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Balloon atrial septostomy (BAS) improves oxygenation in neonates with Transposition of the Great Vessels (TGV). New non-EC marked BAS catheters have obtained temporary approval in France. We aim to investigate outcomes of neonatal BAS in the current area. An on-going multi-center French prospective observational registry was set up in September 2022 including all neonates undergoing BAS for TGV. To date, 60 neonates (93.5% of term-babies, weight: 3.1 [2.8–3.4] Kg, prenatal diagnosis: 88.5%, isolated form of TGV: 68.9%) underwent 62 BAS (50% on general anaesthesia) in 14 participating centres. The procedure was performed over night or during weekend in 39.3% of cases. BAS was performed most often the day of birth (65.6%), in the catheter lab (59%) using an umbilical venous route (67.2%). The latter required conversion to a femoral route in 22.0% of patients. BAS was guided by ultrasounds and fluoroscopy in 90.2% and 55.7% of cases, respectively. Two to 4 BAS manoeuvre were required in 82.0% of cases. In 14.8% of patients, the use of a second type of BAS catheter was required. Z5 and Z6 catheters were used in 45.6% and 54.4% of cases, respectively. Overall, BAS was successfully achieved in 93.5% of cases. BAS failures included 3 crossing failures (n = 3) and a failure of enlargement of the atrial septum with a low-volume Z5 catheter (n = 1). One transient complete atrio-ventricular block was also reported. To date, BAS success rate seems lower than expected. The continuation of this study and its expected European extension will likely contribute to clarify these points in a context of world shortage in dedicated low profile/high volume catheters. [ABSTRACT FROM AUTHOR]

Systemic tricuspid valve regurgitation (TR) is often encountered in patients with atrial correction of transposition of the great arteries (acTGA) or congenitally corrected transposition of the great arteries (ccTGA). When at least moderate, it is related to impaired functional capacity, heart failure and mortality. Management is a matter of debate as medical management is limited and valvular surgery at risk. Among adults with severe and symptomatic systemic mitral regurgitation at high risk for surgery, percutaneous edge-to-edge repair is now proposed as a reasonable alternative. We hypothetised that percutaneous management of systemic TR may be feasible and safe. A monthly national dedicated multidisciplinary meeting was therefore organized, including cardiologists and surgeons dedicated to adults with CHD. All concerned patients were evaluated and a decision was taken and thereafter offered to each patients. So far, 9 patients, of whom 1 female, with a median age of 41 ± 14 years, were included, 4 with acTGA and 5 with ccTGA. The procedures were performed in 4 French tertiary CHD centers between May 2019 and June 2022, following institutional review board approval. The XTR MitraClip device (Abbott, Santa Clara, CA) was used, 1 MitraClip was used in 5 patients, 2 in 2 and 3 in 1. The procedure was not possible in 1 patient, because of impossibility to achieve appropriate orientation of the clip on the tricuspid valve. No complication was reported. At 6 months of follow-up, we noticed a decrease in the TR of at least 1 grade in 8 patients. NYHA functional class improved in 5 patients and diuretics doses decreased in 4. Transcatheter edge-to-edge repair appears as a feasible and safe procedure in patients with significant systemic TR. Further studies need to be performed to precise the optimal position of percutaneous reduction of systemic TR in the management of these patients. [ABSTRACT FROM AUTHOR]

Infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is a rare but severe complication. Among 326 patients who underwent TAVI at Grenoble Alpes University Hospital, six (1.8%) cases of IE and 11 (3.4%) cases of bacteraemia were identified. No cases of IE were linked to the intervention; one was due to Staphylococcus aureus despite a screening and targeted decolonization strategy. This underscores the need for randomized studies to evaluate the benefit and cost-effectiveness of this policy. [ABSTRACT FROM AUTHOR]

