Long-term outcome of surgical revascularisation in patients with reduced left ventricular ejection fraction-a population based cohort study

© The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.BACKGROUND: Surgical revascularization is an established indication for patients with advanced coronary artery disease and reduced left ventricular ejection fraction (LVEF). Long-term outcomes for these patients are not well defined. We studied the long-term outcomes of patients with ischaemic cardiomyopathy who underwent surgical revascularization in a well-defined nationwide cohort. MATERIALS AND METHODS: A retrospective study on 2,005 patients that underwent isolated coronary artery bypass grafting (CABG) in Iceland between 2000-2016. Patients were catagorized into two groups based on their preoperative LVEF; LVEF ≤35% (n = 146, median LVEF 30%) and LVEF >35% (n = 1859, median LVEF 60%). Demographics and major adverse cardiac and cerebrovascular events (MACCE), were compared between groups along with cardiac-specific and overall survival. Mean follow-up was 7.6 years. RESULTS: Demographics were similar in both groups regarding age, gender, and most cardiovascular risk factors. However, patients with LVEF ≤35% more often had diabetes, renal insufficiency, chronic obstructive pulmonary disease and a previous history of myocardial infarction. Thirty-day mortality was four times higher (8% vs 2%, p < 0.001) in the LVEF ≤35%-group compared to controls. MACCE-free survival was 83% and 62% at 1 and 5 years for LVEF ≤35%-group compared to 94% and 82% for the control group. Overall survival was also significantly lower in the same groups, or 87% and 69% (p < 0.001) compared to 98% and 91% (p < 0.001), at 1 and 5 years respectively. CONCLUSIONS: A good long-term outcome after CABG can be expected for patients with reduced LVEF, however, their survival is still significantly inferior to patients with normal ventricular function.Peer reviewe

Tölulegir reikningar á Ising líkani

Ising-líkanið er líkan í safneðlisfræði, sem notað er til þess að lýsa járnseglandi efnum. Í einföldu máli lýsir líkanið spunum á grind og getur hver spuni snúið upp eða niður. Sérhver spuni víxlverkar jafnframt við næstu nágranna á grind og við ytra segulsvið.líkaninu geta komið fram fasabreytingar milli járnseglandi fasa, þar sem mikill meirihluti spuna vísar í sömu stefnu, og óseglandi fasa, þar sem stefur spuna eru handahósfkenndar. Í þessu verkefni er leitast við að nota Monte-Carlo reiknirit til þess að lýsa líkaninu með tölulegum reikningum. Monte-Carlo reiknirit nota slembitölur á einn eða annan hátt til þess að fá tölulega niðurstöðu í reikningum þar sem erfitt er að leiða út nákvæma lausn. Eðli þessara reikninga er slíkt að þeir krefjast mikillar reiknigetu miðað við minnisnotkun. Skjákort eru því tilvalinn vélbúnaður til slíkra reikninga, þar sem þau bjóða upp á hraða samhliða vinnslu en hafa nokkuð takmarkað minni, miðað við vinnslu á hefðbundnari vélbúnað. Reikningar í verkefninu eru útfærðir í CUDA C, forritunarumhverfi úr smiðju Nvidia. Leitast er við að gera sem stærstan hluta reikninganna samhliða þannig að hinn mikli fjöldi reiknieininga á skjákortinu nýtist sem best

