Background-Concomitant functional mitral regurgitation (FMR) in patients undergoing aortic valve replacement (AVR)is frequently not corrected because it may improve after AVR; however, data supporting this assumption are sparse. We ascertained the impact of clinical and echocardiographic parameters on the outcome of patients with or without concomitant FMR at the time of AVR. Methods and Results-Clinical and echocardiographic follow-up was performed on 848 patients who underwent AVR after 1990. Risk factors for mortality and a composite outcome of heart failure (CHF) symptoms, CHF death, or subsequent mitral repair or replacement, were examined with bootstrapped Cox proportional hazard models. Follow-up was 4591 patient-years (mean 5.4Ϯ3.4 years; maximum 14.2 years). FMR Ն2ϩ had no independent adverse effect on survival in patients with aortic stenosis (AS) or insufficiency (AI

Background-The use of stem and/or progenitor cells to achieve potent vasculogenesis in humans has been hindered by low cell numbers, implant capacity, and survival. This study investigated the expansion of CD133 ϩ cells and the use of an injectable collagen-based tissue engineered matrix to support cell delivery and implantation within target ischemic tissue. Methods and Results-Adult human CD133ϩ progenitor cells from the peripheral blood were generated and expanded by successive removal and culture of CD133 Ϫ cell fractions, and delivered within an injectable collagen-based matrix into the ischemic hindlimb of athymic rats. Controls received injections of phosphate-buffered saline, matrix, or CD133

Background-The long-term outcomes of patients with low-gradient aortic stenosis (LGAS) after aortic valve replacement (AVR) are poorly defined. The purpose of this study was to define the long-term outcomes of LGAS patients after AVR and to evaluate the potential impact of prosthesis-patient mismatch (PPM) in these patients. Methods and Results-A cohort of 664 patients undergoing AVR for aortic stenosis after 1990 were followed-up prospectively with annual clinical assessment and echocardiography (total follow-up 3447 patient-years; mean follow-up 5.2Ϯ3.3 years).LGAS was defined as an aortic valve area Ͻ1.2 cm 2 , a mean transvalvular pressure gradient Ͻ40 mm Hg, and a left ventricular (LV) ejection fraction Ͻ50%, and was present in 79 patients. Rates and correlates of survival, freedom from congestive heart failure (CHF), and LV mass regression after AVR were determined using multivariate regression methods. Ten-year survival and freedom from CHF after AVR were 72.7Ϯ7.5% and 68.2Ϯ9.5%, respectively, for patients with LGAS, compared with 89.6Ϯ1.8% and 84.1Ϯ4.2% for patients without LGAS (hazard ratio [HR] for death and postoperative CHF, 3.1Ϯ1.1 and 2.7Ϯ0.9, respectively; PϽ0.01). In LGAS patients, PPM, defined as an indexed effective orifice area Յ0.85 cm 2 /m 2 , was independently associated with increased rates of CHF (HR, 3.6Ϯ2.2; Pϭ0.039), impaired LV mass regression (Pϭ0.037), and a trend toward increased late mortality (HR, 3.0Ϯ1.9; Pϭ0.084). Conclusions-Patients withLGAS have worse long-term outcomes after AVR compared with patients without LGAS.PPM adversely affects the long-term outcomes of LGAS patients and should be avoided in this population.

Compared with the use of mesenchymal progenitor cells, cell transplantation with endothelial progenitor cells after myocardial infarction resulted in better neovascularization and contractility. This suggests that angiogenesis is an important mechanism in attenuating the progression of left ventricular dysfunction after myocardial infarction.

Both on-pump and off-pump coronary artery bypass grafting elicit mobilization of endothelial progenitor cells into the peripheral blood. On-pump coronary artery bypass grafting, however, impairs the migratory function and viability of these vascular repair cells, which are conversely preserved after off-pump surgery. Further work is necessary to determine whether the function and viability of endothelial progenitor cells correlate with vascular outcomes and whether their therapeutic modulation may one day benefit coronary artery bypass grafting patients.