Fifteen-Year Outcomes After Valve-Sparing Aortic Root Remodelling or Exclusion of the Non-Coronary Sinus: When to Preserve the Sinuses of Valsalva?

BACKGROUND: Isolated exclusion of the non-coronary sinus (NCS) is an attractive strategy in valve-sparing aortic root surgery, which avoids the mobilisation and re-implantation of coronary ostia. However, the long-term durability of aortic valve repair and the fate of remnant sinuses of Valsalva remain unclear. METHOD: From January 2006 to December 2013, 29 patients underwent replacement of the ascending aorta extending to the NCS (group NCS) and 56 patients underwent a modified Yacoub procedure (group MY) in our centre by a single surgeon. Significant difference of preoperative parameters was observed between two groups in the presence of bicuspid aortic valve (41.4% vs 12.5%, p=0.002) and the diameter of the sinus of Valsalva (47.3±4.7 mm vs 51.5±4.9 mm, p=0.01). RESULTS: The group NCS, as compared to the group MY, was associated with significantly shorter cardiopulmonary bypass time (106.6±40.5 min vs 138.4±37.5 min, p=0.001) and aortic cross clamping time (69.0±21.8 min vs 105.4±27.8 min, p<0.01). The mean follow-up was 11.5±2.8 years. No surgical re-intervention was performed for aortopathies of the aortic root; the neo-sinus were not dilated in either groups (38.2±4.2 mm vs 34.0±4.0 mm, p<0.01). The 10-year freedom from aortic valve-related re-operation was estimated to be 96.6±3.4% and 94.5±3.1% (p=0.58), and the cumulative 10-year survival rates were 95.2±4.6% and 85.6±4.7% (p=0.61) in the group NCS and the group MY, respectively. CONCLUSIONS: Aortic valve-sparing isolated NCS replacement can be safely performed in selected patients; its early outcomes, overall survival and long-term freedom from aortic valve-related or aortopathy-related re-intervention were comparable to those obtained with the Yacoub procedure.

Fifteen-Year Outcomes Following Valve-Sparing Aortic Root Replacement in Elderly Patients.

BACKGROUND: Valve-sparing aortic root replacement (VSRR) techniques have several advantages such as preservation of physiological haemodynamics of the native aortic valve and avoidance of prosthetic valve-related complications. However, VSRR procedures are generally performed in young patients and the long-term results in elderly patients (≥65 years) are scarce. METHODS: Fifty-six (56) consecutive patients underwent VSRR surgery by a single surgeon at the current centre between January 2006 and December 2013; a modified "remodelling technique" was typically performed. The mean age was 58.86±12.5 years; Marfan syndrome and bicuspid aortic valve were both present in six patients (10.7%); 38 patients (67.8%) presented with greater than moderate aortic regurgitation; and 17 patients (30.4%) were in New York Heart Association (NYHA) class III before surgery. They were divided into two groups according to their ages receiving VSRR surgery: Group E (elderly patients aged ≥65 years, n=24) and Group Y (young patients aged <65 years, n=32). The primary outcomes were aortic valve-related reoperation, cardiovascular reoperation, all-cause mortality, and functional status. RESULTS: One (1) patient in Group E was converted to aortic valve replacement as a result of a failed aortic valve repair. No perioperative mortality was observed. The mean follow-up was 11.5±2.9 years. Aortic valve-related reoperation was noted in two patients of each group (one with endocarditis, one with severe aortic regurgitation). Cardiovascular reoperations were observed in three and six patients, and all-cause deaths in seven and two patients in Group E and Group Y, respectively. The 10-year freedom from aortic valve-related reoperation was estimated to be 91.7±5.6% and 92.7±5.0% (p=0.594), the 10-year freedom from cardiovascular reoperation was 86.4±7.3% and 81.1±7.7% (p=0.781), and the cumulative 10-year survival rates were 74.0±9.2% and 93.8±4.3% (p=0.018) in Group E and Group Y, respectively. During follow-up, 6.7% of patients were in NYHA class III and 6.4% of patients developed moderate-to-severe aortic regurgitation. Cox regression analysis failed to identify predictors for primary outcomes. CONCLUSION: Valve-sparing aortic root replacement can safely be performed in elderly patients with low early mortality and satisfactory long-term freedom from aortic valve-related and cardiovascular re-intervention.

