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A partire dal 2007 è stata avviata dal Ministero della Salute, nell'ambito delle procedure del Comitato LEA (Livelli Essenziali di Assistenza) per l'appropriatezza, l'efficienza e la congruità delle prestazioni erogate dal Servizio Sanitario Nazionale (SSN), una valutazione annuale, tramite indicatori quali/quantitativi, dell'efficienza operativa dei Servizi regionali di sicurezza alimentare e sanità pubblica veterinaria. Nel presente lavoro sono descritti i principi di riferimento, le modalità e gli aspetti più significativi emersi nel corso di tale esperienza durata oltre un decennio.Il sistema di valutazione ha contribuito all'evoluzione del processo di programmazione, a livello nazionale, regionale e locale, e ha avuto evidenti riflessi positivi mostrandosi come un punto di riferimento per quantificare le risorse umane e strumentali, e per la capacità di laboratorio, contribuendo alla chiarezza e coordinamento delle amministrazioni sanitarie sugli obiettivi operativi valutati.L'adozione di un articolato strumento di management ha inoltre offerto utili informazioni ai decisori (policy-makers) nella fase di contrazione del finanziamento e di ricambio generazionale che ha interessato il SSN dal 2008, e che si protrae tuttora1. 1 4° Rapporto GIMBE sulla sostenibilità del Servizio Sanitario Nazionale. Fondazione GIMBE: Bologna, giugno 2019; pp. 64-65. Recuperato da: https://salviamossn.it/var/uploads/contenuti/allegati/4_Rapporto_GIMBE_Sostenibilita_SSN.pdf.

Taxonomy of the South American Portulaca is advancing considerably but many problems and knowledge gaps still remain. As a result of further investigation of the genus, P. ferricola is here proposed as new name to replace, at species rank, the hitherto overlooked P. mucronulata var. microphylla. P. ferricola is a species endemic to ironstone grasslands from eastern Bolivia and central-western Brazil, whose conservation status is here assessed as Endangered (EN). In addition to a discussion of the taxonomy, ecology, and conservation status of the species, we also provide photographs of herbarium specimens and the species in natura.

Seismic capacity assessment of existing buildings is of paramount importance for mitigating the seismic risk in earthquake-prone areas. In Europe, the next version of Eurocode 8 and the current version of the Italian standards suggest the adoption of both linear and nonlinear approaches to perform seismic analyses of existing masonry buildings. This paper discusses with the main issues concerning linear and nonlinear analyses methodologies provided by the Italian standards for existing unreinforced masonry buildings. An historical building located in Southern Italy, representative of the Mediterranean basin buildings, has been chosen as a case study and modelled through the equivalent frame model. According to the Italian standards, the influence of in-plane stiffness of floors and spandrels on the overall seismic capacity of the structure has been considered in the analyses. Beyond the code prescriptions, the effect of different ultimate drifts values assumed for the spandrels on nonlinear behavior of the structure has been analysed. The results of two types of linear analyses (lateral static force method and modal response spectrum analysis) have been compared among them and with those provided by the nonlinear static method. Conclusions show that either behavior and overstrength factors provided by the Italian standards are conservative than those estimated through the nonlinear static analyses. Moreover, it has been remarked that the value of ultimate drift adopted for the spandrel can affect significantly the nonlinear response of the structures, although this topic still represents an open issue.

A growing body of research highlights how communities traumatized by conflict and displacement suffer from long-term mental and psychosocial illnesses. The Russian army’s attack on Ukraine has resulted in an estimated 10 million people being internally or externally displaced from Ukraine, of whom more than 3.8 million have left Ukraine to seek refuge elsewhere in Europe. Soleterre has decided to launch an intervention to provide psychological support to Ukrainian refugees and IDPs, aimed at containing war trauma, assessing the severity of symptoms, and enabling those affected to receive psychological support. The intervention model envisioned the administration of an intake form to provide a rapid collection of qualitative and quantitative information for those arriving in Poland or Lviv from Ukraine. Our results showed how most of the samples reported high or very high levels of anxiety, depression, and sleep disturbances. Moreover, results highlighted how being close to families or being able to keep in touch with them work as a protective factor in enhancing resilience, as well as a support network. These findings underscored the importance of re-thinking our perception of “family” in a broader sense, considering the new facets it can take on in post-conflict situations.

