New-generation Devices Research Articles

Current evidence and indications for left atrial appendage closure.

Atrial fibrillation (AF) is the most common arrhythmia worldwide and its prevalence increases with age. The main and most severe complication of AF is ischemic stroke, yet an estimated 50 % of eligible patients cannot tolerate or are contraindicated to receive oral anticoagulation (OAC). In patients with AF, the left atrial appendage (LAA) is the main source of thrombus formation. Percutaneous LAA closure (LAAC) has emerged over the past two decades as a valuable alternative to OAC for reducing the risk of strokes and systemic embolisms in patients with AF who cannot tolerate long-term OAC. With newer generation devices such as the Watchman (Boston Scientific, Natick, MA, USA) and Amulet (Abbott, Abbott Park, IL, USA) gaining approval from the US Food and Drug Administration in recent years, the safety and efficacy of LAAC in specific populations intolerant to OAC have increased and more patients are being treated. This systematic review provides the indications for LAAC and the evidence for evaluating the use of the currently available device therapies. We also examine the current unsolved problems with patient selection and postprocedural antithrombotic regimens.

Unraveling the structure-property relationship of novel thiophene and furan-fused cyclopentadienyl chromophores for nonlinear optical applications.

Development of organic nonlinear optical materials has become progressively more important due to their emerging applications in new-generation photonic devices. A novel series of chromophores based on innovative thiophene and furan-fused cyclopentadienyl bridge with various powerful donor and acceptor moieties were designed and theoretically investigated for applications in nonlinear optics. To unravel the structure-property relationship between this new push-pull conjugated systems and their nonlinear optical property, multiple methods, including density of states analysis, coupled perturbed Kohn-Sham (CPKS) method, sum-over-states (SOS) model, the two-level model (TSM), hyperpolarizability density analysis, and the (hyper)polarizability contribution decomposition, were performed to comprehensively investigated the nonlinear optical and electronic properties of this new π-system. Due to excellent charge transfer ability of new bridge and distinctive structure of donor and acceptor, the designed chromophores exhibit deep HOMO levels, low excitation energy, high dipole moment difference and large hyperpolarizability, indicating the appealing air-stable property and remarkable electrooptic performance of them. Importantly, THQ-CS-A3 and PA-CS-A3 shows outstanding NLO response properties with βtot value of 6953.9 × 10-30 and 5066.0 × 10-30 esu in AN, respectively. The influence of the push-pull strength, the heterocycle and the π-conjugation of new bridge on the nonlinear optical properties of this novel powerful systems are clarified. This new series of chromophores exhibit remarkable electro-optical Pockels and optical rectification effect. More interestingly, PA-CS-A3 and THQ-CS-A2 also show appealing SHG effect. This study will help people understand the nature of nonlinear optical properties of innovative heteroarene-fused based cyclopentadienyl chromophores and offer guidance for the rational design of chromophores with outstanding electrooptic (EO) performance in the future.

Unravelling multi-layered structure of native SEI on lithium metal electrode and various electrolytes using reactive molecular dynamics

Lithium metal batteries, directly utilizing lithium metal as an anode, are promising as new-generation energy storage devices, and the characteristics of the solid electrolyte interphase (SEI) layer are critical to battery operation. However, the roles of electrolyte compositions on the structure and thickness of the passivating SEI film at the atomistic level have been previously overlooked, resulting in poor understanding of SEI characteristics. In this study, the formation of the native SEI layer on lithium metal electrode and various electrolyte composition is scrutinised using ReaxFF molecular dynamics (MD) simulations. The study successfully identifies different layers of the SEI film using charge distribution as a tool. The decrease in lithium density and the increase in the charge states of oxidised lithium atoms contribute to the identification of an inner layer and a transition layer within the previously known interface layer, as well as the sparse layer. Additionally, different reaction schemes are observed through the analysis of ratio between consumed lithium atoms and electrolyte molecules. Furthermore, results show the lithium salt concentration effects in suppressing the growth of the SEI between the lithium anode and the liquid electrolyte, and inhibiting the formation of key SEI components. This work provides new insights into the nature of SEI surface chemistry and potentially facilitates the design of artificial SEI layers and optimal electrolyte solutions.

