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  • 1
    Online Resource
    Online Resource
    Impact of Combined “CHADS-BLED” Score to Predict Short-Term Outcomes in Transfemoral and Transapical Aortic Valve Replacement
    Hindawi Limited ; 2020
    In:  Journal of Interventional Cardiology Vol. 2020 ( 2020-12-18), p. 1-9
    Details
    In: Journal of Interventional Cardiology, Hindawi Limited, Vol. 2020 ( 2020-12-18), p. 1-9
    Abstract: Background. High CHA2DS2-VASC and HAS-BLED scores are linked to increased mortality in structural and nonstructural cardiovascular interventions irrespective of the presence of atrial fibrillation (AF) or oral anticoagulation. We aimed to use the aforementioned scores to quantify the risk of 30-day mortality, major vascular and bleeding events (MVASC/BARC), and cerebrovascular insults (CVI) in patients undergoing different access routes in transcatheter aortic valve replacement (TAVR). Methods. Out of 1329 patients, 980 transfemoral (TF) TAVR (73.7%) and 349 transapical (TA) TAVR (26.3%) were included. CHA2DS2-VASC, HAS-BLED, and combined “CHADS-BLED” scores were calculated and compared to the predictive value of the established EuroSCORE and STS score. Results. In all-comers TF TAVR patients, the applied risk models showed only poor association with 30-day mortality while, in patients with concomitant AF, a strong association was observed using the combined CHADS-BLED score (c-index: 0.83; 95% CI: 0.76–0.91; p   〈  0.0001). Concerning 30-day mortality, only the STS score for TF TAVR (c-index: 0.68; 95% CI: 0.59–0.76; p  = 0.001) and EuroSCORE for TA TAVR (c-index: 0.66; 95% CI: 0.56–0.76; p  = 0.005) could show some predictive value. High CHADS-BLED was associated with enhanced CVI (3.0% vs. 7.2%; p = 0.0039 ∗ ) and more frequent MVASC/BARC (3.2% vs. 6.3%; p  = 0.0362) in the all-comers TAVR cohort. All risk models failed in the prediction of CVI and MVASC/BARC for TA TAVR patients. Conclusion. The combined CHADS-BLED score was a strong predictor for 30-day mortality in TF TAVR patients with AF. A high CHADS-BLED score showed a good predictive value for major vascular and bleeding events as well as CVI in TF TAVR patients. This study is registered at clinical trials (NCT01805739).
    Type of Medium: Online Resource
    ISSN: 1540-8183 , 0896-4327
    URL: Article
    DOI: 10.1155/2020/9414397
    Language: English
    Publisher: Hindawi Limited
    Publication Date: 2020
    detail.hit.zdb_id: 2103585-4
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  • 2
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    Online Resource
    Effects of solution supersaturation on barite precipitation in porous media and consequences on permeability: Experiments and modelling
    Elsevier BV ; 2020
    In:  Geochimica et Cosmochimica Acta Vol. 270 ( 2020-02), p. 43-60
    Details
    In: Geochimica et Cosmochimica Acta, Elsevier BV, Vol. 270 ( 2020-02), p. 43-60
    Type of Medium: Online Resource
    ISSN: 0016-7037
    URL: Article
    DOI: 10.1016/j.gca.2019.11.018
    RVK:
    TE 1000
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2020
    detail.hit.zdb_id: 300305-X
    detail.hit.zdb_id: 1483679-8
    SSG: 13
    SSG: 16,12
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  • 3
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    Predictors of calcification distribution in severe tricuspid aortic valve stenosis
    Springer Science and Business Media LLC ; 2021
    In:  The International Journal of Cardiovascular Imaging Vol. 37, No. 9 ( 2021-09), p. 2791-2799
    Details
    In: The International Journal of Cardiovascular Imaging, Springer Science and Business Media LLC, Vol. 37, No. 9 ( 2021-09), p. 2791-2799
    Abstract: We investigated aortic valve calcification (AVC) distribution and predictors for leaflet calcification patterns in patients with severe tricuspid aortic valve stenosis undergoing transcatheter aortic valve replacement (TAVR). Patients undergoing routine multi-sliced computed tomography (MSCT) for procedural planning were enrolled. MSCT data were transferred to a dedicated workstation for evaluation (3mensio Structural Heart™, Pie Medical Imaging BV, Maastricht, The Netherlands) and analyzed. Participants were separated into asymmetrical (AC) and symmetrical (SC) leaflet calcification and potential predictors for calcification distribution were identified with univariate and multivariate regression analysis. 567 Participants with severe tricuspid AS were divided into asymmetrical (AC, n = 443; 78.1%) and symmetrical (SC, n = 124; 21.9%) AVC. In AC, the non-coronary cusp was the most calcified cusp (n = 238; 57.7%). SC is more common in females (AC/SC: 49.2% vs. 67.7%; p  〈  0.0001). AVC was more severe in patients with AC, who also have larger aortic root dimensions. Multivariate analysis depicted, inter alia, left ventricular outflow tract (LVOT) calcification  〈  25 Agatston units (OR 1.81 [1.09–3.00], p = 0.021), a mean pressure gradient  〈  36 mmHg (OR 1.77 [1.03–3.05], p = 0.039), and an annulo-apical angle  〉  67° (OR 1.68 [1.00–2.80], p = 0.049) as predictors for SC, although with only moderate predictive value. Data from this retrospective analysis indicate that SC occurs more frequently in females. The cumulative leaflet calcification burden is higher in patients with AC, who also present with larger aortic root dimensions. The predictive value for prominent calcification of different aortic valve cusps in AC patients was only low to moderate. Trial registration number : NCT01805739.
