Edukoi: developing an interactive sonification tool for astronomy between entertainment and education

Edukoi is a software that aims to make interactive sonification suitable to convey and extract information. The program design is a modification of the software Herakoi, which sonifies images in real time mapping pitch to colour using a motion-aware approach for allowing users to interact with images through sound. The pitch-colour association of Hearkoi, albeit pleasing from the entertainment side, is not efficient for communicating specific information regarding colours and hues to listeners. Hence we modified it to create an instrument to be used by visually impaired and sighted children to explore images through sound and extract accurate information. We aim at building a flexible software that can be used in middle-schools for both art and science teaching. We tested its effectiveness using astronomical images, given the great fascination that astronomy always has on kids of all ages and backgrounds. Astronomy is also considered a very visual science, a characteristic that prevents students from learning this subject and having a related career. With this project we aim to challenge this belief and give to students the possibility to explore astronomical data through sound. Here we discuss our experiment, the choices we made regarding sound mappings, and what psychophysiological aspects we aim to evaluate to validate and improve Edukoi.Comment: 4 pages, 3 figures, to be published in the proceedings of "The 28th International Conference on Auditory Display (ICAD 2023) - Special Session on Astronomical Data Sonification

Coronary Angiography After Transcatheter Aortic Valve Replacement (TAVR) to Evaluate the Risk of Coronary Access Impairment After TAVR‐in‐TAVR

n/

Long-term outcomes and prosthesis performance after transcatheter aortic valve replacement: results of self-expandable and balloon-expandable transcatheter heart valves

BACKGROUND: Data on transcatheter aortic valve replacement (TAVR) long-term clinical outcomes and hemodynamic performance of the self-expandable CoreValve (CV) and the balloon-expandable Edwards SAPIEN XT (ES) (Edwards Lifesciences, Irvine, California, USA) transcatheter heart valves (THV) are limited. Therefore, this study aimed to compare long-term clinical outcome data and hemodynamic performance of TAVR with either CV or ES. METHODS: We reviewed prospectively collected data of 171 patients treated with TAVR for severe aortic stenosis (AS) at our center between June 2007 and December 2010, with last follow-up contact in 2016. RESULTS: Out of 171 patients treated with TAVR at our Institution, 87 received a CV and 84 an ES THV. Mean age was 81 [78-85] years, and mean Society of Thoracic Surgeons (STS) score was 7.5% (4.5-13.9%). Hemodynamic success by Valve Academic Research Consortium (VARC) definition was 97.1%. Mean trans-prosthetic gradient remained low and stable during follow-up in both groups (at 5-year 9.2±6.4 versus 12.7±5.1 mmHg, P=0.10). Late prosthesis failure occurred in 4 cases (2.4%). Thirty-day mortality was 4.7%, and estimated survival rates by Kaplan-Meyer after 1, 5 and 8 years were 87.6%, 44.9%, and 24.5%, respectively, without difference between THV groups. Rates of cardiovascular death, stroke, myocardial infarction (MI) and congestive heart failure (CHF) were also similar with CV and ES at long-term follow-up. History of CHF, pre-existent severe mitral regurgitation, paravalvular leak grade ≥2+, and chronic obstructive pulmonary disease were independent predictors of late mortality at multivariable analysis. CONCLUSIONS: Clinical and hemodynamic outcomes of patients treated by self-expandable CV or balloon-expandable ES THV were favorable and similar throughout long-term follow-up, with a rate of prosthesis failure of less than 3%

