Implantation of the EDWARDS INTUITY Valve System is feasible, safe, and efficacious for aortic valve replacement. Aortic crossclamp and cardiopulmonary bypass times were reduced compared with those for conventional aortic valve replacement. Early hemodynamic performance was excellent and remained so up to 1 year.

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NCT01445171.

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In a large series of elderly patients with symptomatic severe aortic stenosis, rapid deployment aortic valve replacement using a subannular balloon-expandable stent frame demonstrated excellent hemodynamic performance and significant left ventricular mass regression. With continued follow-up, future studies will establish whether these favorable structural changes correlate with improvement in long-term survival and functional status.

These data suggest that isolated rapid deployment aortic valve replacement through an upper hemisternotomy can lead to shorter crossclamp times than has been reported historically in the literature. This may facilitate minimal access aortic valve replacement by eliminating the issue of prolonged crossclamp times. Further, low in-hospital mortality and new permanent pacemaker implant rates were observed regardless of surgical approach.

These results indicate that serial leukocyte filters connected to the blood cardioplegia line decrease myocardial cell injury and may therefore help to improve outcome of patients with severely depressed ejection fractions undergoing coronary artery bypass grafting.

-Continuous positive airway pressure, aimed at preventing pulmonary atelectasis, has been used for decades to reduce lung injury in critically ill patients. In neonatal practice, it is increasingly used worldwide as a primary form of respiratory support due to its low cost and because it reduces the need for endotracheal intubation and conventional mechanical ventilation. We studied the anesthetized in vivo rat and determined the optimal circuit design for delivery of continuous positive airway pressure. We investigated the effects of continuous positive airway pressure following lipopolysaccharide administration in the anesthetized rat. Whereas neither continuous positive airway pressure nor lipopolysaccharide alone caused lung injury, continuous positive airway pressure applied following intravenous lipopolysaccharide resulted in increased microvascular permeability, elevated cytokine protein and mRNA production, and impaired static compliance. A dose-response relationship was demonstrated whereby higher levels of continuous positive airway pressure (up to 6 cmH2O) caused greater lung injury. Lung injury was attenuated by pretreatment with dexamethasone. These data demonstrate that despite optimal circuit design, continuous positive airway pressure causes significant lung injury (proportional to the airway pressure) in the setting of circulating lipopolysaccharide. Although we would currently avoid direct extrapolation of these findings to clinical practice, we believe that in the context of increasing clinical use, these data are grounds for concern and warrant further investigation.lipopolysaccharide; spontaneous breathing; dexamethasone CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP), designed to recruit atelectatic lung (17), is widely employed for respiratory failure (49). CPAP delivered through a face mask is useful for a spectrum of acute respiratory failure in adults (7). Such "noninvasive" CPAP support can be applied outside of intensive care units, and clinical studies have demonstrated that it may reduce the need for invasive mechanical ventilation (57, 66) and lessen the incidence of sepsis-associated complications in high-risk postoperative adult patients (57). In preterm neonates, application of CPAP, sometimes for several weeks, may reduce the need for invasive mechanical ventilation, thereby lessening complications and associated costs of neonatal care. For such neonates, a particular type of CPAP, termed "bubble" CPAP, has been developed, whereby oscillatory vibrations developed by high flow of gas through the underwater seal are transmitted to the chest. Because such a system requires minimal equipment, bubble CPAP has immense appeal in terms of operational simplicity and economic cost. Indeed, for these reasons, it has been suggested that such CPAP would be ideal for use in developing countries (27). In fact, laboratory data support the clinical use of CPAP, because when compared with conventional ventilation, CPAP is associated with less inflammatory cytokine production (43) and a more normal pa...