    Type of Medium: Online Resource
    ISSN: 1569-5794 , 1573-0743
    URL: Article
    DOI: 10.1007/s10554-021-02248-6
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 3163889-2
    detail.hit.zdb_id: 2008950-8
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  • 4
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    Online Resource
    Novel insights on outcome in horizontal aorta with self‐expandable new‐generation transcatheter aortic valve replacement devices
    Wiley ; 2020
    In:  Catheterization and Cardiovascular Interventions Vol. 96, No. 7 ( 2020-12), p. 1511-1519
    Details
    In: Catheterization and Cardiovascular Interventions, Wiley, Vol. 96, No. 7 ( 2020-12), p. 1511-1519
    Abstract: The impact of a horizontal aorta (HA) on adverse events (AE) following in transcatheter aortic valve replacement (TAVR) is dealt controversially. Using new‐generation self‐expandable devices, we aimed to reevaluate an appropriate threshold of the aortic root angulation (ARA) in terms of HA and its impact on outcome. Methods The 466 consecutive patients, who underwent transfemoral TAVR with self‐expandable new‐generation devices, were analyzed. Patients were classified into cases with HA (ARA ≥ 51°; n = 225; 48%) and without HA (ARA  〈 51°; n = 241; 52%). Primary endpoints were device success and 30‐day mortality. Secondary endpoints were specific AE according to VARC‐2 definitions. Results Contrast use (107.6 ± 50.1 vs. 94.1 ± 46.1 ml; p = .033) and radiation dose (3,176 [1,928–5,596] vs. 2,651 [1,643–4,394] Gyxcm 2 ; p = .016) were higher in HA. Primary device success was comparable (97.1 vs. 97.8%; p = .773). A 30‐day mortality (3.3 vs. 0.4%; p = .038, plogrank = 0.025), stroke (7.1 vs. 2.7%; p = .033), and major vascular complications (MVASC) (6.6 vs. 2.7%; p = .050) were more frequent in HA. Pronounced calcification of the noncoronary cusp and left ventricular outflow tract, the condition of HA, as well as repositioning maneuvers were independent predictors for overall specific AE. Conclusion An HA above 51° is associated with an increased rate of stroke, MVASC, and 30‐day mortality. Valve size and asymmetric calcification affect the incidence of repositioning maneuvers and subsequent VARC‐2 AE, indicating that an HA—together with specific anatomic features—remains a crucial factor for TAVR‐related outcome with self‐expandable new‐generation devices.
    Type of Medium: Online Resource
    ISSN: 1522-1946 , 1522-726X
    URL: Issue
    URL: Article
    DOI: 10.1002/ccd.v96.7
    DOI: 10.1002/ccd.28961
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2001555-0
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  • 5
    Online Resource
    Online Resource
    Aortic valve calcification is subject to aortic stenosis severity and the underlying flow pattern
    Springer Science and Business Media LLC ; 2021
    In:  Heart and Vessels Vol. 36, No. 2 ( 2021-02), p. 242-251
    Details
    In: Heart and Vessels, Springer Science and Business Media LLC, Vol. 36, No. 2 ( 2021-02), p. 242-251
    Abstract: Sex- and flow-related aortic valve calcification (AVC) studies are still limited in number, and data on the exact calcium quantity and distribution are scarce. Therefore, we aimed to (1) re-define the best threshold of AVC load to distinguish severe from moderate aortic stenosis (AS) in common AS entities and to (2) evaluate differences in the aortic annulus and left ventricular outflow tract (LVOT) calcium load. Nine hundred and thirty-eight patients with contrast-enhanced cardiac MSCT and moderate-to-severe aortic stenosis (AS) were retrospectively enrolled. Patients with severe AS ≤ 1.0 cm 2 ( n  = 841) were further separated into three AS entities: high gradient (HGAS, n  = 370, 44.0%), paradoxical low gradient (pLGAS, n  = 333, 39.6%), and classical low gradient (LGAS, n  = 138, 16.4%). AVC, leaflet, and LVOT calcification were quantified. Aortic valve calcification scores were highest in severe HGAS, and lower in severe pLGAS and classical LGAS. In all severity and AS entities, the non-coronary cusp (NCC) was the most calcified one. LVOT calcification was consistently comparable between gender and AS entities. Accuracy of logistic regression was the highest in HGAS (male vs. female: AVC  〉  2156 Agatston units (AU), c-index 0.76; vs. AVC  〉  1292 AU, c-index 0.85; or AVC density  〉  406 AU/cm 2 , c-index 0.82; vs.  〉  259 AU/cm 2 , c-index 0.86; each p   〈  0.0001*) to diagnose severe AS. AVC could only be used in men to differentiate between severe LGAS and moderate AS. Data from this retrospective analysis indicate that the NCC is subject to pre-dominant degeneration throughout gender, AS severity, and several AS entities. AVC was consistently comparable in severe pLGAS and classical LGAS, but only AVC in severe LGAS could sufficiently distinguish from moderate AS in men. LVOT calcification failed to be a reliable indicator of accelerating AS.
