The FRANCE TAVI registry provided reassuring data regarding trends in TAVR performance in an all-comers population on a national scale. Nonetheless, given that TAVR indications are likely to expand to patients at lower surgical risk, concerns remain regarding potentially life-threatening complications and pacemaker implantation. (Registry of Aortic Valve Bioprostheses Established by Catheter [FRANCE TAVI]; NCT01777828).

Objectif: I~valuer I'incidence, les modalit6s de survenue et I'Evolution des complications digestives apr& chirurgie cardiaque sous circulation extracorporelle (CEC). M&hode : I~tude retrospective sur 6281 aduttes op&& sous CEC entre le I er janvier 1994 et le 31 d&embre 1997. R~..sultats : Soixante patients ont pr6sent6 68 complications digestives (I %) : h6morragie digestive haute (n = 23), isch~mie intestinale (n = 19), chol&ystite aigu~ (n --7), pancrEatite aigu~ (n = 6), dilatation colique ( n = 13). I'incidence de ces complications, faible apr& chirurgie coronaire (0,4 %) ou valvulaire (0,8 %), &ait 61ev& aprEs transplantation cardiaque (6 %) ou chirurgie d'une dissection aortique (9 %). ComparEs ~ une population t6moins, les patients ayant prEsentE une complication digestive avaient un score de Parsonnet plus 61ev6 (29 +_ 15 contre 13 _+ 12 points, P --0,002), &aient plus souvent op&& en urgence (40/60, 66 % contre 1120/6221, 18 %; P = 0,01 ), avaient subi une CEC plus Iongue ( I 14 _+ 66 contre 74 -+ 42 min, P = 0,0 I), et avaient prEsentE plus fr6quem-ent un bas debit cardiaque postop&atoire (45/60, 75 % contre 435/6221,7 %; P = 0,00 I). La mortalit6 globale en presence d'une complication digestive a Et6 de 52 %. Les facteurs associ6s ~ la mortalit6 6talent : survenue d'un sepsis (OR=38,7), survenue d'une insuftisance rEnale (OR=7,9), age > 75 ans (OR= 3,5), ventilation m&anique > 7 jours (OR=2,7), association d'une complication neurologique (OR=3,9). Conclusion : Les complications digestives apr& CEC surviennent chez une population ~. risque. Ces complications s'intEgrent clans un contexte de d6faillance multivisc&ale ~ I'origine d'une mortalitE &v&. Purpose: To determine the incidence, circumstances of occurrence and evolution of gastrointestinal complications after cardiac surgery with extracorporeal circulation (ECC). Methods: Retrospective chart study of gastrointestinal complications in 6,281 patients undergoing ECC between January 1994 and December 1997. Results: Sixty patients developed 68 gastrointestinal complications (1%). Complications included: upper gastrointestinal bleeding (n = 23), intestinal ischemia (n = 19), cholecystitis in --7), pancreatitis (n = 6), and paralytic ileus (n = 16). The incidence of these complications was low after coronary artery (0.4%) or valvular surgery (0.8%) and high after cardiac transplantation (6%) and after surgery for acute aortic dissection (9%). Compared with a control population, patients with gastrointestinal complication had a higher Parsonnet score (29 +_ 15 vs 13 _+ 12 points; P = 0.002), were more frequently operated upon as an emergency (40/60, 66% vs I 120/622 I, 18%; P = 0.01 ), underwent ECC of longer duration (I 14 _+ 66 vs 74 _+ 42 min; P = 0.01 ), and presented more frequently with low cardiac output after surgery (45/60, 75% vs 435/622 I, 7%; P = 0.00 I). The mortality rate after gastrointestinal complications was 52%. The major factor associated with mortality was the occurence of sepsis (OR=38.7). Other factors were: renal failure (OR=7.9...

The purpose of the present study was to analyze the histological aspects of the saphenous veins after the use of the Symmetry aortic connector in off pump coronary artery bypass surgery (OPCAB). Nineteen consecutive patients who underwent OPCAB surgery and who received one proximal saphenous vein anastomosis using the St Jude aortic Symmetry connector system were evaluated. In each patient one small segment of the saphenous vein was cut before the use of the Symmetry connector (V0), then another segment after (V1). All segments were stored in an acetone-formaldehyde-alcohol solution before examination. Examination of the V0 segments showed non-specific media fibrosis. In V1, 11 segments presented with a complete alteration of the endothelial layer (58%) and 8 with severe lesions (more than 80%). Among all the V1 segments, 8 had a dissection of the media (42%) and one presented with a wall thrombus. These results suggest that the use of the aortic connector can be associated with different types of lesions of the venous wall. Thus, further investigation and especially long-term follow-up are mandatory to evaluate the consequences of such lesions upon the grafts' patency.

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