Portulaca ferricola J.R.Ferraz & Hassemer, nom. et stat. nov. ≡ Portulaca mucronulata var. microphylla Legrand (1949: 355) non Richard (1845: 620) (Art. 6.11 of the ICN). Type: — BRAZIL. Mato Grosso do Sul: Corumbá, March 1906, Etchichury 85 (holotype SI 003157!). Diagnosis:— Portulaca ferricola can be morphologically distinguished from the other Portulaca species by the combination of the following characters:slightly swollen roots,decumbent branches and stem covered with an exfoliating bark, lanceolate or ovate-lanceolate leaves, abundant leaf axillary hairs stiff and a hemispheric operculum. Description (Figs. 1, 2, and 4): — Perennial succulent herb, up to 6 cm high; roots slightly swollen, covered with an exfoliating brown bark. Stem branched, covered with an exfoliating brown bark; primary branches 4‒12 cm long, decumbent, covered with an exfoliating bark, green in young living specimens, brownish in old living specimens, pale yellow or brownish in herbarium material; secondary branches usually with internodes very short, which gives the branch the appearance of a fascicle. Leaves alternate, subopposite at the apex, simple, fleshy, green in a wet environment, reddish in a dry environment; petiole 0.4‒0.6 mm long, green lighter than the blade; blades 3.5‒8.5 × 1.0‒ 2.5 mm, terete, lanceolate or ovate-lanceolate, adaxially and abaxially glabrous; base slightly rounded; apex acute, reddish; margins entire; leaf axillary hairs abundant (denser at the apex), up to 2 cm long, stiff, white in living specimens, yellow or brownish in herbarium material. Inflorescence a terminal head, 2‒4-flowered, subtended by an involucre of 6‒15 leaves. Flowers sessile; sepals 2, unequal, connate at the base, 5.2‒7.8 × 4.0‒ 6.5 mm, ovate, apex acuminate, margins scarious; petals 5, magenta, sometimes vinaceous, with a reddish spot in the adaxial surface at the base, 1.5‒2.2 × 0.8‒1.6 cm, obovate, apex obcordate, emarginate; stamens 50‒80, filaments connate at the base and forming a ring ca. 0.8‒1 mm long, filaments 2.0‒4.5(‒5.0) mm long, unequal, magenta, glabrous; anthers ca. 1 mm long, dark yellow, pollen released through longitudinal slits; ovary sub-globose; style 7.5‒8 mm long, very thickened near the stigmatic branches, magenta, glabrous; stigma magenta, 5‒10-lobed, 1.5‒2.2 mm long, linear, 3-nerved, the stigmatic surfaces covered with small hairs. Fruit a circumscissile capsule, sessile or pedicelate, pedicel 0.2‒0.4 mm long, capsule 4.0‒ 6.5 mm long, dehiscence line ca. at the lower third; operculum hemispheric, green, shiny, apiculate; fruit base sometimes reduced. Seeds ca. 30 per capsule, 0.52‒0.85 mm, subreniform, black, ornate, constriction zone present, individual cells elongated, anticlinal walls undulate with T-, U-, and V-type patterns, sometimes bifurcating, periclinal walls convex, the cells toward the peripheral face of the seed par-domed. Etymology:— The specific epithet “ ferricola ” is derived from the Latin ferreus (iron) and - icola (dweller), referring to the ironstone outcrops and shallow ferruginous soils, habitats in which the species is found. Phenology:— Flowering and fruiting times from December to June. Geographic distribution and habitat:— Portulaca ferricola was collected in two municipalities (Corumbá and Ladário) in western Mato Grosso do Sul State, Brazil, and in one province (Germán Busch) in Santa Cruz Department, eastern Bolivia (Fig. 3). This species is endemic to ironstone grasslands (canga vegetation), growing in ironstone outcrops and shallow soils at an elevation of 100–280 m a.s.l. This canga vegetation is surrounding by savannas and Seasonal Decidual Forest and occur along the foot of the plateau hills, presenting an impermeable substrate and with little presence of sediments (Takahasi & Meirelles 2014, Villarroel et al. 2017). The associated plants includes edaphic endemic species, such as Gomphrena centrota Holzhammer (1955: 188), Discocactus ferricola Buining & Brederoo (1975: 2), and Deuterocohnia meziana Kuntze ex Mez (1896: 465) (Lima et al. 2019). Conservation status:— Endangered (EN – B1ab[i, ii, iii]+2ab[i, ii, iii]). There are only five known populations of Portulaca ferricola occupying an AOO (Area of Occupancy) of 20 km 2 and EOO (Extent of Occurrence) of 294.066 km 2. The major threats to this species include habitat degradation, trampling from cattle and direct competition by invasive non-native plant species from adjacent pastures, such as the grass Megathyrsus maximus (Jacquin 1781: 2) Simon & Jacobs (2003: 572). Nomenclatural notes:— Elevation of Portulaca mucronulata var. microphylla to species rank was not possible by means of a new combination, because of the existence of the earlier and validly published name P. microphylla Richard (1845: 620). Therefore, P. ferricola, a new name, is proposed, in accordance with Art. 6.11 of the ICN. Taxonomic notes:— The abundant stiff leaf axillary hairs are an unusual feature in Portulaca species that give herbarium specimens a caterpillar-like appearance (Legrand 1962). In addition to P. ferricola, only three other South American species have very conspicuous stiff trichomes: P. cardenasiana, P. eruca, and P. mucronulata var. mucronulata. Portulaca cardenasiana (dry Chaco vegetation from Bolivia and Paraguay) shares with P. ferricola the ovatelanceolate leaves and branches and roots with exfoliating bark. However, P. ferricola can be distinguished from P. cardenasiana by the smaller branches (4‒12 cm vs. 15‒20 cm), stem habit (decumbent vs. decumbent to erect), apices of branches not widened and with a series of 6‒15 leaves (vs. widened and with more than 20 leaves organized in several series), and operculum shape (hemispheric vs. campanulate to subconical) (Table 1). Furthermore, P. cardenasiana can be easily recognized in herbaria by its short fascicles of leaves overlapped by brown trichomes, which persist after the leaf-fall (Fig. 5). Portulaca ferricola also has reproductive characters similar to P. eruca (endemic species from Argentina and Paraguay; Fig. 6) and P. mucronulata var. mucronulata (mountain range in central Argentina; Fig. 7). P. ferricola differs from P. eruca by the stem ramification and habit (branched and decumbent vs. simple to few branched and decumbent to erect), roots (slightly swollen vs. tuberous), and leaf shape (lanceolate or ovate-lanceolate vs. subulate) (Table 1). On the other hand, P. ferricola can be distinguished from P. mucronulata var. mucronulata by the leaf shape (lanceolate or ovate-lanceolate vs. linear), longer petals (1.5‒2.2 cm vs. 0.8‒1.0 cm), and the presence of an exfoliating bark in the branches, stem and roots (vs. absent) (Table 1). Additional specimens examined:— BOLIVIA. Santa Cruz: Germán Busch, Serranias del Mutún, 14 March 2008, Villarroel et al. 2069 (MO2136220, USZ). BRAZIL. Rodovia BR-262, Serra do Urucum, 14 April 1972, Hatschbach 29490 (MBM021046); Mato Grosso do Sul: Corumbá, Fazenda Banda Alta, 9 June 1994, Hatschbach et al. 60832 (MBM245674); ibidem (US 01344988); ibidem Hatschbach et al. 60832B (MBM245672); Fazenda Monjolinho, Takahasi 824 (COR00030468); ibidem (FUEL056657); Fazenda Monjolinho, 14 December 2006, Takahasi et al. 1169 (COR00030445); ibidem (FUEL056655); Fazenda Figueira, 13 March 2006, Takahasi et al. 970 (COR); ibidem (FUEL056656); Fazenda Banda Alta, 17 January 2007, Takahasi et al. 1193 (COR00007789); ibidem (FUEL056650)., Published as part of Ferraz, José Roberto, Rossetto, Elson Felipe Sandoli, Ribeiro, José Eduardo L. S. & Hassemer, Gustavo, 2022, Taxonomic notes Portulaca (Portulacaceae) in South America I: the taxonomic status of P. mucronulata var. microphylla, pp. 71-81 in Phytotaxa 560 (1) on pages 72-80, DOI: 10.11646/phytotaxa.560.1.5, http://zenodo.org/record/7031241, {"references":["Legrand, C. D. (1949) Las especies del genero Portulaca en la Argentina. Lilloa 17: 311 - 376.","Richard, A. (1845) Botanique. Plantes Vasculaires. In: Sagra, R. (Ed.) Histoire Physique, Politique et Naturelle de l'Ile de Cuba, vol. 10. Bertrand, Paris, 663 pp.","Takahasi, A. & Meirelles, S. T. (2014) Ecologia da vegetacao herbacea de bancadas lateriticas (cangas) em Corumba, MS, Brasil. Hoehnea 41: 515 - 528. https: // dx. doi. org / 10.1590 / 2236 - 8906 - 63 / 2013","Villarroel, D., Aramayo, G. M., Martinez, M. T., Proenca, C. E. B., Munhoz, C. B. R., Klitgaard, B. B., Pinto-Ledezma, J. N. & Nee, M. H. (2017) Natural history of Cerro Mutun: VI. Checklist, status of conservation and new records for Bolivia. Kempffiana 13: 29 - 74.","Holzhammer, E. (1955) Die amerikanischen arten der gattung Gomphrena L. Mitteilungen der Botanischen Staatssammlung. Munchen 2: 178 - 257.","Buining, A. F. H. & Brederoo, A. J. (1975) Discocactus ferricola. Kakteen und andere Sukkulenten 26: 2 - 3.","Mez, C. (1896) Bromeliaceae. In: de Candolle, A. P. de (Ed.) Monographiae Phanerogamarum IX. Masson & Cie., Paris, 990 pp.","Lima, M, S., Takahasi, A., Damasceno-Junior, G. A. & Araujo, A. C. (2019) Checklist of the flora in ironstone outcrops at the Urucum Plateau, Corumba, Mato Grosso do Sul. Biota Neotropica 19: 1 - 25. https: // dx. doi. org / 10.1590 / 1676 - 0611 - BN- 2018 - 0708","Jacquin, N. J. (1781) Icones Plantarum Rariorum, vol. 1. C. F. Wapler, Wien, 20 pp.","Simon, B. K. & Jacobs, S. W. L. (2003) Megathyrsus, a new generic name for Panicum subgenus Megathyrsus. Austrobaileya 6: 571 - 574.","Legrand, C. D. (1962) Las especies americanas de Portulaca. Anales del Museo Nacional de Historia Natural de Montevideo 7: 1 - 147."]}

