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Impact of Small Aortic Annuli on the Performance of Transcatheter Aortic Valve Replacement Bioprostheses: An Updated Meta-analysis of Recent Studies.
No full textA metanalysis of available randomized controlled trials and observational studies comparing self-expanding and balloon-expandable bioprostheses in patients with small aortic annulus and aortic stenosis for short and midterm hemodynamic and clinical outcomes was performed. 21 studies with a total 8647 patients (self-expanding, n=4,336 patients vs balloon-expandable, n= 4,311 patients) were included. Self-expanding bioprostheses had a lower post-operative mean gradient at 30 days (MD -5.16, 95%CI 4.7-5.5, p value <0.001) and at one year (MD -6.6, 95%CI 6.1-7.03, p value <0.001), with a larger indexed Effective Orifice Area (0.17, 95%CI 0.13-0.22, p value <0.001and 0.17, 95%CI 0.08-0.27, p value < 0.001) at both time intervals. Balloon-expandable bioprostheses had a higher risk of 30-day and 1-year severe prosthesis-patient mismatch (RR 1.07, 95%CI 1.04-1.09, p value < 0.001; RR 1.07, 95%CI 1.04-1.11, p value <0.001). 30-day and 1 year paravalvular leaks (RR 0.99, 95%CI 0.98-0.99, p value < 0.001; RR 0.89, 95%CI 0.82-0.95, p value <0.001) and permanent pacemaker implantation (RR 0.97, 95%CI .94-0.99, p value 0.01, I2= 40%,) were lower in balloon-expandable group. Balloon-expandable bioprostheses were associated with lower risk of in-hospital stroke (RR 0.99, 95%CI 0.98-1,p value= 0.01). In conclusion, in patients with small aortic annulus and aortic stenosis, SE bioprostheses have superior haemodynamic performance but higher rates of PVL, PPI and in-hospital stroke. BE bioprostheses were associated with a higher risk of severe PPM
Comments and illustrations of the WFUMB CEUS liver guidelines: rare benign hematological focal liver lesions (hepatic extramedullary hematopoiesis, Hemophagocytic lymphohistiocytosis, reactive lymphoid hyperplasia).
No full textThe manifestation of benign hematological infiltration in the liver is a challenge due to their rare occurrence and therefore, limited awareness and the general need for biopsy and histological confirmation. Owing to the rarity of these lesions, there are limited data concerning their appearance on ultrasound and, specifically, contrast-enhanced ultrasound. In a series of papers, we have compiled the US and CEUS characteristics of rare FLL, where there are few reports and images available, in order to build up a library of these cases. This paper describes the US and CEUS features of benign hematological FLL which include hepatic extramedullary hematopoiesis (EMH), hemophagocytic lymphohistiocytosis (HLH) and reactive lymphoid hyperplasia (RLH). Although these lesions occur rarely in the liver, their correct identification is imperative for appropriate patient`s management
Right ventricular function in marfan patients remains stable despite multiple cardiac interventions.
No full textOBJECTIVES
Mitral valve regurgitation and left ventricular dysfunction are cardiovascular symptoms of Marfan syndrome. There is a paucity of information on tricuspid valve regurgitation and right ventricular function. In patients with Marfan syndrome, we looked at long-term changes in right ventricular function, tricuspid valve regurgitation, and freedom from tricuspid valve repair.
METHODS
Retrospective-observational single-centre analysis on right ventricular function and tricuspid regurgitation in Marfan patients who underwent surgery with cardioplegic arrest between 1995 and 2020. Patients were followed-up from first operation until death, with echocardiographic changes analysed longitudinally. Composite end-point was TAPSE ≤ 16mm, severe tricuspid regurgitation, or tricuspid repair.
RESULTS
The study included 135 patients who underwent 193 operations, 58 of those were reoperations in 40 patients. Median age at first operation was 35 years (IQR 26-46), median follow-up was 8.0 years (IQR 3.0-16.0), and median time-to-first-reoperation was 7.5 years (IQR 3.4-12.5). The composite end-point occurred in 81 observations in 40 patients, mostly as a recurrent event, after median 7.0 years (IQR 1.0-13.0). 10-year-cumulative-incidence for composite end-point was 22.0% (95% CI 15-31), and 9.0% (95% CI 4.4-16) for new-onset TAPSE ≤ 16mm, but no significant change in TAPSE was observed at 10 years. Tricuspid regurgitation was associated with increased risk of annual progression (P < 0.001), but not clinically relevant at 10 years. Actuarial 10-year-survival was 91.1%.
CONCLUSIONS
In Marfan patients with a history of cardiac surgery and subsequent reoperations, the right-ventricular function remains stable. The incidence of severe tricuspid regurgitation and tricuspid repair remain low
Comparing the new concept of impairment in personality functioning with borderline personality disorder: differential psychosocial and psychopathological correlates in a clinical adolescent sample.
