Severe Mismatch Research Articles

One-year clinical outcomes following Edwards INSPIRIS RESILIA aortic valve implantation in 487 young patients with severe aortic stenosis: a single-center experience.

The use of an aortic bioprosthesis is on the rise in younger patients with severe aortic stenosis despite the risk of accelerated structural valve degeneration (SVD). In the search for an optimal valve substitute that would not be prone to SVD, the INSPIRIS bioprosthesis represents a promising solution to lowering the risk of SVD. Here, we report the 1-year outcomes of the INSPIRIS RESILIA aortic bioprosthesis in a population of young patients who underwent aortic valve replacement. In this prospective single-center study, we included all consecutive patients receiving INSPIRIS RESILIA bioprosthesis between June 2017 and July 2021. Patients with isolated severe aortic regurgitation were excluded. Clinical assessment and transthoracic echocardiography were performed preoperatively and at 1 year post-operatively. The primary outcome was overall mortality at one year. A total of 487 patients were included. The mean age was 58.2 ± 11.5 years, 75.2% were men. Most of the interventions were elective, with a mean EuroSCORE II of 4.8 ± 7.9. The valve annulus size in most cases was either 23 mm or 25 mm. Overall mortality at 1-year was 4.1%. At 1-year, 7 patients (1.4%) had a stroke, 4 patients (0.8%) had a myocardial infarction, and 20 patients (4.1%) were hospitalized for congestive heart failure. The Kaplan-Meier estimated survival rates and survival without major adverse cardiac events at 1-year were 96.4% and 96.7%, respectively. At 1-year follow-up, 10 patients (2.1%) had endocarditis and 1 patient (0.2%) had partial prosthetic thrombosis. Pacemaker implantation at 1-year post-operative was necessary in 27 patients (5.5%). Severe patient prosthesis mismatch and severe intra valvular regurgitation were 1.2% and 0.6%, respectively. The Kaplan-Meier estimated survival rates at 1-year of no infective endocarditis preoperative and infective endocarditis preoperative were 97.9 ± 0.7% and 89.5 ± 3.3%, respectively (P < 0.001). Excluding endocarditis-related complication, no structural valve deterioration and no valve failure requiring redo surgery were reported. This is the largest single-center descriptive study of the 1-year outcomes after INSPIRIS RESILIA bioprosthesis implantation. The EDWARDS INSPIRIS RESILIA bioprosthesis provides encouraging clinical outcomes with an excellent 1- year survival rates and good hemodynamic performance. Long-term studies are mandatory to assess valve durability.

A Robust DPCC for IPMSM Based on a Full Parameter Identification Method

This paper proposes a robust deadbeat predictive current control (DPCC) method for the interior permanent magnet synchronous motor (IPMSM) based on a full parameter identification method. The DPCC method is innovatively combined with the high frequency (HF) currents injection method, which can observe inductances, flux linkage, and resistance values of the IPMSM online. After the parameter identification results are obtained, the initial crude parameters are replaced by the identification values in the DPCC method to enhance the robustness of the IPMSM control system. Moreover, a novel online accuracy verification method for parameter identification results is proposed to judge the error estimation level. The proposed method extracts the high bandwidth and the high parameter sensitivity characteristic of the DPCC method. The online identification and verification of IPMSM parameters are proceeded subsequently while achieving robust control of the IPMSM with the DPCC method. Finally, the proposed method is experimentally demonstrated with a 1.5kW motor. The experimental results show that the IPMSM with the proposed method can still work well even in the situation of severe initial parameters mismatch.

