In a selected population of patients percutaneous PIVSD closure is feasible and provides satisfactory survival rate. Procedural success has a protective impact on survival. Timing of the closure remains controversial. Procedure in the non-acute phase carries lower mortality, but at the same time introduces a selection bias. Larger registry-based studies are required.

Background: Coronary artery disease (CAD) and degenerative aortic stenosis often coexist. How-

A b s t r a c t Background:The role of platelets in the pathophysiology of acute coronary syndromes (ACS) is undeniable, but precise relationships between platelet activity and treatment outcomes are a matter of continuant investigation. Among platelet indices, mean platelet volume (MPV) has proven to be a valuable predicting factor in cardiac patients. However, platelet distribution width (PDW) is reported to be a more specific marker of platelet reactivity. Thus, application of PDW in risk stratification of ACS treatment is an up-to-date subject of research. PDW values in the assessment of left ventricular (LV) function have not been previously studied. Aim:The aim of the study was to evaluate whether admission PDW can predict LV systolic function in patients with ACS treated with stent implantation.Methods: On-admission PDW was measured in 278 consecutive patients with diagnosis of ACS, who underwent stent(s) implantation. Echocardiogram with LV ejection fraction (LVEF) estimation was performed within 24 h of percutaneous coronary intervention. Additionally, patients were under one-year follow-up, and one-year all-cause mortality was assessed.Results: According to receiver-operating characteristics (ROC) analysis, a PDW value greater than 12.8 fL could predict LVEF ≤ 35% with sensitivity of 81% and specificity of 39% (AUC 0.614; p = 0.0177). Only a trend was noted in ROC for PDW and one-year mortality (AUC 0.608; p = 0.0815). Multivariate logistic regression analysis has shown that the PDW parameter correlates independently with both systolic heart failure with LVEF ≤ 35% (PDW cut-off: 12.8 fL, OR 2.8107, CI 1.1401-6.9293, p = 0.0248) and one-year mortality (PDW cut-off: 16 fL, OR 2.6750, CI 1.0190-7.0225, p = 0.0457).Conclusions: Admission PDW may serve as a simple and widely available predictor of impaired LV function in patients with ACS. Association between PDW and mortality needs to be confirmed in larger studies.

Background: Bleeding complications after transcatheter aortic valve implantation (TAVI) negatively affect the post-procedural prognosis. Routine use of protamine sulfate (PS) to reverse unfractionated heparin after TAVI was never assessed in a randomized controlled trial. Aims:The aim of this study was to assess the impact of PS on bleeding complications after TAVI.Methods: Between December 2016 and July 2020 311 patients qualified to TAVI in one academic center were screened. Patients that met the inclusion criteria were randomized to either PS or normal saline administration at the moment of optimal valve deployment. Baseline, procedural, and follow-up data for up to 30 days were collected and analyzed. The primary endpoint (PE) was a composite of life-threatening and major bleeding according to Valve Academic Research Consortium within 48 hours after the procedure.Results: Overall, 100 patients (48 males, median age 82 years) met the inclusion criteria and were included in the study. Forty-seven subjects (47%) were randomized to PS. The primary endpoint occurred in 29% of the study population. Despite numerically lower rates of PE in patients randomized to PS, a statistical significance was not reached (21% in the PS group and 36% in the placebo group; odds ratio [OR], 0.48; 95% confidence intervals [CI] 0.2-1.2; P = 0.11). There were no significant differences in secondary endpoints.Conclusions: Routine protamine sulfate administration did not significantly decrease the rate of major and life-threatening bleeding complications after TAVI. Larger studies are required to assess the impact of routine PS use.

Augmented reality (AR) is gaining practicality with the increasing number of applications it offers combined with modern hardware and software. It is becoming a credible tool for peri-procedural assessment in interventional cardiology. We present two cases of left atrial appendage occlusion (LAAO) in patients with atrial fibrillation (AF) and contraindications to oral anticoagulants (OAC) performed with assistance of holograms and AR. The first patient is an 84-year-old woman with a history of heart failure with preserved ejection fraction (HFpEF), stable coronary artery disease (sCAD), paroxysmal AF, and hypertension. Based on high risk of stroke (CHA 2 DS 2 -VASc score 6), the patient was administered OAC; however, due to gastrointestinal bleeding without an overt source and anaemia, anticoagulants were stopped and the patient was referred for LAAO. Because of chest angina aggravation, a coronary angiography was performed revealing a significant lesion in proximal left anterior descending artery, which was subsequently treated with coronary angioplasty. A transoesophageal echocardiography (TEE) and cardiac computed tomography (cCT) were performed in order to exclude thrombus in the left atrium and to assess the morphology and anatomy of the appendage. Based on the perimeter-derived diameter of the landing-zone from cCT (20 mm) and three-dimensional (3D) reconstructions, a 20 mm Amplatzer Amulet ® device was selected and successfully implanted.A transthoracic echocardiography (TTE) performed on the following day showed no signs of pericardial effusion, and a control TEE was scheduled for three months later. Three days after the procedure the patient was discharged. The second patient is an 87-year-old man with a history of paroxysmal AF, HFpEF, sCAD, hypertension, and angiodysplasia of the duodenum and large intestine causing chronic gastrointestinal bleeding. Due to high risk of stroke (CHA 2 DS 2 -VASc score 5) and contraindications to OAC the patient was referred for LAAO. Again, TEE and cCT were performed. According to the perimeter-derived diameter of the LAA landing zone (24 mm), a 25-mm Amplatzer Amulet ® device was selected and, with the assistance of holograms, successfully implanted. A TTE on the following day revealed correct implant position and no cardiac effusion. The patient was discharged three days later and a TEE was scheduled for three months after the procedure. In both cases, in order to facilitate the pre-procedural assessment, cCTs were processed and holographic reconstructions obtained. Next, 3D images were analysed before and during interventions through a set of AR goggles (Microsoft HoloLens ® ) with a variety of gestures and voice commands to allow rotation, magnification, slicing, and partitioning ( Fig. 1). Models were created and managed using Carnalife Holo ® (MedApp S.A., Cracow, Poland) software. A thorough assessment of the LAA and the adjoining structures such as the pulmonary artery and the circumflex artery is essential before LAAO. A 3D reconstruction of the heart accessib...

