Pub Date : 2025-12-01DOI: 10.1016/j.hlc.2025.06.1018
Alistair Royse AM, MD, FRACS , Justin Ren BBiomedSc , Andrea Bowyer MBBS, PhD , Christopher M. Reid MSc, PhD , Rinaldo Bellomo MD, PhD , Julian A. Smith MBMS, MSurgEd, FRACS , Paul Bannon MBBS, FRACS , David Eccleston MBBS , Michael Vallely PhD, FRACS , Elaine Lui MBBS, MMed , Guy Ludbrook MBBS, PhD, MSc , Sandy Clarke PhD , David H. Tian MD, PhD , Colin Royse MBBS, MD , TA Investigators
<div><h3>Background & Aim</h3><div>Conventional coronary artery bypass grafting (CABG) procedures typically utilise the left internal mammary artery and supplementary saphenous vein grafts (SVGs) to re-establish adequate coronary blood flow to ischaemic territories. However, extensive observational studies have consistently demonstrated that SVGs are prone to accelerated atherosclerosis and progressive failure compared to arterial conduits. These limitations have heightened interest in total arterial revascularisation (TAR) as a potentially superior strategy.</div><div><em>Objective:</em> The Total Arterial (TA) Trial, fully funded through the Medical Research Future Fund Cardiovascular Health Mission, aims to determine the angiographic and clinical outcomes of TAR compared to conventional non-TAR operations.</div></div><div><h3>Method</h3><div><em>Design:</em> This study is an open-label, multicentre, randomised controlled trial including 1,000 CABG patients from multiple cardiac institutions across Australia, with an allocation ratio of 1:1. Randomisation occurs at a standardised perioperative time point via computer-generated sequences with variable block size The trial does not impose specific procedural requirements regarding the type of arterial conduit, revascularisation or reconstruction technique, use of sequential or composite methods, or any perioperative management.</div><div><em>Intervention:</em> Total arterial CABG with no use of SVG.</div><div><em>Control:</em> Non-total-arterial CABG with at least one SVG.</div><div><em>Main outcomes:</em> The primary endpoint will be perfect graft patency at 24 months postoperatively. The secondary endpoints include patency, major adverse cardiac and cerebrovascular events, quality of life, all-cause and cardiac mortality. Clinical follow-up visits will be scheduled at 6-month intervals, and angiographic assessments at 3 months and 24 months. Subgroup analyses by diabetes, sex, age, and conduit types are proposed to examine the potential interactions with treatment effects.</div></div><div><h3>Conclusions</h3><div>The TA Trial is one of the largest multicentre trials in the field of coronary revascularisation research, evaluating the graft status and clinical endpoints of TAR versus non-TAR procedures. The study design will provide valuable insights into whether differences in graft failure of SVG translate into differences in survival and cardiac outcomes. Early postoperative coronary angiography may improve understanding of the impact of competitive flow on graft function. The findings from this study will contribute to an improved understanding and help inform the optimal approach for coronary revascularisation, supporting evidence-based improvements in patient care.</div><div><em>Ethics:</em> Ethical approval has been granted by the Melbourne Health Institutional Review Board (HREC/92839/MH-2023), Australia.</div><div><em>Trial registration:</em> The trial has been registered under the A
{"title":"A Prospective, Multicentre Randomised Controlled Study of Angiographic and Clinical Outcomes in Total Arterial Coronary Bypass Grafting: The TA Trial Protocol","authors":"Alistair Royse AM, MD, FRACS , Justin Ren BBiomedSc , Andrea Bowyer MBBS, PhD , Christopher M. Reid MSc, PhD , Rinaldo Bellomo MD, PhD , Julian A. Smith MBMS, MSurgEd, FRACS , Paul Bannon MBBS, FRACS , David Eccleston MBBS , Michael Vallely PhD, FRACS , Elaine Lui MBBS, MMed , Guy Ludbrook MBBS, PhD, MSc , Sandy Clarke PhD , David H. Tian MD, PhD , Colin Royse MBBS, MD , TA Investigators","doi":"10.1016/j.hlc.2025.06.1018","DOIUrl":"10.1016/j.hlc.2025.06.1018","url":null,"abstract":"<div><h3>Background & Aim</h3><div>Conventional coronary artery bypass grafting (CABG) procedures typically utilise the left internal mammary artery and supplementary saphenous vein grafts (SVGs) to re-establish adequate coronary blood flow to ischaemic territories. However, extensive observational studies have consistently demonstrated that SVGs are prone to accelerated atherosclerosis and progressive failure compared to arterial conduits. These limitations have heightened interest in total arterial revascularisation (TAR) as a potentially superior strategy.