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There are no randomized data comparing these strategies, so access site approach is chosen by the multidisciplinary heart team based on patient anatomy and site expertise. We will review the current data in alternative access that in our view supports prioritizing a transaxillary or transcarotid strategy. In addition, we will describe our center's pre-procedural planning, peri-procedural approach, and propose an algorithm for alternative access. 2020 Cardiovascular Diagnosis and Therapy. All rights reserved.Transcatheter aortic valve replacement (TAVR) has become a mainstay in treatment for patients with severe aortic stenosis who are considered high-risk surgical candidates. The use of TAVR in low-risk patients with severe aortic stenosis is being explored as an alternative to surgical aortic valve replacement (SAVR). Recent results from the Medtronic Evolut Low Risk trial and the Placement of Aortic Transcatheter Valves (PARTNER) 3 trial shed light on the use of TAVR in low-risk surgical candidates. The Evolut Low Risk trial compared TAVR with a self-expanding supra-annular bioprosthesis to SAVR in 1468 patients with severe aortic stenosis who were low surgical risk. Patients with a mean age of 74 and a mean Society of Thoracic Surgeons (STS) risk score of 1.9% were randomized to either TAVR or SAVR groups. Using the composite end point of death or disabling stroke at 24 months, the study found an incidence of 5.3% in the TAVR arm and 6.7% in the surgical arm. The Evolut Low Risk trial thus concluded that TAVR the scope of high and intermediate risk surgical patients and is at the very least equivalent to SAVR in the treatment low-risk surgical candidates when using a transfemoral approach in patients without bicuspid aortic valves. In this article we provide an extensive review on the Evolute low risk and PARTNER 3 trials, including a discussion on clinically relevant outcomes. 2020 Cardiovascular Diagnosis and Therapy. All rights reserved.Computed tomography (CT) plays a key role in the peri-procedural planning of left atrial appendage occlusion (LAAO) device placement and post-procedural evaluation. The geometric variability of the interatrial septum, left atrium, and the left atrial appendage morphology can be fully visualized and intuitively appreciated through CT-derived, patient-specific 3D model unique to each individual's anatomy. This review further defines the strengths and limitations of CT peri-procedural imaging in the planning of LAAO. 2020 Cardiovascular Diagnosis and Therapy. All rights reserved.Hypertrophic cardiomyopathy is a genetically determined disorder resulting in left ventricular hypertrophy. In a majority of the estimated 20 million people affected worldwide, left ventricular outflow obstruction is present at rest or with provocation. The presence and degree of obstruction influence the symptomatic presentation, treatment strategies and prognosis of affected individuals. Pharmacologic therapy with beta-adrenergic blocking drugs and calcium channel blockers is the principal treatment strategy in symptomatic patients with left ventricular outflow obstruction but is ineffective in many patients. When symptoms of exertional shortness of breath, chest pain and/or syncope prove refractory to medical therapy and there is persisting left ventricular outflow obstruction, or when there is drug intolerance, septal reduction strategies (surgical myectomy and alcohol septal ablation) are quite effective. Selection of the optimal septal reduction strategy for a given patient has become controversial and nts with hypertrophic obstructive cardiomyopathy (HOCM). 2020 Cardiovascular Diagnosis and Therapy. All rights reserved.Background To study the impact of type of atrial fibrillation on outcomes following transcatheter mitral valve repair. The development of atrial fibrillation (AF) in degenerative mitral regurgitation (MR) can be a sign of progression of MR and associated with adverse outcomes. However, the impact of type of AF in patients undergoing transcatheter mitral valve (MV) repair remains uncertain. Methods Patients 18 years or older who underwent TMVR procedure in 2016 and had a concurrent ICD-10 diagnosis of either paroxysmal or non-paroxysmal AF were included from Nationwide Readmission Database (NRD). The association between type of AF and mortality, stroke, readmission (cardiovascular and non-cardiovascular readmissions) and composite outcome (mortality, inpatient stroke or 30-day readmissions) was analyzed using multivariable logistic regression. Statistical Analysis System (SAS) software 9.4 was used to conduct the analysis. Results A total of 913 (weighted N=1,750) TMVR hospitalizations from NRD for year 2016 wardiovascular Diagnosis and Therapy. All rights reserved.Background There is a higher prevalence of aortic stenosis (AS) in patients with advanced chronic kidney disease (CKD) and European ancestry. However, studies comparing AS progression in white and black patients in an advanced CKD population do not exist. Methods Advanced CKD (stage IV-V) patients who were referred to the UNC Cardiorenal Clinic for pre-operative kidney transplant evaluation, and diagnosed with either AS (mild, moderate, or severe) or a left ventricular outflow tract velocity ≥2 m/s at any point between 2006-2016 were eligible for inclusion. Serial transthoracic echocardiograms over the 10-year period determined AS progression. All echocardiograms acquired after renal transplantation or aortic valve replacement were excluded. selleck kinase inhibitor The rates of change of three indices of AS severity [mean gradient, aortic valve area (AVA), and aortic valve velocity] were compared between white and black patients. link2 Mixed effects linear models with repeated measures were used to estimate the overall and race-stratified population. A study with a larger sample size is needed to confirm our findings. link3 2020 Cardiovascular