TMVR with balloon-expandable aortic valves in extreme surgical risk patients with severe MAC is feasible but associated with high 30-day and 1-year mortality. Most patients who survive the 30-day post-procedural period are alive at 1 year and have sustained improvement of symptoms and transcatheter valve performance. The role of TMVR in patients with MAC requires further evaluation in clinical trials.

The dual theories of embodied mind and situated cognition, in which physical/temporal embodiment and physical/social/cultural environment contribute crucially to the structure of mind, are brought to bear on issues in music perception. It is argued that cognitive universals grounded in human bodily experience are tempered by the cultural specificity that constructs the role of the body in musical performance. Special focus is given to microrhythmic techniques in specific forms of African-American music, using audio examples created by the author or sampled from well-known jazz recordings.

Background: In ST-segment–elevation myocardial infarction (STEMI), infarct size correlates directly with heart failure and mortality. Preclinical testing has shown that, in comparison with reperfusion alone, mechanically unloading the left ventricle (LV) before reperfusion reduces infarct size and that 30 minutes of unloading activates a cardioprotective program that limits reperfusion injury. The DTU-STEMI pilot trial (Door-To-Unload in STEMI Pilot Trial) represents the first exploratory study testing whether LV unloading and delayed reperfusion in patients with STEMI without cardiogenic shock is safe and feasible. Methods: In a multicenter, prospective, randomized exploratory safety and feasibility trial, we assigned 50 patients with anterior STEMI to LV unloading by using the Impella CP followed by immediate reperfusion (U-IR) versus delayed reperfusion after 30 minutes of unloading (U-DR). The primary safety outcome was a composite of major adverse cardiovascular and cerebrovascular events at 30 days. Efficacy parameters included the assessment of infarct size by using cardiac magnetic resonance imaging. Results: All patients completed the U-IR (n=25) or U-DR (n=25) protocols with respective mean door-to-balloon times of 72 versus 97 minutes. Major adverse cardiovascular and cerebrovascular event rates were not statistically different between the U-IR versus U-DR groups (8% versus 12%, respectively, P =0.99). In comparison with the U-IR group, delaying reperfusion in the U-DR group did not affect 30-day mean infarct size measured as a percentage of LV mass (15±12% versus 13±11%, U-IR versus U-DR, P =0.53). Conclusions: We report that LV unloading using the Impella CP device with a 30-minute delay before reperfusion is feasible within a relatively short time period in anterior STEMI. The DTU-STEMI pilot trial did not identify prohibitive safety signals that would preclude proceeding to a larger pivotal study of LV unloading before reperfusion. An appropriately powered pivotal trial comparing LV unloading before reperfusion to the current standard of care is required. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT03000270.

ClinicalTrials.gov Identifier: NCT02202434.

Rationale: Mesenchymal stem cells (MSCs) improve function after infarction, but their mechanism of action remains unclear, and the importance of reduced scar volume, cardiomyocyte proliferation, and perfusion is uncertain.Objective: The present study was conducted to test the hypothesis that MSCs mobilize bone marrow progenitor cells and improve function by stimulating myocyte proliferation in collateral-dependent hibernating myocardium. Methods and Results: Swine with chronic hibernating myocardium received autologous intracoronary MSCs (icMSCs; Ϸ44؋106 cells, n‫)01؍‬ 4 months after instrumentation and were studied up to 6 weeks later. Physiological and immunohistochemical findings were compared with untreated hibernating animals (n‫,)7؍‬ sham-normal animals (n‫,)5؍‬ and icMSC-treated sham-normal animals (n‫. Key Words: mesenchymal stem cells Ⅲ hibernating myocardium Ⅲ bone marrow progenitor cells M esenchymal stem cells (MSCs) can repair a variety of tissues after injury 1 and are currently being used in clinical trials to treat patients with cardiovascular disease. 2 Nevertheless, their precise mechanism of action and the role of myocyte regeneration versus angiogenesis are controversial. Most preclinical investigation has focused on animal models of myocardial infarction in which intravenous, intramyocardial, and intracoronary administration of MSCs have been demonstrated to reduce infarct size and improve left ventricular (LV) function in both acute and chronic infarction. [3][4][5][6][7][8][9][10][11][12][13] Although early studies demonstrated the ability of autologous and allogeneic MSCs to differentiate into vessels, 8,14 smooth muscle, 14 and cardiac muscle, 15,16 the quantitative extent of MSC differentiation into a cardiac cellular phenotype has been small and inconsistent with measured reductions in infarct volume. 4,8,11 Recent investigations have hypothesized that MSCs effect cardiac repair through a paracrine mechanism that stimulates proliferation of endogenous myocytes, but in vivo studies quantifying the magnitude of myocyte proliferation are limited. Most analyses focus on the small rim of border zone tissue between normal and infarcted myocardium rather than larger remote regions or areas at risk of ischemia. 5,9,[17][18][19][20][21][22] Recently, we demonstrated that pravastatin can mobilize cKit ϩ and CD133 ϩ bone marrow progenitor cells (BMPCs). 23 The BMPCs localized in the heart and were accompanied by improved myocardial function in swine, with hibernating myocardium devoid of infarction in the absence of an increase in myocardial perfusion. Although BMPC mobilization had no effect on myocyte proliferation in the normal heart, it increased the frequency of myocytes in the proliferative phase of the cell cycle in diseased hearts and increased myocyte nuclear density with small myocytes that suggested that endogenous myocyte proliferation was stimulated. 23 Likewise, studies with skeletal muscle injection of porcine MSCs into Syrian hamsters 24 and MSCs that overexpressed insulin-like ...