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Nowadays, NiTi shape memory alloys have been extensively used for medical applications especially as transcatheter [6]. This research aims to investigate the effect of heat-treatment temperature on radial force of NiTi self-expanding atrial depressurized device. The function of this ADD is to expand and sustain the hole in the atrial septal and release the pressure in the heart chamber to an acceptable level, and subsequently, prevent it from closing again, without a repeating surgery. The device was made by braiding 72 NiTi wires with diameter 0.1 mm and formed to double-disc shape with 8 mm fenestration size. Heat-treatments were carried out at 560°C, 580°C, and 600°C for 10 min, respectively to obtain suitable mechanical properties and shape setting. In order to evaluate the basic performance of the device, phase transformation temperatures and radial force were investigated. The results show that ADD device can be formed perfectly and excellent superelasticity can be confirmed in all specimens at room temperature, irrespective of heat-treatment temperature. It is confirmed that both radial resistive force and chronic outward force greatly increase while the fenestration size decreases with increasing of compression load. This ensures that the device is able to resist compression of the heart wall. It can be concluded that the optimum heat-treatment temperature is 560°C since the low heat-treatment temperature produces less oxidation and the greatest recovery force.

BACKGROUND: Transcatheter Aortic Valve Implantation (TAVI) has been shown to provide comparable survival benefit and improvement in quality of life to surgical aortic valve replacement (SAVR) for treating patients with severe aortic stenosis (AS) at intermediate surgical risk. This study aimed to evaluate the cost-utility of TAVI compared with SAVR for severe aortic stenosis with intermediate surgical risk in Thailand. METHODS: A two-part constructed model was used to analyze lifetime costs and quality-adjusted life-years (QALYs) from societal and healthcare perspectives. The study cohort comprised severe AS patients at intermediate surgical risk with an average age of 80 years. The landmark trials were used to populate the model in terms of mortality and adverse event rates. All cost-related data and quality of life were based on Thai population. Costs and QALYs were discounted at 3% annually and presented as 2021 values. Incremental cost-effectiveness ratios (ICERs) were calculated. Deterministic and probabilistic sensitivity analyses were conducted. RESULTS: In comparison to SAVR, TAVI resulted in higher total cost (THB 1,717,132 [USD 52,415.51] vs. THB 893,524 [USD 27,274.84]) and higher QALYs (4.88 vs. 3.98) in a societal perspective. The estimated ICER was THB 906,937/QALY (USD 27,684.27/QALY). From a healthcare system perspective, TAVI also had higher total cost than SAVR (THB 1,573,751 [USD 48,038.79] vs. THB 726,342 [USD 22,171.63]) with similar QALYs gained to the societal perspective. The estimated ICER was THB 933,145/QALY (USD 933,145/QALY). TAVI was not cost-effective at the Thai willingness to pay (WTP) threshold of THB 160,000/QALY (USD 4,884/QALY). The results were sensitive to utility of either SAVR or TAVI treatment and cost of TAVI valve. CONCLUSION: In patients with severe AS at intermediate surgical risk, TAVI is not a cost-effective strategy compared with SAVR at the WTP of THB 160,000/QALY (USD 4,884/QALY) from the perspectives of society and healthcare system.

Subclinical atherosclerosis detected by increased coronary artery calcium (CAC) or arterial stiffness as reflected by cardio-ankle vascular index (CAVI) has been associated with major adverse cardiovascular events (MACEs). However, comparative data from these two assessments in the same population are still limited.From 2005 to 2013, patients with stable coronary artery disease (CAD), both asymptomatic and symptomatic who underwent both coronary computed tomography and CAVI were enrolled and followed for occurrence of MACEs (cardiovascular [CV] death, nonfatal myocardial infarction [MI], and nonfatal stroke) until December 2019. A cause-specific hazard model was applied to assess the associations of CAC score, and CAVI with long-term MACEs.A total of 8687 patients participated. Of them, CAC scores were 0, 1-99, 100-399, and ≥400 in 49.7%, 31.9%, 12.3%, and 6.1%, respectively. Arterial stiffness (CAVI ≥ 9.0) was associated with the magnitude of CAC in 23.8%, 36.3%, 44.5%, and 56.2%, respectively. During an average of 9.9 ± 2.4 years follow-up, MACEs occurred in 8.0% (95% CI: 7.4%, 8.6%) of subjects. After adjusting for covariables, CAC scores of 100-399 and ≥400, and CAVIs of ≥9.0 were found to independently predict the occurrence of MACEs with the hazard ratios (95% CI) of 1.70 (1.13, 1.98), 1.87 (1.33, 2.63), and 1.27 (1.06, 1.52), respectively. Other risk predictors were hypertension, diabetes mellitus (DM), chronic kidney disease (CKD), aspirin, and statin therapy.A CAC score ≥100 or a CAVI ≥ 9.0 predicts the long-term occurrence of MACEs in both asymptomatic and symptomatic patients with stable CAD. These two noninvasive tests can be used as screening tools to guide treatment for the prevention of future CV events.