Áunnar erfðabreytingar í BRCA2 tengdum krabbameinum

Inngangur: Arfgenga stökkbreytingin 999del5 í BRCA2 eykur áhættu á krabbameinum í brjóstum, eggjastokkum og blöðruhálskirtli. BRCA2 tekur þátt í viðgerð tvíþátta brota DNA með samstæðri endurröðun, skortur á starfsemi þess eykur óstöðugleika erfðamengisins, sem m.a. getur valdið áunnum DNA eintakafjöldabreytingum (copy number variations, CNVs). Markmið: Að greina CNVs í brjósta, eggjastokka og blöðruhálskirtilskrabbameinum og kanna hvort þau þau væru ólík hjá einstaklingum með stökkbreytinguna 999del5 í BRCA2. Efniviður og aðferðir:CNVs voru greind í 139 sýnum úr brjósta- (115 úr konum, 8 úr körlum), eggjastokka- (10) og blöðruhálskirtilskrabbameinum (6). Stökkbreytingin 999del5 var greind hjá þátttakendum. Niðurstöður: Tap á heilum litningsörmum var algengara hjá 999del5 arfberum (p=.02). Klösun æxlissýna eftir CNVs sýnum í þrjá klasa (clusters). Dreifing æxlisgerða var ójöfn meðal klasa (p<.01) og dreifing 999del5 arfbera meðal klasa var einnig ójöfn (p < .01), klasi tvö hafði hæst hlutfall 999del5 arfbera. Klasarnir voru ekki sjálfstæðir áhættuþættir fyrir lifun sjúklinga. 999del5 arfberar sýndu tengsl milli taps á svæðinu 26-53Mb á litningi 13 við CNVs á sjö öðrum litningsörmum. Tap á svæðinu 26-53Mb á litningi 13 var algengara í klösum tvö og þrjú (p < .001). Ályktanir: Brjósta, eggjastokka og blöðruhálskirtilskrabbamein úr 999del5 arfberum einkennast af tapi á ákveðnum svæðum í erfðamenginu. Klösun sýna byggð á CNVs ber kennsl á þrjá klasa, einn þeirra inniheldur hátt hlutfall 999del5 arfbera, hátt hlutfall eggjastokkakrabbameina og æxli úr þeim hóp sýna miklar breytingar á svæðum sem eru tengd við tap á BRCA2 geninu. Þetta bendir til þess að þessi klasi innihaldi æxli sem eru "BRCA-like"

Long term outcome of valve repair for degenerative mitral valve disease in Iceland

