Clinical outcomes in patients after surgical and transcatheter aortic valve replacement

INTRODUCTION Transcatheter aortic valve implantation (TAVI) and minimally invasive aortic valve replacement (minithoracotomy and ministernotomy) have become a valuable alternative to conventional surgical treatment of severe aortic stenosis (AS) in high-risk patients. OBJECTIVES The aim of the study was to evaluate long-term results and complications in patients with symptomatic AS treated with TAVI, surgical aortic valve replacement (SAVR), minithoracotomy, or ministernotomy. PATIENTS AND METHODS A total of 173 patients with symptomatic AS were enrolled to the study between the years 2011 and 2013. Propensity scores were calculated for TAVI and each surgical method separately. Differences in clinical outcomes between patients treated with TAVI and those treated with surgical methods were adjusted for propensity scores using a logistic regression analysis and presented as adjusted odds ratios with 95% confidence intrervals. RESULTS A median follow-up was 583.5 days (interquartile range, 298–736 days). Before aortic valve replacement (AVR), no significant differences in ejection fraction (EF) were observed between the groups. At 1 week after AVR, mean EF values were significantly higher in patients after TAVI in comparison with the other groups (TAVI, 50.2% ±13.1%; minithoracotomy, 44.1% ±13.4%; ministernotomy, 37.8% ±12.8%; SAVR, 40.3% ±12.5%; P = 0.001). There were no differences in the longest available follow-up mortality between the analyzed groups (P = 0.8). To our best knowledge, this is the first study comparing minithoracotomy, ministernotomy, and SAVR with TAVI in terms of long-term outcomes such as the longest available follow-up mortality, left ventricular (LV) function, complications after the procedure, and conduction disturbances and arrhythmias after the procedure. CONCULSIONS Patients undergoing TAVI show more beneficial long-term outcomes in comparison with patients undergoing minithoracotomy, ministernotomy, and SAVR and do not differ in terms of the longest available follow-up mortality. TAVI seems to have a more favorable effect on LV function and an increase in EF in comparison with the surgical methods

Transformations of Vascular Flora of a Medieval Settlement Site: A Case Study of a Fortified Settlement in Giecz (Wielkopolska Region, Western Poland)

Exceptional components of the cultural landscape of Central Europe include archaeological sites, e.g., castle ruins, prehistoric or medieval fortified settlements, other settlements and burial mounds. The plants associated with them help us explain the processes of species persistence on habitat islands as well as the process of naturalization of crop species, which escape from fields or are abandoned. This study describes the flora of a medieval fortified settlement in Giecz (Wielkopolska region, western Poland), presents plant indicators of former settlements (relics of cultivation), species of high conservation value, and transformations of the vascular flora of this settlement over a few decades. Field research was conducted in 1993–1994, 1998–1999, and 2019. At the study site, 298 species of vascular plant species were recorded, and nearly 70% of them (201 species) have persisted there over the last 20 years. The flora includes seven relics of cultivation (Artemisia absinthium, Leonurus cardiaca, Lycium barbarum, Malva alcea, Pastinaca sativa, Saponaria officinalis, and Viola odorata), 5 species threatened with extinction in Poland and/or Wielkopolska, and 53 species of least concern (LC) according to the European red list. We have attempted to explain the floristic changes. The archaeological site in Giecz is of high conservation value, very distinct from the surrounding cultural landscape because of its specific flora, and composed of species from various habitats (e.g., dry grasslands, wooded patches, meadows, aquatic and ruderal habitats), including threatened, protected, and relic species