Optical coherence tomography-guided versus angiography-guided implantation of everolimus-eluting bioresorbable vascular scaffolds: Comparison of coverage, apposition and clinical outcome. The ALSTER-OCT ABSORB registry

Background: Suboptimal implantation of everolimus-eluting bioresorbable vascular scaffolds (EE-BVS) leading to strut malapposition and lack of neointima coverage has been hypothesized to be linked to late BVS-thrombosis. Optical coherence tomography (OCT) allows assessing subtle differences in BVS-healing. We aimed to link 6-months OCT-data on EE-BVS coverage and malapposition to implantation technique and clinical outcome. Methods: Twenty-nine consecutive EE-BVS-patients were included. EE-BVS-implantation was guided by angiography in the first 17 patients (group 1). Vessel sizing prior to implantation and implantation result was assessed by OCT in the 12 following patients (group 2). EE-BVS-implantation was performed in both groups with adequate lesion preparation, sizing and systematic high-pressure post-dilatation. All patients received 6-months invasive control including OCT-analysis and clinical follow-up for 2 years. Results: The rate of uncovered struts was group 1: 10.8 ± 10.0%; group 2: 10.6 ± 8.2%, p = 0.934. Target lesion failure due to BVS-thrombosis occurred in 2/17 patients at 9 and 18 months (11.8%, group 1), and no patients in group 2 (p = 0.218). Conclusions: Optical coherence tomography analysis at 6-months following EE-BVS-implantation finds almost 90% of struts to be covered. No difference between OCT vs. angiography-guided EE-BVS-implantation was observed. OCT at 6-months was not able to predict late BVS-thrombosis of EE-BVS

Transapical mitral valve implantation for treatment of symptomatic mitral valve disease: a real-world multicentre experience.

AIMS Transcatheter mitral valve implantation (TMVI) is a new treatment option for patients with symptomatic mitral valve (MV) disease. Real-world data have not yet been reported. This study aimed to assess procedural and 30-day outcomes of TMVI in a real-world patient cohort. METHOD AND RESULTS All consecutive patients undergoing implantation of a transapically delivered self-expanding valve at 26 European centres from January 2020 to April 2021 were included in this retrospective observational registry. Among 108 surgical high-risk patients included (43% female, mean age 75 ± 7 years, mean STS-PROM 7.2 ± 5.3%), 25% was treated for an off-label indication (e.g. previous MV intervention or surgery, mitral stenosis, mitral annular calcification). Patients were highly symptomatic (New York Heart Association [NYHA] functional class III/IV in 86%) and mitral regurgitation (MR) was graded 3+/4+ in 95% (38% primary, 37% secondary, and 25% mixed aetiology). Technical success rate was 96%, and MR reduction to ≤1+ was achieved in all patients with successful implantation. There were two procedural deaths and 30-day all-cause mortality was 12%. At early clinical follow-up, MR reduction was sustained and there were significant reductions of pulmonary pressure (systolic pulmonary artery pressure 52 vs. 42 mmHg, p < 0.001), and tricuspid regurgitation severity (p = 0.013). Heart failure symptoms improved significantly (73% in NYHA class I/II, p < 0.001). Procedural success rate according to MVARC criteria was 80% and was not different in patients treated for an off-label indication (74% vs. 81% for off- vs. on-label, p = 0.41). CONCLUSION In a real-world patient population, TMVI has a high technical and procedural success rate with efficient and durable MR reduction and symptomatic improvement

Characterization of the cortical activity underlying conscious somatosensory perception by fMRI

