BACKGROUND:Left ventricular thrombi may complicate acute myocardial infarction, and anticoagulation is the mainstay of management. Surgical thrombectomy may be considered in some patients with a perceived high risk for thromboembolism if there is another indication for urgent cardiac surgery. CASE SUMMARY:A 43-year-old diabetic man presented with a non-ST-segment elevation myocardial infarction and an acute left ventricular thrombus. He had a transaortic thrombectomy and coronary artery bypass graft. DISCUSSION:The usual approach for surgical thrombectomy is left ventriculotomy. This however may cause deterioration of left ventricular function. A left atrial approach has also been described but access may be challenging. A video-assisted transaortic left ventriculoscopy combines excellent visualization provided by the endoscope and avoidance of a left ventriculotomy. TAKE-HOME MESSAGES:Surgical thrombectomy may be beneficial in a select group of patients with acute left ventricular thrombus. A video-assisted transaortic approach provides excellent access and visualization in these patients.

BACKGROUND:We present a case of left ventricular perforation and delayed cardiac tamponade after transcatheter aortic valve implantation (TAVI) managed percutaneously. This report describes a novel technique for management of left ventricular perforation after TAVI. CASE SUMMARY:We performed elective transfemoral TAVI in a frail 85-year-old lady. Anatomical challenges included tortuous and horizontal aorta and a small left ventricular cavity. A 23-mm Sapien valve was implanted. She developed cardiac tamponade the next day needing emergency pericardiocentesis. Left ventricular angiogram showed perforation of the lateral wall. SURGIFLO Hemostatic Matrix was injected into the pericardial space using Agilis steerable introducer with a good outcome. DISCUSSION:Cardiac perforation and tamponade are serious and potentially fatal complications after TAVI. The outcomes in these patients remain poor with high mortality rate even with emergent cardiac surgery. This report describes a novel technique for management of left ventricular perforation after TAVI.

BACKGROUND:Alternative access for transcatheter aortic valve implantation (TAVI) is required for the small subset of patients in whom transfemoral (TF) access is not feasible. The most commonly used alternative access route in the United Kingdom is the subclavian/axillary artery, and historically, most have been performed via surgical cutdown. Transaxillary TAVI can be undertaken via a percutaneous route. However, there exists limited data on the safety and efficacy of this technique. AIMS:This study aims to describe the UK experience of percutaneous axillary (PAx) TAVI. METHODS:This retrospective, multicenter study included every TAVI center in the United Kingdom which had performed > 10 PAx TAVI cases as of November 1, 2023. Each center provided data on all PAx cases carried out up to December 31, 2023. Procedural and clinical endpoints as well as adverse events were assessed according to Valve Academic Research Consortium (VARC)-3 definitions. RESULTS:Nine UK TAVI centers contributed data from 210 PAx cases. VARC-3 technical success was achieved in 92.4%. The incidence of major VARC-3 vascular access site complications was 7.1%, major or life-threatening VARC-3 bleeding occurred in 5.3%, a covered stent was used in 25.2%, and vascular surgical intervention was required in 3.3%. The incidence of in-hospital stroke and mortality were 7.1% and 3.3%, respectively. No statistically significant differences were observed between PAx carried out under conscious sedation (non-GA) and GA with respect to clinical outcomes. CONCLUSION:PAx TAVI is viable and can be performed under conscious sedation with no detriment in terms of clinical outcomes. However, the elevated risk of stroke is a concern.

