First case of trans apical implantation of an aortic valve in a patient with dextrocardia

We describe the clinical presentation and implantation procedure of the first transcatheter aortic valve implantation described in a patient with dextrocardia

First experience with the Edwards SAPIEN transcatheter aortic valve implantation (TAVI). Data from the Western Cape, South Africa

Background: Transcatheter aortic valve implantation (TAVI) is an exciting new technology that was launched in South Africa in October 2009 for the treatment of aortic stenosis in patients at high risk for conventional surgery. We report our initial experience with TAVI in the Western Cape, South Africa. Methods: 70 patients with severe symptomatic aortic stenosis underwent TAVI with the Edwards SAPIEN device (26 via transapical approach and 44 via transfemoral) at Panorama and Vergelegen Mediclinic hospitals in the Western Cape. All implants were performed by a team consisting of 2 cardiothoracic anaesthesiologists, 2 cardiothoracicsurgeons, 2 cardiologists and an echo expert. Results: Patients were at high risk with a mean age of 80 years and a mean logistic EuroSCORE of 26. The acute procedural success rate was 97% with two acute deaths. At 30 days, there were a total of 5 deaths. Major vascular complications were seen in 6 cases (9%). Only one stroke was seen during the follow-up period. Conclusions: With a multidisciplinary team approach and careful patient selection, TAVI can be performed by a high volume centre in South Africa with results comparable to international published outcomes

7-Year experience of transcatheter aortic valve implants (TAVI) in a Western Cape private healthcare setting

CITATION: Weich, H., et al. 2019. 7-Year experience of transcatheter aortic valve implants (TAVI) in a Western Cape private healthcare setting. SA Heart, 16(1):6-12, doi:10.24170/16-1-3406.The original publication is available at http://www.journals.ac.za/index.php/SAHJIntroduction: We describe the largest South African transcatheter aortic valve implantation (TAVI) outcome report of a single team in the Western Cape, over a 7-year period from 2009 - 2016. Methods: All patients who received TAVI at Mediclinic Vergelegen and Mediclinic Panorama were prospectively entered into a database. A total of 244 implants (61 CoreValve and 183 Edwards valves) were performed. Results: Patients were high risk with a mean STS score of 7.89 (standard deviation (SD) 5.7) and mean logistic EuroSCORE of 26.5 (SD 12.5). There was a trend toward lower risk over time. Procedures were initially performed mainly via a transapical approach, but this changed to mostly transfemoral with the introduction of smaller delivery systems. Procedural success rate was 91.8% for CoreValve and 88.5% for Edwards cases. Mean length of hospital stay following TAVI was 9 days initially, but this declined to 4 days for the latter part of our experience. One year mortality was 19% and one year stroke rate was 10%. Conclusion: Despite the limitations of a study of this nature, our group could document outcomes similar to international studies, with improvements over time and illustrating successful cooperation between different hospitals to expand exposure and experience in a resource-constrained environment.http://www.journals.ac.za/index.php/SAHJ/article/view/3406Publisher's versio

NKG2A expression identifies a subset of human V\u3b42 T\ua0cells exerting the highest antitumor effector functions

Human V delta 2 cells are innate-like gamma delta T effectors performing potent immune surveillance against tumors. The constitutive expression of NKG2A identifies a subset of V delta 2 T cells licensed with an intrinsic hyper-responsiveness against cancer. Indeed, the transcriptomic profiles of NKG2A(+) and NKG2A(-) cells characterize two distinct "intralineages'' of V delta 2 T lymphocytes that appear early during development, keep their phenotypes, and show self-renewal capabilities in adult life. The hyper-responsiveness of NKG2A(+) V delta 2 T cells is counterbalanced by the inhibitory signaling delivered by human leukocyte antigen E (HLA-E) expressed on malignant cells as a tumor-escape mechanism. However, either masking or knocking out NKG2A restores the capacity of V delta 2 T cells to exert the highest effector functions even against HLA-E+ tumors. This is highly relevant in the clinic, as the different degrees of engagement of the NKG2A-HLA-E checkpoint in hepatocellular carcinoma, glioblastoma, and non-small cell lung cancer directly impact patients' overall survival. These findings open avenues for developing combined cellular and immunologic anticancer therapies