Grotta Romanelli (Southern Italy, Apulia): legacies and issues in excavating a key site for the Pleistocene of the Mediterranean

Grotta Romanelli, located on the adriatic coast of southern apulia (Italy), is considered a key site for the Mediterranean Pleistocene for its archaeological and palaeontological contents. The research team had to deal with the consequences of more than 40 years of inactivity in the eld and the combined effect of erosion and legal, as well as illegal, excavations. In this paper, we provide a database of all the information published during the rst 70 years of excavations and highlight the outstanding problems and contradictions between the chronological and geomorphological evidence, the features of the faunal assemblages and the limestone artefacts

Coronary Angiography After Transcatheter Aortic Valve Replacement (TAVR) to Evaluate the Risk of Coronary Access Impairment After TAVR‐in‐TAVR

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Sarcopenia detected by computed tomography: a simple tool for screening transcatheter aortic valve implantation candidates

3nononeMassussi, Mauro; Metra, Marco; Adamo, MariannaMassussi, Mauro; Metra, Marco; Adamo, Mariann

Percutaneous mitral valve commissurotomy

Transcatheter therapies have progressively assumed a major role in the treatment of valve heart disease. The major drivers have been population ageing, the high prevalence of valve disease in the elderly, and the consequent need of less invasive treatments for this fragile patient population. While transcatheter aortic valve implantation (TAVI) has achieved a central role in the treatment of severe aortic stenosis across any surgical risk category, transcatheter treatment of mitral valve disease is still the object of intense debate and investigation. The reasons are that the mitral valve apparatus anatomy is more complex, involving valve leaflets, subvalvular apparatus and the left ventricle. Further, the most frequent mitral valve disease, i.e. mitral regurgitation, has different etiologies and is frequently a consequence rather than the cause of left ventricular dysfunction and heart failure. Hence, clinical efficacy of its correction is uncertain. Beyond the varying clinical scenarios, there are a miriad of devices under developement or at different stages of clinical investigations. This book describes the state of the art in the filed of percutaneous treatment of mitral valve disease. It provides a comprehensive review including anatomical basis, in-depth diagnostics, patophysiology, summary of available evidence for transcatheter treatments, state-of-the art of cardiac surgery,description of devices commercially available or under investigation, and clinical examples

Coronary artery disease and TAVI: Current evidence on a recurrent issue

: Coronary artery disease (CAD) is a frequent finding in patients with aortic stenosis (AS). Concomitant coronary artery bypass and aortic valve replacement is considered the gold standard treatment in surgical candidates. However, limited evidence is available regarding the role of coronary revascularization in patients undergoing transcatheter aortic valve implantation (TAVI). How to evaluate CAD severity in patients with AS, whether percutaneous coronary intervention (PCI) needs to be performed and what is the timing for revascularization to minimize procedural risks, remains matters of debate. The aim of this review is to summarize epidemiology, diagnostic tools and possible options for CAD management in patients undergoing TAVI with specific focus on the pros and the cons of the different timing of PCI

Grotta Romanelli (Southern Italy, Apulia): legacies and issues in excavating a key site for the Pleistocene of the Mediterranean

Grotta Romanelli, located on the adriatic coast of southern apulia (Italy), is considered a key site for the Mediterranean Pleistocene for its archaeological and palaeontological contents. The research team had to deal with the consequences of more than 40 years of inactivity in the eld and the combined effect of erosion and legal, as well as illegal, excavations. In this paper, we provide a database of all the information published during the rst 70 years of excavations and highlight the outstanding problems and contradictions between the chronological and geomorphological evidence, the features of the faunal assemblages and the limestone artefacts

Association between surgical risk and 30-day stroke after transcatheter versus surgical aortic valve replacement: a systematic review and meta-analysis

