Selection and management considerations to enhance outcomes in patients supported by left ventricular assist devices
Purpose of review Left ventricular assist devices (LVADs) are life-saving therapies for patients in end-stage heart failure (HF) with reduced ejection fraction regardless of candidacy for heart transplantation. Multiple clinical trials have demonstrated improved morbidity and mortality with LVADs when compared to medical therapy alone. However, the uptake of LVADs as a therapeutic option in a larger section of end-stage HF patients remains limited, partly due to associated adverse events and re-hospitalization. Recent Findings Accurate assessment and staging of HF patients is crucial to guide appropriate use of ...
Source: Current Opinion in Cardiology - October 8, 2022 Category: Cardiology Tags: SPECIAL COMMENTARIES Source Type: research

Transcatheter tricuspid valve intervention: to repair or to replace?
Purpose of review The burden of tricuspid regurgitation (TR) is high in the aging population, almost 4% in the age group over 75 have moderate or more TR. This carries a poor prognosis and an increased incidence of mortality, prolonged hospitalization, and rehospitalization in symptomatic patients with severe TR is observed. Percutaneous tricuspid valve intervention has emerged as a viable therapeutic option, with an increasingly large toolbox of both tricuspid repair and replacement devices. The optimal strategy, timing and patient selection for transcatheter intervention are yet to be determined. This review focuses ...
Source: Current Opinion in Cardiology - October 8, 2022 Category: Cardiology Tags: SPECIAL COMMENTARIES Source Type: research

Frequency and outcomes of periprocedural myocardial infarction in patients with chronic coronary syndromes undergoing percutaneous coronary intervention
Purpose of review Various definitions of periprocedural myocardial infarction (MI) have been proposed by academic groups and professional societies differing in terms of biomarker thresholds and ancillary criteria for myocardial ischemia. The incidence and clinical significance of periprocedural MI substantially varies according to the definitions applied. In this review, we summarize available clinical data on the frequency and outcomes of periprocedural MI according to various MI definitions in patients undergoing percutaneous coronary intervention (PCI). Recent findings Numerous clinical studies and meta-anal...
Source: Current Opinion in Cardiology - October 8, 2022 Category: Cardiology Tags: ISCHEMIC HEART DISEASE: Edited by Peter H. Stone Source Type: research

Myocardial infarction with nonobstructive coronary arteries: the need for precision medicine
Purpose of review Myocardial infarction with nonobstructive coronary arteries (MINOCA) represents about 6–8% of all patients with myocardial infarction (MI), and several pathophysiological mechanisms showed to be involved in this heterogeneous clinical condition. Of note, MINOCA proved to be associated with a significant risk of mortality, angina burden and socioeconomic costs. Recent findings Results from randomized clinical trials evaluating the clinical effectiveness of a comprehensive diagnostic algorithm, along with the acute and long-term management of patients with MINOCA, are pending. Summary In...
Source: Current Opinion in Cardiology - October 8, 2022 Category: Cardiology Tags: ISCHEMIC HEART DISEASE: Edited by Peter H. Stone Source Type: research

Is the world ready for the STICH 3.0 trial?
Purpose of review Coronary artery disease (CAD) is responsible for>50% of heart failures cases. Patients with ischemic left ventricular systolic dysfunction (iLVSD) are known to have poorer outcomes after percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) compared to patients with a normal ejection fraction. Nevertheless, (Source: Current Opinion in Cardiology)
Source: Current Opinion in Cardiology - October 8, 2022 Category: Cardiology Tags: CORONARY ARTERY SURGERY: Edited by Marc Ruel Source Type: research

How to deal with nonsevere stenoses in coronary artery bypass grafting – a critical perspective on competitive flow and surgical precision
Purpose of review For invasive treatment of coronary artery disease (CAD), we assess anatomical complexity, analyse surgical risk and make heart-team decisions for percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). With PCI, treating flow-relevant lesions is recommended, and reintervention easily treats disease progression. For CABG, some stenoses may only be borderline or nonsevere despite a clear surgical indication. As reoperations are not easy, the question on how to address these lesions has been around from the start, but has never satisfactorily been answered. Recent findings ...
Source: Current Opinion in Cardiology - October 8, 2022 Category: Cardiology Tags: CORONARY ARTERY SURGERY: Edited by Marc Ruel Source Type: research

It's not all about ISCHEMIA: the case for coronary artery bypass grafting in stable coronary artery disease
Purpose of Review The recent American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions Guidelines for Coronary Artery Revascularization have raised concerns on the survival benefits of coronary artery bypass grafting (CABG) over guideline-directed medical therapy (GDMT) in stable coronary artery disease (CAD) and appropriate conduit selection for CABG. This review summarizes the evidence supporting CABG for stable CAD and use of the radial artery as a conduit for CABG. Recent Findings CABG has consistently demonstrated a survival benefit over GDMT for pati...
Source: Current Opinion in Cardiology - October 8, 2022 Category: Cardiology Tags: CORONARY ARTERY SURGERY: Edited by Marc Ruel Source Type: research

