Patients with a small aortic annulus represent a challenging subset undergoing transcatheter aortic valve implantation (TAVI), with an increased risk of prosthesis–patient mismatch and suboptimal valve haemodynamics. The SMART trial is the largest head-to-head randomised comparison of self-expanding supra-annular and balloon-expandable TAVI platforms in this patient cohort.

In this interview, interventional cardiologist Dr Jason Sharp (Sydney Adventist Hospital) joins A/Prof Justin Mariani to review the two-year SMART trial outcomes and discuss what these findings may mean for device selection and long-term valve performance in patients with a small aortic annulus.

As the use of TAVI expands into younger and lower-risk populations, long-term durability and clinical outcomes are at the forefront of decision-making.

In this interview A/Prof. Justin Mariani speaks with a leading interventional cardiologist from Sydney, to examine 5-year data from the Evolut Low Risk trial and its implications for contemporary Australian practice.

They discuss the evolving evidence, valve durability, and haemodynamics, and how the latest findings are reshaping referral pathways, shared decision-making and patient selection.

As the use of TAVI expands into younger and lower-risk populations, long-term durability and clinical outcomes are at the forefront of decision-making.

In this interview A/Prof. Justin Mariani speaks with a leading interventional cardiologist from Melbourne, to examine 5-year data from the Evolut Low Risk trial and its implications for contemporary Australian practice.

They discuss the evolving evidence, valve durability, and haemodynamics, and how the latest findings are reshaping referral pathways, shared decision-making and patient selection.

In part one of this series, we unpack the science of amyloid and tau pathology, review evidence for disease modification, examine key clinical trial data and its real-world relevance, and discuss patient selection, biomarker confirmation and eligibility criteria.

In part two of this series we cover ARIA-E and ARIA-H, including their pathophysiology, imaging characteristics and incidence, and outlines which patients are most at risk and the key clinical features to recognise.

We also discuss scenarios where ARIA can mimic stroke and how thrombosis may lead to catastrophic outcomes, along with practical guidance for emergency departments, stroke teams and clinicians managing patients on amyloid-targeting therapies.

Gastroenterology: Liver disease is one of the leading causes of premature death in Australia. Acute decompensation of chronic liver disease is a common reason for emergency department presentation and can lead to prolonged or repeated hospital admission. The transition from compensated cirrhosis to decompensated cirrhosis heralds a watershed moment in the course of the disease. Cirrhosis leaves patients vulnerable to serious complications, so timely diagnosis is important to guide treatment, determine prognosis, and monitor for complications in patients with chronic liver disease.

Early recognition of patients at risk of decompensation, as well as continuation of care on discharge from hospital are both strategies to interrupt the ‘revolving door’ phenomenon in caring for patients with liver disease.

In this interview we review advanced liver disease in a tertiary setting: What should we be aiming for, what are the challenges, and practical tips to overcome these challenges.

Psychiatry: Long-acting injectable antipsychotics (LAIs) play a crucial role in improving adherence and outcomes for patients with schizophrenia, but existing options often come with challenges like complex dosing schedules and the need for oral supplementation.

In this episode we discuss a newly available LAI that simplifies initiation and offers rapid therapeutic levels without the need for oral supplementation. Our experts explore its clinical advantages, practical applications, and real-world experiences, providing valuable insights for psychiatrists looking to enhance treatment strategies.

Tune in for expert perspectives on integrating this innovation into practice.

Epilepsy Miniseries (Part 5): Developmental and epileptic encephalopathies (DEEs) are well-recognised in paediatric practice but often remain undiagnosed in adult neurology. Advances in genetic testing now provide opportunities for formal diagnosis and tailored treatments, even in adult patients.

In this interview, we explore the hallmark clinical features of DEEs, key considerations for genetic testing, and strategies to address the complex needs of these patients.

Learn how to optimise care for adults living with DEEs and integrate new diagnostic tools into practice.

Rheumatology: Take Back Life Miniseries (Part 2): In this episode, we explore the exciting advancements in the treatment of spondyloarthritis, particularly focusing on IL-17 inhibitors, which have significantly transformed the landscape of axial spondyloarthritis care.

These inhibitors are proving highly effective in alleviating disease symptoms, enhancing physical function, and improving patients’ quality of life. We discuss global practises in the prescribing of IL-17 inhibitors, current ASAS and EULAR guidelines, the impact of elevated versus normal CRP on therapy responses, and the importance of shared decision-making in treatment planning.

Join Professor Selmi as he shares his clinical insights and experience using IL-17 inhibitors in managing axial spondyloarthritis, a complex condition where each patient’s journey is unique.

Endocrinology: Many women experience a substantial burden from vasomotor symptoms (VMS) during the menopausal transition, significantly affecting their quality of life, sleep, mood, concentration, and sexual well-being. These symptoms, often beginning before menopause, can persist for over a decade and are linked to declines in physical health.

While hormone therapy remains the standard treatment, it is not suitable for every woman due to medical conditions, risk factors, age, timing post-menopause, or personal preference.

In this interview, we explore the breakthrough development in the understanding of VMS pathophysiology: neurokinin 3B antagonists, a non-hormonal alternative specifically designed for managing these symptoms, which offers promising relief for women seeking effective alternatives to hormone therapy.