Clinical Outcomes in Atrial Fibrillation Patients Undergoing Transcatheter Aortic Valve Replacement With Contemporary Devices.

Atrial fibrillation (AF) has been identified as a marker of advanced cardiac damage in aortic stenosis patients. However, the factors associated with poorer outcomes among AF patients in contemporary TAVR practice, particularly regarding mortality and heart failure (HF)-related hospitalizations, remain largely unknown. Multicenter study including consecutive patients with a history of AF, evaluating the clinical outcomes and predictors of mortality, and HF-related hospitalization, who underwent TAVR with newer-generation devices using balloon or self-expandable valves. A total of 3,476 patients were included. After a median follow-up of 2 (1-4) years, 36.4% had died, with 51.5% of deaths being cardiovascular-related, including 15.6% from HF. HF-related hospitalizations post-TAVR accounted for 34.8% of all hospitalizations and exhibited a significantly higher mortality risk (HR:1.54;95%CI:1.32-1.81;P<0.001). Permanent AF emerged as an independent predictor of all-cause death or HF-related hospitalizations (HR:1.25; 95%CI:1.10-1.40;P<0.001), as did other baseline characteristics, including chronic kidney disease (HR:1.23;95%CI:1.09-1.38;P=0.001), anemia (HR:1.21; 95%CI:1.07-1.36;P=0.002), and New York Heart Association class III or IV (HR:1.13; 95%CI:1.01-1.27;P=0.045). Additionally, early post-procedural complications, including stroke and bleeding also significantly increased the risk of mortality and HF-related hospitalizations (HR:5.52;95%CI:3.12-9.79;P<0.001 & HR:1.17;95%CI:1.03-1.33;P=0.014, respectively). AF patients exhibited a high risk of HF-related hospitalizations in a contemporary TAVR cohort. Several baseline co-morbidities and periprocedural complications, along with permanent (vs. paroxysmal) AF were associated with poorer outcomes. These findings confirm the negative impact of AF despite the continued improvements in TAVR technology and underscore the importance of early intervention and optimization of HF management to improve outcomes in this high-risk population.

Abstract 4121516: Efficacy of Sentinel Cerebral Embolic Protection Device in Transcatheter Aortic Valve Replacement: A Meta-Analysis of Randomized Controlled Trials and Propensity Score Matched Studies

Background: Transcatheter aortic valve replacement (TAVR) is frequently associated with stroke due to debris embolization. Although the risk of stroke with the newer-generation devices is lower, stroke still represents a significant cause of mortality and morbidity after TAVR. The Sentinel cerebral embolic protection (CEP) device (Boston Scientific) is a dual embolic filter device designed to capture debris dislodged during TAVR. The current literature concerning the efficacy of Sentinel CEP in the reduction of stroke in patients undergoing TAVR is limited and inconsistent. Aim: This meta-analysis aimed to compare clinical outcomes with Sentinel CEP device in patients undergoing TAVR. Methods: A comprehensive systematic literature search was performed on PubMed, Embase, Cochrane Library and Clinicaltrial.gov from inception until 1st May 2024 to retrieve randomized controlled trials (RCTs) and propensity-matched studies comparing TAVR with and without the Sentinel CEP device. Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated using the DerSimonian-Laird random-effects model, with a p-value of &lt;0.05 considered statistically significant. Results: 6 studies with a total of 25,130 patients undergoing TAVR (12608: Sentinel CEP device; 12522: Without Sentinel CEP device) were included in this meta-analysis. The use of the Sentinel CEP device in TAVR was associated with a statistically significant lower risk of acute kidney injury [OR: 0.89; 95% CI: 0.81, 0.97; p=0.01]. The use of Sentinel CEP device in TAVR was associated with a statistically insignificant trend towards reduction in stroke [OR: 0.80; 95% CI: 0.58, 1.10; p=0.18], all-cause mortality [OR: 0.74; 95% CI: 0.51, 1.07; p=0.11], and major vascular complications [OR: 0.74; 95% CI: 0.46, 1.19; p=0.21]. Conclusion: The use of the Sentinel CEP device in patients undergoing TAVR does not lead to a statistically significant reduction in stroke, all-cause mortality, and major vascular complications; however, the risk of acute kidney injury is lower. Large, multicentric RCTs are warranted to corroborate the findings of this meta-analysis.

