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Indications for transcatheter aortic valve implantation (TAVI) have expanded in many countries to include patients with aortic stenosis who are at low surgical risk, and a similar expansion to this cohort is anticipated elsewhere in the world, together with an increase in the proportion of patients with bicuspid aortic valve (BAV) morphology as the age of the patients being treated decreases. To date, patients with BAV have been excluded from major randomized trials of TAVI owing to anatomical considerations. As a consequence, BAV has been a relative contraindication to the use of TAVI in international guidelines. Although clinical experience and observational data are accumulating, BAV presents numerous anatomical challenges for successful TAVI, despite advances in device design. Furthermore, in those with BAV, substantial geographical variation exists in patient characteristics, clinical approach and procedural strategy. Therefore, in this Roadmap article, we summarize the existing evidence and provide consensus recommendations from an international group of experts on the application of TAVI in patients with BAV in advance of the anticipated growth in the use of this procedure in this challenging cohort of patients.

Objectives: The aim of this study was to assess cusp symmetry and coronary ostial eccentricity and its impact on coronary access following transcatheter aortic valve replacement (TAVR) using a patient-specific commissural alignment implantation technique. Background: TAVR implantation techniques to obtain neocommissural alignment have been introduced. The impact of cusp symmetry and coronary ostial eccentricity on coronary access after TAVR remains unknown. Methods: Cardiac computed tomographic scans from 200 tricuspid aortic valves (TAVs) and 200 type 1 bicuspid aortic valves (BAVs) were studied. Cusp symmetry and coronary ostial eccentricity were assessed. In addition, the right coronary cusp/left coronary cusp and right coronary artery (RCA)/left coronary artery (LCA) ostia overlap views were calculated and compared. Results: Severe cusp asymmetry (>135°) was more frequent in BAVs (52.5%) than in TAVs (2.5%) (P < 0.001), with the noncoronary cusp being the most common dominant cusp. The RCA ostium was found to be more often eccentric (>20°) than the LCA ostium (28% vs 6%, respectively; P < 0.001). Considering the right/left cusp overlap view, there was <20° deviation between the right coronary cusp–left coronary cusp centered line and the RCA-LCA centered line in 95% of all patients (TAV, 97%; BAV, 93%). The right/left cusp and coronary ostia overlap view differed by <10° and <20° fluoroscopic angulation in 75% and 98% of all cases, respectively. Conclusions: Using the right/left cusp overlap view to obtain commissural alignment in TAVR is also an effective approach to implant one of the transcatheter heart valve commissures in the near center between both coronary ostia in most TAVs and type 1 BAVs. Preprocedural CT assessment remains crucial to assess cusp symmetry and coronary ostial eccentricity.

M&A is carried out to obtain other legal entity’s property right for a certain economic realization, often to share costs, increase efficiency or gain market power. Mergers and acquisitions, well known for its short form M&A, is an important means of business expansion; it is also often used as a tool to avoid certain regulations or laws, e.g., the monopoly and the tax laws (Ross, et al., 2002). Over past ten years, there has been a great deal of cross-border M&A activity involving UK companies. However, domestic and cross-border mergers and acquisitions between UK companies were decreased every year since 2007. In addition, previous studies have revealed a critical finding for companies and shareholders that about 60 to 80 percent of M&A activities did not actually produce any value (Mehmood, 2009). Some researchers also found that mergers can bring large benefits for shareholders of targeted company by using event and accounting study. This study attempts to find out the effect of M&A in UK pharmaceutical firms’ performance. We use the database provided by FAME for the period of 2003-2013. There are two main accounting study methods are applied; cross-sectional analysis and panel analysis. Cross-sectional tried to figure out whether there is difference of profitability between merged and unmerged. Panel analysis is applied to compare the profitability of firms before and after acquisition. After controlling other possible influencing factors, the results of two regression analysis both suggest that M&A activity have no effect on firm’s performance. As a result, contrary to common beliefs and expectations, we conclude that mergers usually do not lead to improve the acquirer's financial performance.

M&A is carried out to obtain other legal entity’s property right for a certain economic realization, often to share costs, increase efficiency or gain market power. Mergers and acquisitions, well known for its short form M&A, is an important means of business expansion; it is also often used as a tool to avoid certain regulations or laws, e.g., the monopoly and the tax laws (Ross, et al., 2002). Over past ten years, there has been a great deal of cross-border M&A activity involving UK companies. However, domestic and cross-border mergers and acquisitions between UK companies were decreased every year since 2007. In addition, previous studies have revealed a critical finding for companies and shareholders that about 60 to 80 percent of M&A activities did not actually produce any value (Mehmood, 2009). Some researchers also found that mergers can bring large benefits for shareholders of targeted company by using event and accounting study. This study attempts to find out the effect of M&A in UK pharmaceutical firms’ performance. We use the database provided by FAME for the period of 2003-2013. There are two main accounting study methods are applied; cross-sectional analysis and panel analysis. Cross-sectional tried to figure out whether there is difference of profitability between merged and unmerged. Panel analysis is applied to compare the profitability of firms before and after acquisition. After controlling other possible influencing factors, the results of two regression analysis both suggest that M&A activity have no effect on firm’s performance. As a result, contrary to common beliefs and expectations, we conclude that mergers usually do not lead to improve the acquirer's financial performance.

M&A is carried out to obtain other legal entity’s property right for a certain economic realization, often to share costs, increase efficiency or gain market power. Mergers and acquisitions, well known for its short form M&A, is an important means of business expansion; it is also often used as a tool to avoid certain regulations or laws, e.g., the monopoly and the tax laws (Ross, et al., 2002). Over past ten years, there has been a great deal of cross-border M&A activity involving UK companies. However, domestic and cross-border mergers and acquisitions between UK companies were decreased every year since 2007. In addition, previous studies have revealed a critical finding for companies and shareholders that about 60 to 80 percent of M&A activities did not actually produce any value (Mehmood, 2009). Some researchers also found that mergers can bring large benefits for shareholders of targeted company by using event and accounting study. This study attempts to find out the effect of M&A in UK pharmaceutical firms’ performance. We use the database provided by FAME for the period of 2003-2013. There are two main accounting study methods are applied; cross-sectional analysis and panel analysis. Cross-sectional tried to figure out whether there is difference of profitability between merged and unmerged. Panel analysis is applied to compare the profitability of firms before and after acquisition. After controlling other possible influencing factors, the results of two regression analysis both suggest that M&A activity have no effect on firm’s performance. As a result, contrary to common beliefs and expectations, we conclude that mergers usually do not lead to improve the acquirer's financial performance.