Three-Year Outcomes With the Multilayer Flow Modulator for Repair of Thoracoabdominal Aneurysms: A Follow-up Report From the STRATO Trial.

PURPOSE: To evaluate midterm outcomes of endovascular repair of types II and III thoracoabdominal aortic aneurysms (TAAA) using the Multilayer Flow Modulator (MFM) in patients unsuitable for open surgery or fenestrated stent-grafts. METHODS: In the prospective, multicenter, nonrandomized STRATO trial (EudraCT registration: 2009-013678-42; ClinicalTrials.gov identifier NCT01756911), 23 patients (mean age 75.8 years; 19 men) with Crawford type II and III TAAA (mean diameter 6.5 cm) were implanted between April 2010 and February 2011. Outcomes included all-cause mortality and stable aneurysm thrombosis with associated branch vessel patency. RESULTS: Through 36 months, there were 7 deaths (none confirmed as aneurysm-related), and no cases of spinal cord injury, device migration or fracture, or respiratory, renal, or peripheral complications. Three patients were lost to follow-up and 2 devices were explanted. The device was patent in the 11 remaining patients at 3 years. Stable aneurysm thrombosis was achieved for 15 of 20 patients at 12 months, 12 of 13 at 24 months, and 10 of 11 at 36 months. The rate of branch patency was 96% at 12 months (primary patency), 100% at 24 months, and 97% at 36 months. Nine patients suffered from endoleaks (attachment site or device overlap); 9 patients underwent 11 reinterventions (3 surgical). Maximum aneurysm diameter was stable for 18 of 20 patients at 12 months, 11 of 13 at 24 months, and 9 of 11 at 36 months. For 10 patients with computed tomography at 36 months, the mean ratio of aneurysm flow volume to total volume had decreased by 83%; the mean ratio of thrombus volume to total volume increased by 159%. CONCLUSION: Through 3 years, endovascular repair with the MFM appears to be safe and effective while successfully maintaining branch vessel patency.

Treatment of Mitral Valve Regurgitation with an Open Rigid Annuloplasty Ring.

BACKGROUND AND AIM OF THE STUDY: Annuloplasty constitutes a major operative step in the surgical treatment of degenerative mitral valve regurgitation (MR). The choice of ring structure to obtain an adequate remodeling of the mitral orifice and to respect the motion of the mitral apparatus remains the subject of debate. The study aim was to determine the clinical and echocardiographic outcome when using an open rigid ring to treat MR. METHODS: A total of 129 patients (94 men, 35 women; mean age 64.5 ± 11.7 years) was referred to the authors' institution between 1997 and 2011 for the surgical management of severe MR. Patients were implanted with a modified open rigid annuloplasty ring, and also underwent anterior and/or posterior leaflet repair. The occurrence of any major adverse cardiac and cerebrovascular event (MACCE) was considered as the primary end-point and was retrospectively collected along with echocardiographic data. RESULTS: The perioperative mortality was 1.6%. The cardiopulmonary bypass and cross-clamp times were 73.3 ± 17.1 min and 51.6 ± 13.0 min, respectively. There was one case (0.7%) of postoperative mitral systolic anterior motion. During a mean follow up period of 6.0 ± 3.1 years, 25 patients (19%) presented a MACCE. MACCE-free survival at one, five and 10 years was respectively 96.8%, 91.3%, and 61.4%. Preoperative determinants of MACCE were paroxysmal/persistent atrial fibrillation (HR 2.53; 95% CI: 1.06-6.01; p = 0.035) and age (HR 1.05; 95% CI: 1-1.09; p = 0.035). CONCLUSIONS: Mitral valve repair with an open-rigid ring offers satisfactory long-term results with a low rate of subsequent MR recurrence and reintervention. Preoperative AF is the main determinant of long-term adverse outcome.

One-year outcomes following repair of thoracoabdominal aneurysms with the multilayer flow modulator: report from the STRATO trial.

