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Publications in this journal

• Prospective analysis of 30-day safety and performance of transfemoral transcatheter aortic valve implantation with Edwards SAPIEN XT versus SAPIEN prostheses.

  Authors: Hélène Eltchaninoff, Eric Durand, Bogdan Borz, Matthieu Godin, Christophe Tron, Pierre-Yves Litzler, Jean-Paul Bessou, Karim Bejar, Chiara Fraccaro, Carlos Sanchez-Giron, Jean-Nicolas Dacher, Fabrice Bauer, Alain Cribier

  Archives of cardiovascular diseases. 105(3):132-40.

  A new generation of balloon-expandable valves (e.g. Edwards SAPIEN XT) enables the use of a decreased sheath size using the NovaFlex™ delivery system for transfemoral transcatheter aortic valveA new generation of balloon-expandable valves (e.g. Edwards SAPIEN XT) enables the use of a decreased sheath size using the NovaFlex™ delivery system for transfemoral transcatheter aortic valve implantation (TAVI). However, there are few data analysing the efficacy and safety of this new prosthesis. To evaluate periprocedural and 30-day clinical outcomes using the Edwards SAPIEN XT compared with the first-generation Edwards SAPIEN prosthesis. Between May 2006 and October 2011, consecutive high-risk or non-operable patients with severe aortic stenosis had TAVI using an Edwards SAPIEN or SAPIEN XT prosthesis. Valve Academic Research Consortium endpoints were used. Of 250 patients who underwent TAVI, 190 were performed transfemorally (78 SAPIEN and 112 SAPIEN XT). Transfemoral access was possible more often using SAPIEN XT (112/123 [91.1%] vs 78/127 [61.4%]; P<0.001). Mean logistic EuroSCORE was significantly lower in the SAPIEN XT group (18.1±11.0% vs 27.3±11.1%; P<0.0001), and the iliofemoral artery minimal lumen diameter was smaller (6.7±1.2 vs 8.5±1.3mm; P<0.0001). Device success was similar in both groups (95.5% for SAPIEN XT and 93.6% for SAPIEN), as was the 30-day combined safety endpoint (15.2% and 17.9%, respectively). At 30days, prosthesis performance was similar in both groups. Short-term safety and performance analysis of the latest generation of balloon-expandable valve, the SAPIEN XT, seem similar to the previous generation. However, transfemoral implantation is more often possible, related to sheath size reduction.

• Development of transcatheter aortic valve implantation (TAVI): A 20-year odyssey.

  Authors: Alain Cribier

  Archives of cardiovascular diseases. 105(3):146-52.

  The development of transcatheter aortic valve implantation (TAVI) by our group has been a 20-year odyssey. In 1993, postmortem studies validated the concept of intravalvular stenting in calcificThe development of transcatheter aortic valve implantation (TAVI) by our group has been a 20-year odyssey. In 1993, postmortem studies validated the concept of intravalvular stenting in calcific aortic stenosis. The first prototypes of balloon-expandable valves were tested in an animal model in 2000. The first-in-man implantation was performed in Rouen in 2002, rapidly followed by two prospective series in compassionate cases in our centre. TAVI took flight in 2004 in the hands of Edwards Lifesciences, with major improvements in devices and approaches. At the same time, the self-expanding CoreValve was launched. Thousands of high-surgical-risk patients were enrolled in feasibility studies, leading to the Conformité Européenne (CE) mark being granted in 2007 for the two devices. A number of postmarketing registries have shown dramatic improvements in procedural and midterm results and decreased complication rates, with more experience and improved technology. The results of the randomized PARTNER study in the USA recently confirmed the important place of TAVI in non-operable and high-surgical-risk patients. To date, more than 50,000 patients have benefited from TAVI worldwide (2300 patients in 33 centres in France in 2011) and the number is consistently increasing. An optimal multidisciplinary collaboration and formally trained experienced physicians are the keys to success. An extension of indications to lower-risk patients might be expected in the coming years but should be cautiously investigated. Ten years after the first-in-man case, TAVI is here to stay and the future is promising.

• The development of transcatheter aortic valve replacement in the USA.

  Authors: Danny Dvir, Israel M Barbash, Itsik Ben-Dor, Petros Okubagzi, Lowell F Satler, Ron Waksman, Augusto D Pichard

  Archives of cardiovascular diseases. 105(3):160-4.

