OBJECTIVES The study compared 1-year outcomes between transcatheter aortic valve replacement (TAVR) patients with bicuspid aortic valve (BAV) morphology and clinically similar patients having... Show moreOBJECTIVES The study compared 1-year outcomes between transcatheter aortic valve replacement (TAVR) patients with bicuspid aortic valve (BAV) morphology and clinically similar patients having tricuspid aortic valve (TAV) morphology.BACKGROUND There are limited prospective data on TAVR using the SAPIEN 3 device in low-surgical-risk patients with severe, symptomatic aortic stenosis and bicuspid anatomy.METHODS Low-risk, severe aortic stenosis patients with BAV were candidates for the PARTNER 3 (Placement of Aortic Transcatheter Valves 3) (P3) bicuspid registry or the P3 bicuspid continued access protocol. Patients treated in these registries were pooled and propensity score matched to TAV patients from the P3 randomized TAVR trial. Outcomes were compared between groups. The primary endpoint was the 1-year composite rate of death, stroke, and cardiovascular rehospitalization.RESULTS Of 320 total submitted BAV patients, 169 (53%) were treated, and most were Sievers type 1. The remaining 151 patients were excluded caused by anatomic or clinical criteria. Propensity score matching with the P3 TAVR cohort (496 patients) yielded 148 pairs. There were no differences in baseline clinical characteristics; however, BAV patients had larger annuli and they experienced longer procedure duration. There was no difference in the primary endpoint between BAV and TAV (10.9% vs 10.2%; P = 0.80) or in the rates of the individual components (death: 0.7% vs 1.4%; P = 0.58; stroke: 2.1% vs 2.0%; P = 0.99; cardiovascular rehospitalization: 9.6% vs 9.5%; P = 0.96).CONCLUSIONS Among highly select bicuspid aortic stenosis low-surgical-risk patients without extensive raphe or subannular calcification, TAVR with the SAPIEN 3 valve demonstrated similar outcomes to a matched cohort of patients with tricuspid aortic stenosis. (C) 2022 by the American College of Cardiology Foundation. Show less
BACKGROUND Subclinical leaflet thrombosis, characterized by hypoattenuated leaflet thickening (HALT) and reduced leaflet motion observed on 4-dimensional computed tomography (CT), may represent a... Show moreBACKGROUND Subclinical leaflet thrombosis, characterized by hypoattenuated leaflet thickening (HALT) and reduced leaflet motion observed on 4-dimensional computed tomography (CT), may represent a form of bioprosthetic valve dysfunction.OBJECTIVES The U.S. Food and Drug Administration mandated CT studies to understand the natural history of this finding, differences between transcatheter and surgical valves, and its association with valve hemodynamics and clinical outcomes.METHODS The PARTNER 3 (The Safety and Effectiveness of the SAPIEN 3 Transcatheter Heart Valve in Low-Risk Patients With Aortic Stenosis) CT substudy randomized 435 patients with low-surgical-risk aortic stenosis to undergo transcatheter aortic valve replacement (n = 221) or surgery (n = 214). Serial 4-dimensional CTs were performed at 30 days and 1 year and were analyzed independently by a core laboratory.RESULTS The incidence of HALT increased from 10% at 30 days to 24% at 1 year. Spontaneous resolution of 30-day HALT occurred in 54% of patients at 1 year, whereas new HALT appeared in 21% of patients at 1 year. HALT was more frequent in transcatheter versus surgical valves at 30 days (13% vs. 5%; p = 0.03), but not at 1 year (28% vs. 20%; p = 0.19). The presence of HALT did not significantly affect aortic valve mean gradients at 30 days or 1 year. Patients with HALT at both 30 days and 1 year, compared with those with no HALT at 30 days and 1 year, had significantly increased aortic valve gradients at 1 year (17.8 +/- 2.2 mm Hg vs. 12.7. +/- 0.3 mm Hg; p = 0.04).CONCLUSIONS Subclinical leaflet thrombosis was more frequent in transcatheter compared with surgical valves at 30 days, but not at 1 year. The impact of HALT on thromboembolic complications and structural valve degeneration needs further assessment. (J Am Coll Cardiol 2020;75:3003-15) (c) 2020 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons. org/licenses/by-nc-nd/4.0/). Show less
Abstract This paper offers an analysis of ka41, an aspectual element in ChangshaXiang Chinese. It is argued that this element occupies a position in the inneraspectualstructure of the clause,... Show moreAbstract This paper offers an analysis of ka41, an aspectual element in ChangshaXiang Chinese. It is argued that this element occupies a position in the inneraspectualstructure of the clause, between the higher aspectual marker ta21 and thelower elements expressing a lexical result (like clean in wash clean). On the basis ofits co-occurrence with various verb types, we treat ka41 as an achievement marker:when present, it blocks any reading in which the denoted event proceeds along amulti-point scale, allowing only the instantaneous, two-point scale reading in whichthe beginning and the endpoint of the event coincide. On the basis of its syntacticdistribution we argue that the syntactic position ka41 occupies is an intermediateaspectual projection (Asp2P) in the inner aspect domain, which is sandwichedbetween the lowest inner aspectual projection dedicated to telicity and the highestone signaling perfectivity (or realization of the end point). We review the implicationsof the analysis for the aspectual domain of Mandarin clauses and point outthat the intermediate inner aspectual projection (Asp2P) we introduce for Changshaappears to be a suitable syntactic position for the structural analysis of the small setof grammaticalized items generally known as “Phase complements” as well. Show less
