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Jednym z celów Dyrektywy MIFID II było ograniczenie konfliktów interesów oraz missellingu pomiędzy dystrybutorami instrumentów finansowych a klientami detalicznymi. Nowością było ograniczenie zakresu wypłacania „zachęt” przez towarzystwa funduszy inwestycyjnych dystrybutorom instrumentów finansowych. W artykule opisano nowe praktyki powstałe na rynku dystrybucji instrumentów finansowych po wdrożeniu Dyrektywy MIFID II oraz wyniki pogłębionej ankiety przeprowadzonej wśród profesjonalistów rynku finansowego. Autorzy dowodzą, że Dyrektywa MIFID II zwiększyła liczbę regulacji dla dystrybutorów instrumentów finansowych, wzmocniła ochronę klientów detalicznych (szczególnie inwestorów indywidualnych), ale z drugiej strony ograniczyła zakres oferty i (w związku z ograniczeniem „zachęt”) pogorszyła sytuację dystrybutorów niepowiązanych z grupami bankowymi.

Aortic stenosis (AS) is the most common valvular heart disease and untreated has a bleak prognosis. The only effective method of treatment is valve replacement, surgical (SAVR), or transcatheter (TAVI).We decided to analyze outcomes and predictors of long-term mortality in patients undergoing TAVI and SAVR.A retrospective analysis of 1229 patients with advanced AS, comprising TAVI (n = 211), SAVR (n = 556), SAVR, and additional procedures (n = 462), operated on from 2014 to 2018, was performed.No significant differences between SAVR and TAVI were found for 24-month mortality in groups of consecutive patients. Postoperative stroke or transient ischemic attack (TIA), chronic obstructive pulmonary disease (COPD), and transfusion of red blood cells (RBCs) were independent predictors of 1-year mortality after SAVR. The above-mentioned factors regarding the increased estimated surgery risk in the EuroSCORE II (4%) were predictors of 2-years mortality after SAVR. Risk factors for 6- and 12-month mortality after TAVI were EuroSCORE II, new onset of atrial fibrillation (NOAF), and the increased RBC distribution width (RDW). Postoperative respiratory failure was an independent risk factor for 6-, 12- and 24-month mortality in both groups of patients.There were no significant differences regarding prognosis after TAVI and SAVR at the 24-month follow-up in the propensity score matching model. Independent predictive factors of late mortality after both procedures were EuroScore II and respiratory failure. Independent predictive factors of late mortality specific for TAVI were NOAF, increased RDW, and for SAVR: TIA, stroke, COPD, and RBC transfusion.

The ability to control the in-plane magnetic anisotropy of a thin film is important for magnetic device applications. One way of accomplishing this task is by glancing angle deposition (GLAD). In this study, thin Co layers have been deposited using GLAD magnetron sputtering on MgO(001) and MgO(110) substrates. For Co films on MgO(001), the in-plane anisotropy direction can be directly controlled via the deposition angle. In contrast, for Co on MgO(110), the anisotropy due to the deposition angle is competing with the anisotropy induced by the substrate, while the growth parameters determine which contribution dominates. On the other hand, while on MgO(001) the deposition angle as well as the film thickness affect the strength of the Co in-plane anisotropy, no influence of these parameters on the magnetic properties is found for films on MgO(110).

Background and Objective Human epidermal growth factor receptor 2 (HER2) protein overexpression is one of the most significant biomarkers for breast cancer diagnostics, treatment prediction, and prognostics. The high accessibility of HER2 inhibitors in routine clinical practice directly translates into the diagnostic need for precise and robust marker identification. Even though multigene next-generation sequencing methodologies have slowly taken over the field of single-biomarker molecular tests, the copy number alterations such as amplification of the HER2-coding ERBB2 gene are hard to validate on next-generation sequencing platforms as they are characterized by chromosomal structural heterogeneity, polysomy, and genomic context of ploidy. In our study, we tested the approach of using whole genome sequencing instead of next-generation sequencing panels to determine HER2 status in the clinical set-up. Methods We used a large dataset of 876 patients with breast cancer whole genomes with curated clinical data and an additional set of 551 patients’ external genomic data. We used the decision-tree-based algorithm for optimization of the diagnostic tool for HER2 status assessment by whole genome sequencing. Results The most efficient approach to assess HER2 status in whole genome sequencing data was the ploidy-corrected copy number, utilizing ERBB2 copy number and mean tumor ploidy. The classifier achieved sensitivity of 91.18% and specificity of 98.69% on the internal validation dataset and 89.86% and 96.06% on the external data, which is similar to other next-generation sequencing methods, currently tested in the clinic. Conclusions We provide evidence that the HER2 status may be reliably determined by whole genome sequencing and is applicable across different laboratory protocols and pipelines. We suggest using the ploidy-corrected copy number for diagnostic purposes. Supplementary Information The online version contains supplementary material available at 10.1007/s40291-021-00571-1.

