Comparison of transcatheter aortic valve implantation outcomes in patients younger than 85 years and those aged 85 years or older: a single-center study

INTRODUCTION

The number of elderly patients requiring treatment of aortic stenosis is expected to grow steadily due to increasing lifespan. Transcatheter aortic valve implantation (TAVI) is an alternative treat‑ ment for patients with aortic stenosis considered nonoptimal candidates for surgical valve replacement.

OBJECTIVES

We aimed to assess age‑related differences in 30‑day and 1‑year cardiovascular mortality, Valve Academic Research Consortium‑2 (VARC‑2)-defined complications in patients undergoing TAVI, by comparing outcomes in patients younger than 85 years and those aged 85 years or older.

PATIENTS AND METHODS

The study group included patients who underwent TAVI at the Institute of Cardiology, Warsaw from January 2009 to July 2019. Clinical, procedural, and follow‑up data were retrospectively collected and compared in 2 groups defined according to age: group 1, younger than 85 years (417) and group 2, aged 85 or older (200).

RESULTS

The surgical risk profile assessed by the EuroSCORE II was significantly higher in the group of older patients (median [interquartile range], 6.5% [3.5%-17.3%] vs 7.2% [3.4%-18.1%]; P = 0.002); 30‑day and 1‑year cardiovascular mortality was 4.3% in group 1 as compared with 5% in group 2 (P = 0.69) and 10.8% in group 1 as compared with 9.4% in group 2 (P = 0.51), respectively. The rate of VARC‑2‑defined complications was similar in both groups, with the exception of major vascular com‑ plications (3.12% vs 8.5%; P = 0.004) and major bleeding (10.8% vs 18.5%; P = 0.008), which were more prevalent in older patients.

CONCLUSION

Cardiovascular mortality at 1 month and 1 year following TAVI is similar in patients aged 85 years or older and in those younger than 85 years.

The Selective Polymorphonuclear Neutrophils (PMN) Degranulation as the Probable Additional Mechanism of the Hemodialysis (HD)-induced Complement Activation

The intracellular lysozyme and beta-glucuronidase contents were estimated in PMN isolated from peripheral blood before HD and those from the first portion of full blood leaving the dialyser. The lysozyme estimations were done by the use of the turbidimetric method and beta-glucouronidase was assayed by measuring the release of phenolphtalein from its beta-glucuronate. The cells leaving the cellophane dialyser showed the significantly decreased lysozyme contents while the estimated intracellular activity of beta-glucuronidase was practically equal in both evaluated samples.

The results seem to indicate that the HD-associated complement activation may result not only from the simple plasma-cellophane ineteraction. The direct cleavage of the inactive C5 complement component by products released from the PMN specific granules seems to play an important role too.

For several years it has been known that the hemodialysis (HD)-induced granulopenia is the result of the pulmonary polymorphonuclear neutrophils (PMN) sequestration (Toren et al., 1970). Recent studies have established that this phenomenon is the consequence of complement activation leading to PMN aggregation with subsequent pulmonary vascular embolization and/or PMN adherence to endothelial surface (Craddock et al. 1977a, Craddock et al., 1979). It was also observed that the contact of patients plasma or plasma obtained from experimental animals with dialyser cellophane results, both in vitro and during HD, in the appearance of the activities: inducing the PMN aggregation, chemotactic and augmenting the PMN adherence (Craddock et al. 1977b, Wysocki et al. 1980). At least the two first are identified as related to the presence of the C5a complement component (Craddock et al., 1977b, O'Flaherty et al., 1979).

Similarly, the disseminated complement activation appears to be the main reason of granulopenia accompanying the filtration leukapheresis (FL), the procedure suitable for PMN collection from donors peripheral blood (Hammerschmidt et al., 1978). The PMN are there sequestered in nylon wool layer and subsequently eluted for transfusion purposes. The exposition of blood to artificial surface leads there, like during HD, to the complement (C5) activation. Although, as reported by Wright et al.) 1978b), when plasma and leukocyte enriched blood were diverted by a cell separator before passage through nylon wool filters during FL, complement activation was evident only in plasma from blood containing leukocytes, indicating that extracorporeal complement activation during FL is dependent in large part upon the interaction of leukocytes with nylon wool. The more precise studies of these authors (Wright et al., 1978a) may imply, that the PMN granule constituents released after the previous adherence of cells to nylon fibers are responsible for the FL-associated complement activation.

The following studies were done in order to evaluate if the PMN degranulation may take part also in complement activation during hemodialysis carried out with the use of cellophane equipment.

Changes in cardiac structure and function among elite judoists resulting from long-term judo practice

AIM

The aim of this study was to investigate the character of changes in cardiac structure and function among elite judoists due to long-term judo practice.