The period was politically grim for the Labor Government and no brighter economically for Queenslanders. Inflation posed the toughest challenge for Cabinet, followed by youth crime, housing and health. Infrastructure cost blowouts also caused the government and Premier Annastacia Palaszczuk enormous public opinion pain leading, in turn, to a rare change in Labor leadership with Palaszczuk's shock resignation and the accession of Steven Miles. The period also saw Queensland record the nation's lowest 'Yes' vote in the First Nations Voice to Parliament referendum, with dreams of a post-referendum treaty now quashed. The cost of living remained arguably the most pressing crisis confronting the Palaszczuk Labor Government. Annual inflation in Brisbane registered 6.3 per cent by mid-year (down from 7.4 per cent the previous quarter), with the September and December quarters registering significant improvements to 5.2 per cent and 4.2 per cent respectively. But, as the economy cooled, so too did employment: joblessness rose from 4.1 per cent in July to 4.4 per cent in December (https://www.qgso.qld.gov.au/). Inflation figures, however, masked devilish details, including a 25 per cent rise in the cost of Brisbane electricity (Courier Mail 27 July, 2023), and a 20 per cent surge in many supermarket staples (Courier Mail 26 October, 2023). It was also reported that Queensland's population was growing faster than any other Australian state or territory: another 2.2 million people would call southeast Queensland home by 2046 (Courier Mail 20 August, 2023). Infrastructure therefore remained a buzzword, especially after cost blowouts in numerous projects caused both economic and political headaches. The Department of Transport revealed in July, for example, that the 65 trains commissioned to be built in Maryborough, originally costed as $7.1 billion, would now cost $9.5 billion (Courier Mail 14 July, 2023). Transport Minister Mark Bailey, initially claiming he did not recall when he discovered the $2.4 billion increase, later conceded he knew before the issue of a media release that expediently omitted the new information. It was later revealed the increase had been approved by Cabinet's Budget Review Committee on 16 May, or eight weeks before the blowout was uncovered (Courier Mail 15 August, 2023). Premier Annastacia Palaszczuk initially blamed a "sick media adviser working from home", and later ordered an inquiry (Courier Mail 8 August, 16 August, 2023). A review by John McKenna QC subsequently found political staffers in Bailey's office did not "direct" public servants to alter the media release, but merely offered "a couple of things to consider" (Courier Mail 22 August, 2023). Labor's embarrassment was compounded when it was revealed the Department of Transport had spent $17 million on external consultants despite the recent Coaldrake Report into the Public Service warning against such engagements (Australian 8 August, 2023). But cost was not the only drag on infrastructure. Work on Queensland's largest project, Brisbane's $6.3 billion Cross River Rail (CCR), was halted when unions protested the 331 safety warnings CCR had been issued (Courier Mail 27 July, 2023). The powerful Queensland Resources Council sector continued its war with the Palaszczuk Government over dramatically increased coal royalty rates (see previous Chronicles). Interestingly, a July Freshwater Strategy poll found 46 per cent of voters supported a reduced coal royalty regime – with 28 per cent supporting the status quo – despite higher royalties providing Queensland's most recent budget surplus (AFR 6 July, 2023). After Treasurer Cameron Dick threatened to seize BHP's mining leases should the company cease its Queensland investments, BHP Chief Executive Mike Henry reiterated his company would not make any new "greenfield" investments in Queensland (Australian 22 August, 2023). Interestingly, opposition leader David Crisafulli refused to confirm the LNP's own coal royalty policy (Australian 14 September, 2023). The Labor Government could offer some good news, however, via a $50 million support package that would keep a copper smelter and refinery open in north Queensland till 2030 despite Glencore's closure of three copper mines around Mount Isa by 2025 (AFR 19 October, 2023). Importantly, the Palaszczuk Government remained committed to its $5 billion CopperString transmission line connecting Mount Isa to Townsville, with cynics suggesting the guarantee was a pre-emptive strike should Labor require the support of the three Katter's Australian Party (KAP) MPs after the next state election (Courier Mail 31 October, 2023). No state or federal government enticements, however, could keep US company Tritrium, a manufacturer of "fast chargers", from closing its Brisbane operations with the