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Background: The association between prior percutaneous coronary intervention (PCI) and prognosis after coronary artery bypass grafting (CABG) remains uncertain. We aimed to evaluate the aforementioned association in a meta-analysis. Methods: PubMed, Cochrane’s Library, and Embase databases were searched for potential studies. A random-effects model was used for the meta-analysis. Meta-regression was performed to evaluate the influence of study characteristics on the outcomes. Results: Thirty-six follow-up studies with 308,284 patients were included, and 40,892 (13.3%) patients had prior PCI. Pooled results showed that prior PCI was associated with higher risks of early (in-hospital or within 1 month) all-cause mortality [odds ratio (OR): 1.26, 95% confidence interval (CI): 1.11–1.44, p = 0.003; I2 = 64%] and major adverse cardiovascular events (MACEs; OR: 1.36, 95% CI: 1.12–1.66, p = 0.002, I2 = 79%), but not with late (follow-up durations from 1 to 13 years) mortality (OR: 1.03, 95% CI: 0.95–1.13, p = 0.44, I2 = 46%) or MACEs (OR: 1.03, 95% CI: 0.97–1.09, p = 0.38, I2 = 0%). Meta-regression showed that the study characteristics of patient number, age, sex, diabetic status, and proportion of patients with prior PCI did not affect the outcomes. Sensitivity analyses limited to multivariate studies excluding patients with acute PCI failure showed similar results (early mortality, OR: 1.25, p = 0.003; early MACE, OR: 1.50, p = 0.001; late mortality, OR: 1.03, p = 0.70). Conclusion: The current evidence, mostly from retrospective observational studies, suggests that prior PCI is related to poor early clinical outcomes, but not to late clinical outcomes, after CABG.

BACKGROUND: In the last decade, transcatheter aortic valve implantation (TAVI) has developed rapidly in China. As TAVI progresses towards low surgical risk patients, the total number of TAVI procedures will grow exponentially. There is a need to develop a domestic TAVI device designed for Chinese patients. AIMS: The aim of this study was to evaluate the safety and efficacy of a self-expanding valve (TaurusOne transcatheter aortic valve system) in the treatment of patients with symptomatic severe aortic stenosis in China. METHODS: A prospective, multicentre, single-arm study was designed to enrol 120 patients with symptomatic severe aortic stenosis undergoing TAVI using the TaurusOne valve. The primary endpoint was all-cause mortality at one year. RESULTS: From September 2017 to April 2019, 120 patients were enrolled (35% bicuspid aortic valve, mean Society of Thoracic Surgeons [STS] score 9.95%). One-year mortality in 120 patients (follow-up rate, 100%), was 6.7% (upper 95% confidence interval: 12.9%), which was significantly lower than the performance goal of 30% (p

Background: The anti-thrombotic strategy for patients with atrial fibrillation (AF) who have undergone percutaneous coronary intervention (PCI) for coronary artery disease (CAD) is a common and difficult challenge. This pilot study aimed to assess the feasibility and safety of “one-stop” left atrial appendage closure (LAAC) combined with PCI as an alternative stroke prophylaxis strategy. Methods: From March 2017 to October 2019, AF patients with elevated bleeding risk and significant stable CAD requiring PCI were recruited to undergo LAAC as alternative stroke prophylaxis in Fuwai Hospital, Beijing, China. LAAC was performed either in the same setting with PCI (i.e. “one-stop” LAAC/PCI), or as staged procedure after PCI. Dual antiplatelet therapy was given for all patients after LAAC. Peri-procedural and intermediate-term clinical outcomes were assessed through hospital clinical records review and standardized telephone interviews. Results: A total of 24 patients were recruited including 13 (54.2%) underwent stage procedure and 11 (45.8%) underwent “one-stop” procedure respectively. The mean CHA(2)DS(2)-VASc and HAS-BLED scores were 4.5±1.4 and 3 (IQR 3,4) respectively. Six patients (46.1%) in the staged procedure cohort were treated with triple anti-thrombotic following PCI, with 2 developed minor bleeding before LAAC. One patient (“one-stop” cohort) had gastrointestinal bleeding 1 day after procedure. Otherwise, there was no device related complication or peri-procedural stroke/myocardial infarction. After a mean 19±5.4 months follow-up, there was no death, myocardial infarction, stroke and systemic embolization detected. Conclusions: In this pilot study, “one-stop” LAAC with PCI was shown to be efficacious with no stroke, MI, VARC-2 major bleeding or CV death reported over a mean follow-up of 19 months, and safe with no major peri-procedural bleeding or device related complications.

