The gold-standard therapy for the treatment of aortic arch pathologies is conventional open surgery. Recently, total endovascular aortic arch replacement with branched stent-grafts has been introduced into clinical practice with the aim of reducing invasiveness especially in selected high-risk patients. The aim of this review is to describe the two most commonly used branched devices for endovascular arch stent-grafting: Nexus (Endospan, Herzlia, Israle) and RelayBranch (Terumo Aortic, Glasgow, United Kingdom). Nexus is a CE-certified off-the-shelf, single branch, double stent graft system. It consists of two different components: a main module for the aortic arch and the descending aorta with a side-branch for the brachiocephalic artery (BCA), and a curved module for the ascending aorta that lands into the sino-tubular junction and connects to the main module through a side-facing self-protecting sleeve. Nexus may be used in urgent-emergency cases and also in patients with only one suitable supra-aortic target vessel but, on the other hand, it makes cerebral blood flow dependent on one source vessel only. The RelayBranch Thoracic Stent-Graft System is a custom made, double branched endograft with a wide window on its superior portion to accommodate two inner tunnels for BCA and left common carotid artery connection; bilateral cervical accesses are generally used to advance guidewires for catheterization of the inner tunnels in a retrograde fashion. RelayBranch can be customized on every patient’s specific anatomy and provides a double blood source for the brain, but it cannot be used in urgent-emergency conditions. Therefore, in order to optimize outcomes, the choice of the most appropriate device should be made considering pros and cons of each system and patient’s anatomy by an experienced aortic team. In conclusion, total endovascular aortic arch exclusion is a promising reality in selected high-risk patients.

Wearable devices (WDs) can objectively assess patient-reported outcomes (PROMs) in clinical trials. In this study, the feasibility and acceptability of using commercial WDs in elderly patients undergoing transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) will be explored. This is a prospective observational study. Participants were trained to use a WD and a smartphone to collect data on their physical activity, rest heart rate and number of hours of sleep. Validated questionnaires were also used to evaluate these outcomes. A technology acceptance questionnaire was used at the end of the follow up. In our participants an overall good compliance in wearing the device (75.1% vs. 79.8%, SAVR vs. TAVR) was assessed. Half of the patients were willing to continue using the device. Perceived ease of use is one of the domains that scored higher in the technology acceptance questionnaire. In this study we observed that the use of a WD is accepted in our frail population for an extended period. Even though commercial WDs are not tailored for clinical research, they can produce useful information on patient behavior, especially when coordinated with intervention tailored to the single patient.

Background: In last few decades, several tools have been developed to measure physical function objectively; however, their use has not been well established in clinical practice. Objective: This study aims to describe the preoperative physical function and to assess and compare 6-month postoperative changes in the physical function of patients undergoing treatment for aortic stenosis with either surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). The study also aims to evaluate the feasibility of wearable devices in assessing physical function in such patients. Methods: This is a prospective observational study. The enrollment will be conducted 1 month before patients’ SAVR/TAVR. Patients will be provided with the wearable device at baseline (activity tracker device, Garmin vívoactive 3). They will be trained in the use of the device, and they will be requested to wear it on the wrist of their preferred hand until 12 months after SAVR/TAVR. After baseline assessment, they will undergo 4 follow-up assessments at 1, 3, 6, and 12 months after SAVR/TAVR. At baseline and each follow-up, they will undergo a set of standard and validated tests to assess physical function, health-related quality of life, and sleep quality. Results: The ethics committee of Vicenza in Veneto Region in Italy approved the study (Protocol No. 943; January 4, 2019). As of October 2020, the enrollment of participants is ongoing. Conclusions: The use of the wearable devices for real-time monitoring of physical activity of patients undergoing aortic valve replacement is a promising opportunity for improving the clinical management and consequently, the health outcomes of such patients. Trial Registration: Clinicaltrials.gov NCT03843320; https://tinyurl.com/yyareu5y International Registered Report Identifier (IRRID): DERR1-10.2196/20072

Background and Objectives: Prosthesis–patient mismatch (PPM) after surgical aortic valve replacement (SAVR) is associated with worse clinical outcomes and worse valve durability. The aim of this retrospective single-center study was to evaluate the consistency between predicted PPM (PPMp) and measured PPM (PPMm) after SAVR with three different bioprostheses. Materials and Methods: We analyzed data of all consecutive patients who underwent surgical aortic valve replacement with Magna Ease, Intuity, and Inspiris Resilia bioprostheses (Edwards Lifesciences, Irvine, CA, USA) at our institution. PPM was defined if EOAi ≤ 0.85 cm²/m². PPMm was determined by institutional echo lab-measured EOAi on discharge-day echocardiogram. PPMp was assessed using reference values for each valve model and size indexed to BSA based on height, weight, prosthesis type, and size. For the overall population and for the three valve types we evaluated the sensitivity, specificity, positive predicted value, negative predicted value, and accuracy of PPMp. Furthermore, the consistency between PPMm and PPMp were evaluated according to prosthesis type, size, stent internal diameter (ID), and true ID. Results: A total of 1323 patients underwent SAVR; complete hemodynamic data were available for 872 patients, who represent the population of our study. Magna Ease, Intuity, and Inspiris Resilia were implanted in 446 (51.1%), 341 (39.1%), and 85 (9.7%) patients, respectively. In 635 out of 872 cases (72.8%), PPMp was consistent with PPMm (Magna Ease: 321/446, 72%; Inspiris Resilia: 58/85, 68.2%; Intuity: 256/341, 75%). Overall, the sensitivity, specificity, positive predicted value, negative predicted value, and accuracy of PPMp were 0.26, 0.83, 0.24, 0.84, and 0.73, respectively (Magna Ease: 0.21, 0.82, 0.3, 0.8, and 0.72; Inspiris Resilia: 0.11, 0.82, 0.14, 0.79, and 0.68; Intuity: 0.45, 0.78, 0.19, 0.93, and 0.75). Conclusions: The consistency between PPMp and PPMm was suboptimal. We did not observe differences between PPMp and PPMm among different valve types. Discordance between PPMp and PPMm was more evident in smaller valve sizes. When implanting small valves, the evaluation of PPMp should be used with caution to avoid unexpected PPMm.