Transcatheter Aortic Valve Implantation in Bicuspid Aortic Valve Patients with Coagulation Factor 7 and 11 Deficiency and Atrial Fibrillation.

Although transcatheter aortic valve implantation (TAVI), which is a less invasive standard treatment for aortic stenosis than surgery, has been recommended even in low-risk patients, its effectiveness in bicuspid aortic valve is still unclear. Cardiac surgery has been proven to cause serious complications in hematological diseases with factor deficiency or bleeding diathesis. In this case, which is the first in the literature to our knowledge, we tried to present the successful TAVI procedure in a young patient with bicuspid aortic stenosis and factor 7, 11 deficiency complicated by atrial fibrillation.

Predictors and Prognostic Implications of Myocardial Injury After Transcatheter Aortic Valve Replacement.

Myocardial injury (MI) is not unusual after transcatheter aortic valve replacement (TAVR). To determine precipitating factors and prognostic outcomes of MI after TAVR, we retrospectively investigated relationships between MI after TAVR and aortic root dimensions, baseline patient characteristics, echocardiographic findings, and procedural features. Of 474 patients who underwent transfemoral TAVR for severe aortic stenosis in our tertiary center from June 2011 through June 2018, 188 (mean age, 77.7 ± 7.7 yr; 96 women [51%]) met the study inclusion criteria. Patients were divided into postprocedural MI (PMI) (n=74) and no-PMI (n=114) groups, in accordance with high-sensitivity troponin T levels. We found that MI risk was associated with older age (odds ratio [OR]=1.054; 95% CI, 1.013-1.098; P=0.01), transcatheter heart valve type (OR=10.207; 95% CI, 2.861-36.463; P=0.001), distances from the aortic annulus to the right coronary artery ostium (OR=0.853; 95% CI, 0.731-0.995; P=0.04) and the left main coronary artery ostium (OR=0.747; 95% CI, 0.616-0.906; P=0.003), and baseline glomerular filtration rate (OR=0.985; 95% CI, 0.970-1.000; P=0.04). Moreover, the PMI group had a longer time to hospital discharge (P=0.001) and a higher permanent pacemaker implantation rate (P=0.04) than did the no-PMI group. Our findings may enable better estimation of which patients are at higher risk of MI after TAVR and thus improve the planning and course of clinical care.

Association between fragmented QRS and postprocedural rhythm disturbances in patients who underwent transcatheter aortic valve implantation.

INTRODUCTION: According to recent studies, the rate of atrioventricular block requiring permanent pacing in patients following transcatheter aortic valve implantation varied between 5.7% and 42.5%. Fragmented QRS is a useful marker of myocardial scar and can predict adverse cardiac events. In this study, we examined association between f ragmented QRS and postprocedural rhythm disturbances and the need for permanent pacing in patients who underwent transcatheter aortic valve implantation. OBJECTIVE: In this study, we examined association between fragmented QRS and postprocedural rhythm disturbances and the need for permanent pacing in patients who underwent transcatheter aortic valve implantation' sentence is enough for it. METHODS: We retrospectively analyzed standard 12-lead electrocardiographic recordings of 124 consecutive patients in whom a CoreValve prosthesis was implanted. We examined 12-lead electrocardiogram before and after procedure along with one- and six-month follow-up. We documented QRS fragmentation and postprocedural rhythm disturbances. RESULTS: There was a significant increase in the frequency of left bundle branch block, (21.1 versus 0%, p<0.05) and the incidence of atrioventricular blocks requiring permanent pacing (21.1 versus 0%, p<0.05) following transcatheter aortic valve implantation in patients whose preprocedural electrocardiogram recordings revealed fragmented QRS compared to those without fragmented QRS. Based our collected data, the presence of QRS fragmentation in anterior derivations was the only independent factor associated with postprocedural rhythm disturbances (B-value 0.217; OR 0.805; 95%CI 0.136-4.78; p=0.004). CONCLUSION: Our data showed an increased risk for the development of new-onset left bundle branch block and atrioventricular blocks following transcatheter aortic valve implantation in patients whose baseline electrocardiogram recordings demonstrated QRS fragmentation.

