Annales de cardiologie et d'angeiologie最新文献

Background: Severe tricuspid regurgitation (TR) carries a poor prognosis and its management is particularly challenging in patients with recurrent TR after prior surgical annuloplasty. For those patients redo surgery is often high-risk and transcatheter valve replacement may be anatomically precluded by the presence of a rigid or semi-rigid ring.

Case summary: We report the case of a 69-year-old woman with a history of rheumatic heart disease, multiple previous cardiac surgeries who presented with heart failure related to severe, symptomatic tricuspid regurgitation caused by leaflet restriction within a previously implanted annuloplasty ring (Carpentier Edwards 30mm). Given a high surgical risk (three prior sternotomies, TRI-SCORE and EuroSCORE II both indicating elevated operative risk) and anatomical screen failure for transcatheter tricuspid valve replacement because of the pre-existing ring, the Heart Team elected transcatheter edge-to-edge repair with the PASCAL system. A single device was implanted in the antero-septal position, achieving no residual leak, without complication.

Conclusion: Transcatheter edge-to-edge repair with the PASCAL device is technically feasible and effective for the treatment of severe TR recurring within a surgical annuloplasty ring, and should be considered as a valid alternative when redo surgery is high-risk and transcatheter valve replacement is anatomically not feasible.

Background: Rotational atherectomy is an established strategy for the treatment of severely calcified coronary lesions. Although reduced burr efficiency is not uncommon during complex procedures, the structural changes responsible for this phenomenon have not been investigated following rotational atherectomy of native coronary lesions.

Case: In a patient undergoing rotational atherectomy for a massively calcified native coronary lesion, we encountered failure of the burr to cross the lesion despite preserved rotational speed. Macroscopic examination suggested surface alteration of the burr. Replacement with a new burr resulted in immediate lesion crossing. To investigate the underlying mechanism, the surface of a new burr was compared with that of a clinically used burr using high-resolution field-emission scanning electron microscopy (FE-SEM).

Findings: FE-SEM demonstrated marked thinning of the cobalt binding matrix and multiple cavities indicating loss of diamond particles. In contrast, the remaining exposed diamond particles showed no obvious structural damage. These observations indicate that progressive degradation of the cobalt matrix, rather than damage of the diamond particles themselves, is the most likely mechanism responsible for reduced abrasive performance of the rotational atherectomy burr.

Conclusions: This report provides the first ultrastructural evidence of rotational atherectomy burr degradation following treatment of a severely calcified native coronary lesion. FE-SEM provides novel mechanistic insight into the progressive loss of the burr's abrasive performance, offering a plausible explanation for a situation frequently encountered by interventional cardiologists in which plaque modification becomes ineffective. Recognition of this mechanism may help operators identify burr wear and consider its replacement.

Coronary angioplasty for congenital anomalies of the coronary arteries (ANOCOR) remains a technically demanding procedure due to the difficulties associated with selective cannulation of the coronary ostium and achieving adequate support for the guide catheter. We report a case of in-stent restenosis in a proximal connection anomaly of the right coronary artery arising from the left coronary sinus, which was successfully treated using an innovative telescopic technique. A 63-year-old female patient, presenting with multiple cardiovascular risk factors and having previously undergone angioplasty of this right coronary artery, was referred for recurrent angina and exertional dyspnea. Myocardial scintigraphy revealed ischemia of the inferior wall, and coronary angiography demonstrated significant in-stent restenosis of the proximal and middle segments of the right coronary artery. Angioplasty was performed via the right femoral approach using a 7 Fr introducer. Selective intubation of the coronary ostium was achieved using a telescopic configuration consisting of inserting a 5 Fr internal mammary guide catheter within a 7 Fr 3.5 Extra Backup (EBU) guide catheter, allowing for optimal coaxial alignment and satisfactory support. This strategy allowed for lesion preparation followed by the implantation of two drug-eluting stents, resulting in an excellent angiographic outcome and significant clinical improvement.

Background: Rotational atherectomy (RA) and orbital atherectomy (OA) are widely used for plaque modification in severely calcified coronary lesions. Historical concerns have suggested that high rotational speeds may induce platelet activation during percutaneous coronary intervention (PCI), but data in the context of contemporary procedural strategies and dual antiplatelet therapy (DAPT) remain limited.

Methods: In this prospective single-centre study, 59 patients with chronic coronary syndrome undergoing atherectomy-assisted PCI were enrolled. RA was performed with high-speed runs (≈180,000rpm) combined with low-speed exploratory runs (≈110,000rpm) while OA used systematic low-speed runs (80,000rpm) and selective high-speed runs (120,000rpm). All patients received aspirin and a P2Y12 inhibitor before PCI. Platelet reactivity was assessed at predefined procedural time points using the VASP (vasodilator-stimulated phosphoprotein) assay and aggregation tests with arachidonic acid (AA) and adenosine diphosphate (ADP).

