Credibility for sale

We develop a model where a sovereign’s incentive to repay its debt depends on the identity of its creditors. Higher exposure to official lenders improves incentives and thus credibility, for instance, because default would jeopardize the benefits from membership in a club (such as EU or EMU). But higher exposure also carries costs, because of reduced flexibility ex post and because official lenders may collude to extract rents. We characterize the equilibrium composition of debt across creditor groups as well as equilibrium debt prices. Our model can account for an important— and still unexplained—feature of sovereign debt crises: Official lending to sovereigns takes place only in times of debt distress and carries a favorable rate. It also offers a novel perspective on the interaction between deficits, debt overhang and the availability of official funds in determining default risk.

Transcatheter aortic valve implantation: the transfemoral access route is the default access

Transcatheter aortic valve implantation (TAVI) is a widely accepted alternative to surgical aortic valve replacement (SAVR) among non-operable patients or selected high-risk patients with degenerative, severe aortic stenosis. TAVI is considered less invasive when compared with SAVR; however, there remain significant differences between different TAVI access routes. The transfemoral approach is considered the least invasive access route, and can be performed as a fully percutaneous procedure in a spontaneously breathing patient under local anaesthesia and mild sedation only. Moreover, transfemoral TAVI patients are typically transferred to coronary care rather than to an intensive care unit after the procedure, and benefit from early ambulation and a reduction in overall length of hospital stay. Considering these patient-specific and health-economic advantages, several TAVI centres follow the least invasive strategy for their patients and have implemented the transfemoral access route as the default access in their institutions. This article provides an overview on the prerequisites for a successful transfemoral TAVI procedure, describes the procedural advantages compared to alternative access routes, and highlights differences in clinical outcomes.