Safety and feasibility of zero-contrast transcatheter aortic valve implantation using balloon-expandable valves in patients with aortic stenosis and severe renal impairment: A single-center study

BackgroundAortic stenosis (AS) and chronic kidney disease (CKD) can coexist. Repeat exposure to contrast media in patients undergoing transcatheter aortic valve implantation (TAVI) has latent mortality risks and increased risk for acute kidney injury. We aimed to assess our “zero-contrast TAVI” protocol for patients with advanced CKD. MethodsConsecutive patients with severe AS who underwent TAVI at a single center registry were enrolled. Zero-contrast TAVI group included patients who underwent TAVI without contrast and who had an estimated glomerular filtration rate <30 mL/min/1.73 m2. Conventional TAVI group included patients who underwent the regular TAVI procedure. Patients using balloon-expandable valves via transfemoral approach were analyzed. Baseline clinical and procedural characteristics and clinical outcomes were compared between two groups. The primary outcome was early safety as defined by Valve Academic Research Consortium Criteria. Secondary outcomes included the presence of severe prosthesis-patient mismatch, moderate or greater perivalvular leakage, and requirement for new dialysis (within 3 months). ResultsA total of 520 patients were analyzed. Among these, 32 (6 %) underwent zero-contrast TAVI and 488 (94 %) conventional TAVI. In the zero-contrast TAVI group, 12 patients (37.5 %) had to use 20.7 (11.0–31.2) mL of contrast media. There were no significant differences in the primary and secondary outcomes between zero-contrast TAVI and conventional TAVI groups (78.1 % vs. 86.8 %, P = 0.184 and 9.4 % vs. 8.1 %, P = 0.738 for the primary and secondary outcomes, respectively). ConclusionsZero-contrast TAVI is feasible, safe, and effective in patients with AS and stage 4 CKD.

Capturing geometric structure change through deformation aware correlation

Capturing the inner structure change of the target is crucial for a siamese tracker confronted with severe deformation or occlusion. The conventional siamese tracker utilizes a strict grid-to-grid correlation to pass the template information towards the current candidate, which may suffer severe mismatch compared to the initial frame caused by undesirable conditions such as rotation and deformation. Thus such mismatch would lead to insufficient information passed from the template and eventually end with a poor performance in classification and regression branches. The inherent CNN structure with the restricted grid-to-grid matching mechanism during correlation is not able to capture the corresponding change of the target structure. Motivated by DCNv2, we propose a novel deformation aware correlation to replace the widely-used depthwise-correlation. An offset-prediction module is proposed based on the similarity matrix to compensate for the mismatch of the grid assignment between template and candidate. Then we utilize an importance bilinear sampling algorithm to assess the similarity of the matching pair, alleviating the occlusion drift problem. Finally, a modulated deformable correlation is fed into the aforementioned input and realizes a better information modulation. We replace the correlation operator on SiamRPN++ with our deformation aware correlation operator and obtain our tracker, SiamDAC. Massive experiments on OTB100, UAV123, VOT2019, LaSOT and DTB70 validate the effectiveness of our proposed operator, especially confronted with severe deformation or occlusion.

Multidetector CT Imaging Biomarkers as Predictors of Prognosis in Shock: Updates and Future Directions.

A severe mismatch between the supply and demand of oxygen is the common sequela of all types of shock, which present a mortality of up to 80%. Various organs play a protective role in shock and contribute to whole-body homeostasis. The ever-increasing number of multidetector CT examinations in severely ill and sometimes unstable patients leads to more frequently encountered findings leading to imminent death, together called "hypovolemic shock complex". Features on CT include dense opacification of the right heart and major systemic veins, venous layering of contrast material and blood, densely opacified parenchyma in the right hepatic lobe, decreased enhancement of the abdominal organ, a dense pulmonary artery, contrast pooling in dependent lungs, and contrast stasis in pulmonary veins. These findings are biomarkers and prognostic indicators of paramount importance which stratify risk and improve patient outcomes. In this review, we illustrate the various CT patterns in shock and review the spectrum and prognostic significance of thoraco-abdominal vascular and visceral alarming signs of impending death with the intention of increasing awareness among radiologists and radiographers to prepare for immediate resuscitation when required.

