Mechanical Circulatory Support Options in Patients With Aortic Valve Pathology.

Mechanical circulatory support (MCS) is used in cardiogenic shock for periprocedural hemodynamic stability in high-risk patients and to support patients with symptomatic coronary artery disease. Depending on the MCS type, oxygenation and ventilation, in addition to increasing blood pressure by augmenting blood flow, can be achieved. MCS typically follows a failure of less invasive maneuvers or intolerance to them, such as significant ventricular arrhythmia burden from inotropic support. MCS options include intra-aortic balloon pump, transvalvular percutaneous left ventricular assist devices, venoarterial extracorporeal membrane oxygenation, and surgically implanted left ventricular assist devices. The number of MCS options has increased, and this has made the decision-making process complicated. MCS decision-making is complex, even in patients without valvular pathology. The presence of aortic valve (AV) abnormalities, such as aortic stenosis, aortic insufficiency, replaced AVs, or AV masses, adds even further to the challenge of selecting the appropriate support strategy. In this narrative review, a concise review of MCS options and the special considerations for various AV pathologies are presented.

High-density lipoprotein carbamylation and dysfunction in vascular disease.

High-density lipoprotein (HDL) is cardioprotective because of its anti-atherogenic properties. Nevertheless, our goal to optimize HDL cholesterol (HDL-C) levels have had little effects on the atherothrombotic burden and suggests a closer look be taken at HDL function and dysfunction. HDL is a group of complex macromolecules composed of a lipid- and proteome that work in synergy to execute its anti-inflammatory, anti-atherogenic, and anti-thrombotic effects. However, throughout its life-span in circulation, HDL undergoes significant modification. Carbamylation, a non-enzymatic and irreversible post-translational modification of protein, is one effector of HDL which has growing evidence that it plays a crucial role in the development and progression of atherosclerotic cardiovascular disease (ASCVD), particularly in chronic kidney disease (CKD). We summarize HDL's function, susceptibility to modification, and discuss HDL carbamylation and its effect in cardiovascular disease.