As we have previously reported, the ORPKI electronic data capture is monitored continuously and modified according to the needs of the rapidly changing everyday practice of interventional cardiology not only in Poland but also worldwide as required by ESC guidelines [1, 2]. The database is endorsed by the Association of Cardiovascular Interventions of the Polish Cardiac Society (AISN PTK) and is daily operated by the Jagiellonian University Medical College, with currently 154 interventional cardiology centers in Poland reporting. ORPKI database analysis of various trends and patterns is published each year [3–5]. On 31st of December 2020 there were 575 PCI operators certified by the AISN PTK in Poland.

Coronary chronic total occlusions (CTO) are increasingly encountered during invasive and non-invasive coronary angiography and remain the most challenging lesions for percutaneous revascularization. During recent years success rates and safety outcomes of CTO percutaneous coronary intervention (PCI) have substantially improved, particularly due to the introduction of new techniques and dedicated equipment as well as specialized training programs of CTO operators. Significantly, the steady advances in CTO PCI techniques have coincided with the new data from randomized clinical trials supporting the role of percutaneous recanalization of CTO in relieving angina and improving the quality of life. The current expert consensus document outlines the rationale, clinical outcomes as well as technical, safety and reimbursement issues of CTO PCI. In addition, the requirements for achieving and maintaining competency in CTO PCI among interventional cardiologists are discussed. Finally, we present the modified hybrid algorithm (the so-called Polish hybrid algorithm) providing some unique refinements to the contemporary CTO PCI strategies. Continuous efforts (including active engagement with the payer) are urgently needed to increase guideline-recommended referrals to CTO PCI, and thus improve the quality of life of CTO patients in Poland.

Mechanical circulatory support (MCS) methods are used in patients with both acute and chronic heart failure, who have exhausted other options for pharmacological or surgical treatments. The purpose of their use is to support, partially or completely, the failed ventricles and ensure adequate organ perfusion, which allows patients to restore full cardiovascular capacity, prolonging their life and effectively improving its quality. The three most popular devices include an intra-aortic balloon pump (IABP), percutaneous assist devices (including Impella, TandemHeart), and venoarterial extracorporeal membrane oxygenation (VA-ECMO). A multidisciplinary approach with the special participation of the Heart Team is required to determine the proper MCS strategy, the choice of the supporting method, and the time of its use. The studies published so far do not allow us to determine which MCS method is the safest and the most effective. Thus, the site experience and accessibility of the method seem to matter most today. MCS finds particular application in patients with acute coronary syndromes complicated by refractory cardiogenic shock, as well as in patients with acute heart failure of the high potential for reversibility. It can also serve as a backup for percutaneous coronary interventions of high risk (complex and high-risk indicated percutaneous coronary intervention [PCI], complex and high-risk indicated PCI [CHIP]). The use of appropriate supportive drugs, precise hemodynamic and echocardiographic monitoring, as well as optimal non-invasive or mechanical ventilation, are extremely important in the management of a patient with MCS. The most serious complications of MCS include bleeding, thromboembolic events, as well as infections, and hemolysis.

