Roadmap fusion imaging in percutaneous coronary intervention reduces contrast medium exposure irrespective of investigator's experience level.

OBJECTIVES: Dynamic Coronary Roadmap (DCR) is a software tool that creates a real-time dynamic coronary artery overlay on fluoroscopic images. The efficacy of DCR in significantly reducing contrast medium use during percutaneous coronary interventions (PCI) has previously been shown. In this study, we aimed to determine if DCR is equally effective irrespective of the performing investigator's experience level. METHODS: In this sub-analysis of a monocentric, open-label, randomized trial, 130 patients with hemodynamic relevant coronary type A and B lesions were randomized and contrast medium use was conducted with (+) or without (-) DCR software. PCI was randomly allocated and performed by an investigator with high (A) or medium (B) experience level. RESULTS: Overall, contrast medium use was significantly reduced by both investigators in the +DCR group, and Investigator B used significantly less contrast medium with the software than Investigator A. The DCR software was not accompanied by increased radiation exposure for the patients or the teams. On the contrary, dose area product was reduced by both investigators, but was significantly reduced by the highly experienced investigator when using DCR. Fluoroscopy time was not different between investigators. Procedural success was 100%. Serious in-hospital adverse events were not observed. One of Investigator A's patients suffered from post-procedural acute kidney injury in the -DCR group. CONCLUSIONS: DCR significantly reduces contrast medium use during PCI irrespective of investigator's experience level.

Real-world experience with the cusp-overlap deployment technique in transcatheter aortic valve replacement: A propensity-matched analysis.

Background: The implantation depth (ID) is a critical condition for optimal hemodynamic and clinical outcomes in transcatheter aortic valve replacement (TAVR). The recently recommended cusp-overlap technique (COT) offers optimized fluoroscopic projections facilitating a precise ID. This single-center observational study aimed to investigate short-term clinical performance, safety, and efficacy outcomes in patients undergoing TAVR with self-expandable prostheses and application of COT in a real-world setting. Materials and methods: From September 2020 to April 2021, a total of 170 patients underwent TAVR with self-expandable devices and the application of COT, while 589 patients were treated from January 2016 to August 2020 with a conventional three-cusp coplanar view approach. The final ID and 30-day outcomes were compared after 1:1 propensity score matching, resulting in 150 patients in both cohorts. Results: The mean ID was significantly reduced in the COT cohort (-4.2 ± 2.7 vs. -4.9 ± 2.3 mm; p = 0.007) with an improvement of ID symmetry of less than 2 mm difference below the annular plane (47.3 vs. 57.3%; p = 0.083). The rate of new permanent pacemaker implantation (PPI) following TAVR was effectively reduced (8.0 vs. 16.8%; p = 0.028). While the fluoroscopy time decreased (18.4 ± 7.6 vs. 19.8 ± 7.6 min; p = 0.023), the dose area product increased in the COT group (4951 ± 3662 vs. 3875 ± 2775 Gy × cm2; p = 0.005). Patients implanted with COT had a shorter length of in-hospital stay (8.4 ± 4.0 vs. 10.3 ± 6.7 days; p = 0.007). Conclusion: Transcatheter aortic valve replacement using the cusp-overlap deployment technique is associated with an optimized implantation depth, leading to fewer permanent conduction disturbances. However, our in-depth analysis showed for the first time an increase of radiation dose due to extreme angulations of the gantry to obtain the cusp-overlap view.

Structured Allocation of Transcatheter Aortic Valve Replacement Patients during Coronavirus Disease 2019 Pandemic: Impact on Patient Selection and Clinical Results.

Due to shortages of medical resources during the Coronavirus Disease 2019 (COVID-19) pandemic, an allocation algorithm for Transcatheter Aortic Valve Replacement (TAVR) was established. We investigated the impact on patient selection and procedural results. In total, 456 TAVR patients before (pre-COVID-19 group) and 456 TAVR patients after (COVID-19 group) the implementation of our allocation algorithm were compared. Concerning patient characteristics, the COVID-19 group revealed a higher rate of cardiac decompensations/cardiogenic shocks (10.5% vs. 1.3%; p < 0.001), severe angina pectoris (Canadian Cardiovascular Society (CCS) II, III and IV: 18.7% vs. 11.8%; p = 0.004), troponin elevation (>14 ng/L: 84.9% vs. 77%; p = 0.003) and reduced left ventricular ejection fraction (LVEF) (<45%: 18.9% vs. 12%; p = 0.006). Referring to procedural characteristics, more predilatations (46.3% vs. 35.1%; p = 0.001) and a longer procedural time (80.2 min (+/−29.4) vs. 66.9 min (+/−17.5); p < 0.001) were observed. The success rate was evenly high; no differences in safety parameters were reported. Examining the utilization of hospital resources, the COVID-19 group showed a shorter in-hospital stay (8.4 days (+/−5.9) vs. 9.5 days (+/−9.33); p = 0.041) and fewer TAVR patients were treated per month (39 (+/−4.55) vs. 46.11 (+/−7.57); p = 0.03). Our allocation algorithm supported prioritization of sicker patients with similar efficient and safe TAVR procedures. In-hospital stay could be shortened.

Multi-Slice Computed Tomography Analysis in Patients Undergoing Transcatheter Aortic Valve Replacement - Impact of Workflows on Measurement of Virtual Aortic Annulus and Valve Size.