La fibrinolyse reste le traitement de désobstruction de référence (ESC/ERS niveau recommandation I) pour les embolies pulmonaires (EP) à haut risque, malgré un risque hémorragique élevé, mais préférable à l'embolectomie chirurgicale, dont le bénéfice risque n'est favorable qu'en cas de contre-indication formelle à la fibrinolyse(1). Ces 2 stratégies sont associées à une mortalité hospitalière proche de 15 %. Nous rapportons ici notre expérience de thromboaspiration percutanée avec le système Flowtrieverࣨ chez une patiente inopérable et contre-indiquée à la thrombolyse. Madame X. 72 ans, aux antécédents de cardiopathie dilatée à fraction d'éjection altérée, se présente pour tableau d'AVC ischémique sylvien. Elle est traitée immédiatement par fibrinolyse et thrombectomie percutanée permettant une régression complète du déficit dès J1. A J5, elle présente une dégradation hémodynamique majeure brutale justifiant d'un traitement par Dobutamine 10 G/kg/min et Noradrénaline 1,2 mg/h. L'angioscanner thoracique met en évidence une EP proximale bilatérale prédominante à gauche avec signes de cœur pulmonaire aigu (Fig. 1A). Devant le très haut risque chirurgical, et la contre-indication formelle à la thrombolyse, l'équipe médicochirurgicale décide d'opter pour une thromboaspiration percutanée avec le système Flowtrieverࣨ (Inari Medical). La procédure est réalisée par voie veineuse fémorale droite sous anesthésie locale (GORE ࣨ DrySeal Flex sheath 33 cm- 26French). Après une angiographie sélective des 2 troncs pulmonaires (Fig. 1B), un guide rigide (Amplatz Superstiffࣨ , Boston Scientific) est positionné dans le tronc lobaire inférieur gauche. Le système Flowtrieverࣨ 24 French est amené sur la partie proximale du thrombus (Fig. 1C). Deux aspirations successives sont réalisées, permettant l'extraction d'une importante masse thrombotique (Fig. 1D). On procède de même dans le dans le tronc droit. L'angiographie de contrôle met en évidence une nette amélioration de la perfusion pulmonaire (Fig. 1E). L'amélioration hémodynamique est immédiate permettant le sevrage rapide des amines et la sortie des soins intensifs le lendemain. Nous présentons ici le cas d'une patiente atteinte d'une EP à haut risque traitée avec succès avec le système de thromboaspiration percutanée Flowtrieverࣨ. Plusieurs techniques de traitement interventionnel de l'EP existent : fibrinolyse in-situ associé ou non à des ultrasons, fragmentation mécanique ; ou plus récemment thromboaspiration, mais leur évaluation face aux traitements de désobstruction existants (héparines, fibrinolyse ou chirurgie) est limitée. Aucune étude randomisée n'est actuellement publiée (2). Le système de thromboaspiration Flowtrieverࣨ est un système simple d'utilisation, bénéficiant d'une large lumière, permettant d'aspirer de grosses masses thrombotiques. Son utilisation a été rapportée dans le registre nord-américain Flare, avec un excellent profil de sécurité (3.8 % de complications majeures) chez 500 patients présentant une EP à risque intermédiaire haut ou une EP à haut risque (3). Le bénéfice-risque de cette nouvelle option interventionnelle reste cependant à préciser face aux stratégies recommandées pour les patients présentant une EP à haut risque et à risque intermédiaire haut. La thromboaspiration percutanée avec le système Flowtrieverࣨ est une alternative intéressante à la chirurgie pour les embolies pulmonaires à haut risque chez les patients contre-indiqués à la fibrinolyse. Son positionnement dans l'arsenal thérapeutique actuel doit être déterminé par des études randomisées. Les auteurs ne déclarent aucun lien d'intérêt concernant ce travail. [ABSTRACT FROM AUTHOR]

The nervous system is frequently involved in patients with infective endocarditis (IE). A systematic review of the literature was realized in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). This study sought to systematically evaluate the published evidence of the contribution of brain magnetic resonance imaging (MRI) in IE. The aim was to identify studies presenting the incidence and type of MRI brain lesions in IE. Fifteen relevant studies were isolated using the Medline, Embase, and Cochrane databases. Most of them were observational studies with a small number of patients. MRI studies demonstrated a wide variety and high frequency of cerebral lesions, around 80 % of which were mostly clinically occult. This review shows MRI's superiority compared to brain computed tomography (CT) for the diagnosis of neurologic complications. Recent developments of sensitive MRI sequences can detect microinfarction and cerebral microhemorrhages. However, the clinical significance of these microhemorrhages, also called cerebral microbleeds (CMBs), remains uncertain. Because some MRI neurological lesions are a distinctive IE feature, they can have a broader involvement in diagnosis and therapeutic decisions. Even if cerebral MRI offers new perspectives for better IE management, there is not enough scientific proof to recommend it in current guidelines. The literature remains incomplete regarding the impact of MRI on concerted decision-making. The long-term prognosis of CMBs has not been evaluated to date and requires further studies. Today, brain MRI can be used on a case-by-case basis based on a clinician's appraisal. [ABSTRACT FROM AUTHOR]