Association between fragmented QRS and postprocedural rhythm disturbances in patients who underwent transcatheter aortic valve implantation

SUMMARY INTRODUCTION: According to recent studies, the rate of atrioventricular block requiring permanent pacing in patients following transcatheter aortic valve implantation varied between 5.7% and 42.5%. Fragmented QRS is a useful marker of myocardial scar and can predict adverse cardiac events. In this study, we examined association between f ragmented QRS and postprocedural rhythm disturbances and the need for permanent pacing in patients who underwent transcatheter aortic valve implantation. OBJECTIVE: In this study, we examined association between fragmented QRS and postprocedural rhythm disturbances and the need for permanent pacing in patients who underwent transcatheter aortic valve implantation' sentence is enough for it. METHODS: We retrospectively analyzed standard 12-lead electrocardiographic recordings of 124 consecutive patients in whom a CoreValve prosthesis was implanted. We examined 12-lead electrocardiogram before and after procedure along with one- and six-month follow-up. We documented QRS fragmentation and postprocedural rhythm disturbances. RESULTS: There was a significant increase in the frequency of left bundle branch block, (21.1 versus 0%, p<0.05) and the incidence of atrioventricular blocks requiring permanent pacing (21.1 versus 0%, p<0.05) following transcatheter aortic valve implantation in patients whose preprocedural electrocardiogram recordings revealed fragmented QRS compared to those without fragmented QRS. Based our collected data, the presence of QRS fragmentation in anterior derivations was the only independent factor associated with postprocedural rhythm disturbances (B-value 0.217; OR 0.805; 95%CI 0.136-4.78; p=0.004). CONCLUSION: Our data showed an increased risk for the development of new-onset left bundle branch block and atrioventricular blocks following transcatheter aortic valve implantation in patients whose baseline electrocardiogram recordings demonstrated QRS fragmentation.

Functional morphology of the suckers and teeth of the medicinal leech Hirudo verbana Carena, 1820 (Annelida; Clitellata; Hirudinida): A scanning electron microscope study.

In this study, the triple jaws and suckers of the leeches belonging to the Hirudo verbana Carena, 1820 (Annelida; Clitellata; Hirudinida) were examined using the stereomicroscopy and scanning electron microscopy. In H. verbana, suckers are seen on the first annulus and last annulus of the body. The mouth opens in the center of the front suction cup, and behind this opening is a movable triple jaw apparatus with many teeth. The posterior sucker disc consists of the last seven body segments and lacks an opening. The shape of the jaw is trignatous. The pharynx is equally located around of the three muscular jaws. The jaws are muscular covered with cuticle and carry a row of teeth arranged at the tip. In this study, it was determined that secretory canal holes were identified between the teeth. The results show that the size of teeth determines long-term bleeding so revealing the structure and working mechanism of the teeth has importance for medicinal leeches. At the same time, the difference of teeth and jaw structures of leeches may be a criterion in the classification of medicinal leeches.

Impact of coronary revascularization on outcomes of transcatheter aortic valve implantation.

OBJECTIVE: Although the effect of coronary revascularization on clinical outcomes before and after transcatheter valve implantation (TAVI) is debatable, there is currently insufficient data to determine the most appropriate revascularization strategy. In this study, we present our single-center experience of percutaneous coronary intervention (PCI) and its effect on clinical outcomes and mortality in patients undergoing TAVI. METHODS: We performed a retrospective analysis of 526 consecutive patients at our center, and 127 patients with obstructive coronary artery disease were included in the study. Patients were divided into two groups: the revascularization group (group 1) and the non-revascularization group (group 2). Procedural complications and long-term all-cause mortality rates were compared between the two groups. RESULTS: Of the 526 patients, group 1 comprised 65 patients (12.3%) who underwent PCI, and group 2 comprised 62 patients (11.7%) who did not undergo revascularization. According to Valve Academic Research Consortium 2 criteria, post-procedural complications, including pericardial effusion, stroke, major vascular complications, major bleeding, and emerging arrhythmias, were similar between the groups. A Kaplan-Meier survival curve analysis showed no significant difference between the revascularization and non-revascularization groups (Overall: 40.0±2.8 month; 95% CI 34.4-45.6 month, p=0.959). After adjustment for basal SYNTAX score, chronic kidney disease stage, previous myocardial infarction, and baseline troponin levels, the long-term survival of group 1 was significantly longer when compared with group 2 (p=0.036). In 75.4% of cases, PCI was performed within 11.0±14.7 days before or after TAVI as a staged procedure. In 13.8% of cases, PCI was performed simultaneously with TAVI. While there was no significant difference in in-hospital, 6-month, and 1-year mortality rates between the simultaneous and staged PCI groups, there was a significant difference in 30-day mortality (11.1% vs. 0%, respectively; p=0.016). CONCLUSION: Peri-procedural and long-term safety outcomes and mortality rates are not significantly different between revascularized and non-revascularized patients, and neither staged nor simultaneous PCI have adverse outcomes in patients undergoing TAVI.

