Invasive Treatment Strategy for Older Patients with Myocardial Infarction.

Background: Whether a conservative strategy of medical therapy alone or a strategy of medical therapy plus invasive treatment is more beneficial in older adults with non-ST-segment elevation myocardial infarction (NSTEMI) remains unclear.

Methods: We conducted a prospective, multicenter, randomized trial involving patients 75 years of age or older with NSTEMI at 48 sites in the United Kingdom. The patients were assigned in a 1:1 ratio to a conservative strategy of the best available medical therapy or an invasive strategy of coronary angiography and revascularization plus the best available medical therapy.

The assessment of aortic stenosis: echocardiography and beyond.

Aortic stenosis is the most common primary valve problem. This article describes its assessment and clinical interpretation using echocardiography and also shows how magnetic resonance, cardiac computed tomography and stress testing may be useful.

Minimally Invasive Versus Conventional Aortic Valve Replacement: A Propensity-Matched Study From the UK National Data.

Objective: Minimally invasive aortic valve replacement (MIAVR) has been demonstrated as a safe and effective option but remains underused. We aimed to evaluate outcomes of isolated MIAVR compared with conventional aortic valve replacement (CAVR).

Methods: Data from The National Institute for Cardiovascular Outcomes Research (NICOR) were analyzed at seven volunteer centers (2006-2012).

The rapid access chest pain clinic: unmet distress and disability.

Aims: To determine the characteristics, clinical needs and level of health-care use of patients with non-cardiac (NCCP) and cardiac-chest pain (CCP) attending a Rapid Access Chest Pain Clinic in an inner-London Hospital.

Methods: A cross-sectional comparison of NCCP and CCP patients on measures of pain, mood, beliefs, somatic symptoms and use of services completed by patients attending the Rapid Access Chest Pain Clinic over an 18-month period.

Results: There were no significant differences between NCCP and CCP patients in terms of chest pain frequency, duration or severity or associated distress; however, NCCP were younger (53 vs.

Theoretical treatise: arterial pressure during aortic surgery.

The optimum arterial perfusion pressure during cardiopulmonary bypass (CPB) remains uncertain. A correlation in some form with the patients' resting pressure almost certainly exists. Temperature and hematocrit affect blood viscosity.

Heparin therapy during extracorporeal circulation: deriving an optimal activated clotting time during cardiopulmonary bypass for isolated coronary artery bypass grafting.

Bull's seminal work on heparin therapy during cardiopulmonary bypass (CPB) was carried out over 30 years ago and has not been updated in the modern era. No correlation with postoperative blood loss was performed. The optimal activated clotting time (ACT) with regard to blood loss has not been established for patients undergoing CPB.

Lissajous figures: an engineering tool for root cause analysis of individual cases--a preliminary concept.

Some patients have short intensive care stay periods and little or no organ dysfunction after cardiac surgery and others do not despite seemingly faultless surgery, perfusion, and anesthesia. These "unknown" reasons for death and morbidity usually relate to organ ischemia and inflammation, but are obviously mutlifactorial. A Lissajous figure is a technique in electrical engineering to compare two different electrical signals.

Patient directed bypass: cooling for aortic surgery--a preliminary concept.

No consensus exists as to the temperature to cool to on bypass for surgery involving the aortic arch. Excluding normothermic surgery, which is rarely performed for arch work, circulatory arrest, anterograde, and retrograde cerebral perfusion either in isolation or in combination remain the techniques of "cerebral protection." To date, no account of individual patient body or cerebral function variation is involved.

Low-impact scenarios may account for two-thirds of blunt traumatic aortic rupture.

Background: Traditionally, blunt traumatic aortic rupture (BTAR) is thought to be a high-velocity injury. It was hypothesised that BTAR has a higher than suspected incidence in low-speed accidents, with unique kinematic and demographic risk factors.

Methods: Using the UK Cooperative Crash Injury Study (CCIS) framework, impact profiling was undertaken for accidents involving BTAR.

