In this registry of patients who underwent transcatheter valve-in-valve implantation for degenerated bioprosthetic aortic valves, overall 1-year survival was 83.2%. Survival was lower among patients with small bioprostheses and those with predominant surgical valve stenosis.

Aging is a major risk factor for a large number of disorders and functional impairments. Therapeutic targeting of the aging process may therefore represent an innovative strategy in the quest for novel and broadly effective treatments against age-related diseases. The recent report of lifespan extension in mice treated with the FDA-approved mTOR inhibitor rapamycin represented the first demonstration of pharmacological extension of maximal lifespan in mammals. Longevity effects of rapamycin may, however, be due to rapamycin's effects on specific life-limiting pathologies, such as cancers, and it remains unclear if this compound actually slows the rate of aging in mammals. Here, we present results from a comprehensive, large-scale assessment of a wide range of structural and functional aging phenotypes, which we performed to determine whether rapamycin slows the rate of aging in male C57BL/6J mice. While rapamycin did extend lifespan, it ameliorated few studied aging phenotypes. A subset of aging traits appeared to be rescued by rapamycin. Rapamycin, however, had similar effects on many of these traits in young animals, indicating that these effects were not due to a modulation of aging, but rather related to aging-independent drug effects. Therefore, our data largely dissociate rapamycin's longevity effects from effects on aging itself.

AimsThe transcatheter mitral valve interventions (TRAMI) registry was established in order to assess safety and efficacy of catheter-based mitral valve interventional techniques in Germany, and prospectively enrolled 828 MitraClip patients (median age 76 years, median log. EuroSCORE I 20.0%) between August 2010 and July 2013. We present the 1-year outcome in this MitraClip cohort—which is the largest published to date.Methods and resultsSeven forty-nine patients (90.5%) were available for 1-year follow-up and included in the following analyses. Mortality, major adverse cardiovascular event rates, and New York Heart Association (NYHA) classes were recorded. Predictors of 1-year mortality were identified by multivariate analysis using a Cox regression model with stepwise forward selection. The 1-year mortality was 20.3%. At 1 year, 63.3% of TRAMI patients pertained to NYHA functional classes I or II (compared with 11.0% at baseline), and self-rated health status (on EuroQuol visual analogue scale) also improved significantly by 10 points. Importantly, a significant proportion of patients regained the complete independence in self-care after MitraClip implantation (independence in 74.0 vs. 58.6% at baseline, P = 0.005). Predictors of 1-year mortality were NYHA class IV (hazard ratio, HR 1.62, P = 0.02), anaemia (HR 2.44, P = 0.02), previous aortic valve intervention (HR 2.12, P = 0.002), serum creatinine ≥1.5 mg/dL (HR 1.77, P = 0.002), peripheral artery disease (HR 2.12, P = 0.0003), left ventricular ejection fraction <30% (HR 1.58, P = 0.01), severe tricuspid regurgitation (HR 1.84, P = 0.003), and procedural failure (defined as operator-reported failure, conversion to surgery, failure of clip placement, or residual post-procedural severe mitral regurgitation) (HR 4.36, P < 0.0001).ConclusionsTreatment of significant MR with MitraClip resulted in significant clinical improvements in a high proportion of TRAMI patients after 12 months. In the TRAMI cohort, the failure of procedural success exhibited the highest hazard ratio concerning the prediction of 1-year mortality.

were linearly related to PVR (Table)however the highest correlation with the severity of PVR was seen with the maximum diameter (r2ϭ0.48, pϽ0.001), mean diameter(r2ϭ0.47, pϽ0.0001), average diameter (r2ϭ0.48, pϽ0.0001) or the annular area (r2ϭ0.48, pϽ0.0001). Conclusions: This study demonstrates that 3DE measurements of the aortic annulus are feasible and are better predictors of PVR after TAVR than 2D sagittal diameter and should be incorporated into the algorithm for balloon-expandable transcatheter valve sizing.Background: Transcatheter aortic valve-in-valve (VIV) implantation is an emerging therapeutic alternative for patients with failed surgical bioprosthesis and may obviate the need for a redo surgery. We aimed to evaluate the clinical results of this technique using a large worldwide registry. Methods: The registry included 416 patients with degenerated aortic bioprosthetic valves (age 77.7 Ϯ 9.7 years; 55.3% men) from 54 cardiac centers. The mode of failure was stenosis (nϭ168, 40.4%), regurgitation (nϭ125, 30%), and combined stenosis and regurgitation (nϭ123, 29.6%). Implanted devices were Edwards SAPIEN (nϭ225), CoreValve (nϭ190) and Melody (nϭ1). Results: Adverse procedural outcomes included 11.1% device malposition and 1.9% ostial coronary obstruction. Post-procedure, valve maximum / mean gradients were 28.5 Ϯ 14.3 mmHg / 16.1 Ϯ 9.0, respectively. Independent predictors for high postprocedural gradients (mean Ն20 mmHg) were baseline bioprosthesis stenosis [vs. regurgitation, odds ratio (OR), 6.33, p Ͻ 0.001)] and the use of the Edwards SAPIEN device (OR 2.1, pϭ 0.008). At 30-day follow-up, all-cause mortality was 7.8% and 87.5% of patients were at New York Heart Association functional class I/II. One-year survival was 82.6%. The strongest independent predictor for 1-year mortality post VIV was baseline bioprosthesis stenosis (vs. regurgitation, OR 3.7, pϭ0.003). Conclusions:The VIV procedure is clinically effective in most patients, with 1-year results comparable with other TAVR cohorts. Baseline bioprosthetic stenosis is the strongest predictor for both elevated post-procedural gradients and 1-year mortality.