Transcatheter aortic valve implantation in 2015

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Variational finite-difference representation of the kinetic energy operator

A potential disadvantage of real-space-grid electronic structure methods is the lack of a variational principle and the concomitant increase of total energy with grid refinement. We show that the origin of this feature is the systematic underestimation of the kinetic energy by the finite difference representation of the Laplacian operator. We present an alternative representation that provides a rigorous upper bound estimate of the true kinetic energy and we illustrate its properties with a harmonic oscillator potential. For a more realistic application, we study the convergence of the total energy of bulk silicon using a real-space-grid density-functional code and employing both the conventional and the alternative representations of the kinetic energy operator.Comment: 3 pages, 3 figures, 1 table. To appear in Phys. Rev. B. Contribution for the 10th anniversary of the eprint serve

Prognostic value of the ratio between prothesis area and indexed annulus area measured by multiSlice-CT for transcatheter aortic valve implantation procedures

Background Postprocedural aortic regurgitations following transcatheter aortic valve implantation (TAVI) procedures remain an is- sue. Benefit of oversizing strategies to prevent them isn’t well established. We compared different level of oversizing in our cohort of con- secutive patients to address if severe oversizing compared to normal sizing had an impact on post-procedural outcomes. Methods From January 2010 to August 2013, consecutive patients were referred for TAVI with preoperative Multislice-CT (MSCT) and the procedures were achieved using Edwards Sapien® or Corevalve devices®. Retrospectively, according to pre-procedural MSCT and the valve size, pa- tients were classified into three groups: normal, moderate and severe oversizing; depending on the ratio between the prosthesis area and the annulus area indexed and measured on MSCT. Main endpoint was mid-term mortality and secondary endpoints were the Valve Academic Research Consortium (VARC-2) endpoints. Results Two hundred and sixty eight patients had a MSCT and underwent TAVI procedure, with mainly Corevalve®. While all-cause and cardiovascular mortality rates were similar in all groups, post-procedural new pacemaker (PM) implantation rate was significantly higher in the severe oversizing group (P = 0.03), while we observed more in-hospital congestive heart-failure (P = 0.02) in the normal sizing group. There was a trend toward more moderate to severe aortic regurgitation (AR) in the normal sizing group (P = 0.07). Conclusions Despite a higher rate of PM implantation, oversizing based on this ratio reduces aortic leak with lower rates of post-procedural complications and a similar mid-term survival

Advances in transcatheter mitral and tricuspid therapies

BACKGROUND: While rheumatic mitral stenosis has been effectively treated percutaneously for more than 20 years, mitral and tricuspid regurgitation treatment appear as a contemporary unmet need. The advent of transcatheter therapies offer new treatment options to often elderly and frail patients at high risk for open surgery. We aimed at providing an updated review of fast-growing domain of transcatheter mitral and tricuspid technology. MAIN BODY: We reviewed the existing literature on mitral and tricuspid transcatheter therapies. Mitraclip is becoming an established therapy for secondary mitral regurgitation in selected patients with disproportionately severe regurgitation associated with moderate left ventricle dysfunction. Evidence is less convincing for primary mitral regurgitation. Transcatheter mitral valve replacement is a promising emerging alternative to transcatheter repair, for secondary as well as primary mitral regurgitation. But further development is needed to improve delivery. Transcatheter tricuspid intervention arrives late after similar technologies have been developed for aortic and mitral valves and is currently at its infancy. This is likely due in part to previously under-recognized impact of tricuspid regurgitation on patient outcomes. Edge-to-edge repair is the most advanced transcatheter solution in development. Data on tricuspid annuloplasty and replacement is limited, and more research is warranted. CONCLUSION: The future appears bright for transcatheter mitral therapies, albeit their place in clinical practice is yet to be clearly defined. Tricuspid transcatheter therapies might address the unmet need of tricuspid regurgitation treatment

Structure of multidisciplinary heart teams, a survey based heart team study.

OBJECTIVES Multidisciplinary approach is well established in various disciplines, with evidence highlighting improved patient outcomes. The objective of this survey was to determine the real world practice of heart teams across Europe. METHODS The survey was drafted after a consensus opinion from the authors. The survey was sent to cardiac surgeons and cardiologist identified through electronic search. The survey link and the information sheet were sent through email followed by survey completion reminders. The survey responses were cumulated and analysed. RESULTS Among 2188 invited clinicians, 220 clinicians from 26 countries took part in the survey (response rate 10%). The completion rate for the survey questions was 85%. 140 (64%) were cardiac surgeons and 80 (36%) were cardiologists. The heart team meeting frequency was weekly according to 104 (55%) respondents. This was conducted face to face according to 139 (73%) of the responses. Eighty seven (56%) of the respondents reported 10% - 20% of patients undergoing percutaneous coronary intervention (PCI) were discussed at the heart team meeting. Seventy nine (47%) respondents had ad hoc PCI institutional guidelines. Fifty four (32%) respondents reported an audit process for the heart team decisions. CONCLUSIONS This survey suggests that there is marked variability in the infra-structure and execution of heart teams in different institutions. The results of the survey suggest a need to formulate guidelines on composition and execution of heart teams which may result in an increase in transparency of decision-making within different institutions in reporting and comparing outcomes

