Direct implantation of the Edwards SapienXT valve during TAVI by the transfemoral route appears safe, efficacious and feasible in those without extreme calcification. © 2016 Wiley Periodicals, Inc.

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This study demonstrates an acceptable occurrence of MI, death, repeat intervention, and stent thrombosis in a high-risk group of V. Eld. patients with de novo lesions. Age alone in the absence of other non-cardiac factors should not prohibit a patient from access to PCI.

Key Clinical MessageIncreasing longevity of heart transplantation recipients and aging donor population accompanied by the older age at transplantation led to an increase in the prevalence of degenerative valvular disease in particular aortic stenosis. TAVI is considered a safe and feasible alternative compared to conventional SAVR in this high‐risk population.

Syncope is a common symptom of patients attending emergency departments, yet presents significant diagnostic and therapeutic challenges. We present a rare cause of recurrent vasovagal syncope with predominant cardioinhibitory response due to lymphoma surrounding and compressing the carotid artery treated successfully with radiotherapy.

There is no ‘gold standard’ non-invasive test to diagnose myocarditis. It is a clinico-histopathological diagnosis.1 Clinical manifestations include: heart failure, chest pain (from either pericarditis or angina from coronary artery spasm/inf lammation), sudden cardiac death and arrhythmias (sinus tachycardia, ectopics, ventricular tachycardia, heart blocks). Examination may reveal raised JVP, pulmonary crackles, a gallop rhythm or a pericardial rub.

Introduction Transcatheter Aortic Valve Implantation (TAVI) is being used increasingly in patients with severe symptomatic Aortic Stenosis (AS). There are few data on length of stay (LOS) in this elderly and co-morbid population. This study evaluates the safety of selective early discharge post TAVI. Methods Data were collected prospectively on all 121 patients who underwent TAVI between 2009 and October 2012. Subjects with severe symptomatic AS were selected for TAVI by the heart team if they had logistic Euroscore >20 and/or were deemed inoperable after direct surgical review. All patients received an Edwards Sapien or Sapien XT valve via transfemoral (n = 89), trans-apical (n = 23) or direct aortic (n = 9) routes. Complications (VARC-2 criteria), LOS and 30 day re-admissions were recorded. Pre-defined minimum LOS was discharge on day 3 post TAVI. Patients were divided into early (200 7 (5.8) COPD on inhalers 42 (34) Prior cardiac surgery 51 (45) NYHA class – no. (%) I 0 (0) II 3 (2.5) III 51 (42) IV 67 (55) Ejection Fraction (EF) – no. (%) >55 43 (36) 36–54 60 (50) <35 18 (15) Heart team decision – no./total (%) High-risk 61/121 (50) Inoperable 60/121 (50) Abstract 84 Table 2 Complications Characteristic All patients 30 day mortality – no. (%) 4 (3.3) CVA – no. (%) 2 (1.7) Major Vascular – no. (%) 9 (7.4) Permanent pacemaker (PPM) – no. (%) 4 (3.3) Dialysis – no. (%) 6 (5.0) Median LOS was 4 days. 40% of patients had been discharged by day 3 post TAVI and 61% by day 4. Transfemoral patients had a significantly shorter median LOS than other routes (3 days vs 6.5 days, p = 0.001). The overall early (30 day) re-admission rate was 10/121 (8.3%). There was no significant difference in re-admissions between the early and delayed discharge groups (9.5% vs 6.4%). There were no deaths between discharge and 30 days and no patients required readmission for PPM. Discussion This study suggests that selective early discharge post TAVI is not associated with higher rates of readmission, sudden death or PPM. Mean LOS of 6 days compares favourably to data from other centres reporting mean LOS of 6.8–15 days. Other studies have recorded readmission rates of between 8–15% so our policy of selective early discharge does not appear to be at a cost of higher readmission. Re-admission rate was lowest in our transfemoral group at 5.6%. Conclusion Selective early discharge following TAVI appears to be safe and is not associated with increased early readmission or delayed complications.

Case report A 28 year old gentleman presented after an episode of collapse with loss of consciousness. He gave a history of non-specific malaise and myalgia over the previous 7 days, with fever, a generalised rash and a non productive cough. He developed progressive shortness of breath with sharp, pleuritic chest pain that was unresponsive to antibiotics in the community.