Background: Balloon aortic valvuloplasty (BAV) may be considered a bridge to further intervention in hemodynamically unstable patients or patients with symptomatic severe aortic stenosis (AS). Aims: This study aimed to retrospectively compare periprocedural and in‑hospital outcomes of AS patients treated with elective BAV (group 1) and rescue BAV (group 2). Methods: We identified 35 patients in whom BAV was performed between 2010 and 2018. Among them, 16 were treated electively (group 1) and 19 urgently (group 2). Results: Overall, BAV resulted in a significant decrease in the mean transaortic gradient by a median (interquartile range [IQR]) value of 5 (1–10) mm Hg (P

Available prediction models are inaccurate in elderly who underwent transcatheter aortic valve implantation (TAVI). The aim of present study was to analyze the separate and combined prognostic values of baseline HDL-C and C-reactive protein (CRP) levels in patients treated successfully with TAVI who had complete 2-year follow-up. We analyzed 334 patients treated with TAVI from 01/2010 to 07/2017 who had measurements of HDL-C and CRP on admission or during qualification for the procedure. Baseline HDL-C ≤46 mg/dl (areas under the curve [AUC] = 0.657) and CRP ≥0.20 mg/dl (AUC = 0.634) were predictive of 2-year mortality. After stratification with both cutoffs, patients with low HDL-C and concomitant high CRP most often had LVEF ≤50% and were high risk as per EuroSCORE II. Those with isolated CRP elevation had the lowest frequency of LVEF ≤50%, but more sarcopenia (based on psoas muscle area). After adjustment in the multivariate analysis for other identified predictors including EuroSCORE II and statin therapy, isolated HDL-C ≤46 mg/dl (identified in 40 patients) and isolated CRP ≥0.20 mg/dl (n = 109) were both independent predictors of 2-year mortality (hazard ratio [HR] = 2.92 and HR = 2.42, respectively) compared with patients with both markers within established cutoffs (n = 105) who had the lowest 2-year mortality (9.5%). Patients with both markers exceeding cutoffs (n = 80) had the highest risk (HR = 4.53) with 2-year mortality of 42.5%. High CRP was associated with increased mortality within the first year of follow-up, whereas low HDL-C increased mortality in the second year. The combination of both markers with EuroSCORE II enhanced mortality prediction (AUC = 0.697). In conclusion, low baseline HDL-C and high CRP jointly contribute to the prediction of increased all-cause mortality after TAVI.

The conventional preference disaggregation approaches for multiple criteria sorting aim at reconstructing an entire set of assignment examples provided by a Decision Maker (DM) with a single preference model instance. In case the DM’s holistic preference information is not consistent with an assumed model, one needs to accept that some assignment examples are not reproduced. We propose a new approach for handling inconsistency in the context of a threshold-based value-driven sorting procedure. Specifically, we introduce preference disaggregation methods for reconstructing all assignment examples with a set of complementary preference models. The proposed approach builds on the assumption that the importance of particular criteria or, more generally, the shape of marginal value functions and their maximal shares in the comprehensive value are contingent (i.e., dependent) on the performance profile of a given alternative. Therefore, in case of inconsistency, the set of assignment examples is divided into subsets, each of which is reconstructed by a unique model to be used only if certain circumstances are valid. We present three methods for learning a set of contingent models, allowing different degrees of variation in the contingent models along two dimensions: the shape of marginal value functions and interrelations between the models. To apply such a set for classification of non-reference alternatives, we learn a decision tree which makes the application of a given model dependent on the alternatives’ profiles represented by the performances on particular criteria, hence allowing to select an appropriate model among the competing models to evaluate a non-reference alternative. The method’s applicability is demonstrated on a problem of evaluating research units representing different fields of science.