  The penetration rate of devices in general, and in transcatheter aortic valve replacement (TAVR) specifically, is significantly delayed in the United States of America (USA) compared with in Europe.The penetration rate of devices in general, and in transcatheter aortic valve replacement (TAVR) specifically, is significantly delayed in the United States of America (USA) compared with in Europe. This is mostly due to the mission statement of the regulatory agencies in the USA, which requires very rigorous clinical testing of a device prior to its approval. The USA had a major role in the development and evaluation of this technology and USA research has enabled clinicians inside and outside of the USA to conduct a concise scientifically based assessment of the performance of TAVR devices in terms of safety and efficacy. In the following review, we provide data on the development of TAVR in the USA, revealing the critical role the USA has played in this extraordinary process.

• Transcatheter aortic valve implantation: Surgical perspectives.

  Authors: Thomas Walther, Jörg Kempfert, Friedrich W Mohr

  Archives of cardiovascular diseases. 105(3):174-80.

  Aortic valve replacement (AVR) is a routine procedure for decades to treat patients with symptomatic aortic stenosis. The introduction of transcatheter aortic valve implantation (TAVI) by ProfessorAortic valve replacement (AVR) is a routine procedure for decades to treat patients with symptomatic aortic stenosis. The introduction of transcatheter aortic valve implantation (TAVI) by Professor Alain Cribier has paved the way for minimally invasive therapeutic options for elderly and high-risk patients with aortic stenosis. Transfemoral and transapical aortic valve implantations have become routine procedures in many centres around Europe. TAVI is usually being performed together by experienced cardiologists and cardiac surgeons who build the interdisciplinary 'Heart Team'. In the future, improved devices together with advanced fusion imaging will lead to a further improvement in clinical outcomes for the sake of our patients.

• A rare case of aortic stenosis in adulthood.

  Authors: Alexis Theron, Alice Tavano, Vlad Gariboldi

  Archives of cardiovascular diseases. 105(3):187-9.

• Transcatheter aortic valve replacement: A breakthrough medical therapy! The 20-year odyssey, and now, a 10-year anniversary.

  Authors: Martin B Leon

  Archives of cardiovascular diseases. 105(3):129-31.

• Transapical aortic valve implantation in Rouen: Four years' experience with the Edwards transcatheter prosthesis.

  Authors: Pierre-Yves Litzler, Bogdan Borz, Hassiba Smail, Jean-Marc Baste, Catherine Nafeh-Bizet, Arnaud Gay, Christophe Tron, Matthieu Godin, Jerome Caudron, Camille Hauville, Jean-Nicolas Dacher, Alain Cribier, Hélène Eltchaninoff, Jean-Paul Bessou

  Archives of cardiovascular diseases. 105(3):141-5.

  The first French transapical transcatheter aortic valve implantation (TAVI) was performed in July 2007 in our department. To report 4-year outcomes of transapical implantation with the EdwardsThe first French transapical transcatheter aortic valve implantation (TAVI) was performed in July 2007 in our department. To report 4-year outcomes of transapical implantation with the Edwards transcatheter bioprosthesis. We prospectively evaluated consecutive patients who underwent transapical implantation with an Edwards transcatheter bioprosthesis between July 2007 and October 2011. Patients were not suitable for conventional surgery (due to severe comorbidities) or transfemoral implantation (due to poor femoral access). Among 61 patients (59.0% men), mean logistic EuroSCORE was 27.5±14.9% and mean age was 81.0±6.8years. Successful valve implantation was achieved in 59/61 patients (96.7%) of patients. The other two patients required conversion to conventional surgery due to prosthesis embolization and died. Six additional patients died in the postoperative period. Causes of perioperative death were two septic shocks (one of peritonitis), two multi-organ failure, one ventricular fibrillation and one respiratory insufficiency. Intraprocedural stroke was not observed in any patient. The actuarial survival rates at 1, 2 and 4years were 73.8%, 67.2% and 41.0%. During this 4-year period, four patients died of cardiovascular events, but no impairment of transprosthesis gradient was observed. Our series of 61 patients who underwent transapical implantation of the Edwards transcatheter bioprosthesis shows satisfactory results, similar to other reports, considering the high level of severity of patients referred for this method. Transapical access is a reliable alternative method for patients that cannot benefit from a transfemoral approach.

• Transcatheter aortic valve implantation: The evolution of prostheses, delivery systems and approaches.