Patient directed perfusion pressure on bypass, an analogy from electrical engineering--a new concept.

Organ ischemia, particularly mesenteric and renal, can occur despite a seemingly adequate perfusion flow and pressure during a period of cardiopulmonary bypass. The blood pressure to run bypass at remains a contentious issue. We present the concept that perfusion pressure during cardiopulmonary bypass should be patient specific, depending on an individual's resting pre-procedural blood pressure.

Preoperative hyponatremia and cardiopulmonary bypass: yet another factor for cerebral dysfunction?

Hyponatremia is common in patients prior to cardiopulmonary bypass (CPB), usually secondary to diuretic therapy. Rapid correction of chronic hyponatremia, which potentially occurs on commencing CPB, may in susceptible patients result in central pontine myelomatosis. There are three parts to this study.

Late-acquired stent malapposition after sirolimus-eluting stent implantation following acute coronary syndrome: angiographic, IVUS, OCT and coronary angioscopic observation.

Drug-eluting stents (DES) have been shown to significantly reduce the incidence of restenosis and target lesion revascularization in a wide variety of clinical situations. DES have also been shown to significantly reduce neointimal hyperplasia as compared to bare-metal stents. However, the antiproliferative properties of DES also delay vascular healing and have been associated with stent malapposition, hypersensitivity reactions and late stent thrombosis.

Mechanisms of glucose intolerance in cystic fibrosis.

Aims: Although cystic fibrosis-related diabetes (CFRD), a poor prognostic factor in cystic fibrosis (CF), is characterized by insulinopenia, the role of insulin resistance is unclear. Using a prospective study design, we measured insulin resistance, pancreatic beta-cell function and correlated glycaemic status with clinical parameters.

Methods: Oral glucose tolerance test was performed in 60 stable adult CF patients.

Effect of foreign surface pacification with albumin, aprotinin, propofol, and high-density lipoprotein.

Foreign surface pacification may significantly reduce the detrimental effects of the cardiopulmonary bypass (CPB) circuit. To date, albumin is the only intervention consistently shown to be beneficial. The cationic physical properties of aprotinin and the known negative charge on the plastic CPB circuit mean that aprotinin binds to the CPB circuit and membrane oxygenator.

Hypertonic cardiopulmonary bypass primes and endothelial damage.

The objective of this study was to investigate whether hypertonic hyperosmolar primes solution (HHPS), with an osmolarity of 2300 mOsmol/L, causes endothelial damage/loss. The bodies' normal osmolarity is -280 mOsmol/L. Aortic endothelial cells were cultured and plated to confluence, confirmed by light microscopy, on a 96-well plate.

Clinical outcomes after percutaneous coronary intervention involving very long segments of drug-eluting stent implantation: single-center experience.

Background: Data on effectiveness and safety following the implantation of very long segments of drug-eluting stents (DES) are lacking.

Aim: To describe our experience of consecutive patients undergoing implantation of very long segments of DES (> 50 mm) in de novo coronary lesions.

Methods: We evaluated major in-hospital complications, target lesion revascularization (TLR) rates and long-term outcomes in 88 consecutive patients (91 procedures) who underwent a single-vessel intervention with implantation of > 50 mm of overlapping DES to de novo lesions between October 2002 and October 2007.

Cardiac comorbidity is not a risk factor for mortality and morbidity following surgery for primary non-small cell lung cancer.

Objective: We examined the effect of cardiac comorbidity on mortality and postoperative complications following surgery for primary non-small cell lung cancer.

Methods: Between October 2001 to December 2005, 1067 consecutive patients underwent lung resection for primary cancer within a single centre; patient data was collected prospectively. Two hundred and seventy-one patients had a history of cardiac comorbidity, which included 196 angina, 118 myocardial infarction, 36 revascularisation, 10 congestive cardiac failure and 19 rhythm disorders (numbers not mutually exclusive).

Is it safe to discharge patients from accident and emergency using a rapid point of care Triple Cardiac Marker test to rule out acute coronary syndrome in low to intermediate risk patients presenting with chest pain?

