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Background Cerebrovascular events remain one of the most devastating complications of transcatheter aortic valve implantation (TAVI). Data from real‐world contemporary cohorts on longitudinal trends and outcomes remain limited. The aim of this study was to assess incidence, temporal trends, predictors, and outcomes of cerebrovascular events following transfemoral TAVI. Methods and Results The CENTER2 (Cerebrovascular Events in Patients Undergoing Transcatheter Aortic Valve Implantation With Balloon‐Expandable Valves Versus Self‐Expandable Valves 2) study includes patients undergoing TAVI between 2007 and 2022. The database contains pooled patient‐level data from 10 clinical studies. A total of 24 305 patients underwent transfemoral TAVI (mean age 81.5±6.7 years, 56% women, median Society of Thoracic Surgeon Predicted Risk of Mortality 4.9% [3.1%–8.5%]). Of these patients, 2.2% (n=534) experienced stroke in the first 30 days after TAVI, and 40 (0.4%) had a transient ischemic attack. Stroke rates remained stable during the treatment period (2007–2010: 2.1%, 2011–2014: 2.5%, 2015–2018: 2.1%, 2019–2022: 2.1%; Ptrend=0.28). Moreover, 30‐day cerebrovascular event rates were similar across Society of Thoracic Surgeon Predicted Risk of Mortality risk categories: 2.1% in low‐risk, 2.6% in intermediate‐risk, and 2.5% in high‐risk patients (P=0.21). Mortality was higher in patients with 30‐day stroke than without at 30 days (20.3% versus 4.7%; odds ratio, 5.1 [95% CI, 4.1–6.5]; P

Background: The reduction in long-term mortality after acute myocardial infarction (AMI) is less pronounced than that of in-hospital mortality among patients with AMI complicated by heart failure (HF) and/or in those with a high residual thrombotic risk (HTR). Aim: To investigate the relative prognostic significance of HTR and HF in AMI survivors. Methods: This retrospective cohort study enrolled patients admitted for AMI in 2014–2015 in all Italian hospitals. HTR was defined as at least one of the following conditions: previous AMI, ischemic stroke or other vascular disease, type 2 diabetes, renal failure. Patients were classified into four categories: uncomplicated AMI; AMI with HTR; AMI with HF and AMI with both HTR and HF (HTR + HF). Cox proportional hazard model was used to evaluate the impact of HTR, HF and HTR + HF on the 5-year prognosis. A time-varying coefficient analysis was performed to estimate the 5-year trend of HR for major averse cardiac and cerebrovascular events (MACCE). Results: a total of 174.869 AMI events were identified. The adjusted 5-year HR for MACCE was 1.74 (p

The general research here introduced concerns the phenomenon of urban sprawl unfolding in the last century and defined as “the physical pattern of low- density settlement in urban areas”. The focus, as part of the more general research cited, is the relationship between sprawl and public transportation. The specific study here present is a possible approach to planning and managing policy responses to urban sprawl through the integration of consolidated settlement systems (with a view to their re-revitalization) with rail green public transportation in the framework of TOD (Transit-Oriented Development). A paramount issue emerges about sprawl: there are prototype case in which TOD and rail green public transportation help concentrate settlement instead of sprawl? No cases have been found. Instead the most recent literature recommends to perform new researches concerning solutions through real world applications, given the total shortage of case studies. The general research framework has been applied in a specific Case Study to support the community of Calabria, the southernmost Mediterranean region of mainland Italy in European Union, within the most urbanized sub-regional sub-area, in analyzing the rampant phenomenon of sprawl and, possibly, in addressing and mitigating it relying on TOD and rail green public transportation. In the Case Study of the present research there are three alternatives in sub regional public transportation: A1; A2; A3. A1 is the status quo. A2 is the upgrading of the railway which, although existing, is illogically neglected. A3 is an unexpected new project by the railway managing body for a new route in the south of the area completely away from the most important settlements and outside any transport or mobility or accessibility institutional public plan. The three alternatives were subjected to social discussions well as a qualitative evaluation by a panel of experts. The multiple criteria valuation approach resulted in a preference for Alternative A2 over Alternatives A1 and A3. The preferred Alternative A2 integrates perfectly with the existing settlement by responding to a fundamental criterion placed at the top of the valuation: integrating the urban railway directly into the existing consolidated inhabited centers. This preferable Alternative A2 has among its peculiar characteristics: – directly connects many of the settlements in the area; – can serve approximately MORE THAN 250,000 potential settled residents; – connects coast to coast the narrowest regional and national isthmus; – creates the fastest and shortest possible connection in the national territory between the two fundamental railway backbones Tyrrhenian (Palermo - Milan - Torino) and Ionian-Adriatic (Reggio Calabria - Venice); – thereby helping to connect two of the Trans European Network and pan-European train mega-corridors I (Palermo - Berlin) and VIII (Skopje - Varna). The A2 Alternative has the further distinctive feature of performing both local and supra-local dual service in a unified venue that is both train-tram and long-distance rail, in analogy with continental benchmarks and experiences, such as the German S-Bahn. Subsequently, in the Case Study, the costs of the Alternative A2 for the upgrading (and “modernization”) of the existing railway has an estimated cost of 168 million appraised by the research team with a detailed quantification, and subsequently, in de facto double-blind estimate, surprisingly confirmed by the railway managing body. According to the latest and most up-dated estimates by the same railway managing body, the completely new route project located far south of all the settlements, constituting the Alternative A3, would cost over 485 million, are reported. This is because all the areas have to be acquired and because the route crosses land with technical difficulties to be overcome by carrying out expensive works. In terms of costs, the preferred Alternative 2 seems to be the most balanced, much more even than the status quo Alternative 1 (do nothing). The latter only apparently has no big investment costs, unless ordinary maintenance. In fact it hides enormous private costs and implicit (and not immediately monetary) social suffering, due to: car commuting (un-pooled) of people; their monetizable travel times, enormous due to congestion; air pollution; accident risks; congestion in cities; high private personal costs of using the individual vehicle (car wear; fuel); parking cost and fine risk; etc.