loss of 200 jobs (AFR 10 November, 2023). Environmental concerns remained in the policy spotlight, especially after reports of alarming tree-clearing rates from the Burnett to Cape York; up to 47 per cent of all tree-clearing between 2015 and 2021 occurred in this region (Australian 4 September, 2023). Yet the state was on track to meet its carbon emissions target – a 30 per cent reduction below 2005 levels – by 2024 (Brisbane Times 18 September, 2023). Part of that success would be found in the Premier's announcement that state-owned energy company CS Energy had purchased a 50 per cent share in the Boulder Creek wind farm in central Queensland – a key element of the Government's $62 billion clean energy plan (AFR 5 October, 2023). In late October, the Palaszczuk Government's renewable energy target was increased to 80 per cent by 2035 (Australian 25 October, 2023). Palaszczuk also flagged legislation to ensure the public ownership of most power stations and all poles and wires (Courier Mail 24 October, 2023). The government then announced that Rio Tinto and Japan's Sumitomo Corporation will invest $111 million to develop a hydrogen plant at Yarwin aluminium refinery near Gladstone – with taxpayers contributing $30 million – after Palaszczuk's trade mission to Singapore, Japan and South Korea (Australian Financial Review [AFR] 12 July, 2023). Palaszczuk would visit China (her fourth visit there as premier) in November. The government's business focus continued with the announcement that Queensland companies could now bid for "tens of billions of dollars in Olympic and public sector contracts" through the new Q2023 project under an "All Queensland, All In" slogan (Brisbane Times 19 July, 2023). The government also won kudos for its popular Smart Energy Savers program that allowed eligible households to access rebates, of up to $1,000, when purchasing energy-efficient white goods (Courier Mail 2 August, 2023). A similar scheme, valued at $16 million, was announced in October for small and medium-sized businesses. Praise also came for Palaszczuk's announcement of a $50 million "Backing Business in the Bush" fund to assist regional business find export markets (Courier Mail 18 August, 2023). The Liberal-National Party (LNP) opposition, however, complained that Labor was investing $26 million less on business innovation than just four years ago (Courier Mail 29 October, 2023). By contrast, the Premier was lauded for her announcement of $76 million in funding to roll out quantum technology in schools and TAFE colleges (Brisbane Times 4 October, 2023). But not all education news was rosy: the recruitment of around 6,600 teachers and teacher aides was "barely bridging the gap" created by teacher resignation rates of up to 9.2 per cent (Courier Mail 17 October, 2023). Palaszczuk also revealed that, in addressing future water security, her government would abandon plans for water recycling and instead build the state's second desalination plant, at a cost of $8 billion, north of Brisbane. Cabinet appeared divided over the issue, with Water Minister Glenn Butcher reportedly endorsing recycling (Courier Mail 10 October, 2023). As so often during Queensland's summers, natural disasters burdened the state economy. Intense bushfires across 59 sites saw firefighters brought in from interstate, and from Canada and New Zealand. In early December, Category Two Cyclone Jasper swept across far north Queensland while, over the Christmas period, severe thunderstorms killed eight people and brought widespread flooding and protracted power outages across the southeast, with the Gold Coast particularly hard hit. Some, including Gold Coast Mayor Tom Tate, criticised the Bureau of Meteorology for an alleged "failure" to forecast the storms' severity (Australian 28 December, 2023). The period also saw some old-fashioned Queensland parochialism as the Palaszczuk Government aggressively confronted the federal Albanese Government – the Premier called on Albanese "to do what's right" – after federal Infrastructure Minister Catherine King announced a new 50:50 Commonwealth-State infrastructure funding arrangement that (after earlier stripping $7.4 billion from the states and territories) would put at risk another $14 billion in Queensland projects (Brisbane Times 14 November, 2023; AFR 29 November, 2023). Nonetheless, Palaszczuk recommitted $107 million to fund the Inland Freight Route (Courier Mail 28 November, 2023). Youth crime was another serious challenge for the Palaszczuk Government. It was reported in July, for example, that more than 85 per cent of Queensland's "most serious young criminals" – numbering 449 in 2023 compared to just 374 in 2022 – had re-offended within 12 months (Courier Mail 21 July, 2023). Other statistics confirmed the trend: Queensland, having a seen a 