PURPOSE: To evaluate endovascular repair of type II and III thoracoabdominal aortic aneurysms (TAAA) using the Multilayer Flow Modulator (MFM) in patients with contraindications for open surgery and fenestrated stent-grafts. METHODS: In this prospective, multicenter, nonrandomized trial (EudraCT registration: 2009-013678-42; ClinicalTrials.gov identifier NCT01756911), 23 patients (19 men; mean age 75.8 years) with Crawford type II (43.5%) and III (56.5%) TAAA (mean diameter 6.5 cm) were treated with the MFM between April 2010 and February 2011. The primary efficacy outcome measure was stable aneurysm thrombosis with associated branch vessel patency at 12 months; the primary safety endpoint was 30-day and 12-month all-cause mortality. RESULTS: The rate of technical success was 100%. In 20 patients with computed tomography scans at 12 months, the primary efficacy outcome was met in 15 patients. The rate of primary patency of covered branch vessels was 96% (53/55); 1 patient with 2 occluded visceral branches underwent successful surgical reintervention. Endoleaks were identified in 5 patients (3 attachment site and 2 at device overlap), 4 of whom underwent reintervention (3 additional MFMs and 1 stent-graft implanted). At 12 months, aneurysm diameter was stable in 18 of 20 patients; the mean ratio of residual aneurysm flow volume to total volume had decreased by 28.9%, and the mean ratio of thrombus volume to total lumen volume had increased by 21.3% (n=17). There were no cases of device migration, loss of device integrity, spinal cord ischemia, or aneurysm rupture. CONCLUSION: At 1 year, endovascular repair with the MFM appears to be safe and effective while successfully maintaining branch vessel patency. Follow-up is ongoing.

Predictive value of five risk scores to predict outcomes after aortic valve replacement in octogenarians.

BACKGROUND AND AIM OF THE STUDY: Operative risk is assessed preoperatively through the use of predictive scores. The study aim was to evaluate the validity of five different scoring systems, including the Society of Thoracic Surgeons (STS) score, additive and logistic European systems (EuroSCORE 1) for cardiac operative risk evaluation, EuroSCORE 2, and the Ambler score in octogenarian patients undergoing aortic valve replacement (AVR). METHODS: A total of 225 patients aged > or = 80 years with aortic stenosis underwent isolated AVR between January 1996 and September 2010. All five scores were evaluated with regards to their accuracy in predicting operative mortality, mortality at one year, and the capacity to identify those patients most likely to die during long-term follow up. RESULTS: The observed operative mortality rate was 7.6%. The observed/expected ratios calculated for perioperative mortality were 0.42, 0.87, 1.16 and 1.16 for the logistic EuroSCORE, Ambler score, STS score and EuroSCORE 2 cohorts, respectively. The Hosmer-Lemeshow statistical test showed that all five scores were well calibrated. The STS score was a good test for predicting operative mortality (AUC 0.81) and the EuroSCORE 2 was fair (AUC 0.72). In terms of predicting the one-year mortality rate, the STS score was ranked as fair (AUC > 0.7). It was noted that patients with a STS score > or = 75th percentile were more likely to die during the follow up period. CONCLUSION: The STS score appeared to be more adequate for predicting operative mortality among patients aged > or = 80 years. STS scores were predictive of both one-year and long-term survival rates. These results indicated that the STS score could be used to guide clinical decision-making for performing AVR in elderly patients.

Off-pump axillo-coronary artery bypass: a simple approach for high-risk myocardial revascularization.

We report the case of a 66-year-old male with increasing angina occurring after two previous coronary artery surgery procedures. The second operation had been complicated by severe mediastinitis necessitating surgical drainage, and sternal stabilization. Angiography revealed an occlusion of the LAD bypass with a patent LAD associated with a stenotic circumflex coronary artery. The ascending aorta was severely calcified. An off-pump axillo-LAD coronary artery bypass was safely performed in conjunction with stenting of the circumflex artery. This approach dramatically simplified the procedure and reduced the operative risk. At the 52-month follow-up, the patient is free of any angina symptoms.

Surgery for acute type A aortic dissection in octogenarians.