Personalized external aortic root support in aneurysm disease
Purpose of review To bring together and annotate publications about personalised external aortic root support reported in the 18 months preceding submission. Recent findings The total number of personalised external aortic root support (PEARS) operations is now approaching 700 in 30 centres in Australia, Belgium, Brazil, Czech Republic, Great Britain, Greece, Ireland, Malaysia, Netherlands, New Zealand, Poland and Slovakia. There are continued reports of stability of aortic dimensions and aortic valve function with the only exceptions known being where the surgeon has deviated from the instructions for use of ...
Source: Current Opinion in Cardiology - October 8, 2022 Category: Cardiology Tags: DISEASES OF THE AORTA, PULMONARY AND PERIPHERAL VESSELS: Edited by Alan Braverman Source Type: research

Ascending aortic intramural hematoma: current concepts
Purpose of review Type A intramural hematoma (TAIMH) is an acute aortic disease characterized by the presence of hematoma in the aortic media and involving the ascending aorta. Open repair seems to be the first treatment approach, although recent evidence highlights that the best management of TAIMH is controversial. This review will focus on the current concept for TAIMH management and factors affecting the decision making. Recent findings Recent studies have evaluated the role of open and endovascular repair, as well as conservative management in patients with TAIMH. More specific imaging findings seem to affe...
Source: Current Opinion in Cardiology - October 8, 2022 Category: Cardiology Tags: DISEASES OF THE AORTA, PULMONARY AND PERIPHERAL VESSELS: Edited by Alan Braverman Source Type: research

Hybrid and endovascular approaches to the aortic arch
Purpose of review The gold standard treatment for aneurysms and dissections involving the aortic arch remains open total arch replacement. High-risk operative candidates may benefit from hybrid or completely endovascular techniques to reduce the risk of perioperative mortality and morbidity. Recent findings Numerous endografts are available for investigational use in the aortic arch as part of investigational device exemption (IDE) programs. Some are fenestrated or scalloped, whereas others are branched, ranging from single branch to triple branch stent-grafts. Initial results for completely endovascular repair ...
Source: Current Opinion in Cardiology - October 8, 2022 Category: Cardiology Tags: DISEASES OF THE AORTA, PULMONARY AND PERIPHERAL VESSELS: Edited by Alan Braverman Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Cardiology)
Source: Current Opinion in Cardiology - October 8, 2022 Category: Cardiology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Role of advanced imaging with cardiac computed tomography and MRI in atrial and ventricular ablation
Purpose of review Increasing evidence supports the use of advanced imaging with cardiac computed tomography (CCT) and cardiac magnetic resonance (CMR) in the work-up of patients with arrythmias being considered for ablation. Recent findings Advances in imaging technology and postprocessing are facilitating the use of advanced imaging before, during and after ablation in patients with both atrial and ventricular arrhythmias. In atrial arrythmias, quantitative assessment of left atrial wall thickness on CCT and quantification of late gadolinium enhancement (LGE) on CMR identify patients more likely to develop r...
Source: Current Opinion in Cardiology - August 15, 2022 Category: Cardiology Tags: SPECIAL COMMENTARIES Source Type: research

New concepts in heart failure with preserved ejection fraction and hypertension
Purpose of review Hypertension (HTN) remains the most common and strongest contributing factor to the development of heart failure with preserved ejection fraction (HFpEF). In this review, we aim to summarize the pathophysiological processes linking HTN to HFpEF and highlight novel concepts in medical and device-based management of HFpEF and HTN. Recent findings Despite the global increase in the prevalence of HFpEF, there has been limited benefit in current medication and device-based therapy for this complex syndrome. The hallmark of HFpEF is an elevated left intra-atrial and ventricular pressure and exertiona...
Source: Current Opinion in Cardiology - August 15, 2022 Category: Cardiology Tags: SPECIAL COMMENTARIES Source Type: research

Coronavirus disease 2019, hypertension, and renin–angiotensin–aldosterone system inhibitors
Purpose of review The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mostly uses the angiotensin-converting enzyme 2 (ACE-2) as cellular receptor for entering the host cells. Some, but not all, animal studies have shown that renin–angiotensin–aldosterone system (RAAS) inhibitors can increase ACE-2 expression. On that premise, it was hypothesized that these agents could make it more likely to develop coronavirus disease 2019 (COVID-19). On the other hand, there was also evidence that being on these agents could lessen the severity of the lung injury in patients with severe SARS-CoV-2 infection. Herein,...
Source: Current Opinion in Cardiology - August 15, 2022 Category: Cardiology Tags: SPECIAL COMMENTARIES Source Type: research

The potential of CRISPR-Cas9 prime editing for cardiovascular disease research and therapy
Purpose of review The ability to edit any genomic sequence has led to a better understanding of gene function and holds promise for the development of therapies for genetic diseases. This review describes prime editing - the latest CRISPR-Cas9 genome editing technology. Prime editing enables precise and accurate genome editing in terminally differentiated, postmitotic cells like cardiomyocytes, paving the way for therapeutic applications for genetic cardiomyopathies. Recent findings Prime editing has been used to precisely insert up to 40 bases, create deletions up to 80 base pairs, and can perform all 12 possib...
Source: Current Opinion in Cardiology - August 15, 2022 Category: Cardiology Tags: SPECIAL COMMENTARIES Source Type: research