15 per cent increase in a single year, was now recording more victims of crime than any other state (Courier Mail 1 August, 2023). With reports that young offenders were brazenly confronting rather than running from police, pressure mounted on Police Commissioner Katarina Carroll, with Police Minister Mark Ryan demanding the courts "do their job" (Courier Mail 25 July, 2023). Indeed, an October YouGov poll found 76 per cent of Queenslanders had beefed up home security, with around 20 per cent now declaring they felt "mostly or very unsafe" in their own homes (Courier Mail 28 October, 2023). Despite the government earlier passing what it deemed the "toughest laws in the nation" (see previous Chronicle), victims of crime declared the new laws weak before marching on Parliament House, with Palaszczuk pilloried for failing to address protestors (Courier Mail 23 August, 2023). Yet the Premier found rebuke from the other side, too, when former Court of Appeal president Margaret McMurdo, Queensland Human Rights Commissioner Scott McDougall and the Queensland Council of Social Service condemned legislation which appeared to override human rights in holding young offenders indefinitely in watch-houses (Courier Mail 28 August, 2023). In the face of that criticism, Cabinet in early September approved a new parliamentary committee, chaired by Independent MP Sandy Bolton (Noosa), to advise on youth crime (Brisbane Times 12 September, 2023). The government also pledged an additional $200 million over five years for victims of crime, and another $250 million to build the state's third children's detention centre (Brisbane Times 28 September; 5 October 2023). But Labor's image was hardly enhanced when Thuringowa MP Aaron Harper addressed yet another victims group which he labelled an LNP "rent-a-crowd" (Courier Mail 31 October, 2023). Harper later apologised. In December, it was announced Townsville would receive its own Polair helicopter before it was reported that 120 police had resigned from the service in the previous five months (Courier Mail 22 December, 2023). The national housing crisis remained a third challenge for Queensland. In July, it was reported that 300,000 Queenslanders had "unmet" housing needs, with the government completing just five per cent of its promised social housing – a $5 billion project unlikely to be completed until 2027 (Courier Mail 1 July, 2023). It was also revealed that almost 100,000 undeveloped blocks of land – including around 60,000 in southeast Queensland – were sitting idle (Courier Mail 26 August, 2023). In response, the government introduced legislation to cut "red tape" and empower the Minister for Planning to expeditiously approve developments. The government also doubled the First Homebuyers' Grant to $30,000 for properties valued up to $750,000 (Brisbane Times 19 November, 2023). Health remained a fourth crisis. Health Minister Shannon Fentiman, for example, reported hospital "ramping" times at some hospitals had blown out to more than 10 hours (Courier Mail 26 July, 2023). The Department's reputation was hardly enhanced when it was revealed that maternity staff shortages were worsening across regional hospitals. September also saw reports that 36 Queensland hospitals employed fewer doctors and nurses than in 2005 (Courier Mail 24 September, 2023). The government was also criticised for labelling outer-suburban medical centres "satellite hospitals" after hundreds of patients with "immediately life-threatening" injuries attended the centres seeking care. To mitigate, Queensland Health spent $1.35 million on an advertising campaign to avoid "confusion" (Courier Mail 14 November; 16 November, 2023). Once again, Opposition leader Crisafulli refused to detail how many health workers his government would employ (Courier Mail 28 November, 2023). Public opinion support for both the government and the premier continued to decline during the period. A May–August Resolve Strategic poll, for example, pegged Labor's primary vote at 32 per cent, and the LNP's at 38 per cent, for a two-party-preferred (2PP) total of 48 to 52 in the LNP's favour. When an August–September Redbridge poll measured Labor's primary vote of just 26 per cent (and 41 per cent for the LNP), and a 2PP of 45 to 55 in the LNP's favour, factional leaders and affiliated trade unions commenced machinations for a leadership change (see below). An early October YouGov poll – taken after Palaszczuk had quashed an early round of leadership rumblings – found an increase in Labor's vote to 33 per cent (41 per cent for the LNP) for a 2PP total of 48 to 52 in the LNP's favour. A September–December Resolve Strategic poll found even better results for Labor, now on 33 per cent primary vote (37 per cent for the LNP) for a much closer 2PP split of 49.5 to 50.5 per cent in the