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).

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1 The pharmaceutical compound, dihydroergotamine (DHE) is dispensed to prevent and reduce the occurrence of migraine attacks. Although still controversial, the prophylactic effect of this drug is believed to be caused through blockade and/or activation of numerous receptors including serotonin (5-HT) receptors of the 5-HT 2 subtype. 2 To elucidate if 5-HT 2 receptors (5-HT 2 Rs) may be involved in DHE prophylactic effect, we performed investigations aimed to determine the respective pharmacological profile of DHE and of its major metabolite 8 0 -hydroxy-DHE (8 0 -OH-DHE) at the 5-HT 2B and 5-HT 2C Rs by binding, inositol triphosphate (IP 3 ) or cyclic GMP (cGMP) coupling studies in transfected fibroblasts. 3 DHE and 8 0 -OH-DHE are competitive compounds at 5-HT 2B and 5-HT 2C Rs. 8 0 -OH-DHE interaction at (5-HT 2B Rs) was best fitted by a biphasic competition curve and displayed the highest affinity with a K i of 5 nm. These two compounds acted as agonists for both receptors in respect to cGMP production with pEC 50 of 8.3270.09 for 8 0 -OH-DHE at 5-HT 2B and 7.8370.06 at 5-HT 2C Rs.4 Knowing that the antimigraine prophylactic effect of DHE is only observed after long-term treatment, we chronically exposed the recombinant cells to DHE and 8 0 -OH-DHE. The number of 5-HT 2B R-binding sites was always more affected than 5-HT 2C Rs. At 5-HT 2B Rs, 8 0 -OH-DHE was more effective than DHE, with an uncoupling that persisted for more than 40 h for IP 3 or cGMP. By contrast, the 5-HT 2C R coupling was reversible after either treatment. 5 Chronic exposure to 8 0 -OH-DHE caused a persistent agonist-mediated desensitisation of 5-HT 2B , but not 5-HT 2C Rs. This may be of relevance to therapeutic actions of the compound.

Elective cardiac surgery in severely obese patients was not associated with increased perioperative morbimortality, but had a higher superficial wound infection risk. Nevertheless, severe obesity itself should not be a contraindication to elective surgery.

Extracorporeal membrane oxygenation can be done through several cannulation sites. Axillary artery cannulation is commonly performed through a Dacron graft sutured in an end-to-side fashion to the axillary artery. Direct cannulation of the axillary artery appears a reliable technique with low rate of complications. We report our experience in 16 patients using the direct cannulation technique.