Transcatheter aortic valve replacement in low-risk young population:A double edge sword?

Since the advent of transcatheter aortic valve replacement(TAVR)in 2002,it has now become the default interventional strategy for symptomatic patients presenting with severe aortic stenosis,particularly in intermediate to highsurgical risk patients.In 2019,the United States Food and Drug Administration approved TAVR in low-risk patients based on two randomized trials.However,these breakthrough trials excluded patients with certain unfavorable anatomies and odd profiles.While currently there is no randomized study of TAVR in young patients,it may be preferred by the young population given the benefits of early discharge,shorter hospital stay,and expedite recovery.Nonetheless,it is important to ruminate various factors including lifetime expectancy,risk of pacemaker implantation,and the need for future valve or coronary interventions in young cohorts before considering TAVR in these patients.Furthermore,the data on long-term durability(>10 years)of TAVR is still unknown given most of the procedures were initially performed in the high or prohibitive surgical risk population.Thus,this editorial aims to highlight the importance of considering an individualized approach in young patients with consideration of various factors including lifetime expectancy while choosing TAVR against surgical aortic valve replacement.

Effect of safety valve types on the gas venting behavior and thermal runaway hazard severity of large-format prismatic lithium iron phosphate batteries

The safety valve is an important component to ensure the safe operation of lithium-ion batteries(LIBs).However,the effect of safety valve type on the thermal runaway(TR)and gas venting behavior of LIBs,as well as the TR hazard severity of LIBs,are not known.In this paper,the TR and gas venting behavior of three 100 A h lithium iron phosphate(LFP)batteries with different safety valves are investigated under overheating.Compared to previous studies,the main contribution of this work is in studying and evaluating the effect of gas venting behavior and TR hazard severity of LFP batteries with three safety valve types.Two significant results are obtained:(Ⅰ)the safety valve type dominates over gas venting pressure of battery during safety venting,the maximum gas venting pressure of LFP batteries with a round safety valve is 3320 Pa,which is one order of magnitude higher than other batteries with oval or cavity safety valve;(Ⅱ)the LFP battery with oval safety valve has the lowest TR hazard as shown by the TR hazard assessment model based on gray-fuzzy analytic hierarchy process.This study reveals the effect of safety valve type on TR and gas venting,providing a clear direction for the safety valve design.

Current knowledge for the risk factors of early permanent pacemaker implantation following transcatheter aortic valve replacement and what is next for the primary prevention?

In this editorial,we comprehensively summarized the preoperative risk factors of early permanent pacemaker implantation after transcatheter aortic valve replacement(TAVR)among patients with severe aortic stenosis from several renowned clinical studies and focused on the primary prevention of managing the modifiable factors,e.g.,paroxysmal atrial fibrillation before the TAVR.

Low-temperature characteristicsof rubbers and performance testsof type 120 emergencyvalve diaphragms

Purpose–The type 120 emergency valve is an essential braking component of railway freight trains,butcorresponding diaphragms consisting of natural rubber(NR)and chloroprene rubber(CR)exhibit insufficientaging resistance and low-temperature resistance,respectively.In order to develop type 120 emergency valverubber diaphragms with long-life and high-performance,low-temperatureresistant CR and NR were processed.Design/methodology/approach–The physical properties of the low-temperature-resistant CR and NRwere tested by low-temperature stretching,dynamic mechanical analysis,differential scanning calorimetryand thermogravimetric analysis.Single-valve and single-vehicle tests of type 120 emergency valves werecarried out for emergency diaphragms consisting of NR and CR.Findings–The low-temperature-resistant CR and NR exhibited excellent physical properties.The elasticityand low-temperature resistance of NR were superior to those of CR,whereas the mechanical properties of thetwo rubbers were similar in the temperature range of 0℃–150℃.The NR and CR emergency diaphragms metthe requirements of the single-valve test.In the low-temperature single-vehicle test,only the low-temperaturesensitivity test of the NR emergency diaphragm met the requirements.Originality/value–The innovation of this study is that it provides valuable data and experience for futuredevelopment of type 120 valve rubber diaphragms.