  Authors: John G Webb, Ronald K Binder

  Archives of cardiovascular diseases. 105(3):153-9.

  It is two decades since the first report of transcatheter implantation of a stented aortic valve in an animal. The first implantation of a transcatheter aortic valve in a human was accomplished justIt is two decades since the first report of transcatheter implantation of a stented aortic valve in an animal. The first implantation of a transcatheter aortic valve in a human was accomplished just one decade ago dramatically demonstrating the promise and feasibility of this new therapy. Over the past 10 years, there have been rapid developments in valves, delivery systems and technical approaches. Today, transcatheter valve implantation is a technical possibility for the great majority of patients with aortic stenosis. The next 10 years may well see this become the dominant therapy for aortic stenosis.

• Patient selection for transcatheter aortic valve implantation: Patient risk profile and anatomical selection criteria.

  Authors: Nicolo Piazza, Ruediger Lange, Giuseppe Martucci, Patrick W Serruys

  Archives of cardiovascular diseases. 105(3):165-73.

  Patient selection plays a crucial role in the success of transcatheter aortic valve implantation (TAVI). It requires meticulous attention to the smallest of details and needs to be performed in aPatient selection plays a crucial role in the success of transcatheter aortic valve implantation (TAVI). It requires meticulous attention to the smallest of details and needs to be performed in a systematic manner for every patient. In essence, the patient must be assessed from access to implantation site. Becoming over "complacent" and "routine" may lead to failure and impact patient safety. TAVI is indicated for high or prohibitive surgical risk patients with severe aortic stenosis. Some patients, however, are too high risk even for TAVI. In addition to patient risk evaluation, anatomical selection criteria need to be considered. Multimodality imaging, using a combination of angiography, echocardiography and multislice computed tomography, is necessary to determine the anatomical suitability for the procedure.

• Transcatheter aortic valve implantation: Our vision of the future.

  Authors: Alec Vahanian, Dominique Himbert, Eric Brochet, Jean-Pol Depoix, Bernard Iung, Patrick Nataf

  Archives of cardiovascular diseases. 105(3):181-6.

  Transcatheter aortic valve implantation (TAVI), introduced 10 years ago by Alain Cribier, has now been performed in more than 50,000 patients worldwide. Our vision of the main directions for theTranscatheter aortic valve implantation (TAVI), introduced 10 years ago by Alain Cribier, has now been performed in more than 50,000 patients worldwide. Our vision of the main directions for the future are fourfold. Firstly, the 'Heart Team' is and will remain, essential for patient selection and the performance of the procedure. Careful training and controlled diffusion of the technique to medico-surgical centres are also keys to success. Secondly, patient selection must be refined, in order to predict the risk of surgery and that of TAVI. The technique is currently limited to very high-risk patients or those with contraindications to surgery. It will be extended to include lower risk patients once there are adequate trial data, the safety of the procedure has been improved and better knowledge of long-term outcomes from the procedure has been obtained. Thirdly, the procedure will be simplified, and should also be safer with an expected decrease in the occurrence of strokes, vascular complications and perivalvular regurgitation. Fourthly, the devices will also improve, with the addition of the potential for repositioning and improvement in durability. The role of imaging with the use of multimodality techniques will no doubt increase and ease the efficacy and safety of the procedure. Overall, the use of TAVI will undoubtedly increase over time, enabling a larger number of patients with severe aortic stenosis to be treated in an effective and safe way, in complement to surgical aortic valve replacement.

• Cardiac multislice computed tomography after transcatheter aortic valve implantation: Features after "valve-in-valve" implantation for degenerative stented aortic bioprosthesis.

  Authors: Jérôme Caudron, Hélène Eltchaninoff, Matthieu Godin, Jean-Nicolas Dacher

  Archives of cardiovascular diseases. 105(3):190-2.

• Heart disease in pregnant women: Recent ESC guidelines.

  Authors: Bernard Iung

  Archives of cardiovascular diseases. 105(2):57-9.

• Testosterone improves cardiac function and alters angiotensin II receptors in isoproterenol-induced heart failure.

  Authors: Ning-Ning Kang, Lu Fu, Jin Xu, Ying Han, Jun-Xian Cao, Jun-Feng Sun, Min Zheng

  Archives of cardiovascular diseases. 105(2):68-76.