A novel multigrid method for electronic structure calculations

A general real-space multigrid algorithm for the self-consistent solution of the Kohn-Sham equations appearing in the state-of-the-art electronic-structure calculations is described. The most important part of the method is the multigrid solver for the Schroedinger equation. Our choice is the Rayleigh quotient multigrid method (RQMG), which applies directly to the minimization of the Rayleigh quotient on the finest level. Very coarse correction grids can be used, because there is no need to be able to represent the states on the coarse levels. The RQMG method is generalized for the simultaneous solution of all the states of the system using a penalty functional to keep the states orthogonal. The performance of the scheme is demonstrated by applying it in a few molecular and solid-state systems described by non-local norm-conserving pseudopotentials.Comment: 9 pages, 3 figure

Accurate Results from Perturbation Theory for Strongly Frustrated S=1/2S=1/2 Heisenberg Spin Clusters

We investigate the use of perturbation theory in finite sized frustrated spin systems by calculating the effect of quantum fluctuations on coherent states derived from the classical ground state. We first calculate the ground and first excited state wavefunctions as a function of applied field for a 12-site system and compare with the results of exact diagonalization. We then apply the technique to a 20-site system with the same three fold site coordination as the 12-site system. Frustration results in asymptotically convergent series for both systems which are summed with Pad\'e approximants. We find that at zero magnetic field the different connectivity of the two systems leads to a triplet first excited state in the 12-site system and a singlet first excited state in the 20-site system, while the ground state is a singlet for both. We also show how the analytic structure of the Pad\'e approximants at $|\lambda| \simeq 1$ evolves in the complex $\lambda$ plane at the values of the applied field where the ground state switches between spin sectors and how this is connected with the non-trivial dependence of the $$ number on the strength of quantum fluctuations. We discuss the origin of this difference in the energy spectra and in the analytic structures. We also characterize the ground and first excited states according to the values of the various spin correlation functions.Comment: Final version, accepted for publication in Physical review

Evaluation of Exchange-Correlation Energy, Potential, and Stress

We describe a method for calculating the exchange and correlation (XC) contributions to the total energy, effective potential, and stress tensor in the generalized gradient approximation. We avoid using the analytical expressions for the functional derivatives of E_xc*rho, which depend on discontinuous second-order derivatives of the electron density rho. Instead, we first approximate E_xc by its integral in a real space grid, and then we evaluate its partial derivatives with respect to the density at the grid points. This ensures the exact consistency between the calculated total energy, potential, and stress, and it avoids the need of second-order derivatives. We show a few applications of the method, which requires only the value of the (spin) electron density in a grid (possibly nonuniform) and returns a conventional (local) XC potential.Comment: 7 pages, 3 figure

Diagonalization in Reduced Hilbert Spaces using a Systematically Improved Basis: Application to Spin Dynamics in Lightly Doped Ladders

A method is proposed to improve the accuracy of approximate techniques for strongly correlated electrons that use reduced Hilbert spaces. As a first step, the method involves a change of basis that incorporates exactly part of the short distance interactions. The Hamiltonian is rewritten in new variables that better represent the physics of the problem under study. A Hilbert space expansion performed in the new basis follows. The method is successfully tested using both the Heisenberg model and the $t-J$ model with holes on 2-leg ladders and chains, including estimations for ground state energies, static correlations, and spectra of excited states. An important feature of this technique is its ability to calculate dynamical responses on clusters larger than those that can be studied using Exact Diagonalization. The method is applied to the analysis of the dynamical spin structure factor $S(q,\omega)$ on clusters with $2 \times 16$ sites and 0 and 2 holes. Our results confirm previous studies (M. Troyer, H. Tsunetsugu, and T. M. Rice, Phys. Rev. $B 53$, 251 (1996)) which suggested that the state of the lowest energy in the spin-1 2-holes subspace corresponds to the bound state of a hole pair and a spin-triplet. Implications of this result for neutron scattering experiments both on ladders and planes are discussed.Comment: 9 pages, 8 figures, Revtex + psfig; changed conten

Real-space local polynomial basis for solid-state electronic-structure calculations: A finite-element approach

We present an approach to solid-state electronic-structure calculations based on the finite-element method. In this method, the basis functions are strictly local, piecewise polynomials. Because the basis is composed of polynomials, the method is completely general and its convergence can be controlled systematically. Because the basis functions are strictly local in real space, the method allows for variable resolution in real space; produces sparse, structured matrices, enabling the effective use of iterative solution methods; and is well suited to parallel implementation. The method thus combines the significant advantages of both real-space-grid and basis-oriented approaches and so promises to be particularly well suited for large, accurate ab initio calculations. We develop the theory of our approach in detail, discuss advantages and disadvantages, and report initial results, including the first fully three-dimensional electronic band structures calculated by the method.Comment: replacement: single spaced, included figures, added journal referenc