Background: Stroke is a feared complication of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). Objectives: With this meta-analysis we aimed to evaluate the incidence of 30-day stroke with TAVR and SAVR focusing on its possible correlation with surgical risk. Methods: Major electronic databases were searched for studies published between January 2002 and October 2019 reporting the rates of 30-day stroke after TAVR and SAVR. Data were pooled using fixed- and random-effects models. The primary outcome of the study was stroke rate within 30-day from TAVR or SAVR. Results were stratified according to surgical risk score (high, intermediate and low). Results: A total of 23 studies were identified (TAVR: 14,589 patients; SAVR: 11,681 patients). Regardless of the model used, in the overall population TAVR was associated with a significant reduction in the risk of stroke compared with SAVR (fixed effect: OR 0.78, 95% CI 0.66-0.92, p = .003; random-effects: OR 0.80, 95% CI 0.64-1.00, p = .045). Rates of 30-day stroke after TAVR and SAVR were not significantly different in the high- (OR 1.01, 95% CI 0.44-1.98, p = .105) and intermediate-risk groups (OR 0.92, 95% CI 0.63-1.36, p = .319), while low-risk patients had a lower rate of 30-day stroke after TAVR than SAVR (OR 0.65, 95% CI 0.50-0.83, p < .001). Meta-regression showed a significant association between surgical risk score and 30-day stroke rate (p = .007). Conclusions: TAVR is associated with a lower risk of 30-day stroke compared with SAVR, mainly as a result of the significant advantage observed in patients at low surgical risk

Deep learning to detect significant coronary artery disease from plain chest radiographs AI4CAD

The predictive role of chest radiographs in patients with suspected coronary artery disease (CAD) is underestimated and may benefit from artificial intelligence (AI) applications

Coronary Access After Transcatheter Aortic Valve Replacement With Commissural Alignment: The ALIGN-ACCESS Study

Background: Coronary access (CA) after transcatheter aortic valve replacement (TAVR) with supra-annular transcatheter heart valves (THV) can be challenging. Specific Evolut R/Pro and Acurate Neo THVs orientations are associated with reduced neo-commissure overlap with coronary ostia, while SAPIEN 3 THV cannot be oriented. With the ALIGN-ACCESS study (TAVR With Commissural Alignment Followed by Coronary Access), we investigated the impact of commissural alignment on the feasibility of CA after TAVR. Methods: We performed coronary angiography after TAVR with intra-annular SAPIEN 3, supra-annular Evolut R/Pro, and Acurate Neo THVs in 206 patients. Evolut THVs were implanted aiming for commissure alignment. Alignment of Acurate Neo was retrospectively assessed in 36, intentionally attempted in 26 cases. The primary end point was the rate of unfeasible and nonselective CA after TAVR. Results: Thirty-eight percent of patients received SAPIEN 3, 31.1% Evolut Pro/R, 30.1% Acurate Neo THV. Final valve orientation was favorable to commissural alignment in 85.9% of Evolut and 69.4% of Acurate Neo cases (with intentional alignment successful in 88.5%). Selective CA was higher for SAPIEN 3 than for aligned and misaligned supra-annular THVs (95% versus 71% versus 46%, P<0.001). Cannulation of at least one coronary was unfeasible with 11% misaligned supra-annular, 3% aligned supra-annular, and 0% SAPIEN 3 THVs. Independent predictors of unfeasible/nonselective CA were implantation of a misaligned supra-annular THV (odds ratio, 4.59 [95% CI, 1.81-11.61]; P<0.01), sinus of Valsalva height (odds ratio, 0.83 [95% CI, 0.7-0.98]; P=0.03), and THV-sinus of Valsalva relation (odds ratio, 1.06 [95% CI, 1.02-1.1]; P<0.01). Conclusions: Commissural alignment improves the rate of selective CA after TAVR with supra-annular THVs. Nevertheless, aligned supra-annular THVs carry higher risk of unfeasible/nonselective CA than SAPIEN 3. Patients with a misaligned supra-annular THV, low sinus of Valsalva, and higher THV-sinus of Valsalva relation are at highest risk of impaired CA after TAVR