Maroua Eid

Objectives: Sex differences in outcomes after transcatheter aortic valve implantation (TAVI) remain incompletely understood. Earlier studies described a “sex paradox,” with women experiencing more procedural complications but similar or superior survival compared with men. However, most data derive from earlier device generations, and contemporary evidence is limited. Methods: We retrospectively analysed all patients with severe aortic stenosis who underwent TAVI at the University Hospital of Angers between January 2012 and December 2023. Clinical and procedural characteristics were collected from a dedicated database. Propensity-score matching (1:1) was performed to account for baseline differences. The primary end-point was 30-day mortality. Results: A total of 2718 patients underwent TAVI, of whom 49.1% were women. Women were older but had fewer comorbidities than men. After matching (1320 pairs), procedural duration was similar, but women more often required alternative access and received self-expandable valves. Thirty-day mortality did not differ between sexes, but all-cause mortality was significantly higher in men (P < .01). Women had a greater incidence of postoperative stroke, particularly in low-risk patients, whereas men had higher rates of acute renal failure and pacemaker implantation. The survival probability was higher for women in overall population and in low- and intermediate-risk patients. Conclusions: In this large, contemporary cohort, women experienced more strokes, whereas men had higher all-cause mortality and conduction-related complications. These findings underscore persistent sex-specific differences in TAVI outcomes and highlight the need for tailored procedural strategies.

Objectives: Transfemoral transcatheter aortic valve implantation (TAVI) has become the preferred approach for treating aortic stenosis in patients over 70 years. Despite advancements in technology and operator experience, major vascular complications (MVCs) remain a concern, potentially affecting outcomes. This study aimed to assess the incidence, risk factors, and clinical impact of MVCs following transfemoral TAVI using propensity score matching. Methods: We retrospectively analysed patients who underwent transfemoral TAVI. Patients were divided into 2 groups: patients who developed MVCs (MVC group) and those who did not present the complication (No-MVC group). The primary end-point was the 30-day mortality. A 1:1 propensity score matching was performed, and clinical outcomes were compared at 30 days and up to 2 years. Results: Between 2012 to 2023, a total of 2296 underwent a percutaneous-transfemoral approach. Major vascular complications occurred in 6.6% (n = 151) and were associated with increased transfusion requirement, major bleeding, reinterventions, and longer hospital stays. Female sex, obesity, higher STS score, use of the Manta closure device, and post-implantation balloon valvuloplasty were independently associated with MVCs. The 30-day mortality was similar between groups (P = .723). The long-term survival was lower in the MVC group (P = .016). Two-year survival after propensity score matching did not differ between groups (P = .08). Conclusions: Major vascular complications after transfemoral transcatheter valve implantation are associated with worse clinical outcomes and reduced long-term survival despite similar at 30-day mortality. Recognizing high-risk patients, optimizing procedural planning, and considering alternative access routes may help reduce vascular complications.

Background: Cardiac surgery remains a high-stakes, technically complex specialty requiring rigorous, structured training. Across Europe, significant variation exists in training pathways, assessment standards, and certification, creating disparities in preparedness among newly qualified cardiac surgeons. To address this, the European Association for Cardio-Thoracic Surgery (EACTS) developed a unified Core Curriculum for the Cardiac/Cardiovascular Surgeon. Methods: This curriculum was developed over 12 months by a taskforce comprising experienced surgeons/trainers, educational experts, and trainee surgeons. Data were gathered through 2 National Trainee Summits (2023 and 2024), with representation from 26 national programmes. Structured feedback from these events and additional stakeholder consultations shaped the framework, which incorporates entrustable professional activities (EPAs), Canadian Medical Education Directives for Specialists (CanMEDS) competencies, and European Board of Cardiothoracic Surgery (EBCTS) syllabus. Results: The curriculum defines clinical and non-clinical competencies across 3 training stages—introductory, intermediate, and advanced—aligned with EPA benchmarks. It outlines requirements for trainees, trainers, training institutions including operative volume, educational content, and assessment methodology. Institutions are encouraged to adopt competency-based progression, minimum case numbers, regular multi-source feedback, and final certification via standardized examinations such as the EBCTS. Emphasis is also placed on supporting struggling trainees, quality assurance mechanisms, and future workforce planning. Conclusion: The EACTS Core Curriculum offers a harmonized, flexible, and competency-based framework for cardiac surgical training. Voluntary adoption of this curriculum across Europe is expected to enhance training quality, ensure patient safety, and facilitate surgeon mobility across borders. It aims to cultivate independent, reflective, and proficient cardiac surgeons equipped for evolving clinical demands.

