Transcatheter Mitral Valve Implantation Systematic Review: Focus on Transseptal Approach and Mitral Annulus Calcification.

INTRODUCTION: This systematic review was performed to evaluate the results of transcatheter mitral valve implantation (TMVI) in the native mitral valve. EVIDENCE ACQUISITION: Medline, EMBASE, and the Cochrane Central register were systematically searched for studies that reported results of TMVI in mitral valve regurgitation and/or stenosis and mitral annular calcification. To improve the sensitivity of the literature search, we performed citation chasing in Google Scholar, Scopus, and Web of Science. EVIDENCE SYNTHESIS: Twelve studies reporting results of TMVI in mitral regurgitation were retrieved and included 347 patients. The transseptal approach represented 28% of cases. Secondary mitral regurgitation was the predominant indication in 63% of cases. Thirty-day mortality was 11% and was lowered with the transseptal approach (7%). Technical success was 92%. Surgical conversion was needed in 5% of patients. Only one patient presented moderate to severe mitral regurgitation. These hemodynamic results were sustainable up to one year of follow-up. Three series focused on results of TMVI in mitral annulus calcification including 167 patients. Only nine patients were treated with TMVI dedicated prosthesis. Eighty-seven patients had their prosthesis delivered through a transseptal approach. Mitral stenosis was present in 63% of cases. Thirty-day mortality was 24%, and none with TMVI prosthesis. Technical success was achieved in 71% of cases and was improved by using TMVI prosthesis (89%). The main complication was left ventricular outflow tract obstruction (20%). Post procedural moderate to severe mitral regurgitation was observed in 4% of cases. CONCLUSION: TMVI seems to be feasible, achieving good technical success and predictable and durable MR reduction.

Comparison of Mitral Valve Replacement and Repair for Degenerative Mitral Regurgitation: a Meta-analysis and Implications for Transcatheter Mitral Procedures.

PURPOSE OF REVIEW: Surgical mitral valve repair is considered superior to replacement to treat primary mitral regurgitation. However, the heterogeneity of cohorts and the lack of consideration of confounding in the published literature raise potential biases. The aim of this study was to pool all available matched data comparing outcomes of mitral valve repair and replacement in the setting of primary mitral regurgitation. RECENT FINDINGS: We searched Medline, Embase and the Cochrane Library Central Register of Controlled Trials to identify propensity-matched studies or reports with multivariable adjustment comparing repair and replacement in patients with primary mitral regurgitation. The primary outcome was all-cause mortality. DerSimonian and Laird random effects were used to perform the meta-analysis. Eight observational studies were selected including 4599 patients (3064 mitral repairs and 1535 replacements). Mean age ranged from 62 to 69 years, and the mean follow-up duration ranged between 3 and 9 years. Replacement was associated with an increased risk of long-term all-cause mortality compared to repair (HR of 1.68, 95% confidence interval 1.35-2.09, p < 0.001, τ2 = 0.03). Surgical era and atrial fibrillation impacted the risk of mortality but not mitral anatomy. Neither repair nor replacement impacted significantly on the risk of re-operation after mitral surgery (HR 1.18, 95% CI 0.85-1.63, p = 0.33, τ2 < 0.01). Mitral valve replacement is possibly associated with higher long-term mortality than mitral valve repair in primary mitral regurgitation but often used as a bailout option in more complex anatomy. Despite this observation, both techniques have similar risk of re-operation.

Simultaneous omnidirectional zero-n¯ and zero-ϕeff non-Bragg gaps in metamaterial-polaritonic photonic superlattices.

Present study shows that the inclusion of single negative polaritonic-like layers in one-dimensional metamaterial photonic superlattices may lead to new effects, such as the simultaneous existence of omnidirectional zero-n¯ and zero-ϕ(eff) non-Bragg gaps for both transversal electric (TE) and transversal magnetic (TM) polarizations, which are also robust to uniaxial anisotropic effects. Such omnidirectional behavior, in the case of the zero-n¯ gap, occurs within the same frequency range for both polarizations, which is not allowed in the case of double negative (DNG) metamaterial-air superlattices, suggesting a route to design and development of omnidirectional optical filters for all polarizations. Furthermore, present results show that, when polaritonic inclusions are considered, the long wavelength approximation is not ever suitable to describe the non-Bragg gap edges.

Vibrational spectra of light and heavy water with application to neutron cross section calculations.

