Greenehogan4336

This study aimed to compare incidence and impact of measured prosthesis-patient mismatch (PPM

) versus predicted PPM (PPM

) after surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR).

TAVR studies have used measured effective orifice area indexed (EOAi) to body surface area (BSA) to define PPM, but most SAVR series have used predicted EOAi. This difference may contribute to discrepancies in incidence and outcomes of PPM between series.

The study analyzed SAVR patients from the PARTNER (Placement of Aortic Transcatheter Valves) 2A trial and TAVR patients from the PARTNER 2 SAPIEN 3 Intermediate Risk registry. PPM was classified as moderate if EOAi≤0.85cm

/m

(≤0.70 if obese body mass index≥30kg/m

) and severe if EOAi≤0.65cm

/m

(≤0.55 if obese). PPM

was determined by the core lab-measured EOAi on 30-day echocardiogram. PPM

was determined by 2 methods 1) using normal EOA reference values previously reported for each valve model and size (PPM

 ; n=929 SAVR, cted EOAi. Severe PPM

is rare (<1.5%), but is associated with increased all-cause death and rehospitalization after SAVR, whereas it is absent following TAVR.

EOAi measured by echocardiography results in a higher incidence of PPM following SAVR or TAVR than PPM based on predicted EOAi. Severe PPMP is rare ( less then 1.5%), but is associated with increased all-cause death and rehospitalization after SAVR, whereas it is absent following TAVR.

The aim of the present study was to evaluate the safety and efficacy of thinner strut Firesorb (100/125μm) sirolimus-eluting bioresorbable scaffolds (BRS) versus cobalt-chromium everolimus-eluting stents (CoCr-EES) in patients with coronary artery disease.

First-generation thicker strut BRS were associated with unexpected device-related adverse outcomes at long-term follow-up.

Eligible patients with 1 or 2 de novo noncomplex coronary lesions were randomized to the Firesorb BRS group or CoCr-EES group in a 11 ratio. The primary endpoint was 1-year angiographic in-segment late loss (LL), powered for noninferiority testing. The key secondary endpoint was the 1-year proportion of covered struts assessed on optical coherence tomography, powered for noninferiority and subsequent superiority testing.

A total of 433 participants from 28 Chinese centers were randomized to the Firesorb BRS group (n=215) or CoCr-EES group (n=218). Patient-level 1-year in-segment LL was 0.17 ± 0.27mm in the Firesorb BRS group andpoint of 1-year proportion of covered struts by optical coherence tomography. (A Trial of Firesorb in Patients With Coronary Artery Disease FUTURE-II [FUTURE-II]; NCT02890160).

The aim of this study was to assess the impact of age on the safety and efficacy of ticagrelor monotherapy after percutaneous coronary intervention (PCI).

As the risk for bleeding and ischemic complications after PCI increases with age, the authors conducted a pre-specified analysis of the TWILIGHT (Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention) trial to evaluate the possible benefits of ticagrelor monotherapy according to age.

The TWILIGHT trial enrolled patients undergoing PCI with drug-eluting stents who fulfilled at least 1 clinical and 1 angiographic high-risk criterion. Age≥65 years was a clinical entry criterion. After 3months of dual-antiplatelet therapy with ticagrelor, event-free patients were randomized to ticagrelor plus placebo or ticagrelor plus aspirin for an additional 12months. The primary endpoint was Bleeding Academic Research Consortium type 2, 3, or 5 bleeding. The key secondary endpoint was the composite of all-cause death, myocardial infarctionn increase in ischemic events, irrespective of age.

The authors sought to evaluate the impact of ischemic burden reduction after chronic total occlusion (CTO) percutaneous coronary intervention (PCI) on long-term prognosis and cardiac symptom relief.

The clinical benefit of CTO PCI is questioned.

In a high-volume CTO PCI center, 212 patients prospectively underwent quantitative [

O]H

O positron emission tomography perfusion imaging before and three months after successful CTO PCI between 2013-2019. Perfusion defects (PD) (in segments) and hyperemic myocardial blood flow (hMBF) (in ml · min

· g

) allocated to CTO areas were related to prognostic outcomes using unadjusted (Kaplan-Meier curves, log-rank test) and risk-adjusted (multivariable Cox regression) analyses. The prognostic endpoint was a composite of all-cause death and nonfatal myocardial infarction.

After a median [interquartile range] of 2.8 years [1.8 to 4.3 years], event-free survival was superior in patients with≥3 versus<3 segment PD reduction (p<0.01; risk-adjusted p=0.04; hazaidual ischemia after CTO PCI had lower rates of all-cause death and nonfatal myocardial infarction. Long-term cardiac symptom relief was associated with normalization of hMBF levels after CTO PCI.Coronary artery fistulas (CAFs) are rare coronary anomalies that are usually diagnosed incidentally with cardiac imaging. Small CAFs are generally asymptomatic and can close over time, while some untreated medium or large CAFs can enlarge, leading to clinical sequelae such as cardiac chamber enlargement or myocardial ischemia. With the advancement of transcatheter equipment and techniques, CAFs have been increasingly closed using a percutaneous approach. However, the procedure is not free of limitations given the risk for myocardial infarction, device embolization, and fistula recanalization. click here In this review, the authors illustrate the contemporary procedural considerations, techniques, and outcomes of transcatheter CAF closure.The rate of medication errors in anaesthesia is a critical safety indicator but the methods to estimate this metric are imperfect. A number of factors that are difficult to control impact their incidence. Newer methods involving computerised records are improving retrospective and real-time monitoring of medication errors.

Communication amongst team members is critical to providing safe, effective medical care. We investigated the role of communication failures in patient injury using the Anesthesia Closed Claims Project database.

Claims associated with surgical/procedural and obstetric anaesthesia and postoperative pain management for adverse events from 2004 or later were included. Communication was defined as transfer of information between two or more parties. Failure was defined as communication that was incomplete, inaccurate, absent, or not timely. We classified root causes of failures as content, audience, purpose, or occasion with inter-rater reliability assessed by kappa. Claims with communication failures contributing to injury (injury-related communication failures; n=389) were compared with claims without any communication failures (n=521) using Fisher's exact test, t-test, or Mann-Whitney U-tests.

At least one communication failure contributing to patient injury occurred in 43% (n=389) out of 910 claims (κ=0.