Heart : official journal of the British Cardiac Society
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Following the first reported case of thoracic endovascular aortic repair (TEVAR) in 1987, there has been rapid technological development and widespread uptake of this approach for thoracic aortic disease. TEVAR has particular advantages for acute thoracic syndromes and there is continuing development of TEVAR for use in the elective situation. This is still a young technology and many unknowns remain, including long-term outcomes and the relative advantages and disadvantages versus both conservative treatment and open surgical repair. The current uses of TEVAR in the treatment of aortic dissection, thoracic aortic aneurysm, penetrating aortic ulcer and trauma are discussed.
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Symptoms in patients with chronic thromboembolic pulmonary hypertension (CTEPH) predominantly occur during exercise, while haemodynamic assessment is generally performed at rest. We hypothesised that exercise imaging of RV function would better explain exercise limitation and the acute effects of pulmonary vasodilator administration than resting measurements. ⋯ Exercise measures of RV function explain much of the variance in the exercise capacity of patients with CTEPH while resting measures do not. Sildenafil increases SVi during exercise in patients with CTEPH, but not in healthy subjects.
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An inflammatory response after cardiac surgery is associated with worse clinical outcomes, but recent trials to attenuate it have been neutral. We evaluated the association between systemic inflammatory response syndrome (SIRS) and mortality after transcatheter (TAVR) and surgical aortic valve replacement (SAVR) for aortic stenosis (AS) and evaluated whether diabetes influenced this relationship. ⋯ Severe SIRS was associated with a higher mortality after SAVR or TAVR. It occurred more commonly after SAVR and had a greater effect on mortality in diabetic patients. These findings may have implications for treatment decisions in patients with AS, may help explain differences in outcomes between different AVR approaches and identify diabetic patients as a high-risk subgroup to target in clinical trials with therapies to attenuate SIRS.