Comprehensive geriatric assessment (CGA)-based cardiac rehabilitation (CR) program is essential for patients before and after transcatheter aortic valve implantation (TAVI). This study aimed to explore the values of CGA and exercise capacity in CR for patients referred to TAVI. A retrospective analysis was conducted in 90 patients referred to TAVI from January to October 2019. CR strategies started before TAVI. The association between clinical characteristics, CGA, and change in six-minute walk distance (Δ6MWD) was analyzed with multivariate regression models. Most of patients had cognitive impairment (50%), malnutrition (61%), and frailty (83%). After the CR, the proportion of cognitive impairment, malnutrition, and frail patients was significantly decreased by 21%, 40%, and 57%, respectively (p = 0.002, p0.001, p0.001). The 6MWD at a month after discharge (291.9 ± 98.8 m) was significantly improved than that at discharge after TAVI (218.8 ± 114.3m, p0.001). The multivariate regression analysis indicated body mass index (BMI; Δ6MWD:12.0, 95% confidence interval [CI] 0.3 to 23.8, p = 0.045), frailty (Δ6MWD: -57.9, 95% CI -81.8 to -34.1, p0.001) and malnutrition (Δ6MWD: -25.1, 95% CI -47.0 to -3.2, p = 0.026) as the associated predictors of Δ6MWD. In conclusion, functional status in patients referred to TAVI could be improved by CGA-based CR. BMI, frailty, and malnutrition were associated with the efficacy of CR on exercise capacity. CGA can play the important role in the evaluation and making strategies for CR in patients.

Background: Galectin-3 may predict mortality for patients with aortic stenosis (AS) after transcatheter aortic valve replacement (TAVR). However, the results were inconsistent. We aimed to evaluate the association between baseline galectin and mortality after TAVR in a meta-analysis. Methods: Related follow-up studies were obtained by systematic search of PubMed, Cochrane’s Library, and Embase databases. Both the fixed- and the random-effect models were used for the meta-analysis. Subgroup analyses were performed to evaluate the influences of study characteristics on the outcome. Results: Five prospective cohort studies with 854 patients were included, with a follow-up period between 1 and 1.9 years. Patients with higher baseline circulating galectin-3 had an increased risk of all-cause mortality after TAVR (random-effects model: risk ratio [RR]: 1.63, 95% confidence interval [CI]: 1.19–2.23, P=0.002; fixed-effects model: RR: 1.62, 95% CI: 1.19–2.20, P=0.002; I2 = 4%). Adjustment of estimated glomerular filtration rate (RR: 1.73, P=0.02) or B-type natriuretic peptide (BNP) or N-terminal pro-BNP (RR: 1.83, P=0.02) did not significantly affect the result. A trend of stronger association between higher baseline circulating galectin-3 and increased risk of all-cause mortality after TAVR was observed in studies with an enzyme-linked fluorescent assay (ELFA) (RR: 3.04, P=0.003) compared with those with an enzyme-linked immunosorbent assay (ELISA) (RR: 1.42, P=0.04; P for subgroup difference =0.06). Conclusion: Higher circulating galectin-3 before the procedure may predict all-cause mortality of AS patients after TAVR.

Manycore processors, with tens to hundreds of tiny cores but no hardware-based cache coherence, can offer tremendous peak throughput on highly parallel programs while being complexity and energy efficient. Manycore processors can be combined with a few high-performance big cores for executing operating systems, legacy code, and serial regions. These systems use heterogeneous cache coherence (HCC) with hardware-based cache coherence between big cores and software-centric cache coherence between tiny cores. Unfortunately, programming these heterogeneous cache-coherent systems to enable collaborative execution is challenging, especially when considering dynamic task parallelism. This paper seeks to address this challenge using a combination of light-weight software and hardware techniques. We provide a detailed description of how to implement a work-stealing runtime to enable dynamic task parallelism on heterogeneous cache-coherent systems. We also propose direct task stealing (DTS), a new technique based on user-level interrupts to bypass the memory system and thus improve the performance and energy efficiency of work stealing. Our results demonstrate that executing dynamic task-parallel applications on a 64-core system (4 big, 60 tiny) with complexity-effective HCC and DTS can achieve: $7 \times$ speedup over a single big core; $1.4 \times$ speedup over an area-equivalent eight bigcore system with hardware-based cache coherence; and 21% better performance and similar energy efficiency compared to a 64-core system (4 big, 60 tiny) with full-system hardware-based cache coherence.