Introduction Severe aortic stenosis (AS) is an ever-growing healthcare problem in ageing populations. Transcatheter aortic valve implantation (TAVI) has revolutionized the treatment of AS. However, TAVI in patients who have undergone mitral valve replacement (MVR) is associated with increased risk of mitral valve damage. Limited data exist on TAVI in patients with AS who underwent MVR in the past. Aim To retrospectively assess the clinical characteristics, detailed echocardiographic and computed tomography measurements, procedural and in-hospital outcome as well as any valve intervention or major adverse cardiovascular events according to VARC-2 criteria at follow-up of patients with a history of MVR, who underwent TAVI. Material and methods Seventeen patients with a history of mitral valve operation, in whom TAVI was performed between 2010 and 2018, were identified. Of these, 15 underwent previous MVR. Results Overall, TAVI resulted in a decrease of mean transaortic gradient by 38.3 ±14 mm Hg (p < 0.001) and a decrease of maximal transaortic gradient by 58.6 ±27.6 mm Hg (p < 0.001). A successful immediate result was obtained in 14 (93.3%) patients. One tamponade occurred during TAVI, which was successfully treated with pericardiocentesis. Post-procedurally, no significant changes in transmitral gradients or mitral regurgitations were observed. Two patients died after hospital discharge, one due to possible internal bleeding and the other due to infection. Conclusions TAVI in patients after MVR is feasible. Meticulous preinterventional echocardiographic and computed tomography planning is essential. Although recommended in previous reports, TEE guidance may not necessarily be obligatory during the procedure.

INTRODUCTION Transcatheter aortic valve-in-valve implantation (ViV-TAVI) emerged recently as an alternative to re-do surgery for patients with failed surgical aortic valve (SAV). OBJECTIVES To evaluate the safety and efficacy of transcatheter aortic valves (TAV) in failed SAV in Poland. PATIENTS AND METHODS Data was acquired using a nationwide, multicenter (n=14) Polish Transcatheter Aortic Valve-in-Valve Implantation (ViV-TAVI) Registry (ClinicalTrials.gov Identifier, NCT03361046) with online form collection and 1-year follow-up. RESULTS ViV-TAVI procedures (n=130) constituted 1.9% of all TAVI in Poland with increasing numbers since 2018 (n=59, 45% of all). Hancock II® (21%), Freestyle® (13%), and homograft (11.5%) were identified as the most frequently treated SAV's with self-expanding, supra-annular Corevalve/Evolut® TAV used in the majority of cases (76%). Average post-procedural pressure gradient (average PG) >20 mmHg was found in 21% and 1-year all-cause mortality was 10.8%. SAV stenosis compared to regurgitation/mixed disease was associated with higher average (16, IQR 13.5 - 22.5 vs 14.5, IQR 10-19 mmHg, p=0.004) whereas implantation of supra-annular TAV resulted in lower average PG (14, IQR 10.5-20 vs. intra-annular 19, IQR 16-26 mmHg, P=0.004). After introduction of 2nd generation TAV, shorter procedure time (120, IQR 80-165 min. vs. 135, IQR 108-200 min., P=0.04), less frequent need for additional TAV (2% vs. 10%, P=0.04) and better 1-year freedrom from cardiovascular deaths (95% vs. 82.8%, hazard ratio 0.25, 95% confidence intervals 0.17-0.88, P=0.03) was observed vs. 1st generation. CONCLUSIONS Transcatheter treatment of failed SAV is becoming more frequent, showing the best hemodynamic effect with the use of supra-annular TAV and improved procedural as well as clinical results with the introduction of 2nd generation TAV.

Impaired myocardial tissue reperfusion affects prognosis of patients with ST-segment elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI) and can be identified by ST-segment analysis. To date, evaluation of the myocardial tissue reperfusion of the right ventricle (RV) among the patients treated with PCI for inferior STEMI with right ventricular infarction (RVI) has not been made yet.Patients with inferior STEMI were screened for RVI. Tissue reperfusion was evaluated by maximal residual ST-segment deviation post PCI, independently for the RV and for inferior wall. Myocardial injury was assessed by the peak creatine kinase-mb (CK-MB) value.Among 456 patients with inferior STEMI, concomitant RVI occurred in 153 (33.5%) subjects (59.86±10.35 years old, 71.9% females). Tissue reperfusion of LV was present in 75 (49%), whereas 55 (35.9%) had both successful LV and RV reperfusion. Among 97 (63.4%) with successful tissue reperfusion of RV, 55 (56.7%) had associated successful tissue reperfusion of inferior wall. Adequate LV reperfusion was accompanied by RV in over 73.3% of patients (P=0.006). Mean peak CK-MB was lower in the group with adequate versus impaired RV tissue-perfusion (197±143 vs. 305±199 U/L, P=0.021 respectively).Impaired reperfusion of RV is observed in more than one third of inferior STEMIs with RVI and is not strictly associated with impaired reperfusion of inferior wall and clinical or angiographic variables, therefore ST-segment analysis for RV is mandatory.