Climate change is the most lethal crises facing Humanity. The majority (99%) of scientists agree that climate change is caused by humans. According to empirical evidence this ecological tragedy is rooted primarily in world-wide enormous fossil energy production and consumption. The civil sector, including settlements, is the world’s “largest fossil energy consumer and polluter”. Green building is the only way to ensure sustainable development and to overcome climate change by decarbonizing the constructions. The aim of the research is to test a strategic solution, applied to the civil sector, valuated through new assessment tools including the novel BIM in updated platforms. Some significant Building Energy Performance Simulation Programs (BEPSPs) are comparatively tested in a Case Study experimented in the simplest Prototype Building. One goal of the present research is to valuate if the ecological coat produces a saving of up to at least 40% of energy consumption in the building in the short-medium terms i. e. by 2030 as required in the EU Directive 2018/844 and if it is economically feasible. The passivation of brown common inefficient Prototype Building is implemented using bio ecological panels made from natural materials. By simply using a six or ten centimeters thick panel coat, the energy saving for heating is around 71% or 82%, way above the set objective of 40% by 2030 as required in the EU Directive 2018/844. The building global energy saving is always more than 55%. The research achieved the general objective and the specific goal set, obtaining the empirical evidence of the extraordinary impacts/benefits produced by insulation using extremely small panels/boards made from local natural cork in a local circular economy structure. Since the economic and financial impacts are of great relevance for the feasibility of the Strategy “Green Building” Strategy, a financial estimate has been developed. It immediately also highlighted the economic profitability, pecuniary convenience and financial feasibility convenience of the Sustainable Scenario. Research appraised a favorable monetary Pay Back\recovery (within only five years from the ecological intervention) of the differential additional upfront cost due to passivation additional works. There is a gap in the real world and a strong request in the research world (Hopkins, 2016) of appraisal concerning financial feasibility of the “Green Building” Strategy. The presented research aims to contribute to answer these demands of economic valuation. Il cambiamento climatico è la crisi più letale che l’umanità deve affrontare. La maggior parte (99%) degli scienziati concorda sul fatto che il cambiamento climatico è causato dall’uomo. Secondo l’evidenza empirica, questa tragedia ecologica è radicata principalmente nell’enorme produzione e consumo di energia fossile a livello mondiale. Il settore civile, compresi gli insediamenti, è il «più grande consumatore di energia fossile e inquinatore con conseguenti emissioni di CO2» al mondo. La bioedilizia, e quindi la decarbonizzazione degli edifici con l’efficienza energetica e quindi il risparmio anche mediante cappotto ecologico, è l’unico modo per garantire uno sviluppo sostenibile e per superare il cam- biamento climatico. Tale approccio è definibile: Strategia “Green Building”. L’obiettivo della ricerca è quello di testare una soluzione strategica, applicata al settore civile, valutata attraverso nuovi strumenti di valutazione tra cui le nuove piattaforme BIM. Sono stati testati comparativamente alcuni importanti programmi di simulazione delle prestazioni energetiche degli edifici in un caso di studio sperimentato in un semplice edificio prototipo. Uno dei passaggi specifici della presente ricerca è quello di valutare se il cappotto ecologico produca un risparmio fino ad almeno il 40% dei consumi energetici dell’edificio nel breve-medio termine, ovvero entro il 2030, come previsto dalla Direttiva UE 2018/844, e se sia economicamente fattibile. La passivazione dell’edificio prototipo comune ed inefficiente è realizzata utilizzando pannelli bioecologici realizzati con materiali naturali. Utilizzando semplicemente un pannello di sei o dieci centimetri di spessore, il risparmio energetico per il riscaldamento si aggira intorno al 71% o 82%, ben al di sopra dell’obiettivo fissato del 40% entro il 2030 come previsto dalla Direttiva UE 2018/844. Il risparmio energetico globale dell’edificio è sempre superiore al 55%. La ricerca ha raggiunto l’obiettivo generale e l’obiettivo specifico prefissato, ottenendo l’evidenza empirica degli straordinari impatti / benefici prodotti dall’isolamento con pannelli di dimensioni estremamente ridotte realizzati con sughero naturale locale in una struttura di economia circolare locale. Poiché gli impatti economici e finanziari sono di grande rilevanza per la fattibilità della Strategia “Green Building”, è stata elaborata una stima finanziaria che ha immediatamente evidenziato anche la redditività economica e la convenienza di fattibilità finanziaria dello Scenario Sostenibile, valutando un favorevole Pay Back\recupero monetario (entro soli cinque anni dall’intervento ecologico) del differenziale costo aggiuntivo dovuto alle opere aggiuntive di passivazione. C’è una lacuna nel mondo reale e una forte richiesta nel mondo della ricerca (Hopkins, 2016) di valutazione riguardante la fattibilità finanziaria della Strategia “Green Building”, e la ricerca presentata mira a contribuire a rispondere a queste esigenze di valutazione economica.

BackgroundSurgery for type A aortic dissection (TAAD) is associated with high risk of mortality. Current risk scoring methods have a limited predictive accuracy.MethodsSubjects were patients who underwent surgery for acute TAAD at 18 European centers of cardiac surgery from the European Registry of Type A Aortic Dissection (ERTAAD).ResultsOut of 3,902 patients included in the ERTAAD, 2,477 fulfilled the inclusion criteria. In the validation dataset (2,229 patients), the rate of in-hospital mortality was 18.4%. The rate of composite outcome (in-hospital death, stroke/global ischemia, dialysis, and/or acute heart failure) was 41.2%, and 10-year mortality rate was 47.0%. Logistic regression identified the following patient-related variables associated with an increased risk of in-hospital mortality [area under the curve (AUC), 0.755, 95% confidence interval (CI), 0.729–0.780; Brier score 0.128]: age; estimated glomerular filtration rate; arterial lactate; iatrogenic dissection; left ventricular ejection fraction ≤50%; invasive mechanical ventilation; cardiopulmonary resuscitation immediately before surgery; and cerebral, mesenteric, and peripheral malperfusion. The estimated risk score was associated with an increased risk of composite outcome (AUC, 0.689, 95% CI, 0.667–0.711) and of late mortality [hazard ratio (HR), 1.035, 95% CI, 1.031–1.038; Harrell's C 0.702; Somer's D 0.403]. In the validation dataset (248 patients), the in-hospital mortality rate was 16.1%, the composite outcome rate was 41.5%, and the 10-year mortality rate was 49.1%. The estimated risk score was predictive of in-hospital mortality (AUC, 0.703, 95% CI, 0.613–0.793; Brier score 0.121; slope 0.905) and of composite outcome (AUC, 0.682, 95% CI, 0.614–0.749). The estimated risk score was predictive of late mortality (HR, 1.035, 95% CI, 1.031–1.038; Harrell's C 0.702; Somer's D 0.403), also when hospital deaths were excluded from the analysis (HR, 1.024, 95% CI, 1.018–1.031; Harrell's C 0.630; Somer's D 0.261).ConclusionsThe present analysis identified several baseline clinical risk factors, along with preoperative estimated glomerular filtration rate and arterial lactate, which are predictive of in-hospital mortality and major postoperative adverse events after surgical repair of acute TAAD. These risk factors may be valuable components for risk adjustment in the evaluation of surgical and anesthesiological strategies aiming to improve the results of surgery for TAAD.Clinical Trial Registrationhttps://clinicaltrials.gov, identifier NCT04831073.