Adaptive triple-fed antenna and thinned RF-chip integration into ultra thin flexible polymer foil

AbstractAttaching a wireless transmission system comprising a radio frequency (RF)-chip and a dipole antenna to dielectric material of largely different permittivity leads to strong variation of the antenna feed impedance. Due to the severe impedance mismatch between the RF-chip and the antenna, the performance of the system may deteriorate drastically. The proposed antenna provides three feed points, which show respective feed-point match to 100 Ohm balanced feeds for three different dielectric environments (free-space and half-spaces of permittivity 4 and 42, respectively). Thereby, the RF-chip incorporates three 100 Ohm balanced output ports that are connected to the antenna from whom only one can be selected to provide the output signal. The respective other two output ports are shorted by an internal switching circuit that is controlled by external DC voltages. The measurement of the reflection coefficient of the stand-alone antenna and the chip agree well with the simulations, allowing to interconnect these two components. Further, the radiation pattern of the whole system is measured for two different scenarios showing good functionalities.

Coordinated Symmetrical Altitude Position and Attitude Control for Stratospheric Airship Subject to Strong Aerodynamic Uncertainties

The stratospheric airship has important value in both commercial and military use. The altitude position control is very crucial for the airship to conduct specific missions, which is also a challenge because of both the severe relative aerodynamic mismatches and the large lag due to the quite low speed of the airship within 15 m/s. In this paper, a coordinated altitude and attitude control method was proposed to realize satisfactory altitude position control while maintaining the attitude stability by properly employing the two actuators, the propeller thrust and the elevator, in a consistent manner. In this process, the references for the vertical speed and the pitch were specified in a straightforward way of proportionating them by considering their physical characteristics and the inherent symmetrical relationship between them, which can be obtained through the kinematics. An extended disturbance observer was used to eliminate the severe aerodynamic uncertainties to symmetrically distribute the two actuator outputs by dynamically decoupling the vertical speed and the pitch angular rate loops into the two independent integrators. As a result, the explicit proportional controllers were sufficient to realize efficient command tracking. Rigorous theoretical investigation was provided to symmetrically prove the quantitative bounded property of the estimation and tracking errors. The simulation results demonstrated the effectiveness of the proposed approach, which can realize a 500-m altitude difference tracking within 200 s with less than 0.5 deg/s pitch angular rate.

Insights into stress corrosion cracking in scratched area of alloy 690TT steam generator tubes

To investigate the stress corrosion cracking behaviors and microscopic mechanism in a scratched area of alloy 690TT, the microstructures of typical cracks are systematically characterized. There is a severe structural mismatch at the interface between fine grain zone and severe deformation zone, and hence cracks tend to propagate continually along this interface. In addition, the scratching leads to fracture and displacement of carbides, which changes their morphologies and distribution. Carbides with small sizes are engulfed by the crack oxidation zone, while large carbides can change the propagation path, and thus the crack grows into the deformation layer.

Evaluation and management of abnormal liver enzymes in the liver transplant recipient: When, why, and what now?

Evaluation and management of abnormal liver enzymes in the liver transplant recipient: When, why, and what now?

Trade-offs in telemetry tag programming for deep-diving cetaceans: data longevity, resolution, and continuity

BackgroundAnimal-borne telemetry instruments (tags) have greatly advanced our understanding of species that are challenging to observe. Recently, non-recoverable instruments attached to cetaceans have increased in use, but these devices have limitations in data transmission bandwidth. We analyze trade-offs in the longevity, resolution, and continuity of data records from non-recoverable satellite-linked tags on deep-diving Ziphius cavirostris in the context of a behavioral response study of acute noise exposure. We present one data collection programming scheme that balances resolution and continuity against longevity to address specific questions about the behavioral responses of animals to noise exposure in experimental contexts. We compare outputs between two programming regimes on a commercially available satellite-linked tag: (1) dive behavior summary defined by conductivity thresholds and (2) depth time-series at various temporal resolutions.ResultsWe found that time-series data vary from the more precisely defined dives from a dive summary record data stream by an acceptable error range for our application. We determined a 5-min time-series data stream collected for 14 days balanced resolution with longevity, achieving complete or nearly complete diving records in 6 out of 8 deployments. We increased our data message reception rate several fold by employing a boat based data capture system. Finally, a tag deployed in a group concurrently with a high-resolution depth recorder showed high depth concordance.ConclusionsWe present the conceptual framework and iterative process for matching telemetry tag programming to research questions that we used and which should be applicable to a wide range of studies. Although designing new hardware for our specific questions was not feasible at the time, we were able to optimize the sampling regime of a commercially available instrument to meet the needs of our research questions and proposed analyses. Nevertheless, for other study species or designs, the complicated intersection between animal behavior and bandwidth of telemetry systems can often create a severe mismatch among research questions, data collection, and analysis tools. More flexible programming and purpose-built instruments will increase the efficacy of these studies and increase the scientific yield relative to the inherently higher risk of invasive studies.

