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Background: Current guidelines recommend transcatheter aortic valve implantation (TAVI) for patients with aortic stenosis and porcelain aorta (PA). Neurological outcomes of patients with PA undergoing TAVI with modern valves require clarification as most trials examined balloon-expandable valves (BEV) and self-expandable valves in intermediate or high-risk patients, but not specifically in patients with PA. Our aim was to compare outcomes, including stroke and mortality, in well-matched patients with and without PA who received BEV during transfemoral TAVI procedures.
View Article and Find Full Text PDFReal-world application of CCTA with CT-FFR for coronary assessment pre-TAVI: the CT2TAVI study.
Int J Cardiovasc Imaging
January 2025
Cardiology, Endeavor NorthShore Cardiovascular Institute, Evanston, IL, USA.
This study aims to evaluate the implementation of concomitant CAD assessment on pre-TAVI (transcatheter aortic valve implantation) planning CTA (CT angiography) aided by CT-FFR (CT-fractional flow reserve) [The CT2TAVI protocol] and investigates the incremental value of CT-FFR to coronary CT angiography (CCTA) alone in the evaluation of patients undergoing CT2TAVI. This is a prospective observational real-world cohort study at an academic health system on consecutive patients who underwent CTA for TAVI planning from 1/2021 to 6/2022. This represented a transition period in our health system, from not formally reporting CAD on pre-TAVI planning CTA (Group A) to routinely reporting CAD on pre-TAVI CTA (Group B; CT2TAVI protocol).
View Article and Find Full Text PDFAccuracy of two-compartment modelling of gas exchange with ventilation-perfusion mismatch in inhalational anesthesia.
Anesthesiology
January 2025
Department of Critical Care, Melbourne Medicine School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia.
Background: Multi-compartment computer models of heterogeneity in alveolar ventilation-perfusion ratios (VA/Q scatter) across the lung explain the significant alveolar-arterial (A-a) partial pressure gradients and associated alveolar dead-space fractions (VDA/VA) seen in anesthetized patients for both carbon dioxide and for anesthetic gases of different blood solubilities. However, the accuracy of a simpler two-compartment model of VA/Q scatter to do this has not been tested or compared to calculations from the traditional Riley model with "ideal", unventilated (shunt) and unperfused (deadspace) compartments.
Methods: Measurements of gas partial pressures in inspired and expired gas and arterial and mixed venous blood from 29 patients undergoing inhalational general anesthesia for cardiac surgery was used to compare the accuracy of two simple models of VA/Q scatter and lung gas exchange in predicting measured alveolar and arterial partial pressure differences, and associated alveolar dead-space calculations for the modern anesthetic gases isoflurane, sevoflurane and desflurane.
See, Touch, Feel: The Need for Modern PCI in TAVR Patients.
JACC Cardiovasc Interv
January 2025
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy.
Intramural hematomas and astrocytic infiltration precede perivascular inflammation in a rat model of repetitive low-level blast injury.
J Neuropathol Exp Neurol
January 2025
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
In modern war theaters, exposures to blast overpressures are one of the most common causes of brain injury. These pervasive events result in acute and chronic cerebrovascular degenerative processes. Using a rat model of blast-induced mild traumatic brain injury, we identified intramural periarterial hematomas as early primary acute lesions induced by blast exposures.
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