1,720,969 research outputs found
INTUITY and INSPIRIS Aortic Valves
No full textAortic valve pathologies, including both stenosis and regurgitation, are among the most common valvular heart diseases. According to current guidelines, surgical aortic valve replacement (SAVR) remains the gold standard treatment for young, low-risk patients with these conditions. SAVR is a well-established procedure with continuous advancements in valve prosthesis design. In particular, biological prostheses offer a range of options, such as stented, stentless, sutureless, and rapid-deployment valves, allowing for patient-specific customization that enhances surgical efficiency and long-term durability.
This project aimed to assess two next-generation valves: the Intuity and Inspiris Resilia valves.
We compared the clinical and hemodynamic outcomes of the Intuity and Inspiris Resilia valves with the historically well-established Magna Ease valve. Data were collected from 2589 patients across two national multicenter registries and one institutional database. A propensity score weighting approach was employed to minimize confounding factors. Our analysis revealed that in isolated SAVR, aortic cross-clamp time was significantly shorter with the Intuity valve. Mortality rates were similar but permanent pacemaker implantation rates were notably lower with the Inspiris valve. Hemodynamic evaluation showed lower trans-prothesis gradients in Intuity and Inspiris group.
We also investigated two critical issues: managing patients with a small aortic annulus and prosthesis-patient mismatch (PPM).
In the small annulus study, we included patients undergoing isolated or combined SAVR with Magna Ease and Intuity valves (sizes 19 and 21) at our institution. After propensity score weighting, we analyzed 666 patients (367 Magna Ease and 299 Intuity). There were no significant differences in postoperative complications and also mid-term survival and re-hospitalization rates were similar. However, Intuity valves demonstrated significantly lower mean gradients overall and for size 21.
In the PPM study, we analyzed 1323 patients who underwent SAVR, with complete hemodynamic data available for 872 at our insitutition. We evaluated both measured PPM (PPMm) and predicted PPM (PPMp), assessing sensitivity, specificity, and overall accuracy. We concluded that PPMp should be used cautiously when implanting small valves to avoid unexpected PPMm.
Lastly, a detailed review of current European and American guidelines was conducted to assess the optimal treatment strategy (SAVR vs. TAVR) and the appropriate prosthesis for individual patients. We analyzed 1227 patients from 35 Italian centers, dividing them based on guideline recommendations. About 60% of the patients fell into a grey zone (65-80 years) according to American guidelines. Despite differing baseline characteristics, 30-day outcomes (mortality and stroke) were similar across groups. Finally, we concluded that despite variations in guideline recommendations, outcomes for SAVR patients were comparable across all groups, supporting the need for harmonized guidelines.
In conclusion, this study confirms the excellent clinical and hemodynamic performance of both analyzed devices, the Intuity and Inspiris Resilia valves. The Intuity valve may be a more favorable choice in patients with smaller body size or during minimally invasive procedures, whereas the Inspiris Resilia valve could be preferred in younger patients with preoperative conduction disorders
Double Transapical Access During Neochord Implantation
No full textMitral valve repair using trans-apical off-pump beating-heart neochordae implantation is a relatively new procedure with promising early and mid-term results in selected patients. However early failures few days after the procedure, requiring surgical reintervention, have been described. We describe a case of intraoperative acute procedural failure treated with a second procedure through a different trans-apical access adjacent to the first one. The final result was excellent with trivial residual regurgitation and the subsequent hospitalization was uneventful. This case demonstrates that a second trans-apical mitral neochordae implantation is feasible and should be considered in case of intraoperative acute procedural failure
A New and Unexpected Complication after Arch Stent Grafting For Residual Dissection
No full textThis report describes an unreported complication after stent-grafting of the aortic arch for residual dissection following ascending aorta and aortic arch replacement for acute type A dissection. The patient developed, one year later, a pseudoaneurysm originating from the proximal suture line and therefore far from the stent-graft landing zone, that fistulized into the pulmonary artery. Possible causes are: suture damage during stent deployment or change of system forces after stent placement leading to high-tension on the suture line. Emergency surgery was performed. Aortic arch stent grafting is a new promising technique but its complications are still not completely known
Aortic dissection during heart transplant: when a nightmare comes true
No full text: Although heart transplant is a simple surgical procedure, it is actually considered challenging to perform this procedure in patients with a long-term left ventricular assist device assistance. We present the case of a patient who was bridged to the transplant by using a Jarvik 2000 left ventricular assist device. During the debridement, an acute type A aortic dissection occurred and the surgical strategy was suddenly replanned. The acute aortic dissection is one of the most feared complications, but it could be well managed, thanks to a rapid replanning of the surgical strategy
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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