Seafloor and Shallow Subsurface of the St. Lawrence River Estuary

A new surficial geology map of the St. Lawrence River Estuary illustrates sediment distribution and variability in a relatively confined environment. This map is based on recently collected geophysical and geological data that provide a link between submarine land-forms and sedimentary units. The strong dichotomy between the areas to the northeast and to the southwest of the Saguenay River is the main characteristic of the St. Lawrence River Estuary. To the northeast, the Lower St. Lawrence Estuary is mainly floored by fine silts within the Laurentian Channel and sediments varying from sands to fine silts on its margins. To the southwest, the Middle Estuary corresponds to a high-energy sedimentary environment that precludes the deposition of fine-grained sediments. In the latter area, Holocene sediments are either absent or correspond to a sand unit shaped by currents. Sommaire Une nouvelle carte de la géologie des sédiments superficiels du fond marin de l’estuaire du Saint-Laurent présente un cas de la distribution et de la variabilité des sédiments dans un environ-nement relativement confiné. Cette carte est basée sur des données géophysiques et géologiques récentes qui assurent un lien entre le relief sous-marin et les unités sédimentaires. La forte dichotomie entre les zones situées au nord-est et au sud-ouest de la rivière Saguenay est la caractéristique principale de l’estuaire du Saint-Laurent. Au nord-est, le fond de l’estuaire maritime du Saint-Laurent est recouvert de silts fins au sein du chenal Laurentien et par des sédiments variant de sables à silts fins sur ses marges. Au sud-ouest, l’estuaire moyen correspond à un environnement sédimentaire de forte énergie qui empêche le dépôt de sédiments fins. Dans cette dernière zone, les sédiments holocènes sont absents ou correspondent à une unité sableuse façonnée par les courants

Aortic Valve Surgery in Nonelderly Patients: Insights Gained From AVIATOR

Aortic valve surgery in non-elderly patients represents a very challenging patient population. The younger the patient is at the point of aortic valve intervention, the longer their anticipated life expectancy will be, with longer exposure to valve-related complications and risk for re-operation. Although the latest international guidelines recommend aortic valve repair in patients with aortic valve insufficiency, what we see in the real world is that the vast majority of these aortic valves are replaced. However, current prosthetic valves has now been shown to lead to significant loss of life expectancy for non-elderly patients up to 50% for patients in their 40s undergoing mechanical aortic valve replacement. Bioprostheses carry an even worse long-term survival, with higher rates of re-intervention. The promise of trans-catheter valve-in-valve technology is accentuating the trend of bioprosthetic implantation in younger patients, without yet the appropriate evidence. In contrast, aortic valve repair has shown excellent outcomes in terms of quality of life, freedom from re-operation and freedom from major adverse valve-related events with similar life expectancy to general population as it is also found for the Ross procedure, the only available living valve substitute. We are at a time when the paradigm of aortic valve surgery needs to change for the better. To better serve our patients, we must acquire high quality real-world evidence from multiple centers globally - this is the vision of the AVIATOR registry and our common responsibility.status: publishe