Philippe Rouvière

Long-term outcomes after cryoablation for ventricular tachycardia during surgical treatment of anterior ventricular aneurysms

Intraoperative map‐guided procedures have been widely advocated as the best surgical strategy for the treatment of ventricular tachycardia (VT), though favorable results have been reported with subendocardial resection without mapping. This study examined the very long‐term results of encircling cryoablation without mapping during surgery for anterior left ventricular aneurysm complicated by VT. Between 1985 and 2003, this procedure was performed in 52 patients, 7 of whom (13.7%) were operated within 1 month of anterior myocardial infarction. Their mean age was 64.4 ± 8.3 years and mean left ventricular ejection fraction was 31.7%± 9.5%. The overall hospital mortality was 1.9%. At 14 years, 86% of patients (95% CI: 75.4–96.6) were free from VT or sudden death. An implantable defibrillator was implanted in five patients (9.6%) during follow‐up. The 14‐year overall survival was 51.4% (95% CI: 33.8–72.4), and two patients (3.8%) underwent cardiac transplantation during follow‐up. The main cause of late death was congestive heart failure in eight patients (40.0%). Favorable long‐term results can be achieved with encircling cryoablation without mapping in patients undergoing surgery for anterior left ventricular aneurysm complicated by VT.

Management of advanced heart failure: a review

ABSTRACT Introduction: Heart failure (HF) has become a global pandemic. Despite recent developments in both medical and device treatments, HF incidences continues to increase. The current definition of HF restricts itself to stages at which clinical symptoms are apparent. In advanced heart failure (AdHF), it is universally accepted that all patients are refractory to traditional therapies. As the number of HF patients increase, so does the need for additional treatments, with an increased proportion of patients requiring advanced therapies. Areas covered: This review discusses extensive evidence for the effect of medical treatment on HF, although the data on the effect on AdHF is scare. Authors review the relevant literature for treating AdHF patients. Furthermore, mechanical circulatory devices (MCD) have emerged as an alternative to heart transplantation and have been shown to enhance quality of life and reduce mortality therefore authors also review the current literature on the different MCD and technologies. Expert commentary: More patients will need advanced therapies, as the access to heart transplantation is limited by the number of available donors. AdHF patients should be identified timely since the window of opportunities for advanced therapy is narrow as their morbidity is progressive and survival is often short.

0403: One-year survival among patients supported with a ventricular assist device: results of the hospital of Montpellier about 29 implantations

Ventricular assist devices (VADs) are used to bridge the patient with end-stage heart failure to cardiac transplantation (BTT) or to destination therapy (DT). Since 2003 in the Montpellier’s hospital, 29 VADs have been implanted (8 to DT). In the majority of cases, the VAD was used in acute end-stage of heart failure; one-year mortality was 45%. Unlike inotropic agents, levosimendan, a new calcium senziter, enhances myocardial contractility without increasing myocardial oxygen consumption. 15 out of 29 patients were on the Intermacs classification level 1, on a scale of 1 to 7, 9 received levosimendan and 6 did not. 9 of 29 patients were undergoing to levosimendan infusion to prevent right ventricular failure; 5 were under mechanical ventilation and 5 under Extra-corporal membran oxygenation (ECMO) or trans-aortic left ventricular discharge by Impella 5.0 (Abiomed) before LVAD. 7 out of 29 patients (77.8%) were alive one year later, among who one died from cancer. 2 patients were under ECMO after LVAD. In contrast, only 6 patients out of 29 patients (20,7%) without levosimendan are alive after one year. Multivariate analysis demonstrated a significant independant effect of levosimendan infusion on one year mortality in this retrospective study.