The relationship between baseline diastolic dysfunction and postimplantation invasive hemodynamics with transcatheter aortic valve replacement.

BACKGROUND Abnormal invasive hemodynamics after transcatheter aortic valve replacement (TAVR) is associated with poor survival; however, the mechanism is unknown. HYPOTHESIS Diastolic dysfunction will modify the association between invasive hemodynamics postTAVR and mortality. METHODS Patients with echocardiographic assessment of diastolic function and postTAVR invasive hemodynamic assessment were eligible for the present analysis. Diastology was classified as normal or abnormal (Stages 1 to 3). The aorto-ventricular index (AVi) was calculated as the difference between the aortic diastolic and the left ventricular end-diastolic pressure divided by the heart rate. AVi was categorized as abnormal (AVi < 0.5 mmHg/beats per minute) or normal (≥ 0.5 mmHg/beats per minute). RESULTS From 1339 TAVR patients, 390 were included in the final analysis. The mean follow-up was 3.3 ± 1.7 years. Diastolic dysfunction was present in 70.9% of the abnormal vs 55.1% of the normal AVi group (P < .001). All-cause mortality was 46% in the abnormal vs 31% in the normal AVi group (P < .001). Adjusted hazard ratio (HR) for AVi < 0.5 mmHg/beats per minute vs AVi ≥0.5 mmHg/beats per minute for intermediate-term mortality was (HR = 1.5, 95% confidence interval [CI] 1.1 to 2.1, P = .017). This association was the same among those with normal diastolic function and those with diastolic dysfunction (P for interaction = .35). CONCLUSION Diastolic dysfunction is prevalent among TAVR patients. Low AVi is an independent predictor for poor intermediate-term survival, irrespective of co-morbid diastolic dysfunction

Dimensional Stability of Two Polyvinyl Siloxane Impression Materials in Different Time Intervals

Statement of the Problem: Dental prosthesis is usually made indirectly; there- fore dimensional stability of the impression material is very important. Every few years, new impression materials with different manufacturers’ claims regarding their better properties are introduced to the dental markets which require more research to evaluate their true dimensional changes. Objectives: The aim of this study was to evaluate dimensional stability of additional silicone impression material (Panasil® and Affinis®) in different time intervals. Materials and Methods: In this experimental study, using two additional silicones (Panasil® and Affinis®), we made sixty impressions of standard die in similar conditions of 23 °C and 59% relative humidity by a special tray. The die included three horizontal and two vertical lines that were parallel. The vertical line crossed the horizontal ones at a point that served as reference for measurement. All impressions were poured with high strength dental stone. The dimensions were measured by stereo-microscope by two examiners in three interval storage times (1, 24 and 168 hours).The data were statistically analyzed using t-test and ANOVA. Results: All of the stone casts were larger than the standard die. Dimensional changes of Panasil and Affinis were 0.07%, 0.24%, 0.27% and 0.02%, 0.07%, 0.16% after 1, 24 and 168 hours, respectively. Dimensional change for two impression materials wasn’t significant in the interval time, expect for Panasil after one week (p = 0.004). Conclusions: According to the limitations of this study, Affinis impressions were dimensionally more stable than Panasil ones, but it was not significant. Dimensional change of Panasil impression showed a statistically significant difference after one week. Dimensional changes of both impression materials were based on ADA standard limitation in all time intervals (< 0.5%); therefore, dimensional stability of this impression was accepted at least until one week

Relationship between Invasive and Echocardiographic Transvalvular Gradients after Transcatheter Aortic Valve Replacement.

INTRODUCTION Lower transcatheter aortic valve replacement (TAVR) pressure gradients have been reported after implantation of self-expanding valves compared with balloon-expandable valves; however, there is a paucity of data on the relationship between invasively measured transvalvular pressure gradients and Doppler-derived measurements. METHODS From September 2013 to September 2018, patients with native aortic valve stenosis who had both intraoperative invasive and postoperative echocardiography transvalvular pressure gradients were included for analysis. We used parametric and nonparametric statistics to compare aortic gradients within and between groups. RESULTS Of 171 patients, 152 (88.9%) patients had TAVR with a balloon-expandable valve and 19 (11.1%) with a self-expanding valve. Among all patients, the invasive aortic gradient was 7.8 ± 3.2 mmHg and the Doppler-derived aortic gradient was 11.0 ± 4.5 mmHg (p < 0.001). Among those who received a balloon-expandable valve, the invasive aortic gradient was 7.5 ± 3 mmHg and the Doppler aortic gradient was 11.4 ± 4.5 mmHg (p < 0.001). In contrast, among patients who received a self-expanding valve, the invasive aortic gradient was 10.3 ± 3.4 mmHg and the Doppler aortic gradient was 8.5 ± 4.6 mmHg (p = 0.18). CONCLUSIONS Balloon-expandable valves were associated with lower invasive measurements versus post-TAVR Doppler gradients, while results were inconclusive regarding self-expanding valves

Early and midterm outcomes of transcatheter aortic valve replacement in patients with bicuspid aortic valves

Background: Bicuspid aortic valve (BAV) stenosis has been considered a relative contraindication to transcatheter aortic valve replacement (TAVR). We compared the outcomes of TAVR in patients with BAV stenosis versus patients with trileaflet aortic valve stenosis. Methods: From March 2012 to September 2017, 727 patients underwent TAVR. Thirty-two patients with BAV were included in this study and compared to 96 patients with comparable risk factors (1:3) with a trileaflet aortic valve (TAV). Transesophageal echocardiography was used to estimate post-TAVR degree of paravalvular leak (PVL). Results: Mean ± standard deviation Society of Thoracic Surgeons risk was 6.01 ± 3.42 in the BAV group and 6.08 ± 3.76 in the TAV group (P = 0.92). Thirty-day mortality was 4.2 (N = 4) in the TAV group and 6.25 (N = 2) in the BAV group (P = 0.63). Three (3.1) patients in the TAV group and two (6.25) patients in the BAV group developed a post operative stroke (P = 0.59). Following TAVR, mean aortic valve gradient significantly decreased in both TAV (42.56 ± 14.93 vs 9.27 ± 5.57, P < 0.001) and BAV (44.12 ± 11.82 vs 9.03 ± 7.29, P < 0.001) groups. No patient had a severe PVL after TAVR, and only two (2.08) patients in the TAV group and one (3.12) patient in the BAV group had moderate PVL (P = 1.0). Patient survival rate at 1 and 2 years was 86 in the BAV group and 90 at 1 and 2 years in the TAV group (P = 0.74). Conclusions: TAVR in BAV disease is feasible with favorable valve performance. Immediate and mid-term outcomes of TAVR in patients with BAV are comparable to those with TAV. © 2018 Wiley Periodicals, Inc

Comparison of Different Invasive Hemodynamic Measurements as a Prediction Tool for Mortality after Transcatheter Aortic Valve Replacement in Men: A Retrospective Observational Study

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