LNP's favour. But, despite an improving Labor vote, Palaszczuk's personal approval ratings continued to decline, with factional and trade union wheels finally moving to replace her with Deputy Premier Steven Miles in early December. A uComms poll taken immediately after Palaszczuk's shock resignation on 10 December revealed a small improvement in Labor's primary vote to 34 per cent (38 per cent for the LNP) for a 2PP total of 48 to 52 in the LNP's favour. A subsequent uComms poll – the first under new premier Steven Miles – now measured Labor's primary vote at 34.4 (and the LNP's at 36.2) for a 2PP total of 49 to 51 per cent in the LNP's favour. Preferred leadership ratings told a similar story. Palaszczuk led LNP leader Crisafulli as preferred premier until the June–July Freshwater Strategy poll found just 44 per cent of voters preferring Palaszczuk, and 45 per cent Crisafulli. The September–December Resolve Strategic poll found Palaszczuk preferred by just 34 per cent, and Crisafulli by 39 per cent. Critically, a December uComms poll saw new premier Miles preferred by 47.8 per cent, and Crisafulli by 52.2 per cent. But leadership satisfaction ratings painted a bleaker Labor picture. Where the May–August Resolve Strategic poll saw Palaszczuk suffer a net approval rating of minus 15 points (and a net plus 11 for Crisafulli), by early October a YouGov poll had recorded a 20-point net deficit in Palaszczuk's satisfaction rating, and a nine-point net positive for Crisafulli. Interestingly, the December uComms found new premier Miles enjoyed a net positive rating of 12.5 points. A Courier Mail poll confirmed Labor's woes in terms of policy management, however, with 32 per cent citing Crisafulli more capable in tackling the cost of living, and just 21 per cent Palaszczuk. Similarly, 37 per cent believed the LNP superior managers of youth crime, and just 14 per cent Labor (Courier Mail 27 October, 2023). The major parties' fundraising mirrored their fortunes: where the LNP raised over $750,000 between July 2022 and May 2023, Labor raised just $167,000, including from so-called "cash-for-access" events previously banned by Palaszczuk (Australian 10 July, 2023). Speculation as to Palaszczuk's future began in mid-2022 when the premier's public opinion support first entered serious decline. Indeed, this author (Courier Mail 9 September, 2022) and former Labor premier Peter Beattie (Courier Mail 18 November, 2022) each penned newspaper opinion articles urging Palaszczuk to consider her position. The murmurs became a roar in late August 2023 when it became clear much of caucus and several trade union leaders concluded that Palaszczuk – who had just departed Queensland for a European holiday – was leading Labor to certain defeat. As expected, the Left-aligned Deputy (and now Acting) Premier Miles insisted Palaszczuk – who now said she was suffering health issues (Australian 31 August, 2023) – would lead Labor to the 2024 election (Brisbane Times 27 August, 2023). Interestingly, Treasurer Cameron Dick – part of Palaszcuk's Labor Forum-AWU faction – wrote an opinion piece setting out his "blueprint" for Queensland (Courier Mail 29 August, 2023). In Palaszczuk's absence, Miles raised his own media profile, with 10 appearances in 13 days, or more than Palaszczuk's July total (Courier Mail 9 September, 2023). Critically, the head of the Left-aligned United Workers' Union (UWU) in Queensland, Gary "Blocker" Bullock – a powerful supporter of Palaszczuk despite their factional difference – now refused to publicly endorse the premier (Australian 1 September, 2023). Reports also emerged of Palaszczuk being long disengaged from numerous cabinet colleagues, including Cameron Dick and Shannon Fentiman, with backbenchers allegedly ignored (Australian 2 September, 2023). Palaszczuk returned to Queensland "refreshed" in mid-September, dared internal critics to identify themselves, and declared herself the "best" person to lead Labor to the next election (AFR 12 September, 2023). But while caucus critics quietened, union leaders continued to vent their spleens. Queensland's CFMEU head Michael Ravbar, for example, labelled the Palaszczuk Government "arrogant" and "lazy" before marching in protest, over industrial relations, on Parliament House in September (Australian 15 September, 2023). Palaszczuk appeared to wrest back party control, at least until October when part of the dominant Left faction (especially among the backbench) – still reeling from tough youth crime laws – expressed concern at Palaszczuk's seemingly unilateral decision to abandon (after the LNP's withdrawal of support) its previously endorsed Path to Treaty for First Nations people (see below) (Courier Mail 20 October, 2023). By early December, pressure on Palaszczuk's leadership returned when retired Labor