Frailty especially seems to be one of the major factors not included into these scores. ...aim of this study was to elucidate whether frailty assessment helps to predict outcome after TAVI. ...major ...stroke and death occurred in 2.67%.
Impact of concomitant mitral regurgitation (MR) on outcome in patients undergoing TAVR appears to be unclear. ...it was aim of this study to evaluate the impact of MR on outcome after TAVR.
...higher rates of significant conduction disturbances with the need for post-interventional pacemaker implantation (PMI) have been reported. ...the aim of analysis was to determine the frequency of ...conduction disturbances and the need for PMI after TAVI and the impact on procedural and mid-term outcome.
Abstract Background Tobacco abuse is still among the most important cardiovascular risk factors in modern society. We investigated whether sub-chronic nicotine exposure can induce endothelial ...dysfunction and communication failure. Methods and results Primary human umbilical vein endothelial cells (HUVEC) were cultured with or without 1 μM nicotine given for the entire cell culture passage until confluence (5 ± 0.5 days). Cells were cultured on special Petri dishes consisting of two compartments which communicated only via a small cellular bridge. We determined the propagation of the NO signal after stimulation of compartment A with ATP by simultaneous spectrophotometric measurement of ATP and methemoglobin formation indicating NO release in compartment B. In HUVECs grown under nicotine we found significantly reduced NO formation in compartment B 5 min after ATP stimulation of compartment A. At that time, there was no ATP detectable in compartment B. The difference in NO-signal-propagation could be abolished with the gap junction blocker Na-propionate. Western blot and immunohistochemistry indicated significantly reduced levels of endothelial gap junction proteins Cx37 and Cx43, but not Cx40. Dye transfer experiments revealed reduced number of communicating cells in nicotine exposed cells indicating the functional relevance. Conclusions These results – for the first time – show that nicotine induces functional intercellular communication failure in endothelial cells probably resulting from down-regulated Cx37 and Cx43 expression.
Balloon inflation and deflation times were less than 2 seconds, The grade for the performance measure "ease of catheter insertion through introducer sheath" was 9.3±0.5 points, 9.1±0.5 for "ease of ...passing catheter over aortic arch, ease of catheter crossing over aortic valve" 9.2±0.7 points, for "speed of balloon inflation" 9.6±0.6 points, for "ability to dilate aortic valve without balloon slippage" 8.9±1.7 points, and for "speed of balloon deflation" 8.9±1.1 points.
The use of microaxial percutaneous left ventricular assist devices (pLVADs) in cardiogenic shock (CS) has increased in recent years, despite limited evidence, and data on sex disparities are ...particularly scarce. This study aimed to compare short-term outcomes between males and females.
Data were retrospectively collected from the Dresden Impella Registry, which is a large, prospective, single-centre registry that consecutively enrolled patients who received microaxial pLVAD. Inclusion criteria were CS due to left ventricular failure with serum lactate >4 mM. Patients with pLVAD other than Impella CP were excluded. The primary endpoint was the composite of all-cause mortality at 30 days or requirement of renal replacement therapy (RRT). Secondary endpoints were the components of the primary endpoint alone. Propensity score matched (PSM) analysis was used to adjust for baseline characteristics.
A total of 319 male (69 years; body mass index, 26.7 kg/m2) and 113 female patients (74 years; 27.9 kg/m2) were included in the study. The primary composite endpoint occurred less frequently in female patients in the unmatched analysis (♂ 75.9% (n=239) vs ♀ 64.4% (n=72); p=0.040) but not in the PSM analysis (♂ 81.1% (n=73) vs ♀ 68.9% (n=42); p=0.056). However, females less frequently required RRT in both analyses (♂ 48.2% (n=126) vs ♀ 25.9% (n=25); p=0.001; PSM: ♂ 49.1% (n=36) vs ♀ 23.3% (n=12); p=0.007). All-cause mortality did not differ between the cohorts.
This study showed no differences in all-cause mortality at 30 days between male and female patients receiving microaxial pLVAD in CS. Larger studies are required to confirm whether female sex is associated with reduced requirement of RRT in CS treated with microaxial pLVAD.
Background
“valve-in-valve” TAVR (VIV-TAVR) is established and provides good initial clinical and hemodynamic outcomes. Lacking long-term durability data baffle the expand to lower risk patients. For ...those purposes, the present study adds a hemodynamic 3-years follow-up.
Methods
A total of 77 patients underwent VIV-TAVR for failing aortic bioprosthesis during a 7-years period. Predominant mode of failure was stenosis in 87.0%. Patients had a mean age of 79.4 ± 5.8 years and a logistic EuroSCORE of 30.8 ± 15.7%. The Society of Thoracic Surgeons-PROM averaged 5.79 ± 2.63%. Clinical results and hemodynamic outcomes are reported for 30-days, 1-, 2-, and 3-years. Completeness of follow-up was 100% with 44 patients at risk after 3-years. Follow-up ranged up to 7.1 years.
Results
Majority of the surgical valves were stented (94.8%) with a mean labeled size of 23.1 ± 2.3 mm and true-ID of 20.4 ± 2.6 mm. A true-ID ≤21 mm had 58.4% of the patients. Self-expanding valves were implanted in 68.8% (mean labeled size 24.1 ± 1.8 mm) and balloon-expanded in 31.2% (mean size 24.1 ± 1.8 mm). No patient died intraoperatively. Hospital mortality was 1.3% and three-years survival 57.1%. All patients experienced an initial significant dPmean-reduction to 16.8 ± 7.1 mmHg. After 3-years mean dPmean raised to 26.0 ± 12.2 mmHg. This observation was independent from true-ID or type of transcatheter aortic valve replacement (TAVR)-prosthesis. Patients with a true-ID ≤21 mm had a higher initial (18.3 ± 5.3 vs. 14.9 ± 7.1 mmHg; p = .005) and dPmean after 1-year (29.2 ± 8.2 vs. 13.0 ± 6.7 mmHg; p = .004). There were no significant differences in survival.
Conclusions
VIV-TAVR is safe and effective in the early period. In surgical valves with a true-ID ≤21 mm inferior hemodynamic and survival outcomes must be expected. Nonetheless, also patients with larger true-IDs showed steadily increasing transvalvular gradients. This raises concern about durability.
BackgroundWest Nile virus (WNV) circulates in an enzootic cycle involving mosquitoes and birds; humans are accidental hosts.AimWe analysed human WNV infections reported between 2010 and 2018 to the ...European Centre for Disease Prevention and Control to better understand WNV epidemiology.MethodsWe describe probable and confirmed autochthonous human cases of WNV infection reported by European Union (EU) and EU enlargement countries. Cases with unknown clinical manifestation or with unknown place of infection at NUTS 3 or GAUL 1 level were excluded from analysis.ResultsFrom southern, eastern and western Europe, 3,849 WNV human infections and 379 deaths were reported. Most cases occurred between June and October. Two large outbreaks occurred, in 2010 (n = 391) and in 2018 (n = 1,993). The outbreak in 2018 was larger than in all previous years and the first cases were reported unusually early. The number of newly affected areas (n = 45) was higher in 2018 than in previous years suggesting wider spread of WNV.ConclusionReal-time surveillance of WNV infections is key to ensuring that clinicians and public health authorities receive early warning about the occurrence of cases and potential unusual seasonal patterns. Human cases may appear shortly after first detection of animal cases. Therefore, public health authorities should develop preparedness plans before the occurrence of human or animal WNV infections.
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