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The use of hybrid operating rooms (HOR) for transcatheter aortic valve implantation (TAVI) has increased, so radiation exposure during procedures that use X-ray fluoroscopy is a fundamental problem not only for patients but also for surgeons and interventional cardiologists, increasing the risk of cataracts among operators. We investigated the efficacy of leaded glasses and protective sheets for ocular radiation protection.Methods and Results: Between January 2020 and February 2021 we enrolled 54 TAVI procedures using the transfemoral approach. The subjects were divided into a curtain protection group (Group C, n=20), glass protection group (Group G, n=17), and sheet protection group (Group S, n=17). The cumulative dose (CD) of the operators showed a decreasing trend in Group S compared with the other two groups. The CD normalized by dose area product (CD/DAP) of the operators was significantly reduced in Group S compared with Group C. However, Group G showed no significant difference compared with Group C. Regarding the distribution of CD/DAP, Group S had a significantly lower distribution than that in groups C and G.Protective sheets provide more stable radiation protection than conventional curtains or leaded glasses.

Although transcatheter aortic valve replacement (TAVR) has demonstrated favorable outcomes in randomized studies, there remains a sizable group of patients in whom TAVR may be futile. Characterizing the survival rate in a wide array of patients undergoing TAVR can help develop effective strategies for improving the allocation of medial resources.The aim of this study was to develop a risk model to estimate 1-year mortality after TAVR from a representative nationwide registry in Japan.The J-TVT (Japan Transcatheter Valve Therapies) registry contains complete data, including 1-year outcomes, on patients undergoing TAVR in Japan. A total of 17,655 patients underwent TAVR between 2013 and 2018. They were randomly divided into 2 groups in a 7:3 ratio to form a derivation cohort of 12,316 patients and a validation cohort of 5,339 patients. A risk model was constructed for 1-year mortality in the derivation cohort, and its discrimination and calibration were assessed in the validation cohort.The mean age of all registered patients was 84.4 years, and 68.8% were women. The mean body size area was 1.43 mA prediction model for 1-year survival following TAVR derived from a national clinical database performed well and should aid physicians managing TAVR patients.

Background Dialysis patients with aortic stenosis are generally considered as being at extreme or high surgical risk. Herein, the first clinical trial was conducted to investigate clinical safety and effectiveness of transcatheter aortic valve replacement (TAVR) using the balloon-expandable transcatheter aortic valve (SAPIEN 3, Edwards Lifesciences, Irvine, CA, USA) in Japanese dialysis patients. Methods The clinical trial is a single arm, prospective, open, non-randomized, Japanese multicenter study. The primary purpose of this trial is to evaluate the efficacy and safety of TAVR using SAPIEN 3 in 28 Japanese dialysis patients. Results Mean age was 79.2 years and 67.9% were male (Mean STS score was 14.3%). Transfemoral and transapical approaches were performed in 25 (89.3%) and 3 patients (10.7%), respectively. All bioprostheses were successfully implanted. Median intensive care unit stay and hospital stay after TAVR were 1.4 days and 6.3 days, respectively. In-hospital mortality was 3.6% and freedom from all-cause mortality at 1 year was 89.3%. Disabling stroke and life-threatening bleeding at 1 year was 7.7% and 8.5%, respectively. There was no structural valve deterioration during follow-up. New York Heart Association functional status, six-minute walk test, and EuroQOL visual analogue scale score significantly improved through 1 year compared with baseline. Conclusions TAVR using SAPIEN 3 is safe and effective for the treatment of Japanese dialysis patients with symptomatic severe aortic valve stenosis.

This study aimed to evaluate the impact of the prolonged COVID-19 pandemic on outpatient antibiotic prescriptions for pediatric respiratory infections at an acute care hospital in Japan in order to direct future pediatric outpatient antibiotic stewardship.The impact of the COVID-19 pandemic and FilmArray Respiratory Panel (RP) on outpatient antibiotic prescriptions was assessed from January 2019 to December 2021 using an interrupted time series analysis of children The COVID-19 pandemic was not significantly related to the antibiotic prescription rate, suggesting that it did not impact physicians’ behavior toward antibiotic prescriptions. Replacing rapid antigen tests with the FilmArray RP introduced on December 1, 2020, did not affect the magnitude of the reduction in antibiotic prescription rate for pediatric respiratory infections.

