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Valve-sparing aortic root replacement in patients with Marfan syndrome avoids the complications of a prosthetic heart valve, particularly life-long anticoagulation therapy. Despite proven durability and excellent event-free survival, the majority of cardiac surgeons have not adopted this approach. Here, Stephen Westaby suggests that the time is right for a change in the surgical guidelines and explains that an early, elective valve-sparing operation can transform the long-term prognosis of patients with Marfan syndrome.

Here, Stephen Westaby highlights the promise of new blood pumps in severely symptomatic patients with heart failure, a patient population with very limited treatment options.

Professor Stephen Westaby and colleagues describe the case of a patient who presented with cardiogenic shock that swiftly deteriorated to severe heart failure. CT revealed a large adrenal tumor that was subsequently indentified as pheochromocytoma. After the tumor was removed, the patient underwent left ventricular assist device implantation as a bridge to left ventricular recovery.

In the first of their two Reviews on cardiogenic shock in acute coronary syndromes, Stephen Westaby and colleagues discuss the evolving epidemiology of this condition, its clinical presentation, and predictors of outcome. They also explore the options for medical therapy and the potential role of therapeutic hypothermia in these patients.

The second of the two Reviews on cardiogenic shock in acute coronary syndromes focuses by Westaby et al. focuses on the use of mechanical circulatory support systems, from intra-aortic balloon pumps, extracorporeal membrane oxygenation, and ventricular assist devices, to the total artificial heart. The authors highlight the importance of multidisciplinary care teams, and discuss some of the ethical and economic issues that impact the use of these devices.

Apoptosis contributes notably to the pathogenesis of heart failure, but these investigators found that upregulation of endogenous antiapoptotic mechanisms counterbalance the death-receptor and mitochondrial apoptotic pathways. Concurrent activation of antiapoptotic factors can interrupt the apoptotic cascade, prevent cell loss despite the presence of multiple proapoptotic factors, and could offer an opportunity for therapeutic intervention.