The introduction of Transcatheter Aortic Valve Implantation (TAVI) has transformed interventional cardiology and minimally invasive cardiac surgery. TAVI is a relatively new technique that is rapidly expanding in its indications and technology as well as places of practice. De-centralisation of this previous supra-specialised procedure can be done safely and efficaciously, to improve the health inequalities across regional and remote Australia. The purpose of this study is to detail the introduction of the TAVI program at a geographically isolated tertiary hospital in regional Australia. Illustrating the safe introduction of TAVI in this location may guide other isolated hospitals on the introduction of the service.

Harlequin Syndrome is an exceedingly rare condition, characterized by unilateral facial flushing and hyperhidrosis. Postulated to be dysregulated sympathetic nervous system stimulation of the dermal vasculature and blood vessels of the face. There is no clear unifying pathological cause. Due to its heterogeneity and rarity, very little is known about treatment of it. Hereafter we describe our experience in successfully curing right-sided Harlequin Syndrome through Video Assisted Thoracoscopic (VATS) Sympathectomy.

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Background: The coronavirus disease-19 (COVID-19) pandemic poses unprecedented challenges to global healthcare. The contemporary influence of COVID-19 on the delivery of lung cancer surgery has not been examined in Queensland. Methods: We performed a retrospective registry analysis of the Queensland Cardiac Outcomes Registry (QCOR), thoracic database examining all adult lung cancer resections across Queensland from 1/1/2016 to 30/4/2022. We compared the data prior to, and after, the introduction of COVID-restrictions. Results: There were 1207 patients. Mean age at surgery was 66 years and 1115 (92%) lobectomies were performed. We demonstrated a significant delay from time of diagnosis to surgery from 80 to 96 days (P < 0.0005), after introducing COVID-restrictions. The number of surgeries performed per month decreased after the pandemic and has not recovered (P = 0.012). 2022 saw a sharp reduction in cases with 49 surgeries, compared to 71 in 2019 for the same period. Conclusion: Restrictions were associated with a significant increase in pathological upstaging, greatest immediately after the introduction of COVID-restrictions (IRR 1.71, CI 0.93-2.94, P = 0.05). COVID-19 delayed the access to surgery, reduced surgical capacity and consequently resulted in pathological upstaging throughout Queensland.