Ide T, Shimamura K, Kuratani T, et al. Impact of the Patency of Inferior Mesenteric Artery on 7-Year Outcomes After Endovascular Aneurysm Repair. Journal of Endovascular Therapy. 2022. Copyright © 2022 The Author(s). doi:10.1177/15266028221121748., Purpose: The impact of preoperative patent inferior mesenteric artery (IMA) on late outcomes following endovascular aneurysm repair (EVAR) remains unclear. This study aimed to investigate the specific influence of IMA patency on 7-year outcomes after EVAR. Materials and Methods: In this retrospective cohort study, 556 EVARs performed for true abdominal aortic aneurysm cases between January 2006 and December 2019 at our institution were reviewed. Endovascular aneurysm repairs performed using a commercially available device with no type I or type III endoleak (EL) during follow-up and with follow-up ≥12 months were included. A total of 336 patients were enrolled in this study. The cohort was divided into the patent IMA group and the occluded IMA group according to preoperative IMA status. The late outcomes, including aneurysm sac enlargement, reintervention, and mortality rates, were compared between both groups using propensity-score-matched data. Results: After propensity score matching, 86 patients were included in each group. The median follow-up period was 56 months (interquartile range: 32–94 months). The incidence of type II EL at discharge was 50% in the patent IMA group and 19% in the occluded IMA group (p

An 82-year-old man who underwent transcatheter aortic valve replacement (TAVR) using a 34-mm Evolut PRO (Medtronic, Minneapolis, MN, USA) for severe aortic stenosis 21 months previously presented with fever. Transesophageal echocardiography showed thickening of the valve leaflets of the transcatheter heart valve and movable structures such as verrucae on the upper edge of the Evolut PRO stent. Contrast-enhanced cardiac computed tomography showed a 72-mm saccular pseudoaneurysm on the dorsal aspect of the ascending aorta at the superior border of the Evolut PRO stent. Because of a suspected infected aortic aneurysm caused by prosthetic valve endocarditis (PVE), we performed aortic valve replacement using 23 mm Avalus (Medtronic, Minneapolis, MN, USA) and ascending aortic replacement using 26 mm Gelweave (Vascutek Terumo Inc, Scotland, UK). The postoperative course was uneventful. This report highlights that patients with PVE after TAVR may develop pseudoaneurysms of the ascending aorta.

Introduction Knowledge is limited on the virologic course of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, particularly the time taken for viral clearance and the optimal time to discontinue isolation. This study aims to identify the clinical and demographic factors influencing the time taken for viral clearance in patients with COVID-19 to determine the optimal isolation period. Methods This two-center retrospective observational cohort study was conducted between March 1 and June 31, 2020. Patients with COVID-19, which was confirmed by real-time reverse transcription polymerase chain reaction, were included. Data were extracted from medical records. The positive duration, which was defined as the period from the day of symptom onset to the negative conversion day, was assessed using a generalized linear model. Results We included 63 patients. The mean positive duration was 20 days. The positive duration was significantly shorter for patients younger than 30 years of age and those between 30 and 60 years of age than for patients older than 60 years of age. We observed a more scattered distribution of the positive duration in older patients than in younger patients. Conclusions Younger patients who recovered from COVID-19 took less time to clear SARS-CoV-2 than older patients; thus, a classification of the isolation periods based on age could be considered. A uniform viral clearance period for older patients may be difficult to determine because of biases such as underlying medical conditions. Further surveillance measures are recommended to determine the viral clearance time and the optimal isolation period.