Get PDFBorderline personality disorder (BPD) is an established diagnosis in adolescence with high comorbidity and psychosocial impairment. With the introduction of the alternative model for personality disorders in DSM-5 (AMPD), personality functioning is operationalized using the Level of Personality Functioning Scale (LPFS), which has been shown to be associated with severity of personality pathology. The present study aimed at examining differential psychopathological and psychosocial correlates of LPFS and BPD. A total of 526 adolescent in- and outpatients were interviewed with the STiP-5.1 (LPFS) and the SCID-II. Mixed linear regression was used to investigate the associations between the two interviews with measures of psychopathology and psychosocial impairment. 11.4% met the diagnostic threshold of both interviews, 16.1% only of the LPFS, and 64.1% were below the diagnostic threshold in both interviews (no PD). The BPD only group was larger than expected-8.4% of patients who met criteria for BPD did not fulfill criteria for significant impairment in the LPFS. The highest burden was found in individuals concurrently showing significant impairment in LPFS and fulfilling BPD diagnosis (LPFS + BPD). Differences between the LPFS only group and the BPD only group were found in risk behavior and traumatic experiences, with higher prevalence in the BPD group. Findings confirm the high psychopathological burden and psychosocial impairment associated with both BPD and LPFS. Those exceeding the diagnostic threshold of LPFS in combination with a BPD diagnosis are characterized by greatest disability. Not all adolescents fulfilling formal BPD diagnosis showed a clinically significant impairment in LPFS, which may refer to a distinct diagnostic group
Impact of comorbidity on complication rates and life expectancy in patients with a leadless pacemaker.
No full textBACKGROUND
Knowledge about impact of age and comorbidities on outcome in patients with leadless pacemakers (LPM) is limited.
OBJECTIVES
To analyse outcome in LPM patients according to age and comorbidities.
METHODS
This Swiss, multi-centre, retrospective analysis includes all patients with LPM implanted between 2015 and 2022. Charlson-Comorbidity-Index (CCI) was determined and patients were divided into a low- (CCI ≤ 5) and high- comorbidity (CCI > 5) group. Peri-procedural complications, in-hospital death, and all-cause mortalities were assessed. Finally, all-cause mortality according to three groups (CCI ≤ 3, 4-5, >5) was compared to age and sex-adjusted mortality in the general Swiss population.
RESULTS
863 patients (median age 81 years, 65% male, 42% with CCI > 5) were included. Peri-procedural/long-term complication rates did not differ between the low- vs. high-comorbidity groups (2.6% vs. 1.7%, p = 0.48 and 1.2% vs. 2.8%, p = 0.12, respectively). In-hospital (3.6% vs. 0.6%, p = 0.002) and all-cause mortality (HR 2.9, 95%CI 2.2-3.8, p < 0.001) were significantly higher in the high-comorbidity group resulting in a three-year mortality of 58% (95%CI 51-65%) vs. 22% (95%CI 17-27%) in the low-comorbidity group. In patients with a CCI ≤ 3, all-cause mortality was comparable to the age- and sex-adjusted mortality of the general Swiss population.
CONCLUSIONS
In elderly patients with high comorbidity, LPM implantation was not associated with increased peri-procedural/long-term complications. All-cause mortality in LPM patients with a CCI ≤ 3 was comparable to age- and sex-adjusted mortality in the general Swiss population. Despite a relatively high three-year mortality due to competing risk factors, LPM implantation is safe, even in elderly patients with high comorbidity.
CONDENSED ABSTRACT
In this Swiss, multi-centre, retrospective cohort analysis, 863 patients implanted with a leadless pacemaker were included and divided into a high-comorbidity (with a CCI > 5) and low-comorbidity (with a CCI ≤ 5) group. There was no between group difference in terms of implantation outcomes and peri-operative or long-term complications. Furthermore, all-cause mortality during follow-up in patients with a CCI ≤ 3 was comparable to age- and sex-adjusted mortality in the general Swiss population. These data indicate that LPM implantation is a safe procedure, even in elderly patients with high comorbidity
Three Kinds of Causal Indeterminacy
Get PDFThe goal of this paper is to argue that there is indeterminacy in causation. I present three types of cases in which it is indeterminate whether an event c caused another event e: (1) cases of absence causation recently discussed by Bernstein and by Swanson, (2) cases leading to Sorites paradoxes for causation, and (3) cases where c and e occur in certain indeterministic causal structures and it is therefore indeterminate whether there is a causal relation between them. These cases, I argue, provide strong evidence that indeterminacy is an important general feature of the causal relation and that philosophical theorizing about causation should take this observation into account
Relationship between Upstream Cardiac Damage and Myocardial Injury in Patients with Aortic Stenosis undergoing Transcatheter Aortic Valve Implantation.
No full textWhy Do Some Lineages Radiate While Others Do Not? Perspectives for Future Research on Adaptive Radiations.
No full textUnderstanding the processes that drive phenotypic diversification and underpin speciation is key to elucidating how biodiversity has evolved. Although these processes have been studied across a wide array of clades, adaptive radiations (ARs), which are systems with multiple closely related species and broad phenotypic diversity, have been particularly fruitful for teasing apart the factors that drive and constrain diversification. As such, ARs have become popular candidate study systems for determining the extent to which ecological features, including aspects of organisms and the environment, and inter- and intraspecific interactions, led to evolutionary diversification. Despite substantial past empirical and theoretical work, understanding mechanistically how ARs evolve remains a major challenge. Here, we highlight a number of understudied components of the environment and of lineages themselves, which may help further our understanding of speciation and AR. We also outline some substantial remaining challenges to achieving a detailed understanding of adaptation, speciation, and the role of ecology in these processes. These major challenges include identifying factors that have a causative impact in promoting or constraining ARs, gaining a more holistic understanding of features of organisms and their environment that interact resulting in adaptation and speciation, and understanding whether the role of these organismal and environmental features varies throughout the radiation process. We conclude by providing perspectives on how future investigations into the AR process can overcome these challenges, allowing us to glean mechanistic insights into adaptation and speciation
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