Abstract Background Hierarchical modelling represents a statistical method used to analyze nested data, as those concerning patients afferent to different hospitals. Aim of this paper is to build a hierarchical regression model using data from the "Italian CABG outcome study" in order to evaluate the amount of differences in adjusted mortality rates attributable to differences between centres. Methods The study population consists of all adult patients undergoing an isolated CABG between 2002–2004 in the 64 participating cardiac surgery centres. A risk adjustment model was developed using a classical single-level regression. In the multilevel approach, the variable "clinical-centre" was employed as a group-level identifier. The intraclass correlation coefficient was used to estimate the proportion of variability in mortality between groups. Group-level residuals were adopted to evaluate the effect of clinical centre on mortality and to compare hospitals performance. Spearman correlation coefficient of ranks (ρ) was used to compare results from classical and hierarchical model. Results The study population was made of 34,310 subjects (mortality rate = 2.61%; range 0.33–7.63). The multilevel model estimated that 10.1% of total variability in mortality was explained by differences between centres. The analysis of group-level residuals highlighted 3 centres (VS 8 in the classical methodology) with estimated mortality rates lower than the mean and 11 centres (VS 7) with rates significantly higher. Results from the two methodologies were comparable (ρ = 0.99). Conclusion Despite known individual risk-factors were accounted for in the single-level model, the high variability explained by the variable "clinical-centre" states its importance in predicting 30-day mortality after CABG.

Clinically significant portal hypertension (CSPH) in patients with compensated advanced chronic liver disease indicates an increased risk of decompensation and death. While invasive methods like hepatic venous–portal gradient measurement is considered the gold standard, non-invasive tests (NITs) have emerged as valuable tools for diagnosing and monitoring CSPH. This review comprehensively explores non-invasive diagnostic modalities for portal hypertension, focusing on NITs in the setting of hepatitis B and hepatitis C virus-related cirrhosis. Biochemical-based NITs can be represented by single serum biomarkers (e.g., platelet count) or by composite scores that combine different serum biomarkers with each other or with demographic characteristics (e.g., FIB-4). On the other hand, liver stiffness measurement and spleen stiffness measurement can be assessed using a variety of elastography techniques, and they can be used alone, in combination with, or as a second step after biochemical-based NITs. The incorporation of liver and spleen stiffness measurements, alone or combined with platelet count, into established and validated criteria, such as Baveno VI or Baveno VII criteria, provides useful tools for the prediction of CSPH and for ruling out high-risk varices, potentially avoiding invasive tests like upper endoscopy. Moreover, they have also been shown to be able to predict liver-related events (e.g., the occurrence of hepatic decompensation). When transient elastography is not available or not feasible, biochemical-based NITs (e.g., RESIST criteria, that are based on the combination of platelet count and albumin levels) are valid alternatives for predicting high-risk varices both in patients with untreated viral aetiology and after sustained virological response. Ongoing research should explore novel biomarkers and novel elastography techniques, but current evidence supports the utility of routine blood tests, LSM, and SSM as effective surrogates in diagnosing and staging portal hypertension and predicting patient outcomes.

Background: Acute type A aortic dissection (TAAD) is associated with significant mortality and morbidity. In this study we evaluated the prognostic significance of preoperative arterial lactate concentration on the outcome after surgery for TAAD. Methods: The ERTAAD registry included consecutive patients who underwent surgery for acute type A aortic dissection (TAAD) at 18 European centers of cardiac surgery. Results: Data on arterial lactate concentration immediately before surgery were available in 2798 (71.7 %) patients. Preoperative concentration of arterial lactate was an independent predictor of in-hospital mortality (mean, 3.5 ± 3.2 vs 2.1 ± 1.8 mmol/L, adjusted OR 1.181, 95%CI 1.129–1.235). The best cutoff value preoperative arterial lactate concentration was 1.8 mmol/L (in-hospital mortality, 12.0 %, vs. 26.6 %, p

Abstract Background Patients with severe aortic stenosis and left ventricular systolic dysfunction have a poor prognosis, and this may result in inferior survival also after aortic valve replacement. The outcomes of transcatheter and surgical aortic valve replacement were investigated in this comparative analysis. Methods The retrospective nationwide FinnValve registry included data on patients who underwent transcatheter or surgical aortic valve replacement with a bioprosthesis for severe aortic stenosis. Propensity score matching was performed to adjust the outcomes for baseline covariates of patients with reduced (≤ 50%) left ventricular ejection fraction. Results Within the unselected, consecutive 6463 patients included in the registry, the prevalence of reduced ejection fraction was 20.8% (876 patients) in the surgical cohort and 27.7% (452 patients) in the transcatheter cohort. Reduced left ventricular ejection fraction was associated with decreased survival (adjusted hazards ratio 1.215, 95%CI 1.067–1.385) after a mean follow-up of 3.6 years. Among 255 propensity score matched pairs, 30-day mortality was 3.1% after transcatheter and 7.8% after surgical intervention (p = 0.038). One-year and 4-year survival were 87.5% and 65.9% after transcatheter intervention and 83.9% and 69.6% after surgical intervention (restricted mean survival time ratio, 1.002, 95%CI 0.929–1.080, p = 0.964), respectively. Conclusions Reduced left ventricular ejection fraction was associated with increased morbidity and mortality after surgical and transcatheter aortic valve replacement. Thirty-day mortality was higher after surgery, but intermediate-term survival was comparable to transcatheter intervention. Trial registration The FinnValve registry ClinicalTrials.gov Identifier: NCT03385915.

