To demonstrate the feasibility of transfemoral transcatheter aortic valve replacement (TAVR) with the 29 mm Edwards SAPIEN XT valve and Novaflex™ + delivery system through a 20F expandable sheath (eSheath™, Edwards Lifesciences, USA). In addition, to describe the use of the Novaflex + delivery system and expandable sheath.TAVR has undergone significant advances in device technology resulting in smaller profile sheaths and delivery systems, allowing transfemoral delivery of a 29 mm valve.Twelve patients underwent transfemoral TAVR with the 29 mm Edwards SAPIEN XT valve and Novaflex + delivery system through a 20F expandable sheath. Baseline clinical and procedural characteristics are evaluated. In-hospital and 30-day outcomes are reported according to Valve Academic Research Consortium criteria.All patients were male with a mean aortic annulus diameter of 25.0 ± 1.1 mm and 25.9 ± 1.2 mm, on transesophageal echocardiography and multidetector computerized tomography, respectively. Mean iliofemoral minimal luminal diameter (MLD) was 8.0 ± 0.8 mm. Successful deployment of the valve occurred in 11 out of 12 patients. Valve embolization occurred in one patient. Aortic valve area increased from 0.7 ± 0.2 to 2.0 ± 0.5 cm(2) (P < 0.001). There were two major vascular complications; however, there were no in-hospital or 30-day neurological events, need for pacemaker insertion, or mortality.Transfemoral TAVR with the 29 mm Edwards SAPIEN XT valve and Novaflex + delivery system through a 20F expandable sheath was feasible with acceptable short-term outcomes.
Background: Shorter door to balloon times are associated with improved outcomes in patients suffering from ST-elevation myocardial infarctions (STEMI). To determine whether prehospital activation of a new regional Australian cardiac catheterisation Laboratory (CCL) reduced pain to balloon time (PTBT), fi rst medical contact to balloon time (FMCTBT), activation of CCL to balloon time (ATBT) and door to balloon time (DTBT). Methods: 200 patients suffering from STEMI who presented to a new regional Australian CCL over a 19 month period were analysed. Prehospital activation (PHA) involved ECGs being performed and interpreted by paramedics who then contacted the on call interventional cardiologist to activate the CCL thus bypassing the emergency department. Hospital activation (HA) involved emergency physicians reviewing patient and activating CCL. Statistical analyses of PTBT, FMCTBT, ATBT and DTBT between these groups was undertaken with SPSS version 22. Results: 77% (154/200) were male, mean age 64 years (36-93 years), 40% (80/200) were prehospital activation STEMIs. There was a signifi cant difference between the following times: PTBT [PHA (163.5mins [IQR: 130,232.7]) vs HA (240mins [IQR:175.5, 413.5]) p=0.000]; FMCTB [PHA (103mins [IQR: 85, 122]) vs HA (152.5 mins [IQR: 109.5, 228.8]) p=0.000]; ATBT [PHA (64mins [IQR: 48, 76.8]) vs HA (71mins [IQR: 57.3, 103.8]) p=0.004]; DTBT [PHA (34.5mins [IQR: 28, 51.8]) vs HA (64mins [IQR: 33, 100.8]) p=0.000]. Conclusions: Prehospital activation of the CCL by paramedics was associated with a signifi cant reduction in times to presentation to a CCL in a regional Australian STEMI population.
Blue whales Balaenoptera musculus in the Indian Ocean (IO) are currently thought to represent 2 or 3 subspecies ( B. m. intermedia, B. m. brevicauda , B. m. indica ), and believed to be structured into 4 populations, each with a diagnostic song-type. Here we describe a previously unreported song-type that implies the probable existence of a population that has been undetected or conflated with another population. The novel song-type was recorded off Oman in the northern IO/Arabian Sea, off the western Chagos Archipelago in the equatorial central IO, and off Madagascar in the southwestern IO. As this is the only blue whale song that has been identified in the western Arabian Sea, we label it the ‘Northwest Indian Ocean’ song-type to distinguish it from other regional song-types. Spatiotemporal variation suggested a distribution west of 70°E, with potential affinity for the northern IO/Arabian Sea, and only minor presence in the southwestern IO. Timing of presence off Oman suggested that intensive illegal Soviet whaling that took 1294 blue whales in the 1960s likely targeted this population, as opposed to the more widely distributed ‘Sri Lanka’ acoustic population as previously assumed. Based upon geographic distribution and potential aseasonal reproduction found in the Soviet catch data, we suggest that if there is a northern IO subspecies ( B. m. indica ), it is likely this population. Moreover, the potentially restricted range, intensive historic whaling, and the fact that the song-type has been previously undetected, suggests a small population that is in critical need of status assessment and conservation action.
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