BACKGROUND AND AIM: Emergency surgery for type A aortic dissection (AAD) is associated with high mortality rates. The published outcomes of such surgery in aging patients are controversial and the optimal management for elderly patients has not been established. Our study aimed to evaluate the outcomes of surgery for AAD in patients over the age of 80 years. MATERIALS AND METHODS: Between January 1996 and January 2010, 236 patients underwent surgery for AAD, of which 15 patients were older than 80 years. We evaluated the operative mortality in the whole cohort compared to the outcomes in the elderly subgroup. We assessed the preoperative risks factors and quality of life after surgery by performance status and the patients' ability to return home. RESULTS: Operative mortality was higher in patients aged >80 years (40% vs. 18%, p = 0.04). The survival rate for patients >80 years at one, three, and five years was 53.3% ± 0.12%, 42.6% ± 0.14%, and 42.6% ± 0.12%, respectively. Of the survivors, six patients were able to return home (40%) and the postoperative performance status was "3" in one patient, "2" in six patients, and "1" in two patients. A preoperative level of 2 or greater was found to be a significant risk factor (p = 0.04). CONCLUSION: Survival in octogenarians undergoing surgery for AAD is possible, and some patients were able to return home with a reasonable level of autonomy. Larger series will be needed to define the optimal management for octogenarians presenting with AAD.

Isolated tricuspid valve surgery after congenital versus left heart-disease surgery: mid-term outcomes.

BACKGROUND: Left heart involvement might be a differential factor in the physiopathology and prognosis of severe tricuspid regurgitation (TR) following cardiac surgery. We aimed to compare the outcomes of isolated tricuspid valve surgery (ITVS) after congenital versus left heart-disease surgery. METHODS: We retrospectively studied and followed up 58 patients who underwent ITVS for TR following cardiac surgery in our center from January 2012 to December 2017. According to the different etiologies of TR, the participants were divided into one group of TR following surgery for congenital heart diseases (CHD) (pCHD group, n=24), and another group of TR following surgery for left heart disease (pVHD group, n=34). RESULTS: Compared to the pCHD group, the pVHD group presented with a more advanced age (P<0.001), higher model for end-stage liver disease (MELD) score calculation (P=0.04), and higher EuroSCORE II calculation (P=0.01). In the post-operative course, the pVHD group showed a longer mechanical ventilation time (P<0.001) and longer intensive care unit stay (P=0.001). However, there was no significant difference between the two groups in in-hospital mortality (8.8% vs. 0, P=0.26), or the incidence of major adverse cardiac and cerebrovascular events (MACCE) (20.6% vs. 12.5%, P=0.47) at follow-up. CONCLUSIONS: Severe TR following surgery for left heart disease is associated with higher surgical risks and a remarkable frailty as compared to that following surgery for CHDs; however, with the development of surgical techniques and peri-operative management, ITVS can be safely performed in both conditions with promising contemporary mid-term outcomes.

Radiofrequency driven cord occlusion for selective termination of pregnancy: evaluation in the fetal sheep.

OBJECTIVE: This study was designed to assess the ability of an ultrasound-guided radiofrequency (RF)-driven procedure to induce complete and irreversible cord occlusion using a 90 days fetal sheep model. STUDY DESIGN: Twenty 90 days gestation sheep underwent general anesthesia. The first ten fetuses were exposed under hysterotomy, and RF electrode was inserted visually in the middle of the umbilical cord and deployed. Fetuses were then replaced into the amniotic fluid and RF procedure (average target temperature of 100 degrees C during 10 minutes) was applied. For the next ten fetuses, RF electrode was inserted into the cords under trans-parietal ultrasound guidance and the same RF procedure was applied. Cord occlusion was assessed by Doppler examination (absence of cordonal flows at the end of the procedure and until fetal heart failure occurred) and by subsequent histopathological analysis. RESULTS: Cord occlusion was always complete at Doppler examination at the end of RF procedure for the ten experiments realized under hysterotomy. No cordonal reperfusion was observed until fetal heart failure. Histopathological analysis confirmed cordonal occlusion at the site of impact. Neither cordonal rupture nor cordonal bleeding was observed for any of the ten experiments. When RF electrode was inserted under ultrasound guidance, complete occlusion could be obtained only for 6 of the ten experiments. CONCLUSION: Our results suggest that RF might be an appropriate method for selective termination of pregnancy. Yet, optimal insertion of the electrode is required to engender a complete and irreversible cord occlusion, and ultrasound-guidance training seems necessary before current human application.