Aortic valve replacement in small aortic root- Bi-leaflet mechanical valve is superior to a Mono-leaflet mechanical valve.

Patient prosthetic mismatch is a serious but avoidable complication of surgical aortic valve replacement (SAVR) complicated by a small aortic annulus. This study aims to compare early and midterm outcomes following aortic valve replacement (AVR) with a mono-leaflet (ML) valve and a bi-leaflet (BL) valve in a small aortic root. From January 1st, 2017 to December 31st, 2019, 98 patients diagnosed with small aortic root underwent isolated aortic valve replacement with either TTK Chitra valve (Mono-leaflet/ ML group) or St. Jude medical valve (Bi-leaflet/ BL group) of size 17/ 19mm. Echocardiography was analyzed from medical records and telephonic follow-up. Baseline parameters were comparable. The ML group had 42 patients and the BL group had 56 patients. Aortic cross-clamp time, the incidence of severe patient prosthetic mismatch (p = 0.002) and mean, peak pressure gradients were high in the ML group. Duration of ventilation, intensive care unit (ICU) stay, the incidence of stroke, need for intra-aortic balloon pump, permanent pacemaker, dialysis, and left ventricular mass index in echocardiography were comparable between the two groups postoperatively. There was no early mortality in both group. Survival at the end of 5years was 57 ± 14.4% in the ML group; 91.8 ± 4% in the BL group (p = 0.005). Univariate and multivariate analysis revealed elderly age as a risk factor for mortality. We conclude that aortic valve replacement without any root widening procedure, using a small-sized mechanical valve provides acceptable early outcomes. Bi-leaflet mechanical valves provide better hemodynamics and survival percentage.

Aortic valve replacement for aortic stenosis in patients under 65-years-old

Aortic valve stenosis is the most common valve disease in the world, with particularly poor prognosis if left untreated. Its management in young patients is based on surgical aortic valve replacement (bioprosthesis or mechanical prosthesis, and Ross or Ozaki technique), and rarely percutaneous (TAVR). In this population, the choice of the technique used is of primary importance in terms of hemodynamic performance and durability. The objective of this work is to compare 5 different techniques used in the management of aortic stenosis in patients under 65 years old at CHRU of Tours. We conducted a retrospective, single-center, observational study at the CHRU of Tours. Five cohorts (mechanical prosthesis, INSPIRIS bioprosthesis, Ross, Ozaki and TAVR) were compared in terms of pre-, per- and postoperative, clinical and hemodynamic parameters. We included 163 patients under 65-years-old with aortic stenosis operated at the CHRU of Tours between January 2015 and October 2021. Hemodynamically, after stratification on the prosthetic caliber, the best results were found with the Ozaki and Ross techniques, followed by TAVR, the INSPIRIS bioprosthesis and finally the mechanical prosthesis. A severe prosthesis-patient mismatch rate of 10% was found in all patients, with no significant difference between the different techniques (P = 0.1827). Clinically, there was no significant difference between the groups in terms of mortality or re-intervention related to the aortic valve after a mean follow-up of 19.2 months (P = 0.6545). However, pacemaker implantation was significantly higher in the TAVR group (P = 0.0178). Each surgical and percutaneous technique has its specific advantages and complications. The excellent short-term hemodynamic parameters of the Ross and Ozaki techniques seem to encourage the use of these techniques in the management of aortic stenosis in young patients. More powerful studies with a longer follow-up time would allow to confirm these preliminary results.