Transcatheter pulmonic valve implantation: Techniques, current roles, and future implications

Right ventricular outflow tract(RVOT)obstruction is present in a variety of congenital heart disease states including tetralogy of Fallot,pulmonary atresia/stenosis and other conotruncal abnormalities etc.After surgical repair,these patients develop RVOT residual abnormalities of pulmonic stenosis and/or insufficiency of their native outflow tract or right ventricle to pulmonary artery conduit.There are also sequelae of other surgeries like the Ross operation for aortic valve disease that lead to right ventricle to pulmonary artery conduit dysfunction.Surgical pulmonic valve replacement(SPVR)has been the mainstay for these patients and is considered standard of care.Transcatheter pulmonic valve implantation(TPVI)was first reported in 2000 and has made strides as a comparable alternative to SPVR,being approved in the United States in 2010.We provide a comprehensive review in this space–indications for TPVI,detailed procedural facets and up-to-date review of the literature regarding outcomes of TPVI.TPVI has been shown to have favorable medium-term outcomes free of reinterventions especially after the adoption of the practice of pre-stenting the RVOT.Procedural mortality and complications are uncommon.With more experience,recognition of risk of dreaded outcomes like coronary compression has improved.Also,conduit rupture is increasingly being managed with transcatheter tools.Questions over endocarditis risk still prevail in the TPVI population.Head-to-head comparisons to SPVR are still limited but available data suggests equivalence.We also discuss newer valve technologies that have limited data currently and may have more applicability for treatment of native dysfunctional RVOT substrates.

Planning of a Single Flow Channel in Valve Blocks Based on Additive Manufacturing and the Ant Colony Algorithm

As electro-hydrostatic actuator(EHA)technology advances towards lightweight and integration,the demand for enhanced internal flow pathways in hydraulic valve blocks intensifies.However,owing to the constraints imposed by traditional manufacturing processes,conventional hydraulic integrated valve blocks fail to satisfy the demands of a more compact channel layout and lower energy dissipation.Notably,the subjectivity in the arrangement of internal passages results in a time-consuming and labor-intensive process.This study employed additive manufacturing technology and the ant colony algorithm and B-spline curves for the meticulous design of internal passages within an aviation EHA valve block.The layout environment for the valve block passages was established,and path optimization was achieved using the ant colony algorithm,complemented by smoothing using B-spline curves.Three-dimensional modeling was performed using SolidWorks software,revealing a 10.03%reduction in volume for the optimized passages compared with the original passages.Computational fluid dynamics(CFD)simulations were performed using Fluent software,demonstrating that the algorithmically optimized passages effectively prevented the occurrence of vortices at right-angled locations,exhibited superior flow characteristics,and concurrently reduced pressure losses by 34.09%-36.36%.The small discrepancy between the experimental and simulation results validated the efficacy of the ant colony algorithm and B-spline curves in optimizing the passage design,offering a viable solution for channel design in additive manufacturing.

Switching Frequency Improvement of a High Speed on/off Valve Based on Pre-excitation Control Algorithm

The high-speed on/off valve(HSV)serves as the fundamental component responsible for generating discrete fluids within digital hydraulic systems.As the switching frequency of the HSV increases,the properties of the generated discrete fluid approach those of continuous fluids.Therefore,a higher frequency response characteristic of HSV is the key to ensure the control accuracy of digital hydraulic systems.However,the current research mainly focuses on its dynamic performance,but neglect its FRC.This paper presents a theoretical analysis demonstrating that the FRC of the HSV can be enhanced by minimizing its switching time.The maximum switching frequency(MSF)is mainly determined by opening dynamic performance when HSV operates with low switching duty ratio(SDR),whereas the closing dynamic performance limits the MSF when HSV operates with high SDR.Building upon these findings,the pre-excitation control algorithm(PECA)is proposed to reduce the switching time of the HSV,and consequently enhance its FRC.Experimental results demonstrate that PECA shortens the opening delay time of HSV by 1.12 ms,the closing delay time by 2.54 ms,and the closing moving time by 0.47 ms in comparison to the existing advanced control algorithms.As a result,a larger MSF of 417 Hz and a wider controllable SDR range from 20%to 70%were achieved at a switching frequency of 250 Hz.Thus,the proposed PFCA in this paper has been verified as an effective and promising approach for enhancing the control performance of digital hydraulic systems.

Electric-controlled pressure relief valve for enhanced safety in liquid-cooled lithium-ion battery packs

The liquid-cooled battery energy sto rage system(LCBESS) has gained significant attention due to its superior thermal management capacity.However,liquid-cooled battery pack(LCBP) usually has a high sealing level above IP65,which can trap flammable and explosive gases from battery thermal runaway and cause explosions.This poses serious safety risks and challenges for LCBESS.In this study,we tested overcharged battery inside a commercial LCBP and found that the conventionally mechanical pressure relief valve(PRV) on the LCBP had a delayed response and low-pressure relief efficiency.A realistic 20-foot model of an energy storage cabin was constructed using the Flacs finite element simulation software.Comparative studies were conducted to evaluate the pressure relief efficiency and the influence on neighboring battery packs in case of internal explosions,considering different sizes and installation positions of the PRV.Here,a newly developed electric-controlled PRV integrated with battery fault detection is introduced,capable of starting within 50 ms of the battery safety valve opening.Furthermore,the PRV was integrated with the battery management system and changed the battery charging and discharging strategy after the PRV was opened.Experimental tests confirmed the efficacy of this method in preventing explosions.This paper addresses the safety concerns associated with LCBPs and proposes an effective solution for explosion relief.