ministers Rob Schwarten (Labor Unity-Old Guard) and Bob Gibbs (Left) urged Palaszczuk to resign (Courier Mail 1 December; 2 December, 2023). Palaszczuk cabinet ally Yvette D'Ath dismissed the men as "old, retired blokes" (Courier Mail 3 December, 2023) before reports former Cooper MP and senior Old Guard figure Kate Jones also agitated for Palaszczuk's removal (Courier Mail 16 December, 2023). Just days later, Queensland Council of Unions head Jacqueline King, angry at Labor's failure to reform sex work laws, refused to endorse Palaszczuk as Labor's best electoral option (Australian 7 December, 2023). Despite the escalating clamour, most observers were shocked when, on the morning of Sunday, 10 December, Palaszczuk announced her resignation as premier (taking effect on 15 December) and her retirement as the Member for Inala (from 31 December). As Queensland premier for almost nine years (and Labor leader for almost 12), Palaszczuk is the state's fifth-longest serving premier. Palaszczuk said she had been pondering retirement in the weeks since the previous National Cabinet meeting where she saw so many new faces. "Renewal is a good thing," a teary Palaszczuk opined before endorsing Miles as her successor (Brisbane Times 10 December, 2023). Other reports, however, suggested Palaszczuk was unwillingly pushed after Bullock and Queensland State Labor President John Battams (Labor Unity-Old Guard) told Palaszczuk they had withdrawn their support. With Palaszczuk's Labor Forum-AWU faction – holding just 18 of the caucus's 52 seats, with the Left (25) and Labor Unity-Old Guard (9) in joint control of the party – Palaszczuk's position was now untenable (Australian 11 December, 2023; Courier Mail 11 December, 2023). On Palaszczuk's resignation, Miles immediately declared himself a leadership candidate, with Left colleague Fentiman declaring her candidacy the following day. No formal announcement came from Dick; although his ambition to succeed Palaszczuk was evident, he clearly lacked the numbers (Australian 12 December, 2023). But Fentiman's fate was sealed when, on the evening of 11 December, Dick – backed by Australian Workers Union leader Stacey Schinnerl – threw Labor Forum support behind Miles (Australian 13 December, 2023). Fentiman withdrew her candidacy the following day. Happy to avoid an open ballot that, required by 2015 party rule changes, would have seen caucus share a protracted postal ballot with the party's rank-and-file and affiliated trade unions, caucus (in Palaszczuk's absence) convened on Friday, 15 December, to formally endorse Miles as Queensland's 40th premier. Dick was the sole candidate for Deputy Premier. The new premier immediately put his own stamp on government: he pledged to be more "consultative" and "transparent"; reinstated an Olympics overseeing agency previously dumped by Palaszczuk; "reflected" on the unpopular $2.7 billion Gabba redevelopment; promised to legislate a 75 per cent reduction (from 2005 levels) in carbon emissions by 2035 (and net-zero by 2050); guaranteed new coalmines and natural gas wells but banned oil and gas developments in rivers or on floodplains; froze vehicle registrations and public transport fares; pledged to build 34,000 homes across southeast Queensland annually; and aggressively tackle youth crime (Brisbane Times 15 December, 2023; Australian 18 December, 2023; Courier Mail 23 December, 2023). The new Miles cabinet was also distinctive. The premier relinquished Palaszczuk's Olympics portfolio and handed it to Grace Grace (Old Guard); Dick remained Treasurer, with State Development, Infrastructure, Local Government and Planning added to his portfolio. Nikki Boyd (Left) assumed Fire and Disaster Recovery, and Minister for Corrective Services, while Bart Mellish (Old Guard) assumed Transport and Main Roads from the now-resigned Mark Bailey (Left). Lance Callum (Left) assumed Employment and Small Business, and Training and Skills Development, while Michael Healy (AWU) won Tourism and Sport. Charis Mullen (AWU) assumed Child Safety, Seniors and Disability Services, and Multicultural Affairs. Backbenchers Ali King, Shane King, Jimmy Sullivan, Jennifer Howard and Corrine McMillan were promoted as Assistant Ministers (Brisbane Times 15 December, 2023). Craig Crawford (Left) was omitted from the frontbench, and Stirling Hinchliffe (AWU) announced he would not contest the next election. Miles's former Director-General, former Labor MP Mike Kaiser (AWU), was also promoted to Director-General of Department of Premier and Cabinet. Few observers believed Queensland would return a majority vote at the Voice to Parliament referendum, held on 14 October, designed to recognise First Nations peoples in the Australian Constitution by establishing an Aboriginal and Torres Strait Islander advisory body. But most