La estenosis aórtica (EA) es la causa más común de enfermedad valvular cardíaca y acomete principalmente a pacientes de edad avanzada, afectando hasta un 3% de la población mayor de 75 años. El reemplazo quirúrgico de la válvula aórtica ha sido la práctica estándar para el tratamiento de EA graves y sintomáticos. Sin embargo, en casos seleccionados, y después de una evaluación cuidadosa del paciente, el implante de válvula aórtica transcatéter se ha convertido en una alternativa para el reemplazo quirúrgico de la válvula. Aunque menos invasivo, el TAVI se caracteriza por una tasa sustancial de complicaciones graves, entre ellas la oclusión coronaria (OC). La OC durante el TAVI es un evento raro, que ocurre en menos del 1% de los casos en los registros y ensayos clínicos recientes. Sin embargo, representa una complicación potencialmente letal.

The effectiveness of an all-timber solution, based on the uses of timber pegs, to reinforce stop-splayed scarf joints with transverse key has been investigated in this paper. An experimental program on unreinforced and timber pegged reinforced scarf joints subjected to tensile loadings has been carried out. Two timber pegs made with ash, and having a diameter equal to 20 mm, have been used as fasteners to reinforce the scarf joints. The experimental outcomes have been analysed and critically discussed, focusing on the role of timber pegs in reinforcing scarf joints. Three fundamental aspects have been investigated: load-bearing capacity, ductility and influence of slenderness ratio (between thickness of members and diameter of the peg) due to the introduction of timber pegs. Test results showed that timber pegs provide adequate robustness to the connections because they modified both force-displacement constitutive behavior (increasing load-bearing capacity, stiffness and ductility) and failure mechanisms from brittle to ductile. It has been also proved that greatest slenderness ratios are effective in enhancing the ductility of the connections; thus, at the same thickness of members, pegs with reduced diameters could be preferred in reinforcing scarf joints. From testing, important findings on the qualitative behavior of scarf joints reinforced by timber pegs are emerged, but the reduced number of specimens did not allow conclusive considerations and future investigations will be necessary to support the obtained results.

Nyctaginaceae are one of the most diverse families in core Caryophyllales. The most diagnostic character of the family is a persistent anthocarp derived from a calyx-like perianth. Anthocarp morphology is highly variable across the family, but its evolution is poorly studied. We investigate anthocarp evolution in Nyctaginaceae through extensive anatomical studies (159 species from 28 genera representing six of seven tribes) and phylogenetic character state reconstructions. We found highly diverse anthocarp anatomy across Nyctaginaceae, with most traits analysed evolving multiple times throughout the family. The representatives of three early-diverging clades of Nyctaginaceae (Leucastereae, Boldoeae and Colignonieae) possess a calyx-like anthocarp with simplified anatomy. The so-called ‘glands’ in Nyctagineae and Pisonieae are emergences, whereas wings originate by accrescence of perianth segments, elongation of the ribs and outgrowths (emergences) of anthocarp mesophyll. Anthocarp anatomy can be considered as a generic-level feature in Colignonieae, Pisonieae, Bougainvilleeae and Nyctagineae. The most dramatic transitions from perianth to anthocarp involve the shrivelling and abscission of the upper perianth part and the maintenance of the basal modified perianth portion that originated in the clade comprising Colignonieae and sister clades.

RESUMO A insuficiencia valvar mitral e uma das doencas valvares adquiridas mais comuns, sendo causa frequente de insuficiencia cardiaca, em geral decorrente de dilatacao do ânulo valvar. Nesse caso, e chamada de funcional ou secundaria e pode estar relacionada a doenca isquemica cardiaca ou a outras cardiopatias dilatadas, de diversas etiologias. Essa valvopatia acomete frequentemente pacientes mais idosos ou com muitas comorbidades e que, por vezes, nao podem ser tratados de forma convencional pela cirurgia valvar mitral, em funcao do [...]

Guapira siqueirae is described in the present paper as a new species from the Atlantic Forest of Espírito Santo State (SE-Brazil). This species can be morphologically distinguished from the other Guapira species by the distal portion of the branches, the bases of the petioles and peduncle that are ferruginous-puberulous, the inflorescences with alternate or opposite branches, the lustrous adaxial surface of matures leaves, and the larger anthocarps. A distribution map and comparisons with morphologically related species are also provided.

