Right ventricle-sparing left ventricular resection and replacement with a continuous-flow rotary blood pump: an in vivo experiment.

Despite recent advances in left ventricular assist device and total artificial heart technologies, these devices are still so large that they pose a significant problem in small patients with refractory heart failure. Excising the left ventricle while preserving the right ventricle--and then replacing the left ventricle with a mechanical pump--has been proposed as an alternative approach to this problem. We conducted a pilot study to evaluate possible surgical techniques and the hemodynamic effects of right ventricle-sparing left ventricular resection and replacement with a continuous-flow rotary blood pump in a healthy bovine model.

Contemporary treatment of unstable angina and non-ST-segment-elevation myocardial infarction (part 2).

In Part 1 of this review, we discussed how plaque rupture is the most common underlying cause of most cases of unstable angina/non-ST-segment-elevation myocardial infarction (UA/NSTEMI) and how early risk stratification is vital for the timely diagnosis and treatment of acute coronary syndromes (ACS). Now, in Part 2, we focus on the medical therapies and treatment strategies (early conservative vs early invasive) used for UA/NSTEMI. We also discuss results from various large randomized controlled trials that have led to the contemporary standards of practice for, and reduced morbidity and death from, UA/NSTEMI.

Difference in patient profiles and outcomes in Japanese versus American patients undergoing coronary revascularization (collaborative study by CREDO-Kyoto and the Texas Heart Institute Research Database).

Although coronary revascularization is common in both Japan and the United States (US), no direct comparison has been performed to demonstrate differences in the clinical characteristics and long-term outcomes of patients in these 2 countries. We analyzed the preprocedural, in-hospital, and long-term data from the Coronary Revascularization Demonstrating Outcome registry (Kyoto, Japan) and the Texas Heart Institute Research Database (Houston, Texas) of 16,100 patients who had undergone elective, initial percutaneous coronary intervention or coronary artery bypass grafting. The Japanese procedures were performed from 2000 to 2002 (n = 8,871, follow-up period 3.

Hypertrophic cardiomyopathy: from genetics to treatment.

Background: Hypertrophic cardiomyopathy (HCM) is the prototypic form of pathological cardiac hypertrophy. HCM is an important cause of sudden cardiac death in the young and a major cause of morbidity in the elderly.

Design: We discuss the clinical implications of recent advances in the molecular genetics of HCM.

Treatment of an infected pacemaker pocket with an antimicrobial envelope.

This article reports the successful treatment of an infected permanent pacemaker pocket after pulse generator replacement in an immunosuppressed patient by means of localized surgical revision of the pulse generator pocket and placement of a sustained-release combination antibacterial envelope in the revised pocket.

Video-assisted thoracoscopic versus open thoracotomy lobectomy in a cohort of 13,619 patients.

Background: Video-assisted thoracoscopic surgery (VATS) is becoming increasingly popular for lung resection in some centers. However, the issue of whether VATS or open thoracotomy is better remains controversial. We compared outcomes of open and VATS lobectomy in a national database.

Left main coronary artery originating from the proper sinus but with acute angulation and an intramural course, leading to critical stenosis.

Because of the variety of their anatomy and clinical implications, coronary anomalies tend to confuse many observers. Recently, our group and other investigators have proposed that only 1 specific type of anomaly, by means of a specific mechanism, is able to cause both symptoms of myocardial ischemia and sudden death. This anomaly is known as anomalous origin of a coronary artery from the opposite sinus of Valsalva, with intramural course (ACAOS).

Contemporary treatment of unstable angina and non-ST-segment-elevation myocardial infarction (part 1).

In this, the 1st part of a 2-part review, we discuss how plaque rupture is the most common underlying pathophysiologic cause of unstable angina and non-ST-segment-elevation myocardial infarction and how early risk stratification is vital in the timely diagnosis and treatment of acute coronary syndrome. Part 2 of this review (to be published in a later issue of this journal) will focus mainly on the various pharmacologic agents and treatment approaches (early invasive vs early conservative) to the management of unstable angina and non-ST-segment-elevation myocardial infarction.

Practical strategies for the management of anticoagulation therapy: unsolved issues in the cardiac catheterization laboratory.

Purpose: Percutaneous coronary intervention (PCI) is the preferred reperfusion strategy in the management of patients with ST-elevation myocardial infarction (STEMI) and higher-risk patients with unstable angina/non-STEMI (UA/NSTEMI). Recent updates have been issued for guidelines from the American College of Cardiology and American Heart Association delineating the appropriate use of anticoagulants as ancillary therapies to PCI. This manuscript reviews the recent clinical trial data supporting the updated guidelines and highlights remaining areas of uncertainty.

Lobectomy for pulmonary vein occlusion secondary to radiofrequency ablation.

Pulmonary vein stenosis, a recognized complication of transcatheter radiofrequency ablation in the left atrium, is often asymptomatic. Significant stenosis is commonly treated with percutaneous balloon dilation with or without stenting. We encountered a case of complete pulmonary vein occlusion that caused lobar thrombosis, pleuritic pain, and persistent cough.

Safe aortic arch clamping in patients with patent internal thoracic artery grafts.

In patients who have undergone coronary artery bypass with a left internal thoracic artery graft, clamping the aorta proximal to the left subclavian artery during descending thoracic and thoracoabdominal aortic aneurysm repair can precipitate major cardiac complications. Many centers use hypothermic circulatory arrest to obviate the need for aortic clamping in these cases. Herein, we describe the successful application of an alternative approach to this problem: performing left carotid-subclavian bypass before aneurysm repair.

Circadian body temperature variability is an indicator of poor prognosis in cardiomyopathic hamsters.

