Procedural Results and Clinical Outcomes of Transcatheter Aortic Valve Implantation in Switzerland: An Observational Cohort Study of Sapien 3 Versus Sapien XT Transcatheter Heart Valves.

BACKGROUND New generation transcatheter heart valves (THV) may improve clinical outcomes of transcatheter aortic valve implantation. METHODS AND RESULTS In a nationwide, prospective, multicenter cohort study (Swiss Transcatheter Aortic Valve Implantation Registry, NCT01368250), outcomes of consecutive transfemoral transcatheter aortic valve implantation patients treated with the Sapien 3 THV (S3) versus the Sapien XT THV (XT) were investigated. An overall of 153 consecutive S3 patients were compared with 445 consecutive XT patients. Postprocedural mean transprosthetic gradient (6.5±3.0 versus 7.8±6.3 mm Hg, P=0.17) did not differ between S3 and XT patients, respectively. The rate of more than mild paravalvular regurgitation (1.3% versus 5.3%, P=0.04) and of vascular (5.3% versus 16.9%, P<0.01) complications were significantly lower in S3 patients. A higher rate of new permanent pacemaker implantations was observed in patients receiving the S3 valve (17.0% versus 11.0%, P=0.01). There were no significant differences for disabling stroke (S3 1.3% versus XT 3.1%, P=0.29) and all-cause mortality (S3 3.3% versus XT 4.5%, P=0.27). CONCLUSIONS The use of the new generation S3 balloon-expandable THV reduced the risk of more than mild paravalvular regurgitation and vascular complications but was associated with an increased permanent pacemaker rate compared with the XT. Transcatheter aortic valve implantation using the newest generation balloon-expandable THV is associated with a low risk of stroke and favorable clinical outcomes. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01368250.

Grain size and diatom valves in sediment cores KS82-30 and KS82-31

Diatoms were studied quantitatively in six latest Quaternary (~70 kyr B.P. to Recent) piston cores from the westernmost Mediterranean, the Alboran Basin, and the Atlantic region immediately to the west of the Straits of Gibraltar. The Atlantic cores completely lack diatoms. In the Alboran Basin, diatoms are common from late Stage 3 (~27.5 kyr B.P.) to Termination lb (9 kyr B.P.) and in Recent core tops, but are absent in the other latest Quaternary intervals. Maximum accumulation of diatoms and highest abundance of species normally in sediments associated with increased productivity occurred during the latest Quaternary deglaciation, in the first phase of Termination I (~14.8 kyr B.P.). In the modern Alboran Basin, a region of high biological productivity occurs immediately east of the Gibraltar Straits. This high productivity results from upwelling associated with the interaction between the Atlantic inflow and the bottom topography near the Spanish coast. The upwelled nutrient-rich waters are then advected to the east and southeast by the surficial anticyclonic gyral circulation. Late Quaternary variations in diatom abundance are considered to reflect changes in this upwelling intensity with highest diatom abundances inferred to result from increased upwelling associated with an intensification of the anticyclonic gyral circulation. Highest inferred upwelling rates occurred during the first phase of latest Quaternary deglaciation. It is possible that an intensification of circulation within the Mediterranean Basin as a whole occurred from late Stage 3 to mid Termination I because widespread hiatus formation has been reported at this time in the Straits of Sicily due to an increase in the formation of intermediate waters. Diatoms were not preserved in other latest Quaternary intervals due to insufficient productivity to counterbalance their dissolution.