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadINNGANGUR Hrörnunartengdur míturlokuleki er helsta ábendingin fyrir míturlokuviðgerð á Vesturlöndum. Tilgangur rannsóknarinnar var að kanna langtímalifun og fylgikvilla míturlokuviðgerða vegna hrörnunartengds leka á Íslandi. EFNI OG AÐFERÐIR Rannsóknin var afturskyggn og náði til 101 sjúklings (meðalaldur 57,7 ár, 80,2% karlar) sem gengust undir míturlokuviðgerð vegna hrörnunartengds leka á Landspítala 2004-2018. Skráðar voru ábendingar fyrir aðgerð, niðurstöður hjartaómunar fyrir aðgerð og aðgerðartengdir þættir. Snemmkomnir (<30 daga) og síðkomnir fylgikvillar voru skráðir og reiknuð 30 daga dánartíðni. Langtímalifun og MACCE (major adverse cardiac and cerebrovascular event) frí lifun var áætluð með aðferð Kaplan-Meier og borin saman við almennt þýði af sama kyni og aldri. Miðgildi eftirfylgdartíma var 83 mánuðir. NIÐURSTÖÐUR Að meðaltali voru gerðar 6,7 (bil 1-14) míturlokuviðgerðir árlega og fengu 99% sjúklinga gervihring. Brottnám á aftara blaði var framkvæmt í 82,2% tilfella og Gore-Tex® gervistög notuð hjá 64,4% sjúklinga. Alvarlegir fylgikvillar greindust hjá 28,7% sjúklinga, algengastir voru hjartadrep tengt aðgerð (11,9%) og enduraðgerð vegna blæðingar (8,9%). Þrjátíu daga dánarhlutfall var 2%, miðgildi dvalar á gjörgæslu einn dagur og heildarlegutími 8 dagar. Einn sjúklingur þurfti enduraðgerð síðar vegna endurtekins míturlokuleka. Fimm ára lifun eftir aðgerð var 93,5% (95%-ÖB: 88,6-98,7) og 10 ára lifun 85,3% (95%-ÖB: 76,6- 94,9). Fimm ára MACCE-frí lifun var 91,1% (95%-ÖB: 85,3-97,2) og eftir 10 ár 81,0% (95%-ÖB: 71,6-91,6). Ekki reyndist marktækur munur á heildarlifun rannsóknarhópsins samanborið við samanburðarþýðið (p=0,135, log-rank próf). ÁLYKTUN Árangur míturlokuviðgerða vegna hrörnunartengds leka er sambærilegur við árangur á stærri hjartaskurðdeildum erlendis. Almennt farnast þessum sjúklingum ágætlega til lengri tíma þrátt fyrir að snemmkomnir fylgikvillar séu tíðirOBJECTIVES: Degenerative mitral valve disease is the most common indication for mitral valve repair in the Western world. The aim of this study was to study the long term outcome of mitral valve repair for degenerative mitral valve regurgitation in Iceland. MATERIAL AND METHODS: A retrospective study of 101 consecutive mitral valve repair patients (average age 57.7 years, 80.2% male) operated in Iceland 2004-2018 for degenerative mitral valve regurgitation. Long term survival and MACCE (major adverse cardiac and cerebrovascular event) free survival was estimated using the Kaplan-Meier method and compared to age and gender matched reference population. Median follow-up time was 83 months. RESULTS: On average there were 6,7 (range 1-14) mitral valve repairs performed annually with 99% of the patients receiving ring annuloplasty. A total of 82 (82,2%) underwent resection of the posterior leaflet and 64.4% recieved Gore-Tex®-chordae. Major early complications occured in 28.7% of