Background: Surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) have been shown to improve symptoms and overall survival in patients with severe, symptomatic aortic stenosis (AS). However, there still remains a group of patients not considered as appropriate candidates due to comorbid conditions and/or hemodynamic instability. The purpose of this study is to evaluate the in-hospital mortality of this high risk group undergoing BAV.Methods: An institutional BAV registry was created to compare baseline clinical characteristics with treatment outcomes and its associations with in-hospital mortality. Univariate analyses for continuous variables were performed with analysis of variance and Mann Whitney tests. Univariate analyses for categorical variables were preformed with Pearson chi square and Fischer's exact test. Multivariate logistic regression analyses were performed with variables statistically significant within the in-hospital mortality group. Results:This retrospective, single-center cohort included 68 patients who underwent BAV with 10 patients (15%) having post-procedural in-hospital mortality. The surviving patients had an average body mass index (BMI) of 25.8 (range 20.9-36.7) as opposed to the in-hospital mortality group with a BMI of 20.2 (range 16.8-22.9). The in-hospital mortality group has significantly higher rates of acute kidney injury (1.3±0.5 vs 2.3±2, P <0.003) prior to procedure, significantly elevated pulmonary artery pressures (45±10 vs 28±12mmHg, P<0.01), and elevated left ventricular end diastolic pressures (28±11 vs 23±23mmHg, P<0.047) when compared to the survival group. Conclusion:Developments in technique with the use vascular closure devices, catheters with smaller sheath sizes, and the use of rapid ventricular pacing has lead to improved outcomes when compared to prior registries. Limited information regarding bridging patients to SAVR/ TAVR with BAV currently exists and more information needs to be obtained, especially as individuals are living longer and aortic stenosis being inevitable.

Second-generation drug-eluting stents are currently considered the standard of care in patients undergoing treatment for coronary artery disease with percutaneous coronary intervention. Despite significant improvements in stenting technology and stent material over the past three decades, the concern that a permanent metallic prosthesis within the coronary vasculature can serve as a trigger for stent-related adverse events, mainly stent thrombosis and in-stent restenosis, still persists. In order to overcome the disadvantages of drug-eluting stents there has been a robust development in the field of bioresorbable coronary scaffolds (BRS). These devices aim to provide temporary scaffolding to restore vessel patency and, after serving its purpose, fully degrade and thus allow restoration of vasomotion along with luminal enlargement. The initial experience with bioresorbable scaffolds in low-risk patients presenting with simple lesions was satisfying and generated optimism among interventional cardiologists by promising better patient outcomes. However, the unrestricted use of these devices in patients presenting with a higher baseline risk and more complex lesions came at the cost of alarmingly high rates of adverse cardiac events, especially the late device thrombosis. Although its non-inferiority compared to metallic everolimus-eluting stents was formally met in the clinical trials, there was a clear trend towards an increased occurrence of myocardial infarction and device thrombosis during the first year after device implantation, which persisted even at long-term follow-up raising concern on the future of BRS. This review article discusses the development, design, clinical data, and future directions in the field of BRS.

A 30-year-old man presented for evaluation of palpitations and exertional dyspnea when climbing stairs, mostly at night. The electrocardiogram showed sinus rhythm and early repolarization changes. What would you do next?