BACKGROUND AND AIMS: There is significant potential to streamline the clinical pathway for patients undergoing transcatheter aortic valve implantation (TAVI). The purpose of this study was to evaluate the effect of implementing BENCHMARK best practices on the efficiency and safety of TAVI in 28 sites in 7 European countries. METHODS: This was a study of patients with severe symptomatic aortic stenosis (AS) undergoing TAVI with balloon-expandable valves before and after implementation of BENCHMARK best practices. Principal objectives were to reduce hospital length of stay (LoS) and duration of intensive care stay. Secondary objective was to document patient safety. RESULTS: Between January 2020 and March 2023, 897 patients were documented prior to and 1491 patients after the implementation of BENCHMARK practices. Patient characteristics were consistent with a known older TAVI population and only minor differences. Mean LoS was reduced from 7.7 ± 7.0 to 5.8 ± 5.6 days (median 6 vs. 4 days; P < .001). Duration of intensive care was reduced from 1.8 to 1.3 days (median 1.1 vs. 0.9 days; P < .001). Adoption of peri-procedure best practices led to increased use of local anaesthesia (96.1% vs. 84.3%; P < .001) and decreased procedure (median 47 vs. 60 min; P < .001) and intervention times (85 vs. 95 min; P < .001). Thirty-day patient safety did not appear to be compromised with no differences in all-cause mortality (0.6% in both groups combined), stroke/transient ischaemic attack (1.4%), life-threatening bleeding (1.3%), stage 2/3 acute kidney injury (0.7%), and valve-related readmission (1.2%). CONCLUSIONS: Broad implementation of BENCHMARK practices contributes to improving efficiency of TAVI pathway reducing LoS and costs without compromising patient safety.

• MeSH
• aortální stenóza * chirurgie   MeSH
• benchmarking * MeSH
• bezpečnost pacientů MeSH
• délka pobytu * statistika a číselné údaje   MeSH
• kritické cesty MeSH
• lidé MeSH
• pooperační komplikace epidemiologie   prevence a kontrola   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• transkatetrální implantace aortální chlopně * metody   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• Geografické názvy
• Evropa MeSH

• MeSH
• lidé MeSH
• podpůrné srdeční systémy * MeSH
• srdce MeSH
• srdeční selhání * chirurgie   MeSH
• transplantace plic * MeSH
• transplantace srdce * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• směrnice pro lékařskou praxi MeSH

Mitral regurgitation is the second most frequent valve disease in the adult population. Until recently, surgical repair or replacement were the only therapeutic options, leaving many patients untreated and even underdiagnosed, most frequently due to a presumably high surgical risk, particularly in those with secondary mitral regurgitation. Over the last few years, there has been exponential growth in the number of catheter-based procedures, with most of them using the transcatheter edge-to-edge repair (TEER) technique. Furthermore, the evolution of other systems is under way that preferentially use the transseptal approach, are more comprehensive, and are aimed at transcatheter mitral valve replacement. The purpose of this article is to review the current transcatheter repair systems and the evidence base for their use.

Mitrální regurgitace představuje druhou nejčastější chlopenní vadu v dospělé populaci. Až do nedávné doby byla jedinou terapeutickou možností chirurgická plastika nebo náhrada mitrální chlopně, přičemž mnoho nemocných nebylo léčeno ani diagnostikováno, nejčastěji z důvodů předpokládaného vysokého rizika operace, zejména u nemocných se sekundární mitrální regurgitací. V průběhu několika posledních let došlo k výraznému nárůstu počtu transkatétrových výkonů, většina z nich využívala principu sblížení obou cípů mitrální chlopně (tzv. transkatétrová edge­‐to­‐edge korekce - TEER). V současnosti jsme svědky vývoje dalších systémů, které využívají prefe

• Klíčová slova
• "edge­‐to­‐edge" intervence mitrální chlopně,
• MeSH
• kardiochirurgické výkony metody   MeSH
• lidé MeSH
• mitrální insuficience * chirurgie   MeSH
• srdeční katetrizace metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