  The renin-angiotensin-aldosterone system is known to play an important role in the pathophysiology and development of heart failure. Several studies have reported the benefits of testosterone inThe renin-angiotensin-aldosterone system is known to play an important role in the pathophysiology and development of heart failure. Several studies have reported the benefits of testosterone in heart failure. However, the mechanisms of testosterone-induced effects on heart failure require further study. To determine the effects of castration and testosterone administration on cardiac function and angiotensin II receptor function in rats with isoproterenol-induced heart failure. Wistar rats were divided randomly into control and heart failure groups. The heart failure groups were further divided into the following groups: castration; castration+testosterone replacement; and sham castration. Echocardiography and haemodynamic measurements were used to evaluate cardiac function. Cardiocyte apoptosis and fibrosis were determined using terminal deoxyribonucleotide transferase-mediated dUTP nick-end labelling (TUNEL) staining and Masson's Trichrome staining, respectively. Angiotensin II receptor (AT1 and AT2) messenger ribonucleic acid (mRNA) expression levels were assayed using real-time reverse transcriptase-polymerase chain reactions, while Western immunoblotting was used to estimate Bcl-2 protein expression levels. Castration significantly increased cardiomyocyte apoptosis and fibrosis that was normally induced by isoproterenol (P<0.05). AT2 receptor mRNA expression in the castration group was increased and Bcl-2 protein expression was decreased compared with the castration+testosterone replacement group (P<0.05). These data suggest that androgen therapy could play an important role in pathophysiological changes in heart failure and have beneficial effects for its treatment.

• Surgical management of patients with Marfan syndrome: Evolution throughout the years.

  Authors: Alireza Samadi, Delphine Detaint, Carine Roy, Florence Arnoult, Gabriel Delorme, Mathieu Gautier, Olivier Milleron, François Raoux, Catherine Meuleman, Ulrik Hvass, Dalil Hamroun, Christophe Beroud, Florence Tubach, Catherine Boileau, Guillaume Jondeau

  Archives of cardiovascular diseases. 105(2):84-90.

  To evaluate the evolution of surgical management in a large population of patients with Marfan syndrome. This is a retrospective study of patients fulfilling the Ghent criteria for Marfan syndrome,To evaluate the evolution of surgical management in a large population of patients with Marfan syndrome. This is a retrospective study of patients fulfilling the Ghent criteria for Marfan syndrome, who visited the Centre de référence national pour le syndrome de Marfan et apparentés and underwent a surgical event before or during follow-up in the centre. One thousand and ninety-seven patients with Marfan syndrome, according to international criteria, came to the clinic between 1996 and 2010. Aortic surgery was performed in 249 patients (22.7%; 20 children and 229 adults), including the Bentall procedure in 140 patients (56%) and valve-sparing surgery in 88 patients (35%); a supracoronary graft was performed in 19 patients (7.6%), usually for aortic dissection. During the past 20 years, the predominant reason for aortic surgery has switched from aortic dissection to aortic dilatation, while age at surgery has tended to increase (from 32.4±11.9 years to 35.2±12.4 years; P=0.075). Mitral valve surgery was performed in 61 patients (5.6%; six children and 55 adults), including 37 valvuloplasties (60.6%) and 18 mitral valve replacements (29.5%). No significant difference was observed when comparing mitral valve surgery before and after 2000. Surgery performed in patients with Marfan syndrome has switched from emergency surgery for aortic dissection to elective surgery for aortic dilatation; this is associated with surgery performed at an older age despite the indication for surgery having decreased from 60mm to 50mm. No significant evolution was observed for mitral valve surgery.

• Birth weight and subsequent blood pressure: A meta-analysis.

  Authors: Min Mu, Su-Fang Wang, Jie Sheng, Yan Zhao, Hu-Zhong Li, Chuan-Lai Hu, Fang-Biao Tao

  Archives of cardiovascular diseases. 105(2):99-113.