Echocardiography Can Improve the Selection of Mechanical Support Strategies for Patients With Severe COVID-19 Respiratory Distress Syndrome.

To the Editor: I read with interest the study by Beyls et al.1 which compared the different clinical characteristics and outcomes of patients with COVID-19–related respiratory distress syndrome (CARDS) requiring veno-venous extracorporeal membrane oxygenation (VV-ECMO) during the three epidemic waves of COVID-19 in France. Despite the increasing knowledge on the particularities of severe COVID-19 and the growing experience in the management of severe CARDS, that study revealed a massive increase in the 90 day mortality of patients undergoing VV-ECMO during the second epidemic wave. One plausible explanation for that important observation could be the fact that over the course of the pandemic, new variants of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) have continuously emerged. Because the different waves of infection were mainly associated with one or more SARS-CoV-2 “variants of concern” (VOC) with different pathogenicity, it appears obvious that the pathogenicity of the dominant VOC in an infection wave can have important impacts on the outcomes of patients with severe COVID-19. Indeed, the Delta/B.1.617.2 variant, which was dominant during the second wave, is known to be associated with higher risk of death than both the previously dominant VOCs (i.e., Alpha/B.1.1.7, Beta/B.1.351 and Gamma/P.1) and the Omicron/B1.1.529 variant which became the dominant VOC during third wave.2,3 The excessively high mortality rate (i.e., 85.7%1) of patients supported by ECMO during the second wave deserves particular attention because a renewed appearance of more pathogenic VOCs cannot be ruled out. The high incidence of extensive pulmonary thrombotic microangiopathy associated with severe ventilation-perfusion mismatch, increased resistance in the pulmonary circulation and frequent afterload-induced right ventricular (RV) failure, which were identified as distinct features of severe CARDS (especially in infections caused by the Delta/B.1.617.2 variant) were often the leading cause of death attributed to COVID-19.4,5 Early detection of patients with increasing RV hemodynamic overloading can facilitate the selection of the most appropriate management (including the requirement of ECMO or a combined respiratory and circulatory support), which can be decisive for the patients’ survival.4 In severe RV afterload mismatch, the RV output decreases substantially, and RV dilation-related tricuspid regurgitation can rapidly increase. In such situations, attempting to treat the underlying etiology of impaired gas exchange using VV-ECMO alone may become insufficient.4 Considering the high incidence and the deleterious prognostic impact of right heart involvement in severe COVID-19 it seems likely that this was also the major cause of the high mortality rate documented by Beyls et al.1 for their ECMO-supported patients (92% with VV-ECMO) during the second wave. Thus, close monitoring of the right heart in patients with CARDS associated with hemodynamic instability, already before overt RV failure develops, could substantially improve therapeutic decision-making. It is therefore difficult to understand the still limited use of routine echocardiography for the surveillance of hospitalized patients with COVID-19. Echocardiography can improve the identification of patients with CARDS requiring ECMO therapy, the selection of the most appropriate support strategy (VV-ECMO, veno-arterial-ECMO, or VV-ECMO plus RV or left ventricle temporary percutaneous mechanical support) and also the weaning decision-making after cardiopulmonary amelioration during the support.

Terahertz Schottky Barrier Diodes Based on Aligned Carbon Nanotube Arrays

Carbon nanotubes (CNTs) with superior electrical characteristics are among the most promising candidate materials for constructing millimeter wave and terahertz wave electronic devices. However, the reported Schottky barrier diodes (SBDs) based on CNTs usually exhibited high series resistance and severe mismatch to lower impedance external circuits, which limits the devices for high frequency applications. In this work, CNT SBDs of lateral structure with a rectify current density of -0.78 mA/μm and a short circuit current responsivity of 6.8 A/W are demonstrated based on aligned carbon nanotube arrays (A-CNTs) with high-density and high-semiconducting purity on a quartz substrate. The A-CNT SBD with a width of 10 μm and an L <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">ch</sub> of 50 nm under zero bias exhibits an ultra-low intrinsic capacitance of 2.5 fF and an intrinsic cutoff frequency <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">f</i> <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">C</sub> of up to 840 GHz, which suggests that CNT-based SBDs are promising for millimeter wave and terahertz wave applications.