Objectives: The aim of this study was to assess acute regurgitation following transcatheter aortic valve replacement, comparing different implanted transcatheter heart valves. Background: Regurgitation following transcatheter aortic valve replacement influences all-cause mortality. Thus far, no quantitative comparison of regurgitation among multiple commercially available transcatheter heart valves has been performed. Methods: Aortograms from a multicenter cohort of consecutive 3,976 transcatheter aortic valve replacements were evaluated in this pooled analysis. A total of 2,258 (58.3%) were considered analyzable by an independent academic core laboratory using video densitometry. Results of quantitative regurgitation are shown as percentages. The valves evaluated were the ACURATE (n = 115), Centera (n = 11), CoreValve (n = 532), Direct Flow Medical (n = 21), Evolut PRO (n = 95), Evolut R (n = 295), Inovare (n = 4), Lotus (n = 546), Lotus Edge (n = 3), SAPIEN XT (n = 239), and SAPIEN 3 (n = 397). For the main analysis, only valves with more than 50 procedures (7 types) were used. Results: The Lotus valve had the lowest mean regurgitation (3.5 ± 4.4%), followed by Evolut PRO (7.4 ± 6.5%), SAPIEN 3 (7.6 ± 7.1%), Evolut R (7.9 ± 7.4%), SAPIEN XT (8.8 ± 7.5%), ACURATE (9.6 ± 9.2%) and CoreValve (13.7 ± 10.7%) (analysis of variance p < 0.001). The only valves that statistically differed from all their counterparts were Lotus (as the lowest regurgitation) and CoreValve (the highest). The proportion of patients presenting with moderate or severe regurgitation followed the same ranking order: Lotus (2.2%), Evolut PRO (5.3%), SAPIEN 3 (8.3%), Evolut R (8.8%), SAPIEN XT (10.9%), ACURATE (11.3%), and CoreValve (30.1%) (chi-square p < 0.001). Conclusions: In this pooled analysis stemming from daily clinical practice, the Lotus valve was shown to have the best immediate sealing. This analysis reflects the objective evaluation of regurgitation by an academic core laboratory (nonsponsored) in a real-world cohort of patients using a quantitative technique.

Scarce data exist on mitral valve (MV) infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI). This multicenter study included a total of 579 patients with a diagnosis of definite IE after TAVI from the IE after TAVI International Registry and aimed to evaluate the incidence, characteristics, management, and outcomes of MV-IE after TAVI. A total of 86 patients (14.9%) had MV-IE. These patients were compared with 284 patients (49.1%) with involvement of the transcatheter heart valve (THV) only. Two factors were found to be associated with MV-IE: the use of self-expanding valves (adjusted odds ratio 2.49, 95% confidence interval [CI] 1.23 to 5.07, p = 0.012), and the presence of an aortic regurgitation >= 2 at discharge (adjusted odds ratio 3.33; 95% CI 1.43 to 7.73, p < 0.01). There were no differences in IE timing and causative microorganisms between groups, but surgical management was significantly lower in patients with MV-IE (6.0%, vs 21.6% in patients with THV-IE, p = 0.001). All-cause mortality rates at 2-year follow-up were high and similar between patients with MV-IE (51.4%, 95% CI 39.8 to 64.1) and patients with THV-IE (51.5%, 95% CI 45.4 to 58.0) (log-rank p = 0.295). The factors independently associated with increased mortality risk in patients with MV-IE were the occurrence of heart failure (adjusted p < 0.001) and septic shock (adjusted p < 0.01) during the index hospitalization. One of 6 IE episodes after TAVI is localized on the MV. The implantation of a self-expanding THV and the presence of an aortic regurgitation >= 2 at discharge were associated with MV-IE. Patients with MV-IE were rarely operated on and had a poor prognosis at 2-year follow-up. (C) 2022 Elsevier Inc. All rights reserved.

BACKGROUND The optimal treatment of patients developing infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is uncertain. OBJECTIVES The goal of this study was to investigate the clinical characteristics and outcomes of patients with TAVI-IE treated with cardiac surgery and antibiotics (IE-CS) compared with patients treated with antibiotics alone (IE-AB). METHODS Crude and inverse probability of treatment weighting analyses were applied for the treatment effect of cardiac surgery vs medical therapy on 1-year all-cause mortality in patients with definite TAVI-IE. The study used data from the Infectious Endocarditis after TAVI International Registry. RESULTS Among 584 patients, 111 patients (19%) were treated with IE-CS and 473 patients (81%) with IE-AB. Compared with IE-AB, IE-CS was not associated with a lower in-hospital mortality (HRunadj: 0.85; 95% CI: 0.58-1.25) and 1-year all-cause mortality (HRunadj: 0.88; 95% CI: 0.64-1.22) in the crude cohort. After adjusting for selection and immortal time bias, IE-CS compared with IE-AB was also not associated with lower mortality rates for in-hospital mortality (HRadj: 0.92; 95% CI: 0.80-1.05) and 1-year all-cause mortality (HRadj: 0.95; 95% CI: 0.84-1.07). Results remained similar when patients with and without TAVI prosthesis involvement were analyzed separately. Predictors for in-hospital and 1-year all-cause mortality included logistic EuroSCORE I, Staphylococcus aureus, acute renal failure, persistent bacteremia, and septic shock. CONCLUSIONS In this registry, the majority of patients with TAVI-IE were treated with antibiotics alone. Cardiac surgery was not associated with an improved all-cause in-hospital or 1-year mortality. The high mortality of patients with TAVI-IE was strongly linked to patients' characteristics, pathogen, and IE-related complications. (C) 2022 by the American College of Cardiology Foundation.

A new species, Neea itanhaensis, is described from São Paulo State, Brazil. N. itanhaensis differs from the other Neea species by its inflorescences with verticillate branching and sessile or subsessile leaves with an acute or oblique base and prominent secondary veins on the abaxial surface that diverge at less than a 90º angle from each other. Illustrations and comments about the taxonomy, phenology, distribution, habitat, conservation status and etymology are provided for the new species.

Objectives This study aimed to compare differences in patient characteristics and clinical outcomes of nonagenarians undergoing transcatheter aortic valve replacement (TAVR) versus patients younger than 90 years of age and to test the predictive accuracy of the logistic EuroSCORE (European System for Cardiac Operative Risk Evaluation), the EuroSCORE II, and the STS-PROM (Society of Thoracic Surgeons Predicted Risk of Mortality) for mortality after TAVR in nonagenarians. Background The prevalence of severe aortic valve stenosis is increasing due to the rising life expectancy. However, there are limited data evaluating outcomes in patients older than 90 years of age. Moreover, the predictive accuracy of risk scores for mortality has not been evaluated in nonagenarian patients undergoing transfemoral TAVR. Methods The CENTER (Cerebrovascular EveNts in Patients Undergoing TranscathetER Aortic Valve Implantation) collaboration (N = 12,381) is an international collaboration consisting of 3 national registries, 6 local or multicenter registries, and 1 prospective clinical study, selected through a systematic online search. The primary endpoint of this study was the difference in 30-day all-cause mortality and stroke after TAVR in nonagenarians versus patients younger than 90 years of age. Secondary endpoints included differences in baseline characteristics, in-hospital outcomes, and the differences in predictive accuracy of the logistic EuroSCORE, the EuroSCORE II, and STS-PROM. Results A total of 882 nonagenarians and 11,499 patients younger than 90 years of age undergoing transfemoral TAVR between 2007 and 2018 were included. Nonagenarians had considerably fewer comorbidities than their counterparts. Nevertheless, rates of 30-day mortality (9.9% vs. 5.4%; relative risk [RR]: 1.8; 95% confidence interval [CI]: 1.4 to 2.3; p = 0.001), in-hospital stroke (3.0% vs. 1.9%; RR: 1.5; 95% CI: 1.0 to 2.3; p = 0.04), major or life-threatening bleeding (8.1% vs. 5.5%; RR: 1.6; 95% CI: 1.1 to 2.2; p = 0.004), and new-onset atrial fibrillation (7.9% vs. 5.2%; RR: 1.6; 95% CI: 1.1 to 2.2; p = 0.01) were higher in nonagenarians. The STS-PROM adequately estimated mortality in nonagenarians, with an observed-expected mortality ratio of 1.0. Conclusions In this large, global, patient-level analysis, mortality after transfemoral TAVR was 2-fold higher in nonagenarians compared with patients younger than 90 years of age, despite the lower prevalence of baseline comorbidities. Moreover, nonagenarians had a higher risk of in-hospital stroke, major or life-threatening bleeding, and new-onset atrial fibrillation. The STS-PROM was the only surgical risk score that accurately predicted the risk of mortality in nonagenarians.