</div><div><em>Objective:</em> The Total Arterial (TA) Trial, fully funded through the Medical Research Future Fund Cardiovascular Health Mission, aims to determine the angiographic and clinical outcomes of TAR compared to conventional non-TAR operations.</div></div><div><h3>Method</h3><div><em>Design:</em> This study is an open-label, multicentre, randomised controlled trial including 1,000 CABG patients from multiple cardiac institutions across Australia, with an allocation ratio of 1:1. Randomisation occurs at a standardised perioperative time point via computer-generated sequences with variable block size The trial does not impose specific procedural requirements regarding the type of arterial conduit, revascularisation or reconstruction technique, use of sequential or composite methods, or any perioperative management.</div><div><em>Intervention:</em> Total arterial CABG with no use of SVG.</div><div><em>Control:</em> Non-total-arterial CABG with at least one SVG.</div><div><em>Main outcomes:</em> The primary endpoint will be perfect graft patency at 24 months postoperatively. The secondary endpoints include patency, major adverse cardiac and cerebrovascular events, quality of life, all-cause and cardiac mortality. Clinical follow-up visits will be scheduled at 6-month intervals, and angiographic assessments at 3 months and 24 months. Subgroup analyses by diabetes, sex, age, and conduit types are proposed to examine the potential interactions with treatment effects.</div></div><div><h3>Conclusions</h3><div>The TA Trial is one of the largest multicentre trials in the field of coronary revascularisation research, evaluating the graft status and clinical endpoints of TAR versus non-TAR procedures. The study design will provide valuable insights into whether differences in graft failure of SVG translate into differences in survival and cardiac outcomes. Early postoperative coronary angiography may improve understanding of the impact of competitive flow on graft function. The findings from this study will contribute to an improved understanding and help inform the optimal approach for coronary revascularisation, supporting evidence-based improvements in patient care.</div><div><em>Ethics:</em> Ethical approval has been granted by the Melbourne Health Institutional Review Board (HREC/92839/MH-2023), Australia.</div><div><em>Trial registration:</em> The trial has been registered under the A","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 12","pages":"Pages 1478-1486"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144717847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.hlc.2025.09.010
Stefano Perlini MD, PhD
{"title":"Letter to the Editor regarding: “iCARDIO Alliance Global Implementation Guidelines on Heart Failure 2025” by Chopra et al. Heart Lung Circ. 2025;34:e55-e82","authors":"Stefano Perlini MD, PhD","doi":"10.1016/j.hlc.2025.09.010","DOIUrl":"10.1016/j.hlc.2025.09.010","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 12","pages":"Pages e170-e171"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145658570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pulmonary embolism (PE) is a common, time-critical condition requiring multidisciplinary care. Interhospital transport is a high-risk period in the patient’s care but offers an opportunity for expedited risk stratification, resuscitation, and transport to definitive care. Patients who require interhospital transfer to specialist centres for PE management have worse outcomes. Despite this, the literature surrounding the interhospital retrieval practice and experience of PE is limited.
Method
A retrospective cohort study was conducted over a 10-year period from January 2014 to June 2024 from the database of a high-volume aeromedical retrieval service in New South Wales, Australia. The study aimed to describe this service’s experience in the care of critically ill patients with PE requiring interhospital transport.
Results
This study included 132 patients in the final analysis, of which 55% were risk stratified as being high risk by European Society of Cardiology criteria. In total, 40% of patients were transferred for specific predetermined advanced PE therapies including extracorporeal support, and 28% of patients received non-thrombolysis advanced PE therapies in the first 24 hours post-transfer. Clinically significant deteriorations in transit occurred in 37% of patients, of which the most common complication was new haemodynamic deterioration (17%).
