Physicians at Allegheny General Hospitals Cardiovascular Institute are the first in Western Pennsylvania and among a select few in the nation to offer a new technique for minimally invasive aortic valve replacement surgery. Called Transapical Transcatheter Aortic Valve Replacement, the procedure is performed through a small chest incision that provides direct access into the heart.

Transapical TAVR is the latest Food and Drug Administration-approved treatment for people suffering from severe aortic valve stenosis, a narrowing of the aortic valve of the heart, which causes it to open and close improperly. Aortic stenosis forces the heart to work harder to push blood through the damaged aortic valve and eventually the hearts muscles weaken, resulting in heart failure and death.

Physicians at AGHs Cardiovascular Institute have been performing transfemoral TAVR procedures for the past year, an approach in which the femoral artery serves as a conduit to access the heart. Surgeons make a small incision in the groin and guide the replacement valve through the femoral artery to the heart.

Patients with smaller or diseased peripheral blood vessels, however, may not be candidates for transfemoral TAVR, said AGH cardiothoracic surgeon Stephen Bailey. In the transapical approach, a small incision is made between the ribs of the left lower chest through which the replacement valve is inserted via a catheter directly into the heart.

With direct access to the heart, the transapical approach allows us to dramatically reduce the invasiveness of this procedure compared to conventional surgical aortic valve replacement, said Bailey, who serves as director of cardiac surgery at AGH. As a result, many patients who would be at high risk for traditional aortic valve replacement surgery and who are not candidates for transfemoral TAVR now have a life-saving option that avoids the heart-lung machine.

The FDA approved TAVR for use in high-risk patients in 2012. Since then, AGH has performed 24 cases, including six using the transapical approach.

Its exciting to be able to help patients with symptomatic aortic stenosis who previously were not candidates for either conventional aortic valve surgery or the transfemoral TAVR procedure regain their health, said Dr. David Lasorda, director of AGHs Division of Interventional Cardiology.

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AGH offers minimally-invasive heart valve replacement

Canonical

It has been almost exactly one year since Canonical announced Mir, a replacement for the X window system. Mir was originally planned to become the default system in the Ubuntu desktop for the 13.10 (October 2013) or 14.04 (April 2014) releases, but it was delayed due to compatibility problems in multi-monitor setups. Those problems were with XMir, an X11 compatibility layer that ensures that Mir can work with existing applications built for X.

It made sense to not turn Mir on by default in the upcoming Ubuntu 14.04 because that's a Long Term Support release that must be stable for five years. But instead of saying that he intends to flip the switch later this year or in 2015, Canonical founder Mark Shuttleworth this week said he expects to do that by the 16.04 release in April 2016. Shuttleworth's comments don't necessarily rule out turning Mir on by default before 16.04, but it's not something Shuttleworth is ready to promise.

Speaking at one of Ubuntu's virtual developer summits, Shuttleworth noted that Mir is already the default on Ubuntu phones and tablets.

Mark Shuttleworth on Mir.

"We don't want to let a love of technology interfere with our mission to be great for the user," Shuttleworth said. Holding up an Ubuntu phone, he said, "this is a great place for us to set the bar very high in terms of performance, where we have freedom to get it right rather than worrying too much about compatibility."

On the desktop, users can install Mir themselves, but it won't be turned on by default for everyone just yet. "My expectation is that within the next 12 months you will see lots of people running Mir as their default display server, and by 16.04 it will be the default display server," Shuttleworth said. "There's lots of reasons why that will let us support more hardware, let us get much better performance, and let us do great things with some of the software companies we care about, who want to squeeze every bit of performance out of the hardware you've got."

Canonical built Mir to power the Unity user interface, a crucial part of building a consistent experience on phones, tablets, and desktops. In starting the Mir project, the company angered parts of the Linux community that are pushing Wayland, a display server that's headed for Fedora and other distributions. Notably, an Intel developer expressed his company's displeasure by refusing to accept Xmir patches into the company's open source graphics driver.

Canonical held firm, saying at the time that "Intel customers who use Ubuntu will not see any regressions as we will simply continue to support XMir in the Intel driver as part of Ubuntu. We believe in a healthy ecosystem of display servers, including X, Wayland, and Mir, and plan to continue to work with upstreams such as Intel to provide the best experience to end users and OEMs."

Ubuntu 14.04 for desktops is shipping with version 7 of Unity, whereas Unity 8 has been rolled out to mobile devices.Phoronix's Michael Larabel tested out Ubuntu 14.04 with various configurations, including one running Mir and Unity 8. He wasn't impressed.

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Ubuntus Mir display server may not be default on desktop until 2016

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