Accurate commissural alignment during ACURATE neo TAVI procedure. Proof of concept.

INTRODUCTION AND OBJECTIVES: Final position of the neo-commissures is uncontrolled during transcatheter aortic valve implantation (TAVI), potentially hindering coronary access and future procedures. We aimed to develop a standard method to achieve commissural alignment with the ACURATE neo valve. METHODS: The relationship between native and TAVI neo-commissures was analyzed in 11 severe aortic stenosis patients undergoing TAVI. Based on computed tomography analysis, an in silico model was developed to predict final TAVI commissural posts position. A modified implantation technique, accurate commissural alignment (ACA) and a dedicated delivery system were developed. TAVI implants were tested in 3-dimensional (3D) printed models and in vivo. Commissural misalignment and coronary overlap (CO) were analyzed. RESULTS: The in silico model accurately predicted final position of commissural posts irrespective of the implantation technique performed (correlation coefficient, 0.994; 95%CI, 0.989-0.998; P<.001). TAVI implant with patient-specific rotation was simulated in 3D printed models and in 9 patients. ACA-oriented TAVI implants presented adequate commissural alignment in vivo (mean commissural misalignment of 7.7 ±3.9°). None of the ACA oriented implants showed CO, whereas in silico conventional implants predicted CO in 6 of the 9 cases. CONCLUSIONS: Accurate commissural alignment of the ACURATE neo device is feasible by inserting the delivery system with a patient-specific rotation based on computed tomography analysis. This is a simple and reproducible method for commissural alignment that can be potentially used for all kinds of TAVI devices.

Papel de una guía paralela en tortuosidades y bucles de las arterias subclavia e innominada: técnica inédita en procedimientos coronarios por vía radial / A parallel wire technique in aortosubclavian loops and tortuosities: a simple and useful technique during transradial coronary angiography and interventions

No disponible

Arteritis de Takayasu: iluminando su afección coronaria / Illuminating coronary artery involvement in takayasu arteritis

No disponible

[Influence of sex on perioperative outcomes in patients undergoing valve replacement for severe aortic stenosis]. / Influencia del sexo en el pronóstico perioperatorio de pacientes sometidos a sustitución valvular por estenosis aórtica severa.

INTRODUCTION AND OBJECTIVES: The influence of sex on the prognosis of patients undergoing aortic valve replacement for severe stenosis is unclear. Nevertheless, a number of studies have regarded sex as an independent risk factor. The aim of this study was to evaluate the influence of sex on perioperative outcomes in patients undergoing valve replacement for severe aortic stenosis. METHODS: This retrospective study involved 577 consecutive patients who underwent aortic valve replacement surgery for severe aortic stenosis between 1996 and April 2007. RESULTS: Women (44% of patients) were older than men (70.3+/-7.9 years vs. 66.8+/-9.8 years; P< .001), had a smaller body surface area (1.68+/-0.15 m(2) vs. 1.83+/-0.16 m(2); P< .001), more often had arterial hypertension (73% vs. 49%; P< .001), diabetes mellitus (33.5% vs. 24.5%; P=.001) and ventricular hypertrophy (89.1% vs. 83.1%; P< .001), and less often had coronary artery disease (19.1% vs. 31.8%; P< .001) and severe ventricular dysfunction (7.9% vs. 17.4%; P< .001). Nevertheless, women more often suffered acute myocardial infarction perioperatively (3.9% vs. 0.9%; P=.016), had a low cardiac output in the postoperative period (30.3% vs. 22.3%; P=.016) and experienced greater perioperative mortality (13% vs. 7.4%; P=.019) than men. However, after adjustment for various confounding factors, female sex was not a significant independent risk factor for mortality (odds ratio = 2.40; 95% confidence interval, 0.79-7.26; P=.119). CONCLUSIONS: Perioperative mortality in women with severe aortic stenosis who underwent valve replacement was high. However, after adjustment for potential confounding factors, particularly body surface area, female sex was not an independent risk factor for mortality.

Influencia del sexo en el pronóstico perioperatorio de pacientes sometidos a sustitución valvular por estenosis aórtica severa / Influence of sex on perioperative outcomes in patients undergoing valve replacement for severe aortic stenosis