Unchalee Permsuwan,1,2 Voratima Yoodee,1,3 Wacin Buddhari,4 Nattawut Wongpraparut,5 Tasalak Thonghong,6 Sirichai Cheewatanakornkul,7 Krissada Meemook,8 Pranya Sakiyalak,9 Pongsanae Duangpakdee,10 Jirawit Yadee1,2 1Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand; 2Center for Medical and Health Technology Assessment (CM-HTA), Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand; 3Pharmaceutical Care Training Center (PCTC), Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand; 4Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; 5Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; 6Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 7Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand; 8Division of Cardiology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 9Division of Cardio-Thoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; 10Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, ThailandCorrespondence: Jirawit Yadee, Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, 239 Suthep Road, Mueang Chiang Mai District, Chiang Mai, 50200, Thailand, Tel +66 5394-4351, Email jirawit.yadee@cmu.ac.thBackground: Transcatheter aortic valve implantation (TAVI) has been shown to be effective in treating patients with severe symptomatic AS who are high-risk population for conventional surgical aortic valve replacement (SAVR). This study aimed to evaluate the cost–utility of TAVI compared with SAVR for severe aortic stenosis with high surgical risk in Thailand.Methods: Lifetime costs and quality-adjusted life years (QALYs) from societal and healthcare perspectives were estimated using a two-part constructed model. The study population consisted of 80-year-old severe AS patients with high surgical risk. Mortality and complication rates were obtained from landmark trials. All cost–related and utility data were based on Thai population. Costs and QALYs were discounted at a rate of 3% annually and presented as 2021 values. Incremental cost-effectiveness ratios (ICERs) were computed. Sensitivity analyses were performed both deterministically and probabilistically.Results: The findings from a societal perspective revealed that TAVI treatment was associated with higher cost (THB 1,551,895 [USD 47,371.64] vs THB 548,438 [USD 16,741.09] and higher QALYs than SAVR treatment (3.15 vs 2.31 QALYs). The estimated ICER was THB 1,196,191/QALY (USD 36,513.78 QALY). For the healthcare system perspective, TAVI treatment resulted in a higher total cost than SAVR treatment (THB 1,451,317 [USD 44,301.49] vs THB 432,398 [USD 13,198.95]) with comparable gains in LY and QALYs from a societal perspective. The ICER was calculated to be THB 1,214,624/QALY (USD 37,076.42/QALY). TAVI was not cost-effective at the Thai willingness to pay (WTP) threshold of THB 160,000/QALY (USD 4884/QALY). The model was the most sensitive to changes in TAVI valve cost and TAVI or SAVR treatment utilities.Conclusion: TAVI is not a cost-effective strategy in patients with severe AS who are at high surgical risk when compared to SAVR at the WTP of THB 160,000/QALY (USD 4884/QALY) from the perspectives of society and the healthcare system.Keywords: cost–utility, transcatheter aortic valve implantation, transcatheter aortic valve replacement, severe aortic stenosis, high surgical risk

We evaluated early outcomes of transcatheter valve‐in‐valve (ViV) implantation in patients with degenerated bio‐prosthesis in tricuspid position. Total of 5 patients were included in our case series. Baseline native tricuspid valve etiology were highly varied ranging from chest wall trauma, Ebstein anomaly, rheumatic heart disease, infective endocarditis and complex congenital heart disease. These differences also made patient comorbidities highly varied. Procedure details were also varied due to different clinical and technical challenges. All cases underwent successful Tricuspid VIV implantation with satisfactory hemodynamics results. All patients experienced improved clinical symptoms at follow up., Transcatheter tricuspid valve‐in‐valve for patients with failed tricuspid bio‐prosthesis can be performed successfully and safely in broad variety of patients with varied underlying tricuspid valve pathology and patient comorbidities. The procedure opens new option for surgical valve selection in patients that required tricuspid valve surgery at young age.

Transcatheter mitral valve repair with the MitraClip, a catheter-based percutaneous edge-to-edge repair technique to correct mitral regurgitation (MR), has been demonstrated in Western studies to be an effective and safe MR treatment strategy. However, randomised clinical trial data on its use in Asian-Pacific patients is limited. Hence, the Asian Pacific Society of Cardiology convened an expert panel to review the available literature on MitraClip and to develop consensus recommendations to guide clinicians in the region. The panel developed statements on the use of MitraClip for the management of degenerative MR, functional MR, and other less common indications, such as acute MR, dynamic MR, hypertrophic obstructive cardiomyopathy, and MR after failed surgical repair. Each statement was voted on by each panel member and consensus was reached when 80% of experts voted ‘agree’ or ‘neutral’. This consensus-building process resulted in 10 consensus recommendations to guide general cardiologists in the evaluation and management of patients in whom MitraClip treatment is being contemplated.

