JANS
This paper utilized the Delphi method to establish interdisciplinary consensus for the initial investigations, diagnostic imaging, referral pathway and interhospital transfer for patients with acute aortic syndrome. The authors represent the coming together of experts from the multidisciplinary team, as well as members of the public, including patient representatives. This comes following the global patient-led work of THINK AORTA.
The incidence, predictors, and prognostic impact of rehospitalization following transcatheter aortic valve implantation (TAVI) has not been widely investigated and reported. This information is especially missing based on real-world practice data. Hence, the authors retrospectively analyzed a total of 1,397 patients who underwent TAVI between 2016 and 2020 in East Denmark. The medical records of all patients were reviewed to validate rehospitalizations up to one year after discharge from the index TAVI. A total of 615 patients (44 percent) had an unplanned rehospitalization within the first year after TAVI. The incidence of unplanned rehospitalization rate was three times higher in the early post-TAVI period (i.e., within 30 days) compared with the late post-TAVI period (i.e., 30 days to 1 year; 2.5 vs. 0.8 per patient-year, respectively; P < 0.001). Early rehospitalization was most frequently procedure related, whereas late rehospitalization was mostly related to baseline comorbidities. Early and late heart failure related rehospitalization was associated with a considerably higher one and five-year mortality risk (hazard ratio (HR) of 4.3 and 3.2 for 1-year mortality and HR of 3.2 and 2.9 for 5-year mortality, respectively; P < 0.001). Given the elevated frequency of rehospitalization following TAVI and the poor long-term survival associated with heart failure related rehospitalization, the authors conclude that TAVI trials should include rehospitalization as a major study endpoint.
In this LACES “Experts’ Insights” interview, Dr. Michael Borger, co-chair of the recently published 2023 ESC/EACTS Endocarditis Guidelines, briefly summarizes the most important take-home messages and changes of the guidelines.
This article looks at the application of prognostic models within cardiothoracic surgery, and medicine in general, using a televised UK dance competition where professional dancers are paired with celebrities as an illustration. The authors use available data from previous series to make predictions about the outcome of the competition and highlight the pitfalls of misapplication of prognostic models, particularly when extrapolating conclusions from demographic data alone.
A condensed, granular and yet comprehensive discussion on a small retrospective series on mostly non-iatrogenic trauma of the subclavian and axillary arteries treated mostly by stenting. Professor Veller's viewpoint is well-placed to bridge the transition from the conflict -related aetiologies to the endovascular and surgical morbidity that inevitably follows the expansion of aortic surgery and intervention. His learned comments on the value of endovascular repair (partial versus complete upper limb ischaemia) and his rationalised scepticism on long-term antithrombotic modulation rend this short invited editorial a 'must' for cardiovascular surgeons and interventionalists. The topic merits further publications. Conflict trauma has offered valuable experience that formatted modern vascular surgery in the beginning of the previous century, and now we reach a reversal of that/.
The ISCHEMIA trial has caused heated discussion in the cardiovascular field, with its results being used to downgrade coronary artery bypass grafting (CABG) recommendations in recent guidelines. The authors of this paper performed a detailed re-analysis of the ISCHEMIA trial and critically examined its findings. Several factors are judged likely to have diluted the potential survival advantage associated with CABG. The authors concluded that the results of ISCHEMIA have been misinterpreted, that they are aligned with previous evidence and should not be used to downgrade recommendations for CABG.