Reshaping bicuspid aortic valve stenosis with an hourglass-shaped balloon for transcatheter aortic valve replacement: A pilot study.

OBJECTIVES: We evaluated the safety and usefulness of preparatory anatomical reshaping with a geometric hourglass-shaped balloon to optimize transcatheter aortic valve replacement (TAVR) outcomes in bicuspid aortic valve (BAV) stenosis. BACKGROUND: TAVR has been increasingly performed for BAV stenosis; however, technical challenges remain. Procedural results are suboptimal given unfavorable valvular anatomies. METHODS: Eligible patients with BAV stenosis were enrolled to undergo aortic valve predilatation with the hourglass-shaped TAV8 balloon before TAVR using the self-expandable Venus A-Valve. Procedural details and outcomes were compared to a sequential group of patients with BAV who underwent TAVR with the same device following preparatory dilatation using a cylindrical balloon. RESULTS: A total of 22 patients were enrolled in the TAV8 group and 53 were included in the control group. Valve downsizing was less common in the TAV8 group (36.4 vs. 67.9%; p = .012). Stable valve release and optimal implant depth were consistently achieved in the TAV8 group with no requirement for a second valve (0 vs. 17.0%; p = .039) and with higher device success rates (100.0 vs 77.4%; p = .014). Residual aortic regurgitation graded as ≥mild was less common in the TAV8 group (13.6 vs 45.3%; p = .009). Mortality was similar (0 vs. 3.8%; p = 1); no major/disabling stroke or conversion to open-heart surgery was seen in either group within 30 days. CONCLUSIONS: Compared with standard cylindrical balloon valvuloplasty, preparatory reshaping with the hourglass-shaped balloon before self-expandable TAVR in BAV was associated with significantly better procedural results and may encourage more promising outcomes.

Meta-Analysis of the Effectiveness and Safety of Transcatheter Aortic Valve Implantation Without Balloon Predilation.

Evidence regarding the safety and feasibility of transcatheter aortic valve implantation without balloon predilation (BP) is scarce. A literature search of PubMed, EMBASE, CENTRAL, and major conference proceedings was performed from January 2002 to July 2015. There were 18 studies incorporating 2,443 patients included in the present study. No differences were observed in the baseline characteristics between patients without BP (no-BP) and with BP. Compared with BP, no-BP had a shorter procedure time (no-BP vs BP, 124.2 vs 138.8 minutes, p = 0.008), used less-contrast medium (no-BP vs BP, 126.3 vs 156.3 ml, p = 0.0005) and had a higher success rate (odds ratio [OR] 2.24, 95% CI 1.40 to -3.58). In addition, no-BP was associated with lower incidences of permanent pacemaker implantation (OR 0.45, 95% CI 0.3 to 0.67), grade 2 or greater paravalvular leakage (OR 0.55, 95% CI 0.37 to 0.83), and stroke (OR 0.57, 95% CI 0.32 to 1.0). Furthermore, no-BP was associated with a 0.6-fold decreased risk for 30-day all-cause mortality (OR 0.60, 95% CI 0.39 to 0.92). However, the difference in the risk for permanent pacemaker implantation, grade 2, or higher aortic regurgitation, stroke was noted to be significant only in the subgroup of the CoreValve-dominating studies. In conclusion, no-BP before transcatheter aortic valve implantation was not only safe and feasible but was also associated with fewer complications and short-term mortality in selected patients especially using self-expandable valve.

