European defence governance and financing cepr.org/voxeu/columns/europ… # via @cepr_org Russian aggression, shifting US commitments, global competition over trade, technology, critical minerals, talent, intellectual property create a narrow window Urgency cannot be over started

🎙️ A Cut Above podcast — The new episode is live now! Recorded live at the EACTS Annual Meeting, this special episode delves into the theme “Nightmares in CABG.” Join hosts @FaisalBakaeen, Thomas Gudbjartsson and @Migas2001 for an open and practical discussion on the challenges of coronary surgery. From fragile conduits and calcified aortas to dissected mammary arteries and “full metal jacket” targets, the panel shares their approaches to complex scenarios, offering valuable insights on preparation, technique and team communication. The conversation highlights patient assessment, intraoperative decision-making and the humility required to learn from complications. It closes with reflections on mentorship, transparency and the power of honest debriefing in shaping safer surgical practice. 🎥 Watch the full episode here: vimeo.com/1128789914?share=c… 🎧 Listen to the podcast here: eacts.org/publications/a-cut…

PARTNER 3 at 7 years can be read both ways like a glass half empty or half full However as @kaulcsmv and @drjohnm pointed out HR less appropriate due to non proportionality OR upper bound for death is almost 2x greater for TAVR and seems important in low risk patients

I wouldn’t say 37% higher risk of stroke or death is an even match. At least from the patients perspective.

I believe the key issue is this "vital sweep" mentioned in the paper — a term I had never encountered before. Interestingly, the curves you refer to are in the supplementary materials and correspond to the non-sweep analysis. Those in the main paper are less separated and refer to the sweep analysis, in which they retrieved vital status for a substantial number of patients, apparently mostly surgical ones. Of course, if the idea was to let readers choose which set of curves they prefer, it doesn’t seem like a particularly sound approach. In any case, collecting follow-up data beyond five years clearly remains a major challenge.

I believe the key issue is the violation of non proportional hazard. When OR is calculated (as occurs when this happens) TAVR has higher risk of stroke or death. This extremely dangerous considering the velocity with which cardiological societies are pushing TAVR to younger pts.

IMPORTANT Hazard ratio for higher death in TAVR arm may be less appropriate due to non-proportional results in years 1-7. As Sanjay writes, the odds ratio of death or disabling stroke at 7 years is 1.37 and upper bound is nearly 2x worse for TAVR. Seems important in low-risk pts

It is really sad how this type of editorials devoid of any substantial arguments with historically re-known authors aim at influencing and put pressure on guide modification

Concerns were raised with the 5 year data of PARTNER 3 regarding mortality (higher with TAVR). The 6 year data posted at the @US_FDA show that curves continue to diverge…..

Open AVR is nationally becoming an operation of the sick and elderly and TAVI an operation of the young and healthy. Makes no sense whatsoever. We are so fortunate at BWH not to follow that trend because of the quality of our clinical and structural cardiologists.

doi.org/10.1093/eurheartj/eh… AVATAR 5 y Lower mortality of SAVR vs watchful waiting in asymptomatic severe AS

A Positive Trial That Fails to Inform Clinical Decisions. Great report by ⁦@drjohnm⁩. “Patients were experimented on, money and time were spent, and little was learned. Yet practice patterns will probably change.” medscape.com/viewarticle/ear…

Now lets see what was that number in EARLY TAVR 👇3x as high as natural history studies !!! That is the power of randomization !!!

Lets just compare the % of patients which develop symptoms in natural history studies of patients with severe AS. This number is 18-19% per year. 👇 jamanetwork.com/journals/jam…

The power of randomization in open blinded trials….it gets almost 30% of patients with AS who were asymptomatic for years to be symptomatic in less than 6 months after randomization !!!! This is EARLY TAVR. nejm.org/doi/full/10.1056/NE…

Announcing 2024 EACTS meeting at National Portuguese TV1 and the challenges patients with ischemic and valve disease and lung cancer face: long waiting times for surgery with severe consequences pt.cision.com/files/tv/2024/…

Great Annual Meeting of The European Association of Cardiothoracic Surgery in Lisbon Outstanding address by Franca Melfi. Best wishes to Volkmar Falk the new President Perioperative medication Guidelines in Cardiac Surgery academic.oup.com/ejcts/artic…

Prof Sanjay Sharma delivering a brilliant talk on benefits of exercise at Gaia Cardiology Meeting

Recurrence of MR. At 1 year 53.4% in Surgery had 0 MR and only 15.9% in TEER. MR 2 or more was 26.9% in TEER and 12.7% in surgery. Unfortunately in this young population, the authors choose to use MR 3 as cut off.