the ablation lines to avoid coronary artery injury.

Background Circumflex coronary artery (CCA) injury during mitral valve surgery is a rare but serious complication whit difficult diagnosis. The aim of our study was to describe the elements of diagnosis that could allow prevention of this complication. Methods and Results From 2006 to 2013 in Rouen University Hospital, 8 patients (1.03%) among 775 undergoing mitral valve surgery (repair or replacement) presented CCA occlusion confirmed by coronary angiography. Sex ratio was 5 men for 3 women with a mean age of 54.2 years. Left main coronary dominance was present in 75%. Mitral valve repair was performed in 5 patients and valve replacement in 3. The diagnosis was suspected by ECG in 7/8 patients: 6 patients (75%) presented ST segment elevation, 1 had permanent AV block while EKG was normal in one. CCA occlusion led to a significant impairment of left ventricular function, median LVEF: decreased from 58 to 43% (p=0.04) although coronary angiography was performed within one hour in 5 patients (62.5%). Five had complete revascularization (4 of those with immediate coronary angiography), while 3 patients were treated medically. Occlusion, assessed by coronary angiography, was preferentially located on the superolateral quarter of the mitral annulus next to the anterolateral commissure predominantly on its mid portion (75%). As regards to the mechanism of CCA occlusion, 37.5% of patients had a stitch passing through the CCA, 50% had a kinking of the vessel due to a stitch located close to the CCA and one of them had a compressive hematoma Follow-up at day-7 was uneventful in 7 patients with one in-hospital death one day after the surgery (cardiac tamponade). Conclusion CCA injury is a rare but serious complication of mitral valve surgery suspected on ECG, due to a stitch always located at the same point of mitral annulus. An eventual intraoperative angiography in hybrid rooms could be a specific solution for patients at risk (large mitral ring, left main coronary dominance).

Background Circumflex coronary artery (CCA) injury during mitral valve surgery is a rare but serious complication whit difficult diagnosis. The aim of our study was to describe the elements of diagnosis that could allow prevention of this complication. Method and results From 2006 to 2013 in Rouen University Hospital, 8 patients (1.03%) among 775 undergoing mitral valve surgery (repair or replacement) presented CCA occlusion confirmed by coronary angiography. Sex ratio was 5 men for 3 women with a mean age of 54.2 years. Left main coronary dominance was present in 75%. Mitral valve repair was performed in 5 patients and valve replacement in 3. The diagnosis was suspected by ECG in 7/8 patients: 6 patients (75%) presented ST segment elevation, 1 had permanent AV block while EKG was normal in one. CCA occlusion led to a significant impairment of left ventricular function, median LVEF: decreased from 58 to 43% (p=0.04) although coronary angiography was performed within one hour in 5 patients (62.5%). Five had complete revascularization (4 of those with immediate coronary angiography), while 3 were treated medically. Occlusion, assessed by coronary angiography, was preferentially located on the superolateral quarter of the mitral annulus next to the anterolateral commissure predominantly on its mid portion (75%). As regards to the mechanism of CCA occlusion, 37.5% of patients had a stitch passing through the CCA, 50% had a kinking of the vessel due to a stitch located close to the CCA and one of them had a compressive hematoma. Follow-up at day-7 was uneventful in 7 patients with one in-hospital death one day after the surgery (cardiac tamponade). Conclusion CCA injury is a rare but serious complication of mitral valve surgery suspected on ECG, due to a stitch always located at the same point of mitral annulus. An eventual intraoperative angiography in hybrid rooms could be a specific solution for patients at risk (large mitral ring, left main coronary dominance).

With the increasing practice of mitral valve repair (MVR) worldwide, more and more surgeons will face cases of valve repair failure. Systolic anterior motion (SAM) is now an infrequent complication of MVR that may lead to early valve repair failure necessitating revision or valve replacement. However, previous studies have shown that most patients with SAM could be successfully managed with medical treatment. To the best of our knowledge, SAM as a cause of late valve repair failure necessitating reoperation has not been previously described. We report here a case of SAM with left ventricular outflow tract obstruction and mitral regurgitation that did not regress under medical treatment and required a redo valve repair 8 years after the first operation.

The patient, who had undergone a complete cure of a tetralogy of Fallot 25 years previously, was discovered to have an ascending aorta aneurysm on echography. Bentall's procedure was carried-out, using a modified indirect coronary artery transplantation based on the Cabrol technique. As reported in the literature complications are mainly right sided and less frequently occur on the left side in this disease. Including the hypothesis of the overload volume which may provoke aortic root dilation, there is also an intrinsic pathology of the media which could often be related to embryogenesis abnormalities, i.e., abnormal migration of cardiac neural crest cells which may explain this condition.