METHODS

A group of male (N = 20, average age: 22.1) and female (N = 15, average age: 19.4) athletes practising judo for about 10 years was subjected to echocardiographic tests carried out during rest (aorta diameter [AoD], diastolic dimension of the left ventricle [Dd], thickness of the interventricular septum [IVST], the thickness of the posterior wall of the left ventricle [LVPWT]), and to measurement of cardiovascular system's action parameters (heart rate [HR], stroke volume [SV], cardiac output [Q], blood pressure [BP]). Moreover, control non trained subjects were also studied, women (N = 30, average age: 19.1) and men (N = 30, average age: 21.4). In order to determine aerobic efficiency, the authors measured the maximal oxygen uptake (VO2max) using the direct method. The anaerobic capacity was estimated on the basis of the maximal anaerobic power, and the volume of the performed work was calculated by means of the 30s Wingate test.

RESULTS

Echocardiographic test values imply that changes in heart morphology induced by long term judo training, such as increase diastolic dimension of the left ventricle, thickness of the interventricular septum and left ventricular posterior wall, resemble more the changes observed in endurance athletes than changes observed in strength athletes.

CONCLUSION

The obtained data indicated that judo training improves both aerobic and anerobic performance and these changes were associated with changes in heart structure and function as compared to non trained control.

[Twin pregnancy complicated by intrauterine death of one twin]

In twin pregnancies single intrauterine death of one fetus is associated with significant morbidity and mortality of the surviving infant. The aims of our retrospective study were to review conditions of twin pregnancies complicated with SIUD in Polish Mother's Memorial Hospital in Łódź between 1989-1999 and to assess the fetal outcome when conservative management had undergone. In this study we reviewed 30 twin gestations involving the intrauterine death of one fetus. The incidence of preterm delivery among pregnancies with fetal death was 83.3%; Caesarean section was the method of delivery in 53.3% cases. Monochorionic placentation was found in 60%. Conservative management until there is no risk for the fetus is apt.

[Increased activity of aminotransferases (ALAT, AspAT) in pregnant women threatened with immature and premature delivery treated with fenoterol]

2330 pregnant women were admitted to the 2nd Department of Pregnancy Pathology at the Polish Mother's Memorial Hospital (PMMH) in Lódź, Poland, during the period from 28th March, 1989 to 30th June, 1991. Out of the group 1055 pregnancies were treated because of the risk of premature delivery (45.28%). In five (5) cases a significant rise of ALAT and AspAT aminotransferase activity occurred during fenoterol therapy. Laboratory tests excluded infectious etiology in the rise of the enzymes in question (no markers typical for HBV, HAV infection). Toxic injury of hepatic cells being suspected, fenoterol therapy was withdrawn, followed by a decrease of aminotransferases activity to normal values in those five (5) cases. No increase in the activity of ALAT and AspAT occurred in further follow up of the pregnant women in pregnancy and in puerperium. Since no other hepatotoxic factors appeared, it may be assumed that a chronic administration of fenoterol can cause transient injuries of hepatic cells. For this reason all pregnant women treated with betamimetics require examinations of the liver.

Influence of hemodialysis on plasma chemotactic activity and the chemotactic responsiveness of polymorphonuclear neutrophils

Thirty patients with chronic renal failure on maintenance hemodialysis (HD) were studied. Plasma chemotactic activity was estimated using the "under agarose" chemotaxis assay during the first 2 h of HD. It was found that in the fifth minute of HD, patients' plasma became chemotactic, reaching the maximum activity at the tenth minute. The chemotactic activity appearance correlated significantly with the decline in the number of the peripheral neutrophils. Patients' neutrophils, after a single passage through the cellophane coil of the dialyzer, revealed significant impairment of directed migration toward both complementary and bacterial chemoattractants. Moreover, the chemotactic properties of neutrophils obtained from dialyzed patients before HD were significantly lower than had been estimated in 15 nondialyzed patients with chronic renal failure. The results confirm HD-induced complement activation and might explain the mechanisms of the increased susceptibility of dialyzed patients to bacterial infections.

[Treatment of acute leukemias in adults. IV. Treatment results on 375 patients at 9 hematology centers]

On the basis of standardized protocols of the therapeutic results of acute non-lymphoblastic leukaemias in adults sent to the Institute of Haematology in Warsaw from 8 haematological centres in Poland it was demonstrated that complete remission occurred in 34.4% of patients (129 out of 375 cases). The mean survival time of the patients treated intensively according to programmes I, II, III and IV 8.6 months, those of patients with complete remission - 13.5 months, patients without complete remission - 3.7 months. The most frequent cause of death (82.5%) were infections and/or haemarrhagic diathesis.

The effect of isolated leukaemic blasts on platelet aggregation

The effect of blastic cells isolated by Böyum's method from the blood of 20 nontreated patients with acute myelogenous leukaemia on normal platelet aggregation has been studied. The isolated blasts in concentration of 2,000/microliter and higher, inhibit normal platelet aggregation induced by ADP or collagen, but have no influence on aggregation initiated by epinephrine. This effect is unaffected by the presence of metabolic poisons or by the disruption of the blastic cell membrane. Our results seem to exclude interference of blastic cells with platelet prostaglandin biosynthesis. In patients with acute leukaemia and an increased leukocyte count the preparation of platelet suspension free of blastic cells is not possible, even by the albumin gradient method or by gel filtration. The leukaemic blast content in platelet-rich suspensions may account for the variations in the aggregation behaviour which are found in these patients. The influence of blastic cells may be an important factor in the bleeding tendency in myelogenous leukaemia