Epidemiology, Traditional and Novel Risk Factors in Coronary Artery Disease.

Coronary artery disease (CAD) mortality has been declining in the United States and in regions where health care systems are relatively advanced. Still, CAD remains the number one cause of death in both men and women in the United States, and coronary events have increased in women. Many traditional risk factors for CAD are related to lifestyle, and preventative treatment can be tailored to modifying specific factors.

Relation of frailty to outcomes after transcatheter aortic valve replacement (from the PARTNER trial).

Transcatheter aortic valve replacement (TAVR) is an effective treatment for severe symptomatic aortic stenosis (AS) in patients who are inoperable or at high risk for surgery. However, the intermediate- to long-term mortality is high, emphasizing the importance of patient selection. We, therefore, sought to evaluate the prognostic value of frailty in older recipients of TAVR, hypothesizing that frail patients would experience a higher mortality rate and a higher likelihood of poor outcome 1 year after TAVR.

Epidemiology, traditional and novel risk factors in coronary artery disease.

Coronary artery disease (CAD) mortality has been declining in the United States and in regions where health care systems are relatively advanced. Still, CAD remains the number one cause of death in both men and women in the United States, and coronary events have increased in women. Many traditional risk factors for CAD are related to lifestyle, and preventative treatment can be tailored to modifying specific factors.

Left main occlusion secondary to aortic root rupture following transcatheter aortic valve replacement managed by left main stenting.

Acute left main coronary occlusion secondary to a periaortic root hematoma secondary to annular rupture during transcatheter heart valve deployment is reported.

Rationale for minimally invasive pulmonary vein isolation and partial autonomic denervation for surgical treatment of atrial fibrillation.

We seek to demonstrate the rationale of a minimally invasive surgical approach to the treatment of atrial fibrillation which combines pulmonary vein antral isolation with targeted partial autonomic denervation. The literature supporting the rationale of this approach is reviewed. There is evidence-based literature that supports both pulmonary vein electrical isolation and targeted partial autonomic denervation in the treatment of atrial fibrillation.

Beating heart surgery: does it make a difference?

Beating heart techniques were introduced into coronary artery bypass graft (CABG) surgery in the mid 1990s in an attempt to decrease the complications associated with the use of cardiopulmonary bypass. Significant advances in technique and technology, including suction stabilizers and exposure devices, have now allowed all coronary vessels to be routinely approached without the support of cardiopulmonary bypass, while maintaining hemodynamic stability. Currently, approximately 25% of all CABG is performed without cardiopulmonary bypass in the United States.

Robotics and coronary artery surgery.

Significant progress in cardiac surgery, and specifically the surgical management of coronary artery disease, has been due in large part to enabling technology. Robotic systems have been recently developed and refined for use in cardiac surgery to facilitate, among other procedures, a totally endoscopic approach to coronary artery bypass surgery. These systems enhance precision through endoscopic approaches by specifically addressing the inherent limitations of conventional endoscopic coronary microsurgical instrumentation via computerized, digital interface, telemanipulation technology.

Improved outcomes in coronary artery bypass grafting with beating-heart techniques.

Objective: Although improved outcomes for selected patients by elimination of cardiopulmonary bypass have been demonstrated, a benefit for all patients undergoing coronary artery bypass grafting by all surgeons has yet to be definitively proved.

Methods: We reviewed our experience with beating-heart surgery from its inception in January 1995 through December 2000. A total of 12,540 patients underwent isolated coronary artery bypass grafting, including 1915 procedures (15%) performed without cardiopulmonary bypass.