GesamtdissertationDas Ziel der vorliegenden Arbeit war die Lokalisation der Kortexareale, in denen neuronale Aktivität mit der bewussten Wahrnehmung von taktilen Reizen assoziiert ist. Hierzu wurde mittels funktioneller Kernspintomographie (fMRT) die Gehirnaktivität parallel zur Präsentation eines somatosensorischen Stimulus gemessen, der aufgrund eines Maskierungsparadigmas einmal bewusst und einmal nicht-bewusst prozessiert wurde. Über den Vergleich der Aktivierungsmuster, die den beiden unterschiedlichen Perzepten des physikalisch identischen Stimulus zugrunde lagen, konnten Areale identifiziert werden, in denen Aktivität mit bewusster Wahrnehmung korreliert. Im Falle des hier genutzten Paradigmas zur rückwärts gerichteten Maskierung (engl. backward-masking) kann ein zeitlich versetzt (später) applizierter Maskierungsstimulus am rechten Zeigefinger, die bewusste Wahrnehmung eines Zielstimulus am linken Zeigefinger verhindern (Meador et al. 1998a). Die Wahrscheinlichkeit der Maskierung hängt einerseits vom Interstimulusintervall (ISI), sowie von der Stimulusintensität ab. Diese Variablen wurden in einem psychophysikalischen Vorexperiment so bestimmt, dass eine Maskierungsrate von ca. 50% erreicht wurde. Für das fMRT-Experiment konnte daraufhin eine gleichgroße Anzahl an bewusst wahrgenommenen Stimuli und nicht-bewusst wahrgenommenen (maskierten) Zielstimuli verglichen werden. Für die bewusste Wahrnehmung des Zielstimulus konnte gezeigt werden, dass sie mit einer vermehrten Aktivierung bilateral im posterioren parietalen Kortex (Sulcus intraparietalis, Lobulus parietalis inferior, BA 40) assoziiert ist, die kontralateral stärker als ipsilateral zur Stimulation ausgeprägt ist. Darüber hinaus fanden sich Aktivierungen bilateral in der anterioren Insel (v.a. BA 13) und im angrenzenden ventralen Frontallappen (Gyrus frontalis inferior, BA 47). Im primären (S1) und sekundären (S2) somatosensorischen Kortex konnten keine Aktivierungsunterschiede detektiert werden. Dieses Resultat steht im Einklang mit Ergebnissen aus Arbeiten, in denen neuronale Korrelate bewusster Wahrnehmung im visuellen System untersucht worden sind (Lumer and Rees 1999; Rees et al. 2002a). Erstmals konnte jetzt gezeigt werden, dass auch im somatosensorischen System Aktivität in einem frontoparietalen Netzwerk eng mit bewusster Wahrnehmung assoziiert ist. Hierbei sind die in dieser Arbeit beschriebenen, besonders die posterior parietalen Aktivierungen deckungsgleich mit Knotenpunkten eines vielfach beschriebenen kortikalen Netzwerks, das selektive Aufmerksamkeit vermittelt (Corbetta and Shulman 2002). Die insuläre Aktivierung spiegelt möglicherweise auch eine kategorische Prozessierung innerhalb eines ventralen somatosensorischen Pfades wieder (Friedman et al. 1986; Murray and Mishkin 1984).The goal of this study was to localize the cortical areas in which neuronal activity would correlate with the conscious perception of tactile stimuli. To do so we used fMRI to measure cortical activity in parallel to the presentation of weak electric stimuli on both index fingers. Due to a stimulation paradigm inducing backward masking the target stimulus was not always consciously perceived. By comparing the cortical activation pattern of the perceived and the failed target stimulus - activity provoked by an identical physical input - we were able to identify the areas in which activity was associated with conscious perception. Fractional backward masking of the target stimulus was accomplished by presenting a more salient masking stimulus on the right index finger after the presentation of the target stimulus on the left index finger (Meador et al. 1998). In case of the conscious perception of the target stimulus significant activations were revealed bilaterally in the posterior parietal cortex (Sulcus intraparietalis, Lobulus parietalis inferior, BA 40), in the anterior isulae (BA 13) and in the inferior frontal cortex (BA 47). There was no detectable difference in activation in the primary (S1) and in the secondary (S2) somatosensory cortex. These results are consistent with findings of studies that focused on neuronal correlates of conscious perception in the visual system (Lumer and Rees 1999; Rees et al. 2002). For the first time we were able to show that also in the somatosensory system conscious perception is strongly associated with activity in a frontoparietal network. Especially the activations in the posterior parietal cortex match with a junction region of a well-investigated cortical network providing selective attention (Corbetta and Shulman 2002). The insular activity may reflect processing of specific stimulus features along a ventral somatosensory pathway (Friedman et al. 1986; Murray and Mishkin 1984)

Complications Following MitraClip Implantation

Purpose of review!#!To provide a detailed overview of complications associated with MitraClip therapy and its development over time with the aim to alert physicians for early recognition of complications and to offer treatment strategies for each complication, if possible.!##!Recent findings!#!The MitraClip system (MC) is the leading transcatheter technique to treat mitral regurgitation (MR) and has been established as a safe procedure with very low adverse event rates compared to mitral surgery at intermediate to high risk or in secondary MR. Lately, the fourth MC generation has been launched with novel technical features to facilitate device handling, decrease complication rates, and allow the treatment of even complex lesions. Although the complication rate is low, adverse events are associated with increased morbidity and mortality. The most common complications are bleeding, acute kidney failure, procedure-induced mitral stenosis, and an iatrogenic atrial septal defect with unknown clinical impact