Implante transcateter valve‐in‐valve para disfunção de biopróteses cirúrgicas aórticas

RESUMOIntroduçãoEstudos recentes têm demonstrado a eficácia do implante transcateter valve‐in‐valve para o tratamento de disfunção de biopróteses em pacientes de alto risco cirúrgico. Apresentamos nossa experiência inicial com o implante valve‐in‐valve.MétodosCaracterizamos o perfil clínico, ecocardiográfico e do procedimento, e reportamos os resultados de médio prazo de pacientes com disfunção de bioprótese submetidos a implante valve‐in‐valve em posição aórtica.ResultadosIncluímos sete pacientes do sexo masculino, com idade de 72,6 ± 10,0 anos. O escore STS foi 9,6 ± 10,5%, e o EuroSCORE logístico foi 22,7 ± 14,7%. Três pacientes apresentavam dupla disfunção; dois tinham insuficiência; e dois exibiam estenose isolada. A via transfemoral foi utilizada em seis casos, e a transapical, em um caso. Os dispositivos implantados incluíram as próteses Sapien XT (n = 5) e CoreValve (n = 2). O sucesso do procedimento foi obtido em seis (85,7%) casos. Após o procedimento, o gradiente médio reduziu‐se de 38,2 ± 9,6mmHg para 20,9 ± 5,9mmHg, e a área valvar elevou‐se de 1,2 ± 0,4cm2 para 1,5 ± 0,5cm2. Ao final de 1 ano, não ocorreram óbitos e nem outros desfechos adversos significativos; 80% dos pacientes encontravam‐se em classe funcional NYHA I/II. Os gradientes transvalvares e a área valvar permaneceram inalterados nesse período.ConclusõesO procedimento valve‐in‐valve foi eficaz na maioria dos pacientes de alto risco cirúrgico com disfunção de bioprótese. Quando realizado em pacientes bem selecionados, resulta em desfechos clínicos e hemodinâmicos satisfatórios.ABSTRACTBackgroundRecent studies have demonstrated the efficacy of the transcatheter valve‐in‐valve implantation for the treatment of bioprosthesis dysfunction in high‐risk surgical patients. This study presents the initial experience with valve‐in‐valve implantation.MethodsClinical, echocardiographic, and procedural profiles were characterized, and the mid‐term results of patients with surgical bioprosthesis dysfunction submitted to valve‐in‐valve implantation in the aortic position were reported.ResultsSeven male patients were included, aged 72.6 ± 10.0 years. The STS score was 9,6 ± 10,5%, and the logistic EuroSCORE was 22.7 ± 14.7%. Three patients had combined aortic bioprosthesis failure; two had isolated regurgitation; and two had isolated stenosis. The transfemoral access was used in six cases, and the transapical access in one case. Implanted devices included Sapien XT (n = 5) and CoreValve (n = 2) prostheses. Procedural success was achieved in six (85.7%) cases. After the procedure, the mean gradient decreased from 38.2 ± 9.6mmHg to 20.9 ± 5.9mmHg, and the valve area increased from 1.2 ± 0.4cm2 to 1.5 ± 0.5cm2. After 1 year, there were no deaths and no other significant adverse outcomes; 80% of patients were in NYHA functional class I/II. The transvalvular gradients and valve area remained unchanged in this period.ConclusionsThe valve‐in‐valve procedure was effective in most high‐risk surgical patients with bioprosthesis dysfunction. When performed in well‐selected patients, it results in satisfactory clinical and hemodynamic outcomes

The plant pathogenic fungus Gaeumannomyces graminis var. tritici improves bacterial growth and triggers early gene regulations in the biocontrol strain Pseudomonas fluorescens Pf29Arp

International audienceIn soil, some antagonistic rhizobacteria contribute to reduce root diseases caused by phytopathogenic fungi. Direct modes of action of these bacteria have been largely explored. However, commensal interaction also takes place between these microorganisms and little is known about the influence of filamentous fungi on bacteria. An in vitro confrontation bioassay between the pathogenic fungus Gaeumannomyces graminis var. tritici (Ggt) and the biocontrol bacterial strain Pseudomonas fluorescens Pf29Arp was set up to analyse bacterial transcriptional changes induced by the fungal mycelium at three times-points of the interaction before cell contact until contact. For this, a Pf29Arp shotgun microarray was constructed. Specifity of Ggt effect was assessed in comparison with the one of two other filamentous fungi, Laccaria bicolor and Magnaporthe grisea. During a commensal interaction, Ggt increased the growth rate of Pf29Arp. Before contact, Ggt induced bacterial genes involved in mycelium colonisation. At contact, genes encoding protein of stress response and a patatin-like protein were up-regulated. Among all the bacterial genes identified, xseB was specifically up-regulated at contact by Ggt but down regulated by the other fungi. Data showed that the bacterium early sensed the fungus presence but main gene alteration occurred during bacterial-fungal cell contact