Exact and reliable measurements of anatomical dimensions in pre-procedural multi-slice computed tomography (MSCT) scans are crucial for optimal valve sizing and clinical results of transcatheter aortic valve replacement (TAVR). This study aimed to investigate interrater reliability between routinely used workflows for pre-procedural analysis. MSCT scans of 329 patients scheduled for TAVR were analyzed using both a 3mensio and SECTRA IDS7 platform. The results were retrospectively compared using the intraclass correlation coefficient, revealing excellent correlation in the analysis of simple diameters and poor correlation in the assessment of more complex structures with impact on calculated valve size.

Oral Health of Lipjan Convicts: Kosovo Prison House.

OBJECTIVES: The oral health services of the prison population are considered more complex than those of the general population. The aim of this study was to examine the oral health status (the DMFT index and OHI index) and to evaluate the relation between the oral health and risk factors of inmates of this population, thus identifying the dental health status of inmates by gender, age, and the duration of their sentence. MATERIALS AND METHODS: Our study has included a total number of 150 inmates, of both genders, from Lipjan prison house in Kosovo. RESULTS: Oral health condition of inmates in Lipjan prison house is severe; the average value of DMFT is 8.44: for minors 6.22, while for adults 9.55. The assessment of DMFT index within the recruited inmates in our study shows that the mean rate of oral cure was 3.21, while the mean extraction value and caries were 3.55 and 3.58, respectively. The mean plaque test value was 1.44. CONCLUSION: Based on this research, we have concluded that the oral health condition of the inmates in Lipjan prison is not good, due to the presence of different risk factors among them.

The Role and Impact of Salivary Zn Levels on Dental Caries.

INTRODUCTION: Minimal attention has been given to the role of salivary microelements, the importance they have in reducing the intensity of caries, and the effect of caries prophylaxes. AIM: This research aimed to determine the concentration and quantity of Zn and its impact on the prevention and the reduction of the intensity of caries in schoolchildren aged 12-13 years with permanent dentition. METHODS: For this research, we analyzed the stimulated and nonstimulated full saliva of 106 schoolchildren divided into three groups by mean decayed, missing, and filled teeth (DMFT) index. The control group consisted of 25 caries-free children, the second group had 47 children with mean DMFT index of 1 to 6, and the third group had 34 children with DMFT index of ≥ 6. Complete saliva was collected from all children in a sterile test tube. RESULTS: The concentration of Zn in saliva before stimulation in caries-free children has variations of the order of 0.001+ to 0.01 mmol/l. The maximum concentration after stimulation is 6.72 mmol/l, while the maximum value is 64.38 mmol/l. CONCLUSION: The Zn concentration in the stimulated saliva showed a significant increase in the group of caries-free children and could be described as a positive value for the reduction of caries.

The Effect of Ca and Mg Concentrations and Quantity and Their Correlation with Caries Intensity in School-Age Children.

INTRODUCTION: Saliva is a watery product formed by the salivary glands and secreted in the mouth. Besides the fundamental factors, saliva with its ingredient is one of the main etiologic factors of caries presence. In the development of dental caries, the relationship between demineralization and remineralization is influenced by the presence of saliva, which facilitates the transportation of ions, oral bacteria, and fermentable carbohydrates to the exposed surfaces of teeth. The main components of saliva electrolytes are sodium, calcium, copper, magnesium, bicarbonates, and organic phosphates. Increase in calcium level in the remineralization solution may enhance the deposition velocity of minerals in the caries lesion. Magnesium, except the similar role as calcium, takes an active part in cellular reparation process. MATERIALS AND METHODS: In this study were included students of age 12-13. Students were divided into three groups; the first group included caries-free children, the second group with DMF = 1-6, and the third group with DMF > 6. Fully stimulated and nonstimulated saliva was collected in sterile graded patches in the morning hours, due to the circadian rhythm in 5-minute length. Chemical analyzes have been conducted at the Faculty of Chemistry, Ss. Cyril and Methodius University in Skopje. Statistical processing has been performed at the Medical Faculty, at the Institute of Medical Statistics in Skopje. RESULTS: Depending on the DMF, before and after stimulation, regarding Ca level, no significant differences were found. However, the Ca level prior to stimulation is significantly higher in the second group compared to the third one. Also, the amount of Ca after stimulation in the first group was significantly higher. No significant differences in Mg level and amount were found prior to and after stimulation, while the amount of Mg after stimulation had a significant difference between groups. CONCLUSION: Saliva mineral analysis has shown significant differences in quantitative and qualitative components between examining groups. The decrease of calcium molality in saliva might play a significant role in caries occurrence; thus, we may suppose that saliva calcium level significantly influences hard dental tissues defense mechanism. Magnesium levels after stimulation showed a significant difference between groups I and III and no significant differences between groups I and II. Magnesium level and amount correlate with calcium level, favoring elemental caries resistance.

Prevalence of Dental Caries in Kosovar Adult Population.

Objectives. The aim of this study was to assess the prevalence of dental caries in the Kosovar adult population. Materials and Methods. A cross-sectional study in Kosovo was conducted examining 9387 patients, aged 18 upwards, between January 2010 and December 2011. Clinical evaluation was done using WHO criteria for evaluation of dental health status and data collection. Results. The prevalence of caries for the whole study was 72.80%. The mean DMFT index was 9.61 (±5.12) in the 18-34-year age group, 11.6 (±6.42) in the 35-44-year age group, 13.68 (±8.12) among the 45-64-year age group, 17.98 (±9.81) in the 65-74-year age group, and 23.19 (±9.41) in the age group of 75+ years, respectively. A significant difference of mean DMFT and its each component was observed between the ages (P < 0.001). Conclusion. This study comes out with the significant levels of dental caries among young Kosovar population (18-34 years old).