There is a lack of data regarding the long-term clinical efficacy of the kissing balloon inflation (KBI) after provisional stenting of coronary bifurcation lesions. The aim of this study was to ...analyze the impact of KBI on long-term clinical outcomes in patients undergoing provisional stenting for the coronary bifurcation lesions in a large real-world population.
A total of 873 patients who underwent percutaneous coronary interventions (PCI) with provisional stenting and had clinical follow up were analyzed. Patients treated with 2-stent strategy were excluded. To reduce the effect of potential confounding factors in this observational study, propensity score matching was conducted.
KBI was performed in 325 patients (37.2%). The median follow-up duration was 37.3 months. Patients treated with KBI more often had a previous PCI (48.6% vs. 42.5% SMD = 0.123). Patients in non-kissing group had more complex coronary disease with higher prevalence of calcification (14.8% vs. 21.4% SMD = 0.172), thrombosis (2.8% vs. 5.8% SMD = 0.152) and longer side branch lesions (8.3% vs. 11.7% SMD = 0.113). There were no significant differences in the major adverse cardiac events including death, myocardial infarction, target lesion revascularization after KBI versus no KBI (15.4% vs. 15.7%, p = 0.28), in total cohort or in matched patients (17.1% vs. 15.8%, adjusted HR 1.01, 95% CI: 0.65–1.65, p = 0.95). The lack of effect of KBI on clinical outcomes was consistent across various subgroups including left main disease.
In this multicenter real-world registry, KBI did not improve long-term clinical outcomes in patients with coronary bifurcation lesions treated with provisional stenting technique.
•While POT considered as a mandatory step of the provisional stenting, efficacy of KBI is still questioned due to controversial data.•In this multicenter real-world registry KBI didn't improve clinical outcomes in patients treated with 1-stent technique.•The lack of effect of KBI on clinical outcomes was consistent across various subgroups including left main bifurcation.
Background: Most complex chronic total occlusions (CTOs) require the utilization of multiple recanalization strategies. However, data on wire manipulation time within CTO percutaneous coronary ...intervention (PCI) are limited. Objectives: We sought to investigate the impact of crossover time between crossing strategies on CTO PCI technical success. Methods: A total of 1026 patients admitted to our center between 2013 and 2019 for CTO PCI were assessed, of whom 143 were included for analysis. In these patients, the primary antegrade approach was changed to retrograde within one procedure. The crossover time between strategies remained at the operator's decision. Results: In most cases the target vessel was the right coronary artery (72%), followed by the left anterior descending (18.2%) and left circumflex (9.1%) arteries. The mean J-CTO score was 2.1 ± 1.1. Logistic regression analysis was used to estimate the odds of technical success associated with various crossover times. The results showed that 33 minutes was the threshold of the initial timing at which to review crossover of antegrade to retrograde recanalization of CTO. The odds of technical success with earlier crossover were 3.4 times higher 95% confidence interval (CI): 1.3 to 8.6. The chances of success reduced by 3% for every 1 minute longer than the threshold time (odds ratio: 0.97; 95% CI: 0.94 to 0.99, p = 0.05). Conclusions: Crossover to the retrograde approach should be considered no later than 33minutes after antegrade wire manipulation in order to maintain the maximum chances of final technical success.
To determine the feasibility of aortic valve neocuspidization (AVNeo) with glutaraldehyde-treated autologous pericardium.
One hundred and seventy (170) AVNeo (84 males/86 females) were performed from ...January 2017 through March 2019 in three centers. All the records were prospectively collected and retrospectively reviewed.
Most of the patients were older than 60 years and over 95% were operated for aortic stenosis. Preoperatively, pressure gradients were 69.9±21.3 mmHg for patients with aortic stenosis, and the surgical annular diameter was 21.0±2.0 mm for all patients. Effective orifice area (EOA) and indexed EOA (iEOA) averaged 0.7±0.3 cm2 and 0.4±0.2 cm2/m2 for patients with aortic stenosis before surgery, respectively. There was no conversion to prosthetic aortic valve replacement. Eight patients needed reoperation for bleeding, but no patient needed reoperation due to early infective endocarditis. There were five in-hospital deaths due to noncardiac cause. Compared to preoperative echocardiographic measurements, postoperative peak pressure gradient decreased significantly (-58.7±1.7 mmHg; P<0.001) and reached 11.2±5.6 mmHg, and mean pressure gradient also decreased significantly (-36.8±1.1 mmHg; P<0.001) and reached 6.0±3.5 mmHg. Accordingly, EOA and iEOA increased significantly 2.0 cm2 and 1.0 cm2/m2 (both P<0.001) to reach 2.7±0.6 cm2 and 1.4±0.3 cm2/m2 after surgery, respectively, with minimal significant aortic regurgitation (0.6% > mild).
