Cardiogenic shock (CS) complicating acute MI (AMI-CS) remains associated with high mortality and morbidity, despite advances in coronary revascularisation and mechanical circulatory support (MCS). Outcomes are determined not only by individual therapies, but also by the organisation of care, with current guidelines emphasising multidisciplinary, system-level approaches to enable rapid diagnosis, triage and treatment. This review examines how CS centres function within regional networks of care. We review definitions of AMI-CS, including haemodynamic, clinical and biochemical markers and their application to early identification and triage. We summarise key components of centre-based management, including revascularisation, invasive haemodynamic assessment, selective MCS use and post-percutaneous coronary intervention critical care. Contemporary data from dedicated CS centres and regionalised network models are compared, highlighting variations in transfer criteria and hub–spoke organisation alongside limitations in current evidence. The distinct phenotypic nuances of out-of-hospital cardiac arrest-associated CS are discussed and gaps in evidence with future perspectives are highlighted.
Background: Inaccurate measurement of lesion length during percutaneous coronary intervention (PCI) increases the risk of restenosis and poor clinical outcomes. Methods: Two interventional cardiologists evaluated angiographic images and made visual estimates of target lesion length and stent length selection. A 2 mm stent overlap of both the proximal and distal lesion edges was considered to be optimal. The target lesion was also assessed for lesion length using the millimetre controls of the CorPath®GRX system (Siemens Healthineers AG, formerly Corindus). Measurements for 10 lesions (randomly selected) were repeated to assess inter-observer variability. The primary endpoint was longitudinal geographic miss (LGM), defined as an absolute difference of 2 mm or more between visual and vascular robotics measurements. Results: A total of 21 lesions in 19 patients were evaluated. LGM was detected in 16/21 lesions. Visual lesion length measurements were short for 15 (71%), long for one lesion (5%) and appropriate for five (24%). Stent or drug-coated balloon length selections were short for 15 lesions and appropriate for six. Conclusion: The CorPath GRX robotic PCI system increases the accuracy of lesion length evaluation and stent length selection compared with visual estimation.
This review explores the surgical treatment options for aortic regurgitation. Aortic valve-sparing operations and total aortic root replacement with valved conduits are established standard procedures. Alterations in any component of the aortic root can lead to aortic regurgitation. Today, the primary valve-sparing techniques are remodelling (Yacoub procedure) and reimplantation (David procedure). Severely calcified aortic valves, cusps with retraction or multiple large fenestrations cannot be repaired. In such cases, the en bloc replacement of the aortic valve and the root with different types of composite valve grafts – known as the Bentall procedure – is a feasible option. The procedure in which the diseased aortic valve is replaced with the patient’s own pulmonary valve is known as the Ross procedure. Large-scale studies and meta-analyses confirm that aortic valve-sparing procedures provide excellent survival and freedom from reoperation, making them the best option for selected patients when performed in experienced centres.
Background: Robotic-assisted percutaneous coronary intervention (rPCI) offers potential benefits, including improved lesion assessment, optimised stent deployment and reduced radiation exposure. However, comparative data, particularly in Japanese populations, remain limited. Aim: To compare procedural and clinical outcomes between second-generation rPCI and manual percutaneous coronary intervention (mPCI) in patients with chronic coronary syndrome and acute coronary syndrome over a 1-year follow-up period. Methods: This retrospective cohort study included 176 patients who underwent rPCI using the second-generation CorPath GRX Vascular Robotic System. Following 1:1 propensity score matching at the lesion level, 176 patients were identified in the mPCI group. The co-primary endpoints were 1-year all-cause mortality and major adverse cardiovascular events, defined as a composite of cardiac death, non-fatal MI, target lesion revascularisation, stent thrombosis and stroke. Results: Both groups had similar baseline characteristics. Compared with mPCI, rPCI was associated with shorter total procedural time (26 minutes [19–37] versus 71 minutes [52–90]; p<0.01), fluoroscopy time (14 minutes [10–18] versus 16 minutes [10–26]; p=0.04), lower contrast volume (99 [82.8–129.0] versus 141 ml [116–172]; p<0.01) and lower dose area product (3,628.3 [2,552.1–5,352.3] versus 6,349.1 [4,080.0–8,382.3]; p<0.01). At 1 year, the co-primary endpoints of all-cause mortality (p=0.33) and major adverse cardiovascular events (p=0.79) were comparable between groups. Conclusion: Compared with mPCI, rPCI was associated with shorter procedural and fluoroscopy times, lower contrast volume and lower dose area product, while demonstrating similar clinical outcomes at 1 year.
Out-of-hospital cardiac arrest (OHCA) remains associated with poor survival and marked variation in post-resuscitation care. Drawing on discussion from the British Cardiovascular Intervention Society (BCIS) OHCA focus group, this article summarises five practical considerations for management following return of spontaneous circulation. First, selective conveyance to specialist cardiac arrest centres may be most effective when aligned with the BCIS algorithm, particularly for patients with features suggesting a reversible cardiac cause. Second, early risk stratification with MIRACLE2 may support decision-making when interpreted alongside specialist clinical judgement. Third, early multidisciplinary team review may improve coherence in a complex condition that often spans cardiology, intensive care, neurology and emergency medicine. Fourth, neuroprognostication is likely to be most robust when delayed appropriately, guided by European Resuscitation Council recommendations and delivered through a structured multimodal multidisciplinary team process. Finally, post-survival rehabilitation and family support should be regarded as core components of the OHCA pathway rather than optional afterthoughts.