cases, most commonly perioperative myocardial infarction (11.9%) and reoperation for bleeding (8.9%). Mortality within 30 days was 2%, the median duration of intensive care unit stay was one day and the median hospital length of stay was 8 days. One patient needed reoperation later for recurrent mitral regurgitation. Five and ten year MACCEfree survival was 91.1% (95%-CI: 85.3-97.2) and 81.0 (95%-CI: 71.6-91.6), respectively. Five year survival was 93.5% (95-CI: 88.6-98.7) and 10 year survival 85.3% (95%-CI: 76.6-94.9), which was not different from an age and gender matched reference population (p=0.135, log-rank test). CONCLUSION: Outcomes of mitral valve repair due to degenerative mitral regurgitation is good in Iceland and results are comparable to larger institutions overseas. Long term prognosis is generally good although early postoperative complications often occur.Vísindasjóður Landspítala, Rannsóknarsjóður Háskóla Íslands og Minningarsjóður Helgu Jónsdóttur og Sigurliða Kristjánssona

Langtímaárangur viðgerða vegna hrörnunartengds míturlokuleka á Íslandi

OBJECTIVES: Degenerative mitral valve disease is the most common indication for mitral valve repair in the Western world. The aim of this study was to study the long term outcome of mitral valve repair for degenerative mitral valve regurgitation in Iceland. MATERIAL AND METHODS: A retrospective study of 101 consecutive mitral valve repair patients (average age 57.7 years, 80.2% male) operated in Iceland 2004-2018 for degenerative mitral valve regurgitation. Long term survival and MACCE (major adverse cardiac and cerebrovascular event) free survival was estimated using the Kaplan-Meier method and compared to age and gender matched reference population. Median follow-up time was 83 months. RESULTS: On average there were 6,7 (range 1-14) mitral valve repairs performed annually with 99% of the patients receiving ring annuloplasty. A total of 82 (82,2%) underwent resection of the posterior leaflet and 64.4% recieved Gore-TexR-chordae. Major early complications occured in 28.7% of cases, most commonly perioperative myocardial infarction (11.9%) and reoperation for bleeding (8.9%). Mortality within 30 days was 2%, the median duration of intensive care unit stay was one day and the median hospital length of stay was 8 days. One patient needed reoperation later for recurrent mitral regurgitation. Five and ten year MACCEfree survival was 91.1% (95%-CI: 85.3-97.2) and 81.0 (95%-CI: 71.6-91.6), respectively. Five year survival was 93.5% (95-CI: 88.6-98.7) and 10 year survival 85.3% (95%-CI: 76.6-94.9), which was not different from an age and gender matched reference population (p=0.135, log-rank test). CONCLUSION: Outcomes of mitral valve repair due to degenerative mitral regurgitation is good in Iceland and results are comparable to larger institutions overseas. Long term prognosis is generally good although early postoperative complications often occur