To clarify the optimal measurements for patients with bicuspid aortic valve (BAV) preferred for transcatheter aortic valve replacement (TAVR), our study compared intraoperative sizing with five different approaches by transthoracic echocardiography (TTE), three-dimensional transesophageal echocardiography (3DTEE) and computed tomography (CT). We enrolled 104 BAV patients prescreened for TAVR but who underwent surgery with direct intraoperative annulus sizing. All five approaches [2DTTE, 3DTEE, area-derived perimeter (CTarea), perimeter-derived diameter (CTperi) and mean diameter (CTmean)] were compared with intraoperative sizing, respectively. Agreements on theoretical valve selections by five methods with those by intraoperative sizing were analyzed. CTarea showed the highest correlation (r = 0.932) and the best agreement with intraoperative sizing. Agreement for theoretical surgical and TAVR prosthesis selection was found in 84.6% and 74.0% BAVs by CTarea (κ = 0.791, κ = 0.585). CTperi-based prosthesis selection led to overestimation of 26.9% for surgical valves (κ = 0.589) and 36.5% for TAVR valves (κ = 0.425). Good correlations were observed between CT measurements and intraoperative sizing regardless of the predominant site of aortic valve calcification (r = 0.860-0.953). The CTarea, which demonstrated the optimal approach to annulus sizing and prosthesis choice of BAVs with high eccentricity, should be included into the BAV-specific annulus sizing recommendation. The insufficiency of CTperi lay in overestimation of surgical or TAVR valve selections. Good agreement of 3DTEE sizing proved its superiority in annulus sizing for BAVs unsuitable for CT, but it should be used with caution for patients with a calcified annulus, where partial acoustic shadowing could lead to image inaccuracy. • The area-derived perimeter by CT is the optimal approach to annulus sizing of BAVs. • The perimeter-derived approach is prone to overestimation of BAVs. • 3DTEE showed its superiority in annulus sizing for BAVs unsuitable for CT, but it should be used with caution in patients with a calcified annulus.

Background: There is limited data about transcatheter aortic valve replacement (TAVR) from China, where there are significant differences in the patient population both clinically and anatomically....

Amdahl's law provides architects a compelling reason to introduce system asymmetry to optimize for both serial and parallel regions of execution. Asymmetry in a multicore processor can arise statically (e.g., from core microarchitecture) or dynamically (e.g., applying dynamic voltage/frequency scaling). Work stealing is an increasingly popular approach to task distribution that elegantly balances task-based parallelism across multiple worker threads. In this paper, we propose asymmetry-aware work-stealing (AAWS) runtimes, which are carefully designed to exploit both the static and dynamic asymmetry in modern systems. AAWS runtimes use three key hardware/software techniques: work-pacing, work-sprinting, and work-mugging. Work-pacing and work-sprinting are novel techniques that combine a marginal-utility-based approach with integrated voltage regulators to improve performance and energy efficiency in high- and low-parallel regions. Work-mugging is a previously proposed technique that enables a waiting big core to preemptively migrate work from a busy little core. We propose a simple implementation of work-mugging based on lightweight user-level interrupts. We use a vertically integrated research methodology spanning software, architecture, and VLSI to make the case that holistically combining static asymmetry, dynamic asymmetry, and work-stealing runtimes can improve both performance and energy efficiency in future multicore systems.

Objectives We sought to describe the morphological characteristics of aortic valve disease in a Chinese population presenting for transcatheter aortic valve replacement (TAVR). Background Racial and regional differences are known to exist in aortic stenosis (AS), but limited data exist comparing the specific anatomical variations between populations. Methods Patients were prospectively evaluated in a Chinese population presenting for TAVR in the Venus A-Valve trial, the first trial evaluating TAVR in China. A systematic anatomical assessment protocol employed contrast-enhanced computed tomography (CT) in all the cases. Results A total of 120 consecutive patients were studied. Of these, 61 (50.7%) were patients with tricuspid, 57 (47.5%) bicuspid, and 2 (1.7%) unicuspid valve morphologies. Of the 57 cases with bicuspid valve, 31 (54.4%) had no raphe (Sievers classification, type 0) and 26 (45.6%) were of raphe type. Although the incidence of bicuspid valve morphology was more than a third in the northern Chinese population, this was lower than the eastern Chinese population (P = 0.035), in whom the incidence was more than half. A comparison of tricuspid morphologies in China versus a Western series of 229 consecutive patients undergoing TAVR assessed with CT showed a threefold excess of leaflet calcium burden in China, with a leaflet calcium volume of 421 mm3 (IQR, 188–688 mm3) versus 142 mm3 (IQR, 58–267 mm3). Conclusions Patients presenting for TAVR in China have a very high frequency of bicuspid valve morphology. Even in tricuspid disease, there are clear differences to Western patients, with a high calcium burden, which presents challenges for TAVR in this population (ClinicalTrials.gov NCT01683474). © 2015 Wiley Periodicals, Inc.