Background: Low body temperature is an independent predictor of poor prognosis in patients with congestive heart failure. The cardiomyopathic hamster develops progressive biventricular dysfunction, resulting in heart failure death at 9 months to 1 year of life. Our goal was to use cardiomyopathic hamsters to examine the relationship between body temperature and heart failure decompensation and death.

Risk-prediction models for mortality after coronary artery bypass surgery: application to individual patients.

Introduction: We derived a risk-assessment model for predicting mortality after coronary artery bypass surgery from patient data from the 1990s and examined the model's accuracy in predicting early mortality in more contemporary patients. We also examined the accuracy of a completely new model and an older model recalibrated with newer data.

Materials And Methods: Three mortality-prediction models were derived: an "old" model from 8959 patients treated during 1993-1999, a "new" model from 5281 patients treated during 2000-2004, and a version of the old model "recalibrated" with the 2000-2004 data.

Lipoprotein-associated phospholipase A2 as a novel risk marker for cardiovascular disease: a systematic review of the literature.

We sought to critically assess the role of lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) in the prediction of cardiovascular events in primary and secondary prevention settings. The inclusion criteria for our study included population-based epidemiologic studies and the presence of clinical outcomes of interest, including atherosclerotic disease, coronary events, stroke, and cardiovascular death. Studies that lacked clinical outcomes or that involved animals were excluded.

Endoluminal abdominal aortic aneurysm repair: the latest advances in prevention of distal endograft migration and type 1 endoleak.

Endovascular abdominal aortic aneurysm repair (EVAR) is an attractive alternative to open surgical repair. Distal endograft migration and type 1 endoleak are recognized to be the 2 main complications of EVAR. First-generation endografts had a stronger propensity for distal migration, modular component separation, thrombosis, and loss of structural integrity.

Differential bone marrow stem cell mobilization by G-CSF injection or arterial ligation in baboons.

Bone marrow stem cells (BMSCs) are mobilized in response to ischemic attacks, e.g. myocardial infarction, to repair the damage, or by cytokines, e.

Histopathologic correlates of myocardial improvement in patients supported by a left ventricular assist device.

Background: Left ventricular assist devices unload the failing heart and improve hemodynamic function and tissue architecture. In some patients improvement allows for left ventricular assist device removal. We retrospectively compared histologic features in patients who were weaned off left ventricular assist device support with those who remained on support without evidence of clinical remission.

Induced pulsation of a continuous-flow total artificial heart in a mock circulatory system.

Background: We studied the hemodynamic effects of inducing an artificial pulse in a continuous-flow total artificial heart consisting of 2 axial-flow pumps in a mock circulatory system.

Methods: We varied the amplitude (maximum minus minimum speed), beat rate and systolic duration of the left pump, right pump or both. Mean left and right pump speeds were maintained at 11 and 8 krpm, respectively.

Optimization of axial-pump pressure sensitivity for a continuous-flow total artificial heart.

Background: In this study, we describe the potential advantages of a continuous-flow total artificial heart (CFTAH) comprising two small, non-pulsatile pumps with optimized responsiveness to the pressure gradient.

Methods: We modified a MicroMed DeBakey axial-flow pump by increasing its inducer-impeller inlet angle, thereby increasing its pressure responsivity. We obtained the in vitro pressure gradient response and compared it with those of the clinically used, unmodified MicroMed DeBakey pump, Jarvik 2000 FlowMaker and HeartMate II.

Continuous-flow total artificial heart supports long-term survival of a calf.

The development and clinical use of continuous-flow left ventricular assist devices (LVADs) stimulated our interest in developing a total heart replacement with continuous-flow rotary blood pumps. We constructed a continuous-flow total artificial heart (CFTAH) from 2 HeartMate II axial-flow LVADs and used this CFTAH to replace the native heart of a calf. The purpose of this experiment was to study the effects of total continuous flow on physiologic parameters at rest and during exercise after the animal recovered from surgery.

Factors contributing to suboptimal vaccination against influenza: results of a nationwide telephone survey of persons with cardiovascular disease.

Vaccination against influenza averts cardiovascular events and is recommended for all patients with coronary heart disease. Because data were unavailable regarding vaccination rates among such patients' household contacts, we sought to estimate the rate of influenza vaccination in persons with cardiovascular disease and their contacts. In 2004, we conducted a random, nationwide telephone survey of 1,202 adults (age, > or = 18 yr) to ascertain knowledge, attitudes, and behaviors regarding influenza vaccination.

PROCLAIM: pilot study to examine the effects of clopidogrel on inflammatory markers in patients with metabolic syndrome receiving low-dose aspirin.

Metabolic syndrome is associated with intravascular inflammation, as determined by increased levels of inflammatory biomarkers and an increased risk of ischemic atherothrombotic events. Evidence suggests that atherothrombosis and intravascular inflammation share predictive biomarkers, including high-sensitivity C-reactive protein, CD40 ligand, P-selectin, and N-terminal pro-brain natriuretic peptide. Patients who had metabolic syndrome were randomized to receive clopidogrel 75 mg/day plus aspirin 81 mg/day (n = 89) or placebo plus aspirin 81 mg/day (n = 92) for 9 weeks to assess the efficacy of each treatment in suppression of inflammatory markers.

The utility of delayed-enhancement magnetic resonance imaging for identifying nonischemic myocardial fibrosis in asymptomatic patients with biopsy-proven systemic sarcoidosis.

Background: The pathophysiology of sarcoidosis includes infiltrative inflammatory injury, as well as interstitial fibrosis formation. Delayed-enhancement (DE) magnetic resonance imaging (MRI) techniques have been shown to identify fibrotic tissue as areas of hyperenhancement. To test the hypothesis that DE-MRI can be used to identify myocardial fibrosis resulting from cardiac sarcoidosis, we assessed this method in asymptomatic patients with biopsy-proven systemic sarcoidosis.