Transcatheter aortic valve implantation (TAVI) has evolved into the dominant therapeutic option for severe aortic stenosis, with procedural refinements and expanding indications increasingly supporting shorter post-procedural monitoring and discharge. International evidence from randomized trials, multi-center registries, and consensus guidelines demonstrates that reduced length of stay (LOS), including next-day or early discharge, can be safely achieved in selected patients when supported by standardized workflows, careful patient selection, and structured outpatient monitoring. In Germany, LOS remains among the longest in Europe, driven by structural, reimbursement, and cultural barriers. With increasing TAVI volumes, demographic pressures, and workforce constraints, these barriers inhibit health system sustainability, procedural capacity, and patient experience. Early discharge below the currently defined thresholds often results in financial disadvantages under the Diagnosis-Related Group (DRG) reimbursement mechanism, thereby disincentivizing standardized adoption and pathway innovation. Yet, a reduction in LOS would yield meaningful system-level advantages, including increased procedural capacity, improved resource allocation, and lower post-procedural bed occupancy costs, all leading to better and more efficient patient pathways. This narrative, practice- and policy-oriented critical perspective evaluates the current German landscape and outlines pragmatic strategies to enable safe early discharge. It synthesizes relevant international evidence, identifies system-level barriers specific to Germany, and proposes a structured roadmap including: (1) standardized eligibility criteria, (2) protocolized peri- and post-procedural pathways, (3) pilot implementation in carefully selected centers with outcome reporting, and (4) reimbursement realignment to avoid wrong financial incentives. Supported by professional medical societies and aligned with international standards, early discharge pathways could enhance efficiency and improve patient-centered care, offering Germany a timely opportunity to modernize TAVI experience and delivery.
Radiopharmaceuticals (RPs) are specific medications that include radioactive substances known as radioisotopes. These medications have distinctive structures featuring a radionuclide and a drug component. Radioisotopes are targeted to specific cells using carriers such as small molecules, peptides, or antibodies. Radiopharmaceuticals have become a critical advancement in biomedical research and clinical procedures because of their great sensitivity, therapeutic effectiveness, and affordability. These radioisotopes can be utilized to diagnose or treat a variety of clinical conditions, according to the type of radiation they emit. Their utilization extends across uses from the treatment of cancer and hyperthyroidism to the imaging of numerous organs, including the brain, heart, kidney, and bone. RPs are administered orally or by injection to patients in clinical settings, and they can be tracked and evaluated using non-invasive imaging techniques, including Positron Emission Tomography (PET), Single Photon Emission Computed Tomography (SPECT), or gamma scintigraphy. Furthermore, DNA breakage caused by the exact deposition of high-energy generated by radionuclides in target cells directly causes cell death. Radio isotopes like α emitters (like 225Ac) can directly cause double-strand breaks; β⁻ emitters (like 177Lu) mostly cause single-strand breaks. By restricting radiation to specific cells, radiopharmaceutical therapy (RPT) minimizes destruction of normal tissues by limiting radiation to targeted cells, unlike conventional radiotherapy, which uses external radiation sources. Even a small dose of targeted vectors can deliver enough radiation to effectively destroy cancer cells. This makes RPT a safe and economical treatment option. The implementation of radiopharmaceuticals in diagnostic techniques for early disease detection leads to improved therapies. The aim of this review is to provide a comprehensive overview of radiopharmaceuticals, highlighting their fundamental concepts and multifaceted applications in biomedical science and clinical practice.
BACKGROUND AND AIMS:Although women with severe symptomatic aortic stenosis have more complications than men when undergoing surgical valve replacement, they are under-represented in clinical trials. The Randomized researcH in womEn all comers wIth Aortic stenosis (RHEIA) trial investigates the balance of benefits and risks of transcatheter aortic valve implantation (TAVI) vs. surgery in women. METHODS:Women were randomized 1:1 to transfemoral TAVI with a balloon-expandable valve or surgery. The primary composite endpoint was death, stroke, or (valve, procedure or heart failure related) rehospitalization at 1 year. Non-inferiority testing with a pre-specified 6% margin and superiority testing were performed in the as-treated population. RESULTS:At 48 European centres, 443 women underwent randomization, and 420 were treated as randomized. Mean age was 73 years, and the mean estimated surgical risk of death was 2.1% (Society of Thoracic Surgeons risk score). Kaplan-Meier estimates of the primary endpoint event rates at 1 year were 8.9% in the TAVI and 15.6% in the surgery group. This difference of -6.8% with an upper 95% confidence limit of -1.5% demonstrated the non-inferiority of TAVI (P < .001). The two-sided 95% confidence interval of -13.0% to -.5% further resulted in superiority (P = .034). The 1-year incidence of the primary endpoint components was: .9% with TAVI vs. 2.0% with surgery for death from any cause, 3.3% vs. 3.0% for stroke, and 5.8% vs. 11.4% for rehospitalization. CONCLUSIONS:Among women with severe aortic stenosis, the incidence of the composite of death, stroke, or rehospitalization at 1 year was lower with TAVI than with surgery. CLINICALTRIALS.GOV NUMBER:NCT04160130.
Previous cohort studies suggest that intraoperative hypotension is associated with acute kidney injury (AKI) in noncardiac surgical patients. We sought to ascertain that intraoperative hypotension is independently associated with AKI within the first 3 days after surgery in a contemporary cohort of noncardiac surgery patients in whom clinicians strove to avoid profound intraoperative hypotension. This was a post hoc secondary analysis of the multicentre EU HYPROTECT registry, which includes patients undergoing major noncardiac surgery who underwent predictive blood pressure monitoring. The primary outcome of this secondary analysis was AKI within the first 3 days after surgery. To quantify the duration and severity of intraoperative hypotension we calculated the area under a mean arterial pressure (MAP) of 65 mmHg. We used logistic regression analysis to identify factors independently associated with AKI. We analysed 697 patients. 62 of these 697 patients (9
Benchmark best practices have been shown to streamline the clinical pathway for patients undergoing transcatheter aortic valve implantation (TAVI), but the impact in diverse health systems is unknown. We evaluated the impact of Benchmark best practices implementation in Germany, Austria, France, Spain, and Italy. International, multicentre registry of severe symptomatic aortic stenosis (AS) patients undergoing TAVI with a balloon-expandable valve, before and after Benchmark best practices implementation. Objectives were to reduce overall and intensive care unit (ICU) length of stay (LoS), and to document 30-day safety. A total of 890 patients were analysed in France, 454 in Spain, 362 in Germany, 300 in Italy, and 176 in Austria. Patients had the highest surgical risk in Germany (EuroSCORE II 6.8 ± 7.3