Introduction: Transcatheter aortic valve implantation (TAVI) is an effective treatment of significant aortic stenosis. Paravalvular leaks (PVLs) are one of the most common complications after the procedure. Objectives: The aim of this study was to assess whether the aortic root morphology affects the occurrence of PVL after TAVI. Patients and methods: We enrolled 50 patients with bicuspid and 50 patients with tricuspid aortic valve who underwent multislice computed tomography (MSCT) and transthoracic echocardiography prior to TAVI. The dimensions of the aortic root were assessed by MSCT. PVL after TAVI was assessed by transthoracic echocardiography. Patients were divided in 2 groups according to the PVL severity: less than moderate PVL (n = 80) and moderate or worse PVL (n = 20), and comparisons between the groups were performed. Results: Patients with at least moderate PVL, compared with those with less than moderate PVL, had greater mean (SD) area (5.2 [1.1] cm2 vs 4.7 [0.8] cm2; P = 0.02), perimeter (8.4 [0.9] cm vs 7.9 [0.7] cm; P = 0.01), and long axis (29.5 [2.7] mm vs 28 [2.7] mm; P = 0.04) of the aortic annulus and greater mean (SD) area (5.3 [1.3] cm2 vs 4.7 [1.1] cm2; P = 0.04) and perimeter (8.6 [1.1] cm vs 8.1 [0.9] cm; P = 0.02) of the left ventricular outflow tract. In multivariable analysis, bicuspid aortic valve disease, interventricular septum hypertrophy, greater left ventricular outflow tract, and postdilatation were significant predictors of moderate PVL following TAVI. Conclusions: The assessment of the aortic root morphology with MSCT can be helpful in predicting PVL after TAVI.

Background The aim of this study was to evaluate the outcomes of transcatheter aortic valve implantation (TAVI) in bicuspid aortic valve (BiAV) stenosis using a mechanically expanded Lotus™ device. The prior experience with first-generation devices showed disappointing results mainly due to increased prevalence of aortic regurgitation (AR) that exceeded those observed in tricuspid stenosis. Methods and results We collected baseline, in-hospital, 30-day and 2-year follow-up data from a prospective, multicentre registry of patients with BiAV undergoing TAVI using Lotus™ valve. Safety and efficacy endpoints were assessed according to VARC-2 criteria. The study group comprised 24 patients. The mean age was 73.5 years and the mean EuroSCORE 2 was 4.35 ± 2.56%. MDCT analysis revealed Type 1 BiAV in 75% of patients. The mean gradient decreased from 60.1 ± 18.3 to 15 ± 6.4 mm Hg, the AVA increased from 0.6 ± 0.19 to 1.7 ± 0.21 cm2. One in-hospital death was observed secondary to aortic perforation. There was no severe AR and the rate of moderate AR equalled 9% at 30 days (n = 2). Device success was achieved in 83% and the 30-day safety endpoint was 17%. In the 2-year follow-up, the overall mortality was 12.5% and the 2-year composite clinical efficacy endpoint was met in 25% of the patients (n = 6) Conclusions The TAVI in selected BiAV patients using the Lotus™ is feasible and characterized by encouraging valve performance and mid-term clinical outcomes. Graphic abstract

