Centre Cardiologique du Nord

Mitral valve replacement (MVR) in patients with complex mitral valve (MV) pathology often necessitates excision of the anterior mitral leaflet (AML), potentially compromising left ventricular (LV) geometry and function. We describe a customised full chordal-sparing mitral valve replacement (FCS-MVRpl) technique that preserves the AML and subvalvular apparatus, aiming to maintain LV architecture and improve postoperative outcomes in patients unsuitable for MV repair. Between 2014 and 2023, 161 consecutive patients underwent FCS-MVRpl. MV pathology included degenerative (n = 94, 57.1%), functional (n = 58, 36.0%), infective (n = 9, 5.6%), and rheumatic (n = 2, 1.2%) disease. Among these, 93 patients (57.8%) exhibited complex MV pathology: massive annular calcification (n = 59, 36.6%), mitral annular disjunction (MAD; n = 25, 15.5%), and posterior annular abscesses due to endocarditis (n = 9, 5.6%). The AML was fully mobilised and translocated, preserving the entire chordal apparatus. In cases with excess leaflet tissue, partial excision of the free edge was performed to facilitate prosthesis seating while maintaining chordal integrity. At 12 months, freedom from procedural complications was 98.6% ± 0.97%, with only two adverse events (1.2%) directly attributable to the technique. Freedom from heart failure-related rehospitalisation was 94.2% ± 1.9%. Multivariable Cox regression identified reduced preoperative left ventricular ejection fraction (LVEF) as a predictor of treatment failure (HR: 0.95; 95% CI: 0.92–0.99; p = 0.015). NYHA functional class improved in the majority of patients: 112 (81.2%) were classified as Class I at follow-up, while 11 (8.0%) experienced deterioration. FCS-MVRpl is a safe and effective alternative for patients with complex MV pathology who are not candidates for repair. Preservation of the AML and subvalvular apparatus supports LV geometry and functional recovery. The technique is particularly beneficial in cases of posterior annular calcification, Barlow disease with excess leaflet tissue, and infective endocarditis involving the posterior annulus. However, it is contraindicated in cases of circumferential MV calcification. Further prospective studies are warranted to validate long-term outcomes and broader applicability.

Abstract Background Tricuspid transcatheter edge-to-edge repair (T-TEER) is an emerging therapeutic intervention for patients with significant tricuspid regurgitation (TR). However, patient selection for T-TEER remains challenging. Prior studies have identified several hemodynamic markers, including the TAPSE/systolic PAP ratio (TAPSE/sPAP), cardiac output (CO), and pulmonary artery pulsatility index (PAPi), as potentially predictive of relevant outcome. The prognostic utility of these parameters in guiding patient selection for T-TEER remains to be fully elucidated. Objective To generate hypothesis as regards the prognostic value of these three invasive hemodynamic markers obtained from right heart catheterization (RHC) in patients eligible to T-TEER in terms of clinical response at one year ("improvement" versus "worse or no change" – the main outcome of TRI-FR trial, based on clinical events (unscheduled hospitalization for heart failure, death, tricuspid surgery) as well as PGA, NYHA and KCCQ). Methods All randomized patients in TRI-FR (N = 300) were eligible and analyzed, except those who withdrew their consent (N = 5), those allocated to T-TEER who experience a technical failure (TR grade 4+ or more in post-intervention) (N = 25), and those who had missing values for at least one of three RHC markers (N = 66). In each treatment arm, a linear relationship between RHC markers and outcome was first assessed using a generalized additive model, transformations were then applied accordingly. We fitted univariate and multivariable logistic regression models. The performances of the final model were investigated through discrimination, expressed as the area under the receiver-operating curve (AUC) and calibration (graphically). Results Out of 148 patients allocated to guideline directed medical therapy (GDMT) alone, and 152 patients allocated to T-TEER on top of GDMT, 109 and 100 were analyzed, and an improvement was observed in 39 out of 106 (36.8%) and 77 (77.8%) out of 99 patients assessed, respectively. In the GDMT alone arm, PAPi (log-transformed) and CO (3-degree polynomial) moderately predicted improvement (AUC = 0.696 and calibration far from good). In the T-TEER on top of GDMT, CO (3-degree polynomial) and TAPSE/sPAP (2-degree polynomial) moderately predicted improvement (AUC = 0.730 and moderate calibration). There were no significant relationship between hemodynamic measures and change in KCCQ or in 6-minute walk distance. Conclusion Key hemodynamic measures might be taken in account for patient selection for tricuspid valve interventions. This hypothesis has to be confirmed and probably added to other key clinical, biological and echocardiographic parameters.

