"Very" Very Late Stent Thrombosis: The Occurrence of Thrombosis 12.3 Years After Paclitaxel-Eluting Stent Implantation.

Very late stent thrombosis (VLST) refers to stent thrombosis occurring beyond one year after coronary intervention. "Very" very or extremely late stent thrombosis (VVLST), occurring after five years of drug-eluting stent (DES) implantation, is extremely rare. We report a case of a 60-year-old male patient with ST-elevation myocardial infarction (STEMI) due to in-stent thrombosis 12.3 years after first-generation DES implantation; we also engage in a brief discussion of its pathogenesis and prevention.

Scalable SoftGroup for 3D Instance Segmentation on Point Clouds.

This paper considers a network referred to as SoftGroup for accurate and scalable 3D instance segmentation. Existing state-of-the-art methods produce hard semantic predictions followed by grouping instance segmentation results. Unfortunately, errors stemming from hard decisions propagate into the grouping, resulting in poor overlap between predicted instances and ground truth and substantial false positives. To address the abovementioned problems, SoftGroup allows each point to be associated with multiple classes to mitigate the uncertainty stemming from semantic prediction. It also suppresses false positive instances by learning to categorize them as background. Regarding scalability, the existing fast methods require computational time on the order of tens of seconds on large-scale scenes, which is unsatisfactory and far from applicable for real-time. Our finding is that the k-Nearest Neighbor ( k-NN) module, which serves as the prerequisite of grouping, introduces a computational bottleneck. SoftGroup is extended to resolve this computational bottleneck, referred to as SoftGroup++. The proposed SoftGroup++ reduces time complexity with octree k-NN and reduces search space with class-aware pyramid scaling and late devoxelization. Experimental results on various indoor and outdoor datasets demonstrate the efficacy and generality of the proposed SoftGroup and SoftGroup++. Their performances surpass the best-performing baseline by a large margin (6%  âˆ¼  16%) in terms of AP 50. On datasets with large-scale scenes, SoftGroup++ achieves a 6× speed boost on average compared to SoftGroup. Furthermore, SoftGroup can be extended to perform object detection and panoptic segmentation with nontrivial improvements over existing methods.

Penile Glans Necrosis Associated With Antiphospholipid Syndrome: A Rare Complication.

Penile glans necrosis is a rare clinical condition caused by trauma, diabetes mellitus, adverse effect of vasoconstrictive solutions, and circumcision. Antiphospholipid syndrome (APS) is categorized as an autoimmune disease with the presence of antiphospholipid antibodies that results in an increased risk of vascular thrombosis and obstetrical complications. In this article, we report a rare case of a 20-year-old boy with penile glans necrosis due to penile vascular thrombosis following catastrophic antiphospholipid syndrome (CAPS) which we successfully treated at People's Hospital 115.

Primary gastrointestinal non-Hodgkin lymphoma: a retrospective study in Vietnam.

Although primary gastrointestinal non-Hodgkin lymphoma (GI NHL) is a rare hematopoietic malignancy, it is the most common extranodal site involved by lymphoma. Treatment methods are chosen based on many factors, including site of lesion, histopathology, symptoms, and patients' choice. Objectives: To evaluate the clinical characteristics, treatment results and prognosis for primary GI NHL in Vietnamese patients. Patients and methods: This was a retrospective descriptive study on 126 patients with primary GI NHL treated at our hospital from 2010 to 2015. Data of all patients were collected and analyzed. Results: B-cell non-Hodgkin's lymphoma was the major pathology with rate of 93.7%, in which Diffuse Large B-Cell Lymphoma type accounted for 58.7%, followed by Mucosa-associated lymphoid tissue lymphoma type 22.2%. Less common forms were cystic type, Burkitt's lymphoma, Mantle cell, T cell. The majority of patients receiving chemotherapy achieved a complete response, up to 70%. Overall survival and 5-year disease-free survival were 74.1% and 59.3%, respectively. Overall, stomach lymphoma had a longer survival rate than those in the small intestine. Factors including Eastern Cooperative Oncology Group score of 2-4, elevated Lactate Dehydrogenase levels at baseline, stage of widespread illness (III/IV), high malignancy histopathology, and lesion size of more than 10 cm were poor prognostic indicators. Conclusions: Gastric lesion was the most frequent site and has better prognosis than other locations. Other prognostic factors for overall survival included Eastern Cooperative Oncology Group score, Lactate Dehydrogenase levels, stage, histopathology, and lesion size.