There have been a number of angiogenic gene therapy trials, yielding mixed results as to efficacy, but demonstrating uniform short-term treatment safety. Data regarding long-term safety of angiogenic gene therapy are limited. Double-blind VIF-CAD trial (NCT00620217) assessed myocardial perfusion and clinical data in 52 refractory coronary artery disease (CAD) patients randomized into treatment (VIF; n = 33) and Placebo (n = 19) arms. VIF group received electromechanical system NOGA-guided intramyocardial injections of VEGF-A165/bFGF plasmid (VIF) into ischemic regions, while the Placebo group-placebo plasmid injections. Full 1-year follow-up data have been published. This study presents the results of over 10-year (median 133 months, range 95-149) safety follow-up of VIF-CAD patients. Overall, 12 (36.4%) patients died in VIF and 8 (42.1%) in Placebo group (P = .68). Cardiovascular mortality was 12/33 (36.4%) in the VIF group and 6/19 (31.6%) in Placebo group (P = .73). Two Placebo patients died due to malignancies, but no VIF patients (P = .17). The Kaplan-Meier curves of combined endpoint: cardiovascular mortality, myocardial infarction and stroke were similar for both patient groups (P = .71). Odds ratio of Placebo group increasing (reaching a worse) their CCS class versus VIF was non-significant (OR 1.28, 95% CI = 0.66-2.45; P = .47). However, CCS class improved in time irrespectively of treatment-OR of reaching a less favorable CCS class per each year of follow-up was 0.74 (95% CI 0.685-0.792; P .0001, pooled data). There were no differences in readmission rates. Intramyocardial VEGF-A165/bFGF plasmid administration appears safe, with no evidence of an increase in the incidence of death, malignancy, myocardial infarction or stroke during 10-year follow-up in this limited patient population.

Background: Alcohol septal ablation (ASA) is an alternative to surgical treatment in patients with hypertrophic obstructive cardiomyopathy (HOCM). Through alcohol-induced necrosis, ASA leads to an increase in left ventricular outflow tract (LVOT) diameter and a decrease in LVOT pressure gradient. Aim: We sought to assess the effect of ASA on left ventricular (LV) wall thickness and mass, left atrial (LA) size, and N-terminal pro–B-type natriuretic peptide (NT-proBNP) level. Methods: The study cohort consisted of 50 patients with HOCM (30 in the ASA group, 20 in the optimal pharmacotherapy group [OPG]). Transthoracic echocardiography (TTE), cardiac magnetic resonance (CMR), and NT-proBNP level analysis were performed at baseline and at six months. Results: All parameters are presented as means. In the ASA group, the maximal LVOT pressure gradient decreased from 122.7 to 54.8 mmHg directly after ASA and to 37.2 mmHg after a further six months (p < 0.0001). The NT-proBNP level decreased from 2174.4 to 1103.4 pg/mL (p < 0.001). On TTE, the interventricular septum (IVS) thickness decreased to from 23.6 to 19.4 mm (p < 0.0001) and the lateral wall (LW) thickness decreased from 15.9 to 14.2 mm (p < 0.007). On CMR, basal IVS thickness decreased from 23.7 to 18.0 mm (p < 0.0001) and the LW thickness decreased from 13.2 to 12.2 mm (p = 0.02). IVS mass reduced from 108.9 to 91.5 g (–16%; p < 0.001). All of the above parameters remained unchanged in the OPG. Conclusions: Successful ASA reduces LV hypertrophy and improves parameters of the LV overload, resulting in LV wall hy­pertrophy regression, and LA size and NT-proBNP level reduction. The above parameters may be as useful in assessing the efficacy of ASA as the LVOT gradient itself.

Author(s): Dąbrowski, M; Hicken, RJ; Frisk, A; Newman, DG; Klewe, C; N'Diaye, AT; Shafer, P; Van Der Laan, G; Hesjedal, T; Bowden, GJ | Abstract: Non-collinear spin structures in materials that combine perpendicular and in-plane magnetic anisotropies are of great technological interest for microwave and spin wave-assisted magnetization switching. [Co/Pt] multilayers are well-known perpendicular anisotropy materials that have the potential to pin the magnetization of a soft magnetic layer, such as permalloy (Py), that has in-plane anisotropy, thereby forming a magnetic exchange spring. Here we report on multilayered [Co/Pt]/Pt/Py films, where an additional ultrathin Pt spacer has been included to control the coupling between the sub-units with in-plane and perpendicular magnetic anisotropy. Vector network analyser (VNA)-ferromagnetic resonance (FMR) measurements were made to obtain a complete picture of the resonant conditions, while the dynamical response of the sub-units was probed by synchrotron-based element- and phase selective x-ray detected FMR (XFMR). For all samples, only slight pinning of the dynamic magnetization of the Py by the [Co/Pt] was noted, and the FMR results were dominated by the 50 nm thick Py layer. Out-of-plane VNA-FMR maps reveal the presence of additional modes, e.g. a perpendicular standing spin-wave (PSSW) state. However, as the magnetic field is reduced below the saturation field, the PSSW state morphs continuously through a series of canted standing spin-wave (CSSW) states into a horizontal standing spin-wave (HSSW) state. The PSSW, CSSW and HSSW states are well described using a multilayer model of the Py film. The observation of CSSW modes is of particular relevance to microwave assisted magnetic recording, where microwave excitation stimulates precession of a soft layer canted out of plane by a pulsed magnetic field.