were stunned by the enormity of Queensland's rejection. Recording the largest 'No' vote of any state or territory, Queensland saw just 31.79 per cent of the state's 3,178,373 formal votes endorse the 'Yes' case. Queensland also recorded the third-lowest turnout. As revealed below, at no time during the period did the 'Yes' vote reach majority support. As outlined below, just three of Queensland 30 federal seats – Brisbane, Griffith and Ryan (all held by the Greens since 2022) – voted 'Yes'. Devastated by the defeat, Palaszczuk immediately reaffirmed her government would continue to develop a treaty, as previously legislated, with First Nations people (Courier Mail 16 October, 2023). But, just days later, Opposition leader David Crisafulli withdrew his party's previously pledged support. Describing the referendum as a "divisive" event, Crisafulli was likely pressured by a conservative rank-and-file LNP membership opposed to further First Nations reconciliation (Australian 19 October, 2023). The following day, Palaszczuk shocked many when she, too, withdrew support for a treaty, arguing that such issues require "bipartisan support" (Australian 20 October, 2023). Interestingly, a Courier Mail opinion poll found support for a treaty, or a "truth-telling" commission, had collapsed in Queensland since the referendum's defeat, falling from 58 per cent in October to just 33 per cent in November (Brisbane Times 19 November, 2023). Queensland lost two political giants during the period. On 11 August, former Nationals Premier Mike Ahern (1987–89) – long respected for his "lock, stock and barrel" embrace of the Fitzgerald Report's post-Bjelke-Petersen anti-corruption recommendations – died aged 81. On 21 October, Bill Hayden, a former Queensland Labor federal MP (Oxley, 1961–88), federal opposition leader (1977–83) and Governor-General (1989–96), also passed, aged 90. Each man was afforded a state funeral. Open access publishing facilitated by Griffith University, as part of the Wiley - Griffith University agreement via the Council of Australian University Librarians.

BackgroundThe Navitor (THV) is the latest iteration of the Portico self-expanding valve system. Early prospective studies have shown promising outcomes, however there is a lack of complementary ‘real-world’ data.AimsTo assess early safety and efficacy outcomes of the Navitor Transcatheter Heart Valve (THV) using registry data from six high-volume UK TAVR centers.MethodsDemographic, procedural and in-hospital outcome data were retrieved from six UK centers. The primary safety end-point was 30-day mortality. Primary efficacy end-points were procedural success, mean aortic gradient, and ≥moderate paravalvular leak (PVL). Secondary endpoints included rates of new pacemaker implantation (PPM), stroke and vascular injury.Results574 patients (Mean age 83.4 years; 54.5% female) underwent Navitor TAVR between January 2020 and May 2023. The 30-day mortality in this patient cohort was 1.6%. Procedural success was 98.1%, mean echo-derived gradient post-TAVR was 7.7±4.8mmHg (95% CI [7.2, 8.3], p<0.001) and 5.1% of patients had ≥moderate PVL (p̂=0.051, 95% CI [0.035, 0.073, p<0.001). New PPM to discharge was required in 11% (p̂ =0.119, 95% CI [0.088, 0.158], p<0.001), stroke occurred in 1.2% of patients (p̂= 0.017, 95% CI [0.006, 0.036], p<0.001) and significant vascular injury in 1.6% (p̂= 0.014, 95% CI [0.005, 0.032], p<0.001).ConclusionEarly procedural outcomes with Navitor TAVR compare favorably to new generation THVs. Procedural success was high with a low incidence of complications.

The House of Representatives election of 2 December, 1972, was a watershed in Australian political history. That election saw the Australian Labor Party terminate the Liberal–Country Party (LCP) Coalition's twenty‐three‐year hegemony and bring to office not only a different type of Labor government but a different prime ministerial style in leader Gough Whitlam. Yet, just six years before, Labor at the 1966 election had suffered a 4.30 per cent two‐party preferred (2PP) swing and the loss of nine seats following Labor's lowest primary vote since 1934. Labor's dramatic reversal of fortunes in just six years therefore remains of enormous historical interest. But, given the 1972 election saw a modest 2.5 per cent 2PP swing to Labor, with the party seizing twelve seats from the Coalition and losing four back to the LCP, the 1969–72 triennium offers little insight into Labor's recovery. In that context, this article, via analyses of House of Representatives election results and public opinion poll data, explores the chronology, demography, and geography of Labor's electoral recovery to argue the 1966–69 triennium remains of far greater value when identifying exactly when, among whom, and where Labor began its pathway to power.

