***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Objective To evaluate the relevance of the individual components of the Valve Academic Research Consortium (VARC)-2 criteria for periprocedural myocardial infa rct ion ( MI ) in  transcatheter aortic valve implantation ( TAVI ) . The association between biomarkers and adverse procedural outcome has been established . However , the additive prognostic importance of signs and symptoms are more uncertain . Methods A total of 125 consecutive TAVI patients were prospect ively included in this study . Biomarkers for MI were analyzed and signs and symptoms according to VARC-2 criteria were collected from clinical records . Results The criteria of elevated biomarkers and of signs or symptoms were found in 27 ( 22 % ) and 32 ( 26 % ) of the patients , respectively . According to VARC-2 definition , 12 ( 10 % ) had MI . VARC-2 definition of MI , Troponin T ( TnT ) > 600 ng/L , and presence of signs or symptoms correlated with 6 months mortality , prolonged ICU stay , elevation of N-terminal prohormone brain natriuretic peptide , and renal impairment . No signs or symptoms were found in 7 ( 44 % ) of the patients who fulfilled the criterion of elevated TnT > 600 ng/L. In the group with positive TnT criterion , there were no significant differences between those with and without signs or symptoms in respect to levels of TnT ( 1014 [ 585–1720 ] ng/L versus 704 [ 515–905 ] ng/L , p = 0.17 ) or creatine kinase-MB ( 36 [ 25–52 ] μg/L versus 29 [ 25–39 ] μg/L , p = 0.32 ) . In the multivariate Cox regression analysis , TnT > 600 ng/L was the only significant independent variable associated with 6-months postprocedural mortality . Conclusions Myocardial injury in TAVI , measured with biomarkers , correlates well with adverse procedural outcome . In this study it is also the strongest predictor for early postprocedural mortality . The additional requirement of signs or symptoms for the diagnosis of MI results in omission of a considerable number of clinical ly significant MI AIM Risk assessment of patients undergoing transcatheter aortic valve implantation ( TAVI )  remains difficult . Biomarkers have been shown to provide potential prognostic information . Here , we aim ed to analyze whether the biomarker high-sensitivity Troponin T ( hsTNT ) could be used to improve risk stratification . METHOD We prospect ively enrolled 267 patients undergoing TAVI . Biomarkers ( hsTNT and NTproBNP ) were measured 1 day before , and 3 and 7 days postprocedure . All possible prognostic factors upon survival time were analyzed by Cox regression analysis . RESULTS A total of 259 patients ( mean age 82±6.1 years ) were available for complete follow-up . The median Logistic EuroSCORE ( Log ES ) and Log ES II were 21.16 % ( Q1=13.92 ; Q3=34.27 ) and 6.42 % ( Q1=3.89 ; Q3=11.07 ) , respectively . Median follow-up was 290 ( Q1=88 ; Q3=529 ) days . A total of 71 deaths occurred during follow-up , and the 30-day mortality was 5.8 % . Median baseline hsTNT was 27.4 pg/mL ( Q1=16.2 ; Q3=46 pg/mL ) . From all potential mortality-associated factors , only preprocedural hsTNT level ( P=.001 ) , elevated Log ES ( P=.03 ) as well as acute kidney injury ( P<.001 ) and chronic obstructive pulmonary disease ( COPD ) ( P=.039 ) emerged as independent prognostic parameters for adverse outcome . We also tested whether the Valve Academic Research Consortium-2 ( VARC-II ) cutoff for myocardial damage ( hsTNT peak value exceeding 15 × the upper reference limit + at least 50 % increase ) was of prognostic relevance . At 72-hours post-TAVI , 36.2 % of the patients matched these VARC-II criteria of myocardial damage . However , these patients did not display a difference in survival compared to patients without significant myocardial injury . CONCLUSION Elevated preprocedural hsTNT represents an independent risk predictor of all-cause death while periprocedural hsTNT elevation failed to show prognostic relevance Background —Postprocedural myocardial infa rct ion ( type 4a ) has been shown to be an