Coronary microvascular dysfunction (CMVD) is common and associated with poorer outcomes in patients with ST Segment Elevation Myocardial Infarction (STEMI). The index of microcirculatory resistance (IMR) and the index of hyperemic microvascular resistance (HMR) are both invasive indexes of microvascular resistance proposed for the diagnosis of severe CMVD after primary percutaneous coronary intervention (pPCI). However, these indexes are not routinely assessed in STEMI patients. Our main objective was to clarify the association between IMR or HMR and long-term major adverse cardiovascular events (MACE), through a systematic review and meta-analysis of observational studies. We searched Medline, PubMed, and Google Scholar for studies published in English until December 2019. The primary outcome was a composite of cardiovascular death, non-cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, and rehospitalization for heart failure occurring after at least 6 months following CMVD assessment. We identified 6 studies, reporting outcomes in 1094 patients (mean age 59.7 ± 11.4 years; 18.2% of patients were women) followed-up from 6 months to 7 years. Severe CMVD, defined as IMR > 40 mmHg or HMR > 33 mmHg/cm/sec was associated with MACE with a pooled HR of 3.42 [2.45; 4.79] (Fig. 1). Severe CMVD is associated with an increased risk of long-term adverse cardiovascular events in patients with STEMI. Our results suggest that IMR and HMR are useful for the early identification of severe CMVD in patients with STEMI after PCI, and represent powerful prognostic assessments as well as new therapeutic targets for clinical intervention. [ABSTRACT FROM AUTHOR]

Background: Right ventricular function predicts outcome in patients with pulmonary hypertension (PH). Therefore accurate assessment of right ventricular function is essential to graduate severity, assess follow-up, and response to therapy. Purpose: To evaluate whether PH severity could be assessed using electrocardiography-gated CT (ECG-gated CT) functional parameters. A further objective was to evaluate cardiac output (CO) using two ECG-gated CT methods: the reference Simpson technique and the fully automatic technique generated by commercially available cardiac software. Material and Methods: Our institutional review board approved this study; patient consent was not required. Twenty-seven patients who had undergone ECG-gated CT and right heart catheterization (RHC) were included. Two independent observers measured pulmonary artery (PA) diameter, PA distensibility, aorta diameter, right ventricular cardiac output (CT-RVCO) and right ventricular ejection fraction (CT-RVEF) with automatic and Simpson techniques on ECG-gated CT. RHC-CO and mean pulmonary arterial pressure (mPAP) were measured on RHC. Relationship between ECG-gated CT and RHC measurements was tested with linear regression analysis. Results: Inter-observer agreement was good for all measurements (r > 0.7) except for CT-RVCO calculated with Simpson's technique (r = 0.63). Pulmonary artery (PA) distensibility was significantly correlated to mPAP (r = -0.426, P = 0.027). CT-RVEF was correlated with mPAP only when issued from Simpson technique (r = -0.417, P = 0.034). CT-RVEF was not significantly correlated to RHC-CO (P > 0.2). CT-RVCO measured with Simpson technique (r = 0.487, P = 0.010) and automatic segmentation (r = 0.549, P = 0.005) correlated equally with RHC-CO. Conclusion: CT-RVEF and CT-RVCO measured on ECG-gated CT are significantly correlated, respectively, to mPAP and RHC-CO in this population with severe reduction of the right ventricular ejection fraction and could be useful for evaluating and following patients with PH. [ABSTRACT FROM AUTHOR]

