These 4 cases elucidate the occurrence of valve thrombosis post-TAVR. Consideration should be given to treatment with dual antiplatelet therapy and oral anticoagulation in patients post-TAVR with increasing mean pressure gradients and maximum aortic valve velocity. Further research should be conducted to create guidelines for antithrombotic therapy following TAVR procedure.

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ImportanceIn patients with severe aortic valve stenosis at intermediate surgical risk, transcatheter aortic valve replacement (TAVR) with a self-expanding supra-annular valve was noninferior to surgery for all-cause mortality or disabling stroke at 2 years. Comparisons of longer-term clinical and hemodynamic outcomes in these patients are limited.ObjectiveTo report prespecified secondary 5-year outcomes from the Symptomatic Aortic Stenosis in Intermediate Risk Subjects Who Need Aortic Valve Replacement (SURTAVI) randomized clinical trial.Design, Setting, and ParticipantsSURTAVI is a prospective randomized, unblinded clinical trial. Randomization was stratified by investigational site and need for revascularization determined by the local heart teams. Patients with severe aortic valve stenosis deemed to be at intermediate risk of 30-day surgical mortality were enrolled at 87 centers from June 19, 2012, to June 30, 2016, in Europe and North America. Analysis took place between August and October 2021.InterventionPatients were randomized to TAVR with a self-expanding, supra-annular transcatheter or a surgical bioprosthesis.Main Outcomes and MeasuresThe prespecified secondary end points of death or disabling stroke and other adverse events and hemodynamic findings at 5 years. An independent clinical event committee adjudicated all serious adverse events and an independent echocardiographic core laboratory evaluated all echocardiograms at 5 years.ResultsA total of 1660 individuals underwent an attempted TAVR (n = 864) or surgical (n = 796) procedure. The mean (SD) age was 79.8 (6.2) years, 724 (43.6%) were female, and the mean (SD) Society of Thoracic Surgery Predicted Risk of Mortality score was 4.5% (1.6%). At 5 years, the rates of death or disabling stroke were similar (TAVR, 31.3% vs surgery, 30.8%; hazard ratio, 1.02 [95% CI, 0.85-1.22]; P = .85). Transprosthetic gradients remained lower (mean [SD], 8.6 [5.5] mm Hg vs 11.2 [6.0] mm Hg; P < .001) and aortic valve areas were higher (mean [SD], 2.2 [0.7] cm2 vs 1.8 [0.6] cm2; P < .001) with TAVR vs surgery. More patients had moderate/severe paravalvular leak with TAVR than surgery (11 [3.0%] vs 2 [0.7%]; risk difference, 2.37% [95% CI, 0.17%- 4.85%]; P = .05). New pacemaker implantation rates were higher for TAVR than surgery at 5 years (289 [39.1%] vs 94 [15.1%]; hazard ratio, 3.30 [95% CI, 2.61-4.17]; log-rank P < .001), as were valve reintervention rates (27 [3.5%] vs 11 [1.9%]; hazard ratio, 2.21 [95% CI, 1.10-4.45]; log-rank P = .02), although between 2 and 5 years only 6 patients who underwent TAVR and 7 who underwent surgery required a reintervention.Conclusions and RelevanceAmong intermediate-risk patients with symptomatic severe aortic stenosis, major clinical outcomes at 5 years were similar for TAVR and surgery. TAVR was associated with superior hemodynamic valve performance but also with more paravalvular leak and valve reinterventions.

A group of 5 women and 11 men walked on a treadmill, each carrying a weight in the right hand. In separate experiments, the mass was varied to give total exhaustion within 3 min, 5 min, 9 min, and 13 min. In additional experiments 50% and 25% of the masses leading to exhaustion after 5 min were used, and these were stopped after 16 min. Heart rate (fc) and systolic blood pressure (BPs) were measured noninvasively. There was a consistent increase in fc x BPs during the experiments leading to exhaustion, while steady-states were obtained in the nonexhausting trials. An electromyogram (EMG) was recorded with cutaneous electrodes over the flexor carpi ulnaris and flexor digitorum superficialis muscles and the number of zero crossings (ZC) of the EMG signal per time unit were analysed. As the subjects approached exhaustion, the number of ZC declined exponentially, reaching approximately 50% of their initial values. In the nonexhausting experiments, however, the decline was slower and less marked, and during the second half of the experiment the number of ZC increased again. Subjectively, endurance was underestimated by all the subjects. It was concluded that cardiovascular and muscle criteria of fatigue in carrying coincided. Prolonged carrying in one hand of more than 6 kg or 10 kg for young healthy women and men respectively should not be recommended, since it could lead to cardiovascular non steady-states and EMG signs of fatigue.

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Background. Current temporary transvenous pacemaker catheters lack sequential atrioventricular (AV) pacing in synchrony. Therefore, a catheter that could provide sequential AV pacing and maintain synchrony may be useful for patients in sinus rhythm who need temporary pacing.  Objective. The purpose of this study was to describe the first in human experience with a novel temporary AV sequential pacing catheter (TAVSP). Methods. We prospectively identified eligible patients undergoing elective cardiac catheterization in whom the TAVSP catheter was delivered and used for temporary AV sequential pacing. Safety endpoints and device performance data were obtained. Results. Ten subjects were screened and enrolled in the study. TAVSP was delivered in all ten subjects, and AV sequential synchronous pacing was successfully obtained. The pacing catheter achieved an excellent pacing threshold and impedance in all ten patients except for one. There were no adverse events during the pacing procedure. Conclusion. Temporary AV sequential pacing using TAVSP catheter is safe and feasible and may be an alternative to conventional temporary pacing catheters to maintain AV synchrony during temporary pacing.

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