Effectiveness of medical treatment in the adult ADHD unit of Landspitali 2015-2017

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadINNGANGUR Athyglisbrestur með ofvirkni (ADHD) er algengasta taugaþroskaröskunin sem greind er hjá börnum en einkenni geta varað fram á fullorðinsár. Á Landspítala starfar þverfaglegt teymi sem sér um greiningu og meðferð ADHD hjá fullorðnum. Markmið þessarar rannsóknar er að meta árangur lyfjameðferðar sem veitt er af teyminu og áhrif fylgiraskana. EFNIVIÐUR OG AÐFERÐIR Rannsóknin var afturskyggn og náði til allra 18 ára og eldri sem komu í fyrsta viðtal til læknis hjá ADHD-teymi Landspítala 2015- 2017 og þáðu lyfjameðferð. Einstaklingar sem höfðu áður fengið meðferð hjá teyminu eða voru þegar á lyfjameðferð voru undanskildir. Upplýsingar um einkenni og líðan fyrir og eftir meðferð fengust úr spurningalistunum ADHD-hegðunarmatskvarði, DASS og QOLS. NIÐURSTÖÐUR Af 211 sjúklingum sem uppfylltu skilyrði rannsóknarinnar voru 144 (68%) sem luku meðferð hjá ADHD-teyminu á að meðaltali 143 dögum. Hvatvísi/ofvirkni reyndist forspárþáttur fyrir að falla úr meðferð með OR=0,96 (p=0,015). Marktækur munur var á öllum breytum fyrir og eftir lyfjameðferð (p<0,001). Fyrir ADHD-einkenni var hrifstærð Cohens d=3,18 fyrir athyglisbrest og 1,40 fyrir hvatvísi/ofvirkni. Hrifstærð fyrir lífsgæði var 1,00 en af DASS-undirkvörðum var hrifstærðin hæst 1,43 fyrir streitu. Fylgni var milli aukinna lífsgæða og minnkandi einkenna. Hjá einstaklingum með fleiri geðgreiningar en ADHD var meðferðarárangur marktækt meiri fyrir DASS en ekki var marktækur munur fyrir athyglisbrest, hvatvísi/ ofvirkni og lífsgæði. Ekki var marktækur munur á meðferðarárangri eftir kyni. ÁLYKTUN Einstaklingar sem ljúka meðferð í ADHD-teymi ná miklum árangri sem felst í minnkun einkenna og betri lífsgæðum. Brottfall úr meðferð er hins vegar mikið vandamál.Background: Attention deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder among children but symptoms may persist into adulthood. At Landspitali - the National University Hospital an interdisciplinary unit is responsible for ADHD-diagnosis and for commencing treatment of adult ADHD. The aim of this study is to evaluate the effectiveness of pharmaceutical treatment provided by the unit and the effects of psychiatric comorbidities. Methods: The study is retrospective and includes all individuals ≥18 years of age who received pharmaceutical treatment in the adult ADHD unit at Landspitali 2015-2017. Individuals who had previously received treatment by the unit or were already on medication for ADHD were excluded. Information on symptoms and wellbeing before and after treatment were obtained from three questionnaires, an ADHD rating scale, DASS and QOLS. Results: Of 211 patients who met inclusion criteria 144 (68%) completed the treatment provided by the unit on average 143 days. Impulsivity/hyperactivity predicted treatment failure with OR=0.96 (p=0.015). There was a statistically significant difference in all key response variables before and after pharmaceutical treatment (p<0.001). The Cohen‘s d effect size for ADHD variables were 3.18 for attention-deficit and 1.40 for impulsivity/hyperactivity. The effect size for quality of life was 1.00 and among the DASS subscales the maximum effect size was 1.43 for stress. Increased quality of life correlated with decreased symptoms as rated by DASS and the ADHD rating scale. Treatment success rates were significantly higher for DASS but not for attention-deficit, impulsivity/ hyperactivity and quality of life among individuals with psychiatric comorbidities alongside ADHD. Gender did not affect treatment effectiveness. Conclusions: Those who complete treatment within the ADHD unit achieve good results with decreased psychiatric symptoms and improved quality of life. Treatment discontinuation is a challenge