Abstract This paper offers an analysis of ka41, an aspectual element in ChangshaXiang Chinese. It is argued that this element occupies a position in the inneraspectualstructure of the clause,... Show moreAbstract This paper offers an analysis of ka41, an aspectual element in ChangshaXiang Chinese. It is argued that this element occupies a position in the inneraspectualstructure of the clause, between the higher aspectual marker ta21 and thelower elements expressing a lexical result (like clean in wash clean). On the basis ofits co-occurrence with various verb types, we treat ka41 as an achievement marker:when present, it blocks any reading in which the denoted event proceeds along amulti-point scale, allowing only the instantaneous, two-point scale reading in whichthe beginning and the endpoint of the event coincide. On the basis of its syntacticdistribution we argue that the syntactic position ka41 occupies is an intermediateaspectual projection (Asp2P) in the inner aspect domain, which is sandwichedbetween the lowest inner aspectual projection dedicated to telicity and the highestone signaling perfectivity (or realization of the end point). We review the implicationsof the analysis for the aspectual domain of Mandarin clauses and point outthat the intermediate inner aspectual projection (Asp2P) we introduce for Changshaappears to be a suitable syntactic position for the structural analysis of the small setof grammaticalized items generally known as “Phase complements” as well. Show less
Abstract This paper offers an analysis of ka41, an aspectual element in ChangshaXiang Chinese. It is argued that this element occupies a position in the inneraspectualstructure of the clause,... Show moreAbstract This paper offers an analysis of ka41, an aspectual element in ChangshaXiang Chinese. It is argued that this element occupies a position in the inneraspectualstructure of the clause, between the higher aspectual marker ta21 and thelower elements expressing a lexical result (like clean in wash clean). On the basis ofits co-occurrence with various verb types, we treat ka41 as an achievement marker:when present, it blocks any reading in which the denoted event proceeds along amulti-point scale, allowing only the instantaneous, two-point scale reading in whichthe beginning and the endpoint of the event coincide. On the basis of its syntacticdistribution we argue that the syntactic position ka41 occupies is an intermediateaspectual projection (Asp2P) in the inner aspect domain, which is sandwichedbetween the lowest inner aspectual projection dedicated to telicity and the highestone signaling perfectivity (or realization of the end point). We review the implicationsof the analysis for the aspectual domain of Mandarin clauses and point outthat the intermediate inner aspectual projection (Asp2P) we introduce for Changshaappears to be a suitable syntactic position for the structural analysis of the small setof grammaticalized items generally known as “Phase complements” as well. Show less
This thesis investigates the morpho-syntax of the aspectual system in one variety of Xiāng (namely: Chángshā), which is one of the ten sub-families of Chinese. Two of the idiosyncratic properties... Show moreThis thesis investigates the morpho-syntax of the aspectual system in one variety of Xiāng (namely: Chángshā), which is one of the ten sub-families of Chinese. Two of the idiosyncratic properties in Xiāng Chinese is that one aspect marker is used to express more than one meaning or that more than one element is used to express one aspectual meaning. I base my analysis on the assumption that inner aspect in Xiāng is a three-layered structure: Asp3P, Asp2P and Asp1P.I focus on two aspect particles, ta21 and ka41. I argue that we have two particles sharing the same morphological form: ta21PERF and ta21PROG. The difference between the two particles lies in the different syntactic positions they occupy. I also point out that ka41 should not be treated as a perfective marker. I suggest that descriptively, ka41 doubles the already existing endpoint and that it does so to make the endpoint definitive. ka41 is used to block further access to the activity preceding the lexical endpoint (for example, such event cannot be present in the progressive). I point out that in Chángshā and Xiāng in general, all three Inner aspect positions can be lexically realized. Show less
Bittner, D.; Mayrhofer, T.; Puchner, S.; Lu, M.; Maurovich-Horvat, P.; Ghemigian, K.; ... ; Ferencik, M. 2016