Sequential Organ Failure Assessment (SOFA) Score for predicting mortality in patients with sepsis in Vietnamese intensive care units: a multicentre, cross-sectional study.

OBJECTIVES: To compare the accuracy of the Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE II) Scores in predicting mortality among intensive care unit (ICU) patients with sepsis in a low-income and middle-income country. DESIGN: A multicentre, cross-sectional study. SETTING: A total of 15 adult ICUs throughout Vietnam. PARTICIPANTS: We included all patients aged ≥18 years who were admitted to ICUs for sepsis and who were still in ICUs from 00:00 to 23:59 of the specified study days (ie, 9 January, 3 April, 3 July and 9 October of the year 2019). PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was hospital all-cause mortality (hospital mortality). We also defined the secondary outcome as all-cause deaths in the ICU (ICU mortality). RESULTS: Of 252 patients, 40.1% died in hospitals, and 33.3% died in ICUs. SOFA Score (areas under the receiver operating characteristic curve (AUROC): 0.688 (95% CI 0.618 to 0.758); cut-off value≥7.5; PAUROC<0.001) and APACHE II Score (AUROC: 0.689 (95% CI 0.622 to 0.756); cut-off value ≥20.5; PAUROC<0.001) both had a poor discriminatory ability for predicting hospital mortality. However, the discriminatory ability for predicting ICU mortality of SOFA (AUROC: 0.713 (95% CI 0.643 to 0.783); cut-off value≥9.5; PAUROC<0.001) was fair and was better than that of APACHE II Score (AUROC: 0.672 (95% CI 0.603 to 0.742); cut-off value≥18.5; PAUROC<0.001). A SOFA Score≥8 (adjusted OR (AOR): 2.717; 95% CI 1.371 to 5.382) and an APACHE II Score≥21 (AOR: 2.668; 95% CI 1.338 to 5.321) were independently associated with an increased risk of hospital mortality. Additionally, a SOFA Score≥10 (AOR: 2.194; 95% CI 1.017 to 4.735) was an independent predictor of ICU mortality, in contrast to an APACHE II Score≥19, for which this role did not. CONCLUSIONS: In this study, SOFA and APACHE II Scores were worthwhile in predicting mortality among ICU patients with sepsis. However, due to better discrimination for predicting ICU mortality, the SOFA Score was preferable to the APACHE II Score in predicting mortality.Clinical trials registry - India: CTRI/2019/01/016898.

Predictive validity of the quick Sequential Organ Failure Assessment (qSOFA) score for the mortality in patients with sepsis in Vietnamese intensive care units.

BACKGROUND: The simple scoring systems for predicting the outcome of sepsis in intensive care units (ICUs) are few, especially for limited-resource settings. Therefore, this study aimed to evaluate the accuracy of the quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) score in predicting the mortality of ICU patients with sepsis in Vietnam. METHODS: We did a multicenter cross-sectional study of patients with sepsis (≥18 years old) presenting to 15 adult ICUs throughout Vietnam on the specified days (i.e., 9th January, 3rd April, 3rd July, and 9th October) representing the different seasons of 2019. The primary and secondary outcomes were the hospital and ICU all-cause mortalities, respectively. The area under the receiver operating characteristic curve (AUROC) was calculated to determine the discriminatory ability of the qSOFA score for deaths in the hospital and ICU. The cut-off value of the qSOFA scores was determined by the receiver operating characteristic curve analysis. Upon ICU admission, factors associated with the hospital and ICU mortalities were assessed in univariable and multivariable logistic models. RESULTS: Of 252 patients, 40.1% died in the hospital, and 33.3% died in the ICU. The qSOFA score had a poor discriminatory ability for both the hospital (AUROC: 0.610 [95% CI: 0.538 to 0.681]; cut-off value: ≥2.5; sensitivity: 34.7%; specificity: 84.1%; PAUROC = 0.003) and ICU (AUROC: 0.619 [95% CI: 0.544 to 0.694]; cutoff value: ≥2.5; sensitivity: 36.9%; specificity: 83.3%; PAUROC = 0.002) mortalities. However, multivariable logistic regression analyses show that the qSOFA score of 3 was independently associated with the increased risk of deaths in both the hospital (adjusted odds ratio, AOR: 3.358; 95% confidence interval, CI: 1.756 to 6.422) and the ICU (AOR: 3.060; 95% CI: 1.651 to 5.671). CONCLUSION: In our study, despite having a poor discriminatory value, the qSOFA score seems worthwhile in predicting mortality in ICU patients with sepsis in limited-resource settings. CLINICAL TRIAL REGISTRATION: Clinical trials registry-India: CTRI/2019/01/016898.