The design of nuclear reactors and neutron moderators require a good representation of the interaction of low energy (E < 1 eV) neutrons with hydrogen and deuterium containing materials. These models are based on the dynamics of the material, represented by its vibrational spectrum. In this paper, we show calculations of the frequency spectrum for light and heavy water at room temperature using two flexible point charge potentials: SPC-MPG and TIP4P/2005f. The results are compared with experimental measurements, with emphasis on inelastic neutron scattering data. Finally, the resulting spectra are applied to calculation of neutron scattering cross sections for these materials, which were found to be a significant improvement over library data.

First-in-man, multicentre assessment of the novel Acrobat Svelt balloon-expandable stent-on-a-wire system

Recently developed, the Acrobat SOAW (Stent-On-A-Wire) coronarysystem combines a very-thin (81 μ) balloon-expandable, Cro-Co (L605) stentmounted on a delivery system with a 0.012” integrated guidewire tip (distance fromthe tip of the wire to the stent is 22mm). We sought to determine the efficacyprofile of this novel device.Methods and results: SVELTE trial is a multicenter, international (Brazil,Netherlands and Colombia), prospective, non-randomised, single-arm study of theAcrobat SOAW for the treatment of de novo coronary lesions no longer than 18mmand located in native vessels of 2.5 to 3.5mm. DS was highly recommended andpost-dilatation was at operator’s discretion. Patients were oriented to stay on dualanti-platelet regimen for at least 1 month. Main exclusion criteria were PCI in thesetting of acute ST-elevation MI and bifurcation lesions. All patients werescheduled to undergo angiographic follow-up at 6 months. The primary endpoint ofthe study was the survival-free of combined MACE (cardiac death, myocardiuminfarction and target-lesion revascularisation) at 30 days. Secondary endpointsincluded 6-month in-stent late lumen loss and binary restenosis as well ascombined MACE rate.A total of 46 patients were enrolled with mean age of 63years old, 76.6% of male and 21.3% of diabetics. Mean RVD and lesion lengthwere 3.03mm and 12.67mm, respectively. The Acrobat stent was deployed in100% of the cases (89.6% of DS) achieving a procedure success rate of 97.8%.Up to 30 days there were no deaths, Q-Wave MIs or urgent TLR. Six-monthinvasive follow-up is ongoing and complete QCA assessment will be available atthe meeting.Conclusions: The Acrobat SOAW may potentially facilitate PCI by reducingtime/cost and minimising peri-procedural complications. The present trialrepresents the first-in-man assessment of this innovative concept.

Adherencia al tratamiento en la esquizofrenia: Consenso de enfermería en salud mental / Treatment adherence in Schizophrenia: Nurse practitioners consensus in mental health

Objetivo. Establecer un consenso español sobre cuidados de enfermería para mejorar la adherencia terapéutica en la esquizofrenia. Material y métodos. Un comité de expertos diseñó un cuestionario específico de 43 preguntas con 409 opciones. Las preguntas se referían a: definición y valoración general de la adherencia en la esquizofrenia; factores implicados; estrategias de intervención en pacientes ambulatorios y en unidades de agudos y el manejo de fármacos antipsicóticos inyectables de larga duración. Se asignaron valores de estrategia de elección, primera, segunda o tercera línea, según las respuestas obtenidas para cada ítem. Se envió el cuestionario a 215 enfermeros/as y se recibieron 160 respuestas a través de un sistema electrónico online que garantizaba su confidencialidad. Resultados y conclusiones. Existe el máximo acuerdo en considerar la gravedad del problema de la adherencia, su repercusión en las recaídas y en la evolución del paciente. Las estrategias preferidas para evaluar la adherencia son: el registro de la administración de inyectables y la impresión clínica del paciente. El grupo de trabajo considera que es preciso intervenir de manera específica cuando el paciente ha sufrido ya varias recaídas a causa del bajo cumplimiento terapéutico o se detecta una nula conciencia de enfermedad. La potenciación de las actitudes positivas hacia el tratamiento y el establecimiento de acuerdos con el paciente acerca de la importancia de tomar los fármacos son las estrategias preferidas por el personal de enfermería para reducir las recaídas por falta de adherencia (AU)