Through a New Lens: Skin-Grafted Free Flaps and Objective Facial Skin Color Matching.

Background: Head and neck ablative surgery can impose aesthetic disfigurement, particularly when severe color mismatch exists between native and reconstructed facial skin. To date, the accuracy, objectivity, and modifiability of facial skin color matching remains poorly understood. Objective: To measure skin color match outcomes after head and neck reconstruction using handheld colorimetry. Methods: Patients undergoing complex head and neck reconstruction involving facial skin were included. A variety of skin paddle donor sites were studied, including split-thickness skin graft (STSG) placement over myocutaneous or adipofasciocutaneous free flaps after de-epithelization. Skin color match (deltaE) was measured during follow-up using a handheld colorimeter. Results: Forty-seven patients were included, with median age 69. The most common flap type was the anterolateral thigh (n = 31, 66%). Twenty patients underwent STSG to the skin paddle. DeltaE measurements among the patients with STSGs demonstrated better color match (lowest deltaE), compared with patients with unaltered skin paddles (3.4 ± 1.0 vs. 6.5 ± 2.5, p < 0.0001). Conclusion: We found the use of STSGs over de-epithelialized myogenous or adipofasciocutaneous flaps improves color match, as measured by handheld colorimetry.

Improved dispersion and interfacial interaction of SiO2@polydopamine fillers in polytetrafluoroethylene composites for reduced thermal expansion and suppressed dielectric deterioration

Copper-clad laminate (CCL) comprised of copper foil and polytetrafluoroethylene (PTFE) faces severe thermal expansion mismatch due to the discrepancy in coefficient of thermal expansion (CTE) between the two components. Incorporating inorganic fillers with low CTE into PTFE has been proved to be a promising way to achieve the goal. However, it is a challenge to achieve homogeneous distribution and good interfacial interaction of fillers in PTFE composites owing to the characteristics of PTFE emulsion. In this work, core@shell structured SiO2@polydopamine fillers (SiO2@PDA) were synthesized and incorporated into PTFE matrix to form SiO2@PDA/PTFE composites. Due to the presence of PDA shell, SiO2@PDA exhibited improved dispersion and interfacial interaction, contributing to the reduced CTE and suppressed dielectric deterioration of SiO2@PDA/PTFE composites. With 40 vol% of filler, the CTE of SiO2@PDA/PTFE composite was efficiently reduced (50%), coupled with a limited sacrifice of only 2% and 40% of increments for dielectric constant (Dk, 2.3) and dielectric loss (Df, 2.4 × 10−3), respectively (@40 GHz), as compared with that of the corresponding SiO2/PTFE composite. The fillers and composites were comprehensively characterized to verify the mechanism of CTE and dielectric properties of the composites.

The H-anastomosis: a novel single-stapled solution to severe luminal size mismatch in stricturing small bowel Crohn's disease.

The H-anastomosis: a novel single-stapled solution to severe luminal size mismatch in stricturing small bowel Crohn's disease.

Plant Species' Capacity for Range Shifts at the Habitat and Geographic Scales: A Trade-Off-Based Framework.

Climate change is causing rapid shifts in the abiotic and biotic environmental conditions experienced by plant populations, but we lack generalizable frameworks for predicting the consequences for species. These changes may cause individuals to become poorly matched to their environments, potentially inducing shifts in the distributions of populations and altering species' habitat and geographic ranges. We present a trade-off-based framework for understanding and predicting whether plant species may undergo range shifts, based on ecological strategies defined by functional trait variation. We define a species' capacity for undergoing range shifts as the product of its colonization ability and the ability to express a phenotype well-suited to the environment across life stages (phenotype-environment matching), which are both strongly influenced by a species' ecological strategy and unavoidable trade-offs in function. While numerous strategies may be successful in an environment, severe phenotype-environment mismatches result in habitat filtering: propagules reach a site but cannot establish there. Operating within individuals and populations, these processes will affect species' habitat ranges at small scales, and aggregated across populations, will determine whether species track climatic changes and undergo geographic range shifts. This trade-off-based framework can provide a conceptual basis for species distribution models that are generalizable across plant species, aiding in the prediction of shifts in plant species' ranges in response to climate change.

