This issue of the journal – as it often does – reflects areas of interventional cardiology at different stages of maturity. The majority of patients undergoing percutaneous coronary intervention do so in the context of acute coronary syndromes and the cardiovascular community has been striving for decades to achieve the perfect balance between preventing thrombus generation on the one hand and eliminating bleeding risk on the other. In this sphere, Onwordi et al and Guedeney et al get this month’s joint prize for the “all you needed to know but were too afraid to ask” papers on antithrombotic therapy in general, and novel oral anticoagulant therapy specifically, in acute coronary syndromes.
Four papers on transcatheter aortic valve implantation (TAVI) demonstrate that this procedure remains under intense scrutiny and that operators continue to strive for optimal treatment for all patients with aortic valve disease. I have provided what I hope is a reasoned overview of the “newest” TAVI complication: delayed coronary obstruction. Yoon et al and Nakashima and Watanabe review data relating to TAVI procedures for bicuspid aortic valves and for small anatomy, respectively. In the absence of any definitive trial data regarding coronary revascularisation in TAVI candidates, an update of available evidence and experience from Cao et al is welcome.
Transcatheter treatment of mitral valve disease is certainly at an early stage of development but Eng and Wang provide an excellent review of transcatheter mitral valve replacement for post-surgical mitral failures, a procedure that for many will be the entry point to transcatheter mitral interventions and a procedure that all structural services are now being asked to undertake.
Finally, cardiogenic shock has always been a feared complication of cardiac disease – and of cardiac interventions – but its treatment outside of transplantation centres has only relatively recently been approached in a scientific and systematic fashion. Truesdell et al tell us how lessons learnt in the heat of battle can be applied to our approach to the treatment of what remains a frequently fatal condition.