Association of leptin levels with pathogenetic risk of coronary heart disease and stroke: a meta-analysis / Associação entre as concentrações de leptina e o risco patogenético de doença arterial coronariana e acidente vascular cerebral: uma metanálise

Objective This meta-analysis aimed to investigate the association of leptin levels with pathogenetic risk of CHD and stroke. Materials and methods Studies were identified in the PubMed, Embase, and Springer link database without language restriction. Odds ratios (ORs) and corresponding 95% confidence intervals (95% CIs) were used as effect indexes. The association of leptin levels with pathogenetic risk of CHD and stroke, as well as the risk variation of CHD with each additional one unit of leptin level were examined via meta-analysis. The publication bias was assessed via Egger’s linear regression test. Results Eight nested case-control studies consisting of 1,980 patients and 11,567 controls were included for current meta-analysis. ORs (95% CIs) of association of leptin levels with CHD and stroke was 1.90 (1.06, 3.43), and 2.14 (1.48, 3.08), respectively. In addition, significant result was obtained regarding the risk variation of CHD with each additional one unit of leptin level (OR =1.04, 95% CI =1.00‐1.08, P=0.044). There was no significant publication bias as suggested by Egger test outcomes. Conclusion There was a significant association of leptin with pathogenetic risk of CHD and stroke, and raised leptin levels could significantly increase the pathogenetic risk of CHD. .

Objetivo O objetivo desta metanálise foi investigar a associação entre os níveis de leptina e o risco patogenético de doença arterial coronariana e acidente vascular cerebral. Materiais e métodos Foram identificados estudos nas bases de dados PubMed, Embase e Springer Link sem restrição quanto à língua. A razão de chances (OR) e os intervalos de confiança de 95% correspondentes (95% CI) foram usados como índices de efeitos. A associação entre os níveis de leptina e o risco patogenético de doença arterial coronariana e acidente vascular cerebral com cada unidade adicional na concentração de leptina foi analisada por meio de metanálise. O viés da publicação foi avaliado por meio do teste de regressão linear de Egger. Resultados Oito estudos com caso controle aninhado envolvendo 1.980 pacientes e 11.567 controles foram incluídos na metanálise. As ORs (95% CIs) da associação entre as concentrações de leptina e a doença arterial coronariana e o acidente vascular cerebral foram de 1,90 (1,06; 3,43) e 2,14 (1,48; 3,08), respectivamente. Além disso, foram obtidos resultados significativos com a variação de risco para a doença arterial coronariana a cada unidade adicional na concentração de leptina (OR =1,04; 95% CI =1,00‐1,08; P=0,044). Não houve viés de publicação significativo sugerido pelos desfechos no teste de Egger. Conclusão Há associação significativa entre a leptina e o risco patogenético de doença arterial coronariana e acidente vascular cerebral, e concentrações aumentadas de leptina podem elevar significativamente o risco patogenético de doença arterial coronariana. .

Biotin-streptavidin cross-bridging: a novel and feasible approach for targeting transplanted cells to damaged tissue.

BACKGROUND: Accumulating evidence indicates the positive impact of endothelium-derived cell therapy in vascular repair. However, low cell transplantation efficiency inevitably and greatly reduces the treatment efficacy of cell transplants. PURPOSE: To modify the surfaces of cells with polypeptides or small-molecule proteins that specifically recognize and bind to damaged tissue. METHODS: We used a biotin-streptavidin binding approach to attach annexin V, which recognizes apoptotic cells, onto bEnd.3 cells that express vascular endothelial growth factor receptor 2 (VEGFR2) and verified that the modified cells could efficiently bind to dead cells in vitro. RESULTS: We analyzed biotinylated VEGFR2-bEnd.3 cells, streptavidin-biotinylated VEGFR2-bEnd.3 cells, and biotinylated annexin V-streptavidin-biotinylated VEGFR2-bEnd.3 cells. Our results from flow cytometry analysis and immunofluorescent examination demonstrated that we successfully labeled the cells in a three-step process. Furthermore, we determined that the positive binding rate correlated with reagent concentration. Immunofluorescent examination illustrated that adding the biotinylated annexin V-streptavidin-biotinylated VEGFR2-bEnd.3 cells to dead cells led to the clustering and aggregation of the modified cells and the dead cells. CONCLUSIONS: Annexin V can be attached to bEnd.3 cells using a biotin-streptavidin binding approach, and the modified cells can specifically recognize and bind to dead cells.