    Type of Medium: Online Resource
    ISSN: 0910-8327 , 1615-2573
    URL: Article
    DOI: 10.1007/s00380-020-01688-9
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 1481441-9
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  • 6
    Online Resource
    Online Resource
    Cerebrovascular Events after Transcatheter Aortic Valve Replacement: The Difficulty in Predicting the Unpredictable
    MDPI AG ; 2022
    In:  Journal of Clinical Medicine Vol. 11, No. 13 ( 2022-07-04), p. 3902-
    Details
    In: Journal of Clinical Medicine, MDPI AG, Vol. 11, No. 13 ( 2022-07-04), p. 3902-
    Abstract: Background: Cerebrovascular events (CVE) are feared complications following transcatheter aortic valve replacement (TAVR). We aimed to develop a new risk model for CVE prediction with the application of multimodal imaging. Methods: From May 2011 to August 2019, a total of 2015 patients underwent TAVR at our institution. The study cohort was subdivided into a derivation cohort (n = 1365) and a validation cohort (n = 650) for risk model development. Results: Of 2015 patients, 72 (3.6%) developed TAVR-related CVE. Pre-procedural factors of our risk model were history of prior CVE, a larger aortic valve area (≥0.55 cm2), a large aortic angulation (≥48.5°), and enhanced calcification of the right coronary cusp (≥447.2 AU), left ventricular outflow tract (≥262.4 AU), and ascending thoracic aorta (≥116.4 AU). Our risk model was superior for in-hospital CVE prediction following TAVR in the establishment cohort (AUC 0.73, 95% CI 0.66–0.80; p 〈 0.001) compared to other risk scores, such as the EuroSCORE II or the CHA2DS2-VASc score. Conclusions: Although CVE prediction in patients undergoing TAVR is challenging due to the complex nature of the TAVR procedure, our study highlights that multimodal imaging is a promising approach to generate a more accurate risk model for CVE prediction.
    Type of Medium: Online Resource
    ISSN: 2077-0383
    URL: Article
    DOI: 10.3390/jcm11133902
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
    detail.hit.zdb_id: 2662592-1
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  • 7
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    Online Resource
    Reactive transport modeling for assessing coupled hydrogeochemical processes at interfaces in deep geological repositories: from the laboratory to the real world
    Copernicus GmbH ; 2023
    In:  Safety of Nuclear Waste Disposal Vol. 2 ( 2023-09-06), p. 123-124
    Details
    In: Safety of Nuclear Waste Disposal, Copernicus GmbH, Vol. 2 ( 2023-09-06), p. 123-124
    Abstract: Abstract. Deep geological repositories with a multi-barrier concept are foreseen by various countries for the disposal of high-level radioactive waste. Simulation tools for a close-to-reality description of repository evolution scenarios are required, especially to resolve the challenging task of comparing and assessing the long-term safety of different repository concepts in different host rocks within the German site-selection process. Chemical, thermal, and pressure gradients at the interfaces of the different barriers in a repository can lead to mineral dissolution and precipitation, generating non-linear responses in transport and mechanical properties of barrier materials and host rocks. Reactive transport modeling (RTM) can be applied to investigate these perturbations and processes across temporal and spatial scales to assess subsurface evolution. Nevertheless, implementing RTM at the continuum scale while accounting for pore-scale heterogeneities and geometry evolution remains a challenge. Pore-scale simulations offer the potential to capture the complex evolution of porous media over a broad range of Peclet and Damköhler numbers, and they can be utilized to improve the RTM by using upscaling methods (Prasianakis et al., 2020). In this context, we developed “lab-on-a-chip” experiments, combining time-lapse high-resolution optical microscopy and confocal Raman spectroscopy to test extended constitutive equations to classically employed Archie's law to improve the description of changes in transport properties (e.g., diffusivity) in evolving porous media in RTM. The 3D Raman tomography of the porous media combined with pore-scale modeling enabled the derivation of upscaled transport parameters. Our results highlight the importance of calibrating pore-scale models with quantitative experiments prior to simulations over a wide range of Peclet and Damköhler numbers, whose results can be further used for the derivation of upscaled modeling parameters. The derived and parameterized constitutive equations based on simple systems have been tested in reactive transport models as a sensitivity case study to evaluate uncertainties in the predictions of the evolution of real subsurface systems such as clay–cement interfaces in deep geological repositories.
    Type of Medium: Online Resource
    ISSN: 2749-4802
    URL: Article
    DOI: 10.5194/sand-2-123-2023
    Language: English
    Publisher: Copernicus GmbH
    Publication Date: 2023
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