Abstract Background Diabetes Mellitus (DM) affects a third of patients with symptomatic severe aortic valve stenosis undergoing transcatheter aortic valve implantation (TAVI). DM is a well-known risk factor for cardiac surgery, but its prognostic impact in TAVI patients remains controversial. This study aimed to evaluate outcomes in diabetic patients undergoing TAVI. Methods This multicentre registry includes data of > 12,000 patients undergoing transfemoral TAVI. We assessed baseline patient characteristics and clinical outcomes in patients with DM and without DM. Clinical outcomes were defined by the second valve academic research consortium. Propensity score matching was applied to minimize potential confounding. Results Of the 11,440 patients included, 31% (n = 3550) had DM and 69% (n = 7890) did not have DM. Diabetic patients were younger but had an overall worse cardiovascular risk profile than non-diabetic patients. All-cause mortality rates were comparable at 30 days (4.5% vs. 4.9%, RR 0.9, 95%CI 0.8–1.1, p = 0.43) and at one year (17.5% vs. 17.4%, RR 1.0, 95%CI 0.9–1.1, p = 0.86) in the unmatched population. Propensity score matching obtained 3281 patient-pairs. Also in the matched population, mortality rates were comparable at 30 days (4.7% vs. 4.3%, RR 1.1, 95%CI 0.9–1.4, p = 0.38) and one year (17.3% vs. 16.2%, RR 1.1, 95%CI 0.9–1.2, p = 0.37). Other clinical outcomes including stroke, major bleeding, myocardial infarction and permanent pacemaker implantation, were comparable between patients with DM and without DM. Insulin treated diabetics (n = 314) showed a trend to higher mortality compared with non-insulin treated diabetics (n = 701, Hazard Ratio 1.5, 95%CI 0.9–2.3, p = 0.08). EuroSCORE II was the most accurate risk score and underestimated 30-day mortality with an observed-expected ratio of 1.15 in DM patients, STS-PROM overestimated actual mortality with a ratio of 0.77 and Logistic EuroSCORE with 0.35. Conclusion DM was not associated with mortality during the first year after TAVI. DM patients undergoing TAVI had low rates of mortality and other adverse clinical outcomes, comparable to non-DM TAVI patients. Our results underscore the safety of TAVI treatment in DM patients. Trial registration The study is registered at clinicaltrials.gov (NCT03588247).

Invasive annual grasses pose a severe threat to drylands of the United States by increasing habitat degradation and the occurrence and severity of wildfires, while simultaneously outcompeting native species. Advances in technology and accessibility of small uncrewed aerial vehicles (sUAV) provide the opportunity for small preserve managers to map and monitor plant invasions in critical habitats for rare and endemic plant species. Many remote sensing techniques rely on the invasive plants' different phenological signals to distinguish them from native plants and habitats. However, invasive annual grasses in the western United States have high variability of interannual productivity and may not green up each year. Therefore, our objective was to use an sUAV (quadcopter drone) to map invasive annual grass regardless of phenological stage in critical Mojave Desert habitat. The study locations were White Dome, a small habitat preserve, and Beehive Dome in Washington County UT, USA. These areas are critical habitats for several endangered and threatened plant species and are covered with sensitive biological soil crusts, making on-the-ground measurements destructive. Using imagery collected with an sUAV we created red, green, blue (RGB) orthomosaics and calculated the Visible Atmospherically Resistant Index (VARI) across these areas. We successfully mapped the litter of invasive annual grasses at one of the two sites. At White Dome, we attained 95.2 % and 84.3 % Producer's and User's Accuracy in mapping invasive annual grasses based on the RGB spectral signature of invasive grass litter. At Beehive Dome, the heterogeneous nature of the edaphic and topographical features made it difficult to accurately map (

Objective: This study sought to investigate the effect of body mass index on outcomes in patients with severe aortic valve stenosis undergoing transcatheter aortic valve implantation. Methods: A total of 12,381 patients undergoing transfemoral transcatheter aortic valve implantation were divided into body mass index categories: underweight (30 kg/m2). Primary endpoints were differences in 30-day and 1-year all-cause mortality. Secondary endpoints included all other clinical endpoints such as stroke. Univariate and multivariate odds ratios were calculated using logistic and cox regression analyses. Results: Two percent (n = 205) of patients were underweight, 29% (n = 3564) were normal weight, 44% (n = 5460) were overweight, and 25% (n = 3152) were obese. Thirty-day mortality was lower in overweight (5.3%, odds ratio, 0.73; 95% confidence interval, 0.61-0.88; P = .001) and obese patients (5.2%, odds ratio, 0.74; 95% confidence interval, 0.60-0.92; P = .006), but higher in underweight (9.8%, odds ratio, 1.51; 95% confidence interval, 0.92-2.47; P = .010) as compared to normal weight patients (6.9%). After multivariate adjustment, 30-day mortality was not significantly different across body mass index categories. However, 1-year mortality was higher in underweight patients (hazard ratio, 1.52; 95% confidence interval, 1.10-2.09; P = .011). Stroke rates were comparable between body mass index groups. Conclusions: For overweight and obese patients with severe aortic valve stenosis undergoing transcatheter aortic valve implantation, there was no 30-day difference in mortality compared with patients with normal weight. However, underweight patients showed higher rates of 1-year mortality after transcatheter aortic valve implantation.

Abstract Background There is limited information on the longer-term outcome after transcatheter aortic valve replacement (TAVR) with new-generation prostheses compared to surgical aortic valve replacement (SAVR). The aim of this study was to compare the mid-term outcomes after TAVR with Sapien 3 and SAVR with Perimount Magna Ease bioprostheses for severe aortic stenosis. Methods In a retrospective study, we included patients who underwent transfemoral TAVR with Sapien 3 or SAVR with Perimount Magna Ease bioprosthesis between January 2008 and October 2017 from the nationwide FinnValve registry. Propensity score matching was performed to adjust for differences in the baseline characteristics. The Kaplan-Meir method was used to estimate late mortality. Results A total of 2000 patients were included (689 in the TAVR cohort and 1311 in the SAVR cohort). Propensity score matching resulted in 308 pairs (STS score, TAVR 3.5 ± 2.2% vs. SAVR 3.5 ± 2.8%, p = 0.918). In-hospital mortality was 3.6% after SAVR and 1.3% after TAVR (p = 0.092). Stroke, acute kidney injury, bleeding and atrial fibrillation were significantly more frequent after SAVR, but higher rate of vascular complications was observed after TAVR. The cumulative incidence of permanent pacemaker implantation at 4 years was 13.9% in the TAVR group and 6.9% in the SAVR group (p = 0.0004). At 4-years, all-cause mortality was 20.6% for SAVR and 25.9% for TAVR (p = 0.910). Four-year rates of coronary revascularization, prosthetic valve endocarditis and repeat aortic valve intervention were similar between matched cohorts. Conclusions The Sapien 3 bioprosthesis achieves comparable midterm outcomes to a surgical bioprosthesis with proven durability such as the Perimount Magna Ease. However, the Sapien 3 bioprosthesis was associated with better early outcome. Trial registration ClinicalTrials.gov Identifier: NCT03385915 .