The number of elderly patients requiring treatment of aortic stenosis is expected to grow steadily due to increasing lifespan. Transcatheter aortic valve implantation (TAVI) is an alternative treat‑ ment for patients with aortic stenosis considered nonoptimal candidates for surgical valve replacement.We aimed to assess age‑related differences in 30‑day and 1‑year cardiovascular mortality, Valve Academic Research Consortium‑2 (VARC‑2)-defined complications in patients undergoing TAVI, by comparing outcomes in patients younger than 85 years and those aged 85 years or older.The study group included patients who underwent TAVI at the Institute of Cardiology, Warsaw from January 2009 to July 2019. Clinical, procedural, and follow‑up data were retrospectively collected and compared in 2 groups defined according to age: group 1, younger than 85 years (417) and group 2, aged 85 or older (200).The surgical risk profile assessed by the EuroSCORE II was significantly higher in the group of older patients (median [interquartile range], 6.5% [3.5%-17.3%] vs 7.2% [3.4%-18.1%]; P = 0.002); 30‑day and 1‑year cardiovascular mortality was 4.3% in group 1 as compared with 5% in group 2 (P = 0.69) and 10.8% in group 1 as compared with 9.4% in group 2 (P = 0.51), respectively. The rate of VARC‑2‑defined complications was similar in both groups, with the exception of major vascular com‑ plications (3.12% vs 8.5%; P = 0.004) and major bleeding (10.8% vs 18.5%; P = 0.008), which were more prevalent in older patients.Cardiovascular mortality at 1 month and 1 year following TAVI is similar in patients aged 85 years or older and in those younger than 85 years.

INTRODUCTION The number of elderly patients requiring treatment of aortic stenosis is expected to grow steadily due to increasing lifespan. Transcatheter aortic valve implantation (TAVI) is an alternative treat‑ ment for patients with aortic stenosis considered nonoptimal candidates for surgical valve replacement. OBJECTIVES We aimed to assess age‑related differences in 30‑day and 1‑year cardiovascular mortality, Valve Academic Research Consortium‑2 (VARC‑2)-defined complications in patients undergoing TAVI, by comparing outcomes in patients younger than 85 years and those aged 85 years or older. PATIENTS AND METHODS The study group included patients who underwent TAVI at the Institute of Cardiology, Warsaw from January 2009 to July 2019. Clinical, procedural, and follow‑up data were retrospectively collected and compared in 2 groups defined according to age: group 1, younger than 85 years (417) and group 2, aged 85 or older (200). RESULTS The surgical risk profile assessed by the EuroSCORE II was significantly higher in the group of older patients (median [interquartile range], 6.5% [3.5%-17.3%] vs 7.2% [3.4%-18.1%]; P = 0.002); 30‑day and 1‑year cardiovascular mortality was 4.3% in group 1 as compared with 5% in group 2 (P = 0.69) and 10.8% in group 1 as compared with 9.4% in group 2 (P = 0.51), respectively. The rate of VARC‑2‑defined complications was similar in both groups, with the exception of major vascular com‑ plications (3.12% vs 8.5%; P = 0.004) and major bleeding (10.8% vs 18.5%; P = 0.008), which were more prevalent in older patients. CONCLUSION Cardiovascular mortality at 1 month and 1 year following TAVI is similar in patients aged 85 years or older and in those younger than 85 years.

