AimsTo assess treatment decision and outcome in patients referred for transcatheter aortic valve implantation (TAVI) in addition to predictive factors of mortality after TAVI.MethodsThree-centre prospective observational study including 358 patients. Endpoints were defined according to the Valve Academic Research Consortium.ResultsOf the 358 patients referred for TAVI, TAVI was performed in 235 patients (65%), surgical aortic valve replacement (AVR) in 24 (7%) and medical therapy (MT) in 99 (28%). Reasons to decline TAVI in favour of AVR/MT were patient preference (29%), peripheral vascular disease (15%) and non-severe aortic stenosis (11%). The logistic EuroSCORE was significantly higher in patients who underwent TAVI and MT in comparison with those undergoing AVR (19 vs. 10%, p = 0.007). At 30 days, all-cause mortality and the combined safety endpoint were 9 and 24% after TAVI and 8 and 25% after AVR, respectively. All-cause mortality was significantly lower in the TAVI group compared with the MT group at 6 months, 1 year and 2 years (12% vs. 22%, 21% vs. 33% and 31% vs. 55%, respectively, p < 0.001). Multivariable analysis revealed that blood transfusion (HR: 1.19; 95% CI: 1.05–1.33), pre-existing renal failure (HR: 1.18; 95% CI: 1.06–1.33) and STS score (HR: 1.06; 95% CI: 1.02–1.10) were independent predictors of mortality at a median of 10 (IQR: 3–23) months after TAVI.ConclusionsApproximately two-thirds of the patients referred for TAVI receive this treatment with gratifying short- and long-term survival. Another 7% underwent AVR. Prognosis is poor in patients who do not receive valve replacement therapy.

Stomatal response to changes in leaf to air vapor pressure difference (VPD) and its influence on total gas exchange were measured for leaves of Podocarpus oleifolius and Podocarpus rospigliosii in an open gas exchange system. Stomatal conductance (g) of both species declined as VPD increased. Once a critical VPD was attained, the decrease in g was sufficient to decrease transpiration rate in spite of increasing VPD. This response pattern suggested "feedforward" control of stomatal response to humidity rather than negative feedback control based on changes in leaf water status. Coupling between CO2 assimilation and g and inherent water-use efficiency were greater in P. oleifolius. Stomatal response to humidity in P. oleifolius was consistent with a recent hypothesis that stomata optimize CO2 assimilation with respect to a given level of water loss by maintaining constant the ratio of the sensitivities of transpiration rate (E) and assimilation rate (A) to changes in g (∂E/∂g/∂A/∂g). This gain ratio did not remain constant in P. rospigliosii as VPD was varied. The possible ecological basis for these differences in gas exchange behavior is discussed.

IntroductionFew reports in the world have shown a differential effect of hypothyroidism in relation to morbidity and mortality following cardiac surgery.ObjectiveTo determine the association between preoperative hypothyroidism, composite and disaggregated outcomes of mortality and complications in patients undergoing first-time isolated myocardial revascularization surgery.MethodsHistorical cohort of patients undergoing myocardial revascularization between January 2008 and December 2014, with 626 patients included for evaluation of the composite and disaggregated outcomes of in-hospital mortality and complications (atrial fibrillation, surgical site infection and reoperation due to bleeding). A logistic regression model was used to determine the association between hypothyroidism and the onset of those outcomes.ResultsCohort of 1696 eligible patients for the study, with 1.8 mortality. Median age, female gender and prevalence of arterial hypertension were all significantly higher among hypothyroid patients. No differences were found in other preoperative or intraoperative characteristics. Hypothyroidism was associated with the presence of the composite outcome, RR 1.6 (1.04-2.4) and atrial fibrillation 1.9 (1.05-3.8). No association with mortality, infections or reoperation due to bleeding was found.ConclusionHypothyroidism is a disease that affects females predominantly and does not determine the presence of other comorbidities. Hypothyroidism is a risk factor for the onset of postoperative fibrillation in patients undergoing myocardial revascularization surgery. Postoperative care protocols focused on the prevention of these complications in this type of patients must be instituted.

Background: To assess treatment decision and outcome in patients referred for Transcatheter Aortic Valve Implantation (TAVI) in addition to predictive factors of mortality after TAVI. Methods: Three-centre prospective observational study including 358 patients. Endpoints were defined according to the Valve Academic Research Consortium. Results: Of the 358 patients referred for TAVI, TAVI was performed in 235 patients (65%), surgical aortic valve replacement (AVR) in 24 (7%) and Medical Therapy (MT) in 99 (28%). Reasons to decline TAVI in favour of AVR/MT were patient's preference (29%) and peripheral vascular disease (15%; Figure 1). The logistic EuroSCORE was significantly higher in patients who underwent TAVI and MT in comparison to those undergoing AVR (19 vs. 10%, pϭ0.007). At 30 days, all-cause mortality and the combined safety endpoint was, respectively, 9 and 24% after TAVI and 8 and 25% after AVR. All-cause mortality was significantly lower in the TAVI group compared to the MT group at 6 months, 1 year and 2 years (12% vs. 22%, 21% vs. 33% and 31% vs. 55%, respectively, pϽ0.001). Multivariable analysis revealed that blood transfusion (HR: 1.19; 95% CI: 1.05-1.33), pre-existing renal failure (HR: 1.18; 95% CI: 1.06-1.33) and STS score (HR: 1.06; 95% CI: 1.02-1.10) were independent predictors of mortality at a median of 10 (IQR: 3-23) months after TAVI. Conclusions:Approximately two-thirds of the patients referred for TAVI receive this treatment with gratifying short-and long-term survival. Another 7% underwent AVR. Prognosis is poor in patients who do not receive valve replacement therapy. TCT-889Sex-related clinical characteristics and outcome before and after trancatheter aortic valve implantation Background: Aortic stenosis is the most common valvulopathy in industrialized countries which is treated with trancatheter aortic valve implantation (TAVI) when patients are inoperable or high risk. Nevertheless, female sex constitutes an unfavorable predictive factor for the outcome of transcatheter interventions for heart diseases. In this study we will evaluate baseline clinical characteristics, echocardiography parameters as well as electrocardiographic changes before and after TAVI. Methods: Consecutive patients who underwent TAVI years were evaluated from an existed database. Baseline characteristics were collected before TAVI while echocardiograms and ECGs were recorded before TAVI and daily for 5 days after the procedure. We separated patients in two groups according to gender. Results: Overall, data from 122 patients (pts) (80.42Ϯ5.6 years, AVA: 0.66Ϯ0.14 cm2) were analyzed. Out of them, 62 (pts) (52.5%) were female and 58 (pts) (47.5%) were male. When we compared both groups for baseline clinical characteristics, we found that women had smaller annulus (22.02Ϯ1.62 vs. 23.98Ϯ2.07, pϽ0.01) and aortic valve area (0.63Ϯ0.14 vs. 0.69Ϯ0.13, pϭ0.012) while AVAi did not differ among two sexes (0.37Ϯ0.07 vs. 0.36Ϯ0.08, pϭ0.61). Women had better baseline LVEF (52.16Ϯ9.37 vs. 47.69Ϯ13.01, pϭ0.03) but higher syst...

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