Redo aortic valve replacement versus valve-in-valve trans-catheter aortic valve implantation: a UK propensity-matched analysis.

This study sought to compare the morbidity and mortality of redo aortic valve replacement (redo-AVR) versus valve-in-valve trans-catheter aortic valve implantation (valve-in-valve TAVI) for patients with a failing bioprosthetic valve. A multicenter UK retrospective study of redo-AVR or valve-in-valve TAVI for patients referred for redo aortic valve intervention due to a degenerated aortic bioprosthesis. Propensity score matching was performed for confounding factors. From July 2005 to April 2021, 911 patients underwent redo-AVR and 411 patients underwent valve-in-valve TAVI. There were 125 pairs for analysis after propensity score matching. The mean age was 75.2±8.5 years. In-hospital mortality was 7.2% (n=9) for redo-AVR versus 0 for valve-in-valve TAVI, p=0.002. Surgical patients suffered more post-operative complications, including intra-aortic balloon pump support (p=0.02), early re-operation (p<0.001), arrhythmias (p<0.001), respiratory and neurological complications (p=0.02 and p=0.03) and multi-organ failure (p=0.01). The valve-in-valve TAVI group had a shorter intensive care unit and hospital stay (p<0.001 for both). However, moderate aortic regurgitation at discharge and higher post-procedural gradients were more common after valve-in-valve TAVI (p<0.001 for both). Survival probabilities in patients who were successfully discharged from the hospital were similar after valve-in-valve TAVI and redo-AVR over the 6-year follow-up (log-rank p=0.26). In elderly patients with a degenerated aortic bioprosthesis, valve-in-valve TAVI provides better early outcomes as opposed to redo-AVR, although there was no difference in mid-term survival in patients successfully discharged from the hospital.

Early- and mid-term outcomes of reinterventions for aortic bioprosthesis failure.

BACKGROUND: The aim of this study was to evaluate early- and mid-term results of our actual practice embedding redo aortic valve replacement and transcatheter procedures for aortic bioprosthetic failure. METHODS: Data for aortic valve reinterventions (redo surgical aortic valve replacement, isolated redo aortic valve replacement, and valve-in-valve transcatheter aortic valve implantation, transcatheter valve-in-valve procedure) were collected (2010-2019). Logistic regression analysis was performed to identify predictors favouring the choice of transcatheter against redo surgery. Cox analysis was used to study the association of preoperative variables with survival. Survival probabilities were calculated with Kaplan-Meier analysis and compared using a log-rank test. RESULTS: A total of 125 patients were included (redo surgical aortic valve replacement: 84 patients, valve-in-valve transcatheter aortic valve implantation: 41 patients). Median age was 74 [63-80] years, 58% of the patients were male and the median logistic EuroSCORE was 15 [8-26] %. There was no early mortality. Eighteen patients (redo surgical aortic valve replacement: 15, valve-in-valve transcatheter aortic valve implantation: 3) sustained at least one postoperative complication. At pre-discharge transthoracic echocardiogram, valve-in-valve transcatheter aortic valve implantation had significantly higher trans-prosthetic gradients (mean gradient: valve-in-valve transcatheter aortic valve implantation 18 mmHg vs. redo surgical aortic valve replacement 14 mmHg, p < 0.001). Overall survival probabilities were 94% and 73% at 1 year and 5 years, respectively. Previous coronary artery bypass surgery operation and age were independently associated with lower survival probabilities during the follow-up. CONCLUSIONS: Redo surgical aortic valve replacement and valve-in-valve transcatheter aortic valve implantation are both safe and effective for aortic bioprosthetic failure. Further valve-in-valve data are needed to determine the haemodynamic performance of transcatheter prostheses and its impact on long-term outcomes.

The combined effect of water deficit stress and TiO2 nanoparticles on cell membrane and antioxidant enzymes in Helianthus annuus L.

