This registry analysis demonstrates the feasibility and potential procedure difficulties when using TAVI for severe NAVR. Acceptable results may be achieved in carefully selected patients who are deemed too high risk for conventional surgery, but the possibility of requiring 2 valves and leaving residual aortic regurgitation remain important considerations.

Objective-Previously, we demonstrated that activated inducible NO synthase (iNOS)-expressing foam cells in human carotid plaques often produce autofluorescent (per)oxidized lipids (ceroid Key Words: atherosclerosis Ⅲ microvessels Ⅲ inducible NO synthase Ⅲ hemorrhage Ⅲ erythrocytes I ntermittent growth is a characteristic of human atherosclerosis. This could be the consequence of recurrent rupture of the fibrous cap followed by thrombus organization into the plaque. 1,2 Other studies have suggested a causative role of hemorrhages of intraplaque microvessels in carotid plaque rupture. [3][4][5] Paterson et al 6 proposed the vascularization theory of plaque evolution by demonstrating hemosiderin deposition in early atheromatous plaques, and they related this to repeated intraplaque capillary rupture, but it remains unclear how hemorrhages contribute to lipid accumulation. Ceroid is one of these lipid components and consists of insoluble mixtures of oxidized lipids and proteins, which mark sites of previous oxidative events. 7 Macrophages play a central role in the production of this fluorescent pigment, and extracellular ceroid deposits ultimately accumulate in the necrotic core of the plaque. 7,8 Furthermore, the upregulation of inducible NO synthase (iNOS), a major ancillary pathway of host defense by activated macrophages, is a characteristic feature of foam cell-rich plaque regions. 9,10 Recently, we showed that iNOS, which is predominantly expressed in macrophages, 10,11 often colocalizes with ceroid 11 or platelet-derived amyloid ␤ 12 in advanced human plaques. Because the reasons See coverfor these associations are unclear, we investigated the role of microvessels in plaque progression. To this end, the distribution of microvessels, ceroid and iNOS (as a marker of macrophage activation), was systematically mapped in human carotid artery plaques. The expression of von Willebrand factor (vWf) in the endothelial cells of intraplaque microvessels is highly variable, ranging from undetectable to thick perivascular deposits. 5 The latter are due to increased vWf biosynthesis during atherogenesis. 13,14 Therefore, vWf was used as a marker of endothelial cell activation. For an unbiased identification of topographical associations, the results were subjected to a cluster analysis. Finally, the formation of iNOS-expressing ceroid-containing foam cells was demonstrated in normocholesterolemic settings on erythrophagocytosis by macrophages in experimental thrombi in rabbit carotid arteries and in murine J774 macrophages in culture. MethodsThe ethics committees of Middelheim Hospital and Antwerp University approved the studies.

The ADVANCE study demonstrates the safety and effectiveness of the CoreValve System with low mortality and stroke rates in higher risk real-world patients with severe aortic stenosis.

We report clinical outcomes following transcatheter aortic valve implantation (TAVI), using the CoreValve revalving system (18 Fr transfemoral or subclavian) or the Edwards Sapien valve (22 Fr transfemoral or 24 Fr transapical) as part of a Belgian prospective non-randomized multicentre registry. All 15 Belgian centres performing TAVI participated to this registry (seven exclusively Edwards Sapien, eight exclusively CoreValve). All consecutive high-risk symptomatic patients with severe aortic stenosis were evaluated by a heart team and screened for eligibility for TAVI. Three hundred and twenty-eight patients underwent TAVI with CoreValve (n = 141; eight subclavian and 133 transfemoral) or Edwards Sapien (n = 187; 99 transfemoral and 88 transapical) up to April 2010. Procedural success was 97%. One-month survival was 88% for the Edwards and 89% for the CoreValve treated patients. One-month mortality was both related to cardiac and non-cardiac reasons. Overall one-year survival was 78% in the CoreValve transfemoral treated patients, 100% in the CoreValve subclavian treated patients, 82% in the Edwards transfemoral treated patients and 63% in the Edwards transapical treated patients. This mid-term mortality was mainly related to age-related, non-cardiac complications.

TAV-in-BAV is feasible with encouraging short- and intermediate-term clinical outcomes. Importantly, a high incidence of post-implantation AR is observed, which appears to be mitigated by MSCT-based TAV sizing. Given the suboptimal echocardiographic results, further study is required to evaluate long-term efficacy.

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Background-Blood transfusion is associated with acute kidney injury (AKI) after transcatheter aortic valve implantation (TAVI). We sought to elucidate in more detail the relation between blood transfusion and AKI and its effects on short-and long-term mortality. Methods and Results-Nine