[Why I don't give up the femoral approach!]

Since its introduction in 1989, the safety of transradial approach compared to the femoral approach is mainly due to reducing entry site complications, allowing early ambulation, but at the price of a higher rate of procedural failure, arterial occlusion and radiation for operators and patients. Nevertheless, these advantages can be minimized with a modern femoral approach requiring a 4-French catheter for diagnostic angiography and a low dose heparin, new antithrombotic drugs and a reasonable use of glycoprotein (GB)IIb-IIIa for angioplasty. The radial approach is the best way to go in hemorrhagic high-risk patients and the femoral approach is safer in complex procedures. The operator has to hold the two accesses and to know when to switch to another approach to minimize complications, procedure time, radiation and contrast use.

[Aortic bioprosthesis implanted percutaneously: three year follow up]

Percutaneous implantation of a bioprosthesis for the treatment of degenerative aortic stenosis ushered in a new era for interventional cardiology, and now represents the best therapeutic option for a growing number of patients for whom surgical aortic replacement would be too risky. This is the case in about a third of symptomatic patients affected. Between 2003 and 2005, we performed initial feasibility studies (I-REVIVE and RECAST) in Rouen, on non-operable patients in a critical state, included for purely compassionate reasons. The valve used was a pericardial bioprosthesis mounted in an expandable balloon stent. The mean age of the patients was 80 years, all had multiple co-morbidity and had been turned down by the cardiac surgeons. In 33 of the 36 included patients, the technique was attempted by the anterograde trans-septal approach (n=27, success rate 80%) or by the retrograde arterial route (n=7, success rate 57%). Echocardiography following implantation revealed a final aortic surface area of 1.70 cm2 and a transvalvular gradient of 9 mmHg. A significant paravalvular aortic leak was noted in 5 cases. There were 6 deaths by 1 month, related to the procedure, and 10 deaths by 6 months, from non-cardiac causes and not related to the procedure. There was no occurrence of coronary occlusion, secondary displacement or dysfunction of the prosthesis. In December 2006, 8 patients reached 2 years of follow up, and two others reached 3 years, symptom free and still with an unchanged valvular function. Significant technological improvements have made the technique simpler, quicker and safer, with very much improved short and long term results. The new trans-apical approach is under evaluation with some promising initial results. More than 280 patients have been implanted to date. Other implantable prostheses are under evaluation. This therapeutic modality looks likely to develop rapidly, and in the near future it should offer a new and optimal solution for all high surgical risk or non-operable patients.

[Cholesterol ester fatty acid composition in Tunisian type 2 diabetics with and without cardiovascular complications]

BACKGROUND

Lipid and glycemic imbalances are frequent disorders found in diabetes type 2. These disorders are influenced by dietary means.

AIM

to investigate saturated fatty acids (SFA), polyunsaturated fatty acids (PUFS) and oleic acid of cholesterol ester fraction in non-insulin dependant diabetes mellitus without cardiovascular complications (NIDDM), non-insulin dependant diabetes mellitus with cardiovascular complications (NIDDMc) and healthy controls.

METHODS

The composition of cholesterol ester fatty acids in 35 NIDDM, 33 NIDDMc and 32 controls were measured by gas-chromatography. Glycaemia and lipid profile were measured using commercial kits.

RESULTS

Compared to NIDDM and to controls, NIDDMc showed a significant increase of different SFA (C12:0, C14:0, C16:0, C18:0). Oleic acid (C18:1) was significantly decreased in NIDDMc and NIDDM compared to controls (15,88 +/- 2,34 and 22,66 +/- 4,14 vs 28,18 +/- 2,90). Linoleic acid (C18:2) was significantly increased in NIDDMc compared to NIDDM and controls (52,59 +/- 5,50 vs 49,29 +/- 8,58 and 39,26 +/- 10,46). Linolenic acid (C18:3) and arachidonic acid (C20:4) were significantly decreased in NIDDMc compared to NIDDM and to controls. Linoleic acid (C18:2) / linolenic acid (C18:3) ratio was increased in NIDDMc.

CONCLUSION

Linoleic (C18:2) acid excess intake found in our NIDDMc could emphasize arachidonic synthesis which is directly transformed while an inflammatory syndrome observed in coronary pathologies.