Conclusions
The population of patients requiring aeromedical retrieval for PE in New South Wales have a high severity of illness, are labour intensive for the retrieval service and frequently deteriorate during transport. Early coordination of care and close collaboration between the retrieval team and the specialist receiving teams offer an opportunity to optimise care.
{"title":"Aeromedical Retrieval of Critically Ill Pulmonary Embolism Patients: A Retrospective Cohort Study of 10 Years in New South Wales","authors":"Ruan Vlok MBBS , Yousif Rassam FACEM , Christopher Partyka FACEM","doi":"10.1016/j.hlc.2025.05.091","DOIUrl":"10.1016/j.hlc.2025.05.091","url":null,"abstract":"<div><h3>Background</h3><div>Pulmonary embolism (PE) is a common, time-critical condition requiring multidisciplinary care. Interhospital transport is a high-risk period in the patient’s care but offers an opportunity for expedited risk stratification, resuscitation, and transport to definitive care. Patients who require interhospital transfer to specialist centres for PE management have worse outcomes. Despite this, the literature surrounding the interhospital retrieval practice and experience of PE is limited.</div></div><div><h3>Method</h3><div>A retrospective cohort study was conducted over a 10-year period from January 2014 to June 2024 from the database of a high-volume aeromedical retrieval service in New South Wales, Australia. The study aimed to describe this service’s experience in the care of critically ill patients with PE requiring interhospital transport.</div></div><div><h3>Results</h3><div>This study included 132 patients in the final analysis, of which 55% were risk stratified as being high risk by European Society of Cardiology criteria. In total, 40% of patients were transferred for specific predetermined advanced PE therapies including extracorporeal support, and 28% of patients received non-thrombolysis advanced PE therapies in the first 24 hours post-transfer. Clinically significant deteriorations in transit occurred in 37% of patients, of which the most common complication was new haemodynamic deterioration (17%).</div></div><div><h3>Conclusions</h3><div>The population of patients requiring aeromedical retrieval for PE in New South Wales have a high severity of illness, are labour intensive for the retrieval service and frequently deteriorate during transport. Early coordination of care and close collaboration between the retrieval team and the specialist receiving teams offer an opportunity to optimise care.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 12","pages":"Pages 1449-1455"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145426807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Precise haemodynamic assessment is critical in heart transplant candidates with advanced left heart failure. While right heart catheterisation (RHC) is the gold standard for evaluating pulmonary haemodynamics, its invasive nature necessitates non-invasive alternatives. Transthoracic echocardiography provides a non-invasive approach to estimate haemodynamic parameters. This study focused on pulmonary regurgitation (PR) jet-derived mean pulmonary artery pressure (mPAP) and Doppler-based pulmonary vascular resistance (PVR), evaluating their correlation and agreement with RHC-derived measurements in this high-risk population.
Method
This prospective, single-centre study included 51 heart transplant candidates with a median ejection fraction of 15% (interquartile range, 13–20). PR jet-derived mPAP was calculated using the formula mPAP=4(PR peak velocity)2+right atrial pressure, and Doppler-based PVR as tricuspid regurgitation peak velocity/time-velocity integral (right ventricular outflow tract)×10+0.16. Correlation and agreement were assessed using Pearson correlation coefficients and Bland–Altman analysis. Subgroup and covariance analyses were performed, and receiver operating characteristic curves determined diagnostic performance.
Results
PR jet-derived mPAP correlated strongly with RHC (r=0.701; p<0.001), with a mean bias of −1 mmHg and limits of agreement from −14.6 to 12.6 mmHg. Echocardiographic PVR showed moderate correlation (r=0.681; p<0.001) and a mean bias of +0.88 Wood units. Subgroup analysis showed better agreement in patients with dilated cardiomyopathy and New York Heart Association class II, while tricuspid coaptation defects were associated with the lowest PVR correlation (r=0.368). Covariance analysis identified time-velocity integral (right ventricular outflow tract) as the strongest predictor of PVR. Receiver operating characteristic analysis identified optimal cut-offs of ≥26 mmHg for mPAP (area under the curve [AUC]=0.939) and ≥3.99 Wood units for PVR (AUC=0.910).
