theheart.org - Interventional/Surgery

Wide variation in PCI for "unclear indications"

Wed, 08 Feb 2012 17:15:34 EST

The latest study on this subject has found that 17% of hospitals in a large US sample conducted at least one-fifth of their procedures in patients whose indications for the procedure were unclear.

PCI appropriateness criteria draw criticism

Wed, 08 Feb 2012 16:45:52 EST

A detailed critique of the national appropriate-use criteria for PCI—questioning the composition of the committee that wrote the criteria, some of the AUCs themselves, and the survey that compared the AUC with current clinical practice—has been published.

Braile Biom�dica launches transapical valve

Tue, 07 Feb 2012 16:30:12 EST

A Brazilian group says they're encouraged by the early results with their transapical transcatheter aortic valve.

SWITCH III: Bivalirudin is as safe as heparin after fondaparinux in PCI patients

Tue, 07 Feb 2012 12:30:10 EST

Recent studies have shown that ACS patients on fondaparinux prior to PCI should switch to another anticoagulant prior to the procedure to avoid thrombus. The SWITCH III trial compares bivalirudin and unfractionated heparin in a small group of these patients.

CTO, even in non-infarct-related artery, bodes ill in NSTEMI patients

Tue, 07 Feb 2012 09:45:51 EST

Swedish researchers examined SCAAR to determine the prognostic significance of a chronic total occlusion in an artery other than the infarct-related one of non-ST-elevation-MI patients.

ICDs charged with sex discrimination: Women get fewer shocks

Mon, 06 Feb 2012 17:00:00 EST

Differences in appropriate-therapy and device-related complication rates in a prospective study question (once again) whether women and men should have the same ICD-eligibility criteria.

MI-shock proposal is cold comfort: Hypothermia might boost survival

Mon, 06 Feb 2012 16:00:00 EST

Some data suggest therapeutic hypothermia might reduce the currently high mortality from cardiogenic shock; let's do the necessary clinical studies to see whether it might be true, urges a published viewpoint.

"Irrational" choices stall adoption of new antiplatelets

Mon, 06 Feb 2012 09:15:50 EST

Dr David Cohen points out some of physicians' potential "psychological" barriers to more rapid adoption of new antiplatelet agents, even though they may be the best choice for their patients.

"Tetherless" power-transmission technology could radically change LVAD therapy

Fri, 03 Feb 2012 11:00:14 EST

New wireless technology used to power implantable ventricular assist devices has the potential to make them far safer than ever before and bring the therapy to patients at earlier stages of heart failure than are currently recommended.

CMS draft of proposed coverage for TAVI

Fri, 03 Feb 2012 09:30:30 EST

The CMS has issued a draft of the conditions under which it will provide coverage for transcatheter aortic-valve replacements, as the technology begins to be rolled out in the US.

The flap over flavonoids

Thu, 02 Feb 2012 15:15:40 EST

The field of flavonoids and polyphenols continues to attract a massive amount of interest, from researchers and the public alike. But can health really be improved by eating chocolate and drinking red wine?

US "roadmap" for TAVI rollout published

Wed, 01 Feb 2012 15:00:32 EST

A new US expert-consensus document on transcatheter aortic-valve implantation aims to smooth the rollout of this new technology stateside.

Restenosis similar with carotid stenting or surgery: CREST

Wed, 01 Feb 2012 13:30:07 EST

At two years, carotid restenosis is infrequent and appears similar whether patients were treated with carotid stenting or endarterectomy.

"Valve-on-a-stick" transaortic TAVI offers alternative to transfemoral route

Tue, 31 Jan 2012 15:15:50 EST

A growing number of centers, especially in Europe, are trying a third route for transcatheter valve implants in select patients. Instead of threading the device from the femoral artery or up through the left ventricular apex, they're deploying it directly through the aorta.

PARTNER CAP data show transapical outcomes improve with practice

Tue, 31 Jan 2012 10:15:37 EST

Only 104 of the 799 high-risk patients in the PARTNER A trial of the Sapien transcatheter valve were treated with the transapical approach, so it can be considered to be only the preliminary experience with this technique. Now data from 822 patients in the continued-access protocol are available.

SYNTAX, FAME trials influence update to PCI/CABG appropriate-use criteria

Mon, 30 Jan 2012 17:35:39 EST

The document somewhat expands the appropriateness of PCI in some patients with left main coronary disease, among other indications.

Women do better after TAVI, hints small study

Mon, 30 Jan 2012 16:00:00 EST

The first foray into possible gender differences in presentation and outcome among patients undergoing TAVI for severe aortic stenosis hints that women may fare better than men after this procedure.