Bordetella trematum and Kerstersia gyiorum are rare gram-negative bacilli that are not frequently detected in human infections. In this report, we describe a case of a 48-year-old man who presented to our hospital with an infected wound on his leg. Discharges from the cracks of the granulation were collected and evaluated in our microbiology laboratory. Gram staining of the specimen showed polymorphonuclear leukocytes and abundant gram-negative bacilli. Three types of colonies were isolated on blood agar and were identified as B. trematum and Alcaligenes faecalis using VITEK MS. Moreover, K. gyiorum and B. trematum were identified and confirmed via 16S ribosomal RNA (rRNA) gene sequencing. The patient successfully recovered following application of meropenem antibacterial therapy and surgical debridement. This is the first reported case of complex wound infection caused by both B. trematum and K. gyiorum. Identification of B. trematum has recently been made possible by routine bacterial identification using matrix-assisted laser desorption-ionization time-of-flight mass spectrometry (MALDI-TOF MS). However, K. gyiorum isolation is still rare, and species identification requires 16S rRNA sequencing. Thus, this case highlighted the importance of using multiple methods, such as MALDI-TOF MS and 16S rRNA gene sequencing, for identification of rarely isolated species from clinical specimens.

A 50-year-old man with decompensated aortic stenosis displayed significantly reduced ejection fraction, an ascending aortic aneurysm (55 mm in diameter), and bilateral giant bullae, and was evaluated as having extremely high surgical risk. Therefore, as a bridge to definitive treatment, he simultaneously underwent transcatheter aortic valve replacement (TAVR) and upper left lung lobectomy. His heart function recovered 6 months later and he underwent surgical aortic valve replacement (SAVR) and graft replacement of the ascending aorta. TAVR may serve as a bridge procedure before SAVR for aortic stenosis in younger patients with high surgical risk.

Long-term survival after surgery for severe aortic stenosis (AS) provides important information regarding the choice between surgical (SAVR) and transcatheter (TAVR) aortic valve replacement. This study investigated the long-term survival of AS patients with low or intermediate surgical risk who underwent SAVR or TAVR in our institution versus that of the Japanese general population.From 2009 to 2019, 1276 consecutive patients underwent SAVR or TAVR for severe AS. Among them, we retrospectively investigated those with low (n = 383) or intermediate (n = 137) surgical risk treated with SAVR and those with low (n = 86) or intermediate (n = 333) surgical risk treated with TAVR. Their post-intervention survival was compared with that of an age- and gender-matched Japanese general population.The overall 5-year survival rate of SAVR for patients with low surgical risk (mean age, 72 ± 9 years) was not significantly different from that of the general population (90 % vs. 89 %, respectively; p = 0.58), whereas that of patients with intermediate surgical risk (77 ± 6 years) was significantly lower than that of the general population (77 % vs. 84 %, respectively; p = 0.03). After TAVR, the 5-year survival of patients with low (78 ± 8 years) or intermediate (83 ± 5 years) surgical risk was significantly lower than that of the general population (low risk, 64 % vs. 81 %, p 0.01; intermediate risk, 66 % vs. 71 %, respectively, p = 0.01).Our study demonstrated that long-term survival after SAVR for AS patients with low surgical risk was as good as that of the age- and gender-matched general population, while the long-term survival after SAVR for intermediate-risk or TAVR for low- or intermediate-risk patients was lower than that of the general population. These findings suggest that SAVR is an appropriate option for AS patients with low surgical risk and good life expectancy, especially in Japan, where the life expectancy is the longest worldwide.

Report on total endovascular repair for a diseased aortic valve and the ascending aorta is few. Therefore, we report a case of prosthetic aortic valve stenosis and internal bovine pericardial flap after ascending aortic replacement complicated by congestive heart failure and hemolysis. Because the patient had high surgical risk and was anatomically suitable to undergo ascending endovascular repair, simultaneous transcatheter aortic valve-in-valve implantation and ascending endografting were performed. Her symptoms of heart failure and hemolysis resolved postoperatively. Thus, a simultaneous transcatheter procedure for a diseased aortic valve and the ascending aorta is a feasible option for appropriately selected patients.