Conclusions
PR jet-derived mPAP showed good agreement with RHC, while Doppler-based PVR estimations demonstrated moderate correlation. These findings support transthoracic echocardiography as a complementary tool for pulmonary haemodynamic assessment, while emphasising the need for RHC for precise measurements.
{"title":"An Integrative Analysis of Echocardiographic and Haemodynamic Parameters in Heart Transplant Candidates: Specific Focus on Pulmonary Regurgitation Jet-Derived Mean Pulmonary Artery Pressure and Pulmonary Vascular Resistance","authors":"Ayşe İrem Demirtola MD , Anar Mammadli MD , Ozan Oğuz MD , Alican Özkan MD , Burcu Demirkan MD , Kumral Çağlı MD","doi":"10.1016/j.hlc.2025.08.021","DOIUrl":"10.1016/j.hlc.2025.08.021","url":null,"abstract":"<div><h3>Background and Aim</h3><div>Precise haemodynamic assessment is critical in heart transplant candidates with advanced left heart failure. While right heart catheterisation (RHC) is the gold standard for evaluating pulmonary haemodynamics, its invasive nature necessitates non-invasive alternatives. Transthoracic echocardiography provides a non-invasive approach to estimate haemodynamic parameters. This study focused on pulmonary regurgitation (PR) jet-derived mean pulmonary artery pressure (mPAP) and Doppler-based pulmonary vascular resistance (PVR), evaluating their correlation and agreement with RHC-derived measurements in this high-risk population.</div></div><div><h3>Method</h3><div>This prospective, single-centre study included 51 heart transplant candidates with a median ejection fraction of 15% (interquartile range, 13–20). PR jet-derived mPAP was calculated using the formula mPAP=4(PR peak velocity)<sup>2</sup>+right atrial pressure, and Doppler-based PVR as tricuspid regurgitation peak velocity/time-velocity integral (right ventricular outflow tract)×10+0.16. Correlation and agreement were assessed using Pearson correlation coefficients and Bland–Altman analysis. Subgroup and covariance analyses were performed, and receiver operating characteristic curves determined diagnostic performance.</div></div><div><h3>Results</h3><div>PR jet-derived mPAP correlated strongly with RHC (r=0.701; p<0.001), with a mean bias of −1 mmHg and limits of agreement from −14.6 to 12.6 mmHg. Echocardiographic PVR showed moderate correlation (r=0.681; p<0.001) and a mean bias of +0.88 Wood units. Subgroup analysis showed better agreement in patients with dilated cardiomyopathy and New York Heart Association class II, while tricuspid coaptation defects were associated with the lowest PVR correlation (r=0.368). Covariance analysis identified time-velocity integral (right ventricular outflow tract) as the strongest predictor of PVR. Receiver operating characteristic analysis identified optimal cut-offs of ≥26 mmHg for mPAP (area under the curve [AUC]=0.939) and ≥3.99 Wood units for PVR (AUC=0.910).</div></div><div><h3>Conclusions</h3><div>PR jet-derived mPAP showed good agreement with RHC, while Doppler-based PVR estimations demonstrated moderate correlation. These findings support transthoracic echocardiography as a complementary tool for pulmonary haemodynamic assessment, while emphasising the need for RHC for precise measurements.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 12","pages":"Pages 1399-1408"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145148976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.hlc.2025.05.085
Steven C. Faddy MScMed , Paul W. Stewart AdDipHMgmt , Michael A. McMullen BHSc , Lindsay Savage RN , Peter Fletcher PhD, FRACP
Background
Regionalised systems of care can improve outcomes for patients suffering ST-elevation myocardial infarction (STEMI). Most reports evaluate primary percutaneous intervention programs in metropolitan centres. We report the outcomes of a prehospital thrombolysis program in rural New South Wales (NSW) with particular focus on the impact of paramedic-delivered thrombolysis on total ischaemic time (TIT).