Percutaneous pulmonary valve implantation (PPVI) using Melody®valve has been validated as a valuable therapeutic option for the management of right ventricular outflow tract (RVOT) dysfunction but remains challenging. The "Folded" modification of the Melody®valve has been reported as a safe and feasible technique in complex RVOT. We sought to evaluate mid-term outcomes in a multicentre cohort who underwent PPVI using the "folded" Melody® valve technique. Patients who underwent PPVI using a Foled Melody®between April 2012 and November 2018 in 6 European tertiary Centerswere retrospectively included. "Folded" Melody® valve technique was successfully performed in 28 patients (mean age = 17.7 ± 10 years old). Indications were: short RVOT and early bifurcation of pulmonary arteries in 12 (42.8%) (Fig. 1) , bioprosthetic valves in 10 (35.7%), coronary arteries proximity in 4 (14.3%) and prevention of retrosternal compression in 2 (7.2%). No complication occurred during procedures. All patients had excellent hemodynamic results. Mean transvalvular peak velocity decreased from 3.8 ± 0.86 m/s before PPVI to 2.4 ± 0.55 m/s in the immediate post-PPVI period. Only 5 patients had trivial pulmonary regurgitation (PR) at discharge. After a median follow up (FU) of 27 ± 17.9 months, all patients were alive, and all, but 3 patients, were free from reintervention: 1 patient (3.5%) developed Melody® valve infective endocarditis 3 months after PPVI and underwent RVOT surgical replacement; Two underwent pulmonary artery stenting 2 and 4 years after of PPVI, but the lesions were not related to the Folded valve. At last FU mean transvalvular peak velocity was 2.6 ± 0.66 m/s and only 5 (17.8%) patients had mild or less PR. No stent fractures were observed. The "folded valve technique" is a safe and feasible modification of the Melody® valve which provides favourable mid-term results without increased rate of valve related complications. [ABSTRACT FROM AUTHOR]

Background Percutaneous paravalvular leakages (PVL) closure has emerged as a palliative alternative to surgical management in selected high-risk patients. Percutaneous procedures are challenging especially for mitral PVL. An accurate imaging of the morphologies of the defects is mandatory together with a precise guiding in the catheterization laboratory to enhance success rate. Purpose We aimed to describe imaging modalities used in clinical practice to guide percutaneous PVL closure and assess the potential interest of new imaging tools. Methods Data from the FFPP ("Fermeture de Fuite paraprothétique") register were used. The FFPP register is an international multi-institutional collaborative register started in 2017. A descriptive analysis of multimodality imaging used to guide PVL closure in clinical practice was performed. Results Data from 173 procedures performed in 19 centers from 3 countries (France, Belgium, Poland) were collected and included 8 cases of PVL following transcatheter valve replacement. Transesophageal echocardiography was used in 167 cases (96.5%) including 87.4% of cases with use of 3D-echocardiography. In one case 3D- echocardiography was combined and fused in real time with fluoroscopy images using echonavigator software. From a sample of 31 patients, details about multimodality imaging were available. Cardiac tomodensitometry (CT) was done before 10 procedures. In one case, fusion between pre-procedural cardiac CT angiography data and fluoroscopy data was used. In 2 cases, printing of a 3D model of the valve with PVL was done (Fig. 1). Conclusion Echocardiography and in particular the 3D mode, is the cornerstone of paravalvular leakages imaging. Other imaging modalities such as cardiac computed tomography and cardiac magnetic resonance imaging may be of complementary interest. New techniques such as imaging fusion and printing may further facilitate the percutaneous approach of paravalvular leakages. [ABSTRACT FROM AUTHOR]

We aimed to investigate whether micro-net on stent could preserve the index of msicrocirculatory resistance (IMR) after primary percutaneous coronary intervention (PCI) in patients with acutemyocardial infarction (AMI). Fifty deux patients with AMI were randomized into two groups: primary PCI with micro-net on stent (MGUARD group, n = 25) and primary PCI with any commercially available (DES group, n = 27). As the primary endpoint, IMR was measured immediately after primary PCI using a pressure-temperature sensor-tipped coronary wire. The secondary endpoint was the left ventricular ejection fraction (LVEF) at six-month follow-up. The IMR in MGUARD group was significantly lower than in DES group (39.6 ± 26.2 U vs. 75.4 ± 60.5 U, P = 0.01). No significant differences in baseline EF (56.2 ± 10.3% vs. 54.9 ± 7.73%, P = 0.7), however, there were significant differences in follow-up EF (63.2 ± 3.8% vs. 54.7 ± 7.79%, P = 0.001). A micro-net on stent significantly improved CMVD compared with a traditional DES in primary PCI and appear as a useful technological option to manage the thrombus. [ABSTRACT FROM AUTHOR]

