Moreover, patients with a positive PCR result for CMV in their atherosclerotic plaques were more likely to have a positive family history for CVD. This suggests a familial vulnerability to CMV replication in the coronary artery walls. Conflict of Interest Disclosure: All authors
have completed and Dinaciclib submitted the Methodist DeBakey Cardiovascular Journal Conflict of Interest Statement and and none were reported Funding/Support: The authors have no funding disclosures to report.
Introduction With more than 60,000 implanted transcatheter heart valves in patients around the world, TAVI has been shown to be a viable treatment for patients with symptomatic severe aortic stenosis who are at high risk for traditional Inhibitors,research,lifescience,medical surgical aortic valve replacement (SAVR).1-4 The PARTNER trial was Inhibitors,research,lifescience,medical the first randomized controlled trial to demonstrate that TAVI is not inferior to SAVR in high-risk patients, since both procedures had similar rates of survival at 1 year.4 According to the German TAVI registry, approximately one-third of Inhibitors,research,lifescience,medical all implanted aortic valve prostheses in 2011 were anticipated to be transcatheter heart valves.5 Although the PARTNER trial recently underscored the value of TAVI for high-risk patients, distinct TAVI-related drawbacks have
been identified, including important differences in periprocedural risks, periprosthetic aortic regurgitation (AR), and the occurrence of significant conduction disturbances. Concerns Inhibitors,research,lifescience,medical remain around the higher, mostly procedure-related incidence of paravalvular leakage compared to SAVR. Since transcatheter heart valves are implanted without sutures, using oversizing to expand a stent at the level of the aortic annulus, several etiologies can be invoked to explain periprosthetic
AR after TAVI, such as heavily calcified cusps, misplacement of Inhibitors,research,lifescience,medical the prosthesis, and/or annulus-prosthesis-size mismatch. Recently published studies report an incidence of periprosthetic AR in more than 70% of all TAVI patients that is graded as moderate or severe in approximately 10% to 20% of them.4, 6-11 Since there is growing evidence that more-than-mild periprosthetic AR after TAVI is associated with dramatically increased mortality and morbidity, this issue must be addressed before TAVI can be extended to younger and healthier patients.6 This next generation of transcatheter heart valves addresses the issue 17-DMAG (Alvespimycin) HCl of repositionability to facilitate accurate placement and include additional features to minimize paravalvular leakage, which should further improve TAVI outcomes. Sadra Medical Lotus™ Aortic Valve The Sadra Medical Lotus valve (Boston Scientific, Natick, Massachusetts) consists of a tri-leaflet bovine pericardial tissue valve mounted on a braided nitinol stent structure that expands in the native annulus as it shortens (the “Chinese finger trap” principle).