Method
Prospective registry study of patients from rural and regional NSW who were diagnosed with STEMI while in the care of NSW Ambulance paramedics.
Results
Between 2008 and 2020, paramedics treated 2,710 patients diagnosed with STEMI while in their care, and 1,674 (61.9%) received thrombolysis in the field. TIT for patients treated in the field was shorter (94; interquartile range [IQR] 69–141 minutes) compared to the estimated time for those treated after arrival at hospital (172; IQR 124–250 minutes; p<0.0001). Multivariate analysis identified prehospital thrombolysis as the strongest predictor of reduced TIT.
Conclusions
This program has delivered substantial reductions in TIT for STEMI patients in regional and rural NSW. Similar programs should be considered wherever a significant proportion of the population does not have timely access to percutaneous coronary intervention.
{"title":"Paramedic-Delivered Prehospital Thrombolysis Reduces the Time to Reperfusion Therapy in Patients Suffering ST Elevation Myocardial Infarction in Rural and Regional NSW","authors":"Steven C. Faddy MScMed , Paul W. Stewart AdDipHMgmt , Michael A. McMullen BHSc , Lindsay Savage RN , Peter Fletcher PhD, FRACP","doi":"10.1016/j.hlc.2025.05.085","DOIUrl":"10.1016/j.hlc.2025.05.085","url":null,"abstract":"<div><h3>Background</h3><div>Regionalised systems of care can improve outcomes for patients suffering ST-elevation myocardial infarction (STEMI). Most reports evaluate primary percutaneous intervention programs in metropolitan centres. We report the outcomes of a prehospital thrombolysis program in rural New South Wales (NSW) with particular focus on the impact of paramedic-delivered thrombolysis on total ischaemic time (TIT).</div></div><div><h3>Method</h3><div>Prospective registry study of patients from rural and regional NSW who were diagnosed with STEMI while in the care of NSW Ambulance paramedics.</div></div><div><h3>Results</h3><div>Between 2008 and 2020, paramedics treated 2,710 patients diagnosed with STEMI while in their care, and 1,674 (61.9%) received thrombolysis in the field. TIT for patients treated in the field was shorter (94; interquartile range [IQR] 69–141 minutes) compared to the estimated time for those treated after arrival at hospital (172; IQR 124–250 minutes; p<0.0001). Multivariate analysis identified prehospital thrombolysis as the strongest predictor of reduced TIT.</div></div><div><h3>Conclusions</h3><div>This program has delivered substantial reductions in TIT for STEMI patients in regional and rural NSW. Similar programs should be considered wherever a significant proportion of the population does not have timely access to percutaneous coronary intervention.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 12","pages":"Pages 1417-1423"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145426825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.hlc.2025.06.1027
Dane Turner BPharm, MD, MClinEpi , Kanisha Kamadasala FRACP , Bruce McGarity FRACP
The management of anticoagulation in patients with non-valvular atrial fibrillation at high risk of bleeding complications can be challenging. One such group is elderly patients with previous intracranial haemorrhage secondary to cerebral amyloid angiopathy (CAA-ICH). These patients have a high rate of rebleeding, which can be predicted by features on cerebral magnetic resonance imaging. Common bleeding risk calculators, such as the HAS-BLED score, underestimate the bleeding event rate in patients with CAA-ICH due to poor patient representation in validation studies. Observational studies and subgroup analyses of small randomised controlled trials have failed to show conclusive evidence of benefit or harm with restarting anticoagulation after CAA-ICH. The results of larger, dedicated randomised controlled trials are eagerly awaited. An alternative to anticoagulation in patients with CAA-ICH and concomitant high ischaemic stroke risk is left atrial appendage closure, which has been shown to be effective in this subgroup. This narrative review will use a case to discuss the currently available evidence on this important topic, given our ageing population.