Percutaneous paravalvular leak closure (PVLc) has emerged as an alternative to surgery. It remains a technically challenging procedure. We aim to compare outcomes after mitral and aortic PVLc. We analyzed data from PVLc procedures performed over the 2 first years of inclusion in the FFPP (Fermeture de Fuite Périprothétique) study, a prospective observational industry-independent cohort study which started in January 2017. We analyzed 147 PVLc (99 mitral–48 aortic), performed in 127 patients (1 procedure in 109 patients, 2 in 16 and 3 in 2) included in 22 centers among 3 countries (France, Poland and Belgium). Age (69 ± 10 versus 69 ± 11 yo), left ventricular ejection fraction (56 versus 51%), Euroscore2 (9 versus 7.6) and rate of mechanical valve (56.7% versus 41.7%, P = 0.1) were not significantly different among mitral and aortic groups. All patients had heart failure and/or hemolytic anemia. Hemolysis was more common in mitral PVL (62 versus 43%, P = 0.04). A mean of 1.4 (min 1, max 3) and 1.8 (min 1 max 5) devices were respectively required for technically successful aortic and mitral PVLc. No complication was reported in procedures with failure of device implantation. Aortic PVLc were faster than mitral PVLc (1h18 versus 2h20), with a trend towards a higher rate of technical success (96% versus 87%, P = 0.1) and fewer rate of major adverse events (worsening hemolysis, stroke, life threatening events and deaths; 2% versus 14%, P = 0.02). At 1 month follow-up, events were reported in 2% of patients (blood transfusion for hemolysis) versus 26.2% (deaths 3.3%; hemolysis 14.8%; heart failure 3.3%; heart failure and hemolysis 4.9%) after successful aortic and mitral PVLc respectively, P = 0.6. Mitral PVLc is a more complex procedure than aortic PVLc, with a lower success rate and a higher risk of peri-procedural and one-month severe adverse events. Longer follow-up data are expected and will be available from this on-going study. [ABSTRACT FROM AUTHOR]

Purpose The relationship between pulmonary arterial hypertension-specific drug therapy (PAH-SDT) and mortality in Eisenmenger syndrome (ES) is controversial. We aimed to investigate outcomes of patients with ES and their relationship with PAH-SDT. Methods Retrospective, observational, nationwide, multicenter, cohort study. Results We included 340 patients with ES (genetic syndrome, n = 119, 35.3%; pre-tricuspid defect, n = 75, 22.1%). Overall, 276 patients (81.2%) received PAH-SDT (monotherapy: endothelin receptor antagonist (ERA) or phosphodiesterase 5 inhibitor (PDE5i), 46.7%; dual therapy: ERA + PDE5i, 40.9%; triple therapy: ERA + PDE5i + prostanoid, 9.1%). Median PAH-SDT duration was 5.5 years [3.0–9.1]. Events (death, lung or heart-lung transplantation) occurred in 95 (27.9%) patients at a median age of 40.5 years [29.4–47.6]. Cumulative occurrence of events was 16.7% [95% CI 12.8–21.6%] and 46.4% [95% CI 38.2–55.4%] at 40 and 60 years of age, respectively. With age at evaluation or time since PAH diagnosis as time scales, cumulative occurrence of events was lower in patients taking one or two PAH-SDTs ( P = 0.0001 and P = 0.004, respectively), with the largest differences in the post-tricuspid defect subgroup ( P < 0.001 and P < 0.02, respectively) versus patients without PAH-SDT. By multivariate Cox analysis with time since PAH diagnosis as the time scale, NYHA/WHO functional class III/IV, lower SaO 2 , and pre-tricuspid defect were associated with a higher risk of events ( P = 0.002, P = 0.01, and P = 0.04, respectively) and one or two PAH-SDTs with a lower risk of events ( P = 0.009). Conclusion In ES, outcomes are poor but seem better with PAH-SDT. ES with pre-tricuspid defects has worse outcomes despite the delayed onset of the disease. [ABSTRACT FROM AUTHOR]

