Risk management of patients with multiple CVDs: what are the best practices?

Introduction: Managing patients with multiple risk factors for CVDs can present distinct challenges for healthcare providers, therefore addressing them can be paramount to optimize patient care.

Areas Covered: This narrative review explores the burden that CVDs place on healthcare systems as well as how we can best optimize the risk management of these patients. Through a comprehensive review of literature, guidelines and clinical studies, this paper explores various approaches to risk management, lifestyle modifications and pharmacological interventions utilized in the management of CVDs.

Long-term risks and benefits of oral anticoagulation in atrial fibrillation patients with cancer: A report from the GLORIA-AF registry.

Background: Anticoagulation therapy in patients with atrial fibrillation (AF) and concomitant cancer can be challenging due to the significantly increased risk of both embolism and bleeding. Moreover, the benefits and risks of vitamin K antagonists (VKA, eg. warfarin) versus non-vitamin K antagonist oral anticoagulants (NOACs) in such patients are less well understood.

Malperfusion syndrome in patients undergoing repair for acute type A aortic dissection: Presentation, mortality, and utility of the Penn classification.

Background: The current study aims to report the presentation of the malperfusion syndrome in patients with acute type A aortic dissection admitted to surgery and its impact on mortality.

Methods: Data were retrieved from the multicenter European Registry of Type A Aortic Dissection. The Penn classification was used to categorize malperfusion syndromes.

Refining the CHA2DS2VASc risk stratification scheme: shall we drop the sex category criterion?

Aims: The CHA2DS2VASc score is recommended for stroke risk stratification in patients with atrial fibrillation (AF). This score assigns one extra point to female sex based on evidence from the early 2000s, suggesting higher thromboembolic risk in women. This incremental risk of thromboembolism in women has decreased over time between 2007 and 2018, becoming non-significant in recent years.

Machine learning for outcome prediction in patients with non-valvular atrial fibrillation from the GLORIA-AF registry.

Clinical risk scores that predict outcomes in patients with atrial fibrillation (AF) have modest predictive value. Machine learning (ML) may achieve greater results when predicting adverse outcomes in patients with recently diagnosed AF. Several ML models were tested and compared with current clinical risk scores on a cohort of 26,183 patients (mean age 70.

Video-assisted thoracoscopic surgery repair of an idiopathic internal mammary artery aneurysm.

A discussion of an internal mammary artery aneurysm is a rare finding in the literature. This condition can cause serious complications, including haemothorax and pneumo-haemothorax, and can lead to haemorrhagic shock; it can also be fatal. These effects can be explained by the rate of flow of the blood in the internal mammary artery, that is, 150 ml/minute, which leads to a blood loss of one litre in minutes.

Early Intervention in Patients With Asymptomatic Severe Aortic Stenosis and Myocardial Fibrosis: The EVOLVED Randomized Clinical Trial.

Importance: Development of myocardial fibrosis in patients with aortic stenosis precedes left ventricular decompensation and is associated with an adverse long-term prognosis.

Objective: To investigate whether early valve intervention reduced the incidence of all-cause death or unplanned aortic stenosis-related hospitalization in asymptomatic patients with severe aortic stenosis and myocardial fibrosis.

Design, Setting, And Participants: This prospective, randomized, open-label, masked end point trial was conducted between August 2017 and October 2022 at 24 cardiac centers across the UK and Australia.

Impact of Catheter Ablation on Atrial Fibrillation Burden and Symptoms in Patients With Hypertrophic Cardiomyopathy.

Background: Atrial fibrillation (AF) is more common in patients with hypertrophic cardiomyopathy (HCM) and is often highly symptomatic. The impact of catheter ablation (CA) may be under-reported when evaluated by long-term freedom from any atrial arrhythmia.

Objectives: This study aims to evaluate whether CA of AF in patients with HCM would significantly reduce AF burden and improve symptoms.

Sex-related disparities in aortic stenosis from disease awareness to treatment: a state-of-the-art review.

This state-of-the-art review aimed to synthesize evidence from various sex-stratified studies on aortic stenosis (AS), focusing on the difference in clinical presentation, anatomical characteristics, pathophysiology, and management of AS. In comparison to men, women with AS are present at later stages, are older, more symptomatic, frailer, and exhibit higher operative risk [Society of Thoracic Surgeons (STS) score]. Women tend to have smaller aortic valve (AV) areas and left ventricular (LV) outflow tract, leading to lower stroke volumes (SVs) than men and have a higher prevalence of paradoxical, low-flow, low-gradient AS.

Safety and performance of the ultrathin sirolimus-eluting coronary stent in an all-comer patient population: the S-FLEX UK-II registry.

Objective: We evaluated the clinical safety and performance of the ultrathin strut biodegradable polymer-coated Supraflex Cruz (Sahajanand Medical TechnologiesLtd., Surat, India) sirolimus-eluting stent (SES) in an all-comer patient population requiring coronary stent implantation.

Study Design: The study was a prospective, observational, multicentre, single-arm registry.

How to advance from minimally invasive coronary artery bypass grafting to totally endoscopic coronary bypass grafting: challenges in Europe versus United States of America.

Robotic coronary and intra-cardiac surgery has been available for more than 25 years. In this period, multiple studies have demonstrated the beneficial effects of robotic surgery over conventional open surgery. Throughout the years, technical developments have enabled us to perform totally endoscopic coronary artery bypass (TECAB) grafting.

Challenging anticoagulation decisions in atrial fibrillation: a narrative review.

Atrial fibrillation (AF) is common and warrants consideration of oral anticoagulant (OAC) medication. Usually, the decision is straightforward, following the pathway outlined in the European Society of Cardiology's guideline; however, certain situations fall outside of this evidence base - such as a diagnosis of subclinical AF made via implanted devices or wearable electrocardiogram monitors, or alternatively diagnosis of 'secondary AF' following a major stressor. Subclinical AF is associated with stroke, though not to the extent of clinical AF, and the benefits of anticoagulation appear to be lower.