  Hypertension is becoming an important health problem in many countries. The 'small baby syndrome hypothesis' suggests that an inverse linear relationship exists between birth weight and later risk ofHypertension is becoming an important health problem in many countries. The 'small baby syndrome hypothesis' suggests that an inverse linear relationship exists between birth weight and later risk of hypertension; however, this relationship is under debate. We conducted a meta-analysis to examine the association between birth weight and subsequent blood pressure. Among 78 studies reporting on the association between birth weight and subsequent blood pressure, 20 articles (reporting 27 original studies) were eligible for inclusion. Low birth weight (<2500g) compared with birth weight greater than 2500g was associated with an increased risk of hypertension (odds ratio [OR] 1.21; 95% confidence interval [CI] 1.13, 1.30); high birth weight (>4000g) compared with birth weight less than 4000g was associated with a decreased risk of hypertension (OR 0.78; 95% CI 0.71, 0.86). When low birth weight (<2500g) was compared with birth weight greater than 2500g, mean systolic blood pressure (SBP) increased by 2.28mmHg (95% CI 1.24, 3.33); when high birth weight (>4000g) was compared with birth weight less than 4000g, mean SBP decreased by 2.08mmHg (95% CI -2.98, -1.17). These findings indicate that there is an inverse linear association between birth weight and later risk of hypertension, and that this association primarily exists between birth weight and SBP.

• A sword of Damocles in an asymptomatic man presenting with serendipitously detected ventricular pre-excitation.

  Authors: Pascal Defaye, Adama Kane, Romain Cassagneau, Peggy Jacon

  Archives of cardiovascular diseases. 105(2):122-4.

• Letter relating to the publication entitled "Evolution of acute coronary syndrome with normal coronary arteries and normal cardiac magnetic resonance imaging" by Chopard et al. (Arch Cardiovasc Dis 2011;104:509-17).

  Authors: Frederic Mouquet, Pierre-Vladimir Ennezat

  Archives of cardiovascular diseases. 105(2):127-8.

• French Ministry of Health prospective multicentre study using bio-active stents coated with titanium nitride oxide: The EVIDENCE Registry.

  Authors: Michaël Angioi, Paul Barragan, Simon Cattan, Frédéric Collet, Patrick Dupouy, Philippe Durand, Jean Fajadet, Gérard Finet, Benoit Gerardin, Antoine Gommeaux [......] Christophe Loubeyre, Pierre Meyer, Marie-Claude Morice, Marc-Éric Moulichon, Smain Sayah, Marc Silvestri, Xavier Tabone, Thierry Unterseeh, Olivier Wittenberg, Jean-Marc Lablanche

  Archives of cardiovascular diseases. 105(2):60-7.

  Coronary stents have evolved over time, from bare-metal stents to drug-eluting stents, and now to bioactive stents. We sought to explore the immediate outcome of the titanium-nitride-oxide-coatedCoronary stents have evolved over time, from bare-metal stents to drug-eluting stents, and now to bioactive stents. We sought to explore the immediate outcome of the titanium-nitride-oxide-coated bioactive stent, Titan2(®), in real-world practice, and the incidence of major cardiac events at follow-up. Consecutive patients admitted for percutaneous intervention for at least one significant (≥50%) lesion in a native coronary artery were treated with Titan2(®) stent implantation. The primary endpoint was total major adverse cardiac events at 12-month follow-up. Secondary endpoints included target lesion revascularization at 12-month follow-up and the duration of dual antiplatelet therapy. Among 356 patients (mean age 67.4±12.1years), 77.2% were male and 39.3% were treated for myocardial infarction (MI). A total of 546 Titan2(®) stents were implanted in 420 lesions. Angiographic and clinical procedural success was achieved in all cases. No cases of in-hospital major adverse cardiac events or acute stent thrombosis were reported. Of 335 patients (94.1%) with 12-month clinical follow-up, four (1.2%) died, MI occurred in five (1.5%), target lesion revascularization was performed in 17 (5.1%) and major adverse cardiac events occurred in 24 (7.2%). One patient (0.3%) suffered late stent thrombosis during follow-up, but no cases of acute or subacute stent thrombosis occurred. Dual antiplatelet therapy continued beyond 6months in 64.5% of patients. In real-world practice, Titan2(®) stent implantation achieves an excellent immediate outcome, with a low incidence of major adverse cardiac events at 12-month follow-up.

• Prevalence of cardiovascular disease in Gabon: A population study.

  Authors: Edgar Brice Ngoungou, Victor Aboyans, Philomène Kouna, Roger Makandja, Jean Emmanuel Ecke Nzengue, Carine Ndong Allogho, Marc Laskar, Pierre-Marie Preux, Philippe Lacroix

  Archives of cardiovascular diseases. 105(2):77-83.

