ES-003

Right bundle branch block is an established predictor for new conduction disturbances and need for a permanent pacemaker ( PPM ) after transcatheter aortic valve replacement. The aim of the study was to evaluate the absolute rates of transcatheter aortic valve replacement related PPM implantations in patients with pre‐existent right bundle branch block and categorize for different transcatheter heart valves.

We pooled data on 306 transcatheter aortic valve replacement patients from 4 high‐volume centers in Europe and selected those with right bundle branch block at baseline without a previously implanted PPM . Logistic regression was used to evaluate whether PPM rate differed among transcatheter heart valves after adjustment for confounders. Mean age was 83±7 years and 63% were male. Median Society of Thoracic Surgeons score was 6.3 (interquartile range, 4.1–10.2). The following transcatheter valve designs were used: Medtronic CoreValve (n=130; Medtronic, Minneapolis, MN); Edwards Sapien XT ( ES ‐ XT ; n=124) and Edwards Sapien 3 ( ES ‐3; n=32; Edwards Lifesciences, Irvine, CA); and Boston Scientific Lotus (n=20; Boston Scientific Corporation, Marlborough, MA). Overall permanent pacemaker implantation rate post‐transcatheter aortic valve replacement was 41%, and per valve design: 75% with Lotus, 46% with CoreValve, 32% with ES ‐ XT , and 34% with ES ‐3. The indication for PPM implantation was total atrioventricular block in 98% of the cases. Lotus was associated with a higher PPM rate than all other valves. PPM rate did not differ between ES ‐ XT and ES ‐3. Ventricular paced rhythm at 30‐day and 1‐year follow‐up was present in 81% at 89%, respectively.

Right bundle branch block at baseline is associated with a high incidence of PPM implantation for all transcatheter heart valves. PPM rate was highest for Lotus and lowest for ES ‐ XT and ES ‐3. Pacemaker dependency remained high during follow‐up.

With the use of enzyme systems (ES) the directed biocatalytic destruction of subcellular structures of the yeast biomass Saccharomyces cerevisiaе has been conducted for obtaining products of the specified structural-fractional composition. The composition of ES-1 included the enzymes catalyzing the hydrolysis of cell wall polysaccharides of yeast. Enzymes were dosed out at the rate of β-glucanase - 300 units of β-GcS/g of yeast, mannanase - 28.9 units of MS/g of yeast. ES-2, along with the enzymatic composition of ES-1, also contained a proteolytic complex, which included enzymes of bacterial origin, which were neutral, serine and metal-depended proteases (in a dosage of 2 units of PS/g of yeast). ES-3 consisted of the enzymes with β-glucanase, mannanase, proteolytic activities and was further reinforced by high dose of proteases of fungal origin (10 units PS/g of yeast) for the implementation of deep hydrolysis of protein substances of yeast cell protoplasm to low molecular weight peptides and free amino acids. The action of enzymatic systems with different substrate specificity on the degree of destruction of subcellular structures of yeast was illustrated by electron microscopy. The resulting degradation products had different fractional composition and structural features. The results showed that ЕS-1 treatment of yeast led to deformation of the cell walls, but did not affect the composition of the protein fractions, represented by peptides with different molecular weight (20-60 kDa) that were characteristic for the starting material. The use of ES-2 has provided a deeper degradation of the protein-polysaccharide matrix of the cell walls and partial hydrolysis of proteins with the formation of soluble protein components with molecular weight less than 14 kDa. ES-3 treatment of yeast cells allowed to obtain composition with predominant content (89%) of free amino acids and short peptides with molecular weight up to 300 Da. The efficacy of targeted destruction of subcellular structures of Saccharomyces cerevisiae with getting of fermentation biomass with the specified fractional composition of protein substances for the production of food ingredients with special functional effects has been shown.