Psychological Status and Warfarin Therapy in Patients after Valve Replacement during the COVID-19 Pandemic:A Cross-sectional Study

Objective The standardization of warfarin anticoagulant therapy is the key to lifelong treatment for patients after heart valve replacement.The present study explored the possible risk factors for anxiety and depression during the coronavirus disease 2019(COVID-19)pandemic and analyzed the influence of psychological state on medication safety.Methods Eligible patients received a web-based questionnaire survey via the Wenjuanxing platform during outpatient visits.Depression was evaluated by the Self-Rating Depression Scale(SDS).Anxiety was evaluated by the Self-Rating Anxiety Scale(SAS).Medication adherence was evaluated by the Morisky scale.Results A total of 309 patients(aged 52.2±11.4 years)were included in the present study.The SDS score of all included patients was 36.9±9.4 points,of which 11(3.6%)patients were diagnosed as having depression.The SAS score of all included patients was 43.1±9.3 points,of which 71(23%)patients were diagnosed as having anxiety.Seven patients(2.3%)had both anxiety and depression.Logistic regression analysis revealed that only monthly income was an independent influencing factor for depression.Regarding anxiety,patients who underwent repeated operations had a 2.264-fold greater risk,and patients who received combination medication had a 2.140-fold greater risk.More bleeding events and coagulation disorders could be observed in patients with anxiety,depression or both.When anxiety occurred,patients showed worse medication adherence.However,depression had no significant effect on medication adherence.Conclusion During the COVID-19 pandemic,the detection rate of mental illnesses such as anxiety and depression was high,which seriously affected the medication safety of warfarin.Analysis of its influencing factors will provide a reference for further standardized regulation of warfarin anticoagulant therapy after valve replacement.

Novel heart valve leaflet designs with stiff polymeric materials and biomimetic kinematics

Despite continuous efforts to improve the robustness of cardiac valve implants,neither bioprosthetic nor mechanical valves fulfill both hemodynamic and durability requirements.This study discussed novel flexible leaflet designs,focusing on polymeric materials with proven hemocompatibility,such as polyether ether ketone,of much higher stiffness than native tissue,aiming at optimal valve implants.A biomimetic valve with a single-curvature belly-curve(B-C)was used as a reference for new design variants with a double-curvature B-C with varying radii.Soft(13.2 MPa)and stiff(2.4 GPa)leaflet materials and different thicknesses were studied using lean simulations and in vitro experiments under physiologic hemodynamic conditions.The performance was assessed using opening pressure(OP)and orifice area(OA).The latter was determined by a newly developed automatized image processing tool.Experimental trends are in agreement with simulations and demonstrated that a buckling-inspired double-curvature leaflet design significantly enhances the trileaflet valve opening behavior,which is particularly advantageous for stiffer leaflet materials.Compared to the reference,the best-performing variant showed an OP improvement of 47%and 44%based on simulations and experiments,respectively.In contrast,the achieved mean pressure differential was directly comparable to state-of-the-art bioprosthetic valves.The OA was slightly reduced for new variants but still in the satisfying range.

The use of fluoroscopy for detecting hypertensive lung edema due to prosthetic valve dysfunction: a case report

Heart valve diseases affect more than one hundred million people around the world,which are a serious cause of illness and mortality.[1]Among the valve diseases,mitral valve insufficiency ranks second in the list of valve diseases requiring surgical repair in Europe.[2]Prosthetic valve replacement is the standard treatment in cases where repair is not sufficient for valve diseases.[3]Mechanical and bioprosthetic valves can be preferred for replacement,mechanical valves are more durable and require lifelong use of anticoagulants.The disadvantage of bioprosthetic valves is early degeneration,and infective reoperation is required due to the formation of endocarditis.[4-5]The risk of thromboembolism,lifetime anticoagulant use and complications related to anticoagulation remain disadvantages of valve surgery.[3]The most important complication requiring urgent intervention is valve dysfunction due to thrombosis.It usually occurs due to inappropriate use of the anticoagulants.[6]Surgical treatment is used for severe obstructions,such as thrombi larger than 10 mm.Thrombolytic therapy can be applied in small thrombi and in cases where surgical intervention is risky.