Visual Pretraining via Contrastive Predictive Model for Pixel-Based Reinforcement Learning.

In an attempt to overcome the limitations of reward-driven representation learning in vision-based reinforcement learning (RL), an unsupervised learning framework referred to as the visual pretraining via contrastive predictive model (VPCPM) is proposed to learn the representations detached from the policy learning. Our method enables the convolutional encoder to perceive the underlying dynamics through a pair of forward and inverse models under the supervision of the contrastive loss, thus resulting in better representations. In experiments with a diverse set of vision control tasks, by initializing the encoders with VPCPM, the performance of state-of-the-art vision-based RL algorithms is significantly boosted, with 44% and 10% improvement for RAD and DrQ at 100 steps, respectively. In comparison to the prior unsupervised methods, the performance of VPCPM matches or outperforms all the baselines. We further demonstrate that the learned representations successfully generalize to the new tasks that share a similar observation and action space.

Highly sensitive detection of EGFR L858R mutation at the mRNA level.

The missense mutation EGFR L858R implies increased sensitivity to EGFR tyrosine kinase inhibitor (TKIs) therapy, despite a significant non-response rate. Currently, detection of EGFR L858R mutation is mostly DNA based, therefore, the allele-specific expression level of the mutated gene and its clinical relevance is hidden. Based on the extendable blocking probes and hot-start protocol for reverse transcription, we have developed and validated a novel one-step realtime RT-PCR assay that enables detection of EGFR L858R mutation at the mRNA level. This RNA-based assay was able to detect the EGFR L858R mutation in a 10,000-fold excess of its wildtype counterpart, indicating an analytical sensitivity of 0.01%. In comparison to the reference DNA-based assay, the RNA-based assay further detected the EGFR L858R mutation in significantly additional formalin-fixed paraffin-embedded (FFPE) samples (19.2% vs 15.0%). Interestingly, our data showed that the relative mRNA levels of EGFR L858R mutation varied greatly in tumor tissues (∼4 logs); and the circulating mRNA of EGFR L858R mutation was detectable in plasma of NSCLC patients. This novel RNA-based PCR assay provides a simple and ultrasensitive tool for detection of EGFR L858R mutation at the mRNA level as a new class of biomarkers.

Actor-critic learning-based energy optimization for UAV access and backhaul networks.

In unmanned aerial vehicle (UAV)-assisted networks, UAV acts as an aerial base station which acquires the requested data via backhaul link and then serves ground users (GUs) through an access network. In this paper, we investigate an energy minimization problem with a limited power supply for both backhaul and access links. The difficulties for solving such a non-convex and combinatorial problem lie at the high computational complexity/time. In solution development, we consider the approaches from both actor-critic deep reinforcement learning (AC-DRL) and optimization perspectives. First, two offline non-learning algorithms, i.e., an optimal and a heuristic algorithms, based on piecewise linear approximation and relaxation are developed as benchmarks. Second, toward real-time decision-making, we improve the conventional AC-DRL and propose two learning schemes: AC-based user group scheduling and backhaul power allocation (ACGP), and joint AC-based user group scheduling and optimization-based backhaul power allocation (ACGOP). Numerical results show that the computation time of both ACGP and ACGOP is reduced tenfold to hundredfold compared to the offline approaches, and ACGOP is better than ACGP in energy savings. The results also verify the superiority of proposed learning solutions in terms of guaranteeing the feasibility and minimizing the system energy compared to the conventional AC-DRL.

Factors relating to mortality in septic patients in Vietnamese intensive care units from a subgroup analysis of MOSAICS II study.