Clinical outcomes after transcatheter aortic valve implantation in active cancer patients and cancer survivors.

BACKGROUND: In this study, we aimed to evaluate the clinical characteristics, perioperative, and mid-term outcomes of patients with severe symptomatic aortic stenosis and active cancer disease and cancer survivors undergoing transcatheter aortic valve implantation. METHODS: Between December 2011 and March 2019, a total of 550 patients (248 males, 302 females; mean age: 77.6±7.9 years; range, 46 to 103 years) who underwent transcatheter aortic valve implantation for severe symptomatic aortic stenosis in our center were retrospectively analyzed. Baseline demographic characteristics, cancer type, laboratory data, procedural data, and outcome data of the patients were collected. The primary outcome measure was all-cause mortality at 30 days and every six months up to maximally available follow-up. Follow-up was performed at 30 days, six months, and 12 months after the procedure and annually thereafter. RESULTS: Of the patients, 36 had a cancer diagnosis-active (n=10) or cured (n=26). The most common types of cancer were colorectal (16.6%), prostate (13.8%), leukemia (11.1%), and bladder (11.1%) cancers. Post-procedural complication rates were similar between the two groups. No mortality was observed in the cancer group at one month of follow-up. During follow-up, seven patients died within one year due to non-cardiac reasons. Although mortality at one year was higher in cancer patients, it did not reach statistical significance (23.3% vs. 11.6%, respectively; p=0.061). The estimated cumulative survival rate was 71.0% in the non-cancer group and 58.3% in the cancer group. The multivariate Cox regression analysis revealed that cancer was independently associated with cumulative mortality after adjusting for age, sex, body mass index, and atrial fibrillation (p=0.008). CONCLUSION: Our study results show that transcatheter aortic valve implantation is safe and feasible in active cancer patients and cancer survivors with similar short-term and mid-term mortality and procedure-related complication rates, compared to non-cancer patients.

Impact of transcatheter aortic valve implantation in symptomatic patients with very severe aortic stenosis.

OBJECTIVE: Aortic stenosis (AS) is a progressive disease, and valve replacement-the only treatment option-should be performed after it becomes symptomatic and before irreversible myocardial damages develop. Surgical valve replacement is recommended in patients with very severe AS (VSAS), even if they are asymptomatic. However, there is no detailed study on the effect of transcatheter aortic valve implantation (TAVI) in patients with VSAS. Our aim in this study is to show the feasibility and safety of TAVI in symptomatic patients with VSAS. METHODS: A total of 505 consecutive patients with symptomatic AD who underwent TAVI in our center were retrospectively studied. The mean age of the patients was 77.8±7.6 years, and 56.4% of them were women. The patients were divided into 2 groups: a group with VSAS (n=134 patients) and a group with high-gradient AS (HGAS) (n=371 patients). RESULTS: Female sex, left ventricular ejection fraction, small left ventricle, hypertrophic left ventricle were more common in the group with VSAS; on the other hand, histories of coronary artery disease bypass surgery, myocardial infarction, and atrial fibrillation were less frequent. Predilatation and Edwards SAPIEN 3 were less used in the group with VSAS. There was no statistical difference in major complications and in-hospital mortality (group with VSAS: 5 patients, group with HGAS: 16 patients; p=0.769) according to the Valve Academic Research Consortium-2 criteria. There was a significant difference between the 2 groups in favor of the group with VSAS on the Cox regression model survival curve (p<0.001). CONCLUSION: In this study, it has been shown that TAVI can be feasible and safe in symptomatic VSAS, with acceptable complications and higher survival rates. Currently, further randomized studies are required to perform TAVI in patients with asymptomatic VSAS currently indicated for surgical aortic valve replacement.

Transcatheter Tricuspid Valve-in-Valve Implantation With a Novel Balloon Expandable Myval THV.

