[TAVI - New Frontiers]. / TAVI ­ Neue Grenzen.

TAVI - New Frontiers Abstract. In this overview, the current major challenges in the field of TAVI are discussed with available supporting data. Valve-in-valve procedures have become routine with reliable evidence to optimise outcomes and minimise the risk of patient prosthesis mismatch. Treating bicuspid aortic valve anatomy remains a challenge with no imminent sign of randomised data to assist treatment decisions; however, it seems clear that improving transcatheter technology and operator experience can lead to excellent results in selected patients. Despite the lingering risk of valve leaflet thrombosis, dual-antiplatelet therapy after TAVI appears to do more harm than good in comparison to single antiplatelet therapy. Whether oral anticoagulation may yet tip the scales toward net clinical benefit remains to be determined. Finally, with TAVI firmly established as the preferred treatment for patients with high and intermediate surgical risk, and as a suitable alternative to surgery in some low risk patients, increasing attention is being turned to the timing of valve intervention. In particular, there is a clear trend away from the traditional symptomatology and strict haemodynamic parameter-driven strategies that have dictated treatment algorithms until now, toward investigating and treating aortic stenosis before the occurrence of deleterious extra-valvular effects.

Pacing Strategies of Ultracyclists in the "Race Across AMerica".

PURPOSE: To examine pacing strategies of ultracyclists competing in the Race Across AMerica (RAAM), the world's longest ultracycling race, covering ~4860 km from the West to the East coast of America. METHODS: Age, cycling speed at and across time stations, race distance, relative difference in altitude between time stations, wind velocity, wind gradient, and temperature at each time station were recorded for women and men competing from 2010 to 2014. Changes in cycling speed and power output of elite and age-group finishers were analyzed using mixed-effects regression analyses. RESULTS: Cycling speed decreased across time stations for women and men where men were faster than women. Power output decreased across time stations in women and men and was lower for women for all finishers, the annual 3 fastest, and age group 60-69 y but not for age groups 18-49 and 50-59 y. The change in temperature and altitude had an influence on cycling speed and power output in all finishers, the annual top 3, nonfinishers, and in all different age groups for both women and men but in the age group 50-59 y altitude had no influence on cycling speed. CONCLUSIONS: Positive pacing (ie, decrease in speed throughout the race) seemed to be the adequate strategy in the RAAM. The top 3 finishers started faster and had a higher power output at the start than less successful competitors, achieved the highest peak cycling speeds and power output, and maintained peak cycling speed and power output longer before slowing down.