Indications and outcomes of TAVI (transcatheter aortic valve implantation) in Iceland

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadINNGANGUR Ósæðarlokuþrengsl eru algengasti lokusjúkdómurinn á Vesturlöndum. Hefðbundin meðferð við alvarlegum þrengslum hefur verið opin ósæðarlokuskipti en síðastliðin ár hefur ósæðarlokuísetning með þræðingartækni (TAVI) rutt sér til rúms hér á landi sem erlendis. Markmið rannsóknarinnar var að kanna árangur TAVI-aðgerða á Íslandi með áherslu á ábendingar, fylgikvilla og lifun. EFNIVIÐUR OG AÐFERÐIR Rannsóknin var afturskyggn og tók til allra TAVI-aðgerða sem framkvæmdar hafa verið á Íslandi frá janúar 2012 til loka júní 2020. Skráðir voru bakgrunnsþættir sjúklinga, afdrif og fylgikvillar en einnig heildarlifun sem borin var saman við íslenskt viðmiðunarþýði af sama kyni og aldri. Meðal eftirfylgd var 2,4 ár. NIÐURSTÖÐUR Alls voru framkvæmdar 189 aðgerðir (meðalaldur 83 ± 6 ár, 41,8% konur), allar með sjálfþenjandi lífrænni gerviloku. Flestir sjúklingar (81,5%) höfðu alvarleg hjartabilunareinkenni (NYHA-flokkar III-IV) og miðgildi EuroSCORE-II var 4,9 (bil 0,9-32). Á hjartaómskoðun fyrir aðgerð var hámarks þrýstingsfallandi að meðaltali 78 mmHg og lokuflatarmál 0,67 cm2 . Rúmlega fjórðungur (26,5%) sjúklinga þurfti ísetningu varanlegs gangráðs í kjölfar TAVI-aðgerðar. Aðrir fylgikvillar voru oftast æðatengdir (13,8%), en hjartaþröng greindist í 3,2% tilfella og heilablóðfall í 2,6%. . Mikill randstæður leki við gerviloku sást hjá 0,5% sjúklinga. Dánartíðni innan 30 daga frá aðgerð var 1,6% (n=3) og lifun einu ári frá aðgerðadegi 93,5% (95% ÖB: 89.8-97.3). Heildarlifun var sambærileg lifun viðmiðunarþýðis af sama kyni og sama aldri (p=0,23). ÁLYKTANIR Árangur TAVI-aðgerða hér á landi er mjög góður, ekki síst þegar litið er til lágrar 30 daga dánartíðni og heildarlifunar sem var sambærileg og hjá viðmiðunarþýði. Auk þess var tíðni alvarlegra fylgikvilla lág.INTRODUCTION: Surgical aortic valve replacement (SAVR) has been the standard of treatment for aortic stenosis but transcatheter aortic valve implantation (TAVI) is increasingly used as treatment in Iceland and elsewhere. Our objective was to assess the outcome of TAVI in Iceland, focusing on indications, complications and survival. MATERIAL AND METHODS: This retrospective study included all TAVI-procedures performed in Iceland between January 2012 and June 2020. Patient characteristics, outcome and complications were registered, and overall estimated survival compared to an age and sex matched Icelandic reference-population. The mean follow-up was 2.4 years. RESULTS: Altogether 189 TAVI procedures (mean age 83±6 years, 41.8% females), were performed, all with a self-expanding biological valve. Most patients (81.5%) had symptoms of severe heart failure (NYHA-class III-IV) and median EuroSCORE-II was 4.9 (range: 0.9-32). Echocardiography pre-TAVI showed a mean aortic-valve area of 0.67 cm2 and a max aorticvalve gradient of 78 mmHg. One out of four patients (26.5%) needed permanent pacemaker implantation following TAVI. Other complications were mostly vascular-related (13.8%) but cardiac cardiac temponade and stroke occurred in 3.2 and 2.6% of cases, respectively and severe paravalvular aortic valve regurgitation in 0.5% cases. Thirty-day mortality was 1.6% (n=3) with one-year survival of 93.5% (95% CI: 89.8-97.3). Finally long-term survival survival of TAVI-patients was similar to the matched reference population (p=0.23). CONCLUSIONS: The outcome of TAVI-procedures in Iceland is good, especially regarding 30-day mortality and long-term survival that was comparable to a reference population. Incidence of major complications was also low