ASCERT: Better survival for CABG vs PCI in some high-risk patients

Mon, 30 Jan 2012 14:00:00 EST

The ASCERT study, a unique collaboration between the CMS, ACC, and STS, compares survival rates with bypass surgery and PCI in over 190�000 patients.

Surgeons insist TAVI reimbursement rollout won't be repeat of carotid-stenting debacle

Mon, 30 Jan 2012 09:00:55 EST

Now that the FDA has approved a transcatheter aortic valve, cardiac surgeons and cardiologists are working together to put all of their ducks in a row to secure national Medicare coverage for the procedure.

More data needed on carotid atherosclerosis, CMS advisers agree

Fri, 27 Jan 2012 12:30:43 EST

The Centers for Medicare & Medicaid Services' Medicare Evidence Development & Coverage Advisory Committee met to once again discuss the latest available evidence on different treatments of carotid atherosclerosis, and the only clear message was these questions remain a moving target.

Riata Summit insights: Vigilance key to following functional but "recalled" ICD leads

Fri, 27 Jan 2012 10:00:32 EST

UPDATED // Most attending the recent Riata ICD lead summit felt that fluoroscopic screening of Riata recipients was a reasonable thing to do, at odds with some recommendations; remote monitoring has its limits here, say VA data.

Proximal balloon superior to distal protection in carotid artery stenting

Thu, 26 Jan 2012 17:45:14 EST

Proximal balloon-occlusion devices do not cross the lesion before it is stented, which helps to significantly reduce embolic load in the brain during the carotid procedure, according to researchers.

Cardiologists flagging woeful patient care say they paid with their jobs

Wed, 25 Jan 2012 15:30:00 EST

An echocardiographer and cardiac surgeon who say their jobs were axed in retaliation after they lodged numerous complaints of substandard patient care at a county hospital in Santa Clara are suing some of their former bosses, including two other cardiologists. The plaintiffs also claim they suffered severe harassment as a result of expressing their concerns. The defendants' attorney says the case "is hotly disputed."

Pay for SGR repeal with war savings, say medical groups

Tue, 24 Jan 2012 15:45:34 EST

A letter to Rep Dave Camp from 110 medical societies admits that war savings from military pullbacks are a "budget gimmick" but says they could retire SGR debt, another budget gimmick.

PLATO: PPI analysis "raises flag" but should not change practice

Tue, 24 Jan 2012 13:00:47 EST

A new analysis of the PLATO study has found that use of a proton-pump inhibitor was independently associated with a higher rate of cardiovascular events but that this was apparent in both the ticagrelor and clopidogrel arms. The finding is likely due to confounding and should not precipitate any change in advice on this subject, says the lead author.

Cardiologists accused of defrauding Medicare by performing unnecessary cardiac procedures

Mon, 23 Jan 2012 16:30:18 EST

A new whistle-blower lawsuit filed in US District Court claims that five cardiologists from two medical practices in Erie, PA defrauded Medicare by performing unnecessary cardiac and vascular surgeries and interventional procedures between 2001 and 2005.

Gifts, pep talks have some success post-PCI and in hypertension

Mon, 23 Jan 2012 16:00:00 EST

Some of the first research showing that positive affect interventions—including phone calls to bolster self-affirming thoughts and small gifts—generate some success in post-PCI and hypertensive patients has been published. An editorialist describes the work as "innovative" and calls for many more studies of this kind.

"Recalled" Riata ICD leads: Brainstorming conference aims for guidance

Fri, 20 Jan 2012 13:30:08 EST

The lead failures can take years to manifest with inappropriate shocks or a variety of other issues, or they may not cause problems at all. There could be more agreement on how to manage the patients after today's Minnesota Heart Institute Riata ICD Lead Summit.

Lower mortality rates at two years with transradial PCI, Italian registry shows

Thu, 19 Jan 2012 16:45:25 EST

In a propensity-score-matching analysis, the mortality rate at two years was 8.8% among patients treated via the radial artery and 11.4% in the femoral-PCI patients, a statistically significance difference. Transradial PCI was also associated with a significantly reduced need for vascular surgery and blood transfusions.

FFR shows benefit in FAME II; enrollment halted

Wed, 18 Jan 2012 12:00:29 EST

An interim analysis of the FAME II study shows a significant benefit of fractional-flow-reserve-guided stenting plus optimal medical therapy over and above optimal medical therapy alone; as a result the data safety monitoring board has said no further patients should be randomized to medical therapy alone.