adverse prognostic indicator after  elective percutaneous coronary intervention ( PCI ) . The Cardiac Remote Ischemic Preconditioning in Coronary Stenting ( CRISP Stent ) study demonstrated that remote ischemic preconditioning reduced procedural symptoms , ECG ST-segment deviation , and cardiac troponin I release after elective PCI and reduced the major adverse cardiac and cerebral event ( MACCE ) rate at 6 months . We were interested to confirm if this early benefit in MACCE rate in the remote ischemic preconditioning group was sustained long-term . Methods and Results — Patients were telephoned by research ers blinded to the r and omization details . MACCE , defined as all-cause mortality , nonfatal myocardial infa rct ion , transient ischemic attack or stroke , and heart failure requiring hospital admission , were adjudicated by case note and national data base review . One hundred ninety-two ( 89.3 % ) of the 225 patients with elective PCI r and omized in the original study were available for long-term follow-up ( mean time to event or last follow-up : 1579.7±603.6 days ) . There were a total of 59 ( 30.7 % ) MACCEs . Patients with an MACCE had a higher mean cardiac troponin I after PCI ( ±SD ) : 2.07±6.99 versus 0.91±2.07 ng/mL ( P=0.05 ) . The MACCE rate at 6 years remained lower in the remote ischemic preconditioning group ( hazard ratio , 0.58 ; 95 % confidence interval , 0.35–0.97 ; P=0.039 ; absolute risk reduction=0.13 and number needed to treat=8 to prevent the MACCE at 6 years ) . Conclusions —Remote ischemic preconditioning reduces the incidence of postprocedural cardiac troponin I after elective PCI and confers an MACCE-free survival benefit at both short- and long-term follow-up . Clinical Trial Registration —URL : http://www.ukcrn.org.uk . Unique identifier : UKCRN Non-r and omised studies of the effects of interventions are critical to many areas of healthcare evaluation , but their results may be biased . It is therefore important to underst and and appraise their strengths and weaknesses . We developed ROBINS-I ( “ Risk Of Bias In Non-r and omised Studies - of Interventions ” ) , a new tool for evaluating risk of bias in estimates of the comparative effectiveness ( harm or benefit ) of interventions from studies that did not use r and omisation  to allocate units ( individuals or clusters of individuals ) to comparison groups . The tool will be particularly useful to those undertaking systematic review s that include non-r and omised studies Background Elevated concentrations of troponin T have prognostic impact in patients with various cardiovascular diseases including those with severe aortic stenosis .  Transcatheter aortic valve implantation ( TAVI ) has improved prognosis for patients without a surgical option . Whether this affects the prognostic value of preinterventional troponin T remains unclear . Methods We therefore conducted a prospect i ve study in 198 consecutive patients with subsequent , successful transfemoral TAVI  and analyzed cardiac troponin T ( cTnT ) levels with a new generation , high-sensitive troponin T assay before and after TAVI , as well as their prognostic value after 12 months . Results Patients with severe aortic stenosis ( AS ) showed significant elevation of preinterventional cTnT levels . Postinterventional cTnT levels significantly rose further about sevenfold after transfemoral TAVI and peaked at day three until they steadily declined thereafter . Baseline renal function ( P = 0.011 ) , the duration of intraprocedural rapid pacing ( P = 0.0012 ) , and baseline cTnT ( P = 0.0001 ) values predicted the magnitude of postinterventional cTnT elevations . Interestingly , Kaplan – Meier curve analysis revealed , that although cTnT levels were not predictive for short-term mortality , preinterventional as well as postinterventional peak cTnT showed prognostic value for 1-year mortality , regardless of successful TAVI . Conclusions Pre- and postinterventional hscTnT levels signal adverse 1-year mortality in patients with severe AS independent