Diagnosis and Therapy. All rights reserved.Background Myocardial contraction fraction (MCF), a volumetric measurement of myocardial shortening, may help to improve risk stratification in patients with severe aortic stenosis (AS) referred for transcatheter aortic valve replacement (TAVR) especially in those with preserved left ventricular ejection fraction (LVEF). We investigated the association between MCF and 1-year all-cause mortality in patients with severe AS who underwent TAVR. Methods MCF was calculated as the ratio of stroke volume (SV) to myocardial volume. Patients referred for TAVR from 2011 to 2015 were eligible for inclusion and were divided into two groups according to the estimated MCF (MCF ≤30% vs. MCF >30%). The primary endpoint was 1-year all-cause mortality. A Cox regression analysis was performed for independent risk factors of mortality. Receiver operating curve (ROC) was performed for assessing the best cut-off point of MCF for predicting the primary outcome [area under the curve (AUC) 0.60; 95% confidence interval (CI) 0.453-0.725]. Baseline patient and echo characteristics were included for multivariate analysis. Results Of 126 patients (mean age 82±5 years, 45.2% male), 44.4% showed MCF ≤30%. Patient with reduced MCF showed higher body mass index (28.1±5.8 vs. 26.0±4.5 kg/m2, P=0.031), higher surgical EuroScore II (6.2±4.5 vs. 4.7±3.2, P=0.032), lower LVEF (54.2%±11.9% vs. 58.5%±10.8%, P=0.042) and more severe AS (indexed aortic valve area 0.40±0.09 vs. 0.45±0.10 cm2/m2, P=0.030). The median follow-up was of 14 [3.5-33] months, and 16% of patients died. Patients with MCF ≤30% showed significantly increased all-cause mortality (Log-rank P=0.002). In a multivariate model adjusting for clinical and echo variables, MCF ≤30% was independently associated with increased risk for all-cause 1-year mortality [hazard ratio (HR) 2.76, 95% CI 1.03-7.77, P=0.04]. Conclusions In a population of patients undergoing TAVR, MCF ≤30% was independently associated with increased mortality. 2020 Cardiovascular Diagnosis and Therapy. All rights reserved.Background Atrial fibrillation (AF) is common in patients undergoing transcatheter aortic valve replacement (TAVR) but there is conflicting evidence on whether AF impacts outcomes after TAVR. Methods Hospitalizations of adults ≥50 years old who had undergone elective TAVR from 2012 to 2015 were included. Poisson regression was used to assess changes in in-hospital complications, average length of stay (LOS) after TAVR, and discharge disposition over time. Multivariable logistic, linear, and generalized logistic regression models, adjusting for patient and hospital characteristics, were used to estimate the effect of AF on inpatient outcomes. Results A total of 7,266 TAVR hospitalizations were included; AF was present in 44% of patients. Between 2012 and 2015, there was a significant decrease in the incidence of acute kidney injury, blood transfusion, average LOS, and inpatient mortality both for AF and non-AF patients. However, the incidences of vascular complications and major bleeding decreased only among non-AF patients. After adjustment, AF was associated with increased incidences of TIA/stroke (OR 1.36, 95% CI 1.01, 1.85), acute kidney injury (OR 1.54, 95% CI 1.33, 1.78), blood transfusion (OR 1.14, 95% CI 1.00, 1.30), transfer to a skilled nursing facility (OR 1.38, 95% CI 1.23, 1.55), and longer average LOS (CIE 1.30, 95% CI 1.06, 1.54). AF was not associated with inpatient mortality (OR 1.09, 95% CI 0.81, 1.48). Conclusions AF is prevalent among patients undergoing TAVR, and is associated with higher incidences of inpatient complications, discharge to a skilled nursing facility, and longer average LOS. While the incidence of many complications has declined in the past few years, continued efforts to further reduce complications in patients with AF is urgently required for expansion of TAVR to broader populations. 2020 Cardiovascular Diagnosis and Therapy. All rights reserved.Layered materials, such as MoS2, are being intensely studied due to their interesting properties and wide variety of potential applications. These materials are also interesting as supports for low-dimensional metals for catalysis, while recent work has shown increased interest in using 2D materials in the electronics industry as a Cu diffusion barrier in semiconductor device interconnects. The interaction between different metal structures and MoS2 monolayers is therefore of significant importance and first-principles simulations can probe aspects of this interaction not easily accessible to experiment. Previous theoretical studies have focused particularly on the adsorption of a range of metallic elements, including first-row transition metals, as well as Ag and Au. However, most studies have examined single-atom adsorption or adsorbed nanoparticles of noble metals. This means there is a knowledge gap in terms of thin film nucleation on 2D materials. To begin addressing this issue, we present in this paper ein-Institut.In the present study Ar+ cluster ions accelerated by voltages in the range of 5-10 kV are used to irradiate single crystal ZnO substrates and nanorods to fabricate self-assembled surface nanoripple arrays. The ripple formation is observed when the incidence angle of the cluster beam is in the range of 30-70°. The influence of incidence angle, accelerating voltage, and fluence on the ripple formation is studied. Wavelength and height of the nanoripples increase with increasing accelerating voltage and fluence for both targets. The nanoripples formed on the flat substrates remind of aeolian sand ripples. The ripples formed at high ion fluences on the nanorod facets resemble well-ordered parallel steps or ribs. The more ordered ripple formation on nanorods can be associated with the confinement of the nanorod facets in comparison with the quasi-infinite surface of the flat substrates. Copyright © 2020, Zeng et al.; licensee Beilstein-Institut.