Impact of prior hospitalization for heart failure on clinical outcomes of patients after transcatheter aortic valve implantation with new-generation devices: Insights from the LAPLACE-TAVI registry.

A history of hospitalization for heart failure (HHF) before transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement is associated with the prognosis of patients with severe aortic stenosis (AS). However, the impact of prior HHF on clinical outcomes after contemporary TAVI using new-generation transcatheter heart valves (THVs) has not been thoroughly investigated. Using data from the aLliAnce for exPloring cLinical prospects of AortiC valvE disease (LAPLACE)-TAVI registry, we investigated 2,752 patients who underwent TAVI with new-generation THVs with a median follow-up of 627 days. The primary outcomes were all-cause mortality and heart failure readmission after TAVI. Patients with a history of HHF (n = 809) showed a higher 30-day mortality than patients without prior HHF (n = 1,943). A Kaplan-Meier analysis revealed that the prior HHF group showed a higher incidence of the primary outcome than the non-prior HHF group (27.4% vs. 16.4%, log-rank p = 0.001). In a Cox regression analysis, prior HHF was significantly associated with the risk of the primary outcome, even after adjusting for covariates (hazard ratio, 1.344; 95% confidence interval, 1.103-1.638; p = 0.003). A subanalysis showed that the prior HHFgroup with ejection fraction (EF) ≥ 50% had a higher risk of the primary outcome than the non-prior HHFgroup, whereas the prior HHF group with EF < 50% had the worst outcome. A history of prior HHF is associated with worse outcomes in patients with severe AS, both in those with preserved EF and those with reduced EF, even after TAVI using new-generation devices.

Hybrid rib fabric electromagnetic shielding measurement in X-band

This study involves measurement and evaluation of the electromagnetic shielding effectiveness (EMSE) in the X-band frequency range of rib-knitted fabrics formed from hybrid conductors. Hybrid conductive fabrics were made by knitting copper, silver, and stainless steel conductors together with cotton yarn. The basic theory of EMSE is introduced, and the waveguide measurement setup described. The through-reflect-line calibration setup was used to obtain accurate results. After calibration of the established waveguide measurement setup, hybrid conductive fabrics were tested. The measurements were analyzed and the fabrics compared. The aim is to produce a hybrid fabric that is suitable for general use, has a good EMSE, is easy to produce, and offers low-cost high-frequency solutions. An easy-to-produce and low-cost EMSE material is required, especially in new-generation wearable flexible electronic devices and military applications.

Efficacy of Sentinel Cerebral Embolic Protection Device in Transcatheter Aortic Valve Replacement: A Meta-Analysis of Randomized Controlled Trials and Propensity Score-Matched Studies.

Transcatheter aortic valve replacement (TAVR) is frequently associated with stroke due to debris embolization. Although the risk of stroke with newer-generation devices is lower, stroke still represents a significant cause of mortality and morbidity post-TAVR. The Sentinel cerebral embolic protection device (CEPD) is a dual-embolic filter device designed to capture debris dislodged during TAVR. A systematic literature search was performed on the major bibliographic databases to retrieve studies that compared TAVR with and without Sentinel CEPD. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the DerSimonian-Laird random-effects model, with a P value of <0.05 considered statistically significant. This meta-analysis included 6 studies with 25,130 patients undergoing TAVR (12,608: Sentinel CEPD; 12,522: without Sentinel CEPD). The use of the Sentinel CEPD in TAVR was associated with a statistically significant lower risk of acute kidney injury (OR: 0.89; 95% CI: 0.81-0.97; P = 0.01]. The use of Sentinel CEPD in TAVR was associated with a statistically insignificant trend toward a reduction in stroke (OR: 0.80; 95% CI: 0.58-1.10; P = 0.18), all-cause mortality (OR: 0.74; 95% CI: 0.51-1.07; P = 0.11), and major vascular complications (OR: 0.74; 95% CI: 0.46-1.19; P = 0.21). The use of Sentinel CEPD in patients undergoing TAVR does not lead to a statistically significant reduction in stroke, all-cause mortality, or major vascular complications; however, the risk of acute kidney injury is lower. Further randomized studies are warranted to confirm these findings.