The European Commission adopted the European Adaptation Strategy obliging all the Member States to implement national plans in order to to cope with the inevitable Climate Change impacts by 2017. Creating a waterproof city requires intensive cooperation, public awareness and citizen involvement. The issues are very topical because of the recent increase in extreme events related to climate change: heavy rains, tornadoes, water scarcity, drought. Recent years have witnessed phenomena due to climate change, with temperatures and rainfall levels that are of significant interest not when drawing up average figures, but especially in the maximum seasonal and daily peak intensity figures. The methodology looks at some case studies that have been characterized by the experimentation of policies and strategies for the successful adaptation and mitigation of hydraulic risks, in particular with regard to the preparation of climate adaptation strategies that have been tested successfully in some cities like Copenhagen, Rotterdam and Vancouver. The main goals and results of the research are related to the possibility of repeating the most successful proceedures, with the aim of providing the municipalities of Southern Italy, and in particular of the Calabrian and Sicilian areas, with the appropriate tools and strategies to create waterproof cities with the full involvement of the settled communities. Creare una Waterproof City lungo il mare Mediterraneo La Commissione europea ha adottato la strategia europea di adattamento con l'obbligo per tutti gli Stati membri di attuare piani nazionali per far fronte agli impatti dei cambiamenti climatici entro il 2017. Creare una città waterproof richiede un'intensa cooperazione ed un forte coinvolgimento dei cittadini. Le questioni sono di grande attualità a causa del recente aumento degli eventi estremi legati ai cambiamenti climatici: forti piogge, tornado, scarsità d'acqua, siccità. Negli ultimi anni ci sono stati fenomeni dovuti ai cambiamenti climatici, con temperature e precipitazioni che hanno valori significativi di interesse non nella conformazione del valore medio, ma soprattutto nella massima intensità di picco stagionale e giornaliera. La metodologia prevede lo studio di alcuni casi studio in italia e nel mondo che si sono caratterizzati per la sperimentazione di politiche e strategie di successo nell’adattamento e mitigazione dei rischi idraulici, in particolare riguardo la predisposizione di strategie di adattamento climatico che sono state sperimentate con successo in alcune città come Copenhagen, Rotterdam, Vancouver…Gli obiettivi ed i risultati della ricerca sono relativi alla replicabilità delle best practices analizzate, con lo scopo di fornire ai comuni del Mezzogiorno italiano, ed in particolare delle zone di studio calabresi e siciliane, gli opportuni strumenti e strategie per realizzare delle waterproof city con il pieno coinvolgimento delle comunità insediate.

Recent studies suggest that X-linked glucose-6-phosphate dehydrogenase (G6PD) deficiency entails a proinflammatory state that may increase the risk of several disease conditions. However, it is not clear how this relates to the degree of enzyme insufficiency and, in heterozygous females, to skewed inactivation of the X chromosome. This study aimed to (i) investigate the enzyme activity in a cohort of 232 subjects (54.3% females) from Northern Sardinia, Italy, further stratified into three subgroups (G6PD normal, partial deficiency and total deficiency); (ii) measure the levels of some non-specific inflammatory markers, such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and those derived from cell counts, such as neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR) and platelet-to-lymphocyte ratio (PLR), in relation to the underlying molecular defect and X inactivation. G6PD activity was measured in red blood cells according to G6PD/6PGD ratio, and X-chromosome inactivation was assessed by the HUMARA method. Overall, ESR was increased in males with total deficiency compared with normal males (15.0 ± 7.2 vs. 11.9 ± 6.2, p = 0.002, Tukey’s test), albeit not in males with partial deficiency. High-sensitivity CRP was slightly increased in males with total deficiency, compared to males with normal G6PD activity (5.96 ± 3.39 vs. 3.95 ± 2.96, p = 0.048). In females, neither marker showed significant differences across the subgroups. MLR was significantly and progressively increased from normal to totally deficient subjects with intermediate values in partially deficient subjects (0.18, 0.31 and 0.37, ANOVA p = 0.008). The NLR and PLR were not different in the three subgroups. Our findings show that G6PD deficiency may be associated with a proinflammatory profile, especially in elderly females, and worsened by the concomitant asymmetric inactivation of the X chromosome.

The impact of thrombocytopenia on postoperative bleeding and other major adverse events after cardiac surgery is unclear. This issue was investigated in a series of patients who underwent isolated coronary artery bypass grafting (CABG) from the prospective, multicenter E-CABG registry. Preoperative thrombocytopenia was defined as preoperative platelet count

Background. Cardiac contractility modulation (CCM) is a novel device-based therapy for patients with heart failure with reduced and mild reduced ejection fraction (HFrEF/HFmrEF). CCM increases cardiac performance and produces reverse left ventricular remodeling, with improved symptoms, functional capacity, quality of life, and reduced HF-related hospitalizations. However, to date, little evidence is available on the effects of CCM on right ventricle (RV) function. Therefore, we analyzed the effects of CCM on RV systolic function and RV–pulmonary artery (PA) coupling. Methods. Twenty-one (65 ± 12.5 years) patients with NYHA class III, ejection fraction < 40% and QRS < 120 ms were assessed at baseline. During follow up, two patients had died, and so nineteen patients were evaluated six months after CCM therapy. Using echocardiography, tricuspid annular systolic excursion (TAPSE), myocardial systolic excursion velocity (RVs), and RV free-wall strain was measured. PA systolic pressure (PASP) was estimated from tricuspid regurgitation, adding the right atrial pressure estimation. The RV-PA coupling was calculated as TAPSE/PASP ratio. Results. After six months, patients who underwent CCM therapy showed a reduction in RV diameters and improved RV systolic function, as evidenced by the increase in both TAPSE (16.6 ± 4.2 mm vs. 18.5 ± 3.6 mm; p < 0.05), RVs (10.1 ± 1.8 cm/s vs. 11.3 ± 11.4 cm/s; p < 0.05), and RV strain (−13.7 ± 1.8% vs. −15.6 ± 2.3%; p < 0.05). CCM also determined a reduction in PASP (34.2 ± 9.8 mmHg vs. 28 ± 6.2 mmHg; p < 0.05) and an increase in the TAPSE/PASP ratio (0.52 ± 0.14 mm/mmHg vs. 0.66 ± 0.23 mm/mmHg; p < 0.05). Conclusions. At six months, CCM increases RV reverse remodeling and performance, reducing RV size and improving RV systolic function, PASP, and RV-PA coupling.