Background: Both balloon-expandable (BE) and self-expandable (SE) valves for transcatheter aortic valve implantation (TAVI) are broadly used in clinical practice. However, adequately powered randomized controlled trials comparing these two valve designs are lacking. Methods: The CENTER-study included 12,381 patients undergoing transfemoral TAVI. Patients undergoing TAVI with a BE-valve (n = 4096) were compared to patients undergoing TAVI with an SE-valve (n = 4096) after propensity score matching. Clinical outcomes including one-year mortality and stroke rates were assessed. Results: In the matched population of n = 5410 patients, the mean age was 81 ± 3 years, 60% was female, and the STS-PROM predicted 30-day mortality was 6.2% (IQR 4.0–12.4). One-year mortality was not different between patients treated with BE- or SE-valves (BE: 16.4% vs. SE: 17.0%, Relative Risk 1.04, 95%CI 0.02–1.21, p = 0.57). One-year stroke rates were also comparable (BE: 4.9% vs. SE: 5.3%, RR 1.09, 95%CI 0.86–1.37, p = 0.48). Conclusion: This study suggests that one-year mortality and stroke rates were comparable in patients with severe aortic valve stenosis undergoing TAVI with either BE or SE-valves.

Objectives We aimed to explore angiographic patterns and in‐hospital outcomes of patients with concomitant coronavirus disease‐19 (COVID‐19) and myocardial infarction (MI). Background Patients with COVID‐19 may experience MI during the course of the viral infection. However, this association is currently poorly understood. Methods This is a multicenter prospective study of consecutive patients with concomitant COVID‐19 and MI who underwent coronary angiography. Quantitative and qualitative coronary angiography were analyzed by two observers in an independent core lab. Results A total of 152 patients were included, of whom 142 (93.4%) had COVID‐19 diagnosis confirmation. The median time between symptom onset and hospital admission was 5 (1–10) days. A total of 83 (54.6%) patients presented with ST‐elevation MI. The median angiographic Syntax score was 16 (9.0–25.3) and 69.0% had multi‐vessel disease. At least one complex lesion was found in 73.0% of patients, 51.3% had a thrombus containing lesion, and 57.9% had myocardial blush grades 0/1. The overall in‐hospital mortality was 23.7%. ST‐segment elevation MI presentation and baseline myocardial blush grades 0 or 1 were independently associated with a higher risk of death (HR 2.75, 95%CI 1.30–5.80 and HR 3.73, 95%CI 1.61–8.61, respectively). Conclusions Patients who have a MI in the context of ongoing COVID‐19 mostly present complex coronary morphologies, implying a background of prior atherosclerotic disease superimposed on a thrombotic milieu. The in‐hospital prognosis is poor with a markedly high mortality, prompting further investigation to better clarify this newly described condition.

In elderly (75 years or older) patients living in Latin America with severe symptomatic aortic stenosis candidates for transfemoral approach, the panel suggests the use of transcatheter aortic valve implant (TAVI) over surgical aortic valve replacement (SAVR). This is a conditional recommendation, based on moderate certainty in the evidence (⨁⨁⨁Ο).This recommendation does not apply to patients in which there is a standard of care, like TAVI for patients at very high risk for cardiac surgery or inoperable patients, or SAVR for non-elderly patients (eg, under 65 years old) at low risk for cardiac surgery. The suggested age threshold of 75 years old is based on judgement of limited available literature and should be used as a guide rather than a determinant threshold.The conditional nature of this recommendation means that the majority of patients in this situation would want a transfemoral TAVI over SAVR, but some may prefer SAVR. For clinicians, this means that they must be familiar with the evidence supporting this recommendation and help each patient to arrive at a management decision integrating a multidisciplinary team discussion (Heart Team), patient’s values and preferences through shared decision-making, and available resources. Policymakers will require substantial debate and the involvement of various stakeholders to implement this recommendation.

Orientador: Carlos Eduardo Keutenedjian Mady Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Engenharia Mecânica Resumo: Os secadores das fábricas de gelatina utilizam ar com baixa umidade absoluta para fazer o processo de secagem, sendo estes sistemas energo-intensivos. Para este processo de remoção da água do ar, existem diferentes tecnologias que são empregadas, sendo as três principais os sistemas de desumidificação: sólido dessecante, líquido dessecante e condensação da água presente no ar. A escolha de qual é a melhor tecnologia passa por diversos aspectos, nem sempre cartesianos. Como em todos eles existem consumo de energia elétrica e calor, os indicadores de desempenho baseados na Primeira Lei da Termodinâmica nem sempre se demonstraram adequados por não fazerem diferenciação da qualidade da energia consumida. Em razão disso, foram propostos indicadores baseados na Segunda Lei da Termodinâmica, isto é, todas as transferências numa única base termodinâmica: capacidade de realização de trabalho. Para a comparação, foram avaliados os indicadores de eficiência exergética e um índice de água removida por consumo de exergia nos sistemas (SMERex). A partir dessas grandezas físicas, foi possível verificar possibilidades de redução de consumo de exergia nos sistemas, por meio da instalação de bombas de calor e verificar que o sistema de condensação com bomba de calor foi o que teve melhor desempenho para produção de gelatina (especificidades do ar de saída do secador) e para os valores médios de temperatura e umidade do ar, respeitando-se o local em que é produzida Abstract: The industrial dryers for gelatine uses air with low humidity to increase the performance of dry the product, and this process has a high energy consumption. To remove the water from the air there are available many technologies, and the main three used are the liquid desiccant, solid desiccant and condensation of water present in the air reaching the dew point. To choose the best technology many factors have to be considered, and as all systems has electrical energy and heat consumption, the key performance indicators of the first law of thermodynamics were not feasible, so the indicators were defined upon the second law of thermodynamics. Thus, with the second law enable to compare all the energy sources regarding the maximum work capacity of this source (exergy). To do this evaluation was used indicators based in the exergy efficiency and an indicator of the exergy consumed to condensate the water (SMERex). Therefore, were possible to analyze the possibilities to reduce the exergy consumption in the systems with an installation of a heat pump and to verify the best option for dehumidification in the production was the condensation system with heat pump (with the condition to use in the gelatine dryers) and to different inlet temperatures and moisture of the air in the place that are produce Mestrado Planejamento de Sistemas Energéticos Mestre em Planejamento de Sistemas Energéticos

