Third-Generation Transcatheter Aortic Heart Valve with Reverse Parachute Sealing Cuff in Patients with Aortic Valve Disease.

BACKGROUND: The Navitor (Abbott Inc, IL, USA) transcatheter heart valve is a novel third-generation self-expanding bioprosthesis with specific features to mitigate paravalvular regurgitation (PVR). Owing to its novelty, there is a paucity of data on its application in clinical practice. METHODS: Consecutive cohort analysis of the use of the Navitor system in an as-treated clinical setting at a quaternary heart hospital. RESULTS: Sixty consecutive non-clinical trial patients treated with Navitor were identified. All patients underwent a successful procedure. The mean age was 79.3 years (±SD 7.82), 56.67% (n=34) were female, and the mean STS score was 4.87 (±SD 5.70). At 30 days post-procedure, all patients were alive with no readmissions for heart failure. One patient had a major vascular complication (1.7%). Four patients (7.14% of patients without a pre-existing pacemaker) received a new permanent pacemaker. Two patients (3.4%) had a non-disabling stroke. PVR at 30 days was trivial or none in 75% of patients, and no patient had worse than mild PVR. CONCLUSIONS: The Navitor system in this as-treated cohort was associated with favourable clinical, haemodynamic, and safety outcomes.

Optical and electrical programmable computing energy use comparison.

Optical computing has been proposed as a replacement for electrical computing to reduce energy use of math intensive programmable applications like machine learning. Objective energy use comparison requires that data transfer is separated from computing and made constant, with only computing variable. Three operations compared in this manner are multiplication, addition and inner product. For each, it is found that energy use is dominated by data transfer, and that computing energy use is a small fraction of the total. Switching to optical from electrical programmable computing does not reduce energy use.

The Prophylactic Chimney Snorkel Technique for the Prevention of Acute Coronary Occlusion in High Risk for Coronary Obstruction Transcatheter Aortic Valve Replacement/Implantation Cases.

Coronary occlusion (immediate or delayed) is an uncommon but potentially devastating complication of transcatheter aortic valve replacement/implantation (TAVR/TAVI). Several patient-related, anatomical, device and procedural risk factors can be assessed to risk-stratify patients and assist in procedural planning. In patients at high risk for coronary occlusion, coronary protection measures should be employed. In the highest risk patients, consideration should be given to prophylactic techniques to prevent coronary occlusion. This how-to-do-it report provides a framework for risk assessment for coronary occlusion followed by a step-wise description of the emerging chimney snorkel coronary stenting technique as a predictable procedural approach for the management of this potentially challenging clinical scenario.

Transcatheter Aortic Valve Replacement is Associated with Comparable Clinical Outcomes to Open Aortic Valve Surgery but with a Reduced Length of In-Patient Hospital Stay: A Systematic Review and Meta-Analysis of Randomised Trials.

BACKGROUND: Aortic valve replacement is indicated in patients with severe symptomatic aortic stenosis (AS). Transcatheter aortic valve replacement (TAVR) has evolved as a potential strategy in a growing proportion of patients in preference to surgical aortic valve replacement (SAVR). This meta-analysis aims to assess the differential outcomes of TAVR and SAVR in patients enrolled in published randomised controlled trials (RCTs). METHODS: A systematic literature search of Cochrane Library, EMBASE, OVID, and PubMed MEDLINE was performed. Randomised controlled trials of patients with severe AS undergoing TAVR compared with SAVR were included. Clinical outcomes and procedural complications were assessed. RESULTS: Five RCTs with a total of 3,828 patients (1,928 TAVR and 1,900 SAVR) were analysed. There was no statistically significant difference in combined rates of all-cause mortality and stroke at 30-days for TAVR vs SAVR (6.3% vs 7.5%; OR 0.83; 95% CI: 0.64-1.08; P=0.17) or at 12 months (17.2% vs 19.2%; OR 0.87; 95% CI: 0.73-1.03; P=0.29). No statistically significant difference was seen for death or stroke separately at any time point although a numerical trend in favour of TAVR for both was recorded. Length of in-patient stay was significantly less with TAVR vs SAVR (9.6 +/- 7.7 days vs 12.2 +/- 8.8 days; OR -2.94; 95% CI: -4.64 to -1.24; P=0.0007). Major vascular complications were more frequent in patients undergoing TAVR vs SAVR (8.2% vs. 4.0%; OR 2.15; 95% CI: 1.62-2.86; P <0.00001) but major bleeding was more common among SAVR patients (20.5% vs 44.2%; OR 0.34; 95% CI: 0.22-0.52; P=<0.00001). CONCLUSIONS: Transcatheter aortic valve replacement and SAVR are associated with overall similar rates of death and stroke among patients in intermediate to high-risk cohorts but with reduced length of in-patient hospital stay.

