BackgroundThe Small Annuli Randomized to Evolut or SAPIEN Trial showed superior hemodynamics of self-expanding valves (SEVs) over balloon-expandable valves (BEVs) in patients with small aortic annuli (SAA). The long-term clinical implications of these hemodynamic differences are unknown.MethodsWe conducted an observational cohort study of patients with SAA, defined as an aortic valve annular area ≤430 mm2 on cardiac computed tomography, who underwent transcatheter aortic valve replacement using BEV or SEV at a single institution between August 2013 and February 2021. Patients undergoing valve-in-valve procedures or alternative access were excluded. Patient-prosthesis mismatch (PPM) was defined as moderate when indexed effective orifice area of 0.65-0.85 cm2/m2 and severe when indexed effective orifice area was <0.65 cm2/m2 (or <0.55 cm2/m2 for body mass index >30 kg/m2). The primary outcome of the study was mortality and major adverse cardiovascular events.ResultsA total of 258 patients were included. The majority were female (81%) with intermediate surgical risk (median STS risk score 4.23); 90 patients (35%) received a BEV (median age 80 years [73, 86]) and 168 (65%) received a SEV (81 years [75, 85], p = 0.699). Comorbidities and risk profiles were well balanced between groups. At 30 days post-transcatheter aortic valve replacement, SEV had lower aortic valve mean gradients (8 mmHg [6, 11] vs. BEV 14 mmHg [10, 18], p < 0.001), lower peak velocities (1.86 m/s [1.60, 2.34] vs. BEV 2.52 m/s [2.14, 2.90], p < 0.001), and were less likely to have PPM (SEV 18% vs. BEV 42% (p < 0.001). At 3 years, both groups had similar mortality (SEV 23% vs. BEV 22%, p = 0.875). PPM was not associated with long-term mortality.ConclusionsIn patients with SAA, we observed no difference in mortality between SEV and BEV up to 3 years after the index procedure, despite early differences in valve hemodynamics.
Critical problems facing developing economies is revenue mobilization. A lot of leakages exist in the system which restricts governments from realizing their fullest potentials, meeting social functions and stabilizing the economy. In developing countries, lesser monitoring is conducted into this fundamental role of government. This book highlights typical challenges affecting governments' downstream revenue mobilizations and recommend procedures to alleviate this plight. Is a goldmine of ideas
Acute pulmonary embolism (PE) is a restrictive pulmonary vascular compromise with devastating complications depending on size and location. Massive and sub-massive classifications reflect hemodynamic compromise and cardiac dysfunction due to right ventricular strain, respectively. In addition to cardiac dysfunction, pulmonary ischemia and infarction play a key clinical factor. Mainstay management is with anticoagulation to prevent further clot propagation. Recent technological advances have revolutionized treatment modalities. Mechanical thrombectomy, catheter-based clot retrieval, is an effective way to eliminate emboli, restore cardiopulmonary function, and prevent ischemic injury. One such device, the FlowTriever System, has emerged as a way interventionalists can proceed with embolectomy and provide high level, life-saving care for acutely decompensated patients.
As part of the Ghanaian government's efforts to revive the national economy a series of measures were instituted. They included devaluation of the local currency, reduction of budget deficits and the rehabilitation of basic infrastructure. The mining industry plays an important role in the national economy and special measures were also introduced to encourage its rehabilitation and development. A new licensing system was introduced and a new fiscal regime was established which inter alia allows mining companies to retain part of their export earnings offshore. The response of the private investment community to those changes has been excellent and investment in the mining industry has increased substantially.