Human modification of water and nutrient flows has resulted in widespread degradation of aquatic ecosystems. The resulting global water crisis causes millions of deaths and trillions of USD in economic damages annually. Semiarid regions have been disproportionately affected because of high relative water demand and pollution. Many proven water management strategies are not fully implemented, partially because of a lack of public engagement with freshwater ecosystems. In this context, we organized a large citizen science initiative to quantify nutrient status and cultivate connection in the semiarid watershed of Utah Lake (USA). Working with community members, we collected samples from ~200 locations throughout the 7,640 km2 watershed on a single day in the spring, summer, and fall of 2018. We calculated ecohydrological metrics for nutrients, major ions, and carbon. For most solutes, concentration and leverage (influence on flux) were highest in lowland reaches draining directly to the lake, coincident with urban and agricultural sources. Solute sources were relatively persistent through time for most parameters despite substantial hydrological variation. Carbon, nitrogen, and phosphorus species showed critical source area behavior, with 10-17% of the sites accounting for most of the flux. Unlike temperate watersheds, where spatial variability often decreases with watershed size, longitudinal variability showed an hourglass shape: high variability among headwaters, low variability in mid-order reaches, and high variability in tailwaters. This unexpected pattern was attributable to the distribution of human activity and hydrological complexity associated with return flows, losing river reaches, and diversions in the tailwaters. We conclude that participatory science has great potential to reveal ecohydrological patterns and rehabilitate individual and community relationships with local ecosystems. In this way, such projects represent an opportunity to both understand and improve water quality in diverse socioecological contexts.

To date, reliable tests enabling the identification of celiac disease (CD) patients at a greater risk of developing poly-autoimmune diseases are not yet available. We therefore aimed to identify non-invasive microbial biomarkers, useful to implement diagnosis of poly-autoimmunity. Twenty CD patients with poly-autoimmunity (cases) and 30 matched subjects affected exclusively by CD (controls) were selected. All patients followed a varied gluten-free diet for at least 1 year. Fecal microbiota composition was characterized using bacterial 16S ribosomal RNA gene sequencing. Significant differences in gut microbiota composition between CD patients with and without poly-autoimmune disease were found using the edgeR algorithm. Spearman correlations between gut microbiota and clinical, demographic, and anthropometric data were also examined. A significant reduction of Bacteroides, Ruminococcus, and Veillonella abundances was found in CD patients with poly-autoimmunity compared to the controls. Bifidobacterium was specifically reduced in CD patients with Hashimoto's thyroiditis and its abundance correlated negatively with abdominal circumference values in patients affected exclusively by CD. In addition, the duration of CD correlated with the abundance of Firmicutes (negatively) and Odoribacter (positively), whereas the abundance of Desulfovibrionaceae correlated positively with the duration of poly-autoimmunity. This study provides supportive evidence that specific variations of gut microbial taxa occur in CD patients with poly-autoimmune diseases. These findings open the way to future validation studies on larger cohorts, which might in turn lead to promising diagnostic applications.

The manuscript investigate the travel behavior in three saudi cities: Riyadh, Dammam and Buraydah. The whole transport system, accessibility and different mobility are related to urban strategies, urban patterns and to urban plans that, at different level, manage the country defining aims and strategies for the development and management of the territory. Travel behavior inside these three important and different cities is influenced by the whole urban structure, by economy reason and by urban and political strategies. Not less important are social factors that has to be studied and has to inspire every urban action. Make more diversified, dynamic and modern economy seems to be the priority of national agenda of Kingdom of Saudi Arabia. As happened in the past, exogenous factors are addressing a rapid transformation of the public policy, in which urban mobility is one main paradigm. In this framework, a part of paper focused on the main determinants of urban travel behavior and the blueprint agenda of government to make more transit oriented the cities. Although the urban travel behavior is complex phenomena in Saudi Arabia, of which the main effect is related to massive car dependency of people for mobility, some clarifications would suggest the approach to analyse current factors are impacting on national choices and introduce ideas to make urban policy part of a bigger project.

The Netherlands is a fragile and vulnerable land; dutch landscape consists of a dense network of polders characterized by key elements such as dams, windmills and farms; it is a unique landscape but, at the same time, is very fragile and constantly changing; spatial planning is very important, just as important is the resilience of the system and its adaptation to climate change. Rotterdam is a delta city and, in a period of heavy climate change, it will experiment more extreme weather conditions, such as heavier rainstorms, longer periods of drought and more heat waves, as well as higher water levels in the river Meuse; so is important to know that it is a deep vulnerable city and need right strategies to overcome the problem and to be adapted to conseguences of climate change. Resilience has been under the attention of the municipality for about fifteen years; Rotterdam is the inspiring example to other delta cities around the world going through a sustainability approach; as a green city is an attractive and resilient city where people love to live, work and relax; sustainability is an integral part of all area development projects in Rotterdam; sustainable areas are future-proof areas with good living conditions. In Rotterdam, architects and urban designers are finally responding to the threats of rising sea levels by "welcoming the water" into city, so the waterscape is becoming a new paradigm of spatial planning; Rotterdam is striving to become a climate proof city that will be safe and attractive to inhabitants, visitors and businesses, and will remain so in the future. A healthy delta city in which it is pleasant to live, work and spend leisure time.

We report the case of a 65-year-old man with acute GFR decline to 37 mL/min and uncontrolled high blood pressure. He was suspected for renovascular hypertension and underwent a renal color Doppler ultrasound scan that detected a bilateral atherosclerotic renal artery stenosis. A digital selective angiography by percutaneous transluminal angioplasty and stenting (PTRAs) was successfully performed. Blood pressure rapidly normalized, GFR increased within a few days, and proteinuria disappeared thereafter. These clinical goals were accompanied by a significant increase of circulating renal stem cells (RSC) and a slight increase of resistive index (RI) in both kidneys. This single observation suggests the need for extensive studies aimed at evaluating the predictive power of RI and RSC in detecting post-ischemic renal repair mechanisms.

