Aortic root enlargement to mitigate patient-prosthesis mismatch: do early adverse events justify reluctance?†.

OBJECTIVES:: Concomitant aortic root enlargement (ARE) at the time of surgical aortic valve replacement can be performed to avoid patient-prosthesis mismatch, an important predictor of adverse long-term outcome. METHODS:: We performed a single-centre, retrospective analysis of 4120 patients receiving isolated aortic valve replacement, of whom 171 (4%) had concomitant ARE between January 2005 and December 2015. The analysis of postoperative outcome and early mortality was performed. Owing to inequality of the groups, patients were matched 1:1. RESULTS:: The mean age of all 4120 patients was 68.8 ± 10.5 years, and comorbidities were equally balanced after matching. The mean aortic cross-clamp time, cardiopulmonary bypass time and total operative time were prolonged by 19, 20 and 27 min in the ARE group, respectively. Early mortality was not statistically significantly different with 1.4% in the surgical aortic valve replacement and 1.8% in the ARE group. Postoperative complications were <5% in all matched 338 patients: bleeding (3% vs 3%), pericardial effusion (3.0% vs 4.2%), sternal instability (1.8% vs 0%) and sternal wound infection (3.0% vs 1.2%). A significant higher number of patients had respiratory failure after ARE (unmatched: 17.1% vs 9.9%, P < 0.001; matched: 18.3% vs 9.5%, P = 0.028). Factors independently associated with overall mortality were age [hazard ratio (HR) 1.71], chronic obstructive pulmonary disease (HR 1.47), diabetes (HR 1.82), atrial fibrillation (HR 2.14) and postoperative respiratory failure (HR 2.84). CONCLUSIONS:: ARE can be performed safely in experienced centres with no significant increase in the risk of early postoperative surgical complications and early mortality. However, the surgeon and the intensive care unit team should be aware of an increased risk for postoperative respiratory failure in ARE patients.

Logarithmic boundary layers in strong Taylor-Couette turbulence.

We provide direct measurements of the boundary layer properties in highly turbulent Taylor-Couette flow up to Re=2×106) (Ta=6.2×10(12)) using high-resolution particle image velocimetry and particle tracking velocimetry. We find that the mean azimuthal velocity profile at the inner and outer cylinder can be fitted by the von Kármán log law u+=1/κ lny+ +B. The von Kármán constant κ is found to depend on the driving strength Ta and for large Ta asymptotically approaches κ≈0.40. The variance profiles of the local azimuthal velocity have a universal peak around y+≈12 and collapse when rescaled with the driving velocity (and not with the friction velocity), displaying a log dependence of y+ as also found for channel and pipe flows.

Parallax correction for precise near-wall flow investigations using particle imaging.

For the basic understanding of turbulence generation in wall-bounded flows, precise measurements of the mean velocity profile and the mean velocity fluctuations very close to the wall are essential. Therefore, three techniques are established for high-resolution velocity profile measurements close to solid surfaces: (1) the nanoprobe sensor developed at Princeton University, which is a miniaturization of a classical hot-wire probe [Exp. Fluids 51, 1521 (2011)]; (2) the laser Doppler velocimetry (LDV) profile sensor, which allows measurement of the location of the particles inside the probe volume using a superposition of two fringe systems [Exp. Fluids 40, 473 (2006)]; and (3) the combination of particle image velocimetry and tracking techniques (PIV/PTV), which identify the location and velocity of submicrometer particles within the flow with digital imaging techniques [Exp. Fluids 52, 1641 (2006)]. The last technique is usually considered less accurate and precise than the other two. However, in addition to the measurement precision, the effect of the probe size, the position error, and errors due to vibrations of the model, test facility, or measurement equipment have to be considered. Taking these into account, the overall accuracy of the PTV technique can be superior, as all these effects can be compensated for. However, for very accurate PTV measurements close to walls, it is necessary to compensate the perspective error, which occurs for particles not located on the optical axis. In this paper, we outline a detailed analysis for this bias error and procedures for its compensation. To demonstrate the capability of the approach, we measured a turbulent boundary layer at Re(δ)=0.4×10(6) and applied the proposed methods.