BACKGROUND: Use of the current echocardiography-based indications for aortic regurgitation (AR) surgery might result in late valve replacement at the stage of irreversible myocardial damage. Therefore, we aimed to identify simple models combining multiple echocardiography or magnetic resonance imaging (MRI)-derived indices and natriuretic peptides (BNP [brain natriuretic peptide] or NT-proBNP [N-terminnal pro-B type natriuretic peptide]) to predict early disease decompensation in asymptomatic severe AR. METHODS: This prospective and multicenter study included asymptomatic patients with severe AR, preserved left ventricular ejection fraction (>50%), and sinus rhythm. The echocardiography and MRI images were analyzed centrally in the CoreLab. The study end point was the onset of indication for aortic valve surgery as per current guidelines. RESULTS: The derivative cohort consisted of 127 asymptomatic patients (age 45±14 years, 84% males) with 41 (32%) end points during a median follow-up of 1375 (interquartile range, 1041-1783) days. In multivariable Cox regression analysis, age, BNP, 3-dimensional vena contracta area, MRI left ventricular end-diastolic volume index, regurgitant volume, and a fraction were identified as independent predictors of end point (all P<0.05). However, a combined model including one parameter of AR assessment (MRI regurgitant volume or regurgitant fraction or 3-dimensional vena contracta area), 1 parameter of left ventricular remodeling (MRI left ventricular end-diastolic volume index or echocardiography 2-dimensional global longitudinal strain or E wave), and BNP showed significantly higher predictive accuracy (area under the curve, 0.74-0.81) than any parameter alone (area under the curve, 0.61-0.72). These findings were confirmed in the validation cohort (n=100 patients, 38 end points). CONCLUSIONS: In asymptomatic severe AR, multimodality and multiparametric model combining 2 imaging indices with natriuretic peptides, showed high accuracy to identify early disease decompensation. Further prospective studies are warranted to explore the clinical benefit of implementing these models to guide patient management. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT02910349.

• MeSH
• aortální insuficience * diagnostické zobrazování   etiologie   chirurgie   MeSH
• dospělí MeSH
• echokardiografie MeSH
• funkce levé komory srdeční MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• natriuretický peptid typu B MeSH
• tepový objem MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

Mechanical circulatory support (MCS) with an implantable left ventricular assist device (LVAD) is an established therapeutic option for advanced heart failure. Most of the currently used LVADs generate a continuous stream of blood that decreases arterial pulse pressure. This study investigated whether a change of the pulse pressure during different pump speed settings would affect cerebral autoregulation and thereby affect cerebral blood flow (CBF). The study included 21 haemodynamically stable outpatients with a continuous-flow LVAD (HeartMate II, Abbott, USA) implanted a median of 6 months before the study (interquartile range 3 to 14 months). Arterial blood pressure (measured by finger plethysmography) was recorded simultaneously with CBF (measured by transcranial Doppler ultrasound) during baseline pump speed (8900 rpm [IQR 8800; 9200]) and during minimum and maximum tolerated pump speeds (8000 rpm [IQR 8000; 8200] and 9800 rpm [IQR 9800; 10 000]). An increase in LVAD pump speed by 800 rpm [IQR 800; 1000] from the baseline lead to a significant decrease in arterial pulse pressure and cerebral blood flow pulsatility (relative change ?24% and ?32%, both p < 0.01), but it did not affect mean arterial pressure and mean CBF velocity (relative change 1% and ?1.7%, p = 0.1 and 0.7). In stable patients with a continuous-flow LVAD, changes of pump speed settings within a clinically used range did not impair static cerebral autoregulation and cerebral blood flow.

• MeSH
• dospělí MeSH
• hemodynamika * MeSH
• lidé středního věku MeSH
• lidé MeSH
• mozkový krevní oběh * MeSH
• podpůrné srdeční systémy statistika a číselné údaje   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

OBJECTIVE: Approximately 3.4% of adults aged >75 years suffer from aortic stenosis (AS). Guideline indications for aortic valve replacement (AVR) distinguish between patients with symptomatic and asymptomatic severe AS. The present analysis aims to assess contemporary practice in the treatment of severe AS across Europe and identify characteristics associated with treatment decisions, namely denial of AVR in symptomatic patients and assignment of asymptomatic patients to AVR. METHODS: Participants of the prospective, multinational IMPULSE database of patients with severe AS were grouped according to AS symptoms, and stratified into subgroups based on assignment to/denial of AVR. RESULTS: Of 1608 symptomatic patients, 23.8% did not undergo AVR and underwent medical treatment. Denial was independently associated with multiple factors, including severe frailty (p=0.024); mitral (p=0.002) or tricuspid (p=0.004) regurgitation grade III/IV, and the presence of renal impairment (p=0.017). Of 392 asymptomatic patients, 86.5% had no prespecified indication for AVR. Regardless, 36.3% were assigned to valve replacement. Those with an indexed aortic valve area (AVA; p=0.045) or left ventricular ejection fraction (LVEF; p<0.001) below the study median; or with a left ventricular end systolic diameter above the study median (p=0.007) were more likely to be assigned to AVR. CONCLUSIONS: There may be considerable discrepancies between guideline-based recommendations and clinical practice decision-making in the treatment of AS. It appears that guidelines may not fully capture the complete clinical spectrum of patients with AS. Thus, there is a need to find ways to increase their acceptance and the rate of adoption.