BackgroundProcedural improvements combined with the contemporary clinical profile of patients undergoing transcatheter aortic valve replacement (TAVR) may have influenced the incidence and outcomes of infective endocarditis (IE) following TAVR. We aimed to determine the temporal trends, characteristics, and outcomes of IE post-TAVR.MethodsObservational study including 552 patients presenting definite IE post-TAVR. Patients were divided in 2 groups according to the timing of TAVR (historical cohort [HC]: before 2014; contemporary cohort [CC]: after 2014).ResultsOverall incidence rates of IE were similar in both cohorts (CC vs HC: 5.45 vs 6.52 per 1000 person-years; P = .12), but the rate of early IE was lower in the CC (2.29‰ vs 4.89‰, P ConclusionsAlthough overall IE incidence has remained stable, the incidence of early IE has declined in recent years. The microorganism, high rate of complications, and very low rate of surgical treatment remained similar. In-hospital and 1-year mortality rates were high but progressively decreased over time.

Background: Acute kidney injury (AKI) has shown to adversely affect outcomes in patients undergoing transcutaneous aortic valve replacement (TAVR), and its correct risk estimation may interfere in procedural planning and strategies. The aim of the study was to test and compare 6 scores in predicting AKI after TAVR. Methods: We tested 6 scores (the contrast material limit score, volume-to-creatinine clearance ratio, ACEF, CR4EATME3AD3, Mehran model A, and Mehran model B) in a total of 559 consecutive patients included in the Brazilian TAVR registry. Results: All scores had a poor accuracy and calibration to predict the occurrence of AKI grade 1 or 2. All scores improved the accuracy of AKI risk prediction when stratified for AKI grade 2/3 and AKI grade 3 for all scores. The CR4EATME3AD3 was the best predictor of AKI stage 2/3 (AUC: 0.62; OR: 1.12; 95% CI 1.01–1.26; p = 0.04) and AKI stage 3 (AUC: 0.64; OR: 1.16; 95% CI 1.02–1.32; p = 0.02). Mehran models A and B were both good models for AKI stage 3 (AUC: 0.63; OR: 1.10; 95% CI 1.01–1.22; p = 0.05; and AUC: 0.62; OR: 1.10; 95% CI 1.00–1.21; p = 0.05, respectively). Conclusions: None of the current models demonstrated validity in detecting AKI when its lower grades were evaluated. CR4EATME3AD3 was the best score in predicting moderate to severe AKI after TAVR. These findings suggest that contrast-induced AKI may not be the only factor related to kidney injury after TAVR.

The patient reported angina measurement with the Seattle Angina Questionnaire (SAQ) has shown to have prognostic implications and became an endpoint in clinical trials. Our objective was to study physician-reported and SAQ severity with the total coronary atherosclerotic burden as assessed by 4 angiographic scores. We prospectively analyzed data of consecutive patients scheduled for coronary angiography or percutaneous coronary intervention. The Canadian Cardiovascular Society (CCS) angina categories was used as physician-reported angina. SAQ domains were categorized as severe (0 to 24), moderate 25 to 75 and mild angina (75). All angina assessments were done before coronary angiography. Gensini, Syntax, Friesinger, and Sullivan angiographic scores were used for total atherosclerotic burden quantification: 261 patients were included in the present analysis. The median age was 66.0 (59.0 to 71.8) years, 53.6% were male and 43.7% had diabetes. The median SYNTAX score was 6.0 (0 to 18.0). The worse the symptoms of CCS categories, the more severe was the atherosclerotic burden in all angiographic scores: SYNTAX (p = 0.01); Gensini (p0.01); Friesinger (p = 0.02) and Sullivan (p = 0.03). Conversely, SAQ domains were not able to discriminate the severity of CAD in any of the scores. The only exception was the severe SAQ quality of life that had worse Gensini score than the mild SAQ quality of life (p = 0.04). In conclusion, CCS angina categories are related to the total atherosclerotic burden in coronary angiography, by all angiographic scores. SAQ domains should be used as a measure of patient functionality and quality of life but not as a measure of CAD severity.

INTRODUCTION AND OBJECTIVES Acute kidney injury (AKI) is frequently observed after transcatheter aortic valve implantation (TAVI) and is associated with higher mortality. However, the impact of AKI on long-term outcomes remains controversial. Therefore, we sought to evaluate the impact of AKI on short- and long-term outcomes following TAVI using the Valve Academic Research Consortium 2 criteria. METHODS Consecutive patients (n = 794) with severe aortic stenosis who underwent TAVI were included in a multicenter Brazilian registry. Logistic regression analysis was used to identify predictors of AKI. Four-year outcomes were determined as Kaplan-Meier survival curves, and an adjusted landmark analysis was used to test the impact of AKI on mortality among survivors at 12 months. RESULTS The incidence of AKI after TAVI was 18%. Independent predictors of AKI were age, diabetes mellitus, major or life-threatening bleeding and valve malpositioning. Acute kidney injury was independently associated with higher risk of all-cause death (adjusted HR, 2.8; 95%CI, 2.0-3.9; P < .001) and cardiovascular mortality (adjusted HR, 2.9; 95%CI, 1.9-4.4; P < .001) over the entire follow-up period. However, when considering only survivors at 12 months, there was no difference in both clinical endpoints (adjusted HR, 1.2; 95%CI, 0.5-2.4; P = .71, and HR, 0.7; 95%CI, 0.2-2.1; P = .57, respectively). CONCLUSIONS Acute kidney injury is a frequent complication after TAVI. Older age, diabetes, major or life-threatening bleeding, and valve malpositioning were independent predictors of AKI. Acute kidney injury is associated with worse short- and long-term outcomes. However, the major impact of AKI on mortality is limited to the first year after TAVI.