Introduction Few studies assessed the development of transcatheter aortic valve implantation (TAVI) in Poland since its introduction in 2008. Effects of the Valve-for-Life initiative in the country have not been reported. Objective To investigate TAVI adoption and practice in Poland in the years 2008-2019. Patients and methods The Polish Interventional Cardiology TAVI Survey (PICTS) analysed reports of TAVI activity of all 23 TAVI centres. It consisted of 94 questions, focused on the topics: 1. characteristics of centres. 2. the annual number of TAVI in the years 2008-2019. 3. pre-, intra-, and post-procedural management, 4. a list of TAVI Team members. It was obligatory to answer all questions. The registry survey was published on-line RESULTS: Since 2008, 102 certified operators have performed a total of 6910 procedures. In 2019 the annual number of TAVI reached 1550 (40.38 implants per million inhabitants). Among patients aged ≥ 65 years, TAVI penetration rate was 18.65% in 2019. Inoperable and high-risk patients were treated in all centres, while 18 also treated medium and 5 low-risk patients. The rate of transfemoral implantations increased to 93.5% of all procedures. Conclusions The survey highlighted a slow, positive rate of adoption of TAVI in Poland. We found a significant treatment gap in patients with severe aortic stenosis. Remarkable regional variations in TAVI experience exist among Polish TAVI centres. Further multinational cooperation is warranted to tackle identified limitations in access to these life-saving procedures.

We report a transient plasmonic spin skyrmion topological quasiparticle within surface plasmon polariton vortices, which is described by analytical modeling and imaging of its formation by ultrafast interferometric time-resolved photoemission electron microscopy. Our model finds a twisted skyrmion spin texture on the vacuum side of a metal/vacuum interface and its integral opposite counterpart in the metal side. The skyrmion pair forming a hedgehog texture is associated with co-gyrating anti-parallel electric and magnetic fields, which form intense pseudoscalar E·B focus that breaks the local time-reversal symmetry and can drive magnetoelectric responses of interest to the axion physics. Through nonlinear two-photon photoemission, we record attosecond precision images of the plasmonic vectorial vortex field evolution with nanometer spatial and femtosecond temporal (nanofemto) resolution, from which we derive the twisted plasmonic spin skyrmion topological textures, their boundary, and topological charges; the modeling and experimental measurements establish a quantized integer photonic topological charge that is stable over the optical generation pulse envelope.

INTRODUCTION Chronic kidney disease (CKD) is frequent in patients treated with transcatheter aortic valve replacement. Yet, the procedure can improve kidney function, that is, it can lead to acute kidney recovery (AKR). OBJECTIVES The aim of the study was to assess kidney function changes after transcatheter aortic valve replacement and their impact on long‑term outcomes. PATIENT AND METHODS In 432 patients (median age, 83 years; female sex, 63.4% ), estimated glomerular filtration rate (eGFR) was measured before and after the procedure. Chronic kidney disease was defined as a prior diagnosis or baseline eGFR of less than 60 ml/min/1.73 m2. Median (interquartile range [IQR]) follow‑up was 44.7 (31.2-48) months. RESULTS Overall, 66.7% of patients had CKD. An increase in eGFR of 10% or greater at 48 hours (median [IQR], 39.8% [26.2%-51.8%]) was observed in 55.2% of patients with CKD and lasted until discharge (31.8% [17.8%-49%]) in 35.8% (the AKR group). In 17.4% of patients (64.3% with CKD), there was a drop in eGFR of 10% or greater at 48 hours, which remained at discharge in 6.5% of patients (the AKI group; median [IQR] eGFR drop, -22.8% [-40.6% to -14.9%] and -22.8% [-37.5% to -16.2%], respectively). There was a stepwise increase in AKR prevalence from CKD stage 1 and 2 (11.5%) to 4 (52%) (P = 0.03). In‑hospital mortality (P = 0.01) was highest with AKI (10.7%); intermediate with CKD but no AKR (6.6%); and lowest with neither CKD nor AKI (1.5%) or with AKR (1%). Estimated 4‑year mortality was correspondingly different (46.9%, 47.2%, 25.5%, 35.4%, respectively; P