This site is not optimized for Internet Explorer 8 (or older).
Please upgrade to a newer version of Internet Explorer or use an alternate browser such as Chrome or Firefox.
Journal and News Scan
The New York Times revisits the spiraling increase in health care costs in the United States.
The authors performed off-pump left ventricular reconstruction for ischemic cardiomyopathy in ovine model applying epicardial catheter-based ventricular reconstruction. Six weeks after ventricular reconstruction end-systolic volume was decreased by 38% and ejection fraction increased by 13%. Histopathology showed appreciable reduction of the chronic infarct in the left ventricle.
The authors analyzed cardiac CT scans of 70 patients for the smallest distance between each point on the annulus and each of the left circumflex and right coronary arteries. The global minimum for the left circumflex was <5 mm for about 30% of patients. Knowledge of the exact anatomic relationships could help to reduce iatrogenic complications of mitral annuloplasty.
The authors present a case series of 11 patients with N3 non-small-cell lung cancer who received multimodality treatment including surgery. They conclude that such regimen is worth to be considered in selected patients.
Intermittent lower body perfusion during repair of acute DeBakey type I aortic dissection in moderate hypothermic circulatory arrest (MHCA) seems to be protective against renal failure and increase of liver enzymes compared to MHCA only in a study on 107 patients.
Effect of statin drugs on thoracic aortic aneurysms The American Journal of Cardiology, 10/09/2013 Clinical Article Stein LH et al. - Pharmacologic interventions for thoracic aneurysms remain poorly characterized. The results of a pilot study by the group suggested improved outcomes among patients with thoracic aortic aneurysm who were taking statins. These findings provide a medicinal option for the arsenal of treatment options for patients with aneurysms of the thoracic aorta. Methods The authors undertook a comprehensive analysis of a larger cohort of patients from the Database of the Aortic Institute at Yale-New Haven Hospital. A total of 1,560 patients met the inclusion criteria. The adverse events (i.e., death, dissection, or rupture) and surgery rates for patients with (n = 369, 24%) and without (n = 1,191, 76%) statin therapy were compared. They evaluated 3 anatomic components of the aorta: root, ascending and arch, and descending and thoracoabdominal aortic aneurysms. Results A smaller proportion of the statin group had adverse events: overall, 7% versus 15%; ascending and arch, 6% versus 15%; and descending and thoracoabdominal aortic aneurysms, 8% versus 20%. Also, a smaller proportion of statin patients required surgery: overall, 48% versus 60%; ascending and arch, 51% versus 62%; and descending and thoracoabdominal aortic aneurysms, 36% versus 59% (p <0.001 to 0.01). The protective effect of statins was seen in all segments, except the aortic root. Log-rank evaluation of the interval to an adverse event or surgery was longer among statin-treated patients (p <0.001). The protective effect of statins was seen in all segments, except the aortic root. Log-rank evaluation of the interval to an adverse event or surgery was longer among statin-treated patients (p <0.001). Logistic regression analysis found statin use, angiotensin receptor blocker use, and chronic obstructive pulmonary disease were associated with decreased adverse events, and statin use, angiotensin receptor blocker use, (beta)-blocker therapy, and age were associated with a decreased odds of requiring surgery. Multiple logistic regression analysis found only statins were associated with a decreased odds of an adverse event and that statins, coronary artery disease, and chronic obstructive pulmonary disease were associated with a decreased odds of undergoing surgery.
The efficacy of high dose and low dose Edoxaban, an oral factor Xa inhibitor, was compared to Warfarin in patients with high risk a-fib. The efficacy endpoint was stroke or systemic embolus, the safety endpoint was bleeding. Edoxaban was non-inferior to Warfarin for both doses in terms of efficacy, and was associated with reduced risks of bleeding and cardiovascular death.
The incidence of device thrombosis in HeartMate II VAD devices in 3 centers was investigated. 895 devices were implanted 2004-present. The incidence of device thrombosis increased from 2.2% in the earlier period to 8.4% in the past 2 years. During the same interval the time to thrombosis decreased from 18.6 mos to 2.7 mos. Elevated LDH levels presaged thrombosis. In patients who did not undergo device replacement or transplant after thrombosis, the mortality at 6 mos was 48%.
Short article describing the autopsy findings in the first patient to have a transcatheter valve implantation in the inferior vena cava for tricuspid insufficiency. Three months following implantation, the prosthesis remained in place and with normal appearances. Some interesting autopsy pictures can be found in the manuscript.
Systematic review article comparing surgical versus percutaneous revascularization for ischaemic heart disease in patients with unprotected left main disease (ULMD), diabetes, multivessel CAD or left ventricular dysfunction. The authors reinforce the idea that patients suffering with diabetes appear to do better with surgery. In patients with ULMD, multivessel disease, or left ventricular dysfunction, the type of therapy should be determined by the complexity of the lesions. Patients with SYNTAX score above 22 are better served with coronary artery bypass graft surgery, whereas in patients with a SYTAX score equal or below 22, percutaneous revascularization should be the first choice.