Balloon Aortic Valvuloplasty in the Transcatheter Valve Era: Single Centre Indications and Early Safety Data in a High Risk Population.

BACKGROUND: The introduction of transcatheter aortic valve implantation (TAVI) has generated a renewed interest in the techniques available to treat high-risk patients with severe aortic stenosis (AS). We report our single centre experience with balloon aortic valvuloplasty (BAV) focussing on indications, procedural success and 30-day outcomes. METHODS: We retrospectively reviewed all patients that underwent BAV procedures at our institution between August 2012 and August 2014. Procedural success and complications were adjudicated according to VARC-2 criteria. RESULTS: Fifty-one consecutive adult patients with severe symptomatic AS underwent a total of 55 BAV procedures. The patients had a mean age of 88±5.7 years and all had extensive comorbidities with a high surgical risk (mean logistic EuroSCORE of 25.22%±14.5%). Indications for BAV included palliation of symptoms n=42 (76%); bridge to definitive valve replacement (n=6, 11%); and evaluation of response (n=6, 11%). The procedure was completed in all patients with no intraprocedural deaths (within 24hours) and low 30-day mortality at 3.9% (n=2). Minor vascular complications occurred in 11.8% (n=6), whilst permanent pacemaker implantation was required in 5.8% (n=3). There were no cases of myocardial infarction, stroke, tamponade, severe aortic regurgitation or major vascular complications during 30-day follow-up. CONCLUSIONS: Balloon aortic valvuloplasty may be performed safely and effectively with high procedural success and low 30-day complications, even in a very high-risk and elderly cohort of patients in whom the role of TAVI is uncertain or inappropriate.

Daily transcranial direct current stimulation (tDCS) leads to greater increases in cortical excitability than second daily transcranial direct current stimulation.

BACKGROUND: Evidence from recent clinical trials suggests that transcranial direct current stimulation (tDCS) may have potential in treating neuropsychiatric disorders. However, the optimal frequency at which tDCS sessions should be administered is unknown. OBJECTIVE/HYPOTHESIS: This study investigated the effects of daily or second daily tDCS sessions on motor cortical excitability, over a 5-day period. METHODS: Twelve healthy volunteers received daily or second daily sessions of tDCS to the left primary motor cortex over the study period, in a randomized, intraindividual crossover design. Motor cortical excitability was assessed before and after tDCS at each session through responses to transcranial magnetic stimulation. RESULTS: Over a fixed 5-day period, tDCS induced greater increases in MEP amplitude when given daily rather than second daily. Analyses showed that this difference reflected greater cumulative effects between sessions rather than a greater response to each individual tDCS session. CONCLUSIONS: These results demonstrate that in the motor cortex of healthy volunteers, tDCS alters cortical excitability more effectively when given daily rather than second daily over a 5-day period.