Perceval valve intermediate outcomes: a systematic review and meta-analysis at 5-year follow-up.

OBJECTIVES: New technologies for the treatment of Aortic Stenosis are evolving to minimize risk and treat an increasingly comorbid population. The Sutureless Perceval Valve is one such alternative. Whilst short-term data is promising, limited mid-term outcomes exist, until now. This is the first systematic review and meta-analysis to evaluate mid-term outcomes in the Perceval Valve in isolation. METHODS: A systematic literature review of 5 databases was performed. Articles included evaluated echocardiographic and mortality outcomes beyond 5 years in patients who had undergone Perceval Valve AVR. Two reviewers extracted and reviewed the articles. Weighted estimates were performed for all post-operative and mid-term data. Aggregated Kaplan Meier curves were reconstructed from digitised images to evaluate long-term survival. RESULTS: Seven observational studies were identified, with a total number of 3196 patients analysed. 30-day mortality was 2.5%. Aggregated survival at 1, 2, 3, 4 and 5 years was 93.4%, 89.4%, 84.9%, 82% and 79.5% respectively. Permanent pacemaker implantation (7.9%), severe paravalvular leak (1.6%), structural valve deterioration (1.5%), stroke (4.4%), endocarditis (1.6%) and valve explant (2.3%) were acceptable at up to mid-term follow up. Haemodynamics were also acceptable at up mid-term with mean-valve gradient (range 9-13.6 mmHg), peak-valve gradient (17.8-22.3 mmHg) and effective orifice area (1.5-1.8 cm2) across all valve sizes. Cardiopulmonary bypass (78 min) and Aortic cross clamp times (52 min) were also favourable. CONCLUSION: To our knowledge, this represents the first meta-analysis to date evaluating mid-term outcomes in the Perceval Valve in isolation and demonstrates good 5-year mortality, haemodynamic and morbidity outcomes. KEY QUESTION: What are the mid-term outcomes at up to 5 years follow up in Perceval Valve Aortic Valve Replacement? KEY FINDINGS: Perceval Valve AVR achieves 80% freedom from mortality at 5 years with low valve gradients and minimal morbidity. KEY OUTCOMES: Perceval Valve Aortic Valve Replacement has acceptable mid-term mortality, durability and haemodynamic outcomes.

Chemical composition, antibacterial and modulatory action of the essential oil of Croton rhamnifolioides leaves Pax and Hoffman / Composição química, ação antibacteriana e moduladora do óleo essencial das folhas de Croton rhamnifolioides Pax and Hoffman

The species Croton rhamnifolioides is a shrub popularly known as "quebra faca", utilized in teas or infusions for the treatment of gastrointestinal disorders as ulcers, gastric discomfort, vomiting and hemorrhagic diarrhea. This work has as its main objective to evaluate the chemical composition of the essential oil of the Croton rhamnifolioides leaves (EOC), antibacterial activity and modulatory activity of antibiotic resistance, against bacterial strains of Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa and, and antifungal activity against Candida albicans, Candida krusei and Candida tropicalis. The chemical composition was determined through chromatography with a gas phase coupled with mass spectrometry (CG/MS), whereas antimicrobial activity and modulation were determined by microdilution assay. The chemical composition of the oil revealed 21 compounds, with the major compounds being spathulenol (22.46%) and 1,8-cineol (18.32%). The antimicrobial activity was not significant with MIC>1024 µg/mL, however, was observed a synergistic interference when essential oil associated with the antibiotics aminoglycoside and -lactam, and the antifungal polyene.

Croton rhamnifolioides is é um arbusto conhecido popularmente como "quebra-faca" e utilizado como chá ou infusão para o tratamento de problemas gastro-intestinais como úlceras, desconforto gástrico, vômitos e diarréias hemorrágicas. O objetivo deste trabalho foi avaliar a composição química do óleo essencial das folhas de Croton rhamnifolioides (OEC), atividade antibacteriana, moduladora da resistência bacteriana, contra linhagens bacterianas de Escherichia coli, Staphylococcus aureus e Pseudomonas aeruginosa e, atividade antifúngica contra Candida albicans, C. krusei e C. tropicalis. A composição química foi determinada através de Espectroscopia de Massas acoplada a Cromatografia Gasosa (EM/CG), enquanto as atividades antimicrobianas e moduladoras foram determinadas pelo método de microdiluição. A composição química do OEC revelou a presença de 21 compostos, sendo os principais o Espatulenol (22,46%) e 1,8-cineol (18,32%). A atividade antimicrobiana não foi considerada significativa apresentando MIC > 1024 µg/mL, contudo, foi observado um sinergismo quando o óleo essencial foi associado com aminoglicosídios, -lactâmicos e antifúngicos poliênicos.