Temporal Trends, Characteristics, and Outcomes of Infective Endocarditis After Transcatheter Aortic Valve Replacement

BACKGROUND Procedural improvements combined with the contemporary clinical profile of patients undergoing transcatheter aortic valve replacement (TAVR) may have influenced the incidence and outcomes of infective endocarditis (IE) following TAVR. We aimed to determine the temporal trends, characteristics, and outcomes of IE post-TAVR. METHODS Observational study including 552 patients presenting definite IE post-TAVR. Patients were divided in 2 groups according to the timing of TAVR (historical cohort [HC]: before 2014; contemporary cohort [CC]: after 2014). RESULTS Overall incidence rates of IE were similar in both cohorts (CC vs HC: 5.45 vs 6.52 per 1000 person-years; P = .12), but the rate of early IE was lower in the CC (2.29‰ vs 4.89‰, P < .001). Enterococci were the most frequent microorganism. Most patients presented complicated IE ( CC: 67.7%; HC: 69.6%; P = .66), but the rate of surgical treatment remained low (CC: 20.7%; HC: 17.3%; P = .32). The CC exhibited lower rates of in-hospital acute kidney injury (35.1% vs 44.6%; P = .036) and in-hospital (26.6% vs 36.4%; P = .016) and 1-year (37.8% vs 53.5%; P < .001) mortality. Higher logistic EuroScore, Staphylococcus aureus etiology, and complications (stroke, heart failure, and acute renal failure) were associated with in-hospital mortality in multivariable analyses (P < .05 for all). CONCLUSIONS Although overall IE incidence has remained stable, the incidence of early IE has declined in recent years. The microorganism, high rate of complications, and very low rate of surgical treatment remained similar. In-hospital and 1-year mortality rates were high but progressively decreased over time

Le forme della regalità nella Roma latino-sabina

The analysis of historical sources, onomastics data, and the festive calendar, shows that the most archaic Roman kingship was structured in the form of a diarchy between a lifelong king-priest and a temporary warrior-king: the latter ruled in the season of war, while in peacetime the city government was led in turn by the patres (interregnum). This diarchy could be the result of the influence, on Roman institutions, of the constitutional structures of the Greeks and of the Italic peoples, since among other Indo-European cultures, like Vedic India and the Celts, the pattern seems rather to be a triad — composed of a priest, a supreme king and a warrior king — surviving in Rome only at a theological level in the Pre-Capitoline triad Iuppiter Mars Quirinus. Given these premises, the subsequent Etruscan monarchy appears to be the result of the rising of the army commander to a tyrannical and lifelong power, and of the marginalization of the rex sacrorum, while the Republic seems a partial restoration of the oldest constitution