The transcatheter tricuspid valve-in-valve implantation has not yet been clarified, and several case series have documented results in patients with tricuspid bioprosthetic valve degeneration who underwent transcatheter implantation of Edwards SAPIEN XT and SAPIEN 3 (Edwards Lifesciences, Irvine, CA) and Medtronic (Minneapolis, MN) valves. Here, we present the case of a patient with severe bioprosthetic tricuspid valve stenosis who was successfully treated with the transfemoral route through the 29-mm novel balloon expandable Myval transcatheter heart valve (Meril Life Sciences Pvt Ltd, Vapi, Gujarat, India) system.

Transcatheter Aortic Valve Implantation in Patients with Connective Tissue Disease.

BACKGROUND: There is still no consensus on the treatment of patients with connective tissue disease (CTD) with severe symptomatic aortic stenosis (AS). The aim of this study was to evaluate the feasibility and safety of transcatheter aortic valve implantation (TAVI) in patients with CTD. METHODS: Five hundred and fifty consecutive symptomatic severe AS patients who underwent TAVI between 2011 and 2019 were included in this retrospective study, of whom 14 had CTD. Follow-up was performed 30 days, 6 months, and 1 year after the procedure. RESULTS: Of the 14 (2.5%) patients who had CTD, most had rheumatoid arthritis (n = 10), followed by lupus erythematosus (n = 2), scleroderma (n = 1) and mixed (n = 1) CTD. The mean age was 77.6 ± 7.9 years, and there was no statistical difference between the CTD and no-CTD groups. In addition, significantly more of the CTD patients (85.7%) were female compared to the no-CTD group (p = 0.018). None of the patients in the CTD group had acute kidney injury, stroke, major bleeding, or pericardial effusion. However, significantly more patients in the CTD group (n = 4) needed permanent pacemaker implantation than in the no-CTD group (p = 0.008). There were no significant differences between the two groups in terms of mean discharge time (CTD 4.6 ± 2.0, no-CTD 4.5 ± 2.3 days, p = 0.926) and in-hospital mortality [CTD 1 (7.1%), no-CTD 21 (3.9%); p = 0.542]. CONCLUSIONS: In this study, we presented the results of TAVI in patients with and without CTD. The TAVI procedure had similar mid-term outcomes in the two groups, and the CTD group had numerically lower rates of major complications at the cost of a higher incidence of pacemaker implantation.

Efficacy and safety of carotid artery stenting: Experience of a single center.

OBJECTIVE: Moderate and severe carotid artery stenosis in the internal carotid artery causes 10% to 15% of all strokes. The aim of this study was to evaluate the safety and short-term efficacy of carotid artery stenting (CAS) performed at a tertiary referral center. METHODS: The records of patients who underwent CAS between January 2017 and May 2018 at a tertiary care center were analyzed retrospectively and a total of 145 patients were included in the study. RESULTS: The mean age of the patients was 70.1±8.6 years, 75.2% of the study group was male, and 37.9% had hypertension. Of the patients evaluated, 81 (55.9%) were classified as symptomatic and 64 (44.1%) were classified as asymptomatic. A percutaneous coronary intervention was performed after CAS more often in symptomatic patients (38.9%), while it was observed at the same rate both before (25.9%) and after (25.9%) CAS in the asymptomatic group, but the difference between the groups was not statistically significant. A distal embolic protection device (EPD) was used in symptomatic patients (59.2%) and in the asymptomatic group (78.7%); however, a proximal EPD was used significantly more often in symptomatic patients (45.6%) compared with asymptomatic patients. No patient death was recorded while in hospital, and stroke/transient ischemic attack (TIA) development was observed in 5 (3.4%) patients. Stroke was seen in 2 patients (2.4%) and TIA in 3 patients (3.7%) in the symptomatic group; TIA or stroke was not seen in the asymptomatic group. CONCLUSION: The results of this study revealed that CAS was a safe and practical procedure with an acceptable complication rate. In the appropriate patients, experienced interventionists can achieve good results when aggressive risk modification is applied and an EPD and optimal medical therapy are used.

Transcatheter valve-in-valve implantation Edwards Sapien XT in a direct flow valve after early degeneration.

