Critical Issues in PCI : ” Left ” main cries foul . . . calls for “ Right ” thinkers ?

Conquering  left main disease is considered as crowning glory for the Interventional cardiologists. For over three decades , CABG has remained the undisputed modality which is being challenged  today. Fortunately, the Incidence of true isolated  left main disease is  low .(If Medina bifurcation subset is excluded)   With growing expertise , advanced hardware and Imaging ( like a 360 degree OCT fly through view ) one can virtually sit inside the left main and complete a PCI . Still , coronary care is much . . . much  . . . more than a technology in transit ! Most importantly, these complex PCIs require rigorous maintenance protocol  with meticulous platelet knockout drugs , patient compliance and the genetic fate of drug efficacy . (Clopidogrel has since entered the final laps of inefficiency while Ticagrelor has some more time I guess !) What is the current thinking  about  unprotected left main PCI ? Let us know it from real life experts ! Take Our Poll (function(d,c,j){if(!d.getElementById(j)){var pd=d.createElement(c),s;pd.id=j;pd.src='https://s1.wp.com/wp-content/mu-plugins/shortcodes/js/polldaddy-shortcode.js';s=d.getElementsByTagName(c)[0];s.parentNode.insertBefore(pd,s);} else if(typeof jQuery !=='undefined')jQuery(d.body).trigger('pd-script-load');}(document,'script','pd-polldaddy-loader')); For those answered , yes to  the above question please leave this page , as the following question might ...
Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: Tags: CABG Indications cardiac surgery Cardiology -Interventional -PCI cardiology -Therapeutics Cardiology -unresolved questions cardiology wisdom cath lab tips and tricks best option for left main disease left main pci or cabg precombat synta Source Type: blogs

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CONCLUSION: In patients with ULMCA disease, PCI was comparable with CABG for long-term MACCE and death rates. The TVR rate was higher in the PCI group. PMID: 31941834 [PubMed - as supplied by publisher]
Source: The Journal of Invasive Cardiology - Category: Cardiology Tags: J Invasive Cardiol Source Type: research
Publication date: Available online 16 January 2020Source: Progress in Neuro-Psychopharmacology and Biological PsychiatryAuthor(s): Minjing Shao, Chuanjun Zhuo, Xiangyang Gao, Ce Chen, Yong Xu, Hongjun Tian, Gongying Li, Deguo Jiang, Wenqiang WangAbstractImportanceIt has been suggested that patients with schizophrenia have higher than expected mortality following acute coronary events. However, the in-hospital revascularization rate in patients with schizophrenia and acute myocardial infarction (AMI) compared to mentally healthy patients remains unknown.ObjectiveTo evaluate the revascularization rate in schizophrenic patien...
Source: Progress in Neuro Psychopharmacology and Biological Psychiatry - Category: Psychiatry Source Type: research
We report recent trends and predictors of ACS hospitalisation LOS in New Zealand. METHODS: Using routine national hospitalisation datasets, we calculated mean LOS for ACS admissions annually from 2006 to 2016, by demographics, ACS subtype and ACS procedures (coronary angiography, percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG)). We also identified predictors of longer LOS. RESULTS: Among 185,962 ACS hospitalisations, mean LOS decreased from 7.8 to 6.7 days between 2006 and 2016 (adjusted decrease = -0.18 days/year). Decline in LOS was observed for all demographic subgroups by age...
Source: New Zealand Medical Journal - Category: General Medicine Tags: N Z Med J Source Type: research
A new 3-year analysis shows that repeat revascularization is more common after PCI than bypass surgery, but durability remains an issue for both strategies.Medscape Medical News
Source: Medscape Cardiology Headlines - Category: Cardiology Tags: Cardiology News Source Type: news
Accumulating evidence consistently demonstrates that blood transfusion in cardiac surgery is related to decreased short- and long-term survival. We aimed to evaluate periprocedural blood loss and transfusion r...
Source: Journal of Cardiothoracic Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Research article Source Type: research
Abstract BACKGROUND/OBJECTIVES: The increasing complexity of patients undergoing cardiac surgery requires extended myocardial ischaemic periods. Cardiac surgeons demand a cardioplegic solution with prolonged myocardial protection. Therefore, we introduced Custodiol in our centre in 2011. The aim of this study was to investigate the safety and efficacy of Custodiol compared with the standard method of cardioplegia. METHODS: Between 2011 and 2016, 188 adult patients who underwent mitral valve surgery combined with coronary artery bypass grafting were included in this retrospective study. In 113 patients, Custod...
Source: Perfusion - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Perfusion Source Type: research
ConclusionThis study did not show a clinically important increase in PaCO2 associated with higher SpO2 values in this specific population of obese patients after CABG. Partial pressure of carbon dioxide increased with liberal oxygen administration in almost half of the patients, but no predictive factor was identified.Trial registrationwww.clinicaltrials.gov (NCT02917668); registered 25 September, 2016.
Source: Canadian Journal of Anesthesia - Category: Anesthesiology Source Type: research
Thyroid storm is a rare, life-threatening disease triggered by an acute event or trauma, such as surgery of the thyroid or another area, and infection. However, recent studies have shown that irregular use or ...
Source: Journal of Cardiothoracic Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Case report Source Type: research
ConclusionSternal wire complications secondary to migration beyond the sternum are rare but potentially fatal. Precise wire location and risk assessment with CT are more appropriate when wire location cannot be clearly delineated by plain film radiography.
Source: Journal of Cardiac Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: CASE REPORT Source Type: research
ConclusionsCABG, including with the use of BIMA, can be performed in obese patients without an increased risk of mortality or hospital readmission out to 5 years. Although rates of postoperative DSWI increase with increasing BMI, this finding did not appear to be magnified in patients with BIMA, although the sample size was limited in this subanalysis. These data support the notion that BIMA use should not be precluded in the obese.
Source: Journal of Cardiac Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: ORIGINAL ARTICLE Source Type: research
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