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Journal and News Scan
Yang JH et al. – Limited data are available on comparing the clinical outcomes of coronary artery bypass grafting (CABG) and drug–eluting stent (DES) implantation in patients with reduced left ventricular systolic function in the DES era. DES implantation provides comparable long–term clinical outcomes, except for repeat revascularization, to CABG in patients with coronary artery disease and chronic left ventricular systolic dysfunction.
From January 2003 to December 2010, 953 patients with reduced left ventricular systolic function, defined as a left ventricular ejection fraction <50%, who had undergone percutaneous coronary intervention with DESs (n = 402) or CABG (n = 551) were enrolled in a retrospective, observational registry.
After propensity score matching, the long-term cumulative rate of death was not significantly different between the 2 groups (DES vs CABG 21.3% vs 19.1%; adjusted hazard ratio 1.23, 95% confidence interval 0.57 to 2.66, p = 0.603). However, the rate of major adverse cardiac and cerebrovascular events (35.5% vs 24.1%, adjusted hazard ratio 1.69, 95% confidence interval 1.04 to 2.77, p = 0.036) was higher in the DES group than the CABG group. This was driven by the higher incidence of repeat revascularization in the DES group (11.3% vs 4.3%, adjusted hazard ratio 3.65, 95% confidence interval 1.01 to 10.37, p = 0.018). In conclusion, DES implantation provides comparable long-term clinical outcomes, except for repeat revascularization, to CABG in patients with coronary artery disease and chronic left ventricular systolic dysfunction.
Association between early surgical intervention vs watchful waiting and outcomes for mitralregurgitation due to flail mitral valve leaflets.
In this retrospective study the authors compare the outcomes between early surgery and watchful waiting in a large group of patients with mitral regurgitation due to flail mitral leaflets and without class I indication for surgery. Those patients who underwent early surgery had lower long term mortality and heart failure risk. There were no differences in the short term outcomes.
Aspirin should be added to anticoagulation for patients with prosthetic heart valves - a cochrane review
. – Patients with prosthetic heart valves are at increased risk for valve thrombosis and arterial thromboembolism. Oral anticoagulation alone, or the addition of antiplatelet drugs, has been used to minimise this risk. An important issue is the effectiveness and safety of the latter strategy. This is an update of our previous review; the goal was to create a valid synthesis of all available, methodologically sound data to further assess the safety and efficacy of combined oral anticoagulant and antiplatelet therapy versus oral anticoagulant monotherapy in patients with prosthetic heart valves. Adding antiplatelet therapy, either dipyridamole or low–dose aspirin, to oral anticoagulation decreases the risk of systemic embolism or death among patients with prosthetic heart valves. The risk of major bleeding is increased with antiplatelet therapy. These results apply to patients with mechanical prosthetic valves or those with biological valves and indicators of high risk such as atrial fibrillation or prior thromboembolic events. The effectiveness and safety of low–dose aspirin (100 mg daily) appears to be similar to higher–dose aspirin and dipyridamole. In general, the quality of the included trials tended to be low, possibly reflecting the era when the majority of the trials were conducted (1970s and 1980s when trial methodology was less advanced).
Middle-aged people with hidden heart disease may gain protection from flu vaccination, researchers reveal today.
A study has found that receiving vaccination halves the risk of heart attacks in people over the age of 50 with narrowed arteries.
Australian researchers say their findings may show that flu is a clinically important factor in the risk of heart attack.
Researchers compared 275 patients who suffered a heart attack with another 284 who had not.
The study found no link between suffering flu and having a heart attack - but they did find that being vaccinated was linked to a 45% reduced risk of suffering a heart attack.
Writing in the journal Heart, the researchers call for flu vaccination programmes to be extended to people over the age of 50.
Researcher Professor Raina Macintyre, of the University of New South Wales, Sydney, Australia, writes: "As such, even a small effect of influenza vaccination in preventing heart attacks may have significant population health gains."
Cardioprotective and prognostic effects of remote ischaemic preconditioning in patients undergoing coronary artery bypass surgery: a single-centre randomised, double-blind, controlled trial
Patients undergoing first time CABG using CPB were randomized to remote ischemic preconditioning (left upper arm) or control after induction of anesthetic. The metric was myocardial injury measured by troponin levels during the first 3 postop days. Preconditioning resulted in lower troponin levels and in lower operative mortality.
Interesting case report of a patient with previous triple valve replacement who underwent a transfemoral implantation of a 29-mm Edwards SAPIEN XT percutaneous valve into a failing tricuspid valve bioprosthesis.
Predictive Factors, Management and Clinical Outcomes of Coronary Obstruction Following Transcatheter Aortic Valve Implantation: Insights from a Large Multicenter Registry
A multicenter TAVI registry that included nearly 6,700 patients identified 44 who suffered coronary obstruction following TAVI. This complication was associated with older age, female sex, no prior CABG, and use of a balloon-expandable valve. 30-day mortality was 41%. The left coronary artery was most commonly affected, and patients were at increased risk who had lower mean ostial height and smaller sinus diameters.
This survey of healthcare workers at a German university clinic explored attitudes towards complementary and alternative medicine (CAM). Women were more interested than men (80% vs 20%) and nurses were more interested than physicians (72% vs 57%). Physicians had more concern than nurses about possible adverse effects (52% vs 12%). Almost 3 out of 4 did not feel adequately informed about CAM.
- Recommendations for implementing professionalism and quality policies
- Opportunities to translate current communication and teamwork knowledge into clinical practice
- Recommendations for future action and research opportunities in the physical and safety culture of the OR
Unfortunately , there are lots of stories like this around at the moment. He didn't undergo surgery, he had a stent.