We describe a series of optical transmission experiments based around single-mode, multi-core fiber (MCF) amplified with 19-core, C+L band erbium-doped fiber amplifier (EDFA). The cladding-pumped amplifier uses two multi-mode pumps in each of C and L band to provide gain bandwidth over more than 75 nm. For recirculating transmission of PDM-16QAM signals on 345 wavelength carriers between 1530.52 nm and 1605.52 nm, we measure 0.715 Pb/s transmission over a distance of 2009 km (64 recirculations), equivalent to a throughput-distance product of 1.44 exabit/s x km. Next, using PDM-QPSK modulation, we investigate trans-oceanic transmission distances, measuring throughputs of 18.6 Tb/s and 14.5 Tb/s in 2 cores after 255 recirculations, a distance of 8007 km. Further, we evaluate the combined EDFA and fiber crosstalk penalties showing a core and wavelength dependence in agreement with previous MCF crosstalk measurements. These results demonstrate the potential of high core-count EDFAs to combine both high capacity transmission over transoceanic distances with benefits of SDM integration.

The INSPIRIS RESILIA valve is designed to dilate its valve annulus in transcatheter aortic valve-in-surgical aortic valve (TAV-in-SAV), a catheter therapy for biological valve deterioration. RESILIA tissue has improved anti-calcification properties. An 83-year-old man on hemodialysis undergoing surgical aortic valve replacement (SAVR) with a 25-mm INSPIRIS for severe aortic stenosis 22 months ago presented with general malaise. Transthoracic echocardiography revealed severe bioprosthetic stenosis (peak velocity: 3.5 m/s, mean pressure gradient: 32 mmHg, and effective orifice area: 0.45 cm

A 94-year-old man who underwent transcatheter aortic valve (TAV) replacement 6 years ago was admitted because of exertional dyspnea. Transthoracic echocardiography revealed severe aortic regurgitation owing to TAV dysfunction. The patient was considered to have a high risk of occlusion of the sinus of Valsalva during TAV-in-TAV. Therefore, we performed TAV-in-TAV concomitant with coronary artery bypass grafting (CABG). The postoperative course was uneventful, and computed tomography 9 months later revealed patency of both the grafts. Concomitant CABG could be considered as one of the options in patients with a high risk of coronary occlusion during TAV-in-TAV.

ObjectivePostprocedural ischaemic and bleeding risks after transcatheter aortic valve replacement (TAVR) remain a major concern. Nevertheless, no reliable risk models incorporating both possibilities are currently available. We aimed to assess the accuracy of percutaneous coronary intervention (PCI)-derived models and the performance of a recalibrated model that included variables more applicable to TAVR.MethodsThis study included 26 869 patients who had been enrolled in a national registry. Ischaemic events were defined as myocardial infarction, stroke, transient ischaemic attack or peripheral embolism at 1 year. Bleeding events were defined as any bleeding based on the Valve Academic Research Consortium-2 consensus document at 1 year. Patterns of Non-adherence to Anti-Platelet Regimen in Stented Patients (PARIS) and Coronary Revascularisation Demonstrating Outcome Study in Kyoto (CREDO-Kyoto) integer scoring systems were tested. The models were recalibrated by applying new variables using the Fine and Gray method.ResultsThe 1-year cumulative incidences for ischaemic and bleeding events were 2.7% and 3.1%. Patients with high PARIS and CREDO-Kyoto risk scores had higher incidences of both ischaemic (3.3% vs 2.4% vs 2.4%, pConclusionsThe PCI-derived models demonstrated modest accuracy but was inadequate for risk stratification of TAVR patients at 1-year follow-up.Trial registration number3395.

Perioperative stroke is one of the most serious complications after transcatheter aortic valve replacement (TAVR), and it should be especially noted in patients with an atheroma in the ascending aorta. Here, we report the first experience of transfemoral (TF)-TAVR with the insertion of a filter device for two patients with severe aortic stenosis who were incidentally detected a grade 4 atheroma in the ascending aorta preoperatively. The patients had a favorable postoperative course without any cerebrovascular events or procedure-related complications.

We describe a new functions of the cladding pumping multicore EDFA to extend the distance of space division multiplexing transmission. As a typical example, it is reported that core-to-core crosstalk can be reduced by applying a propagation direction interleaved configuration.