Transcatheter aortic valve replacement (TAVR) is well established for patients who cannot undergo surgery (Leon et al., N Engl J Med 2010;363:1597) or are high risk for surgery (Smith et al., N Engl J Med 2011;364:2187-2198). Experience with the TAVR procedure has led to recent reports of successful transcatheter mitral valve replacement (TMVR) procedures (Cheung et al., J Am Coll Cardiol 2014;64:1814; Seiffert et al., J Am Coll Cardiol Interv 2012;5:341-349) separately or simultaneously with the TAVR. However, these reports were of simultaneous valve-in-valve procedures (Cheung Anson, et al. J Am Coll Cardiol 2013;61:1759-1766). A recent report from Portugal also reported simultaneous transpical implantation of an inverted transcatheter aortic valve-in-ring in the mitral position and transcatheter aortic valve (Hasan et al., Circulation 2013;128:e74-e76). There has been an experience of TMVR only in native mitral valve for mitral valve stenosis, but none in both aortic and mitral valves. We report the first in human case of simultaneous transapical TAVR and TMVR in native valves secondary to valvular stenosis. Our patient was not a candidate for percutaneous balloon mitral valvuloplasty secondary to a high Wilkins Score. Sizing of the aortic valve was based on the transesophageal echocardiogram (TEE), whereas sizing of the mitral valve was based on TEE measurements and balloon inflation during left ventriculography. © 2015 Wiley Periodicals, Inc.

Background and hypothesis: The association of abnormal ventricular conduction with co-morbidities and effect of conduction abnormalities on TAVR outcomes have not been well investigated. Methods: A retrospective chart review was conducted in 200 consecutive TAVR patients. ECG data was collected and stratified into normal conduction (WNL, n=138), LBBB (n=25), RBBB (n=20), and intra-ventricular conduction delay (IVCD, n=17). Outcomes were adjudicated according to the PARTNER trial definitions (NEJM 2010; 363: 1597-1607). Analyses of variation, correlation, chi-square, and logistic regression were used. The study was approved by the institutional IRB. Results: There was no association between any conduction delay and history of CVA, PVD, chronic renal disease, smoking, hyperlipidemia, hypertension, or COPD. Conduction delays were associated with decreased ejection fraction (LBBB 45.4+/-2.2, RBBB 50.3+/-1.5, IVCD 48.0+/-3.2 vs. 50.7+/-10.9 in WNL conduction, p= 0.03) and lower aortic valve gradient (LBBB 35.0+/- 3.2 mm Hg, RBBB 42.2+/- 2.9, IVCD 40.5 +/- 5.0 vs. 46.2+/-1.5 in WNL conduction, p= 0.022). Standard error was used as the measure of dispersion. Despite the decreased ejection fraction and lower aortic valve gradient, conduction delays were not associated with an increased incidence of post-TAVR death, re-hospitalizations, stroke, or acute renal failure. Conclusion: Despite association with decreased ejection fraction and lower aortic valve gradient, electrocardiographic conduction delays do not lead to inferior TAVR outcomes.

Background: Hospital and long-term outcomes in cardiovascular (CV) and neurological (CNS) patients treated with therapeutic temperature manipulation were compared to investigate predictors of poor prognosis. Methods: Hospital data and long-term outcomes were collected in 89 consecutive CV or CNS patients treated with either therapeutic normothermia or hypothermia at a single institution. The study was approved by the IRB. Analysis of variance, chi-square, and logistic regression were used (Table). Results: In both CNS and CV patients, increased hospital mortality were observed with advanced age (P= 0.05), tachycardia (P= 0.02), hyperglycemia (P= 0.01), increased calcium (P= 0.03), decreased hemoglobin (P= 0.02), and hyperlipidemia (P=0.05). Advanced age retained predictive significance in multivariate logistic regression (HR 1.045, p=0.034, 95%CI 1.003-1.088). Long-term mortality was increased in patients with history of renal disease (P=0.04), elevated admission creatinine (P=0.04), and hyperlipidemia (P=0.001). Conclusions: Hospital, but not long-term outcomes, are determined by admission metabolic derangements and age in patients undergoing therapeutic temperature manipulation. In survivors to hospital discharge renal dysfunction and dyslipidemia appear to be associated with worse outcomes. Additional studies of this important subject are needed.

Background: NSAIDs may exert direct deleterious effects on CV system, while non-selective (NS) -NSAIDs may also diminish cardio-protective effect of low-dose aspirin. On another hand, NSAIDs may decrease CRP levels and ameliorate systemic inflammation. We have investigated short and long-term outcomes associated with NSAIDs use in post-PCI patients. Methods and Material: NSAID utilization, hospital and long-term outcomes of 2933 percutaneous coronary revascularizations (PCI) were collected and analyzed. Patients not on aspirin, or treated with rofecoxib and valdecoxib were excluded. ANOVA, Chi-square, Kaplan-Meyer analysis with log-rank test, and logistic regression were utilized. The study was approved by the Institutional IRB. Results: Patients treated with NS-NSAIDs, but not celecoxib, experienced longer length of stay, higher incidence of peri-procedural myocardial infarction, and mildly increased post-PCI mortality (Table). These effects were unchanged after adjustment for age (p=0.001), ejection fraction (p<0.001), and history of previous MI (p<0.001). There was a trend towards lower long-term (50+/-15 months) mortality in NS-NSAIDs (9%) and celecoxib (6.7%) treated patients, when compared to the rest of the cohort (11.3%, Table). Conclusion: Non-selective NSAIDs, but not Celecoxib, are associated with prolonged hospital stay and increased peri-procedural myocardial infarction in PCI patients. Long-term mortality does not appear to be affected by the NSAIDs use at the time of PCI. Randomized studies of this important clinical question are needed.