No doubt about it: when doubtful role models undermine men's and women's math performance under threat.

Past work has shown that female role models are effective buffers against stereotype threat. The present research examines the boundary conditions of this role model effect. Specifically, we argue that female role models should avoid expressing doubt about their math abilities; otherwise they may cease to buffer women from stereotype threat. For men, a non-doubtful male role model should be seen as threatening, thus harming performance. A doubtful male role model, however, should be seen as non-threatening, thus allowing men to perform up to their ability in math. To test this reasoning, men and women were exposed to either an outgroup or ingroup role model who either expressed doubt or did not. Participants then took a math exam under stereotype threat conditions. As expected, doubtful ingroup role models hurt women, but helped men's performance. Outgroup role models' expressed doubt had no differential effect on performance. We also show that expressions of doubt take on a different meaning when expressed by a female rather than a male role model.

Adapting the botanical landscape of Melbourne Gardens (Royal Botanic Gardens Victoria) in response to climate change.

Botanic gardens around the world maintain collections of living plants for science, conservation, education, beauty and more. These collections change over time - in scope and content - but the predicted impacts of climate change will require a more strategic approach to the succession of plant species and their landscapes. Royal Botanic Gardens Victoria has recently published a 'Landscape Succession Strategy' for its Melbourne Gardens, a spectacular botanical landscape established in 1846. The strategy recognizes that with 1.6 million visitors each year, responsibility for a heritage-listed landscape and the need to care for a collection of 8500 plant species of conservation and scientific importance, planting and planning must take into account anticipated changes to rainfall and temperature. The trees we plant today must be suitable for the climate of the twenty-second century. Specifically, the Strategy sets out the steps needed over the next twenty years to transition the botanic garden to one resilient to the climate modelled for 2090. The document includes a range of practical measures and achievable (and at times somewhat aspirational) targets. Climate analogues will be used to identify places in Australia and elsewhere with conditions today similar to those predicted for Melbourne in 2090, to help select new species for the collection. Modelling of the natural and cultivated distribution of species will be used to help select suitable growth forms to replace existing species of high value or interest. Improved understanding of temperature gradients within the botanic garden, water holding capacity of soils and plant water use behaviour is already resulting in better targeted planting and irrigation. The goal is to retain a similar diversity of species but transition the collection so that by 2036 at least 75% of the species are suitable for the climate in 2090. Over the next few years we hope to provide 100% of irrigation water from sustainable water sources, and infrastructure will be improved to adapt to predicted higher temperatures and more climatic extremes. At all times there will be a strong focus on assisting the broader community in their response to climate change.

Familial Atrial Myxoma: Three Related Cases at an Australian Tertiary Institution.

Carney complex accounts for up to two-thirds of familial cardiac myxoma. It is a rare autosomal dominant syndrome, which is also characterized by multiple mucocutaneous lesions and endocrine tumors. We report on three first-degree relatives who underwent surgical resection at the same Australian tertiary institution. One patient re-presented with a recurrent tumor at an interval of 6 years. In this context, the role of interval surveillance, family screening, and genetic testing is explored. We recommend interval echocardiographic surveillance for affected individuals and first-degree relatives given the high risk of recurrence and the morbidity and mortality associated with cardiac tumors in any location.

Extended trochanteric osteotomy via the direct lateral approach in revision hip arthroplasty.

A review of the results of the extended trochanteric osteotomy through a modified direct lateral approach in revision total hip arthroplasty was done. We reviewed 44 patients (45 procedures) at a minimum of 2 years followup (mean, 3.8 years; range, 2.1-7.2 years). There were 26 men and 18 women with a mean age at the time of surgery of 70.8 years (range, 36.9-90.4 years). Indications for use of the trochanteric osteotomy included facilitation of cement removal (25 procedures), proximal femoral varus deformity (14 procedures), trochanteric malposition (five procedures), and previous trochanteric osteotomies with significant bony overgrowth (three procedures). The mean length of the osteotomy was 133.9 mm. The mean migration of the osteotomized fragment was 2.1 mm (range, 0-20 mm) with significantly more proximal migration seen with the use of cerclage wires when compared with cables. There were two cases of trochanteric escape, for which the patients required repeat open reduction internal fixation. There were two late fractures of the greater trochanter. One femoral component had early subsidence for which the patient required re-revision with a further extended trochanteric osteotomy. The mean time to union of the remaining 40 hips was 10.3 months (range, 6-24 months). There only was one dislocation postoperatively. The extended trochanteric osteotomy through the modified direct lateral approach in revision total hip arthroplasty is a reproducible and reliable technique with a lower dislocation rate but a higher incidence of trochanteric fracture and escape than previously described with its use in the posterior approach.