Atomic-Level Structure of the Organic-Inorganic Interface of Colloidal ZnO Nanoplatelets from Dynamic Nuclear Polarization-Enhanced NMR.

Colloidal semiconductor nanoplatelets (NPLs) have emerged as a new class of nanomaterials that can exhibit substantially distinct optical properties compared to those of isotropic quantum dots, which makes them prime candidates for new-generation optoelectronic devices. Insights into the structure and anisotropic growth of NPLs can offer a blueprint for their controlled fabrication. Here, we present an atomic-level investigation of the organic-inorganic interface structure in ultrathin and stable benzamidine (bza)-supported ZnO NPLs prepared by the modified one-pot self-supporting organometallic approach. High-resolution transmission electron microscopy analysis showed a well-faceted hexagonal shape of ZnO NPLs with lateral surfaces terminated by nonpolar (101̅0) facets. The basal surfaces are flat and well-formed on one side and corrugated on the other side, which indicates that the layer-by-layer growth in the thickness of the NPLs likely occurs only in one direction via the expansion of 2D islands on the surface. The ligand coordination modes were elucidated using state-of-the-art dynamic nuclear polarization (DNP)-enhanced solid-state NMR spectroscopy supported by density functional theory chemical shift calculations. Specifically, it was found that (101̅0) nonpolar facets are stabilized by neutral L-type bza-H ligands with hydrogen bond-supported η1-coordination mode, while polar (0001) and (0001̅) facets are covered by μ2-coordinated X-type anionic bza ligands with different conformations of aromatic rings. Moreover, the ligand packing on (101̅0) lateral facets was determined using 13C natural abundance (∼1.1%) homonuclear dipolar correlation experiments. Overall, an in-depth understanding of the growth mechanism and the unique bimodal X-type/L-type ligand coordination shell of ZnO NPLs is provided, which will facilitate further design of anisotropic nano-objects.

Outcomes of transcatheter aortic valve implantation for native aortic valve regurgitation.

Large datasets of transcatheter aortic valve implantation (TAVI) for pure aortic valve regurgitation (PAVR) are scarce. We aimed to report procedural safety and long-term clinical events (CE) in a contemporary cohort of PAVR patients treated with new-generation devices (NGD). Patients with grade III/IV PAVR enrolled in the FRANCE-TAVI Registry were selected. The primary safety endpoint was technical success (TS) according to Valve Academic Research Consortium 3 criteria. The co-primary endpoint was defined as a composite of mortality, heart failure hospitalisation and valve reintervention at last follow-up. From 2015 to 2021, 227 individuals (64.3% males, median age 81.0 [interquartile range {IQR} 73.5-85.0] years, with EuroSCORE II 6.0% [IQR 4.0-10.9]) from 41 centres underwent TAVI with NGD, using either self-expanding (55.1%) or balloon-expandable valves (44.9%; p=0.50). TS was 85.5%, with a non-significant trend towards increased TS in high-volume activity centres. A second valve implantation (SVI) was needed in 8.8% of patients, independent of valve type (p=0.82). Device size was ≥29 mm in 73.0% of patients, post-procedure grade ≥III residual aortic regurgitation was rare (1.2%), and the permanent pacemaker implantation (PPI) rate was 36.0%. At 30 days, the incidences of mortality and reintervention were 8.4% and 3.5%, respectively. The co-primary endpoint reached 41.6% (IQR 34.4-49.6) at 1 year, increased up to 61.8% (IQR 52.4-71.2) at 4 years, and was independently predicted by TS, with a hazard ratio of 0.45 (95% confidence interval: 0.27-0.76); p=0.003. TAVI with NGD in PAVR patients is efficient and reasonably safe. Preventing the need for an SVI embodies the major technical challenge. Larger implanted valves may have limited this complication, outweighing the increased risk of PPI. Despite successful TAVI, PAVR patients experience frequent CE at long-term follow-up.