p = 0.59; EuroSCORE II, AUC 0.59; p = 0.23; STS, AUC 0.55; p = 0.52; ACEF, AUC 0.54; p = 0.69; Ambler's, AUC 0.54; p = 0.70; OBSERVANT, AUC 0.597; p = 0.21; SURTAVI, AUC 0.535; p = 0.65. SURTAVI model was calibrated best in high-risk patients showing coherence between expected and observed mortality (10.8% vs. 9.4%, p = 0.982). ACEF demonstrated best classification accuracy (17.5% vs. 6.9%, p = 0.053, respectively). Conclusions: None of the investigated risk scales proved to be optimal in predicting 30-day mortality in unselected, real-life population with aortic stenosis referred to TAVI. This data supports primary role of heart team in decision process of selecting patients for TAVI. (Cardiol J 2016; 23, 2: 169-177)

Background The aim of this study was to evaluate the outcomes of transcatheter aortic valve implantation (TAVI) in bicuspid aortic valve (BiAV) stenosis using a mechanically expanded Lotus™ device. The prior experience with first-generation devices showed disappointing results mainly due to increased prevalence of aortic regurgitation (AR) that exceeded those observed in tricuspid stenosis. Methods and results We collected baseline, in-hospital, 30-day and 2-year follow-up data from a prospective, multicentre registry of patients with BiAV undergoing TAVI using Lotus™ valve. Safety and efficacy endpoints were assessed according to VARC-2 criteria. The study group comprised 24 patients. The mean age was 73.5 years and the mean EuroSCORE 2 was 4.35 ± 2.56%. MDCT analysis revealed Type 1 BiAV in 75% of patients. The mean gradient decreased from 60.1 ± 18.3 to 15 ± 6.4 mm Hg, the AVA increased from 0.6 ± 0.19 to 1.7 ± 0.21 cm 2. One in-hospital death was observed secondary to aortic perforation. There was no severe AR and the rate of moderate AR equalled 9% at 30 days (n = 2). Device success was achieved in 83% and the 30-day safety endpoint was 17%. In the 2-year follow-up, the overall mortality was 12.5% and the 2-year composite clinical efficacy endpoint was met in 25% of the patients (n = 6) Conclusions The TAVI in selected BiAV patients using the Lotus™ is feasible and characterized by encouraging valve performance and mid-term clinical outcomes.

Both transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) have been proven to effectively correct von Willebrand Factor (vWF) pathologies, however there is limited data simultaneously comparing outcomes of both approaches. We prospectively enrolled patients with severe aortic stenosis referred for TAVI (n = 52) or SAVR (n = 48). In each case, vWF antigen (vWF:Ag), vWF activity (vWF:Ac) and activity-to-antigen (vWF:Ac/Ag) ratio were assessed at baseline, 24 h and 72 h after procedure. VWF abnormalities were defined as reduced vWF:Ac/Ag ratio (< 0.8). Bleeding events in both arms were classified according to Valve Academic Research Consortium (VARC-2) definitions. Overall, there was no difference between patients referred for TAVI and SAVR in vWF:Ac (1.62 ± 0.52 vs 1.71 ± 0.64; p = 0.593), vWF:Ag (1.99 ± 0.81 vs 2.04 ± 0.81; p = 0.942) or vWF:Ac/Ag ratio (0.84 ± 0.16 vs 0.85 ± 0.12; p = 0.950). Pathological vWF:Ac/Ag ratio was found in 20 (38%) TAVI and 15 (31%) SAVR patients (p = 0.407). Normalization of vWF:Ac/Ag ratio at day 3 after procedure was achieved in 19 (95%) TAVI and 13 (87%) SAVR patients (p = 0.439). Similar prevalence of major or life-threatening bleedings (MLTB) after TAVI and SAVR in entire groups was observed (19% vs. 23%, p = 0.652). VWF abnormalities were associated with higher incidence of MLTB in SAVR (53% vs 9%, p < 0.001), but not TAVI (15% vs. 22%, p = 0.132). Accordingly, in receiver-operating characteristic curve analysis vWF:Ac/Ag ratio < 0.8 showed significant sensitivity and specificity for predicting MLTB in SAVR group (AUC 0.735, 95% CI 0.538–0.931, p = 0.019). We proved that abnormal function of vWF is corrected successfully after both TAVI and SAVR, but vWF abnormalities are predictive of MLTB only in surgical patients.Electronic supplementary materialThe online version of this article (10.1007/s11239-019-01917-7) contains supplementary material, which is available to authorized users.