Coronary access after transcatheter aortic valve replacement

Coronary artery disease (CAD) and aortic stenosis (AS) often coexist. While the clinical impact of CAD on subjects with AS undergoing transcatheter aortic valve replacement (TAVR) is controversial, current guidelines suggest revascularization of proximal severe CAD before TAVR. This recommendation is mainly based on concerns about the possibility to reaccess the coronary arteries once the transcatheter heart valve (THV) is in place. In fact, previous case series report challenges in cannulation of coronary ostia after TAVR, particularly with self-expandable THVs. These aspects are important as indication to TAVR is moving towards younger patients, who are more likely to need CA, giving the progressive nature of CAD and their longer life expectancy. The first objective of our research was to assess the incidence of coronary access (CA) after TAVR at long-term follow up in a high-volume center, evaluating safety and feasibility of coronary angiography and percutaneous coronary intervention (PCI) after TAVR with different types of THVs. At a median follow up over 3 years, incidence of CA after TAVR was 5.3%. In one out of three patients, indication to CA was an acute coronary syndrome, and PCI was performed in over half of the cases. Independent predictors of CA after TAVR were younger age, previous PCI and CABG. CA of both vessels was feasible in all patients with an intra-annular THV, while the right coronary artery was not engaged in two patients with a supra-annular THV. PCI was successful in all but one case. All-cause mortality tended to be higher for patients needing CA for acute coronary syndrome. Secondly, we evaluated advantages and pitfalls of CA after TAVR in the presence of bicuspid aortic valve (BAV) stenosis. We performed post-TAVR 3-dimensional computed tomography in patients with BAV treated both with balloon-expanding and self-expandable THVs. In this particular anatomical setting, CA after TAVR as advantages and pitfalls. For instance, the potential asymmetrical prosthesis expansion when the rafe is located between the left and right coronary cusp generates a larger free space between the valve frame and the coronary ostia, thereby simplifying CA. On the contrary, the higher implantation of the THV in the setting of BAV represents a potential challenge for CA. Finally, we aimed to assess the feasibility of CA after TAVR-in-TAVR. In fact, as TAVR indication is moving towards patients with longer life expectancy, THV degeneration will be increasingly common. TAVR-in-TAVR is an appealing therapeutic option in this setting, but concerns have been raised about the risk of acute coronary obstruction and the possibility to re-access the coronaries once the second prosthesis is in place. In fact, when the second THV is implanted, the leaflets of the first prosthesis are displaced vertically, creating a cylindric cage which will impair CA and possibly coronary flow. Consequently, there is a risk plane under which the first valve frame will not be crossable after TAVR-in-TAVR. We therefore developed a novel, imaging-based algorithm to predict possible coronary access impairment after TAVR-in-TAVR, based on the way CA is gained after the index TAVR and on the distance between prosthesis frame and aortic wall under the level of the RP. We then tested our hypothesis by performing coronary angiography after TAVR in 137 consecutive patients. According to our algorithm, CA after TAVR-in-TAVR might be impaired in almost 1/3 of patients currently treated by TAVR. This risk appears to be less frequent with intra-annular SAPIEN 3 as compared to supra-annular Evolut R/Pro and Acurate Neo THVs. Implantation of a supra-annular device, female gender and small sino-tubular junction are independent predictors of possible CA impairment after TAVR-in-TAVR. These results, which will need to be validated in clinical practice, are important for patient counseling and prosthesis selection in subjects with longer life expectanc