of successful aortic valve replacement BACKGROUND Previous trials have shown that among high-risk patients with aortic stenosis , survival rates are similar with transcatheter aortic-valve replacement ( TAVR ) and surgical aortic-valve replacement . We evaluated the two procedures in a r and omized trial involving intermediate-risk patients . METHODS We r and omly assigned 2032 intermediate-risk patients with severe aortic stenosis , at 57 centers , to undergo either TAVR or surgical replacement . The primary end point was death from any cause or disabling stroke at 2 years . The primary hypothesis was that TAVR would not be inferior to surgical replacement . Before r and omization , patients were entered into one of two cohorts on the basis of clinical and imaging findings ; 76.3 % of the patients were included in the transfemoral-access cohort and 23.7 % in the transthoracic-access cohort . RESULTS The rate of death from any cause or disabling stroke was similar in the TAVR group and the surgery group ( P=0.001 for noninferiority ) . At 2 years , the Kaplan-Meier event rates were 19.3 % in the TAVR group and 21.1 % in the surgery group ( hazard ratio in the TAVR group , 0.89 ; 95 % confidence interval [ CI ] , 0.73 to 1.09 ; P=0.25 ) . In the transfemoral-access cohort , TAVR result ed in a lower rate of death or disabling stroke than surgery ( hazard ratio , 0.79 ; 95 % CI , 0.62 to 1.00 ; P=0.05 ) , whereas in the transthoracic-access cohort , outcomes were similar in the two groups . TAVR result ed in larger aortic-valve areas than did surgery and also result ed in lower rates of acute kidney injury , severe bleeding , and new-onset atrial fibrillation ; surgery result ed in fewer major vascular complications and less paravalvular aortic regurgitation . CONCLUSIONS In intermediate-risk patients , TAVR was similar to surgical aortic-valve replacement with respect to the primary end point of death or disabling stroke . ( Funded by Edwards Lifesciences ; PARTNER 2 Clinical Trials.gov number , NCT01314313 . ) OBJECTIVES The aim of this study was prospect i ve investigation of silent and clinical ly apparent cerebral embolic events and neurological impairment after  transfemoral aortic valve implantation ( TAVI ) .  BACKGROUND TAVI is a novel therapeutic approach for multimorbid patients with severe aortic stenosis . We investigated peri-interventional cerebral embolism with diffusion-weighted magnetic resonance imaging ( DW-MRI ) and its relationship to clinical and serologic parameters of brain injury . METHODS Cerebral DW-MRI was performed before , directly , and 3 months after  TAVI  with the current third-generation self-exp and ing CoreValve ( Medtronic , Minneapolis , Minnesota ) prosthesis . At the timepoints of the serial MRI studies , focal neurological impairment was assessed according to the National Institutes of Health Stroke Scale ( NIHSS ) , and serum concentration of neuron-specific enolase ( NSE ) , a marker of the volume of brain tissue involved in an ischemic event , were determined . RESULTS Thirty patients were enrolled ; 22 completed the imaging protocol . Three patients ( 10 % ) had new neurological findings after TAVI , of whom only 1 ( 3.6 % ) had a permanent neurological impairment . Of the 22 TAVI patients with complete imaging data , 16 ( 72.7 % ) had 75 new cerebral lesions after TAVI presumed to be embolic . The NIHSS and NSE were not correlated with DW-MRI lesions . CONCLUSIONS The incidence of clinical ly silent peri-interventional cerebral embolic lesions after TAVI is high . However , in this cohort of 30 patients , the incidence of persistent neurological impairment was low . ( Incidence and Severity of Silent and Apparent Cerebral Embolism After Conventional and Minimal-invasive Transfemoral Aortic Valve Replacement ; NCT00883285 ) 
    Output:
    
Conclusions : PPMI is common following TAVR and is strongly associated with 30-day and 1-year mortality .
Detection of PPMI has potential to identify TAVR patients at highest risk of subsequent adverse events