Bleeding is one of the most frequent complications in patients undergoing transcatheter aortic valve replacement (TAVR). Importantly, major bleeding is associated with poor clinical outcomes after TAVR. However, large studies on bleeding complications in the contemporary TAVR population are limited. The aim of this study was to assess the incidence, temporal trends, clinical outcomes, and predictors of bleeding in patients undergoing transfemoral TAVR. The CENTER2 study is a pooled patient-level database from 10 clinical studies including patients who underwent TAVR between 2007 and 2022. A total of 23,562 patients underwent transfemoral TAVR. The mean age was 81.5 ± 6.7 years, and 56% were women. Major bleeding within the first 30 days was observed in 1,545 patients (6.6%). Minor bleeding was reported in 1,143 patients (4.7%). Rates of major bleeding decreased from 11.5% in 2007-2010 to 5.5% in 2019-2022 (P trend < 0.001). Dual antiplatelet therapy was associated with higher major bleeding rates compared with single antiplatelet therapy (12.2% vs 9.1%; OR: 1.40; 95% CI: 1.13-1.72; P = 0.002). Patients with major bleeding had increased mortality risk during the first 30 days (14.1% vs 4.3%; OR: 3.66; 95% CI: 3.11-4.31; P < 0.001) and during 1-year follow-up (27.8% vs 14.5%; HR: 1.50; 95% CI: 1.41-1.59; P < 0.001). Minor bleeding did not affect 1-year mortality risk (16.7% vs 14.5%; HR: 1.11; 95% CI: 0.93-1.32; P = 0.27). Predictors of major bleeding were female sex and peripheral vascular disease. Bleeding complications remain frequent and important in patients undergoing transfemoral TAVR. Increased mortality risk in major bleeding persists after the initial 30 days. (Cerebrovascular Events in Patients Undergoing Transcatheter Aortic Valve Implantation With Balloon-Expandable Valves Versus Self-Expandable Valves [CENTER]; NCT03588247) [Display omitted] [ABSTRACT FROM AUTHOR]

Treatment with β-blockers is the main strategy for managing patients with heart failure and reduced ejection fraction because of their ability to reverse the neurohumoral effects of the sympathetic nervous system, with consequent prognostic and symptomatic benefits. However, to date, they are underused, mainly because of the misconception that hypotension and bradycardia may worsen the haemodynamic status of patients with HFrEF and because of the presence of comorbidities falsely believed to be absolute contraindications to their use. To promote proper use of β-blockers in this article, we review the clinical pharmacology of β-blockers, the evidence of the beneficial effects of these drugs in heart failure with reduced ejection fraction, and the current guidelines for their use in clinical practice and in the presence of comorbidities (e.g., pulmonary disease, diabetes, atrial fibrillation, peripheral arterial disease, etc.). It is hoped that the practical approach discussed in this review will allow for a proper diffusion of knowledge about the correct use of β-blockers and the drug-disease interactions to achieve their increased use and titration, as well as for the selection of a specific agent with a view to a properly tailored approach for HFrEF patients.

The risk of recurrent events among survivors of acute myocardial infarction (AMI) is understudied. The aim of this analysis was to investigate the role of residual high thrombotic risk (HTR) as a predictor of recurrent in-hospital events after AMI. This retrospective cohort study included 186,646 patients admitted with AMI from 2009 to 2010 in all Italian hospitals who were alive 30 days after the index event. HTR was defined as at least one of the following in the 5 years preceding AMI: previous myocardial infarction, ischemic stroke/other vascular disease, type 2 diabetes mellitus, renal failure. Risk adjustment was performed in all multivariate survival analyses. Rates of major cardiac and cerebrovascular events (MACCE) within the following 5 years were calculated in both patients without fatal readmissions at 30 days and in those free from in-hospital MACCE at 1 year from the index hospitalization. The overall 5-year risk of MACCE was higher in patients with HTR than in those without HTR, in both survivors at 30 days [hazard ratio (HR), 1.49; 95% confidence interval (CI), 1.45-1.52; p

The authors aimed to investigate life expectancy after adult cardiac surgery. Nationwide study including University and non-University hospitals. Consecutive adult patients who underwent heart valve and coronary artery surgery from a nationwide administrative registry. Surgical procedures on the heart valves and coronary arteries. The authors estimated the 10-year relative survival of adult patients who underwent surgery for heart valve diseases and coronary artery disease taken from a nationwide administrative registry. Overall, data on 415,472 patients were available for this study. Among them, 394,445 (94.9%) survived 90 days after surgery, and their 10-year survival was 58.0% (95% CI 57.8-58.3); the expected survival was 70.1%, and the relative survival was 0.83 (95% CI 0.82-0.83). Patients who underwent surgical repair of the mitral valve and aortic valve had relative survival of 0.96 and 0.92, respectively. Isolated coronary artery bypass grafting had a relative survival of 0.88. Surgical replacement of the heart valves had a relative survival below 0.80. Poor results with relative survival <0.70 were observed after complex cardiac surgery. Relative survival was <0.60 in patients who underwent double- or triple-valve surgery combined with coronary artery surgery. The authors observed markedly lower relative survival among women (0.77, 95% CI 0.77-0.78) compared with men (0.86, 95% CI 0.85-0.86) at 10 years. Such a difference was observed after almost all different procedures. The present findings provided a picture of the real expectation in terms of the late survival of patients after having undergone adult cardiac surgery. This information should be communicated to patients and their relatives before surgery, and it may be relevant in the decision-making process and in planning tertiary prevention. [ABSTRACT FROM AUTHOR]

Air pollution causes more damage to health and economy than previously understood, contributing to approximately one in six deaths globally. However, pollution reduction policies remain controversial even when proven effective and cost negative, partially because of misunderstanding and growing mistrust in science. We used an expert assessment to bridge these research–policy divides in the State of Utah, USA, combining quantitative estimates from 23 local researchers and specialists on the human health and economic costs of air pollution. Experts estimated that air pollution in Utah causes 2480 to 8000 premature deaths annually (90% confidence interval) and decreases the median life expectancy by 1.1 to 3.6 years. Economic costs of air pollution in Utah totaled $0.75 to $3.3 billion annually, up to 1.7% of the state’s gross domestic product. Though these results were generally in line with available estimates from downscaled national studies, they were met with surprise in the state legislature, where there had been an almost complete absence of quantitative health and economic cost estimates. We discuss the legislative and personal responses of Utah policy makers to these results and present a framework for increasing the assimilation of data into decision making via regional expert assessment. In conclusion, combining quantitative assessments from local experts is a responsive and cost-effective tool to increase trust and information uptake during time-sensitive policy windows.