Sepsis is the most common cause of in-hospital deaths, especially from low-income and lower-middle-income countries (LMICs). This study aimed to investigate the mortality rate and associated factors from sepsis in intensive care units (ICUs) in an LMIC. We did a multicenter cross-sectional study of septic patients presenting to 15 adult ICUs throughout Vietnam on the 4 days representing the different seasons of 2019. Of 252 patients, 40.1% died in hospital and 33.3% died in ICU. ICUs with accredited training programs (odds ratio, OR: 0.309; 95% confidence interval, CI 0.122-0.783) and completion of the 3-h sepsis bundle (OR: 0.294; 95% CI 0.083-1.048) were associated with decreased hospital mortality. ICUs with intensivist-to-patient ratio of 1:6 to 8 (OR: 4.533; 95% CI 1.621-12.677), mechanical ventilation (OR: 3.890; 95% CI 1.445-10.474) and renal replacement therapy (OR: 2.816; 95% CI 1.318-6.016) were associated with increased ICU mortality, in contrast to non-surgical source control (OR: 0.292; 95% CI 0.126-0.678) which was associated with decreased ICU mortality. Improvements are needed in the management of sepsis in Vietnam such as increasing resources in critical care settings, making accredited training programs more available, improving compliance with sepsis bundles of care, and treating underlying illness and shock optimally in septic patients.

Quality of Work Life in Healthcare: A Comparison of Medical Representatives and Hospital Pharmacists.

This study aims to access the quality of work-life and characteristics between medical representatives and hospital pharmacists to understand the current QWL status among these health workers. This research was led with a cross-sectional design conducted with a survey using the work-related quality of life scale-2. There were 296 medical representatives and 344 hospital pharmacists participating in this study. The results showed that medical representatives had better QWL scores than hospital pharmacists. This study suggests that governments and the international community should invest in workplace programs for pharmacists that improve their QWL.

A Comprehensive Survey of Enabling and Emerging Technologies for Social Distancing-Part I: Fundamentals and Enabling Technologies.

Social distancing plays a pivotal role in preventing the spread of viral diseases illnesses such as COVID-19. By minimizing the close physical contact among people, we can reduce the chances of catching the virus and spreading it across the community. This two-part paper aims to provide a comprehensive survey on how emerging technologies, e.g., wireless and networking, artificial intelligence (AI) can enable, encourage, and even enforce social distancing practice. In this Part I, we provide a comprehensive background of social distancing including basic concepts, measurements, models, and propose various practical social distancing scenarios. We then discuss enabling wireless technologies which are especially effect- in social distancing, e.g., symptom prediction, detection and monitoring quarantined people, and contact tracing. The companion paper Part II surveys other emerging and related technologies, such as machine learning, computer vision, thermal, ultrasound, etc., and discusses open issues and challenges (e.g., privacy-preserving, scheduling, and incentive mechanisms) in implementing social distancing in practice.

A Comprehensive Survey of Enabling and Emerging Technologies for Social Distancing-Part II: Emerging Technologies and Open Issues.

This two-part paper aims to provide a comprehensive survey on how emerging technologies, e.g., wireless and networking, artificial intelligence (AI) can enable, encourage, and even enforce social distancing practice. In Part I, an extensive background of social distancing is provided, and enabling wireless technologies are thoroughly surveyed. In this Part II, emerging technologies such as machine learning, computer vision, thermal, ultrasound, etc., are introduced. These technologies open many new solutions and directions to deal with problems in social distancing, e.g., symptom prediction, detection and monitoring quarantined people, and contact tracing. Finally, we discuss open issues and challenges (e.g., privacy-preserving, scheduling, and incentive mechanisms) in implementing social distancing in practice. As an example, instead of reacting with ad-hoc responses to COVID-19-like pandemics in the future, smart infrastructures (e.g., next-generation wireless systems like 6G, smart home/building, smart city, intelligent transportation systems) should incorporate a pandemic mode in their standard architectures/designs.

Non-surgical chronic rhinosinusitis and quality of life: A Vietnamese perspective.

OBJECTIVE: Evidences which illustrate symptoms of chronic rhinosinusitis (CRS) had negative effects on society and individuals are growing these days. The aims of this study are to assess the quality of life (QoL) of individuals with CRS and to analyze the relationship between socio-demographic as well as clinical factors and the quality of life of patients. METHODS: A cross-sectional and prevalence-based study was conducted from May to July, 2018. We used The Sinonasal Outcome Test-22 (SNOT-22) questionnaire to evaluate the quality of life of patients with chronic rhinosinusitis. In addition, the univariate logistic regression analysis and logistic regression models were used to calculate the Crude odds ratio (OR), adjusted odds ratio (aOR), and 95% confidence intervals (CIs) for factors. Statistical significance was considered as P-value <0.05. RESULTS: Among 315 participants, about two fifths of them were diagnosed with CRS. The statistical test illustrated that all factors illustrated significant differences. The main exposure variable, CRS, was significantly associated with poor quality of life, with a 78.02-fold increase in the odds of having a good quality of life score. CONCLUSIONS: Our findings have shown that patients with CRS experience a poorer quality of life than healthy controls. The influencing factors included gender, economic status, exercise and nasal discharge.