The 2022 Australian federal election saw a record high vote for minor parties and independent candidates and record-low levels of voter identification with the major parties. Scholars have since described the 2022 election as both a "dealigning" and a "realigning" event. Such descriptions are useful commencement points but not definitive. In determining a more accurate classification, this article offers three arguments: first, that younger and female voters swung heavily against the Coalition indeed suggests a "dealigning" election, albeit merely the most recent in a long process of "dealignment"; second, that the election hinged disproportionately on the short-term factor of Prime Minister Scott Morrison's unpopular leadership suggests the poll was also a "deviating" event; and, third, it is impossible to classify the 2022 election as genuinely "realigning" until subsequent elections confirm the propensity of former Labor and Liberal Party voters to re-elect Greens and "Teal" candidates.

Introduction: The role of balloon aortic valvuloplasty (BAV) in the era of transcatheter aortic valve replacement remains a topic of debate. We sought to study the safety and feasibility of combined BAV and percutaneous coronary intervention (BAV-PCI). Methods: Between November 2009 and July 2020, all patients undergoing BAV were identified and divided into three groups: combined BAV-PCI (group A), BAV with significant unrevascularised CAD (group B), and BAV without significant CAD (group C). Procedural outcomes and 30-day and one-year mortality were compared. Results: A total of 264 patients were studied (n = 84, 93, and 87 patients in groups A, B, and C, respectively). The STS score was 10.2 ± 8, 13.3 ± 19, and 8.1 ± 7, p = 0.026, in groups A, B, and C, respectively. VARC-3 adjudicated complications were similar among groups (11%, 13%, and 5%, respectively, p = 0.168, respectively). Thirty-day and one-year mortality were 9.8% (n = 26) and 32% (n = 86) of the entire cohort. The differences among groups did not reach statistical significance. Using univariate Cox regression analysis, group B patients were at higher risk of dying compared to group A patients (HR 1.58, 95% CI: 1.11–2.25, p = 0.010). With multivariate Cox regression analysis, the predictors of mortality were STS score, cardiogenic shock, mode of presentation, and lack of subsequent definitive valve intervention. Conclusion: In high-risk patients with aortic valve stenosis, combined BAV-PCI is safe and feasible with comparable outcomes to BAV with and without significant CAD.

BACKGROUND:Breathlessness due to medical conditions commonly causes emergency department presentations and unplanned admissions. Acute-on-chronic breathlessness is a reason for 20% of emergency presentations by ambulance with 69% of these being admitted. The emergency department may be inappropriate for many presenting with acute-on-chronic breathlessness.AIM:To examine predictors of emergency department departure status in people with acute-on-chronic breathlessness.DESIGN, SETTING AND METHOD:Secondary analysis of patient-report survey and clinical record data from consecutive eligible attendees by ambulance. Variables associated with emergency department departure status (unifactorial analyses; p<0.05) were included in a binary logistic regression model. The study was conducted in a single tertiary hospital. Consecutive survey participants presenting in May 2015 with capacity were eligible. 1,212/1,345 surveys were completed. 245/1,212 presented with acute-on-chronic breathlessness, 171 of whom consented to clinical record review and were included in this analysis.RESULTS:In the final model, the odds of admission were increased with every extra year of age [OR 1.041 (95% CI: 1.016 to 1.066)], having talked to a specialist doctor about breathlessness [9.262 (1.066 to 80.491)] and having a known history of a heart condition [4.177 (1.680 to 10.386)]. Odds of admission were decreased with every percentage increase in oxygen saturation [0.826 (0.701 to 0.974)].CONCLUSION:Older age, lower oxygen saturation, having talked to a specialist, and having history of a cardiac condition predict hospital admission in people presenting to the emergency department with acute-on-chronic breathlessness. These clinical factors could be assessed in the community and may inform the decision regarding conveyance.

The 2020 Queensland state election was the first Australian state (but not territory) poll conducted under the pall of the COVID-19 pandemic. Despite often unpopular border closures and severe business restrictions, the Palaszczuk Labor Government was easily re-elected to a third term with a net seat gain. As always, the results revealed a heterogenous electorate varying widely in vote preference according to geographical location. This article argues that, unlike early analyses of Queensland elections, the state is not dichotomised simply between 'Coast' and 'Inland' or between 'Brisbane' and 'the Bush'. Instead, the article builds on previous research to argue Queensland divides into six regions of voter behaviour, each with its own distinct economic and demographic characteristics.