Introducción y objetivos. La influencia pronóstica del sexo de los pacientes sometidos a sustitución valvular aórtica por estenosis severa tiene un papel controvertido, y algunos estudios le atribuyen un papel relevante como marcador de riesgo independiente. El objetivo del estudio es valorar la influencia pronóstica perioperatoria del sexo de los pacientes sometidos a sustitución valvular por estenosis aórtica severa. Métodos. Estudio retrospectivo en el que se analizó una cohorte de 577 pacientes sometidos a cirugía de reemplazo valvular aórtico por estenosis aórtica entre 1996 y abril de 2007. Resultados. Las mujeres (44%) tenían mayor edad (70,3 ± 7,9 frente a 66,8 ± 9,8 años; p < 0,001), menos superficie corporal (1,68 ± 0,15 frente a 1,83 ± 0,16 m2; p < 0,001), más hipertensión arterial (el 73 frente al 49%; p < 0,001), diabetes mellitus (el 33,5 frente al 24,5%; p = 0,001) e hipertrofia ventricular (el 89,1 frente al 83,1%; p < 0,001), menos enfermedad coronaria (el 19,1 frente al 31,8%; p < 0,001) y menos disfunción ventricular severa (el 7,9 frente al 17,4%; p < 0,001). A pesar de esto, las mujeres tuvieron más infarto agudo de miocardio perioperatorio (el 3,9 frente al 0,9%; p = 0,016), bajo gasto en el postoperatorio (el 30,3 frente al 22,3%; p = 0,016) y mortalidad perioperatoria que los varones (el 13 frente al 7,4%; p = 0,019). El sexo femenino no se mostró, al ajustar por los diferentes factores de confusión, como factor independiente relacionado con la mortalidad (odds ratio = 2,4; intervalo de confianza del 95%, 0,79-7,26; p = 0,119). Conclusiones. La mortalidad perioperatoria de las mujeres con estenosis aórtica severa sometidas a sustitución valvular es alta. Al ajustar por potenciales factores de confusión, especialmente superficie corporal, el sexo femenino no se comporta como factor independiente de mortalidad (AU)

Introduction and objectives. The influence of sex on the prognosis of patients undergoing aortic valve replacement for severe stenosis is unclear. Nevertheless, a number of studies have regarded sex as an independent risk factor. The aim of this study was to evaluate the influence of sex on perioperative outcomes in patients undergoing valve replacement for severe aortic stenosis. Methods. This retrospective study involved 577 consecutive patients who underwent aortic valve replacement surgery for severe aortic stenosis between 1996 and April 2007. Results. Women (44% of patients) were older than men (70.3±7.9 years vs. 66.8±9.8 years; P<.001), had a smaller body surface area (1.68±0.15 m2 vs. 1.83±0.16 m2; P<.001), more often had arterial hypertension (73% vs. 49%; P<.001), diabetes mellitus (33.5% vs. 24.5%; P=.001) and ventricular hypertrophy (89.1% vs. 83.1%; P<.001), and less often had coronary artery disease (19.1% vs. 31.8%; P<.001) and severe ventricular dysfunction (7.9% vs. 17.4%; P<.001). Nevertheless, women more often suffered acute myocardial infarction perioperatively (3.9% vs. 0.9%; P=.016), had a low cardiac output in the postoperative period (30.3% vs. 22.3%; P=.016) and experienced greater perioperative mortality (13% vs. 7.4%; P=.019) than men. However, after adjustment for various confounding factors, female sex was not a significant independent risk factor for mortality (odds ratio = 2.40; 95% confidence interval, 0.79-7.26; P=.119). Conclusions. Perioperative mortality in women with severe aortic stenosis who underwent valve replacement was high. However, after adjustment for potential confounding factors, particularly body surface area, female sex was not an independent risk factor for mortality (AU)

The Mediterranean diet and incidence of hypertension: the Seguimiento Universidad de Navarra (SUN) Study.

The Mediterranean diet is receiving increasing attention in cardiovascular epidemiology. The association of adherence to the Mediterranean diet with the incidence of hypertension was evaluated among 9,408 men and women enrolled in a dynamic Spanish prospective cohort study during 1999-2005. Dietary intake was assessed at baseline with a validated semiquantitative food frequency questionnaire, and a 9-point Mediterranean diet score was constructed. During a median follow-up period of 4.2 years (range, 1.9-7.9), 501 incident cases of hypertension were identified. After adjustment for major hypertension risk factors and nutritional covariates, adherence to the Mediterranean diet was not associated with hypertension (the hazard ratio was 1.10 (95% confidence interval (CI): 0.81, 1.41) for moderate adherence and 1.12 (95% CI: 0.79, 1.60) for high adherence). However, it was associated with reduced changes in mean levels of systolic blood pressure (moderate adherence, -2.4 mm Hg (95% CI: -4.0, -0.8); high adherence, -3.1 mm Hg (95% CI: -5.4, -0.8)) and diastolic blood pressure (moderate adherence, -1.3 mm Hg (95% CI: -2.5, -0.1); high adherence, -1.9 mm Hg (95% CI: -3.6, -0.1)) after 6 years of follow-up. These results suggest that adhering to a Mediterranean-type diet could contribute to the prevention of age-related changes in blood pressure.