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Background The mortality rate for a patient with a refractory cardiogenic shock on venoarterial (VA) extracorporeal membrane oxygenation (ECMO) remains high, and hyperoxia might worsen this prognosis. The objective of the present study was to evaluate the association between hyperoxia and 28-day mortality in this setting. Methods We conducted a retrospective bicenter study in two French academic centers. The study population comprised adult patients admitted for refractory cardiogenic shock. The following arterial partial pressure of oxygen (PaO 2 ) variables were recorded for 48 h following admission: the absolute peak PaO 2 (the single highest value measured during the 48 h), the mean daily peak PaO 2 (the mean of each day’s peak values), the overall mean PaO 2 (the mean of all values over 48 h), and the severity of hyperoxia (mild: PaO 2  < 200 mmHg, moderate: PaO 2  = 200–299 mmHg, severe: PaO 2  ≥ 300 mmHg). The main outcome was the 28-day all-cause mortality. Inverse probability weighting (IPW) derived from propensity scores was used to reduce imbalances in baseline characteristics. Results From January 2013 to January 2020, 430 patients were included and assessed. The 28-day mortality rate was 43%. The mean daily peak, absolute peak, and overall mean PaO 2 values were significantly higher in non-survivors than in survivors. In a multivariate logistic regression analysis, the mean daily peak PaO 2 , absolute peak PaO 2 , and overall mean PaO 2 were independent predictors of 28-day mortality (adjusted odds ratio [95% confidence interval per 10 mmHg increment: 2.65 [1.79–6.07], 2.36 [1.67–4.82], and 2.85 [1.12–7.37], respectively). After IPW, high level of oxygen remained significantly associated with 28-day mortality (OR = 1.41 [1.01–2.08]; P  = 0.041). Conclusions High oxygen levels were associated with 28-day mortality in patients on VA-ECMO support for refractory cardiogenic shock. Our results confirm the need for large randomized controlled trials on this topic.

Some patients with aortic stenosis have a bleeding tendency that may result, as this study shows, from an acquired form of von Willebrand syndrome. High shear forces at the stenotic valve change the shape of the von Willebrand protein, resulting in proteolysis, loss of the largest multimers, and reduction in platelet adhesion to the vascular endothelium. Aortic-valve stenosis can be complicated by bleeding, particularly that due to gastrointestinal angiodysplasia (Heyde's syndrome). 1 – 3 This hemorrhagic syndrome is associated with acquired type 2A von Willebrand syndrome, which is characterized by the loss of the largest multimers of von Willebrand factor. 4 – 7 Proteolysis of von Willebrand factor as it passes through the stenotic valve is one of the proposed causes of the bleeding. High shear forces can induce structural changes in the shape of the von Willebrand factor molecule, leading to exposure of the bond between amino acids 842 and 843, which is sensitive to the action of a . . .

Purpose: To review the use of thoracic endovascular aortic repair (TEVAR) for late pseudoaneurysm formation after surgical repair of aortic coarctation. Methods: From May 2001 to May 2005, 8 patients (5 men; mean age 47.6 years, range 18–73) with a history of aortic coarctation repairs 17 to 40 years prior were referred to our institution for an anastomotic thoracic pseudoaneurysm. TEVAR was performed successfully in 7 patients; 1 died of suspected aneurysm rupture before the scheduled procedure. A carotid-subclavian bypass was performed in 3 patients. Results: All the procedures were immediately successful. No type I endoleaks were seen on the final control angiogram, but 2 of the patients with carotid-subclavian bypasses required additional left subclavian artery embolization due to type II endoleak. One of these patients died before embolotherapy on the 5th postoperative day from presumed aneurysm rupture (14% 30-day mortality rate). Over a follow-up period ranging from 15 to 72 months (mean 37), all the false aneurysms have remained thrombosed and the mean diameter has decreased from 44 to 23 mm. No endograft-related complications have occurred, and no further interventions have so far been necessary. Conclusion: TEVAR is a feasible alternative treatment for patients who have already undergone surgical repair of aortic coarctation. Technical issues regarding the endovascular strategy should be discussed with a multidisciplinary team to define the correct interventional plan.

Enteroviral RNA (EV-RNA) was detected in endomyocardial tissue by means of retrotranscription and polymerase chain reaction (RT-PCR) followed by slot-blot hybridization. The myocardial biopsy specimens studied were taken at the time of heart transplantation from 15 patients with dilated cardiomyopathy (DCM) and from 10 patients with ischemic cardiomyopathy (ICM). Specimens from 18 (72%) of the 25 patients were positive for EV-RNA, whereas no control specimens (myocardial specimens from 29 healthy organ donors and atrial specimens from 15 patients with acute myocardial infarction treated by anatomic bypass) yielded evidence of EV-RNA. The rates of EVRNA detection for the two groups requiring heart transplantation did not differ significantly (66.7% vs. 80.0%; χ2 test). Our findings support a link between enteroviral infection in both DCM and ICM and suggest a pathogenic role for the enteroviruses.

We report a case of total thrombosis of a right ventricular assist device in a patient during biventricular assistance. The thrombosis occurred 18 days following implantation and the right ventricular device was immediately removed without any complications. The patient was successfully transplanted after 3 months of left ventricular assistance.

ObjectivesMedicine procurement disorders, commonly referred to as ‘shortages’, are a health-threatening phenomenon that have been reported by several stakeholders around the world. This study aimed to describe data from a mitigation tool, namely a shortages report implemented within one of the largest university hospitals in France over a 6-year period.MethodsFor 6 years (from 1 June 2014 to 31 May 2020) the data used were collected from different sources: purchasing groups, distributors, manufacturers and the national health agency. The report included: medicine identification, disorder duration, starting and ending dates, available alternative products, the Anatomical Therapeutic and Chemical (ATC) classification. Different situations were described: medicine shortages, quotas, supply tensions and market withdrawals.ResultsOver the 6-year period, 1780 disorders were registered comprising 0.67% market withdrawals, 16.97% quotas, 79.89% shortages and 2.47% supply tensions. The median duration of a disorder was 56 days and the most affected ATC classes were the nervous system (N), anti-infectives (J) and the cardiovascular system (C). A substitute medicine was registered for one-third of the disorders. In the N class, the most frequent level 4 classes were N01BB (local anaesthetic amids such as lidocaine, levobupivacaine and ropivacaine), N03AX (other antiepileptics) and N05AX (other antipsychotics). In the J class, the most frequent level 4 classes were J01CR (penicillin combinations), J01CA (extended-spectrum penicillins such as piperacillin and amoxicillin) and J01XX (other antibiotics for systematic use).ConclusionsProcurement disorders are still spreading. The study results are similar to those of other research teams around the world. Common answers have to be found to deal with the phenomenon, that include standardisation and risk assessment methods.