Stents have contributed to the development of the interventional catheterization for congenital heart diseases (CHD). The aim of this study was to describe indications, results and adverse events in current practice. Methods The participation to this study was proposed to all catheterization laboratories specialized in CHD in France (M3C network). All cases with stents implantation in 2013 in pediatric and adult CHD were retrospectively included. Adverse events were assessed using the Bergersen classification. Results 174 stents were implanted during 132 procedures in 127 patients by 6 main operators in 9 centers. Patients were aged 15.7±15.1years old (min 5day-old - max 70years old). Sixteen types of procedures were identified. Main indications were transcatheter pulmonary valve replacement (29 patients, 23.0%), pulmonary artery branches angioplasty (34 patients, 27.0%), aortic (re)coarctation stenting (37 patients, 29.4%) and ductus arteriosus stenting (11 patients, 8.7%). 18 patients (14.3%) were under one y.o and 35 (27.8%) were over 18y.o. Main pathologies were tetralogy of Fallot and variants (ACC-CHD 8.3, n=45, 35.7%), and aortic coarctation (ACC-CHD 9.2, n=36, 28.6%). More than 1 stent was implanted in 32 procedures (24.4%, max. 5 stents). Main stents implanted were the CP stent (33.0%), EV3 LD max (22.0%), Valeo (16.2%) and valved stents (15.0%). 98.5% procedures were considered as successful. Serious adverse events were observed in 12.9%. After multivariate adjustment, only procedure type was related to the risk of total adverse events (OR: 3.0, 95%CI 1.1-7.9) but not to stent related adverse events. Age, weight, center, operator, type of stents, stent diameter, genetic disorder and type of CHD were not significantly related to the risk of adverse events. Conclusion Stents are used in various CHD catheterization procedures, from infancy to adult age. Adverse events rate is significant and seems related to the type of procedure. [ABSTRACT FROM AUTHOR]

Abstract A 24-year-old patient was admitted for dyspnoea and syncope. He had a previous history of complete atrio-ventricular septal defect and trisomy 21. At the age of 6 months, in 1984, cardiac catheterization revealed a quasi-systemic pulmonary arterial hypertension with a bidirectional shunt corresponding to an Eisenmenger syndrome. Corrective cardiac surgery was not performed at this time because surgical risk was considered too high. Until the age of 20 years old, he showed few symptoms while under medical treatment. But since 2006, his functional status became worse with an increased dyspnoea, syncopes, and severe cyanosis. In these conditions, haemodynamic parameters have been re-evaluated in 2006 and 2008. They highlighted a late and progressive development of a valvular and infundibular pulmonary stenosis leading to a normalisation of pulmonary arterial pressures. At the age of 24 , the patient underwent corrective cardiac surgery which was successful. Late development of both infundibular and valvular pulmonary stenosis have not been described before in non operated congenital ventricular septal defects, but development of one or the other abnormality would be found in 8% of patients. The physiopathological mechanism of this obstruction is unclear. Nevertheless, in unoperated congenital cardiac shunt lesions, reversibility of severe pulmonary arterial hypertension should be reconidered and re-assessed during follow up.