Objective. Establish a Spanish Consensus on nurse care to increase therapeutic compliance in schizophrenia. Material and methods. An experts committee designed a specific questionnaire having 43 questions. The questions referred to the definition and general assessment of compliance in schizophrenia, factors involved, intervention strategies in outpatients/inpatients and management of long duration injectable antipsychotic drugs a. First, second or third line strategy values of choice were assigned according to the answers obtained for each item. The questionnaire was sent to 160 nurse practitioners. The answers were received with an online electronic system that guaranteed their confidentiality. Results and conclusions. There is maximum agreement on considering the seriousness of the compliance problem, its repercussion in relapses, the patient’s course and increase in health care costs. The strategies preferred to evaluate compliance are: counting of the injectable drug administration and clinical assessment. The workgroup considers that specific intervention is necessary when the patient has already suffered several relapses due to low therapeutic compliance or when null awareness of disease is detected. The promotion of positive patient behaviours on treatment and the patient awareness development about treatment compliance importance are the nurse practitioners favourite strategies to reduce the relapses caused by poor adherence (AU)

Search for anomalous effects in H2O/D2O mixtures by neutron total cross section measurements.

We investigate anomalies ascribed to quantum entanglement phenomena recently reported in deep inelastc neutron scattering (DINS) measurements by an independent neutron technique on H(2)O/D(2)O mixtures. We performed transmission experiments to study several liquid H(2)O/D(2)O mixtures at room temperature in the epithermal energy range. We obtain the total cross sections of the mixtures, which are in agreement with the expected results according to the tabulated values within a 0.3% relative error. We observe no anomalies and stress the limitations of the validity of the data-processing procedures employed in the DINS experiments where the anomalies were reported.

Incidence and predictors of atrial flutter in the general population.

OBJECTIVES: The goal of our study was to determine the incidence and predictors of atrial flutter in the general population. BACKGROUND: Although atrial flutter can now be cured, there are no reports on its epidemiology in unselected patients. METHODS: The Marshfield Epidemiological Study Area (MESA), a database that captures nearly all medical care among its 58,820 residents was used to ascertain all new cases of atrial flutter diagnosed from July 1, 1991 to June 30, 1995. To identify predisposing risk factors, we employed an age- and gender-matched case-control study design using eight additional variables. RESULTS: A total of 181 new cases of atrial flutter were diagnosed for an overall incidence of 88/100,000 person-years. Incidence rates ranged from 5/100,000 in those <50 years old to 587/100,000 in subjects older than 80. Atrial flutter was 2.5 times more common in men (p < 0.001). The risk of developing atrial flutter increased 3.5 times (p < 0.001) in subjects with heart failure and 1.9 times (p < 0.001) for subjects with chronic obstructive pulmonary disease. Among those with atrial flutter 16% were attributable to heart failure and 12% to chronic obstructive lung disease. Three subjects (1.7%) without identifiable predisposing risks were labeled as having "lone atrial flutter." CONCLUSIONS: This study, the first population-based investigation of atrial flutter, suggests this curable condition is much more common than previously appreciated. If our findings were applicable to the entire U.S. population, we estimate 200,000 new cases of atrial flutter in this country annually. At highest risk of developing atrial flutter are men, the elderly and individuals with preexisting heart failure or chronic obstructive lung disease.

Left ventricular function after myocardial infarction: clinical and angiographic correlations.

There is a paucity of information correlating the angiographic findings immediately after myocardial infarction with the clinical status before infarction. Therefore, the coronary anatomy, collateral circulation and quantitative left ventricular function were studied in 39 patients who underwent angiography within 3 weeks of a first transmural myocardial infarction. In all patients, the vessel supplying the infarct was totally occluded at the time of angiography. Patients without angina before infarction (Group I) had fewer coronary obstructions than did patients with a long history of angina before infarction (Group II) (1.5 +/- 0.5 versus 2.5 +/- 0.5, respectively, p less than 0.001) but worse overall and regional left ventricular function. These paradoxical differences between Groups I and II were evident in patients with anterior as well as inferior infarction. Patients in Group I had significantly lower collateral scores than did patients in Group II (0.6 +/- 0.8 versus 1.9 +/- 0.9, respectively, p less than 0.0001) and 13 of 22 patients in Group I had no collateral vessels compared with only 1 of 17 in Group II (p less than 0.001). Partial preservation of anterior wall function in Group II patients with anterior infarction was related both to the presence of collateral vessels and to the more distal obstruction of the left anterior descending coronary artery in these patients as compared with patients with anterior infarction in Group I. In contrast, in patients with inferior wall infarction, no relation could be found between the presence of collateral vessels and regional left ventricular function, although only two patients in this series with inferior infarction did not have collateral vessels.(ABSTRACT TRUNCATED AT 250 WORDS)