Multicenter, propensity-weighted comparison of stented, rapid-deployment and new-generation aortic valves

BackgroundConventional stented, rapid deployment and new-generation stented valves are now available for surgical aortic valve replacement (SAVR). New-generation devices feature advanced tissue treatment for theoretical prolonged durability and a new stent design able to expand in case of future transcatheter Valve-in-Valve. Aim of this retrospective, multicenter, propensity-weighted study was to compare early clinical and hemodynamic outcomes of these three different bioprostheses. MethodsWe analyzed data of 2589 patients from two national multicenter registries and one Institutional database. Study devices were Magna Ease, Intuity/Intuity Elite and Inspiris Resilia (Edwards Lifesciences, Irvine, CA, USA) and were implanted in 296 (11.4 %), 1688 (65.2 %) and 605 (23.4 %) patients, respectively. A propensity score weighting approach was employed. ResultsIn isolated SAVR, aortic cross clamp (ACC) time was shorter for Intuity (Magna Ease: 87, Intuity: 55, Inspiris: 70 min; Magna Ease vs. Intuity: p < 0.001; Inspiris vs. Intuity: p < 0.001). Overall mortality was 2 %, 1.7 % and 0.5 % in Magna Ease, Intuity and Inspiris groups, respectively (Magna Ease vs. Intuity: p = 0.476; Inspiris vs. Intuity: p = 0.395); permanent pace-maker implantation rate was lower for Inspiris (Magna Ease: 6 %, Intuity: 6 %, Inspiris: 2 %; Magna Ease vs. Intuity: p = 0.679; Inspiris vs. Intuity: p < 0.001). Median mean gradients were 13, 10 and 10 mmHg for Magna Ease, Intuity and Inspiris, respectively (Magna Ease vs. Intuity: p < 0.001; Inspiris vs. Intuity: p = 0.13). ConclusionsAll study devices provide excellent early clinical and hemodynamic outcomes. Inspiris shows low rates of permanent pace-maker implantation and its transaortic gradients are similar to rapid-deployment valves and lower than Magna Ease.

Electrical Control of the Valley-Layer Hall Effect in Ferromagnetic Bilayer Lattices.

The layertronics based on the layer degree of freedom are of essential significance for the construction and application of new-generation electronic devices. Although the Hall layer effect has been realized theoretically and experimentally, it is mainly based on topological and antiferromagnetic lattices. On the basis of the low-energy effective k·p model, the mechanism of the controllable valley-layer Hall effect (V-LHE) in a bilayer ferromagnetic lattice through interlayer sliding has been proposed. Due to the broken time-reversal and inversion symmetries, the V-LHE based on the valley, layer degree of freedom, ferromagnetism, and ferroelectricity can be predicted. In addition, valley and layer indexes can be controlled by magnetization orientation and slipping, respectively. The mechanism can be demonstrated in the real bilayer CrSI lattice through first-principles calculations. Moreover, V-LHE can be effectively tuned by the perpendicular external electric field in configurations without out-of-plane polarization. These findings provide a new platform for the research of valleytronics and layertronics.

Challenges and Advances in Interventional Cardiology for Coronary Artery Disease Management.

The development of percutaneous coronary intervention (PCI) has been one of the greatest advances in cardiology and has changed clinical practice for patients with coronary artery disease (CAD). Despite continuous improvements in operators' experience, techniques, and the development of new-generation devices, significant challenges remain in improving the efficacy of PCI, including calcification, bifurcation, multivascular disease, stent restenosis, and stent thrombosis, among others. The present review aims to provide an overview of the current status of knowledge of endovascular revascularization in CAD, including relevant trials, therapeutic strategies, and new technologies addressing particular scenarios that can impact the prognosis of this vulnerable population.

Outcomes of transfemoral TAVR using two new-generation devices in patients with horizontal aorta.