Results: Among 60 patients (mean age 74.1 years, 72.8% male), 38 underwent RA and 22 OA. No significant increase in platelet reactivity was observed between baseline and final measurements for any test (AA: P=0.174; ADP: P=0.437; VASP: P=0.071), with values remaining stable or slightly decreased. Subgroup analyses showed consistent results for RA and OA, with no significant variation by technique. Procedural kinetics over four time points showed no transient elevation of platelet reactivity at any stage. All procedures were angiographically successful.

Conclusion: Under contemporary DAPT, atherectomy-assisted PCI with RA or OA does not induce platelet hyperreactivity. These results support the biological safety of modern atherectomy strategies, although their mechanistic nature warrants confirmation in larger outcome-driven studies.

Background: Out-of-hospital cardiac arrest is a major public health challenge in France, with approximately 46,000 cases per year and survival rates ranging from 4 to 10%. Early prehospital management is a key determinant of vital and neurological prognosis.

Methods: Single-center, retrospective, observational study including 100 patients managed by the mobile intensive care unit of Melun General Hospital between January 2021 and September 2025. Neurological outcome was assessed using the Cerebral Performance Category score. Bivariate analysis and multivariate logistic regression were performed to identify factors associated with in-hospital survival. Numerical variables are reported as median [quartile1-quartile 3].

Results: Median age was 66 years [54.5-73], with 59% male patients. Cardiac arrest occurred at home in 78% of cases. Bystander cardiopulmonary resuscitation was initiated in 80% of cases; public automated external defibrillator use remained marginal (9%). Median no-flow duration was 3minutes [1-8.5] and median low-flow duration was 20minutes [13-30]. Asystole was the initial rhythm in 76% of cases. In-hospital survival was 20%. Multivariate analysis showed that shorter no-flow and low-flow intervals were independently associated with survival. Bystander intervention was not significant after adjustment.

Conclusion: Prehospital time intervals, especially no-flow duration, are the primary determinants of survival after out-of-hospital cardiac arrest. Strengthening public training in basic life support and improving automated external defibrillator accessibility are priority targets to improve outcomes.

Introduction: Despite improvements in diagnostic and therapeutic strategies, infective endocarditis (IE) remains a life-threatening disease with high in-hospital mortality. However, most contemporary data originate from tertiary referral centres with on-site cardiac surgery. The recruitment bias may lead to an underestimation of the true morbidity and mortality of IE in general hospitals.

Objective: The ENDOCARRAS register aimed to determine the epidemiological characteristics and prognosis of patients with IE admitted to the Arras hospital center, French care facility with 1600 beds including a cardiology and intensive care service without on-site cardiac surgery.

Method: From January 1st, 2003, to December 31st, 2024, all pts with a definite or possible diagnosis of IE according to modified Duke criteria (applicable at the time of admission) were included. Demographic characteristics, comorbidities, microbiology, imaging modalities, therapeutic strategies, and quality-of-care indicators were collected. Primary endpoints were in-hospital and one-year all-cause mortality. Multivariable logistic regression analyses were performed to identify independent predictors of in-hospital death.

Results: Three hundred and six pts were included. The mean age was 71±13 years, and 59.5% were male. IE was definite in 75% of cases, involving native valves (68.3%), prosthetic valves (20.6%), or intracardiac devices (12.7%). The most frequently identified pathogens were aureus Staphylococci (40.2%), oral streptococci (13%), and enterococci (12.7%). Transoesophagal echocardiography, positron-emission tomography and cardiac CT were performed respectively in 74%, 36.4%, and 4.6% of points. Embolic events occurred in 46.7% of points. Comorbidities included heart failure (36.6%), chronic kidney disease stage 4/5 (19.3%), and bedridden status (17.6%). Cardiac surgery was performed in only 22.9% of pts and contraindicated in 34%. In-hospital and 1-year mortality rates were 27.8 and 40%, respectively. In hospital mortality rise dramatically to 41.5% in patients older than 75 years, compared to 18.6% in younger patients (P<0.001). Age>75 years and the absence of advanced cardiac imaging independently predicted mortality. Over time, IE incidence increased while surgical rates declined.

Conclusion: In this real-world monocentric registry spanning 11 years, IE appears increasingly frequent, with persistently high in-hospital mortality and low utilization of cardiac surgery, particularly among older points with severe comorbidities.