Notes

Usefulness on the job Cervical Assessment Simulation inside Health care Pupil Education.
The aim of this observational study was to evaluate the impact of concomitant coronary artery disease (CAD) on outcomes in patients undergoing percutaneous valve repair with the MitraClip system.

Mitral valve regurgitation and CAD are often coexistent in elderly patients undergoing percutaneous mitral valve repair. The impact of CAD and revascularization on outcomes in this patient cohort, however, remains uncertain.

In 444 MitraClip patients, CAD severity was assessed, represented by the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score (SS), as well as the residual SS (rSS) and SYNTAX score II (SS-II). Patients were stratified according to CAD severity and SS-II values (SS≤3 vs. SS >3 and SS-II≤45 vs. SS-II >45) and according to remaining CAD burden into 2 groups (rSS=0 vs. rSS >0) to compare 1-year all-cause mortality.

Higher SS, rSS, and SS-II were associated with mortality (22% for SS >3 vs. 9.6% for SS≤3 [p<0.001], 31.4% for rSS >0 vs. 9.6% for rSS=0 [p<0.001], and 17.1% for SS-II > 45 vs. 11.2% for SS-II≤45 [p=0.044]). The rSS was an independent predictor of 1-year all-cause mortality (p=0.001) in multivariate analysis.

The complexity of CAD, as assessed using the SS, is associated with outcomes in patients undergoing MitraClip procedures. The burden of residual CAD after percutaneous coronary intervention is an independent predictor of 1-year all-cause mortality. BRD7389 Patients undergoing complete revascularization had the most favorable outcomes independent of mitral regurgitation etiology.
The complexity of CAD, as assessed using the SS, is associated with outcomes in patients undergoing MitraClip procedures. The burden of residual CAD after percutaneous coronary intervention is an independent predictor of 1-year all-cause mortality. Patients undergoing complete revascularization had the most favorable outcomes independent of mitral regurgitation etiology.
The aim of this study was to investigate the impact of valvular and nonvalvular atrial fibrillation (AF) in patients undergoing transcatheter aortic valve replacement (TAVR).

AF has been associated with adverse clinical outcomes after TAVR. However, the differential impact of valvular as opposed to nonvalvular AF has not been investigated.

In a retrospective analysis of a prospective registry, valvular AF was defined as AF in the setting of concomitant mitral stenosis or the presence of a mitral valve prosthesis. The presence of mitral stenosis was determined by pre-procedural echocardiography. The primary endpoint was a composite of cardiovascular death or disabling stroke at 1 year after TAVR.

Among 1,472 patients undergoing TAVR between August 2007 and June 2018, AF was recorded in 465 patients (31.6%) and categorized as nonvalvular in 376 (25.5%) and valvular in 89 (6.0%). AF scores including HAS-BLED, CHADS
, and CHA
DS
-VASc were comparable between patients with nonvalvular and valvular AF. The primary endpoint occurred in 9.3% of patients with no AF, in 14.5% of patients with nonvalvular AF (hazard ratio 1.57; 95% confidence interval 1.12 to 2.20; p=0.009), and in 24.2% of patients with valvular AF (hazard ratio 2.75; 95% confidence interval 1.71 to 4.41; p<0.001). Valvular AF conferred an increased risk for cardiovascular death or disabling stroke compared with nonvalvular AF (hazard ratio 1.77; 95% confidence interval 1.07 to 2.94; p=0.027).

The presence of valvular AF in patients undergoing TAVR increased the risk for cardiovascular death or disabling stroke compared with both no AF and nonvalvular AF. (SWISS TAVI Registry; NCT01368250).
The presence of valvular AF in patients undergoing TAVR increased the risk for cardiovascular death or disabling stroke compared with both no AF and nonvalvular AF. (SWISS TAVI Registry; NCT01368250).
This study sought to assess patent fossa ovalis (PFO) anatomy by transesophageal echocardiography (TEE) in patients undergoing percutaneous suture-mediated PFO closure to identify predictors of post-procedural residual atrial right-to-left shunt (RLS).

Percutaneous suture-mediated PFO closure has been proven to be a safe and effective technique in most PFO patients.

From June 2016 to October 2019, 247 consecutive patients underwent percutaneous suture-mediated PFO closure at our institution. Of them, 230 (46 ± 13 years of age, 146 women) had complete and technically evaluable pre-procedural TEE. The following parameters in short-axis view were assessed presence and grade of spontaneous RLS, PFO length and width, presence of atrial septal aneurysm and its maximal bulge, and presence of an embryonic or fetal remnant (Chiari network or Eustachian valve).

At the first follow-up transthoracic echocardiography performed between 3 and 6months from the closure procedure, a residual RLS≥2 grade was found in 37 (16%) patients. Grade of pre-procedural spontaneous RLS (hazard ratio 1.99; 95% confidence interval 1.14 to 3.48; p=0.016) shunt and PFO width (hazard ratio 2.52; 95% confidence interval 1.85 to 3.43; p<0.001) were both found to be significantly associated with significant residual RLS at multivariable analysis. The presence of atrial septal aneurysm and its maximal bulge and of congenital remnants was not associated with significant residual RLS.

Percutaneous suture-mediated PFO closure is feasible in the majority of septal anatomies; however, PFO >5mm in width and spontaneous large RLS are less likely to be closed with 1 stitch only.
5 mm in width and spontaneous large RLS are less likely to be closed with 1 stitch only.
The aim of this study was to evaluate the impact of CHA
DS
-VASc and HAS-BLED scores on ischemic and bleeding events of patients enrolled in the Amplatzer Amulet Observational Study.

Baseline CHA
DS
-VASc and HAS-BLED scores have been validated in atrial fibrillation patients to guide about anticoagulation but not in patients treated by left atrial appendage occlusion (LAAO).

Subjects were stratified according to CHA
DS
-VASc and HAS-BLED scores. Clinical outcomes were collected through 2 years and adjudicated by an independent committee.

Subjects were considered at low (n=156), moderate (n=715), and high (n=215) risk for ischemic stroke, corresponding to CHA
DS
-VASc scores of<3, 3 to 5, and≥6, respectively. The annual rates of ischemic stroke were 1.1%, 2.0%, and 3.5%, respectively. When compared with the predicted rate, LAAO reduced the risk of ischemic stroke by 56%, 69%, and 68%. Device-related thrombus occurred in 0.7%, 1.5%, and 3.0% of subjects at low, moderate, and high risk for ischemic stroke, respectively.
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