AimsThere is still conflicting evidence if women with persistent atrial fibrillation (AF) profit from a pulmonary vein isolation (PVI) plus strategy. We evaluated the efficacy of a spatio-temporal dispersion-targeted ablation strategy in women from the TAILORED-AF trial.Methods and resultsIn TAILORED-AF, 370 patients were randomised to either a personalised, artificial intelligence (AI)-guided tailored ablation or to PVI-only. AF substrate mapping data and 12-month ablation outcomes were compared between women and men. Overall, 21% patients were female (70.4 ± 6.9 vs. 64.5 ± 8.5 years for men, P < 0.001). While spatio-temporal dispersion extent was similar between groups, left atrial low-voltage surface area (<0.2 mV) was significantly larger in women (P < 0.01). In women, the single-procedure freedom from AF (76% vs. 50%, log-rank P < 0.001) and any atrial arrhythmia (56% vs. 38%, log-rank P < 0.05) were significantly superior to PVI alone with a tailored procedure. In the PVI-only group, the single-procedure freedom from AF (50% vs. 70%, log-rank P < 0.001) and any atrial arrhythmia (38% vs. 61%, log-rank P < 0.001) were significantly lower in women. After a tailored ablation, no significant differences were observed between women and men regarding freedom from AF (76% vs. 91%, log-rank P = 0.07) or any atrial arrhythmia (56% vs. 62%, log-rank P = 0.69) free survival.ConclusionCompared to men, PVI-only in women with persistent AF leads to a significantly lower freedom from atrial arrhythmia. A personalised spatio-temporal dispersion-targeted ablation strategy led to a higher rate of freedom from any atrial arrhythmia than standard PVI after a single procedure in women and comparable outcomes between women and men.Registration identificationclinicaltrials.gov NCT04702451

Acknowledgements We thank all the local investigators and assistant personnel for their great effort. Furthermore, we thank all the POTTER-AF collaborators.

Prostate cancer remains one of the most commonly diagnosed malignancies in men globally, with a notable proportion presenting at the metastatic stage. Whilst metastases predominantly affect lymph nodes, bones, lungs and liver, reports of metastasis to the digestive system are rare, posing unique challenges in prognosis and management. The present study reports a rare case of metastatic prostate adenocarcinoma to the colon, providing information on its clinical characteristics and therapeutic approach. The patient began hormonal intensification therapy resulting in a rapid decline in prostate specific antigen levels and a favorable clinical response over 3 years. Understanding the management of digestive metastases is crucial for optimizing patient outcomes. Diagnostic evaluation should include a colonoscopy, whilst therapeutic decisions are guided by hormonal therapy with or without chemotherapy. Local treatments have limited utility and molecular profiling aids in tailoring treatment strategies.

Pelvic congestion syndrome (PCS) is a major cause of chronic pelvic pain in women of reproductive age. It is often associated with pelvic venous insufficiency and venous dilatation of the ovarian and uterine veins, resulting in a variety of symptoms exacerbated by venous hypertension. Despite its prevalence, PCS lacks standardized diagnostic and management protocols, making effective treatment challenging. The purpose of this expert consensus statement was to summarize the opinions of French radiologists and gynecologists regarding the diagnosis, imaging, treatment, and management of PCS. A working group of 14 expert radiologists and gynecologists from various French medical centers used a Delphi panel approach with several rounds of remote and face-to-face meetings to formulate and refine expert opinions based on the current literature and clinical expertise. These opinions were categorized according to diagnostic criteria, imaging techniques, therapeutic options, and follow-up protocols. The group formulated 72 initial opinions, and 65 were retained after rigorous evaluation for consensus. Key diagnostic tools include Doppler ultrasound for detection of venous reflux and magnetic resonance imaging for detailed assessment of venous anatomy. Endovascular embolization was highlighted as the primary treatment approach and recommended after thorough imaging evaluation. Noninvasive treatments and multidisciplinary care were also emphasized for comprehensive management. The expert opinion also included post-treatment follow-up to assess quality of life and symptom resolution. This structured consensus approach helped develop standardized expert opinions on management of, providing clear guidelines for diagnosis, treatment, and follow-up. These guidelines should improve clinical practice and patient care in the management of PCS.

Comprehensive knowledge of the clinical presentation, contemporary management, and outcomes on "all-comer" patients referred for mitral valve surgery (MVS) are critical to evaluate current practice and adherence to guidelines, understand selection biases, and inform key stakeholders on quality improvement. MITRACURE is a large international retrospective registry of consecutive adult patients who underwent isolated or combined MVS for mitral regurgitation (MR) in France or Canada in 2019 with in-depth clinical and echocardiographic characterization. Patients operated on for isolated mitral stenosis or who had a prior mitral valve intervention were excluded. Data were obtained from detailed chart abstraction and were site reported. In 2019, 3522 patients underwent MVS (48% combined) across 40 centers (88±46 MVSs/center, median 80, interquartile [51-131]). Mean age was 65±12 years, and 35% were women. The most common MR etiology was myxomatous (61%), followed by functional (9%), infective endocarditis (9%), and rheumatic disease (7%). MR quantification was performed in only 43%. Advanced clinical presentation was common: 43% were in New York Heart Association class III/IV, 30% exhibited congestive heart failure, 47% were on diuretics, 22% had atrial fibrillation/flutter, 35% presented with reduced ejection fraction, and 22% had pulmonary hypertension (≥50 mm Hg). Most patients were symptomatic or presented with class I/IIa indication for intervention, and an early intervention was performed only in 3% of patients. The repair rate was 62% overall and 80% in myxomatous disease. In-hospital mortality was 4.5% overall but 2.3% in patients with myxomatous MR (1.8% isolated, 3.1% combined). MITRACURE provides a contemporary, multicenter, "real-world" picture of the clinical presentation, management, and in-hospital outcomes of MVS for MR in two Western countries. Patients were often referred late in the disease process, with few patients undergoing early intervention. The higher mortality and lower repair rates reported may be more reflective of an unselected MR patient population but have room for improvement. Our results underline the need to develop strategies to improve management and outcomes of patients with MR.