Economic outcomes among chronic obstructive pulmonary disease Vietnamese patients: Approach considerations from a social perspective.

OBJECTIVE: Chronic obstructive pulmonary disease (COPD) is associated with major burden on economic effects. The objective of this study was to explore cost categories caused by COPD in Vietnam and the relationships between those costs and some demographic factors. METHODS: A cross-sectional study was carried out among 359 COPD patients who visited Dong Nai General Hospital in Vietnam in 2018. Patients were classified according to codes from the International Classification of Diseases, 10th revision (ICD-10) (J44: Chronic obstructive pulmonary disease). Demographic information and clinical status of the data were illustrated by descriptive statistics. With the bootstrapping method, cost data are represented as an arithmetic mean cost (Bootstrap 95% CI). RESULTS: The sample of this study consisted of 359 patients, of which 280 (78.0%) were outpatient department (OPD) patients compared to the 79 (22%) inpatient department (IPD) patients. Total costs per visit were estimated at $87.10 (95% CI $76.20-$99.50) and $372.10 (95% CI $320.10-$430.00) for OPD and IPD, respectively. The costs had an increasing trend with the number of comorbidities, the severity, and the duration of COPD. The annual costs were higher in men than in women, but there was a "low burden" group of OPD stage IV patients. Costs per visit of the "low burden" group were more correlated with demographic categories than those of the "high burden" group. CONCLUSIONS: The results of this perspective study illustrate that Vietnamese COPD is associated with a significant economic burden. The cost of this disease per case is shown to be proportional to the severity and comorbidities of COPD; additionally, "high burden" groups have double the total costs of COPD.

Hypoglyceamia cases in diabetic patients with insulin and oral hypoglycemic agents: A retrospective research in a secondary health facility.

OBJECTIVE: In Vietnam, prevalence of diabetes in adults is estimated at 5.5% and the total cases of diabetes in adults was over 3,5 million in 2017. Hypoglycaemia is one of the most-observed adverse reaction associated with the consumption of insulin and oral hypoglycaemia agents. The objective is to report the hypoglycaemia cases in type 2 diabetes mellitus (T2DM) patients with medication therapies attending a secondary health facility. METHODS: We conducted this retrospective research on 1,006 T2DM patients at Lam Dong General Hospital, Lam Dong province in three years between 2016 and 2018 using ICD-10 code of E11. A total of 523 eligible T2DM patients were enumerated to select hypoglycaemia cases while treated with insulin therapy or oral intake of hypoglycaemia agents. Information were extracted from hospital electronic databases, sensitive information was coded. RESULTS: Among 523 eligible T2DM patients, 92.4% (n=483) patients experienced at least one symptom of hypoglycaemia. The mean age of the selected patients was 51.2}5.2. Females were dominated by males in terms of number. Frequency of hypoglycaemia symptoms was 0-1 time per week for most of patients. The main hypoglycaemia symptoms that most of patients with T2DM suffered were sweating and drowsiness (83% and 70% respectively). Seizures, headache and loss of consciousness accounted for lowest percentages. CONCLUSIONS: The frequency of hypoglycaemia in T2DM patients in Lam Dong General Hospital was very high. Physician consideration and patient education are necessary in hypoglycaemia management.

Single nucleotide and structural variants of CYP2D6 gene in Kinh Vietnamese population.