The relationship between body height and the risk of non‒communicable diseases such as cardiovascular disease and cancer has been the subject of much debate in the epidemiological literature. Concerns have recently arisen over spurious associations due to confounding factors like birth cohort, especially in the context of epidemiological transition. The population of Sardinia represents an interesting case study, as the average physical stature of inhabitants was the lowest recorded in Europe until a few decades ago. In this population we tested whether height is an independent risk factor for cardiovascular disease and cancer. We analysed the stature of 10,427 patients undergoing endoscopy for any reason, for whom a detailed clinical history of cardiovascular disease and/or malignancies had been documented. Poisson regression modelling was used to test the association between stature and disease risk. When patients were subdivided according to sex and height tertiles, the risk of cardiovascular disease proved significantly greater for subjects in the lowest tertile irrespective of sex (men: 1.87; 95%CI 1.41‒2.47; women: 1.23; 95%CI 0.92‒1.66) and smaller for those in the highest tertile (men: 0.51; 95%CI 0.35‒0.75; women: 0.41; 95%CI 0.27‒0.61). However, after adjusting the risk for birth cohort and established risk factors, it mostly resulted in non-significant values, although the overall trend persisted. Similar results were obtained for all-cancer risk (relative risk for men and women in the lowest tertile: 1.44; 95%CI 1.09-1.90 and 1.17; 95%CI 0.93-1.48, in the highest tertile: 0.51; 95%CI 0.36-0.72 and 0.62; 95%CI 0.47-0.81, respectively) as well as for some of the most common types of cancer. We concluded that the risk of developing cardiovascular disease and malignancies does not vary significantly with stature in the Sardinian population, after adjusting for birth cohort and more obvious risk factors.

OBJECTIVE: SARS-CoV-2 causes acute respiratory disease, interstitial and alveolar pneumonia, and involves numerous organs and systems such as the kidney, heart, digestive tract, blood, and nervous system. We aimed to evaluate the incidence of renal manifestations in patients diagnosed with COVID-19 infection. PATIENTS AND METHODS: We performed a monocentric, cross-sectional, observational study, conducted on 114 patients with SARSCoV-2. Clinical and laboratory parameters [renal function, serum electrolytes, inflammatory state, blood gas analysis, Interleukin 6 (IL-6) and urinalysis] were evaluated. The same values were checked out after two months (T1), however after negativization. RESULTS: We enrolled 114 patients (59 males) with a mean age of 63.8 ± 13.9 years. We found hematuria in 48 patients (55.8%), proteinuria in 33 patients (38.4%), leukocyturia in 61 patients (70.9%), acute kidney injury (AKI) in 28 patients (24.6%), AKI in chronic kidney disease (CKD) in 24 patients (21.1%). Moreover, we found a significant increase of inflammatory indexes as C Reactive Protein (CRP), lactic dehydrogenase (LDH), alpha 1 and alpha 2 globulins with a subsequent reduction at T1 (p = 0.016, p < 0.001, p = 0.005, p = 0.007; respectively). Hemoglobin and erythrocyte values significantly decreased (p < 0.001, p = 0.003, respectively), and we found lymphopenia (p < 0.001). Also, we found elevated levels of the D-Dimer (p < 0.001) and a significant increase in the International Normalized Ratio (INR) (p = 0.038). We also showed a significant improvement after negativization in oxygen partial pressure (p = 0.001) and oxygen saturation (p < 0.001) and a significant increase in pH (p = 0.018) and bicarbonate concentration (p = 0.042). Moreover, we found a significant increase in IL-6 (p = 0.004). Also, we reported mild hyponatremia and hypokalemia with subsequent significant recovery (p < 0.001, p < 0.001, respectively) and mild hypochloremia with a recovery to the limits of statistical significance (p = 0.053). At the entrance, we found an increase in serum glucose with a significant reduction during recovery (p < 0.001). CONCLUSIONS: The prevalence of AKI and/or CKD and/or abnormal urinalysis in patients diagnosed with COVID-19 on admission seems to be high and appears as a negative prognostic factor. Urinalysis appears to be very useful in unveiling the potential kidney impairment of COVID-19 patients; therefore, urinalysis could be used to reflect and predict the disease severity. We also recommend a careful evaluation of metabolic alterations, inflammatory states, and electrolytic disorders in COVID-19 patients. [ABSTRACT FROM AUTHOR]

This observational cohort study was designed by the PRIORITY (PRedictIng long-term Outcomes afteR Isolated coronary arTery bypass surgery) steering committee to evaluate the 10-year follow-up outcome of bilateral internal thoracic arteries (BITA) versus single internal thoracic artery. The PRIORITY project was designed to evaluate long-term outcome of 2 large prospective multicenter cohort studies of coronary artery bypass grafting. Clinical data on isolated coronary artery bypass grafting were merged with administrative data to collect follow-up information. The primary endpoint was the composite outcome of major adverse cardiac and cerebrovascular events at 10-year follow-up. Secondary endpoints were individual components of major adverse cardiac and cerebrovascular events at 10 years and surgical site complications or infections. A propensity score–based inverse probability treatment weighting (IPTW) was used to overcome the selection bias related to the observational nature of the study. The study population consisted of 10,988 patients who underwent isolated coronary artery bypass grafting. BITA was used in 23.5%. The use of BITA is related to lower incidence of major adverse cardiac and cerebrovascular events at 10 years (adjusted hazard ratio [HR] 0.88, 95% CI 0.79-0.98, P <.001). BITA correlated with better 10-year survival (IPTW adjusted HR 0.87, 95% CI 0.78-1.00, P =.05), re-revascularization (IPTW adjusted HR 0.83, 95% CI 0.74-0.92, P <.001), and myocardial infarction (IPTW adjusted HR 0.86, 95% CI 0.77-0.95, P =.005) but to increased incidence of surgical site complications or infections (HR 2.12, 95% CI 1.39-3.24, P <.001). In propensity-matched patients, use of BITA was associated with improved 10-year survival, freedom from repeat revascularization, and myocardial infarction but also higher incidence of surgical site complications. [ABSTRACT FROM AUTHOR]