Challenging anatomies and comorbidities have impact on success in transcatheter aortic valve replacement (TAVR). There is controversy whether the extent of the aortic angle (AA) has an impact on procedural outcomes. Matched comparative outcome data of new generation transcatheter heart valves (THVs) in horizontal aorta (HA) are scarce. A total of 1582 patients with severe native aortic stenosis (AS) treated with the SAPIEN3 Ultra (Ultra; n = 526) or ACURATE Neo2 (Neo2; n = 1056) THVs from January 2017 to January 2023 were analyzed. Patients with non-horizontal aortas (AA < 51.7°, n = 841) were excluded. The population was matched by 1-to-1 nearest-neighbor matching (Ultra, n = 246; Neo2, n = 246). Clinical and procedural outcome were evaluated according to VARC-3 recommendations. Technical success (93.1% vs. 94.7%, p = 0.572) was high after Ultra and Neo2. Device success (80.5% vs. 89.8%, p = 0.05) was inferior with Ultra. Neo2 reveals superior hemodynamic properties with lower rate of severe prosthesis patient mismatch (12.0% vs. 3.7%, p = 0.001) and elevated gradients ( 20 mmHg: 11.9% vs. 1.7%, p < 0.001). Ultra showed a lower rate of relevant paravalvular regurgitation ( mild paravalvular regurgitation or Valve-in-Valve due to paravalvular regurgitation: 0.0% vs. 3.7%, p = 0.004). The rate of procedural bailout maneuvers (0.8% vs. 0.4%, p = 1.000) and thirty-day all-cause mortality (1.3% vs. 2.2%, p = 0.496) was similar. Transfemoral TAVR in patients with severe aortic stenosis and HA, using the balloon expandable Sapien3 Ultra and self-expanding ACURATE Neo2 prosthesis, is feasible and safe. Therefore, valve selection between these platforms should be made irrespective of the aortic angle by a team experienced with both valves based on their specific advantages. Large, randomized trials in this sub-group of patients would be necessary to compare long term outcomes.

The role of ventricular assist device in the management of advanced heart failure: a literature review

The ventricular assist device has become a reliable and enduring therapy for patients with end-stage heart failure, with over 22,000 implantations to date. Initially designed as a bridge-to-transplant option but now it has become permanent cure for patients with acute heart failure. VAD has significant advancements in medical management and technology, particularly with the introduction of newer-generation devices, have greatly enhanced patient outcomes. This progress has led to an increasing use of ventricular assist devices as a destination therapy. Nonetheless, the substantial burden of adverse events remains a critical challenge in the current state of ventricular assist device therapy, despite this, its viable alternative of heart transplantation as it has solved the complications of donor heart and proved significant success among patient with acute heart failure.

Influence of underlayer roughness on the properties of Sc0.4Al0.6N thin films prepared via sputter deposition

Abstract A ScAlN thin film is one of the key materials of MEMS and high-frequency filters used in new-generation communication devices. Piezoelectricity can be improved by increasing Sc concentration. However, abnormal grains often appear at high Sc concentrations, degrading crystallinity and piezoelectricity. Herein, we demonstrated that underlayer roughness considerably affects the emergence of abnormal grains in a Sc0.4Al0.6N thin film formed via reactive DC sputtering. Dry etching with Ar plasma can effectively reduce the surface roughness of amorphous SiN and polycrystalline Si. Sc0.4Al0.6N thin films deposited on amorphous SiN and polycrystalline Si with sufficient flat surfaces exhibited a low density of abnormal grains, high crystallinity and piezoelectricity, and low loss tangent. Moreover, such high-quality thin films were obtained on a borophosphosilicate glass flattened using a reflow process without Ar etching. Therefore, underlayer roughness played an important role. The findings can help enable the large-scale production of highly doped ScAlN thin films.

Transcatheter mitral valve repair with MitraClip: comparison of NT, NTr, and XTr Devices.

Transcatheter edge-to-edge repair (TEER) has become an established minimally invasive treatment for significant mitral regurgitation. Ongoing refinements and the availability of different clipping devices have expanded the indications for and effectiveness of TEER, but comprehensive comparative data on this issue are lacking. In this study, we compared NT, NTr, and XTr MitraClip devices (Abbot) for TEER. Details on patient, imaging, and procedural details, as well as short- and long-term outcomes, were sought from a national prospective clinical registry on TEER with MitraClip. The primary outcome of interest was discharge after procedural success without major clinical complications. A total of 2236 patients were included, 1228 (54.9%) in whom NT implantation only was attempted, 233 (10.4%) in whom NTr but not XTr implantation was attempted, and 775 (34.7%) in whom XTr implantation was attempted. Clinical and imaging features differed substantially across the groups, reflecting expanding indications with NTr and XTr devices. In-hospital outcomes were largely similar among the 3 groups, including death. Long-term unadjusted estimates of effect showed significant differences in several outcomes, including death, rehospitalization, and their composite, which demonstrated that NT was associated with more unfavorable outcomes compared with the other devices (all P less than .05). However, most differences depended on baseline features, as adjusted analysis showed no significant differences for early as well as long-term outcomes, including long-term death, rehospitalization, and their composite (all P greater than .05). New-generation MitraClip devices are associated with favorable procedural and clinical outcomes, despite being used in patients with more adverse features, when compared with patients treated with previous devices.