Resumen Introduccion y objetivos El dano renal agudo (DRA) ocurre con frecuencia tras el implante percutaneo de valvula aortica (TAVI) y se asocia con una mayor mortalidad. Sin embargo, el impacto del DRA en la evolucion a largo plazo continua siendo controvertida. Por dicho motivo se evalua el impacto del DRA el resultado a corto y largo plazo tras el TAVI usando los criterios Valve Academic Research Consortium 2. Metodos Se incluyeron 794 pacientes consecutivos con estenosis aortica grave en un registro multicentrico brasileno. Para la identificacion de los predictores de DRA se utilizo el analisis de regresion logistica. La supervivencia a 4 anos se determino mediante las curvas de Kaplan-Meier y para determinar el impacto del DRA en la mortalidad entre los supervivientes a 12 meses se uso un analisis de punto de referencia ajustado. Resultados La incidencia de DRA tras el TAVI fue del 18%. Los predictores independientes de DRA fueron: edad, diabetes mellitus, hemorragia mayor o amenazante para la vida y la malaposicion valvular. El DRA se asocio independientemente con un riesgo mayor de muerte total (HR ajustada = 2,8; IC95%, 2,0-3,9; p Conclusiones El DRA es una complicacion frecuente tras el TAVI. La edad avanzada, la diabetes, la hemorragia mayor o amenazante para la vida y la malaposicion valvular eran factores predictivos de DRA. El DRA se asocio con el pronostico a corto y largo plazo, sin embargo, el impacto del DRA sobre la mortalidad se limito al primer ano tras el TAVI.

Objectives The authors aimed to determine the procedural learning curve and minimum annual institutional volumes associated with optimum clinical outcomes for transcatheter aortic valve replacement (TAVR). Background Transcatheter aortic valve replacement (TAVR) is a complex procedure requiring significant training and experience for successful outcome. Despite increasing use of TAVR across institutions, limited information is available for its learning curve characteristics and minimum annual volumes required to optimize clinical outcomes. Methods The study collected data for patients at 16 centers participating in the international TAVR registry since initiation of the respective TAVR program. All cases were chronologically ordered into initial (1 to 75), early (76 to 150), intermediate (151 to 225), high (226 to 300), and very high (>300) experience operators for TAVR learning curve characterization. In addition, participating institutions were stratified by annual TAVR case volume into low-volume ( 100) groups for comparative analysis. Procedural and 30-day clinical outcomes were collected and multivariate regression analysis performed for 30-day mortality and the early safety endpoint. Results A total of 3,403 patients comprised the study population. On multivariate analysis, all-cause mortality was significantly higher for initial (odds ratio [OR]: 3.83; 95% confidence interval [CI]: 1.93 to 7.60), early (OR: 2.41; 95% CI: 1.51 to 5.03), and intermediate (OR: 2.53; 95% CI: 1.19 to 5.40) experience groups compared with the very high experience operators. In addition, the early safety endpoint was significantly worse for all experience groups compared with the very high experience operators. Low annual volume ( Conclusions TAVR procedures display important learning curve characteristics with both greater procedural safety and a lower mortality when performed by experienced operators. In addition, TAVR performed at low annual volume (

In-plane seismic behaviour of Cross-Laminated Timber (CLT) walls is influenced by panel-to-panel and panel-to-foundation mechanical connections, which consist of hold-downs and angle brackets. Due to the platform constructional technology, the orthogonal to grain timber-to-timber contact is also involved in the seismic response of the panels. To date, literature theoretical approaches to evaluating the flexural load-bearing capacity of CLT panels focus their attention on the schematization of hold-downs and angle brackets only, under evaluating the role of timber compressed in the perpendicular direction. In this paper the influence of orthogonal to grain timber properties on the overall seismic behaviour of CLT walls has been investigated, proposing a general theoretical model to schematize the panel-to-panel and panel-to-foundation connections. A parabola-rectangle constitutive behaviour has been defined to describe the orthogonal to grain timber behaviour in the connection zones, while hold-downs and angle brackets are modelled adopting literature models. Five different failure conditions, described by mathematical formulations, able to describe the entire axial force-bending moment interaction domain have been defined. The proposed model has also been employed to schematize the connection zones in multi-storey CLT walls with openings, allowing to investigate the effect of the orthogonal to grain properties on its seismic behaviour. Results of nonlinear analyses demonstrate a significant influence of orthogonal to grain timber properties on seismic behaviour of the walls, affecting their strength, stiffness, ductility and collapse mechanisms.

The whole Mediterranean area historical heritage is mostly constituted by 'ancient' unreinforced masonry constructions which are particularly vulnerable to earthquakes. Due to the particular attitude to out-of-plane collapse mechanisms, 'ancient' constructions largely contribute to increase the seismic risk. In this paper, a methodology for retrofitting unreinforced masonry buildings, aimed to gradually transforms the 'ancient' masonry building into a 'modern' code-conforming building, is proposed. This approach has been applied to an existing masonry building located near L'Aquila (Italy) and damaged during the 2009 earthquake. The results demonstrate the usefulness of a methodological approach to implement retrofitting actions. Thus, appears more easily to calibrate the interventions as a function of the structural weakness and to quantify the role of each intervention in terms of capacity-to-demand ratio. Moreover, a gradual control of the seismic performance enhancement with respect to the original capacity can be achieved, avoiding high economic costs related to unnecessary interventions.

This paper deals with the influence of the rolling shear deformation on the flexural behavior of CLT (Cross-Laminated Timber) panels. The morphological configuration of the panels, which consist of orthogonal overlapped layers of boards, led to a particular shear behavior when subjected to out-of-plane loadings: the low value of the shear modulus in orthogonal to grain direction (i.e., rolling shear modulus) gives rise to significant shear deformations in the transverse layers of boards, whose grains direction is perpendicular with respect to the tangential stresses direction. This produces increases of deflections and vibrations under service loads, creating discomfort for the users. Different analytical methods accounting for this phenomenon have been already developed and presented in literature. Comparative analyses among the results provided by some of these methods have been carried out in the present paper and the influence of the rolling shear deformations, with reference to different span-to-depth (L/H) ratios investigated. Moreover, the analytical results have also been compared with those obtained by more accurate 2D finite element models. The results show that, at the service limit states, the influence of the rolling shear can be significant when the aspect ratios became less than L/H = 30, and the phenomenon must be accurately considered in both deflection and stress analysis of CLT floors. Contrariwise, in the case of higher aspect ratios (slender panels), the deflections and stresses can be evaluated neglecting the rolling shear influence, assuming the layers of boards as fully-connected.

