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Hi, everyone.

This is John Mandrola from the Heart.org Medscape Cardiology, and this is this week in cardiology for

September 26, 2025. This week, a very bold trial in valvular heart disease, a cardiovascular prevention

trial whose message is humility, dogma in VTE, venous trauma embolism, challenged, more news on GLP1, A-drugs,

and a public service announcement.

First is the double-choice trial.

Last couple of weeks, I've had some tough criticisms of trials.

This week, I will start with a very nice example of evidence-based medicine done right. A German team led by Professor

Holger Thiel presented results of their double-choice trial at the ESE meeting. This compared

a minimalist approach to Tavi sedation versus standard of care.

The clinical question surrounded the use of just, just local anesthetic and nothing else to do a tavi versus standard of care,

which included conscious sedation and local anesthesia.

In Germany, standard of care has long progressed to conscious sedation from local anesthesia. In Germany, standard of care has long progressed to conscious

sedation from general anesthesia. Now, I find the fact that my German colleagues would do

and German patients would accept a major operation such as Tavi without sedation, remarkable.

It speaks to the different cultures of medical practice because here,

in the southeastern United States, and likely most places in the U.S., sedation is used for about

everything. I try to hold the line on wide-awake loop recorder insertions, but even some patients

want sedation for loop recorders. Never mind, Tavi. But nonetheless, the ability to do Tavi

...