Transapical aortic valve implantation following a left pneumonectomy.

Transapical transcatheter aortic valve implantation is an emerging technique for high-risk patients with symptomatic aortic valve stenosis, peripheral vascular disease, and severe concomitant comorbidities. However, a previous major surgical intervention involving the left hemithorax and the lung has always been considered a technical surgical challenge or even a potential contraindication for this minimally invasive procedure. With this report, we demonstrate, for the first time, that a previous left pneumonectomy followed by mediastinal radiotherapy does not affect the feasibility of transapical transcatheter aortic valve implantation, and we discuss the preoperative workup and the peculiar intraoperative cardiac imaging and surgical assessment.

Short-term clinical outcomes among patients undergoing transcatheter aortic valve implantation in Switzerland: the Swiss TAVI registry.

AIMS: To evaluate short-term clinical outcomes following transcatheter aortic valve implantation (TAVI) using CE-mark approved devices in Switzerland. METHODS AND RESULTS: The Swiss TAVI registry is a national, prospective, multicentre, monitored cohort study evaluating clinical outcomes in consecutive patients undergoing TAVI at cardiovascular centres in Switzerland. From February 2011 to March 2013, a total of 697 patients underwent TAVI for native aortic valve stenosis (98.1%), degenerative aortic bioprosthesis (1.6%) or severe aortic regurgitation (0.3%). Patients were elderly (82.4±6 years), 52% were females, and the majority highly symptomatic (73.1% NYHA III/IV). Patients with severe aortic stenosis (mean gradient 44.8±17 mmHg, aortic valve area 0.7±0.3 cm²) were either deemed inoperable or at high risk for conventional surgery (STS 8.2%±7). The transfemoral access was the most frequently used (79.1%), followed by transapical (18.1%), direct aortic (1.7%) and subclavian access (1.1%). At 30 days, rates of all-cause mortality, cerebrovascular events and myocardial infarction were 4.8%, 3.3% and 0.4%, respectively. The most frequently observed adverse events were access-related complications (11.8%), permanent pacemaker implantation (20.5%) and bleeding complications (16.6%). The Swiss TAVI registry is registered at ClinicalTrials.gov (NCT01368250). CONCLUSIONS: The Swiss TAVI registry is a national cohort study evaluating consecutive TAVI procedures in Switzerland. This first outcome report provides favourable short-term clinical outcomes in unselected TAVI patients.

Evaluation gériatrique des patients agés candidats a un remplacement valvulaire aortique percutané [Geriatric assessment in old patients candidate to transcatheter aortic implantation].

Aortic stenosis mostly occurs among old-old patients. Once symptoms appear, prognosis is guarded, with 2-year mortality as high as 50%. Transcatheter Aortic Valve Implantation (TAVI) is a new therapeutic option in patients at very high surgical risk, who are mostly older persons. However, TAVI is associated with some complications, and patient selection remains a challenge. Comprehensive geriatric assessment (CGA) identifies patients with medical and functional problems likely to affect the TAVI post-operative course. Collaboration between cardiologists and geriatricians will likely become a standard approach to enhance the assessment of these frail patients and identify those most likely to benefit from TAVI.

Surgical outcomes of deep sclerectomy versus Baerveldt aqueous shunt implantation following initial failed deep sclerectomy

Purpose: To examine the efficacy and safety of repeat deep sclerectomy (DS) versus Baerveldt shunt (BS) implantation as second line surgery following failed primary DS. Methods: Fifty one patients were prospectively recruited to undergo BS implantation following failed DS and 51 patients underwent repeat DS, for which data was collected retrospectively. All eyes had at least one failed DS. Surgical success was defined as IOP≤21mmHg and 20% reduction in IOP from baseline. Success rates, number of glaucoma medications (GMs), IOP, and complication rates were compared between the two groups at year 1, post-operatively. Results: Mean age, sex and the proportion of glaucoma subtypes were similar between groups. Preoperatively IOP was significantly lower in DS group vs BS group (18.8mmHg vs 23.8mmHg, p<0.01, two sample t-test). Postoperatively IOP was significantly higher in DS group than BS group (14.6mmHg vs 12.0mmHg, p<0.01, two-sample t-test). In the DS group, 47% of eyes did not achieve 20% reduction in IOP from baseline, as a result the success rates were significantly lower in eyes with DS (51%) than in eyes with BS (88%) (p=0.02, log-rank test). Preoperatively the number of GMs used in DS and BS groups were similar (2.2 vs 2.7 p=0.02, two sample t-test). Postoperatively there remained no significant difference in GMs between groups (0.9 vs 1.1, p= 0.58, two sample t-test). Complication rates were similar between the two groups (12% vs 10%). Conclusions: Baerveldt tube implantation was more effective in lowering IOP than repeat deep sclerectomy in eyes with failed primary DS, at year one. Complications were minor and infrequent in both groups

Long-term clinical outcome after sirolimus-stent implantation for in sirolimus-eluting stent restenosis

Rapport de synthèse : But: la resténose intra-stent au sirolimus (SAS) reste un problème clinique. Parmi tes diverses approches thérapeutiques disponibles aujourd'hui aucune n'a la primauté car tes résultats à moyen terme restent relativement médiocres. Méthodologie: les patients souffrant d'une resténose intra-SAS chez lesquels un second SAS a été implanté comme traitement de cette resténose ont été inclus dans ce registre. Lors d'ischémie clinique ou électrique après implantation d'un SAS les malades chez lesquels l'angioplastie au ballon seul ne donnait pas un résultat satisfaisant ont bénéficié de l'implantation d'un stent actif dans un stent actif. Résultats: vingt-sept patients sont inclus dans ce registre. La resténose était de type focale dans 34% des cas, diffuse dans 59% des cas et proliférative dans 7% des cas. La procédure a été un succès chez tous les patients sans complications aiguës durant l'hospitalisation. A 14±7 mois, on dénombre 8 (30%) événements cardiaques majeurs (1 mort, 1 infarctus du myocarde, 4 revascularisations additionnelles de la lésion, 1 revascularisation additionnelle du vaisseau cible). Un patient a subi un pontage aorto-coronarien. Dix-neuf patients (70%) ont évolué sans aucun problème. Conclusion: en conclusion, l'implantation d'un SAS pour traiter une resténose intra-SAS est réalisable avec un très bon résultat immédiat. Cependant, l'incidence d'un événement cardiaque majeur reste élevée à long terme.

Modélisation et implantation d'un guichet virtuel pour les administrations publiques

Dans le cadre de ce travail de thèse intitulé, nous avons étudié les impacts des nouvelles technologies de l?information et de la communication sur les administrations publiques. Notre objectif principal était de modéliser un guichet virtuel puis d?en implémenter un prototype. Nous avons donc dans un premier temps étudié une sélection de réalisations internationales et suisses dans le domaine, ainsi que des travaux de recherche visant à développer des modèles pour un état électronique. Nous avons ensuite travaillé sur la base des résultats d?une enquête de terrain menée au sein d?une administration cantonale et auprès de citoyens. Ces données de base nous ont permis de définir un modèle de guichet virtuel, qui couvre les aspects statiques et dynamiques d?un tel système. Enfin nous avons utilisé le modèle abstrait pour définir l?architecture théorique de notre prototype de guichet virtuel, avant d?effectuer certains choix technologiques et de l?implémenter.