To characterize the anatomy of aorto-iliofemoral arterial tree according to aortic valve phenotype by CT in patients referred for transcatheter aortic valve replacement (TAVR). We retrospectively enrolled 215 patients screened for TAVR who underwent CT. Dimensions, calcification, vascular tortuosity index score and other putative risk features of 13 different regions were evaluated for bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) morphology. The study consisted of 44% BAVs with younger age than TAVs. The dimensions of the annulus, sinus of Valsalva, ascending aorta and aortic arch were consistently larger in BAVs. The prevalence of calcification of aortic arch was significantly higher in TAVs even after adjustment for atherosclerotic risk factors. BAVs was associated with two-fold higher odds of having over I degree AA calcification (odds ratio 2.02; 95% CI 1.60–5.31; p

Post-dilatation (PD) for self-expanding transcatheter aortic valve replacement (TAVR) demands a distinct procedural strategy and availability of an appropriate sheath and balloon and the identification of patients requiring PD for TAVR has other implications, such as case selection for

Although gender related differences have been explored in transcatheter aortic valve replacement (TAVR), differences in aortic valvar complex and cardiac anatomy and their potential influence on outcomes remain poorly elucidated. A consecutive contemporary series of patients undergoing TAVR were

This poster will describe a taped-out 2×2mm 1.3 M-transistor test chip in IBM 130 nm designed using our new Python-based hardware modeling framework. The goal of our tapeout was to demonstrate the ability of this framework to enable Agile hardware design flows.

A power analysis attack countermeasure, called power-awareness-based hiding, is proposed. It is effective in implementing nonlinear operations, S-boxes, in cryptographic algorithms. An advanced encryption standard (AES) S-box circuit has been implemented in this approach using the Domino logic array style. The post-layout simulation results show that the power-aware hiding AES S-box achieves a delay of 1.56 ns and a mean power consumption of 3.57 mW. The proposed method improves the power delay product by 65%, the normalised energy deviation by 43% and the normalised standard deviation by 30% compared to other secure methods.

The preferred depth of implant for self-expanding transcatheter aortic valve replacement (TAVR) has become increasingly high. However, the impact on outcomes of contemporary self-expanding valves (SEV), which are both retrievable and repositionable, has been poorly elucidated. We sought to study the

We sought to describe the morphological characteristics of aortic valve disease in a Chinese population presenting for transcatheter aortic valve replacement (TAVR).Racial and regional differences are known to exist in aortic stenosis (AS), but limited data exist comparing the specific anatomical variations between populations.Patients were prospectively evaluated in a Chinese population presenting for TAVR in the Venus A-Valve trial, the first trial evaluating TAVR in China. A systematic anatomical assessment protocol employed contrast-enhanced computed tomography (CT) in all the cases.A total of 120 consecutive patients were studied. Of these, 61 (50.7%) were patients with tricuspid, 57 (47.5%) bicuspid, and 2 (1.7%) unicuspid valve morphologies. Of the 57 cases with bicuspid valve, 31 (54.4%) had no raphe (Sievers classification, type 0) and 26 (45.6%) were of raphe type. Although the incidence of bicuspid valve morphology was more than a third in the northern Chinese population, this was lower than the eastern Chinese population (P = 0.035), in whom the incidence was more than half. A comparison of tricuspid morphologies in China versus a Western series of 229 consecutive patients undergoing TAVR assessed with CT showed a threefold excess of leaflet calcium burden in China, with a leaflet calcium volume of 421 mm(3) (IQR, 188-688 mm(3) ) versus 142 mm(3) (IQR, 58-267 mm(3) ).Patients presenting for TAVR in China have a very high frequency of bicuspid valve morphology. Even in tricuspid disease, there are clear differences to Western patients, with a high calcium burden, which presents challenges for TAVR in this population (ClinicalTrials.gov NCT01683474).