Nine-year routine clinical experience of aortic valve replacement with ATS mechanical valves.

BACKGROUND AND AIM OF THE STUDY: The study aim was to update the authors' experience with aortic valve replacement (AVR) using the ATS mechanical prosthesis in terms of early and long-term outcome in routine practice. METHODS: This retrospective analysis was extracted from clinical data available between April 1996 and February 2005, of AVR with the ATS Medical prosthesis in 510 consecutive patients (345 men, 165 women; mean age 62 +/- 12 years), of whom 296 underwent isolated AVR (iAVR). Concomitant surgical procedures included coronary artery bypass grafting (AVR+CABG, n = 47), mitral valve procedure (AVR+MVP, n = 59), ascending aortic replacement (AVR+AAR, n = 74) and other procedures (AVR+Miscellaneous, n = 34). Early and late morbidity/mortality were analyzed for the entire group in case of emergency surgery, preoperative low left ventricular ejection fraction (LVEF <50%) and in elderly people (age > or = 70 years). RESULTS: The overall 30-day mortality was 7.2% (iAVR 4.7%; AVR+CABG 4%; AVR+MVP 8.5%; AVR+AAR 2.9%; AVR+Miscellaneous 14.7%). The five- and nine-year global survival rates were respectively 81.14 +/- 2.4% and 67.02 +/- 10.4%. Long-term survival was lower in case of emergency surgery (p = 0.001), when the preoperative LVEF was <50% (p = 0.03), and when patients were aged > or = 70 years (p = 0.0005). Linearized postoperative valve-related death was 1.1% per patient-year (pt-yr). However, nine years' freedom from valve-related death and valve-related morbidity were not significantly different when the patient age was > or = 70 years. The linearized rate for postoperative thromboembolism complication was 0.4% per pt-yr, and that for postoperative bleeding complication 0.63% per pt-yr. There were two perivalvular leaks (0.05%/pt-yr). Neither valve thrombosis, structural dysfunction nor endocarditis were observed. CONCLUSION: The findings of this retrospective study point to a globally very good performance of the ATS valve, and essentially similar to previously reported results with these and other available mechanical valves.

[Long-term outcome of surgical angioplasty of left main coronary artery].

OBJECTIVE: To assess long-term outcome of coronary artery diseased patients undergone the surgical angioplasty of left main coronary artery. METHODS: From September 1983 to December 2004, 162 patients were operated on for left main coronary artery stenosis with surgical angioplasty. The data were retrospectively analyzed. Operative death associated factors were evaluated with univariate analysis, and long-term survival was estimated by Kaplan-Meier analysis. RESULTS: The in-hospital mortality was 8% for all the patients but only 5.1% for the patients with simple left main coronary artery stenosis. A significant drop of operative mortality was noted in the later era of treatment (1983 to 1994 vs. 1994 to 2004). The operative death was more likely associated with no-isolated left main coronary artery pathologic feature and the urgency of surgery. An average of 102 (8 to 264) months' follow-up was completed in 95% of discharged patients. Coronary event occurred in 42 patients in the follow-up period and it was mortal for 9 cases. The overall long-term survival was 81% at 10 years and 52% at 20 years. The coronary event-free survival was 77% at 10 years and 41% at 20 years. CONCLUSIONS: Surgical angioplasty of left main coronary artery could produce excellent long-term outcome with acceptable per-operative mortality in left main coronary artery stenosis patients. This technique should deserve an important place in therapeutic options for this cohort of patients.

Intramyocardial Implantation of bone marrow-derived stem cells enhances perfusion in chronic myocardial infarction: dependency on initial perfusion depth and follow-up assessed by gated pinhole SPECT.