  Data supporting epidemiological transition from a predominant burden of infectious diseases to one of chronic diseases in Africa result mostly from hospital surveys. To estimate the cardiovascularData supporting epidemiological transition from a predominant burden of infectious diseases to one of chronic diseases in Africa result mostly from hospital surveys. To estimate the cardiovascular disease (CVD) burden in Gabon. The study was conducted in Ntoum (8765 inhabitants). All subjects aged greater or equal to 40 years were invited to participate. Participants were interviewed about CVD history and risk factors; they responded to questionnaires on claudication and angina and had a clinical examination, including lower limb pulse palpation and bilateral brachial pressure measurement. Subjects were considered to have CVD in case of history of CVD (coronary artery, cerebrovascular and peripheral arterial diseases), a positive questionnaire or an abnormal finding during clinical examination. The study included 736 subjects (313 men; 423 women). Systolic hypertension was highly prevalent (up to 47.7% and 53.7% in men and women aged 50 to 60 years, respectively). Of the 382 patients with hypertension, 74 (19.4%) were treated and only 22 (5.8%) were considered to have controlled hypertension. Overall, CVD was identified in 98 (13.3%) cases. Overall and newly diagnosed CVD prevalence rates were 14.7% and 11.5% for men and 14.9% and 8.9% for women, respectively. The presence of CVD was associated with hypertension (hazard ratio [HR] 3.69, 95% confidence interval [CI] 2.21-6.16; P<0.0001). Hypertension was predictive of stroke (HR 4.57, 95% CI 1.26-16.50; P<0.05), peripheral artery disease (HR 2.03, 95% CI 1.03-4.00; P<0.05) and subclavian artery stenosis (HR 5.79, 95% CI 2.21-15.2; P<0.05). Our findings provide strong evidence of ongoing epidemiological transition in Gabon, where CVD prevalence rates increase mainly with hypertension, affecting about one in six individuals aged over 40 years.

• Assessment of left ventricular ejection fraction using the wall motion score index in cardiac magnetic resonance imaging.

  Authors: Réal Lebeau, Karim Serri, Marie-Claude Morice, Thomas Hovasse, Thierry Unterseeh, Jean-François Piéchaud, Jérôme Garot

  Archives of cardiovascular diseases. 105(2):91-8.

  Left ventricular ejection fraction (LVEF) is an important indicator of left ventricular function and of the severity and prognosis of ischaemic heart disease. Assessment of regional function usingLeft ventricular ejection fraction (LVEF) is an important indicator of left ventricular function and of the severity and prognosis of ischaemic heart disease. Assessment of regional function using the wall motion score index (WMSI) is an alternative means of evaluating left ventricular function. We attempted to evaluate LVEF by a method using the WMSI with cardiac magnetic resonance imaging (MRI). One hundred and twenty-two patients referred for evaluation of heart disease had rest WMSI evaluation by cardiac MRI. The WMSI was evaluated using the 16-segment model and score proposed by the American Society of Echocardiography. In our first group of 80 patients, a correlation between WMSI and cardiac MRI LVEF was established and a regression equation was derived. This regression equation was then used in 42 consecutive patients to compare WMSI LVEF with the gold standard MRI LVEF. In the first 80 patients, MRI LVEF and WMSI correlated very well (r=0.93). Similarly, in the second group of 42 patients, WMSI LVEF derived from the regression equation correlated very well with MRI LVEF (r=0.94). An objective evaluation of LVEF can be easily made using the WMSI with cardiac MRI, which correlates very well with standard MRI planimetric methods.

• Left ventricle assist device: When and which patients should we refer?

  Authors: Jean-Noël Trochu, Pascal Leprince, Marie Bielefeld-Gomez, Olivier Bastien, Florence Beauvais, Jean-Pierre Gueffet, Damien Logeart, Richard Isnard, Marie-Christine Iliou, Christophe Leclercq, Claude Girard

  Archives of cardiovascular diseases. 105(2):114-21.

  Progress in the medical treatment of patients with heart failure with systolic dysfunction, cardiac resynchronization therapy, internal cardiac defibrillators and multidisciplinary managementProgress in the medical treatment of patients with heart failure with systolic dysfunction, cardiac resynchronization therapy, internal cardiac defibrillators and multidisciplinary management programmes has resulted in dramatic improvements in survival and quality of life; however, this progress has led to an increase in the prevalence of advanced heart failure. In the context of organ shortage for cardiac transplantation, the technological developments in left ventricular assist devices, shown in recent positive clinical studies, provide real hope for patients with advanced heart failure. This article summarizes the most recent clinical studies concerning left ventricular assist devices and discusses for whom and when a left ventricular assist device should be proposed.