L'insuffisance mitrale (IM) ischémique aigüe est une complication grave de l'infarctus, pouvant être responsable d'un œdème aigu du poumon (OAP) sévère. Malgré un traitement symptomatique intensif, il peut être difficile d'améliorer l'état clinique du patient sans une prise en charge rapide de sa valvulopathie. Si la chirurgie cardiaque reste la référence, il s'agit d'une intervention lourde à laquelle il n'est pas toujours possible de conduire le patient sans un risque opératoire élevé. Il y a quelques années, a vu le jour une technique de réparation percutanée, le Mitraclip®. L'utilisation de cette technique nouvelle reste en cours d'évaluation, avec des résultats discordants dans les études princeps (1,2). Elle se développe dans la prise en charge de populations plus instables (3). Notre objectif était d'utiliser cette technique de réparation valvulaire peu invasive pour stabiliser nos patients en OAP réfractaire sur IM ischémique aigüe, trop précaires pour la chirurgie. 1-Patiente de 72 ans hospitalisée en réanimation pour OAP massif avec intubation orotrachéale, insevrable de la ventilation mécanique après 72h de déplétion. Découverte en échographie trans-oesophagienne d'une IM ischémique sévère. Après angioplastie de la coronaire droite, décision de pose de Mitraclip® en urgence, permettant l'extubation de la patiente le lendemain. Evolution secondaire vers la réapparition d'une IM sévère symptomatique : remplacement valvulaire biologique à distance. 2- Patiente de 79 ans hospitalisée en soins intensifs pour OAP révélant un infarctus ambulatoire avec IM ischémique sévère. Dégradation hémodynamique rapide, sous dobutamine et ballon de contre-pulsion intra-aortique (CPBIA). Décision de Mitraclip® de sauvetage avant angioplastie de l'IVA. Evolution rapidement favorable, sevrage de la CPBIA à J2 et de la dobutamine à J6. Pas de nouvel épisode d'OAP à un an de l'épisode aigu. 3-Patient de 75 ans hospitalisé en soins intensifs pour syndrome coronarien aigu sur sténose serrée de la coronaire droite stentée. Présence dès l'arrivée d'une IM ischémique sévère. Evolution vers l'OAP puis le choc cardiogénique, sous dobutamine et CPBIA. Décision de pose de Mitraclip® en urgence. Succès procédural mais évolution vers le choc cardiogénique réfractaire conduisant au décès rapide du patient. Présentation de trois cas d'OAP sur IM sévères ischémiques, prises en charge en urgence par Mitraclip®. L'évolution des patients est hétérogène avec un succès partiel, un succès complet, et un décès. Si le pronostic des patients reste sévère, la prise en charge d'une IM aigüe réfractaire au traitement médical par Mitraclip® est une technique relativement simple qui permet parfois de stabiliser les patients les plus graves (Fig. 1-2). Une étude récente comparant la survie des patients traités chirurgicalement, médicalement, ou par voie percutanée, pour une IM sévère à moins de 90 jours d'un infarctus, est d'ailleurs en faveur de la prise en charge percutanée (4). La bonne sélection des patients qui bénéficieront le plus de cette technique reste encore un challenge. La prise en charge des IM aigües sévères reste un challenge, et le Mitraclip® un nouvel outil dont la place reste à définir mais qui peut permettre de sortir le patient de la phase critique. Les auteurs ne déclarent aucun lien d'intérêt concernant ce travail. [ABSTRACT FROM AUTHOR]

Purpose To evaluate the safety of extended-delay stenting (> 7 days between procedures) in the setting of percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI). Methods This ongoing prospective observational study is being conducted in STEMI patients with a high thrombus burden in the infarct-related artery (IRA). Patients are enrolled if the operator decides to try to restore the best TIMI flow with the thinnest tool (i.e. wire, aspiration, or thin balloon) and defer stent implantation for > 7 days under optimal anticoagulation to reduce thrombus burden. The primary endpoint is the composite of reocclusion of the IRA or sudden death between the two procedures, and deterioration of the flow (from the final flow achieved after the first procedure to the initial flow at the second procedure). Results Between January 2014 and January 2015, 127 patients (of 135 we will enroll) were enrolled at 14 centres: 110 were men and the mean age ± SD was 57.1 ± 13.0 years. Ninety-eight patients underwent a primary PCI as the first procedure and 29 patients underwent PCI after fibrinolysis. The final TIMI flow at the first procedure was 3 in 119 patients, 2 in 7 patients, and 1 in 1 patient. This final flow was spontaneous (same as initial flow, in the absence of intervention) in 43 patients, and after wire in 3 patients, thrombus aspiration in 60, and with a 1.5–2.5 mm diameter balloon in 21 patients. At the end of the first PCI, the residual culprit lesion was 61 ± 24%. Aspirin, P2Y12 inhibitors, and anticoagulants were used in all patients between the two procedures, and a glycoprotein IIb/IIIa inhibitor in 42 patients. The second procedure was performed between 7 and 26 days after the first. None of the patients died between the two procedures; 1 patient experienced a reocclusion of the IRA 15 min after the first procedure. In all cases, initial TIMI flow in the IRA (at the start of the second procedure) was the same as or better than the final flow after the first procedure. A stent was implanted in 80 patients, whereas no significant lesion was documented in 47 patients. Final results will be presented at the meeting. Conclusions In PCI for acute STEMI, when the thrombus burden is high, stenting delayed by 7–26 days with intensive antithrombotic cover appears safe, with only 1 of 127 patients developing an IRA reocclusion. [ABSTRACT FROM AUTHOR]