OBJECTIVES: This study provides a thorough analysis of cardiac surgeons' involvement in transcatheter aortic valve replacement (TAVR) activities in France, covering decision-making, procedural roles, training, and outcome analysis. METHODS: A nationwide survey was sent to all cardiac surgeons and all cardiac surgery trainees in France. Subgroup analysis was performed for age, status (established versus in-training), and type of practice facility. RESULTS: A total of 172 surgeons from both private and public sectors responded to the survey. Most respondents, 71%, had TAVR activity, and there were no significant differences between subgroups. Most respondents with TAVR activities, 30%, had average access (once per week). Almost one-third of centers had >3 established surgeons with TAVR activity, whereas 19% had no in-training surgeons with TAVR activity. TAVR was the only structural practice for 67% of surgeons, while 33% practiced other structural procedures. When asked, 82% of surgeons were against establishing TAVR programs in centers without a cardiac surgery program. Most TAVR patients, 72%, were discussed by the Heart Team, and only 9% of surgeons said their relationship with the interventional cardiologist was disrupted. Two-thirds of vascular complications were managed by cardiac surgery, and only 6% of cardiac surgeons admitted were unfit to handle any vascular complications. CONCLUSIONS: In France, cardiac surgeons are becoming increasingly involved in TAVR procedures as an integral part of the Heart Team.

OBJECTIVES: There are significant disparities in global access to cardiothoracic surgery. Training a diverse cohort of global cardiothoracic surgeons is a critical step. However, little is known about training pathways globally, and there is a lack of standardization in training. METHODS: The Global Thoracic Surgery Residents’ Association developed a 25-item survey covering the five domains of country of origin, access to cardiothoracic surgical training, variations in training, barriers and facilitators to training, and future plans of cardiothoracic surgery trainees. The survey was disseminated electronically and over social media platforms. RESULTS: A total of 73 responses from trainees in 21 countries were received. Wide variations were found in training programmes, including length of training, operative autonomy, reliance on simulation, trainee supervision and minimum case requirements. Common barriers included discrimination, separation from family and inadequate supervision and volume. Facilitators included participation in global rotations and mentorship. The majority (78%) of trainees plan on additional training. CONCLUSIONS: There is a lack of standardization of trainee experience with extreme variations in global cardiothoracic training programmes in terms of length of training, reliance on simulation, supervision, research opportunities and minimum case requirements. These variations are opportunities to think forward in terms of collectively working on standardization of trainee experience, developing innovative modalities to increase supervision of trainees and recognizing trainee interest in research. There is a clear demand for increased global collaboration and the transfer of knowledge and techniques in addition to trainee recognition of need for further training.

OBJECTIVES: Antiplatelet therapy increases the risk of bleeding and transfusion in patients undergoing extracorporeal circulation. Reduced goal-directed anticoagulation is a personalized approach to reduce the anticoagulation based on a lower targeted activated clotting time. We assessed whether reduced goal-directed anticoagulation using optimized extracorporeal circulation alleviates the risk of severe bleeding in patients treated by dual antiplatelet therapy (DAPT) compared to aspirin alone during coronary artery bypass grafting (CABG). METHODS: A total of 2275 patients undergoing CABG from 2002 to 2022 were selected after propensity matching from a retrospective cohort of 3018 patients. Patients treated with a combination of aspirin and prasugrel or ticagrelor or clopidogrel were included in the DAPT group (n = 1111). Patients treated with aspirin alone (ASA) constituted the control group (n = 1164). Optimized extracorporeal circulation was conducted under reduced systemic anticoagulation with a target activated clotting time 250 s. Severe bleeding was assessed using 3 validated scores of bleeding: UDPB, E-CABG, and BARC-4. RESULTS: While all scores showed low ranges of severe bleeding (<6%), they were significantly higher after DAPT compared to ASA (P values for UDPB, E-CABG, and BARC-4 at 0.016, 0.006, and 0.063, respectively). Higher maximal activated clotting time was associated with higher rate of transfusion (P < 0.001) and bleeding (P < 0.001) after multivariate adjustment. Mortality was 1.24% in DAPT vs 0.94% in ASA group (P = NS), whereas cardiac death, myocardial infarction, stroke, and transient ischaemic attack were low (<1%) and similar between groups. CONCLUSIONS: Despite higher bleeding under DAPT compared to ASA alone, optimized extracorporeal circulation with reduced goal-directed anticoagulation alleviated severe bleeding which remained low in patients undergoing CABG.

Filip P A Casselman, Marcus D Lance, Aamer Ahmed, Alice Ascari, Juan Blanco-Morillo, Daniel Bolliger, Maroua Eid, Gabor Erdoes, Renard Gerhardus Haumann, A

Filip P A Casselman, Marcus D Lance, Aamer Ahmed, Alice Ascari, Juan Blanco-Morillo, Daniel Bolliger, Maroua Eid, Gabor Erdoes, Renard Gerhardus Haumann, A