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Background: Feasibility and early results of transfemoral aortic valve implantation using the ACURATE neo/TF TM self-expanding stent are reported. Methods and Results:The study group of 15 patients (mean age 83.3±6.0) was enrolled with a mean EuroSCORE and STS score of 21.9±11.6% and 7.5±3.1%, respectively. Clinical and echocardiographic evaluations were performed at baseline, discharge, 30 days and 6 months. The primary endpoint was all-cause mortality at 30 days. Transcatheter aortic valve implantation (TAVI) using the ACURATE neo/TF device was successful in 14 patients; 1 patient underwent valve-in-valve implantation because the prosthetic valve embolized during withdrawal of the delivery system. Conversion to surgery, coronary obstruction, peri-operative stroke, and pacemaker implantation did not occur at 30 days. Mean transvalvular gradients at discharge significantly decreased from 44.2±10.5 mmHg (preprocedural) to 7.7±3.1 mmHg (P<0.0001) and effective orifice area significantly increased from 0.77±0.12 to 1.69±0.25 cm 2 (P<0.0001). None or trace paravalvular leak was revealed in 50.0%, and no patient exhibited moderate or higher paravalvular leak. The overall mortality at 30 days and 6 months was 0% and 6.7%, respectively. Conclusions:A new self-expanding TF TAVI device, ACURATE neo/TF, is safe and effective in the treatment of severe aortic stenosis in elderly patients at high risk for surgery. (Circ J 2015; 79: 1037 -1043

OCT-identified microchannels increased sharply within the first year and were correlated with intimal volume and coronary risks. This suggests that neovascularization may play an important role in the progression of cardiac allograft vasculopathy.

risk in non-valvular AF (NVAF) patients treated with direct oral anticoagulants (DOAC). Methods Subjects We conducted a single-center prospective observational registry of NVAF patients with DOAC: Safety and effectiveness of 4 Different dIrect oRal anticoagulants, dabigatran, rivaroxaban, apixaban and edoxaban in rEal-world Clinical pracTice (DIRECT registry; UMIN000033283). All serial adult patients (aged ≥18 years) at Osaka Police Hospital with NVAF who were users of dabigatran, rivaroxaban, apixaban, or edoxaban from June 2011 to November 2017 were enrolled. If a patient ever used DOAC during I n daily clinical practice, bleeding risk assessment in patients with atrial fibrillation (AF) is of paramount importance, given that bleeding events in patients with cardiovascular disease can be life-threatening. 1-5 In order to assess the bleeding risk precisely and objectively, we can use the bleeding risk assessment scores, ORBIT or HAS-BLED scores. 2,4,6 The previously reported bleeding risk factors are older age, anemia, bleeding history, insufficient kidney function, treatment with antiplatelets, hypertension, stroke, labile international normalized ratio and so on. 2,4 No factors associated with systemic inflammation have been reported to date. Several studies, however, suggested that systemic inflammation could play a critical role in the subsequent cardiovascular events, 7-9 therefore it is highly possible that activation of systemic inflammatory status could predict subsequent bleeding events. The purpose of the present study was to investigate the impact of systemic inflammation on subsequent bleeding Editorial p 376

Transcatheter aortic valve implantation (TAVI) is an effective and less invasive treatment for the increasing population of individuals with severe aortic stenosis (AS). Echocardiography is crucial in the assessment of AS patients from pre- to post-procedure. Transthoracic echocardiography (TTE) may be used to assess patient suitability for TAVI, as well as evaluate the severity of AS, the aortic valve complex, aortic valve morphology, mitral regurgitation (MR), and left ventricular function. Transesophageal echocardiography (TEE) is usually used as an intra-procedural monitoring tool to provide feedback during the procedure, to assess prosthetic valve function, and to detect complications rapidly before and after balloon aortic valvuloplasty (BAV) or transcatheter heart valve (THV) deployment. In this review, the role of echocardiography in the pre-, intra-, and post-TAVI procedure periods is described in detail.

Background Stent thrombosis (ST) remains a significant medical issue. In particular, longer‐term mortality and clinical predictors after ST occurrence have yet to be elucidated. Methods and Results This was a multicenter, retrospective, observational study. A total of 187 definite ST cases from January 2008 to December 2017 were enrolled, and the long‐term clinical outcomes were investigated. The primary outcome measure was the cumulative mortality after ST occurrence. In addition, independent predictors of mortality were assessed. Among the stent types causing ST, bare‐metal stent, first‐generation drug‐eluting stent, second‐generation drug‐eluting stent, and third‐generation drug‐eluting stent comprised 31.0%, 19.3%, 36.9%, and 6.4% of cases, respectively. Median duration from stent implantation to ST was 680.5 (interquartile range, 33.8–2450.5) days. Cumulative mortality was 14.6%, 17.4%, 21.2%, 24.4%, and 33.8% at 1, 2, 3, 5 and 10 years, respectively. The cumulative mortality did not significantly differ by type of stent, and mortality of late ST was higher than that of early ST and very late ST; however, it did not reach statistical significance after the multivariate analysis. Independent predictors of mortality were hemodialysis (hazard ratio [HR], 7.80; 95% CI, 3.07–19.81; P <0.001), culprit lesions in the left main trunk (HR, 8.14; 95% CI, 1.71–38.75; P =0.008), culprit lesions in the left coronary artery (HR, 2.77; 95% CI, 1.10–6.96; P =0.030), and peak creatine kinase (HR, 1.017; 95% CI, 1.011–1.022; P <0.001). Conclusions The 10‐year cumulative mortality after ST reached 33.8%. Close follow‐up is thus mandatory for patients with ST, especially with hemodialysis, culprit lesions in the left main trunk and left coronary artery, and high peak creatine kinase.

Switching from carvedilol to bisoprolol may help with continuation of β-blocker treatment as well as dosage increase in HF patients with adverse symptoms or signs, allowing them to reach the target dose.