Large-Scale Surface Modification of Decellularized Matrix with Erythrocyte Membrane for Promoting In Situ Regeneration of Heart Valve

In situ regeneration is a promising strategy for constructing tissue engineering heart valves(TEHVs).Currently,the decellularized heart valve(DHV)is extensively employed as a TEHV scaffold.Nevertheless,DHV exhibits limited blood compatibility and notable difficulties in endothelialization,resulting in thrombosis and graft failure.The red blood cell membrane(RBCM)exhibits excellent biocompatibility and prolonged circulation stability and is extensively applied in the camouflage of nanoparticles for drug delivery;however,there is no report on its application for large-scale modification of decellularized extracellular matrix(ECM).For the first time,we utilized a layer-by-layer assembling strategy to immobilize RBCM on the surface of DHV and construct an innovative TEHV scaffold.Our findings demonstrated that the scaffold significantly improved the hemocompatibility of DHV by effectively preventing plasma protein adsorption,activated platelet adhesion,and erythrocyte aggregation,and induced macrophage polarization toward the M2 phenotype in vitro.Moreover,RBCM modification significantly enhanced the mechanical properties and enzymatic stability of DHV.The rat models of subcutaneous embedding and abdominal aorta implantation showed that the scaffold regulated the polarization of macrophages into the anti-inflammatory and pro-modeling M2 phenotype and promoted endothelialization and ECM remodeling in the early stage without thrombosis and calcification.The novel TEHV exhibits excellent performance and can overcome the limitations of commonly used clinical prostheses.

Isogeometric Analysis of Hyperelastic Material Characteristics for Calcified Aortic Valve

This study explores the implementation of computed tomography(CT)reconstruction and simulation techniques for patient-specific valves,aiming to dissect the mechanical attributes of calcified valves within transcatheter heart valve replacement(TAVR)procedures.In order to facilitate this exploration,it derives pertinent formulas for 3D multi-material isogeometric hyperelastic analysis based on Hounsfield unit(HU)values,thereby unlocking foundational capabilities for isogeometric analysis in calcified aortic valves.A series of uniaxial and biaxial tensile tests is executed to obtain an accurate constitutive model for calcified active valves.To mitigate discretization errors,methodologies for reconstructing volumetric parametric models,integrating both geometric and material attributes,are introduced.Applying these analytical formulas,constitutive models,and precise analytical models to isogeometric analyses of calcified valves,the research ascertains their close alignment with experimental results through the close fit in displacement-stress curves,compellingly validating the accuracy and reliability of the method.This study presents a step-by-step approach to analyzing themechanical characteristics of patient-specific valves obtained fromCT images,holding significant clinical implications and assisting in the selection of treatment strategies and surgical intervention approaches in TAVR procedures.

Rates, predictors, and causes of readmission after transcatheter aortic valve replacement in patients with chronic kidney disease

BACKGROUND Transcatheter aortic valve replacement(TAVR)is a revolutionary procedure for severe aortic stenosis.The coexistence of chronic kidney disease(CKD)and TAVR introduces a challenge that significantly impacts patient outcomes.AIM To define readmission rates,predictors,and causes after TAVR procedure in CKD stage 1-4 patients.METHODS We used the national readmission database 2018 and 2020 to look into readmission rates,causes and predictors after TAVR procedure in patients with CKD stage 1-4.RESULTS Out of 24758 who underwent TAVR and had CKD,7892(32.4%)patients were readmitted within 90 days,and had higher adjusted odds of being females(adjusted odds ratio:1.17,95%CI:1.02-1.31,P=0.02)with longer length of hospital stay>6 days,and more comorbidities including but not limited to diabetes mellitus,anemia,and congestive heart failure(CHF).CONCLUSION Most common causes of readmission included CHF(18.0%),sepsis,and complete atrioventricular block.Controlling readmission predictors with very close followup is warranted to prevent such high rate of readmission.

Navigating postoperative complications:Uveitis-glaucoma-hyphema syndrome after Ahmed glaucoma valve implantation

Altwijri and Alsirhy reported a case of uveitis-glaucoma-hyphema syndrome after an Ahmed glaucoma valve implantation surgery in an advanced primary open-angle glaucoma patient,being the first ever recorded of its kind.The author describes the position of the tube as the origin of the anterior chamber inflam-mation and hyphema,which resolved shortly after shortening and relocating it.This publication emphasizes the importance of precise implant positioning and close-up patient follow-up after glaucoma filtration surgery as an important standard for healthcare providers.