CYP2D6 genetic variations could result in alteration of CYP2D6 enzyme activity, leading to dissimilarity among individuals in regard of drug metabolism.This study aims to detect all genetic variants, allele, and genotype frequencies of CYP2D6 gene in 136 unrelated healthy Kinh Vietnamese volunteers. All single nucleotide variants (SNVs) and structural variations (SVs) of CYP2D6 gene were identified by Sanger sequencing and multiplex ligation-dependent probe amplification (MLPA) assay.Totally, 30 SNVs and 9 SVs including a whole gene deletion, 8 hybrid structures, and tandem arrangements were identified. Of the 7 novel SNVs detected, the 3157G>T (R329L) substitution was predicted to be deleterious by PROVEAN; the 3851G>A (W358X) variant resulted in a truncated protein; and the 2988G>A variant located in the intron 6 was predicted to be capable of modifying splicing motif by Human Splicing Finder. We determined 29 different genotypes of CYP2D6 from 136 individuals. The most common alleles were the CYP2D6*10 (43.75%), *1 (18.75%), and tandem arrangement *36-*10 (12.13%).This study provides best information on CYP2D6 polymorphism comprising the newly discovered SNVs, structural variations, and their frequencies in Kinh Vietnamese. These new data would be valuable in view of precise dosing of CYP2D6 metabolized drugs and giving better treatment outcome.

Nonanemic extramedullary hematopoiesis in the posterior mediastinum.

Extramedullary hematopoiesis is a rare condition characterized by the formation of blood cells outside the bone marrow. It is commonly seen in patients with hematopoietic disorders or chronic anemia. Here, we report the case of a 55-year-old patient who had extramedullary hematopoiesis that manifested as an asymptomatic posterior mediastinal mass. Chest computed tomography showed a 30 × 35-mm mass located on the left side of the D11 vertebra. Laboratory investigations revealed no signs of anemia. The tumor was safely and completely removed using video-assisted thoracoscopic surgery. Pathological studies confirmed the extramedullary hematopoiesis nature of the tumor.

Comprehensive and Integrative Experimentation Setup for Large Animal Hybrid Valvular Heart Surgery.

BACKGROUND: Experimental surgical procedures for atrioventricular valves present promising translational capabilities, and preclinical studies are necessary to assess their applicability and to train young enthusiastic heart teams. Here, we present a synopsis of experimental surgical procedures on porcine models for mitral valvular (MV) and tricuspid valvular (TV) interventions; mitral valve-in-valve implantation (MViV), transapical cardioscopic (TAC) MV replacement (MVR), TAC-MV annuloplasty, and tricuspid valve-in-a-ring (TViR) procedures. METHODS: Twenty-five (n = 25) female Yorkshire pigs of 55-65 kg is the total number used in the four approaches; seven animals underwent MViV, six TAC-MVR, six TAC-MV annuloplasty, and six TViR, respectively. All were subjected to a first conventional valvular surgery (bioprosthetic valve replacement and/or prosthetic ring repair). Then, after 4 wk, a less-invasive second surgery was performed using the transcatheter approaches under investigation. Except for the TAC-MVR and annuloplasty procedures, all animals were followed up for additional 4 wk. RESULTS: (1) MViV (n = 7): Standard MVR was successfully performed in all animals. Transvalvular pressure gradients and flow velocities were (Pmax 3.77 ± 0.8 mmHg; Pmean 2.1 ± 0.6 mmHg, Vmax 97 ± 13 cm/s; Vmean 68 ± 21 cm/s). Effective MViV followed (Pmax 16.7 ± 1.8 mmHg; Pmean 6.2 ± 1.2 mmHg, Vmax 216 ± 32 cm/s; Vmean 110 ± 24 cm/s). (2) TAC-MVR (n = 6): The overall bypass time was 177.2 ± 44.2 min. Transprosthetic Pmean was 4.6 ± 2.4 mmHg; no paravalvular leaks in all animals. (3) TAC-MV annuloplasty (n = 6): The implantation time was 47 ± 6 min. MV was competent, left ventricular ejection fraction (LV-EF%) was 63 ± 4%. (4) TViR (n = 6): Conventional TV ring repair was performed in all animals (Pmax 2.42 ± 0.7 mmHg; Pmean 1.3 ± 0.6 mmHg, Vmax 82 ± 10.4 cm/s; Vmean 65.4 ± 21 cm/s). All TViRs were implanted efficiently (Pmax 4.7 ± 1.6 mmHg; Pmean 2.7 ± 0.8 mmHg, Vmax 105 ± 31 cm/s; Vmean 81 ± 16 cm/s). A mild paravalvular leak was observed in one animal (16%). CONCLUSIONS: All studied experimental valvular interventions are feasible, within the context of well-trained cardiac surgery specialists, and all possibilities should be considered when treating a patient to determine which one suits best his individual challenges and scope.