{"title":"A Fine Balance: Anticoagulation for Non-Valvular Atrial Fibrillation After Cerebral Amyloid Angiopathy–Related Intracranial Haemorrhage","authors":"Dane Turner BPharm, MD, MClinEpi , Kanisha Kamadasala FRACP , Bruce McGarity FRACP","doi":"10.1016/j.hlc.2025.06.1027","DOIUrl":"10.1016/j.hlc.2025.06.1027","url":null,"abstract":"<div><div>The management of anticoagulation in patients with non-valvular atrial fibrillation at high risk of bleeding complications can be challenging. One such group is elderly patients with previous intracranial haemorrhage secondary to cerebral amyloid angiopathy (CAA-ICH). These patients have a high rate of rebleeding, which can be predicted by features on cerebral magnetic resonance imaging. Common bleeding risk calculators, such as the HAS-BLED score, underestimate the bleeding event rate in patients with CAA-ICH due to poor patient representation in validation studies. Observational studies and subgroup analyses of small randomised controlled trials have failed to show conclusive evidence of benefit or harm with restarting anticoagulation after CAA-ICH. The results of larger, dedicated randomised controlled trials are eagerly awaited. An alternative to anticoagulation in patients with CAA-ICH and concomitant high ischaemic stroke risk is left atrial appendage closure, which has been shown to be effective in this subgroup. This narrative review will use a case to discuss the currently available evidence on this important topic, given our ageing population.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 12","pages":"Pages 1313-1318"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145408750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.hlc.2025.05.099
Kaushalendra Rathore FRACS
{"title":"Australian National Lung Cancer Screening Program: Are We Well Equipped to Accommodate Influx of Surgical and Non-Surgical Follow-Up Cases?","authors":"Kaushalendra Rathore FRACS","doi":"10.1016/j.hlc.2025.05.099","DOIUrl":"10.1016/j.hlc.2025.05.099","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 12","pages":"Pages 1310-1312"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145495327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.hlc.2025.05.090
Tony Vu MD , Silvana Marasco FRACS, PhD
Aim
This retrospective analysis study aimed to assess short-term haemodynamic outcomes of the Perceval sutureless valve (LivaNova, London, UK) at an Australian institution.
Methods
Patients undergoing sutureless aortic valve replacement (SU-AVR) between 2014 and 2022 at the Alfred Hospital were included. The haemodynamic performance of the SU-AVR was assessed by obtaining echocardiogram reports. Mean aortic effective orifice area (cm2), mean transaortic pressure gradient (mmHg) and left ventricular mass (g) were investigated.
Results
Seventy-three (73) patients underwent SU-AVR. Fifteen (15) patients were lost to follow-up. The mean follow-up was 36.93±23.28 months in 58 patients. Patients were followed up to 72 months. Median follow-up was 36.0 (interquartile range: 39.0) months. Isolated AVR was performed in 29 patients (39.7%) and coronary artery bypass graft+AVR was performed in 31 patients (42.5%). The mean (±standard deviation) cardiopulmonary bypass time was 83.2±36.8 minutes and the mean aortic cross-clamp time was 59.2±32.1 minutes. There was one case of structural valve deterioration causing aortic stenosis and two cases of major paravalvular leak. Five (5) explants were performed (paravalvular leak; n=2, infective endocarditis; n=2, structural valve deterioration; n=1). The preoperative mean gradient was 40.55±18.02 mmHg. At 36 months, the gradients remained low at 11.25±4.74 mmHg. Left ventricular (LV) remodelling occurred as demonstrated by a mean LV mass of 248.34±68.6 g preoperatively and 200.0±47.57 g at 36 months. The mean aortic effective orifice area was 0.948±0.48 cm2 preoperatively and 1.86±0.43 cm2 at 36 months. Good haemodynamic performance was observed across the 72-month follow-up period. Seven mortalities were recorded, with causes attributed to sepsis (n=1, 1.37%), endocarditis (n=5, 6.85%) and withdrawal of ventricular assist device (n=1, 1.37%). Morbidity included stroke (n=2), renal insufficiency (n=6), pneumonia (n=8) and return to theatre for bleeding (n=5).
Conclusion
The deployment of the Perceval S bioprosthesis valve has excellent haemodynamic performance at a mean of 36 months of follow-up.
