Eight years of experience

Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.INTRODUCTION: Aortic stenosis is the most prevalent type of valvular disease in Europe. Surgical aortic valve replacement (SAVR) is the standard therapy, while transcatheter aortic valve implantation (TAVI) is an alternative in patients at unacceptably high surgical risk. Assessment by a heart team is recommended by the guidelines but there is little published evidence on this subject. The purpose of this paper is to describe the experience of a multidisciplinary TAVI program that began in 2008. METHODS: The heart team prospectively assessed 473 patients using a standardized approach. A total of 214 patients were selected for TAVI and 80 for SAVR. Demographic, clinical and procedural characteristics and long-term success rates were compared between the groups. RESULTS: TAVI patients were older than the SAVR group (median 83 vs. 81 years), and had higher surgical risk scores (median EuroSCORE II 5.3 vs. 3.6% and Society of Thoracic Surgeons score 5.1 vs. 3.1%), as did the patients under medical treatment only. These scores were unable to assess multiple comorbidities. Patients' outcomes were different between the three groups (mortality with SAVR 25% vs. TAVI 37.6% vs. conservative therapy 57.6%, p=0.001). CONCLUSIONS: The heart team program was able to select candidates appropriately for TAVI, SAVR and conservative treatment, taking into account the risk of both invasive treatments. The use of a prospective standardized heart team approach is recommended, but requires continuous monitoring to ensure effectiveness in a timely manner.publishersversionpublishe

Simulation of wave action on a moored container carrier inside Sines’ Harbour

The integrated numerical tool SWAMS (Simulation of Wave Action on Moored Ships) is used to simulate the behavior of a moored container carrier inside Sines’ Harbour. Wave, wind, currents, floating ship and moorings interaction is discussed. Several case scenarios are compared differing in the layout of the harbour and wind and wave conditions. The several harbour layouts correspond to proposed alternatives for the future expansion of Sines’ terminal XXI that include the extension of the East breakwater and of the quay. Additionally, the influence of wind on the behavior of the ship moored and the introduction of pre tensioning the mooring lines was analyzed. Hydrodynamic forces acting on the ship are determined using a modified version of the WAMIT model. This modified model utilizes the Haskind relations and the non-linear wave field inside the harbour obtained with finite element numerical model, BOUSS-WMH (Boussinesq Wave Model for Harbors) to get the wave forces on the ship. The time series of the moored ship motions and forces on moorings are obtained using BAS solver. © 2015 Taylor & Francis Group, London

The Malveira fire test: Full-scale demonstration of fire modes in open-plan compartments

