Pre-procedural pacing bias among transcatheter aortic valves with higher post-procedure pacing rates: evidence from the UK TAVI Registry.

Rates of permanent pacemaker (PPM) implantation following transcatheter aortic valve implantation (TAVI) are higher than following surgery and are dependent on patient factors and valve type. There is an increasing trend towards pre-emptive PPM insertion in patients with significant conduction disease prior to TAVI. We report results from the British Cardiovascular Intervention Society (BCIS) on pre- and post-procedural PPM implantation in the TAVI population. All centres in the United Kingdom performing TAVI are required to submit data on all TAVI procedures to the National database which are then reported annually. During 2015, there were 2373 TAVI procedures in the UK. 22.4% of TAVI patients had a PPM implanted either pre-procedure (including the distant past), or during the in-hospital procedural episode. Of these, 7.9% were pre-procedure and 14.5% post-procedure. Overall PPM rates were Edwards Sapien (13.5%), Medtronic CoreValve (28.2%) and Boston Lotus (42.1%; p < 0.01). Pre-procedure pacing rates were Edwards Sapien (6.0%), Medtronic CoreValve (9.1%) and Boston Lotus (12.3%; p < 0.01). Pre-procedural pacing rates for the Boston Lotus valve have risen year-on-year from 5.8% (2013) to 8.6% (2014) to 12.3% (2015). The UK TAVI Registry demonstrates a pre-procedural permanent pacing bias amongst patients receiving transcatheter valves with higher post-procedure pacing rates. Pre-emptive permanent pacing is likely to be responsible for this difference.

Mechanisms of root reinforcement in soils: an experimental methodology using four-dimensional X-ray computed tomography and digital volume correlation.

Vegetation on railway or highway slopes can improve slope stability through the generation of soil pore water suctions by plant transpiration and mechanical soil reinforcement by the roots. To incorporate the enhanced shearing resistance and stiffness of root-reinforced soils in stability calculations, it is necessary to understand and quantify its effectiveness. This requires integrated and sophisticated experimental and multi-scale modelling approaches to develop an understanding of the processes at different length scales, from individual root-soil interaction through to full soil-profile or slope scale. One of the challenges with multi-scale models is ensuring that they sufficiently closely represent real behaviour. This requires calibration against detailed high-quality and data-rich experiments. This study presents a novel experimental methodology, which combines in situ direct shear loading of a willow root-reinforced soil with X-ray computed tomography to capture the three-dimensional chronology of soil and root deformation within the shear zone. Digital volume correlation (DVC) analysis was applied to the computed tomography dataset to obtain full-field three-dimensional displacement and strain information. This paper demonstrates the feasibility and discusses the challenges associated with DVC experiments on root-reinforced soils.