Rate and duration of hospitalisation for acute pulmonary embolism in the real-world clinical practice of different countries : Analysis from the RIETE registry

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Transseptal Transcatheter Mitral Valve‐in‐Valve Replacement ( TS MViV ) : Technical Considerations and Step‐by‐Step Procedure

The use of surgical mitral valve replacement with bioprosthetic valves has increased in recent decades. Bioprosthetic valves have many advantages compared to mechanical valves: in particular, they do not require long‐term anticoagulation. Conversely, bioprosthetic valves are prone to degeneration and have limited durability. As the number of surgical mitral valve implantations increases, the number of failed bioprostheses requiring intervention increases as well. Surgical redo of mitral valve replacement carries a high mortality risk, making transseptal transcatheter mitral valve in valve replacement an attractive alternative. Is a safe, elegant, and effective procedure. In this chapter, we will review step by step the percutaneous transseptal approach for mitral valve replacement

Conduction Disturbances Associated with TAVR

Despite the improvement in the incidence of periprocedural complications associated with transcatheter aortic valve replacement (TAVR), conduction disturbances remain the most frequent complication of TAVR procedures. Studies have demonstrated worse outcomes in patients with new‐onset left bundle branch block and complete heart block requiring permanent pacemaker implantation after TAVR. Conduction disturbances occur as a consequence of direct mechanical injury to the conduction system during the procedure. There are well‐described associated risk factors for the development of conduction disturbances. This chapter provides an overview of incidence, predictors, and clinical outcomes and reviews the new implantation techniques introduced to decrease the risk and potential deleterious effects of the conduction disturbances associated with TAVR. This is important as TAVR indications are expanding to younger and lower‐risk populations

Mastering structural heart disease

"The aim of this book is to incorporate the different structural cardiology areas, latest techniques, devices, clinical research trials, future directions and innovation ideas into a practical and friendly "questions and answers" format, augmented by cases and reviews. The most renowned worldwide specialists on each of the topics will provide a concise overview, with valuable insights, knowledge and practical tips based on their experience. This will be supplemented by online clinical cases and vignettes for a complete overview of the topics in an absorbing, simplified method. The aim of this book is to be a valuable educational resource for interventional cardiologists, general cardiologists, cardiac surgeons, fellows in training and internists"-

Laparoscopic and open colorectal surgery in everyday practice: retrospective study.

BACKGROUND: Most studies available on laparoscopic colorectal surgery focus on highly selected patient groups. The aim of the present study was to review short- and long-term outcome of everyday patients treated in a general surgery department. METHODS: Retrospective review was carried out of a prospective database of all consecutive patients having undergone primary laparoscopic (LAP) or open colorectal surgery between March 1993 and December 1997. Follow-up data were completed via questionnaire. RESULTS: A total of 187 patients underwent LAP resection and 215 patients underwent open surgery. Follow up was complete in 95% with a median of 59 months (range, 1-107 months) and 53 months (range, 1-104 months), respectively. There were 28 conversions (15%) in the LAP group and these remained in the LAP group in an intention-to-treat analysis. The LAP operations lasted significantly longer for all types of resections (205 vs 150 min, P < 0.001) and hospital stay was shorter (8 vs 13 days, P < 0.001). Recovery of intestinal function was faster in the LAP group, but only after left-sided procedures (3 vs 4 days, P < 0.01). However, preoperative patient selection (more emergency operations and patients with higher American Society of Anesthesiologists (ASA) score in the open group) had a major influence on these elements and favours the LAP group. Surprisingly, the overall surgical complication rate (including long-term complications such as wound hernia) was 20% in both groups with rates of individual complications also being comparable in both groups. CONCLUSION: Despite a patient selection favourable to the laparoscopy group, only little advantage in postoperative outcome could be shown for the minimally invasive over the open approach in the everyday patient

Inferior vena cava agenesis in patients with lower limb deep vein thrombosis in the RIETE registry. When and why to suspect

Background: Limited data exist about the clinical presentation and outcomes of patients with inferior vena cava agenesis (IVCA) who develop deep vein thrombosis (DVT). Methods: We used the RIETE (Registro Informatizado Enfermedad Trombo Embólica) registry to compare clinical characteristics and outcomes of patients with lower limb DVT, according to the presence or absence of IVCA. Major outcomes included recurrent DVT, major bleeding and post-thrombotic syndrome (PTS). Results: Among 50,744 patients with lower-limb DVT recruited in October 2018, 31 (0.06%) had IVCA. On multivariable analysis, patients aged < 30 years (odds ratio [OR]: 17.9; 95%CI: 7.05–45.3), with unprovoked DVT (OR: 2.49; 95%CI: 1.17–5.29), proximal (OR: 2.81; 95%CI: 1.05–7.53) or bilateral DVT (OR: 11.5; 95%CI: 4.75–27.8) were at increased risk to have IVCA. Patients with DVT and IVCA had lower odds to present with coexisting PE (OR: 0.22; 95%CI: 0.07–0.73). During the first year of follow-up, the rates of DVT recurrences (hazard ratio [HR]: 1.30; 95%CI: 0.07–6.43), pulmonary embolism (HR: 2.30; 95%CI: 0.11–11.4) or major bleeding (HR: 1.32; 95%CI: 0.07–6.50) were not significantly different with those with versus those without IVCA. One year after the index DVT, IVCA patients had a higher rate of skin induration (OR: 3.70; 95%CI: 1.30–9.52), collateral vein circulation (OR: 3.57; 95%CI: 1.42–8.79) or venous ulcer (OR: 5.87; 95%CI: 1.36–1.87) in the lower limb than those without IVCA. Conclusions: Certain clinical features such as unprovoked and bilateral proximal DVT in young patients should raise the suspicion for IVCA. Patients with IVCA had higher odds for symptoms of post-thrombotic syndrome