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Journal and News Scan
December 15, 2014
Submitted by: Joel Dunning
The CardioWest Total Artificial Heart (CW-TAH) is a pneumatically driven pump that completely replaces the patient’s native ventricles orthotopically. The device weighs 160 g and consists of two artificial ventricles, four Medtronic Hall tilting disk valves, two membranes, and two drivelines tunneled through the skin, which connect the ventricles to an external console generating pulsatile flow (1). At maximum stroke volume (close to 70 mL), it delivers a cardiac output between seven and nine litres per minute. Variations in cardiac output are determined by variations in venous return and peripheral resistance linked to the patient’s position and level of physical activity (2). The CW-TAH is indicated for use in patients with refractory cardiac failure as a bridge to transplantation, and when used for this indication, improves survival to transplant (3). Portable drivers have been approved in both Europe and the United States to allow stable patients to be discharged home while awaiting their transplant (4).
- Slepian MJ, Smith RG, Copeland JG. The Syncardia CardioWest Total Artificial Heart. In: Baughman KL, Baumgartner WA. eds. Treatment of Advanced Heart Disease. New York, NY: Taylor and Francis Group, 2006:473.
- Bellotto F, Compostella L, Agostoni P, et al. Peripheral adaptation mechanisms in physical training and cardiac rehabilitation: the case of a patient supported by a CardioWest total artificial heart. J Card Fail 2011;17:670-5. [PubMed]
- Copeland JG, Smith RG, Arabia FA, et al. Cardiac replacement with a total artificial heart as a bridge to transplantation. N Engl J Med 2004;351:859-67. [PubMed]
- Jaroszewski DE, Anderson EM, Pierce CN, et al. The SynCardia freedom driver: a portable driver for discharge home with the total artificial heart. J Heart Lung Transplant 2011;30:844-5. [PubMed]
December 13, 2014
Submitted by: Arie Blitz
This publication by the University of Louisville group provides an excellent comparative analysis of the outcomes after continuous-flow (CF) vs. pulsatile flow (PF) LVADs. Although the outcomes after CF LVAD implantation are clearly superior than those of PF LVADs, there are certainly unique morbidities after CF LVAD implantation. The authors argue that these differential outcomes beg the question: Should pulsatility algorithms be introduced in all contemporary CF LVADs?
December 13, 2014
Submitted by: Joel Dunning
We are in the wrong specialty !!
December 11, 2014
Submitted by: J. Rafael Sadaba
In this manuscript, the authors report on a retrospective study looking at the progression of aortic stenosis (AS) in 1558 patients with mild, moderate and severe AS and preserved left ventricular function. They conclude that the progression of severity depends significantly on the severity of the AS at baseline. Although the average rate of progression in AS mean gradient is slower than previously reported, a significant proportion of patients were observed to progress to higher grades of severity or AVR within the recommended time frames for echocardiographic follow-up. In this model, few clinical variables were associated with significantly accelerated progression: in patients with mild AS only age and gender and in patients with moderate AS renal disease and hyperlipidemia beyond age and gender.
December 11, 2014
Submitted by: Arie Blitz
In this Duke study, all CF LVAD implantations during the 2005 to 2013 era were analyzed, and those patients who underwent CF LVAD implantation and later replacement were reviewed. Two groups of patients were compared: those undergoing VAD replacement via a resternotomy approach (n=20) and those undergoing VAD replacement via a nonsternotomy approach (n=22). After VAD replacement, the latter group exhibited improved survival and reduced morbidity as compared to the former. Hence, it may be preferable to replace LVADs via a nonsternotomy approach if concomitant cardiac conditions do not need to be addressed.
December 11, 2014
Submitted by: Arie Blitz
Provocative study that analyzes lower body perfusion in a porcine model during cardiopulmonary bypass with an actuated IABP in place to effect pulsatile perfusion. Parameters of distal perfusion including measurement of pressures and microsphere perfusion indicate that flow distal to the balloon pump may be impaired.
December 10, 2014
Submitted by: Marcelo Jimenez
This interesting article summarizes the evidence from clinical, radiologic and pathologic investigations that lung cancer, specifically adenocarcinoma, may metastasize through the airways, defined as discontinuous spread of cancer cells from the primary tumor through the airways to adjacent or distant lung parenchyma. The presence of persistent or growing centrilobular nodules on CT images may be considered suspicious for aerogenous spread in patients with primary lung adenocarcinoma. This form of intrapulmonary metastasis would have significant implications in treatment and adds new opportunities in lung cancer research.
December 7, 2014
Submitted by: J. Rafael Sadaba
This manuscript reports on the findings of a meta-analysis of retrospective observational studies comparing clinical outcomes at 1-year in patients treated by either transfemoral (TF) or transapical (TA) transcatheter aortic valve implantation for sever aortic stenosis. Major vascular complications were more common in the TF group and 30-day hospital mortality was higher in the TA group. There were no significant differences at 1-year in all-cause mortality, incidence of myocardial infarction or incidence of stroke.
December 7, 2014
Submitted by: J. Rafael Sadaba
In this retrospective, multicentre study, the authors evaluate clinical outcomes in 139 patients with bicuspid aortic valves undergoing transcatheter aortic valve implantation (TAVI) with either a self or a balloon-expandable prosthesis. Short and intermediate clinical outcomes were encouraging, demonstrating the feasibility of TAVI in this group of patients. The mean finding was a high prevalence (28.4%) of post procedural more than grade II aortic regurgitation (AR). Nevertheless, when the measures for sizing had been obtained with multislice computed tomography, more than grade II AR was detected in 17.4% of the patients. No significant differences were found between self and balloon-expandable prosthesis.
December 7, 2014
Submitted by: J. Rafael Sadaba
In this prospective randomized study from the Cardiothoracic Trials Network Investigators, the authors compare the results between CABG alone and CABG plus mitral valve repair in 301 patients with ischemic moderate mitral insufficiency and coronary artery disease. In these patients, the addition of mitral valve repair with a rigid or semirigid complete annuloplasty ring to CABG, was not associated with greater improvement in the left ventricular end-systolic volume index (primary endpoint) at 1 year. There were also no significant differences between the groups in mortality, the composite end point of cardiac or cerebrovascular events, readmissions, or quality of life. There were more neurological events in the CABG plus repair group. The authors conclude that, at one-year follow up, there is no meaningful advantage in adding mitral valve annuloplasty in patients with moderate ischemic mitral insufficiency undergoing CABG.