Transcatheter Aortic Valve Implantation for Aortic Regurgitation: A Comprehensive Review.

Aortic regurgitation (AR), a left-sided valvular heart disease, poses challenges in both diagnosis and treatment. From rheumatic fever to trauma, the vast etiologies of AR can manifest with varying symptoms and disease progression. Nonetheless, without interventions, patients with acute and chronic symptomatic AR have a poor prognosis. This article synthesizes current knowledge on AR management, emphasizing advancements in transcatheter aortic valve implantation (TAVI). While surgical aortic valve replacement remains the gold standard, TAVI has emerged as a promising alternative, particularly for inoperable patients. It is currently used off-label for patients with bicuspid valve and valve-in-valve procedures. Clinical data from various studies underscore TAVI's efficacy in AR, demonstrating improvements in left ventricular function and mortality rates with use of the new-generation devices. However, challenges persist with conditions such as aortic aneurysms, including device positioning and selection. With ongoing technological innovations, TAVI holds potential as a viable option in selected AR patients, necessitating further research for optimized outcomes.

Sex differences in the outcomes after transcatheter aortic valve replacement with newer generation devices: A meta-analysis.

Transcatheter aortic valve replacement (TAVR) is a reasonable therapeutic approach among patients with symptomatic severe aortic stenosis irrespective of surgical risk. Data regarding sex-specific differences in the outcomes with newer generation valves are limited. Electronic databases were searched for studies assessing sex differences in the outcomes of patients undergoing TAVR with newer generation valves (SAPIEN 3 or Evolut). Random effects model was constructed for summary estimates. Four observational studies with 4522 patients (44.8% women) were included in the meta-analysis. Women were older and had a lower prevalence of coronary artery disease and mean EuroScore. Women had a higher incidence of short-term mortality (up to 30 days) (risk ratio [RR]: 1.60, 95% confidence interval [CI]: 1.14-2.25), but no difference in 1-year mortality (RR: 0.92, 95% CI: 0.72-1.17). There was no significant difference in the incidence of major bleeding (RR: 1.16, 95% CI: 0.86-1.57), permanent pacemaker (PPM) (RR: 0.80, 95% CI: 0.62-1.04), or disabling stroke (RR: 1.16, 95% CI: 0.54-2.45). In this meta-analysis, we found that women undergoing TAVR with newer-generation devices were older but had a lower prevalence of comorbidities. Women had a higher incidence of short-term mortality but no difference in the 1-year mortality, bleeding, PPM, or stroke compared with men. Future studies are required to confirm these findings.

Ultrananocrystalline diamond (UNCD™) coating for new-generation implantable medical devices/prostheses

Ultrananocrystalline diamond (UNCD™) coating for new-generation implantable medical devices/prostheses In this materials science piece, Orlando Auciello, describes the development of a unique multifunctional/best biocompatible ultrananocrystalline diamond (UNCDTM) coating for new-generation implantable medical devices and prostheses. Materials’ surfaces of vital medical devices, such as silicon (Si) microchip (artificial retina) implanted on human retina, restoring partial vision to people blinded by genetically induced photoreceptors degeneration, and metallic dental implants, are attacked chemically by eyes’ fluids or oral fluids respectively. Metallic stents/artificial heart valves, inside human blood vessels, activate blood enzymes, inducing coagulation, and fibrinolytic, leading to thrombus formation (i.e., blood clot in blood vessels, obstructing blood flow or loosed clot getting stuck in arteries/veins’ walls, causing life-threatening stroke/heart attack.