UNLABELLED: Cell therapy-induced changes in the perfusion of areas of myocardial infarction (MI) remain unclear. This study investigated whether an original pinhole SPECT technique could be applied to a rat MI model to analyze local improvement in myocardial perfusion relating to engraftment sites of bone marrow-derived stem cells (BMSCs). METHODS: Four-month-old MI rats were either untreated (n = 8) or treated (n = 10) by intramyocardial injection of (111)In-labeled BMSCs. Early distribution of (111)In-BMSCs within the MI target was evidenced by dual (111)In/(99m)Tc pinhole SPECT 48 h later. Myocardial perfusion was serially monitored by (99m)Tc-sestamibi pinhole gated SPECT up to 3 mo after transplantation. RESULTS: Forty-eight hours after transplantation, (111)In-BMSCs were observed in all treated rats and in 18 of their 32 underperfused MI segments (<70% sestamibi uptake before transplantation). During the subsequent 3-mo follow-up, the perfusion of MI segments worsened in untreated rats (absolute change in sestamibi uptake, -3% +/- 3%; P < 0.05) but improved in treated rats (+4% +/- 7%; P < 0.05). This perfusion improvement was unrelated to the initial detection of (111)In-BMSCs (+2% +/- 6% in segments with (111)In-BMSCs vs. +5% +/- 7% in those without; not statistically significant) but was strongly associated with less severe perfusion defects before transplantation (+6% +/- 6% in segments with 60%-70% sestamibi uptake [n = 19] vs. -1% +/- 6% in those with <60% uptake [n = 13]; P = 0.003). CONCLUSION: When BMSCs are injected within chronic MI, perfusion enhancement predominates in the MI areas showing a high enough residual perfusion before treatment but not in those of the initial cell engraftment, giving evidence of dependency on the perfusion and metabolic environment at implantation sites.

Bilateral vs unilateral internal mammary revascularization in patients with left ventricular dysfunction.

AIM: To investigate the survival benefit of bilateral internal mammary artery (BIMA) grafts in patients with left ventricular dysfunction. METHODS: Between 1996 and 2009, we performed elective, isolated, primary, multiple cardiac arterial bypass grafting in 430 consecutive patients with left ventricular ejection fraction ≤ 40%. The early and long-term results were compared between 167 patients undergoing BIMA grafting and 263 patients using left internal mammary artery (LIMA)-saphenous venous grafting (SVG). RESULTS: The mean age of the overall population was 60.1 ± 15 years. In-hospital mortality was not different between the two groups (7.8% vs 10.3%, P = 0.49). Early postoperative morbidity included myocardial infarction (4.2% vs 3.8%, P = 0.80), stroke (1.2% vs 3.8%, P = 0.14), and mediastinitis (5.3% vs 2.3%, P = 0.11). At 8-year follow-up, Kaplan-Meier-estimated survival (74.2% vs 58.9%, P = 0.02) and Kaplan-Meier-estimated event-free survival (all cause deaths, myocardial infarction, stroke, target vessel revascularization, heart failure) (61.7% and 41.1%, P < 0.01) were significantly higher in the BIMA group compared with the LIMA-SVG group in univariate analysis. The propensity score matching analysis confirmed that BIMA grafting is a safe revascularization procedure but there was no long term survival (P = 0.40) and event-free survival (P = 0.13) in comparison with LIMA-SVG use. CONCLUSION: Our longitudinal analysis suggests that BIMA grafting can be performed with acceptable perioperative mortality in patients with left ventricular dysfunction.

Prognostic factors associated with 15-year mortality in patients with hospitalized systolic HF: Results of the observational community-based EPICAL cohort study.