Risk of permanent pacemaker implantation following transcatheter aortic valve replacement:Which factors are most relevant?

Transcatheter aortic valve replacement(TAVR)has emerged as a formidable treatment option for severe symptomatic aortic stenosis ahead of surgical aortic valve replacement.The encouraging results from large randomized controlled trials has resulted in an exponential rise in the use of TAVR even in the low-risk patients.However,this is not without challenges.Need for permanent pacemaker(PPM)post-TAVR remains the most frequent and clinically relevant challenge.Naturally,identifying risk factors which predispose an individual to develop high grade conduction block post-TAVR is important.Various demographic factors,electrocardiographic features,anatomic factors and procedural characteristics have all been linked to the development of advanced conduction block and need for PPM following TAVR.Amongst these electrophysiological variables,most notably a prolonged QRS>120 ms regardless of the type of conduction block seems to be one of the strongest predictors on logistic regression models.The index study by Nwaedozie et al highlights that patients requiring PPM post-TAVR had higher odds of having a baseline QRS>120 ms and were more likely to be having diabetes mellitus that those who did not require PPM.

Predictors of permanent pacemaker implantation following transcatheter aortic valve replacement-the search is still on!

Several anatomical,demographic,clinical,electrocardiographic,procedural,and valve-related variables can be used to predict the probability of developing con-duction abnormalities after transcatheter aortic valve replacement(TAVR)that necessitate permanent pacemaker(PPM)implantation.These variables include calcifications around the device landing zone and in the mitral annulus;pre-existing electrocardiographic abnormalities such as left and right bundle branch blocks(BBB),first-and second-degree atrioventricular blocks,as well as bifas-cicular and trifascicular blocks;male sex;diabetes mellitus(DM);hypertension;history of atrial fibrillation;renal failure;dementia;and use of self-expanding valves.The current study supports existing literature by demonstrating that type 2 DM and baseline right BBB are significant predictors of PPM implantation post-TAVR.Regardless of the side of the BBB,this study demonstrated,for the first time,a linear association between the incidence of PPM implantation post-TAVR and every 20 ms increase in baseline QRS duration(above 100 ms).After a 1-year follow-up,patients who received PPM post-TAVR had a higher rate of hospital-ization for heart failure and nonfatal myocardial infarction.

Pacemaker post transcatheter aortic valve replacement:A multifactorial risk?

Pacemaker post-transcatheter aortic valve replacement is related to multifactorial risk.Nwaedozie et al brought to the body of evidence electrocardiogram and clinical findings.However,procedural characteristics have at least as much impact on the final need for a permanent pacemaker and potentially on the pacing rate.In this regard,long-term follow-up and understanding of the impact of long-term stimulation is of utmost importance.

Research on static characteristic of double redundance double nozzle flapper valve based on AMESim

The feedback spring rod of the armature assembly is cancelled in the double redundance double nozzle flapper valve(DRDNFV),and the difficulty of valve core displacement control is increased.Therefore,this paper intends to study the static characteristic of DRDNFV through the AMESet and AMESim simulation.It is explored under the circumstance of the fixed orifices being clogged and experimentally verified on the test bench.The results show that the pressure gain increases and the flow gain decreases with the increasing clogged degree of the fixed orifices on both sides.The zero bias increases synchronously with the increasing clogged degree of the unilateral fixed orifice.The experimental results are basically consistent with the theoretical curves and the theoretical correctness of the simulation model is effectively verified.The results can provide the theoretical reference for design,debugging,maintenance and fault diagnosis of DRDNFV.

Animal Model of Aortic Valve Calcification: Their Methodology Helps Us Understand Aortic Valve Calcification

Aortic valve calcification disease (CAVD) is the most prevalent degenerative valve disease in humans, leading to significant morbidity and mortality. Despite its common occurrence, our understanding of the underlying mechanisms remains incomplete, and available treatment options are limited and risky. A more comprehensive understanding of the biology of CAVD is essential to identify new therapeutic strategies. Animal models have played a crucial role in advancing our knowledge of CAVD and exploring potential treatments. However, these models have inherent limitations as they cannot fully replicate the complex physiological mechanisms of human CAVD. In this review, we examine various CAVD models ranging from pigs to mice, highlighting the unique characteristics of each model to enhance our understanding of CAVD. While these models offer valuable insights, they also have limitations and shortcomings. We propose that the guide wire model shows promise for future CAVD research, and streamlining the methodology could enhance our understanding and expand the research scope in this field.