[EN] This paper characterises the fire dynamics in the Large-Scale Demonstrator Malveira Fire Test, a full-scale fire experiment carried out in an industrial building in Portugal. The Malveira Fire Test is the second stage in the series of full-scale experimental programmes developed for the Real Fires for the Safe Design of Tall Buildings project at the University of Edinburgh. This experiment focuses on the fire dynamics in large open floor plan compartments. Results from this test provide relevant data for defining design fire input methodologies applied to compartments typically found in tall buildings. The test showed three distinct fire behaviour modes characterised by the ratio between the velocities of the fire front (V-s) and the burnout front (V-BO); a travelling fire mode with V-s/V-BO approximate to 1, a growing fire mode with V-s/V-BO > 1 and a fully-developed fire mode with V-s/V-BO -> infinity. The three modes are correlated to the incident heat flux onto the fuel surface arising from the resulting compartment energy distribution. The energy distribution depends on the compartment characteristics, the fuel distribution and the resulting fluid mechanics. A description of the instrumentation and analysis of results are presented to support a theoretical justification for the transitions between fire modes.This work formed part of the EPSRC funded Real Fires for the Safe Design of Tall Buildings project (Grant No. EP/J001937/1) at the University of Edinburgh. The authors are extremely grateful to EPSRC for funding this work. The authors would like to thank the Bombeiros Voluntarios da Malveira for provision of the experimental building and support during the test. The authors are once again indebted to Rockwool International A/S for providing a significant amount of materials used in this experiment. The authors would like to thank Levantina de Pesaje for their support designing the mass loss system.Hidalgo, JP.; Goode, T.; Gupta, V.; Cowlard, A.; Abecassis-Empis, C.; Maclean, J.; Bartlett, AI.... (2019). The Malveira fire test: Full-scale demonstration of fire modes in open-plan compartments. Fire Safety Journal. 108:1-20. https://doi.org/10.1016/j.firesaf.2019.102827S120108Majdalani, A. H., Cadena, J. E., Cowlard, A., Munoz, F., & Torero, J. L. (2016). Experimental characterisation of two fully-developed enclosure fire regimes. Fire Safety Journal, 79, 10-19. doi:10.1016/j.firesaf.2015.11.001Torero, J., Majdalani, A., Abecassis-Empis, C., & Cowlard, A. (2014). Revisiting the Compartment Fire. Fire Safety Science, 11, 28-45. doi:10.3801/iafss.fss.11-28K. Fujita, reportCharacteristics of a Fire inside a Non-combustible Room and Prevention of Fire Damage – Report No. 2(h), Japanese Building Research Institute, Japan..Harmathy, T. Z. (1972). A new look at compartment fires, part I. Fire Technology, 8(3), 196-217. doi:10.1007/bf02590544Torero, J. L., Law, A., & Maluk, C. (2017). Defining the thermal boundary condition for protective structures in fire. Engineering Structures, 149, 104-112. doi:10.1016/j.engstruct.2016.11.015Usmani, A. S., Chung, Y. C., & Torero, J. L. (2003). How did the WTC towers collapse: a new theory. Fire Safety Journal, 38(6), 501-533. doi:10.1016/s0379-7112(03)00069-9Stern-Gottfried, J., Rein, G., Bisby, L. A., & Torero, J. L. (2010). Experimental review of the homogeneous temperature assumption in post-flashover compartment fires. Fire Safety Journal, 45(4), 249-261. doi:10.1016/j.firesaf.2010.03.007Stern-Gottfried, J., & Rein, G. (2012). Travelling fires for structural design–Part I: Literature review. Fire Safety Journal, 54, 74-85. doi:10.1016/j.firesaf.2012.06.003Stern-Gottfried, J., & Rein, G. (2012). Travelling fires for structural design-Part II: Design methodology. Fire Safety Journal, 54, 96-112. doi:10.1016/j.firesaf.2012.06.011Rackauskaite, E., Hamel, C., Law, A., & Rein, G. (2015). Improved Formulation of Travelling Fires and Application to Concrete and Steel Structures. Structures, 3, 250-260. doi:10.1016/j.istruc.2015.06.001Dai, X., Welch, S., & Usmani, A. (2017). A critical review of «travelling fire» scenarios for performance-based structural engineering. Fire Safety Journal, 91, 568-578. doi:10.1016/j.firesaf.2017.04.001Hidalgo, J. P., Cowlard, A., Abecassis-Empis, C., Maluk, C., Majdalani, A. H., Kahrmann, S., … Torero, J. L. (2017). An experimental study of full-scale open floor plan enclosure fires. Fire Safety Journal, 89, 22-40. doi:10.1016/j.firesaf.2017.02.002Maluk, C., Linnan, B., Wong, A., Hidalgo, J. P., Torero, J. L., Abecassis-Empis, C., & Cowlard, A. (2017). Energy distribution analysis in full-scale open floor plan enclosure fires. Fire Safety Journal, 91, 422-431. doi:10.1016/j.firesaf.2017.04.004Hidalgo, J. P., Maluk, C., Cowlard, A., Abecassis-Empis, C., Krajcovic, M., & Torero, J. L. (2017). A Thin Skin Calorimeter (TSC) for quantifying irradiation during large-scale fire testing. International Journal of Thermal Sciences, 112, 383-394. doi:10.1016/j.ijthermalsci.2016.10.013McCaffrey, B. J., & Heskestad, G. (1976). A robust bidirectional low-velocity probe for flame and fire application. Combustion and Flame, 26, 125-127. doi:10.1016/0010-2180(76)90062-6Hidalgo, J. P., Welch, S., & Torero, J. L. (2015). Performance criteria for the fire safe use of thermal insulation in buildings. Construction and Building Materials, 100, 285-297. doi:10.1016/j.conbuildmat.2015.10.014Cleveland, W. S., & Devlin, S. J. (1988). Locally Weighted Regression: An Approach to Regression Analysis by Local Fitting. Journal of the American Statistical Association, 83(403), 596-610. doi:10.1080/01621459.1988.1047863

Upper extremity transvenous access for neuroendovascular procedures: an international multicenter case series

BackgroundRadial artery access for transarterial procedures has gained recent traction in neurointerventional due to decreased patient morbidity, technical feasibility, and improved patient satisfaction. Upper extremity transvenous access (UETV) has recently emerged as an alternative strategy for the neurointerventionalist, but data are limited. Our objective was to quantify the use of UETV access in neurointerventions and to measure failure and complication rates.MethodsAn international multicenter retrospective review of medical records for patients undergoing UETV neurointerventions or diagnostic procedures was performed. We also present our institutional protocol for obtaining UETV and review the existing literature.ResultsOne hundred and thirteen patients underwent a total of 147 attempted UETV procedures at 13 centers. The most common site of entry was the right basilic vein. There were 21 repeat puncture events into the same vein following the primary diagnostic procedure for secondary interventional procedures without difficulty. There were two minor complications (1.4%) and five failures (ie, conversion to femoral vein access) (3.4%).ConclusionsUETV is safe and technically feasible for diagnostic and neurointerventional procedures. Further studies are needed to determine the benefit over alternative venous access sites and the effect on patient satisfaction