Indications and outcomes of TAVI (transcatheter aortic valve implantation) in Iceland

Publisher Copyright: © 2021 Laeknafelag Islands. All rights reserved.INNGANGUR Ósæðarlokuþrengsl eru algengasti lokusjúkdómurinn á Vesturlöndum. Hefðbundin meðferð við alvarlegum þrengslum hefur verið opin ósæðarlokuskipti en síðastliðin ár hefur ósæðarlokuísetning með þræðingartækni (TAVI) rutt sér til rúms hér á landi sem erlendis. Markmið rannsóknarinnar var að kanna árangur TAVI-aðgerða á Íslandi með áherslu á ábendingar, fylgikvilla og lifun. EFNIVIÐUR OG AÐFERÐIR Rannsóknin var afturskyggn og tók til allra TAVI-aðgerða sem framkvæmdar hafa verið á Íslandi frá janúar 2012 til loka júní 2020. Skráðir voru bakgrunnsþættir sjúklinga, afdrif og fylgikvillar en einnig heildarlifun sem borin var saman við íslenskt viðmiðunarþýði af sama kyni og aldri. Meðal eftirfylgd var 2,4 ár. NIÐURSTÖÐUR Alls voru framkvæmdar 189 aðgerðir (meðalaldur 83 ± 6 ár, 41,8% konur), allar með sjálfþenjandi lífrænni gerviloku. Flestir sjúklingar (81,5%) höfðu alvarleg hjartabilunareinkenni (NYHA-flokkar III-IV) og miðgildi EuroSCORE-II var 4,9 (bil 0,9-32). Á hjartaómskoðun fyrir aðgerð var hámarks þrýstingsfallandi að meðaltali 78 mmHg og lokuflatarmál 0,67 cm2. Rúmlega fjórðungur (26,5%) sjúklinga þurfti ísetningu varanlegs gangráðs í kjölfar TAVI-aðgerðar. Aðrir fylgikvillar voru oftast æðatengdir (13,8%), en hjartaþröng greindist í 3,2% tilfella og heilablóðfall í 2,6%. Mikill randstæður leki við gerviloku sást hjá 0,5% sjúklinga. Dánartíðni innan 30 daga frá aðgerð var 1,6% (n=3) og lifun einu ári frá aðgerðadegi 93,5% (95% ÖB: 89.8-97.3). Heildarlifun var sambærileg lifun viðmiðunarþýðis af sama kyni og sama aldri (p=0,23). ÁLYKTANIR Árangur TAVI-aðgerða hér á landi er mjög góður, ekki síst þegar litið er til lágrar 30 daga dánartíðni og heildarlifunar sem var sambærileg og hjá viðmiðunarþýði. Auk þess var tíðni alvarlegra fylgikvilla lág. INTRODUCTION: Surgical aortic valve replacement (SAVR) has been the standard of treatment for aortic stenosis but transcatheter aortic valve implantation (TAVI) is increasingly used as treatment in Iceland and elsewhere. Our objective was to assess the outcome of TAVI in Iceland, focusing on indications, complications and survival. MATERIAL AND METHODS: This retrospective study included all TAVI-procedures performed in Iceland between January 2012 and June 2020. Patient characteristics, outcome and complications were registered, and overall estimated survival compared to an age and sex matched Icelandic reference-population. The mean follow-up was 2.4 years. RESULTS: Altogether 189 TAVI procedures (mean age 83±6 years, 41.8% females), were performed, all with a self-expanding biological valve. Most patients (81.5%) had symptoms of severe heart failure (NYHA-class III-IV) and median EuroSCORE-II was 4.9 (range: 0.9-32). Echocardiography pre-TAVI showed a mean aortic-valve area of 0.67 cm2 and a max aortic-valve gradient of 78 mmHg. One out of four patients (26.5%) needed permanent pacemaker implantation following TAVI. Other complications were mostly vascular-related (13.8%) but cardiac cardiac temponade and stroke occurred in 3.2 and 2.6% of cases, respectively and severe paravalvular aortic valve regurgitation in 0.5% cases. Thirty-day mortality was 1.6% (n=3) with one-year survival of 93.5% (95% CI: 89.8-97.3). Finally long-term survival survival of TAVI-patients was similar to the matched reference population (p=0.23). CONCLUSIONS: The outcome of TAVI-procedures in Iceland is good, especially regarding 30-day mortality and long-term survival that was comparable to a reference population. Incidence of major complications was also low.INTRODUCTION: Surgical aortic valve replacement (SAVR) has been the standard of treatment for aortic stenosis but transcatheter aortic valve implantation (TAVI) is increasingly used as treatment in Iceland and elsewhere. Our objective was to assess the outcome of TAVI in Iceland, focusing on indications, complications and survival. MATERIAL AND METHODS: This retrospective study included all TAVI-procedures performed in Iceland between January 2012 and June 2020. Patient characteristics, outcome and complications were registered, and overall estimated survival compared to an age and sex matched Icelandic reference-population. The mean follow-up was 2.4 years. RESULTS: Altogether 189 TAVI procedures (mean age 83?}6 years, 41.8% females), were performed, all with a self-expanding biological valve. Most patients (81.5%) had symptoms of severe heart failure (NYHA-class III-IV) and median EuroSCORE-II was 4.9 (range: 0.9-32). Echocardiography pre-TAVI showed a mean aortic-valve area of 0.67 cm2 and a max aorticvalve gradient of 78 mmHg. One out of four patients (26.5%) needed permanent pacemaker implantation following TAVI. Other complications were mostly vascular-related (13.8%) but cardiac cardiac temponade and stroke occurred in 3.2 and 2.6% of cases, respectively and severe paravalvular aortic valve regurgitation in 0.5% cases. Thirty-day mortality was 1.6% (n=3) with one-year survival of 93.5% (95% CI: 89.8-97.3). Finally long-term survival survival of TAVI-patients was similar to the matched reference population (p=0.23). CONCLUSIONS: The outcome of TAVI-procedures in Iceland is good, especially regarding 30-day mortality and long-term survival that was comparable to a reference population. Incidence of major complications was also low.Peer reviewe