In recent years, the use of bioprosthetic valve (BPV) has increased significantly with both surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) due to reasons such as the advantage of not using anticoagulants. Nevertheless, major disadvantage of all BPV is the risk of early structural valve deterioration, leading to valve dysfunction, and requires reoperation, which significantly increases the risk of mortality or major morbidity especially after SAVR. There are a limited number of TAV-in-TAV case reports due to TAVI BPV degeneration. In our knowledge, this is the second report of TAV-in-TAV implantation wherein a previously implanted transfemoral 25-mm nonmetallic Direct Flow SVD valve treated with ViV TAVI via Edwards Sapien XT.

Epicardial Ablation Complications.

The percutaneous epicardial approach has become an adjunctive tool for electrophysiologists to treat disparate cardiac arrhythmias, including accessory pathways, atrial tachycardia, and particularly ventricular tachycardia. This novel technique prompted a strong impulse to perform epicardial access as an alternative strategy for pacing and defibrillation, left atrial appendage exclusion, heart failure with preserved ejection fraction, and genetically engineered tissue delivery. However, because of the incremental risk of major complications compared with stand-alone endocardial ablation, it is still practiced in a limited number of highly experienced centers across the world.

Association between monocyte to high-density lipoprotein cholesterol ratio and bicuspid aortic valve degeneration

Background/aim: From a pathophysiological point of view, inflammation is thought to be more dominant in bicuspid aortic valve (BAV) stenosis than tricuspid aortic valve (TAV) stenosis. Our study aimed to determine the association between monocyte to high- density lipoprotein cholesterol (HDL-C) ratio (MHR), a new inflammatory marker, and the speed of progression of stenosis and pathophysiology of BAV stenosis. Materials and methods: A total of 210 severe aortic stenosis patients (70 consecutive BAV patients, 140 matched TAV patients) were retrospectively enrolled in the study. Clinical and echocardiographic data and laboratory results related to our research were collected retrospectively from the patients' records. MHR was measured as the ratio of the absolute monocyte count to the HDL-C value. Results: Seventy BAV (mean age: 72.0 ± 9.1 years, 42.9% female) and 140 TAV patients (mean age: 77.9 ± 8.3 years, 51.4% female) with severe aortic stenosis were enrolled in this study. There was no difference between the two groups in terms of another baseline demographic or clinic findings except age (P < 0.001). Monocyte count, hemoglobin level, mean platelet volume was significantly higher, and HDL-C level was significantly lower in the BAV group, while other lipid and CBC parameters were found to be similar. In the multivariate analysis, MHR (P = 0.005, 95% CI: 0.90­0.98) and, as expected, age (P = 0.001, 95% CI: 1.02­1.11) were found to be significant as the independent predictor of BAV, after adjusting for other risk factors. Conclusion: Our study showed a significant correlation between increased MHR and BAV. MHR was determined as a significant independent predictor for the speed of progression and diagnosis of severe BAV stenosis in multivariate analysis.

The triglyceride-glucose index predicts peripheral artery disease complexity

Background/aim: High levels of triglyceride (TG) and fasting blood glucose (FBG) values increase atherosclerosis risk. This study evaluates the relationship between peripheral artery disease (PAD) severity and complexity, as assessed by TransAtlantic InterSociety Consensus-II (TASC-II) classification and the triglyceride-glucose (TyG) index. Materials and methods: A total of 71 consecutive patients with PAD (males 93%, mean age 63.3 ± 9.7), who underwent percutaneous peripheral intervention were included retrospectively. The patients were divided into two groups according to the angiographically detected lesions. Those with TASC A-B lesions were included in Group 1, and those with TASC C-D lesions were included in Group 2. TyG index was calculated as formula: ln[fasting TG (mg/dL) × fasting plasma glucose (mg/dL)/2]. Results: There were 40 patients in Group 1 (90.3% men, with a mean age of 63.6 ± 9.3 years) and 31 patients in Group 2 (96.8% men, with a mean age of 62.0 ± 8.6 years). In the majority of patients in both groups, the target vessels are iliac arteries and femoral arteries. In Group 2, platelet count and TyG index were significantly high, according to Group 1. The TyG index was significantly correlated with TASC-II, Rutherford category, HbA1c, and HDL-C. Conclusion: In this present study, we showed that the TyG index was an independent predictor of peripheral artery disease complexity, according to TASC-II classification, for the first time in the literature.