Background: Percutaneous mitral valve repair (PMVR) using theMitraClip (TM) system has become a valuable alternative in patients with severe mitral regurgitation (MR) and high surgical risk. We sought to evaluate the prognostic value of the SYNTAX II score (SSII) in patientswith concomitant coronary artery disease (CAD) undergoing a Mitraclip procedure.Methods: In seventy-five consecutive patients who underwent PMVR at the University Heart Center Zurich and the Cardiocentro Ticino, the SSSII was calculated at baseline. Clinical endpoints comprised of all-causemortality, mitral valve surgery due to failure of PMVR or reoperation, hospitalization for congestive heart failure, heart transplantation and the composite of all four endpoints.Results: Patientswere followed for a median of 271 days. Andwere divided in tertiles of SSII: SSII low= 46.5 (n= 25), SSII mid 46.6-54.4 (n= 25) and SSII high = 54.5 (n= 25). Patients in the highest SSII tertile had a lower left ventricular ejection fraction (33% vs. 40% vs. 53%) with a higher log-BNP (3.6 vs. 3.45 vs. 3.16) when compared to SSII mid and SSII low, respectively. However, the anatomical syntax score (SS) did not differ significantly within the tertiles (9.1 +/- 6.3 (SSII Low) vs 9.5 +/- 7.6 (SSII Mid) vs 10.2 +/- 6.7(SSII High), p= 0.837). The primary endpoint occurred in 33% of patients (n = 25). By multivariate analysis patients in the high SSII tertile (OR = 6.12, 95% confidence interval, [CI] 1.45-25.86, p= 0.014) and patientswith a history ofMI (OR= 3.57, 95% confidence interval, [CI] 1.17-10.88, p = 0.025) were at significantly higher risk of experiencing adverse events. Furthermore, in a combined outcome ROC curve analysis, the SSII showed good discrimination with an AUC of 0.73, p= 0.001. A cutoff SSII N49 has been identified to have a sensitivity of 83% and specificity of 53% with approximately 45% of the patients experiencing an event during follow-up.Conclusion: Using SSII in CAD patients undergoingPMVR is feasible and of prognostic significance hencewidening its clinical utility in valvular heart disease. (C) 2017 Elsevier B.V. All rights reserved.

AIMSThe aim of our study is to report our single-centre experience with concomitant MitraClip (MC) and left atrial appendage occlusion (LAAO) and further to assess the feasibility, safety and short-term outcome of such an approach.METHODS AND RESULTSTwenty-five consecutive patients underwent MC with concomitant LAAO at our hospital (combined group). As a control group, 25 consecutive patients with atrial fibrillation (AF) undergoing standalone MC were selected. Baseline parameters were equal between the two groups. Patients in the combined group had longer procedural time (90.0 min vs. 66.0 min, p=0.02) and radiation time (32.0 min vs. 18.0 min, p=0.01). There were no procedural deaths. At 30 days, one patient died due to cerebral haemorrhage (combined vs.CONTROL4% vs. 0%, p=0.32) and two had acute kidney injury (combined vs.CONTROL4% vs. 4%, p=1.00). In multivariate analysis, the association of LAAO with device or procedural success was not significant.CONCLUSIONSLAAO along with MC in a single stage procedure is feasible. These preliminary results have to be validated in a large randomised study, in order to assess the efficacy of combined LAAO that can be expected to become evident only after longer follow-up.

BACKGROUND:Published procedural and short-term outcome of the Portico valve for Transcatheter Aortic Valve Implantation (TAVI) is limited. We report a single-center patient series assessing procedural and 30-day outcome of this device.METHODS AND RESULTS:Procedural and 30-day follow-up data were prospectively collected from a consecutive series of 73 patients (80.7±6.9years, 45% male, mean STS score: 4.8±3.9) with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). Transfemoral access was used in 69 patients (94.5%), whereas in the remainder subclavian access was used. Concomitant interventions were performed in 30% of the patients. At 30days, all-cause mortality and the rate of neurological events were both 2.7%. The rates of non-minor bleeding and major vascular complications were 8.2% and 4.1%, respectively. Clinically significant aortic regurgitation was limited to a single case (1.4%) of moderate regurgitation at discharge, which was reduced to mild at 30days. Overall pacemaker rate after TAVI was 12% and the transprosthetic gradient was 6.9±3.2mmHg.CONCLUSIONS:TAVI using the Portico system was associated with low mortality and a low rate of neurological events at 30days and excellent hemodynamic outcome with no more than mild residual aortic regurgitation.

The interest in rotational atherectomy (RA) has increased over the past decade as a consequence of more complex and calcified coronary stenoses being attempted with percutaneous coronary interventions. Yet adoption of RA is hampered by several factors: amongst others, by the lack of a standardised protocol. This European expert consensus document stems from the awareness of the large heterogeneity in the protocols adopted to perform rotational atherectomy. The objective of the present document is to provide some points of consensus among highly experienced operators on the most controversial steps of RA in an attempt to build the basis of a standardised and universally accepted protocol.

AIMSWe investigated whether myeloid-related protein 8/14 complex (MRP8/14) expressed by infiltrating monocytes and granulocytes may represent a mediator and early biomarker of acute coronary syndromes (ACS).METHODS AND RESULTSImmunohistochemistry of coronary thrombi was done in 41 ACS patients. Subsequently, levels of MRP8/14 were assessed systemically in 75 patients with ACS and culprit lesions, with stable coronary artery disease (CAD), or with normal coronary arteries. In a subset of patients, MRP8/14 was measured systemically and at the site of coronary occlusion. Macrophages and granulocytes, but not platelets stained positive for MRP8/14 in 76% of 41 thrombi patients. In ACS, local MRP8/14 levels [22.0 (16.2-41.5) mg/L] were increased when compared with systemic levels [13.4 (8.1-14.7) mg/L, P = 0.03]. Systemic levels of MRP8/14 were markedly elevated [15.1 (12.1-21.8) mg/L, P = 0.001] in ACS when compared with stable CAD [4.6 (3.5-7.1) mg/L] or normals [4.8 (4.0-6.3) mg/L]. Using a cut-off level of 8 mg/L, MRP8/14 but not myoglobin or troponin, identified ACS presenting within 3 h from symptom onset.CONCLUSIONIn ACS, MRP8/14 is markedly expressed at the site of coronary occlusion by invading phagocytes. The occurrence of elevated MRP8/14 in the systemic circulation prior to markers of myocardial necrosis makes it a prime candidate for the detection of unstable plaques and management of ACS.