Coronary Revascularization in Diabetics: The Background for an Optimal Choice

Cardiovascular disease is ranked as the leading cause of death world wide, responsible for 17.1 million deaths globally each year. Such numbers are often difficult to comprehend. Heart disease kills one person every 34 seconds in the USA alone. Although the leading killer, the incidence of cardiovascular disease has declined in recent years due to a better understanding of the pathology, implementation of lipid lowering therapy new drug regimens including low molecular weight heparin and antiplatelet drugs such as glycoprotein IIb/IIIa receptor inhibitors and acute surgical intervention. The disease burden has a great financial impact on global healthcare systems and major economic consequences for world economies. This text aims to deliver the current understanding of coronary artery disease and is split into three main sections: 1. Epidemiology and pathophysiology of coronary artery disease 2. Coronary artery disease diagnostics and 3. Treatment regimens for coronary artery diseas

Hypereosinophilia with a pinch of salt and pepper

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Early and mid-term outcome of patients with low-flow-low-gradient aortic stenosis treated with newer-generation transcatheter aortic valves

Peer reviewe

Site fidelity of Hippocampus guttulatus Cuvier, 1829 at Mar Piccolo of Taranto (Southern Italy; Ionian Sea)

AbstractLack of detailed knowledge on ecological niche, life cycles, spatial distribution, reproductive biology and space use strongly affects the selection of useful tools and measures in the conservation of threatened marine species. Especially for sedentary and slow species, behaviour and movement capacities are supposed to be the most important functional traits. Indeed, behavioural variability concerning available space and the close presence of individuals is considered a crucial trait for the population dynamics assessments, especially when disturbances of various causes are present in the environment. The present study aimed to investigate the site fidelity and degree of movement of Hippocampus guttulatus, an emblematic and threatened Mediterranean seahorse species. With this aim, a number of seahorses were tagged and monitored throughout two years within a limited area of the lagoon of Mar Piccolo of Taranto (Southern Italy). The studied individuals were initially morphometrically measured for size, sex and life-cycle stage and subsequently monitored through repeated four-month surveys each year. Obtained results indicated high site fidelity regardless of habitat type. Movement pattern was in line with the data on congeneric species, although values were slightly higher. The analyses showed differences in movement degree among different sexes and life-cycle stages and indicated greater mobility of adult females compared to males and juveniles. The investigated parameters showed a great variability suggesting that even small-scale environmental factors can influence the species mobility. Finally, a change in the population structure has been observed, with the loss of large individuals in 2016 and reduced recruitment in 2017. These findings indicated the possible presence of stressors that could lead to the alteration of the seahorse population at Mar Piccolo of Taranto

Totally percutaneous valve replacement for severe aortic regurgitation in a degenerating bioprosthesis

Recently, the feasibility and safety of percutaneous aortic valve replacement (PAVR) has been reported in the treatment of degenerative aortic valve stenosis in patients at high-risk for surgical aortic valve replacement (AVR).1 However, so far this therapy has been limited to patients with severe stenosis of the native valve. We report the case of a patient with severe aortic regurgitation owing to bioprosthesis dysfunction who was successfully treated by implantation of a CoreValve (CoreValve Inc, Irvine. Calif) prosthesis with a totally percutaneous approach

SOURCE 3: 1-year outcomes post-transcatheter aortic valve implantation using the latest generation of the balloon-expandable transcatheter heart valve

AIMS: Transcatheter aortic valve implantation (TAVI) has developed from a procedure for patients with aortic stenosis inoperable or high risk for surgery, into a treatment option even for intermediate risk elderly patients. This development has been facilitated by the clinical learning curve and constant improvements of transcatheter heart valves used. We present total 1-year results of SOURCE 3, the European post-approval multicentre registry of the latest generation balloon expandable SAPIEN 3TM (Edwards Lifesciences, Irvine, CA, USA). METHODS AND RESULTS: Participating centres have submitted their consecutive experience with the SAPIEN 3, dependent on patients consent. Data were prospectively collected and all end point-related outcomes adjudicated according to VARC-2 definitions by an independent committee. Between July 2014 and October 2015, in total 1946 patients (mean age 81.6\u2009\ub1\u20096.7\u2009years, 52% male) were enrolled in 80 centres from 10 European countries. At 1\u2009year, all-cause mortality was 12.6%, cardiovascular mortality 8.0%, stroke 3.1%, disabling stroke 1.4%, and rate of new pacemakers 13.2%. Causes of death were 62.0% cardiovascular and 38.0% non-cardiovascular, with heart failure (13.4%) and pulmonary complications (12.7%) being the main reasons for fatal outcomes. Multivariable analysis identified New York Heart Association Class IV and renal insufficiency as predictors of mortality, while higher BMI's improved survival. Severe (zero) and moderate paravalvular leakage (2.6%) was rare at 1\u2009year. CONCLUSION: In SOURCE 3, we observe a low complication rate and mortality at 1\u2009year. Given the low incidence of higher degree paravalvular leakages, this variable did no longer affect outcome. Clinicaltrial.gov number: NCT02698956

SOURCE 3 Registry Design and 30-Day Results of the European Postapproval Registry of the Latest Generation of the SAPIEN 3 Transcatheter Heart Valve

BACKGROUND: The SOURCE 3 Registry (SAPIEN Aortic Bioprosthesis European Outcome) is a European multicenter, observational registry of the latest generation of transcatheter heart valve, the SAPIEN 3 (Edwards Lifesciences, Irvine, CA). Its purpose is to document outcomes of clinical safety and performance after European approval was given. METHODS: Here, we present the 30-day outcome of the SOURCE 3 Registry. All data are self-reported, and all participating centers have committed to support their consecutive experience with the SAPIEN 3 transcatheter heart valve, dependent on patient consent, before the start of the study. Adverse events are defined with Valve Academic Research Consortium 2 criteria and adjudicated by an independent clinical events committee. RESULTS: A total of 1950 patients from 80 centers in 10 countries were enrolled between July 2014 and October 2015. Of those, 1947 patients underwent transcatheter aortic valve implantation (TAVI) with the SAPIEN 3 (mean age, 81.6 +/- 6.6 years; 48.1% female). Main comorbidities included coronary artery disease (51.5%), renal insufficiency (27.4%), diabetes mellitus (29.5%), chronic obstructive pulmonary disease (16.0%), and a mean logistic EuroSCORE of 18.3 +/- 13.2. Transfemoral access was used in 87.1% (n=1695); nontransfemoral, in 252 patients. Conscious sedation was used in 59.9% of transfemoral procedures, and in 50% of patients, TAVI was performed without aortic balloon valvuloplasty. Implantation success (1 valve in the intended location) was 98.3%. Conversion to conventional surgery (0.6%) and use of cardiopulmonary bypass (0.7%) were rare. Adverse events were low, with site-reported 30-day all-cause mortality of 2.2%, cardiovascular mortality of 1.1%, stroke of 1.4%, major vascular complications of 4.1%, life-threatening bleeding of 5%, and post-TAVI pacemaker implantation of 12%. Moderate or greater paravalvular regurgitation was observed in 3.1% of reporting patients. CONCLUSIONS: Results from the SOURCE 3 Registry demonstrate contemporary European trends and good outcomes of TAVI in daily practice when this third-generation TAVI device is used.Peer reviewe

TCT-338 Spontaneous coronary Artery dissection in sudden death victims and surviving patients: which are the differences?

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Giant Aneurysm of the Right Atrial Appendage in a 39-Year-Old Woman

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