A 32-year-old man with a medical history of chronic kidney disease on chronic hemodialysis and nontransfusion-dependent thalassemia was referred to the cardiology unit for evaluation before kidney transplantation. He denied any symptoms of chest pain, palpitation, or syncope. His family history was unremarkable for cardiac disease. His functional status was class I. His physical examination revealed a soft systolic ejection murmur at the left upper parasternal border. His chest radiograph demonstrated cardiomegaly without pulmonary edema. A routine 12-lead ECG was performed as shown in Figure 1. Figure 1. An initial 12-lead ECG. Please turn the page to read the diagnosis. The 12-lead ECG shows sinus rhythm with ST-segment–elevation in leads I and aVL and ST-segment–depression in leads III and aVF followed by the large bizarre T waves. The differential diagnosis for ST-segment–elevation includes conditions such as acute myocardial infarction, early repolarization, left ventricular hypertrophy, left bundle-branch block, acute pericarditis, hyperkalemia, Brugada syndrome, pulmonary embolism, and cardioversion.1 Infrequently, an artifact should be considered to be …

Post-infarct ventricular septal rupture is life-threatening condition, challenging in management. Surgical and transcatheter approach are treatment of choices. A 53 year-old female presented with chest pain for 1 day. Electrocardiogram had ST-elevation on inferior leads. Echocardiogram revealed

Arterial stiffness assessed by cardio-ankle vascular index (CAVI) is commonly used as a surrogate marker of subclinical atherosclerosis. The aim of study is to demonstrate the association of CAVI and coronary artery calcification (CAC) or coronary stenosis in the asymptomatic metabolic syndrome (MS

Objectives This study investigated characteristics and clinical impact of device-related thrombus formation after Watchman device implantation in atrial fibrillation (AF) patients. Background Left atrial appendage occlusion using the Watchman device is an effective alternative to anticoagulation for stroke prevention in AF patients. However, device-related thrombus formation remains an important concern after Watchman implantation. Methods From 2006 to 2014, 119 consecutive AF patients underwent Watchman implantation. Transesophageal echocardiographic (TEE) follow-up was scheduled at 45 days, at 6 months, and at 12 months after the procedure. The incidence, characteristics, and clinical course of device-related thrombus formation detected by TEE were assessed. Results Follow-up TEE identified thrombus formation on the Watchman device in 4 patients (3.4%). The prevalence of chronic AF was 100% in patients with thrombus, which was higher than that for patients without thrombus (40.0%). Deployed device size was numerically larger in patients with thrombus (29.3 ± 3.8 mm vs. 25.7 ± 3.2 mm, respectively). All patients with thrombus discontinued any of the anticoagulant/antiplatelet therapy which was required under the study protocol. After restarting or continuing warfarin and aspirin therapy, complete resolution of the thrombus was achieved in all patients at subsequent follow-up TEE. Warfarin therapy was discontinued within 6 months for all cases, and there was no thrombus recurrence. The mean follow-up duration was 1,456 ± 546 days, with no death, stroke, or systemic embolization events in patients with thrombus. Conclusions AF burden, device size, and anticoagulant/antiplatelet regimens can be associated with device-related thrombus after Watchman device implantation. Short-term warfarin therapy was effective, and the clinical outcomes were favorable.

Background— An increase of systolic forward flow was frequently observed after successful MitraClip implantation in patients with significant mitral regurgitation. However, the impact of systolic forward flow improvement on post–MitraClip outcomes remains unknown. Methods and Results— Study population included 160 patients who underwent successful MitraClip implantation. The systolic forward flow was noninvasively calculated as the forward stroke volume (FSV) at baseline before the MitraClip procedure and before discharge with pulse-wave Doppler using transthoracic echocardiography. The optimal threshold of discharge/baseline FSV ratio for 3-year all-cause death was assessed. The best cutoff ratio was 1.09 (9% FSV increase from baseline, P =0.006). The FSV responders were defined as those with >9% increase of FSV from baseline (n=93). From discharge to 12-month follow-up, a significant reduction of LV end-diastolic and end-systolic volumes was observed in the responders, whereas no significant change was observed in the nonresponders. Furthermore, the proportion of New York Heart Association functional class III/IV was significantly lower in the responders at 12 months (2.9% versus 14.6%; P =0.03). Among patients with estimated glomerular filtration rate P =0.002). Multivariable logistic analysis identified higher baseline FSV, less mitral regurgitation severity, and functional mitral regurgitation as independent predictors of the nonresponders. Conclusions— FSV increase after MitraClip implantation was associated with more favorable clinical and anatomic outcomes. Severity and pathogenesis of mitral regurgitation and pre-MitraClip FSV predicted postprocedural FSV response.

We appreciate the interest from Drs Dharmarajan and Dharmarajan on our article, and we are thankful for the comments. In fact, end stage renal disease is a strong risk factor for cardiovascular disease, including myocardial infarction. Moreover, patients with chronic kidney disease presenting with myocardial infarction receive fewer evidence-based therapies and have significantly greater mortality rates compared with patients without chronic kidney disease. …

Background: Anemia is associated with mortality and poor outcomes in patients with cardiovascular disease undergoing interventional procedures, including percutaneous coronary intervention, transcatheter aortic valve implantation, and percutaneous mitral valve repair. In patients with atrial

Percutaneous mitral valve repair using the MitraClip system is a novel therapy for surgical high-risk mitral regurgitation (MR). In United States, MitraClip therapy for functional MR is performed on setting of the COAPT randomized trail. However, clinical outcomes of MitraClip therapy for patients