Contemporary look at VTE after joint surgery

Tue, 17 Jan 2012 16:00:00 EST

One in 100 patients who have knee-replacement surgery and one in 200 who undergo hip replacement will have a venous thromboembolic event in the hospital, despite receiving modern anticoagulant prophylaxis, a new review shows. These numbers will help inform patients and clinicians, say the authors, but an editorialist notes that to get a better picture, it will be necessary to look at a longer postsurgery time frame.

BRIDGE study published: Cangrelor suited for important antiplatelet niche

Tue, 17 Jan 2012 16:00:00 EST

The intravenous antiplatelet with a very short half-life is the ideal candidate for bridging patients on clopidogrel or other thienopyridines to surgery, the authors say.

Thoracic endoprosthesis gets traumatic transection approval

Mon, 16 Jan 2012 11:30:00 EST

The FDA has expanded approval for the Gore TAG Thoracic Endoprosthesis to include treatment of "life-threatening tears or ruptures of the aorta."

Resveratrol scientists react to Das fraud scandal: "Research will continue"

Fri, 13 Jan 2012 17:20:01 EST

As the controversy over the research fraud allegations against Dr Dipak Das enters its third day, researchers told heartwire what the news means for the field of resveratrol research and, more pressingly, an upcoming scientific meeting.

Red-wine researcher charged with photo-editing fraud

Fri, 13 Jan 2012 09:30:31 EST

A University of Connecticut investigation found Dr Dipak K Das guilty of falsifying and fabricating images that appeared in published research.

Serum potassium targets in acute MI need rethink, analysis suggests

Tue, 10 Jan 2012 16:00:00 EST

Recommendations to routinely raise serum potassium levels when ventricular arrhythmias are a concern may be based on outmoded data, according to authors of one of the largest analyses of its kind.

New DES best older stents for deaths, restenosis in latest SCAAR data

Tue, 10 Jan 2012 15:00:18 EST

The latest data from the Swedish registry that launched the international furor over stent thrombosis with drug-eluting stents is now providing reassuring data about the safety and efficacy of the latest generation of the devices.

Aortic stenosis grading system misses rare, high-risk group

Mon, 09 Jan 2012 17:00:00 EST

A new study has examined the clinical outcomes of asymptomatic aortic-stenosis patients classified by valve area plus flow-gradient patterns instead of the older, inherently inconsistent system based on separate area, gradient, and flow measurements.

Informed consent questioned in Florida patient's death after stem-cell treatment

Fri, 06 Jan 2012 14:15:42 EST

A Florida cardiologist is accused of malpractice after a patient treated with a novel stem-cell therapy died of a brain infarct.

MitraClip: Encouraging results in nonsurgical patients

Fri, 06 Jan 2012 10:00:00 EST

While the clip did appear to reduce mitral regurgitation and improve remodeling in patients unsuitable for surgery in the EVEREST II trial, problems with the comparator group make the results difficult to interpret.

RESPECT PFO/stroke trial completes enrollment

Wed, 04 Jan 2012 17:00:32 EST

After eight years of sluggish patient accrual, the RESPECT trial looking at the Amplatzer device for the prevention of cryptogenic stroke has finally collected enough events for the trial to be stopped.

Public Citizen requests recall of the Wingspan stent

Wed, 04 Jan 2012 16:15:25 EST

A consumer-advocacy group argues that the Wingspan Stent System provides less benefit and causes more harm than aggressive medical treatment alone.

Type 2 diabetes adds risk to tissue valves

Tue, 03 Jan 2012 17:15:47 EST

Type 2 diabetes is a known determinant of degeneration of both native and prosthetic valve implants, so a group of Italian researchers investigated whether bioprosthetic valves also degenerate faster in diabetic patients vs nondiabetic patients.

Bariatric surgery reduces CV events, but mechanisms remain a mystery

Tue, 03 Jan 2012 16:00:00 EST

The latest data from the Swedish Obese Subjects study show that bariatric surgery reduces the risk of cardiovascular events and CV death among obese individuals, compared with usual care. But weight loss is not the reason behind this reduced risk, meaning that guidelines that use BMI to determine who will get such surgery need updating, say the authors and an editorialist.

US leads in shorter hospital stays, early readmission after STEMI

Tue, 03 Jan 2012 16:00:00 EST

Patients with ST-segment-elevation MI were more likely to be hospitalized again within a month if they had been treated in the US, and American patients had the shortest initial hospitalization, in a retrospective study of data from an international trial. The work identifies national differences in this measure of care—30-day-readmission—and it should help guide future investigations, the authors say.