Predictors of&amp;nbsp;bioprosthetic valve dysfunction after transcatheter aortic valve implantation

Recently, the Valve Academic Research Consortium (VARC)-3 criteria redefined bioprosthetic valve dysfunction (BVD) after transcatheter aortic valve implantation (TAVI). However, the rate of BVD is scarcely reported in current practice. We aimed to evaluate the rate and predictors of BVD after TAVI based on the VARC-3 criteria. We retrospectively analysed patients who had undergone TAVI using single-centre data. BVD was reported as exposure-adjusted event rates with a patient-year unit (per 100 patient-years). Predictors of BVD after TAVI were analysed using Fine-Gray competing risk regression to account for the competing risk of death. Among 514 patients, the rate of BVD was 7.5 events per 100 patient-years (n=74) at a median follow-up of 1.9 years. The main cause of BVD was moderate or severe prosthesis-patient mismatch (PPM; n=59). The Fine-Gray model demonstrated that predilatation was associated with a lower rate of BVD, mainly moderate or severe PPM (adjusted subdistribution hazard ratio [sub-HR] 0.42, 95% confidence interval [CI]: 0.21-0.88). In a subgroup analysis, the patients with a small aortic annulus (area <400 mm2 or perimeter <72 mm) tended to benefit from predilatation (p for interaction=0.03). The same regression model also demonstrated that a small balloon-expandable valve (BEV; ≤23 mm) was associated with a higher rate of BVD (adjusted sub-HR 2.46, 95% CI: 1.38-4.38). Our study suggested that the rate of BVD in patients undergoing TAVI is relatively low at midterm follow-up. Predilatation, particularly in small annuli and small BEV might have an impact on BVD, mainly caused by moderate or severe PPM, after TAVI.

Clinical outcomes in women and men with small aortic annuli undergoing transcatheter aortic valve implantation: A multicenter, retrospective, propensity score-matched comparison

BackgroundSex-specific characteristics in patients with aortic stenosis and small annuli undergoing transcatheter aortic valve implantation (TAVI) might affect clinical outcomes and hemodynamics. MethodsTAVI-SMALL 2 international retrospective registry included 1378 patients with severe aortic stenosis and small annuli (annular perimeter <72 mm or area < 400 mm2) treated with transfemoral TAVI at 16 high-volume centers between 2011 and 2020. Women (n = 1233) were compared with men (n = 145). One-to-one propensity score (PS) matching resulted in 99 pairs. Primary endpoint was incidence of all-cause mortality. Incidence of pre-discharge severe prosthesis-patient mismatch (PPM) and its association with all-cause mortality were investigated. Binary logistic and Cox regression were performed to adjust the treatment effect for PS quintiles. ResultsIncidence of all-cause mortality at a median follow-up of 377 days did not differ between sex in the overall (10.3 vs. 9.8%, p = 0.842) and PS-matched (8.5 vs. 10.9%, p = 0.586) populations. After PS matching, pre-discharge severe PPM was numerically higher in women vs. men (10.2 vs. 4.3%), even though no evidence of a difference was found (p = 0.275). Within the overall population, women with severe PPM suffered a higher incidence of all-cause mortality when compared to those with less than moderate PPM (log-rank p = 0.024) and less than severe PPM (p = 0.027). ConclusionsNo difference in all-cause mortality at medium-term follow-up was observed between women and men with aortic stenosis and small annuli undergoing TAVI. Incidence of pre-discharge severe PPM was numerically higher in women than men, and it was associated with increased all-cause mortality in women.