Coronary access after transcatheter aortic valve replacement

Coronary artery disease (CAD) and aortic stenosis (AS) often coexist. While the clinical impact of CAD on subjects with AS undergoing transcatheter aortic valve replacement (TAVR) is controversial, current guidelines suggest revascularization of proximal severe CAD before TAVR. This recommendation is mainly based on concerns about the possibility to reaccess the coronary arteries once the transcatheter heart valve (THV) is in place. In fact, previous case series report challenges in cannulation of coronary ostia after TAVR, particularly with self-expandable THVs. These aspects are important as indication to TAVR is moving towards younger patients, who are more likely to need CA, giving the progressive nature of CAD and their longer life expectancy. The first objective of our research was to assess the incidence of coronary access (CA) after TAVR at long-term follow up in a high-volume center, evaluating safety and feasibility of coronary angiography and percutaneous coronary intervention (PCI) after TAVR with different types of THVs. At a median follow up over 3 years, incidence of CA after TAVR was 5.3%. In one out of three patients, indication to CA was an acute coronary syndrome, and PCI was performed in over half of the cases. Independent predictors of CA after TAVR were younger age, previous PCI and CABG. CA of both vessels was feasible in all patients with an intra-annular THV, while the right coronary artery was not engaged in two patients with a supra-annular THV. PCI was successful in all but one case. All-cause mortality tended to be higher for patients needing CA for acute coronary syndrome. Secondly, we evaluated advantages and pitfalls of CA after TAVR in the presence of bicuspid aortic valve (BAV) stenosis. We performed post-TAVR 3-dimensional computed tomography in patients with BAV treated both with balloon-expanding and self-expandable THVs. In this particular anatomical setting, CA after TAVR as advantages and pitfalls. For instance, the potential asymmetrical prosthesis expansion when the rafe is located between the left and right coronary cusp generates a larger free space between the valve frame and the coronary ostia, thereby simplifying CA. On the contrary, the higher implantation of the THV in the setting of BAV represents a potential challenge for CA. Finally, we aimed to assess the feasibility of CA after TAVR-in-TAVR. In fact, as TAVR indication is moving towards patients with longer life expectancy, THV degeneration will be increasingly common. TAVR-in-TAVR is an appealing therapeutic option in this setting, but concerns have been raised about the risk of acute coronary obstruction and the possibility to re-access the coronaries once the second prosthesis is in place. In fact, when the second THV is implanted, the leaflets of the first prosthesis are displaced vertically, creating a cylindric cage which will impair CA and possibly coronary flow. Consequently, there is a risk plane under which the first valve frame will not be crossable after TAVR-in-TAVR. We therefore developed a novel, imaging-based algorithm to predict possible coronary access impairment after TAVR-in-TAVR, based on the way CA is gained after the index TAVR and on the distance between prosthesis frame and aortic wall under the level of the RP. We then tested our hypothesis by performing coronary angiography after TAVR in 137 consecutive patients. According to our algorithm, CA after TAVR-in-TAVR might be impaired in almost 1/3 of patients currently treated by TAVR. This risk appears to be less frequent with intra-annular SAPIEN 3 as compared to supra-annular Evolut R/Pro and Acurate Neo THVs. Implantation of a supra-annular device, female gender and small sino-tubular junction are independent predictors of possible CA impairment after TAVR-in-TAVR. These results, which will need to be validated in clinical practice, are important for patient counseling and prosthesis selection in subjects with longer life expectanc

DinoSAVR noqueado por los asteroides TAVI

Over the last decade, transcatheter aortic valve replacement (TAVR) has become the preferred treatment for patients with severe aortic stenosis at increased risk for surgery. Consequently, this new technology has been recently tested in low-risk subjects. The PARTNER 3 trial randomized 1000 patients (mean Society of Thoracic Surgeons score, 1.9%; mean age, 73 years) to undergo TAVR with a balloon-expandable valve or surgical aortic valve replacement showing that TAVR was superior in terms of the composite endpoint of death, stroke and re-hospitalization at 1 year. In the Evolut Low Risk trial that randomized 1468 patients with the use of a self-expandable prosthesis, TAVR was non-inferior to surgery for the primary composite endpoint of death or disabling stroke at 24 months. While the available 1-year follow up does not answer the question of transcatheter valves durability, these results will definitely change our everyday clinical practice.En la última década, el reemplazo valvular aórtico transcatéter (TAVR, por sus siglas en inglés) se ha convertido en el tratamiento preferente para los pacientes con estenosis aórtica grave y con alto o incluso moderado riesgo quirúrgico. En consecuencia, esta nueva tecnología ha sido evaluada en sujetos de bajo riesgo quirúrgico. En el estudio PARTNER 3 se aleatorizó a 1.000 pacientes (puntuación media de la Society of Thoracic Surgeons, 1,9%; edad media, 73 años) para ser sometidos a TAVR con una válvula balón expandible o a reemplazo quirúrgico de válvula aórtica, y se halló que la TAVR fue superior en términos del objetivo final compuesto de muerte, ictus y reingreso a 1 año. En el ensayo Evolut Low Risk, en el que 1.468 pacientes fueron aleatorizados a TAVR con una prótesis autoexpandible o cirugía, la TAVR no fue inferior a esta última en términos del criterio de valoración principal compuesto de muerte o accidente cerebrovascular discapacitante a los 24 meses. Si bien el seguimiento a 1-2 años disponible no responde a la pregunta sobre la durabilidad de las válvulas transcatéter, estos resultados cambiarán nuestra práctica clínica diaria