• PET scan in suspected but unproven pacemaker endocarditis.

  Authors: Sana Amraoui, Jeannette Texier-Maugein, Pierre Bordachar

  Archives of cardiovascular diseases. 105(2):125-6.

• PALLAS: insights into permanent atrial fibrillation.

  Authors: Jean-Marc Davy, François Roubille, Jean-Luc Pasquié

  Archives of cardiovascular diseases. 105(1):1-4.

• Aortic root dilatation in young patients with cryptogenic stroke and patent foramen ovale.

  Authors: Niall G Keenan, Eric Brochet, Jean-Michel Juliard, Mihaela Malanca, Pierre Aubry, Laurent Lepage, Caroline Cueff, Guillaume Jondeau, Bernard Iung, Alec Vahanian, David Messika-Zeitoun

  Archives of cardiovascular diseases. 105(1):13-7.

  No previous study has looked for an association between aortic dilatation and the clinical sequelae of patent foramen ovale (PFO), although a possible relationship has been identified in caseNo previous study has looked for an association between aortic dilatation and the clinical sequelae of patent foramen ovale (PFO), although a possible relationship has been identified in case reports. To compare aortic dimensions in patients with symptomatic PFO and healthy controls. Forty-seven patients were identified who presented with cryptogenic cerebrovascular accident (CVA) assessed as most likely secondary to PFO (confirmed by contrast study), were aged less than 50 years and underwent percutaneous PFO closure. Forty-seven age-, sex- and body surface area-matched healthy controls were also identified. Aortic root diameters were greater in PFO patients. The difference was more marked at the levels of the sinuses of Valsalva (34±4 vs 31±3 mm, P<0.01) and the proximal ascending aorta (32±4 vs 29±3, P<0.01) and more modest at the level of the aortic annulus (23±3 vs 22±2 mm, P=0.20). In addition, patients with massive right-to-left shunting tended to have larger aortic diameters. In contrast, left ventricular end-systolic and end-diastolic diameters were not larger than in controls (30±4 vs 32±5 mm, P=0.10 and 48±5 vs 50±4 mm, P=0.04, respectively). The present study shows that aortic diameter is increased in young patients with cryptogenic CVA and PFO compared with in healthy subjects. Our results suggest that aortic dilatation may potentiate the risk of CVA in PFO patients and support further research in this area.

• Single-centre experience with an 8-mm tip catheter for radiofrequency catheter ablation of outflow tract ventricular ectopic beats.

  Authors: Antoine Da Costa, Lila Khris, Abdallah Nadrouss, Pierre Chafiotte, Cécile Romeyer-Bouchard, Laurence Bisch, Alexie Gate-Martinet, Karl Isaaz

  Archives of cardiovascular diseases. 105(1):24-32.

  Radiofrequency ablation (RFA) of outflow tract ventricular ectopic beats (OTVEBs) can be performed using a 4-mm or externally-cooled tip RFA catheter, but no data are available concerning the safetyRadiofrequency ablation (RFA) of outflow tract ventricular ectopic beats (OTVEBs) can be performed using a 4-mm or externally-cooled tip RFA catheter, but no data are available concerning the safety and efficacy of a large-tip (8-mm) catheter. To evaluate the feasibility of using an 8-mm tip catheter in patients with OTVEBs. In this prospective cohort study, the 8-mm tip catheter was tested in patients who were referred to our centre for RFA of symptomatic OTVEBs. The mean age of the 16 patients recruited between September 2008 and March 2010 was 53±18 years and 56.3% were male. Mean left ventricular ejection fraction was 62±9%, mean ventricular ectopic beat width was 144±21 ms, and all patients had left bundle branch block. Fourteen patients had inferior axis QRS morphology and two had superior. The main symptoms were palpitations and pre-syncope. RFA parameters were: procedure time 94±35 min; duration of application 11±10 min; impedance 81±12 Ω; temperature 50±5 °C; and power 46±17 W. RFA succeeded in 15 over 16 patients (93.8%); and recurrence was seen in one patient after a mean follow-up time of 11±6 months. No complications were noted. This preliminary study suggests that an 8-mm tip catheter may represent an alternative for RFA in patients with OTVEBs in whom a 4-mm tip was not successful. Larger randomized studies are therefore warranted.

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