{"title":"Use of the Perceval-S Bioprosthesis at an Australian Tertiary Centre","authors":"Tony Vu MD , Silvana Marasco FRACS, PhD","doi":"10.1016/j.hlc.2025.05.090","DOIUrl":"10.1016/j.hlc.2025.05.090","url":null,"abstract":"<div><h3>Aim</h3><div>This retrospective analysis study aimed to assess short-term haemodynamic outcomes of the Perceval sutureless valve (LivaNova, London, UK) at an Australian institution.</div></div><div><h3>Methods</h3><div>Patients undergoing sutureless aortic valve replacement (SU-AVR) between 2014 and 2022 at the Alfred Hospital were included. The haemodynamic performance of the SU-AVR was assessed by obtaining echocardiogram reports. Mean aortic effective orifice area (cm<sup>2</sup>), mean transaortic pressure gradient (mmHg) and left ventricular mass (g) were investigated.</div></div><div><h3>Results</h3><div>Seventy-three (73) patients underwent SU-AVR. Fifteen (15) patients were lost to follow-up. The mean follow-up was 36.93±23.28 months in 58 patients. Patients were followed up to 72 months. Median follow-up was 36.0 (interquartile range: 39.0) months. Isolated AVR was performed in 29 patients (39.7%) and coronary artery bypass graft+AVR was performed in 31 patients (42.5%). The mean (±standard deviation) cardiopulmonary bypass time was 83.2±36.8 minutes and the mean aortic cross-clamp time was 59.2±32.1 minutes. There was one case of structural valve deterioration causing aortic stenosis and two cases of major paravalvular leak. Five (5) explants were performed (paravalvular leak; n=2, infective endocarditis; n=2, structural valve deterioration; n=1). The preoperative mean gradient was 40.55±18.02 mmHg. At 36 months, the gradients remained low at 11.25±4.74 mmHg. Left ventricular (LV) remodelling occurred as demonstrated by a mean LV mass of 248.34±68.6 g preoperatively and 200.0±47.57 g at 36 months. The mean aortic effective orifice area was 0.948±0.48 cm<sup>2</sup> preoperatively and 1.86±0.43 cm<sup>2</sup> at 36 months. Good haemodynamic performance was observed across the 72-month follow-up period. Seven mortalities were recorded, with causes attributed to sepsis (n=1, 1.37%), endocarditis (n=5, 6.85%) and withdrawal of ventricular assist device (n=1, 1.37%). Morbidity included stroke (n=2), renal insufficiency (n=6), pneumonia (n=8) and return to theatre for bleeding (n=5).</div></div><div><h3>Conclusion</h3><div>The deployment of the Perceval S bioprosthesis valve has excellent haemodynamic performance at a mean of 36 months of follow-up.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 12","pages":"Pages 1456-1463"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145426496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.hlc.2025.11.003
{"title":"2025 at the Heart Foundation – a year in review","authors":"","doi":"10.1016/j.hlc.2025.11.003","DOIUrl":"10.1016/j.hlc.2025.11.003","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 12","pages":"Pages 1487-1488"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145658358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.hlc.2025.08.001
Ian R. Hamilton-Craig PhD, FRACP, FCSANZ, FLS , Peter J. Psaltis PhD, FRACP, FCSANZ , Nicholas A. Marston MD MPH , Adam J. Nelson PhD, FRACP, FCSANZ
{"title":"Letter to the Editor: “No Time to Waste - Upfront Combination Lipid Lowering Therapy for Post-Acute Coronary Syndromes,” Regarding the: National Heart Foundation of Australia & Cardiac Society of Australia and New Zealand: Comprehensive Australian Clinical Guideline for Diagnosing and Managing Acute Coronary Syndromes 2025 by Brieger et al., Heart Lung Circ. 2025;34:309–397.","authors":"Ian R. Hamilton-Craig PhD, FRACP, FCSANZ, FLS , Peter J. Psaltis PhD, FRACP, FCSANZ , Nicholas A. Marston MD MPH , Adam J. Nelson PhD, FRACP, FCSANZ","doi":"10.1016/j.hlc.2025.08.001","DOIUrl":"10.1016/j.hlc.2025.08.001","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 12","pages":"Pages e172-e173"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145658571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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