The total new PPMI rate was 14.6%. On multivariate analysis for predictors of PPMI, pre-procedure third generation balloon expandable valve TAVR, right bundle branch block (RBBB), shorter membranous septum (MS) length, and noncoronary cusp device-landing zone calcium volume (NCC-DLZ CA) were included. Predictive probabilities were generated using this logistic regression model. If 3 pre-procedural risk factors were present, the c-statistic of the model for PPMI was area under the curve of 0.88, sensitivity of 77.1%, and specificity of 87.1%; this risk model had high negative predictive value (95.7%). The addition of the procedural factor of device depth to the model, with the parameter of difference between implantation depth and MS length, combined with RBBB and NCC-DLZ CA increased the c-statistic to 0.92, sensitivity to 94.3%, specificity to 83.8%, and negative predictive value to 98.8% CONCLUSIONS: By using a precise characterization of distribution of calcification in the AVC in a single-center, retrospective study, NCC-DLZ CA was found to be an independent predictor of new PPMI post-third generation balloon expandable valve TAVR. The findings also reinforce the importance of short MS length, pre-existing RBBB, and ventricular implantation depth as important synergistic PPMI risk factors. This risk model will need validation by future prospective multicenter studies.

Cross-sectional 3D echocardiographic sizing of the aortic annulus dimension offers discrimination of post-TAVR paravalvular AR that is significantly superior to that of 2D-TEE. Cross-sectional data should be sought from 3D-TEE if good CT data are unavailable for TAVR sizing.

Both leaflet and LVOT calcium are significant predictors of PVL and exert an important synergistic influence on this complication, even in appropriately sized valves. With careful attention to thresholds for detection, clinically relevant leaflet calcium volumes can be identified with either non-contrast or contrast CT scans.

A new benzophenone-diketopiperazine-type potent antimicrotubule agent was developed by modifying the structure of the clinical candidate plinabulin (1). Although the right-hand imidazole ring with a branched alkyl chain at the 5-position in 1 was critical for the potency of the antimicrotubule activity, we successfully substituted this moiety with a simpler 2-pyridyl structure by converting the left-hand ring from a phenyl to a benzophenone structure without decreasing the potency. The resultant compound 6b (KPU-300) exhibited a potent cytotoxicity, with an IC50 value of 7.0 nM against HT-29 cells, by strongly binding to tubulin (K d = 1.3 μM) and inducing microtubule depolymerization.

No abstract

Left ventricular pseudoaneurysm (LVP) formation is a rare but potentially life-threatening complication of transapical transcatheter aortic valve replacement (TAVR). Conventionally, a pseudoaneurysm has been treated surgically; however, improved transcatheter technique and device technology have made a percutaneous closure of LVP an increasingly viable option, especially in a patient unfavorable for surgery. A TAVR candidate is most likely at increased surgical-risk or inoperable. Therefore a percutaneous closure can be a reasonable strategy for LVP, but its experience following this emerging aortic valve procedure remains limited. We describe a case of LVP formation after TAVR in which it was efficiently treated with a percutaneous closure using a transapical approach via LVP. The first attempt was performed with a transfemoral approach. Pre-closure angiography revealed an eccentric shape of a LVP neck like a "chicken leg". This shape caused serious difficulty to cross LVP with a wire and it was not accomplished. However, the LVP location was at the apex and we could access from a chest wall through the pseudoaneurysm in the second attempt. This approach allowed a close and coaxial wire manipulation and the neck of LVP was finally crossed. After that, a closure device was deployed and the second procedure was successfully completed. An approach selection often contributes to a procedural success. This is the first case of a percutaneous LVP closure following TAVR using a transapical access and may suggest this approach as a possible option for this catheter closure in TAVR candidates. © 2016 Wiley Periodicals, Inc.

A n 81-year-old woman presented for a scheduled 1-month follow-up after an uneventful valve-in-valve transapical transcatheter aortic valve replacement (TA-TAVR) using a 23-mm Sapien XT prosthesis (Edwards Lifesciences, Irvine, California). Although the patient remained asymptomatic after discharge, a transthoracic echocardiogram revealed a left ventricular (LV) pseudoaneurysm, with a 10-mm neck, at the location of the transapical access site (Figure 1A, Online Video 1). Subsequent heart team discussion led to the decision to proceed with percutaneous closure via an antegrade transseptal approach. The procedure was performed under general anesthesia and transesophageal echocardiographic guidance. Following transseptal puncture, an 8-F Mullins sheath was further advanced into the LV through the mitral valve with a support of a 6-F balloon floating catheter, and then an initial LV FI GURE 1 Transthoracic Echocardiogram With Contrast (Apical 4-Chamber View) (A) Transthoracic echocardiogram with contrast at 1-month follow-up post-transapical transcatheter aortic valve replacement revealed a left ventricular (LV) pseudoaneurysm (asterisk) with a neck (Online Video 1). (B) Transthoracic callouts echocardiogram with contrast after pseudoaneurysm closure showed a well-seated 12-mm Amplatzer Muscular ventricular septal defect occluder (white arrows) across the neck of the LV pseudoaneurysm without significant shunt (Online Video 2).

Prognostication of PVAR in the intermediate range of echocardiographic severity remains unreliable and is greatly enhanced by the integration of heart-rate-adjusted transcatheter haemodynamics.