Current results and remaining challenges of trans-catheter aortic valve replacement expansion in intermediate and low risk patients

TAVR has become the standard treatment in patients at increased surgical risk (STS or EuroSCORE II 654% or logistic EuroSCORE I 65 10% or other risk factors not included in these scores such as frailty, porcelain aorta, sequelae of chest radiation) and it is increasingly being performed in patients at intermediate to low (STS or EuroSCORE II <4% or logistic EuroSCORE I < 10%) surgical risk. Although non-inferiority has been demonstrated in intermediate and low-risk patients, several challenges need to be addressed before expansion to younger patients. Current trends, trials results, and remaining challenges are summarized and discussed in this review

The acute haemodynamic effect of the MitraClip therapy: afterload mismatch evaluation in functional mitral regurgitation

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The non-technical skills needed by graduates of technical colleges in metalwork technology

This study centered on the views of the professionals about the non-technical skills considered crucial as recruitment prerequisite among graduates of metalwork technology from technical and vocational institutions in Nigeria. It will also examine the possibility of integrating these skills into the curriculum. The study made use of the survey research design. One research question guided the study. The population for the study comprised metalwork technology professionals in Ogun State, Southwestern Nigeria. A 36-item questionnaire was the instrument used for data collection. The instrument was validated by experts from the University of Lagos (UNILAG). The reliability of the instrument was determined using Cronbach Alpha and the reliability index which stood at 0.79. The data collected were analysed using mean statistic and standard deviation. The study revealed that professionals placed great importance on communication skills, problem-solving skills, teamwork skills and self-management qualities among others, as important recruitment prerequisite among graduates of metalwork technology from technical and vocational institutions in Nigeria. The study concludes with the suggestions that non-technical skills should be integrated into the curriculum particularly in the field of metalwork technology in technical colleges. Students should be familiar with the employers’ recruitment criteria while they are still in schools in order to equip them with the necessary skills needed for employment

211 * CLINICAL AND ANATOMICAL PREDICTORS OF MITRACLIP THERAPY FAILURE FOR FUNCTIONAL MITRAL REGURGITATION

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Defining a new standard for IVUS optimized drug eluting stent implantation: The PRAVIO study

ObjectivesPreliminary Investigation to the Angiographic Versus IVUS Optimization Trial is a single center prospective observational intravascular ultrasound (IVUS) guided stent implantation study assessing new criteria for optimal drug eluting stent (DES) deployment.BackgroundIVUS assessment of DES often reveals underexpansion and malapposition. Optimal stent deployment is currently poorly defined and previous criteria may not be suitable in long and complex lesions.MethodsOptimization was defined as achieving >/or 70% of the cross-sectional area (CSA) of the postdilation balloon. This criterion was applied in 113 complex lesions. The size of this balloon was calculated according to vessel media-to-media diameters at various sites inside the stented segment. The IVUS guided treated lesions were matched according to diabetes, vessel type, reference vessel diameter, minimum lumen diameter (MLD), and lesion length with a group of angiographic treated lesions to compare final MLD achieved.ResultsMean minimum stent CSA according to the postdilation balloon utilized was 4.62 mm(2), 6.26 mm(2), 7.87 mm(2), and 9.87 mm(2) for 2.5 mm, 3.0 mm, 3.5 mm, and 4 mm balloons, respectively. Final MLD (mm) was significantly larger in the IVUS compared to the angiographic-guided group (3.09 +/- 0.50 vs. 2.67 +/- 0.54; P < 0.0001). There were no procedural complications related to IVUS use.ConclusionsWe propose new IVUS criteria based on vessel remodeling that results in an increment in the final MLD, compared to angiographic guidance, which is much larger than any previously published study. This criterion seems to be safely achievable. A proposed randomized study (angiographic vs. IVUS optimization trial) has been launched to test these concepts

TCT-515 Multi-Center, Post-marketing Evaluation of the Elixir DESolve® Novolimus Eluting Bioresorbable Coronary Stent System: 6-month Results from the DESolve PMCF Study

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TCT-332 A study comparing a paclitaxel drug-eluting balloon with a paclitaxel-eluting stent in diabetic patients with small coronary vessels disease: a sub-study of the the BELLO (Balloon Elution and Late Loss Optimization) Trial

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Gas chromatography mass spectrometry couple with quadrupole time-of-flight (GC-QTOF MS) as a powerful tool for profiling of oxygenated sesquiterpenes in agarwood oil

Agarwood (Aquilaria malaccensis) is very well known as the most expensive wood in the world due to its wide applications in perfumery, cosmetic traditional medicine, and religious ceremonies. The study aimed to give an in-depth characterisation focusing on marker compounds in A. malaccensis from different places in Malaysia. The establishment of an oxygenated sesquiterpenes chemical profile of the fungus-infected agarwood oil was achieved by gas chromatography mass spectrometry (GC–MS) coupled with quadrupole time (QTOF) technique. Aroma compounds were identified as sesquiterpenes and oxygenated sesquiterpenes where agarospirol was found in samples of all locations (3.12%, 3.54%, 3.36% and 2.26% from Melaka, Pahang, Kelantan A and Kelantan B respectively) and also N-hexadecanoic acid as one of the major compounds. Both compounds were further isolated by Prep-GC and confirmed by NMR. This study provides a reference for agarwood oil analysis from different origins in Malaysia

Atypical ST-Segment-Elevation Myocardial Infarction Presentation in Patients With COVID-19 at a High-Volume Center in New York City

Atypical presentations of ST-segment-elevation myocardial infarction (STEMI) have been reported in patients who have COVID-19. We have seen this occurrence in our center in Bronx, New York, where multitudes of patients sought treatment for the coronavirus. We studied the prevalence of atypical STEMI findings among patients with COVID-19 who presented during the first 2 months of the pandemic. Consistent with previous reports, 4 of our 10 patients with COVID-19 and STEMI had no identifiable culprit coronary lesion; rather, they often had diffuse ST-segment elevations on surface electrocardiograms along with higher levels of D-dimer and inflammatory markers. In contrast, 32 of 33 patients without COVID-19 (97%) had a culprit lesion. The patients with COVID-19 and a culprit lesion more often needed thrombectomy catheterization and administration of glycoprotein IIb/IIIa inhibitors. Our study confirms that patients with COVID-19 often have atypical STEMI presentations, including the frequent absence of a culprit coronary lesion. Our findings can help clinicians prepare for these atypical clinical presentations

Uncertainties and challenges in surgical and transcatheter tricuspid valve therapy: a state-of-the-art expert review

Tricuspid regurgitation (TR) is a frequent and complex problem, commonly combined with left-sided heart disease, such as mitral regurgitation. Significant TR is associated with increased mortality if left untreated or recurrent after therapy. Tricuspid regurgitation was historically often disregarded and remained undertreated. Surgery is currently the only Class I Guideline recommended therapy for TR, in the form of annuloplasty, leaflet repair, or valve replacement. As growing experience of transcatheter therapy in structural heart disease, many dedicated transcatheter tricuspid repair or replacement devices, which mimic well-established surgical techniques, are currently under development. Nevertheless, many aspects of TR are little understood, including the disease process, surgical or interventional risk stratification, and predictors of successful therapy. The optimal treatment timing and the choice of proper surgical or interventional technique for significant TR remain to be elucidated. In this context, we aim to highlight the current evidence, underline major controversial issues in this field and present a future roadmap for TR therapy