AMS 14C Dating on the Fossvogur Sediments, Iceland

From the 13th International Radiocarbon Conference held in Dubrovnik, Yugoslavia, June 20-25, 1988.Several new AMS 14C dates on shells from the Fossvogur sea sediments in southern Iceland are reported. Up till now, researchers have assumed that the Fossvogur sediments formed during the last interglacial period (Eem), some 100,000 years ago. However, a recent 14C determination from this location yielded an age of ca 11,000 yr. Because of the importance of these sediments for the Quaternary chronology of Iceland, further sampling for 14C dating was subsequently initiated. The present results on several shell samples collected from the Fossvogur layers strongly indicate that these sediments were formed during the warm Allerød period toward the end of the last glaciation.This material was digitized as part of a cooperative project between Radiocarbon and the University of Arizona Libraries.The Radiocarbon archives are made available by Radiocarbon and the University of Arizona Libraries. Contact [email protected] for further information.Migrated from OJS platform February 202

Early outcome of surgical aortic valve replacement for aortic stenosis in Icelandic females

Publisher Copyright: © 2019 Laeknafelag Islands. All rights reserved.Inngangur Ósæðarlokuskipti er önnur algengasta hjartaskurðaðgerðin á Íslandi. Markmið rannsóknarinnar er að meta í fyrsta sinn á Íslandi snemmkominn árangur opinna ósæðarlokuskipta vegna ósæðarlokuþrengsla hjá konum. Efniviður og aðferðir Afturskyggn rannsókn á 428 sjúklingum sem gengust undir opin ósæðarlokuskipti vegna ósæðarlokuþrengsla á Íslandi 2002-2013. Upplýsingar fengust úr sjúkraskrám og voru skráðir fylgikvillar aðgerðar og farið var yfir hjartaómanir fyrir og eftir aðgerð. Forspárþættir dauða innan 30 daga voru metnir með lógistískri aðhvarfsgreiningu og heildarlifun áætluð (Kaplan-Meier). Miðgildi eftirfylgdartíma var 8,8 ár (0-16,5 ár). Niðurstöður Af 428 sjúklingum voru 151 konur (35,3%) og voru þær að meðaltali tveimur árum eldri en karlar (72,6 ± 9,4 ára á móti 70,4 ± 9,8, p=0,020). Einkenni fyrir aðgerð voru sambærileg milli kynja en konur höfðu marktækt hærra EuroSCORE II fyrir aðgerð (5,2 ± 8,8 á móti 3,2 ± 4,6, p=0,002). Hámarks-þrýstingsfall yfir ósæðarlokuna var hærra hjá konum (74,4 ± 29,3 mmHg á móti 68,0 ± 23,4 mmHg, p=0,013) en tíðni snemmkominna fylgikvilla, bæði minniháttar og alvarlegra, var sambærileg milli kynja líkt og 30 daga dánartíðni (8,6% á móti 4,0%, p=0,076) og 5 ára lifun (80,1% á móti 83,0% fyrir karla, p=0,49). Kvenkyn reyndist ekki vera forspárþáttur fyrir dauða innan 30 daga þegar leiðrétt var fyrir öðrum þekktum forspárþáttum dauða (ÁH: 1,54, 95%-ÖB: 0,63-3,77) svo sem aldri. Ályktanir Á Íslandi eru konur um þriðjungur þeirra sem gangast undir ósæðarlokuskipti vegna ósæðarlokuþrengsla. Þær eru rúmlega tveimur árum eldri en karlar þegar kemur að aðgerð og virðast hafa lengra gengin ósæðarlokuþrengsli. Tíðni fylgikvilla eftir aðgerð, 30 daga dánartíðni og langtímalifun var engu að síður sambærileg hjá kynjunum.Introduction: Aortic valve replacement (AVR) for aortic stenosis (AS) is the second most common open-heart procedure performed in Iceland. The aim of this study was to analyze the early outcome of AVR among females in Iceland. Materials and methods: This was a retrospective study including 428 patients who underwent surgical AVR due to AS in Iceland from 2002-2013. Information was gathered from medical records, including pre- and postoperative results of echocardiography and complications. Overall survival was estimated (Kaplan-Meier) and logistic regression used to identify predictors of operative mortality. The median follow-up time was 8.8 years (0-16.5 years). Results: Of the 428 patients, 151 were female (35.3%), that were on average 2 years older than men (72.6 ± 9.4 vs. 70.4 ± 9.8 yrs., p=0.020). Preoperative symptoms were similar, but women had significantly higher EurosSCORE II than men (5.2 ± 8.8 vs. 3.2 ± 4.6, p=0.002). Maximal pressure-gradient across the aortic valve was higher for women (74.4 ± 29.3 mmHg vs. 68.0 ± 23.4 mmHg, p=0,013) but postoperative complications, operative mortality (8.6% vs. 4.0%, p=0.068) and 5-year survival (78.6% vs. 83.1%, p=0.245) were comparable for women and men. Logistic regression analysis showed that female gender was not an independent predictor of 30-day mortality (OR 1.54, 95% CI 0.63-3.77). Conclusions: Females constitute one third of patients that undergo AVR for AS in Iceland. At the time of surgery females are two years older than men and appear to have a more significant aortic stenosis at the time of surgery. However, complication rates, operative mortality and long-term survival were comparable for both genders.Peer reviewe