Nanotechnology has become one of the several approaches attempting to ameliorate the severe effect of drought on plant's production and to increase the plants tolerance against water deficit for the water economy. In this research, the effect of foliar application of TiO2, nanoparticles or ordinary TiO2, on Helianthus annuus subjected to different levels of water deficit was studied. Cell membrane injury increased by increasing the level of water deficit and TiO2 concentration, and both types of TiO2 affected the leaves in analogous manner. Ord-TiO2 increased H2O2 generation by 67-240% and lipid peroxidation by 4-67% in leaves. These increases were more than that induced by Nano-TiO2 and the effect was concentration dependent. Proline significantly increased in leaves by water deficit stress, reaching at 25% field capacity (FC) to more than fivefold compared to that in plants grown on full FC. Spraying plants with water significantly decreased the activities of enzymes in the water deficit stressed roots. The water deficit stress exerted the highest magnitude of effect on the changes of cell membrane injury, MDA, proline content, and activities of CAT and GPX. Nano-TiO2 was having the highest effect on contents of H2O2 and GPX activity. In roots, the level of water deficit causes highest effect on enzyme activities, but TiO2 influenced more on the changes of MDA and H2O2 contents. GPX activity increased by 283% in leaves of plants treated with 50 and 150 ppm Nano-TiO2, while increased by 170% in those treated with Ord-TiO2, but APX and CAT activities increased by 17-197%, in average, with Ord-TiO2. This study concluded that Nano-TiO2 didn't ameliorate the effects of drought stress on H. annuus but additively increased the stress, so its use in nano-phytotechnology mustn't be expanded without extensive studies. Supplementary Information: The online version contains supplementary material available at 10.1007/s12298-022-01153-z.

Re-sternotomy for aortic valve replacement in octogenarian patients in age of evolving transcatheter therapies.

BACKGROUND: The aim of this study was to analyze perioperative results and long-term survival of re-sternotomy for surgical aortic valve replacement (SAVR) in octogenarians in age of transcatheter therapies. METHODS: This is a retrospective, single-center study (April 2000 to December 2019). Perioperative data were compared for re-sternotomy with isolated SAVR (Isolated redoSAVR) and re-sternotomy with SAVR and concomitant cardiac procedure (Associated redoSAVR). Regression analyses were performed to identify predictors of in-patient mortality. Hazard ratios and Kaplan-Meier survival curves were compared for groups. RESULTS: There were 163 patients (Isolated redoSAVR; 69, Associated redoSAVR; 94). Emergency/salvage cases were excluded. The median age was 83 (81-85) years and the median logEuroSCORE was 19.2 (13.0-26.7)%. The follow-up was 4.2 ± 3.5 years. Inpatient mortality was 4.9% (1.4% vs. 7.4% for Isolated redoSAVR and Associated redoSAVR respectively, p = .08). TIA/stroke rate was 8% (9% vs. 7% for Isolated redoSAVR and Associated redoSAVR, respectively, p = .78). COPD was a predictor of inpatient mortality (odds ratio: 8.86; 95% confidence interval: 1.19-66.11, p = .03). Survival was 88.7%, 86.4%, 70.1%, 49.5%, and 26.3% at 1, 2, 5, 7, and 10 years. There was no survival difference between Isolated redoSAVR and Associated redoSAVR (log rank p = .36, Wilcoxon p = .84). Significant adverse predictors of long-term survival were COPD, postoperative TIA/stroke, and length of stay. Survival was lower than age and gender-matched first-time SAVR and general population of the United Kingdom. CONCLUSION: RedoSAVR in octogenarians is associated with significant morbidity and mortality. Shared decision-making should consider emerging transcatheter therapies as a valuable option in selected patients.

New antimicrobial and cytotoxic benzofuran glucoside from Senecio glaucus L.

The ethyl acetate fraction of the dried aerial parts of Senecio glaucus L. exhibited significant antimicrobial activity against some of selected bacteria and fungi. Also, it showed potent cytotoxicity against PANC-1 cancer cell lines under glucose deficient medium. The ethyl acetate fraction was subjected to different chromatographic techniques for isolation of the bioactive compounds. A new benzofuran glucoside; 2,3-dihydro-3ß-hydroxyeuparin 3-O-glucopyranoside (1) was isolated. Additionally, two known flavonoid compounds isorhamentin 3-O-ß-D-glucoside (2), and isorhamentin 3-O-ß-D-rutinoside (3) were first identified in S. glaucus. Compound 1 exhibited potent antimicrobial activities against two Gram-positive bacteria, one Gram-negative bacteria, and two fungi. Also, it displayed potent cytotoxic activity against PANC-1 cancer cell lines under glucose deficient medium (IC50 7.5 µM). However, the isolated flavonoid glycosides (2 & 3) showed moderate antimicrobial activities against two Gram-positive bacteria, two Gram-negative bacteria, four fungi, and did not show any cytotoxic activity against PANC-1.