AVNeo is feasible and reproducible with good clinical results. Hemodynamically, AVNeo produces immediate postoperative low-pressure gradients, large EOA, and minimal regurgitation of the aortic valve. Further studies are necessary to evaluate mid- and long-term evolution.
The present paper considers the manufacturability of polymer composite material tooling intended for molding and bonding of complex curvature honeycomb sandwich structures. The tooling structure ...consists of inner and outer shells and glass-fiber-reinforced honeycomb core placed between them. The inner shell is glass-fiber-reinforced plastic based on TEIS-53 molten heat-resistant epoxy-bismaleimide resin and Т-10-14 structural fiberglass.
The aim of this research article is to study and evaluate YouTube as an effective instrument of transmitting lecture information. The factors that motivate teachers to use YouTube in undergraduate ...studies are specified. Within the scopes of the research study, students were shown a YouTube video lecture before each lecture in a classroom. According to the author’s idea, these YouTube video lectures contained theoretical fundamentals, which created the necessary background for lectures in the classroom, where some case studies based on theories from video lectures were discussed. During the study, students were asked about their preferences on the YouTube video lectures, factors that motivate them to watch these lectures, things they would like to improve in the video lectures, and types of video lectures they mostly like. The findings show, that an unusual background location in the video can attract the students’ attention. Another conclusion that was made was that students get used to video lectures during the semester and hence by the end of the course they stop perceiving video lectures as something new. To conclude, video lectures no matter how popular they are in terms of number of views, allow teachers to use a time, which was originally planned for theory, for case studies that in many ways makes the educational process more attractive for students and practically focused.
The object of research. High-strength concrete containing a multicomponent additive MB10-50C. The mineral part of the additive is represented by industrial by-products - silica fume and fly ash, and ...the organic part includes a superplasticizer of the C-3 grade. The subject of the study is the characteristics of the mechanical properties (compressive and splitting tensile strength, modulus of elasticity, Poisson's ratio, limiting deformations) of high-strength concrete after a short- and long-term exposure to elevated temperatures up to 400°C. Method. The high-strength concrete was heated in electric furnaces, and the properties were evaluated based on the residual characteristics after the samples cooled down. The characteristics of the properties of concrete are determined according to the national standards of the Russian Federation. Results. The long-term heating of high-strength concrete at temperatures of 90 and 200°C caused an increase in the residual compressive strength by an average of 5 and 10%, respectively. Compressive strength after long-term heating at 300 and 400°C decreased and accounted for 90 and 70% of the initial values, respectively. Long-term heating up to 200°C did not lead to significant changes in the splitting tensile strength, but the splitting tensile strength decrease by about 30 and 70% at heating up to 300°C and 400°C, respectively. Values of the initial elastic modulus and Poisson's ratio after heating at 90-400°C only decreased, while the dependence of the characteristics on the value of the heating temperature is linear. The heating of high-strength concrete at 200-400°C increased the ultimate longitudinal strain by 1,25-1,69 times and the ultimate transverse strain by 2-3,87 times.
BACKGROUND We report a 66-year-old patient who received implantation of HeartMate II LVAD (St. Jude Medical, Minneapolis, MN, USA) as destination therapy 10 years ago. CASE REPORT Preoperatively, the ...patient developed acute heart failure due to transmural myocardial infarction requiring catecholamine therapy and intra-aortic balloon pump. Echocardiography revealed a left ventricular ejection fraction of 15%. We saw an indication for left ventricular assist device (LVAD) implantation. The intraoperative course was uncomplicated. The operation time was 153 minutes and the cardiopulmonary bypass time was 69 minutes. The procedure was performed in normothermia, and no further combined procedures were necessary. Only one re-hospitalization, due to driveline infection, was required. Once a month, the patient visited our heart failure outpatient clinic for laboratory control, echocardiographic examination, and device measurement. There was always a normal LVAD function. During the 10 years of follow-up, the patient did not have any other complications. CONCLUSIONS Patients with a strict indication for LVAD and fewer risk factors can show a relatively uncomplicated postoperative course. Our case report demonstrates the opportunity to care for a patient for years using LVAD. Modern LVADs are reliable cardiac support systems as destination therapy from the long-term perspective. Careful patient selection, timely decision on LVAD implantation, and structured patient care are critical.
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