AIMS: Little data on very long-term survival and associated prognostic factors in heart failure (HF) are available. The aim was to describe 15-year survival and to identify the baseline prognostic factors associated with mortality in a community-based sample of patients hospitalized for systolic HF. METHODS: Vital status was collected 15years after inclusion of 352 patients hospitalized for systolic HF born in France from the prospective cohort EPICAL. The prognostic value of baseline socioeconomic, clinical and biological characteristics on 15-year mortality was assessed using Cox models. RESULTS: The mean (±SD) age was 63.9 (±10.8)years, 76% of the patients were male, median left ventricular ejection fraction (LVEF) was 23% IR [18-27]. Overall, the mean (±SD) follow-up was 1826 (±111)days. A total of 290 (82.4%) deaths and 22 heart transplantations occurred during the follow-up. The 15-year survival rate was 13.2% (95% CI [9.0-16.3]), i.e. 4.7 times lower than the one observed in the general population. Baseline characteristics associated with 15-year mortality were: age older than 65years (HR=1.48, CI 95% [1.15-1.90]), diabetes mellitus (1.31 [1.00-1.72]), chronic kidney disease (1.73 [1.23-2.43]), serious comorbidity (1.29 [1.02-1.64]), time from first HF diagnosis exceeding 1year at inclusion (1.68 [1.26-2.24]), HF hospitalization during the previous 12months (1.36 [1.04-1.78]), heart rate higher than 110 beats per minute (1.87 [1.26-2.76]), LVEF % (0.88 per quartile increase [0.80-1.98]), and serum sodium below 130mmol/L (3.14 [1.76-5.61]. CONCLUSIONS: Only 13% of patients hospitalized for HF survived at 15years. The usual mid-term prognostic factors are also predictive of very long-term survival.

Short-term heart retention and distribution of intramyocardial delivered mesenchymal cells within necrotic or intact myocardium.

Cell therapy with bone marrow mesenchymal stem cells (BMSCs) is a new strategy for treating ischemic heart failure, but data concerning the distribution and retention of transplanted cells remain poor. We investigated the short-term myocardial retention of BMSCs when these cells are directly injected within necrotic or intact myocardium. 111Indium-oxine-labeled autologous BMSCs were injected within either 1-month-old infarction (n = 6) or normal myocardium (n = 6) from rats. Serial in vivo pinhole scintigraphy was scheduled during 1 week in order to track the implanted cells. The myocardial retention of BMSCs was definitely higher in myocardial infarction than in normal myocardial area (estimated percent retention at 2 h: 63 +/- 3% vs. 25 +/- 4%, p < 0.001) and the estimated cardiac retention values were unchanged in both groups along the 7 days of follow-up. On heart sections at day 7, labeled BMSCs were still around the injection site and appeared confined to the scarred tissue corresponding either to the infarct area or to the myocardium damaged by needle insertion. BMSCs have a higher retention when they are injected in necrotic than in normal myocardial areas and these cells appear to stay around the injection site for at least a 7-day period.

Ventricular Dysfunction in Patients with Acute Coronary Syndrome Undergoing Coronary Surgical Revascularization: Prognostic Impact on Long-Term Outcomes.

BACKGROUND: Patients with non-ST elevation acute coronary syndrome complicated by left ventricular dysfunction (LVEF) are a poor prognosis group. The aim of our study was to assess the short and long term LEVF prognostic value in a cohort of NSTE-ACS patients undergoing surgical revascularization. METHODS: We performed elective and isolated CABG on a cohort of 206 consecutive patients with LVEF≤0.40 complicating acute coronary syndrome. The case cohort was compared with a cohort of controls (LVEF>0.40) randomly selected (2:1) among patients who underwent the procedure during this period. RESULTS: The Kaplan-Meier 5-year estimated survival rates for patients in the low and normal LVEF groups were 70.8% (95% confidence interval CI: 64.2-77.4) and 81.7% (95%CI: 77.8-85.6), respectively. A low LVEF was associated with both a higher all-cause (HR [95%CI] = 1.84[1.18-2.86]) and a higher cardiovascular mortality (HR = 2.07 [1.27-3.38]) during the first 12 months of follow-up. After adjustment for potential confounders, a low LVEF remained associated with a higher cardiovascular mortality only (1.87[1.03-3.38]) during the first 12 months of follow-up. After 12 months of follow-up, a low LVEF was no more associated with all-cause, nor cardiovascular mortality. CONCLUSION: Patients with low LVEF might require more intensive care than patients with normal LVEF during the year after the surgical procedure, but once the first postoperative year over, the initial low LVEF was no more associated with long term mortality.