Objectives: To explore the rate, the determinants of success, and the hemodynamic impact of balloon postdilatation (BPD) of self-expanding transcatheter heart valves (SE-THVs). Background: BPD is commonly used to optimize valve expansion and reduce paravalvular leakage (PVL) after transcatheter aortic valve implantation (TAVI) without clearly knowing its hemodynamic benefits. Methods: Patients (n = 307) who received a SE-THV were stratified according to whether a BPD was performed or not. Patients who received BPD were stratified according to the severity of PVL remaining after BPD into two groups: Successful BPD (≤mild PVL + BPD) and Failed BPD (moderate-severe PVL + BPD). Results: BPD was performed in 121 patients (39.4%) and was successful in 106 patients (87.6% of attempts). A ratio of the postdilatation balloon diameter to the annulus diameter ≤0.95 was an independent predictor of BPD failure (OR: 10.72 [2.02-56.76], P =.005). Peak transvalvular pressure gradient (PG) was lower in the Successful BPD group (14[12-22] mm Hg) than in the Failed BPD group (18[16-23] mm Hg, P =.029), and did not rise in either group during follow-up (median [IQR], 364[161-739] days). Conclusion: BPD was performed in 39% of patients who received a SE-THV, and was successful in the majority of attempts. BPD failure was more likely in patients with a small postdilatation balloon-to-annulus diameter ratio. Effective BPD improved THV hemodynamic performance, and this was maintained in the intermediate-term post-TAVI.

The femoral venous approach for percutaneous edge-to-edge repair of the mitral valve with the MitraClip system (Abbott Vascular, Santa Clara, California) may not be possible in patients with occlusion or congenital anomalies of the inferior vena cava (IVC) or limited by the presence of an IVC filter

Transcatheter aortic valve implantation (TAVI) is undeniably invading the “surgical” space and expanding its indication. Over the last five years, there has been a real revolution in TAVI technology with the introduction of newer devices that aimed to simplify the procedure1. These swift advances have transformed the landscape in structural heart disease and culminated in a broader use of TAVI in clinical practice2,3. The procedure is not only spreading worldwide but is also becoming less aggressive for the patient with the so-called “minimalist approach”.

Background: No data exist about the characteristics of infective endocarditis (IE) post-transcatheter aortic valve replacement (TAVR) according to transcatheter valve type. We aimed to determine the incidence, clinical characteristics, and outcomes of patients with IE post-TAVR treated with balloon-expandable valve (BEV) versus self-expanding valve (SEV) systems. Methods: Data from the multicenter Infectious Endocarditis After TAVR International Registry was used to compare IE patients with BEV versus SEV. Results: A total of 245 patients with IE post-TAVR were included (SEV, 47%; BEV, 53%). The timing between TAVR and IE was similar between groups (SEV, 5.5 [1.2–15] months versus BEV, 5.3 [1.7–11.4] months; P =0.89). Enterococcal IE was more frequent in the SEV group (36.5% versus 15.4%; P P =0.01; valve leaflet, SEV, 23.9%; BEV, 38.5%; P =0.01). BEV recipients had a higher rate of stroke/systemic embolism (20.0% versus 8.7%, adjusted OR: 2.46, 95% CI: 1.04–5.82, P =0.04). Surgical explant of the transcatheter valve (SEV, 8.7%; BEV, 13.8%; P =0.21), and in-hospital death at the time of IE episode (SEV, 35.6%; BEV, 37.7%; P =0.74) were similar between groups. After a mean follow-up of 13±12 months, 59.1% and 54.6% of the SEV and BEV recipients, respectively, had died ( P =0.66). Conclusions: The characteristics of IE post-TAVR, including microorganism type, vegetation location, and embolic complications but not early or late mortality, differed according to valve type. These results may help to guide the diagnosis and management of IE and inform future research studies in the field.

Objectives To report clinical, angiographic characteristics, outcomes, and predictors of unsuccessful procedures in patients who underwent chronic total occlusion (CTO) percutaneous coronary interventions (PCI) in Latin America. Background CTO PCI has been increasingly performed worldwide, but there is a lack of information in this region. Methods An international multicenter registry was developed to collect data on CTO PCI performed in centers in Latin America. Patient, angiographic, procedural and outcome data were evaluated. Predictors of unsuccessful procedures were assessed by multivariable analysis. Results We have included data related to 1,040 CTO PCIs performed in seven countries in Latin America (Argentina, Brazil, Chile, Colombia, Ecuador, Mexico, and Puerto Rico). The mean age was 64 ± 10 years, and CTO PCI was performed mainly for angina control (81%) or treatment of a large ischemic area (30%). Overall technical success rate was 82.5%, and it was achieved with antegrade wire escalation in 81%, antegrade dissection/re-entry in 8% and with retrograde techniques in 11% of the successful procedures. Multivariable analysis identified moderate/severe calcification, a blunt proximal cap and a previous attempt as independent predictors of unsuccessful procedures. In-hospital major adverse cardiovascular events (MACE) occurred in 3.1% of the cases, death in 1% and cardiac tamponade in 0.9% CONCLUSIONS: CTO PCI in Latin America has been performed mainly for ischemia relief. Procedures were associated with a success rate above 80% and low incidence of MACE. Predictors of unsuccessful procedures were similar to those previously reported in the literature.

Objectives We sought to investigate a new angiographic method for aortic regurgitation (AR) severity assessment in the setting of transcatheter aortic valve implantation (TAVI). Background AR after TAVI is common but challenging to quantitate, especially in the cath-lab. Methods In 228 patients, AR was quantitated before and after TAVI by echocardiography and by video-densitometric analysis of aortograms. Contrast time–density curves for the aortic root (the reference region) and the left ventricular outflow tract, LVOT were generated. LVOT-AR was calculated as the area under the curve of the LVOT as a fraction of the area under the curve of the reference region. Results LVOT-AR was 0.10 ± 0.08, 0.13 ± 0.10 and 0.28 ± 0.14 in none-trace, mild and moderate-severe post-TAVI AR as defined by echocardiography (P 0.17 corresponded to moderate-severe AR on echocardiography (area under the curve = 0.84). At follow-up (median, 496 days), patients with LVOT-AR ≤ 0.17 showed a significant reduction of LV mass index (LVMi; 121 [95–148] vs. 140 [112–169] g/m2, P = 0.009) and the prevalence of LV hypertrophy (LVH; 64 vs. 88%, P = 0.001) compared to baseline. In patients with LVOT-AR > 0.17, LVMi (149 [121–178] vs. 166 [144–188] g/m2, P = 0.14) and the prevalence of LVH (74 vs. 87%, P = 0.23) did not show a significant change. Compared to patients with LVOT-AR ≤ 0.17, those with LVOT-AR > 0.17 had an increased 30-day (16.4% vs. 7.1%, P = 0.035) and one year mortality (32.9 vs. 14.2%, log rank P value = 0.001; HR: 2.690 [1.461–4.953], P = 0.001). Conclusions LVOT-AR > 0.17 corresponds to greater than mild AR as defined by echocardiography and predicts impaired LV reverse remodeling and increased early and midterm mortality after TAVI. © 2017 Wiley Periodicals, Inc.