Purpose: To determine whether patients presenting with chest pain who are at low to intermediate risk for ACS can safely be discharged from Accident and Emergency using Triple Cardiac Marker [TCM] [CK-MB, myoglobin, troponin I] without increasing risk and cost effective use of coronary care facilities.

Methods: Retrospective review of consecutive patients presented to A&E between Dec 2003 and July 2004 was performed and these patients were prospectively followed for six months for future coronary events and hospital admissions. A total of 325 patients presented to A&E with chest pain that were at low to intermediate risk for ACS.

The whole nine yards: multiple cardiac surgical and percutaneous interventions in a patient during 30 years of care.

A 38-year-old man underwent coronary artery bypass graft surgery for angina pectoris following myocardial infarction. During the following 28 years, he required two repeat coronary artery bypass graft surgical procedures, nine percutaneous coronary interventions and 17 coronary angiograms. His treatment included saphenous vein, left internal mammary artery and gastroepiploic artery grafting, percutaneous transluminal coronary angioplasty and intragraft thrombolytic therapy, directional coronary atherectomy, cutting balloon angioplasty, intracoronary stenting with bare-metal and drug-eluting stents, treatment for in-stent restenosis, stenting of the left main and circumflex coronary arteries and saphenous vein graft as well as intracoronary pressure wire diagnostics.

Late outcomes after drug-eluting stent implantation in "real-world" clinical practice.

Background: We report the late outcomes in 411 consecutive patients undergoing drug-eluting stent (DES) implantation by a single operator between 2003-2006.

Methods: Prospective registry with continuous follow up. Patients with stable angina (SA) or acute coronary syndrome (ACS) received DES for long lesions, small vessels, chronic total occlusion, bifurcation, aorto-ostial, left main, post atherectomy or saphenous vein graft lesions, multivessel/multilesion single-vessel (V) disease, in-stent restenosis (ISR) or diabetes.

Transmission of Pseudomonas aeruginosa epidemic strain from a patient with cystic fibrosis to a pet cat.

Chronic infection with Pseudomonas aeruginosa is common in cystic fibrosis (CF) and certain strains are more transmissible and virulent than others. Of these, the Liverpool Epidemic Strain (LES) is highly transmissible and cross infection has been reported between patients with CF and healthy non-CF relatives. However, the risk of transmission from humans to animals is unknown.

The radial approach: is this the route to take?

The benefits of the transradial approach have clearly been demonstrated over the years in various studies. The reduced incidence of access site complications and early mobilization are some of the benefits making this technique popular with interventional cardiologists worldwide. With increasing experience and availability of dedicated equipment this technique is now been increasingly used for complex catheter interventions.

Circumstances and mode of in-hospital death following 9,914 consecutive patients undergoing percutaneous coronary interventions in the northwest of England.

Aim: To better describe the epidemiological causes of in-hospital death after percutaneous coronary intervention (PCI) in the present stent era.

Methods: Systematic review of all in-hospital deaths following PCI in North West England from 2001 to 2003. Sixty-two in-hospital deaths (0.

Attenuation of receptor-dependent and -independent vasoconstriction in the human radial artery.

Background: Vasodilator strategies used to treat bypass grafts in the operating theatre, such as nitrates, phosphodiesterase inhibitors and calcium channel antagonists have a broad but short-lived effect against a variety of vasoconstrictor stimuli. Treatments that react irreversibly with proteins modulating vasoconstriction have the advantage that their effects can last well into the postoperative period. In addition systemic effects are avoided as the treatment is localised to the treated graft.

The utility of intrapleural instillation of autologous blood for prolonged air leak after lobectomy.

Purpose Of Review: Air leak after pulmonary lobectomy is a relatively common problem, which when persistent can be a cause of other postoperative morbidity as well as contributing to extended hospitalization. A number of methods have been proposed to prevent and treat air leakage, but none have proved incontrovertibly effective. This article reviews the practice of using autologous blood as an effective technique to treat postoperative air leaks after lobectomy.