• MeSH
• aortální stenóza diagnóza   chirurgie   MeSH
• echokardiografie MeSH
• kvalita zdravotní péče * MeSH
• lidé MeSH
• management nemoci * MeSH
• následné studie MeSH
• prospektivní studie MeSH
• senioři MeSH
• směrnice pro lékařskou praxi jako téma * MeSH
• stupeň závažnosti nemoci MeSH
• transkatetrální implantace aortální chlopně normy   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH

AIMS: There is an increasing awareness of gender-related differences in patients with severe aortic stenosis and their outcomes after surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI). METHODS: Data from the IMPULSE registry were analysed. Patients with severe aortic stenosis (AS) were enrolled between March 2015 and April 2017 and stratified by gender. A subgroup analysis was performed to assess the impact of age. RESULTS: Overall, 2171 patients were enrolled, and 48.0% were female. Women were characterised by a higher rate of renal impairment (31.7 vs 23.3%; p<0.001), were at higher surgical risk (EuroSCORE II: 4.5 vs 3.6%; p=0.001) and more often in a critical preoperative state (7.0vs 4.2%; p=0.003). Men had an increased rate of previous cardiac surgery (9.4 vs 4.7%; p<0.001) and a reduced left ventricular ejection fraction (4.9 vs 1.3%; p<0.001). Concomitant mitral and tricuspid valve disease was substantially more common among women. Symptoms were highly prevalent in both women and men (83.6 vs 77.3%; p<0.001). AVR was planned in 1379 cases. Women were more frequently scheduled to undergo TAVI (49.3 vs 41.0%; p<0.001) and less frequently for SAVR (20.3 vs 27.5%; p<0.001). CONCLUSIONS: The present data show that female patients with severe AS have a distinct patient profile and are managed in a different way to males. Gender-based differences in the management of patients with severe AS need to be taken into account more systematically to improve outcomes, especially for women.

• MeSH
• aortální chlopeň chirurgie   MeSH
• aortální stenóza epidemiologie   chirurgie   MeSH
• časové faktory MeSH
• hodnocení rizik metody   MeSH
• incidence MeSH
• lidé MeSH
• následné studie MeSH
• registrace * MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• sexuální faktory MeSH
• srdeční chlopně umělé * MeSH
• stupeň závažnosti nemoci MeSH
• transkatetrální implantace aortální chlopně metody   MeSH
• věkové faktory MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Evropa MeSH

INTRODUCTION: Inherited thrombophilias represent a concerning risk factor due to a proclivity to an aberrant clot formation. However, in patients with left ventricular assist device (LVAD), their impact on bleeding and thrombotic complications remains still poorly understood. The aim of the present study was to evaluate the effect of thrombophilic mutation directed anticoagulation therapy on adverse clinical outcomes in LVAD patients. MATERIALS AND METHODS: About 138 consecutive patients indicated for LVAD implant (HeartMate II, Abbott, Plymouth, USA) were prospectively screened for three major thrombophilic mutations: factor II (prothrombin), factor V Leiden, and homozygous methylenetetrahydrofolate reductase (MTHFR). Subsequently, discordant individualized anticoagulation targets of INR 2.5-3.0 in thrombophilia positive and INR 1.8-2.2 in negative patients were established; notably without anti-platelet agents given the center standard of care. RESULTS: Mean age was 50 ± 12.7 years, 83% male. Mean duration of support was 464.5 days (SD 482.9; SEM 41.1) and median of 310 days (IQR 162; 546). Full thrombophilia positive cohort analysis has not revealed any significant impact on event free survival. In contrast, detailed analysis of specific thrombophilias subsets has revealed Factor II prothrombin mutation as a significant predisposition for the pump thrombosis risk (SHR 10.48; p = 0.001) despite more aggressive prespecified anticoagulation target. Moreover, the incidence of bleeding events in prothrombin group was also significantly increased (SHR 6.0; p = 0.03). CONCLUSIONS: Our observations suggest that specific thrombophilias in LVAD patients may pose different intensity predisposition for thrombotic complications. Factor II (prothrombin) positive mutation was identified as significant risk factor associated with the pump thrombosis.

• MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• podpůrné srdeční systémy * škodlivé účinky   MeSH
• prospektivní studie MeSH
• protrombin MeSH
• trombofilie * diagnóza   genetika   MeSH
• trombóza * genetika   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Kontext: Cílem studie bylo zjistit závažnost zánětlivé odpovědi po výkonu PEARS (personalized external aortic root support) s vytvořením personalizovaného externího stentu pro aortální kořen ve srovnání se standardní profylaktickou operací aortálního kořene (standard prophylactic aortic root surgery, SPARS). Materiál a metody: Studie byla monocentrickou, retrospektivní analýzou nemocničních záznamů pacientů, u nichž byla v období 1998-2017 provedena buď PEARS (skupina PEARS), nebo SPARS (skupina SPARS). U všech pacientů se rutinně stanovovaly hodnoty C-reaktivního proteinu (CRP) a počet bílých krvinek (white blood count, WBC) a provádělo se echokardiografické vyšetření. Horečka byla definována jako tělesná teplota ≥ 38 °C. Diagnóza perikarditidy se stanovovala na základě nejméně tří známek z bolesti na hrudi, perikardiálního výpotku, elevace úseku ST, zvýšených hodnot CRP a tělesné teploty. Výsledky: Do skupin PEARS a SPARS bylo zařazeno 13, resp. 14 pacientů s indikací k profylaktické operaci aortálního kořene. Většina pacientů v obou skupinách měla Marfanův syndrom s kauzální mutací v genu pro fibrilin 1 (FBN1) (62 % vs. 79 %). Vstupní charakteristiky pacientů v obou skupinách byly podobné s výjimkou aortálního kořene, který byl ve skupině SPARS statisticky významně větší než ve skupině PEARS (60 ± 12 mm vs. 48 ± 5 mm; p = 0,003). Všechny operace byly úspěšné a proběhly bez větších komplikací. Nejvyšší hodnoty CRP a WBC byly statisticky významně vyšší ve skupině PEARS (264,5 ± 84,4 mg/l vs. 184,6 ± 89,6 mg/l; p = 0,034, resp. 15,2 ± 3,8 109/l vs. 11,9 ± 3,3 109/l; p = 0,029). Časná a recidivující horečka vyžadující opětovnou hospitalizaci se vyskytla častěji ve skupině PEARS (77 % vs. 36 %; p = 0,032, resp. 46 % vs. 7 %; p = 0,020). Časná a recidivující perikarditida vyžadující hospitalizaci byla rovněž častější ve skupině PEARS (31 % vs. 0 %; p = 0,024, resp. 31 % vs. 0 %; p = 0,024). Závěry: Metoda PEARS je velmi slibná chirurgická metoda; pooperační zánětlivá odpověď se však vyskytuje častěji a ve srovnání s metodou SPARS je závažnější. Tyto výsledky je však samozřejmě nutno dále zkoumat a ověřovat.

Background: The study aimed to determine the severity of inflammatory response after the personalized external aortic root support (PEARS) procedure in comparison to after the standard prophylactic aortic root surgery (SPARS). Materials and methods: The study was a single-centre, retrospective, based on hospital record analysis of patients who underwent the PEARS procedure (PEARS group) or SPARS (SPARS group) during 1998-2017. C-reactive protein (CRP), white blood count (WBC), and echocardiography were routinely obtained. Fever was defined as body temperature ≥38 °C. Diagnosis of pericarditis included a minimum of three signs from chest pain, pericardial effusion, ST elevation, elevated CRP, and body temperature. Results: PEARS and SPARS groups consisted of 13 and 14 patients, respectively, scheduled for prophylactic aortic root. A majority of patients in both groups had Marfan syndrome with causal mutation in the fibrillin 1 (FBN1) gene (62% vs 79%). Patient baseline characteristics were similar in the two groups, except aortic root was significantly larger in the SPARS group than in the PEARS group (60±12 mm vs 48±5 mm; p = 0.003). All surgical procedures were successful and without major complications. The peak values of CRP and WBC were significantly higher in the PEARS group (264.5±84.4 mg/L vs 184.6±89.6 mg/L; p = 0.034 and 15.2±3.8 109/L vs 11.9±3.3 109/L; p = 0.029). Early and recurrent fever requiring hospital readmission was significantlymore frequent in the PEARS group (77% vs 36%; p = 0.032 and 46% vs 7%; p = 0.020). Early and recurrent pericarditis requiring hospital readmission was also more frequent in the PEARS group (31% vs 0%; p = 0.024 and 31% vs 0%; p = 0.024)., Conclusions: The PEARS procedure is an extremely promising surgical technique, but the postoperative inflammatory response occurs frequently and more severely in comparison to SPARS. Clearly, these findings warrant further investigation.

• MeSH
• aortální aneurysma * chirurgie   MeSH
• C-reaktivní protein analýza   MeSH
• lidé MeSH
• Marfanův syndrom chirurgie   MeSH
• perikarditida chirurgie   MeSH
• pooperační komplikace MeSH
• profylaktické chirurgické výkony MeSH
• retrospektivní studie MeSH
• zánět MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH

• Publikační typ
• úvodníky MeSH