Enoxaparin prophylaxis doesn't cut mortality in acute-care setting

Fri, 30 Dec 2011 09:00:02 EST

Antithrombotic prophylaxis remains important in this group for other reasons, but don't expect it to necessarily prevent death, according to researchers.

Mayo report: It takes docs about 30 TAVIs to achieve proficiency

Thu, 29 Dec 2011 17:15:00 EST

Two new single-center studies shed light on the contemporary experience with new transcatheter aortic-valve systems. One looks at the "learning curve" required for operators to become proficient with the devices, and the other investigates how patient selection for these procedures has changed over time.

Analysis slams use of clopidogrel loss-of-function gene test; proponents fire back

Thu, 29 Dec 2011 15:30:00 EST

A new meta-analysis and especially an accompanying editorial argue against current use of CYP2C19 genotyping to define risk of subsequent CV events in patients considered for clopidogrel. Proponents of the test defend its use and describe what they see as flaws in the study.

Troponins at admission and three hours allow MI diagnosis or rule-out

Wed, 28 Dec 2011 18:30:00 EST

Troponin levels measured using a sensitive or highly sensitive assay can help with early MI rule-out, suggests a study that makes a case supporting the possible approval of the high-sensitivity assay in the US.

MR beats out SPECT in CE-MARC crossover trial

Fri, 23 Dec 2011 18:30:00 EST

UPDATED // The diagnostic accuracy of SPECT imaging for assessment of myocardial ischemia is variable and exposes patients to ionizing radiation, so evidence that magnetic resonance can be at least as accurate might make it an attractive alternative.

Congress postpones Medicare pay cut

Fri, 23 Dec 2011 09:30:15 EST

UPDATED // After the Senate had overwhelmingly approved the plan and a tumultuous few days among House Republicans, this morning Congress voted to put off a steep cut in Medicare physician reimbursements that was to take effect on January 1, 2012.

Combining wireless sensors and genomics for CVD prevention?

Mon, 19 Dec 2011 10:00:31 EST

Monitoring an individual's risk for MI in the future would ideally first take into account his or her genome sequence or other biomarkers and then might use an implanted nanosensor smaller than a grain of sand. In an excerpt from his new book, The Creative Destruction of Medicine, theheart.org's editor in chief offers a glimpse of what that might look like.

FDA approves AtriCure AF ablation system

Fri, 16 Dec 2011 15:15:00 EST

The FDA has approved the AtriCure Synergy Ablation System for the treatment of AF in patients undergoing open concomitant CABG surgery and/or valve replacement or repair.

Another Maryland doc charged with overstenting

Fri, 16 Dec 2011 11:45:00 EST

A member of the Maryland Health Care Commission committee, tasked with helping to prevent a repeat of the Dr Mark Midei case, is accused of the same type of inappropriate practice.

Riata ICD lead "alert" is now a class I recall

Fri, 16 Dec 2011 09:30:00 EST

The US FDA has designated a recent physician advisory letter relating to St Jude Medical's Riata family of ICD leads as a class I recall, the most serious. The letter, issued last month, warned doctors that more leads than it first thought were affected by a problem related to insulation failure.

AHA Statistics: New year, same trends

Thu, 15 Dec 2011 16:00:12 EST

The new annual update on the state of America's heart health is out and provides some encouraging news about outcomes while underscoring the severity of the country's problems with obesity and poor fitness.

AF following TAVI associated with higher risk of stroke

Wed, 14 Dec 2011 16:00:00 EST

A small study indicates that even a very short episode of AF following TAVI might be associated with an increased risk of stroke. The findings have implications for antithrombotic therapy after TAVI, say the authors and accompanying editorialists.

PCI at centers without on-site surgery backed by meta-analysis

Tue, 13 Dec 2011 16:00:00 EST

A new meta-analysis of over a million patients sheds more light on the benefits of allowing centers with no bypass-surgery capability to perform PCI, a practice that remains controversial.

Survey says: Most cardiologists support elective PCI sans on-site CABG�.�.�.�with caveats

Tue, 13 Dec 2011 08:00:00 EST

Is elective angioplasty without surgical backup on-site safe and effective enough for the US? Where would you send a family member? Sparks flew on both sides of the debate, as captured in a survey conducted jointly by theheart.org and US News & World Report.

"Striking" variation in PCI/CABG across Ontario hospitals

Mon, 12 Dec 2011 12:00:00 EST

A large study in Ontario has identified a threefold variation in the ratio of PCI to CABG, depending on which hospital a patient attends. The widest range was seen among those with multivessel disease, and the results indicate that proper, unbiased discussion with each patient is needed to determine the best course of treatment for each individual, say the authors and accompanying editorialists.