Mechanical circulatory support in cardiogenic shock
Purpose of review
Cardiogenic shock remains a complex clinical syndrome with high morbidity and mortality. The purpose of this article is to review important landmark trials as well as the relevant recent literature for percutaneous mechanical circulatory support following acute myocardial infarction.
Recent findings
The sole use of intraaortic balloon pumps for cardiogenic shock following acute myocardial infarction continues to be questioned with downgrading of its recommendation in recent years, there however may remain a role in patients with mechanical complications of their myocardial infarction. The combined us...
Source: Current Opinion in Cardiology - February 6, 2020 Category: Cardiology Tags: HEART FAILURE: Edited by Haissam Haddad Source Type: research
The risk and prevention of sudden death in patients with heart failure with reduced ejection fraction
Purpose of review
Patients with heart failure are at increased risk of sudden cardiac death. The methods to predict patients at high risk of sudden cardiac death in heart failure are neither sensitive nor specific; both overestimating risk in those with ejection fractions less than 35% and not identifying those at risk with ejection fractions greater than 35%.
Recent findings
The absolute risk of sudden cardiac death in patients with heart failure have decreased over the past 20 years. New novel tools are being developed and tested to identify those at higher risk of sudden cardiac death. Reduction in the risk of sudd...
Source: Current Opinion in Cardiology - February 6, 2020 Category: Cardiology Tags: HEART FAILURE: Edited by Haissam Haddad Source Type: research
Iron deficiency in heart failure: getting to the guidelines
Purpose of review
Iron deficiency is a common condition affecting approximately 50% of patients with heart failure. The purpose of this review is to explore the impact of iron deficiency on patients’ quality of life and outcomes. Moreover, how intravenous replacement, even in the absence of anemia, can improve these outcomes.
Recent findings
The role of iron deficiency anemia has long been a part of assessing reversible and treatable contributors to patients’ symptoms in heart failure. Recent studies have demonstrated how vital identifying not only anemic patients but those who are iron deficient without anemia, m...
Source: Current Opinion in Cardiology - February 6, 2020 Category: Cardiology Tags: HEART FAILURE: Edited by Haissam Haddad Source Type: research
Modes of bioprosthetic valve failure: a narrative review
Purpose of review
A thorough understanding of the modes of bioprosthetic valve failure is critical as clinicians will be facing an increasing number of patients presenting with failed bioprostheses in coming years. The purpose of this article is to review modes of bioprosthestic valve degeneration, their management, and identify gaps for future research.
Recent findings
Guidelines recommend monitoring hemodynamic performance of prosthetic valves using serial echocardiograms to determine valve function and presence of valve degeneration. Modes of bioprosthetic valve failure may be categorized as structural degeneration...
Source: Current Opinion in Cardiology - February 6, 2020 Category: Cardiology Tags: VALVULAR HEART DISEASE: Edited by Subodh Verma and Bobby Yanagawa Source Type: research
Speckle tracking echocardiography: imaging insights into the aorta
Purpose of review
Pathophysiologic changes of aortic tissue may not always manifest as aneurysms, nor does the size of an aneurysm necessarily represent the severity of tissue abnormality – approximately 40% of patients who present with dissection have aortic diameters below criteria recommended for surgical resection. Noninvasive imaging-based quantification of aortic biomechanics has the potential to improve our knowledge of the pathophysiology of aortic disease, including patient-specific risk-stratification and intraoperative surgical decision-making.
Recent findings
We summarize the current state of clinical ut...
Source: Current Opinion in Cardiology - February 6, 2020 Category: Cardiology Tags: VALVULAR HEART DISEASE: Edited by Subodh Verma and Bobby Yanagawa Source Type: research
Surgical management of mitral annular calcification
Purpose of review
The aim of the article is to discuss different therapeutic options for patients with severe mitral valve dysfunction because of mitral annular calcification (MAC), including mitral valve repair, conventional mitral valve replacement, percutaneous transcatheter mitral valve replacement (TMVR), and hybrid procedures.
Recent findings
Optimal management of severe mitral valve disease because of MAC remains challenging. Various ‘resect’ or ‘respect’ repair strategies have been standardized and are applicable in eligible patients. Mitral valve replacement with a standard surgical bioprosthesis is o...
Source: Current Opinion in Cardiology - February 6, 2020 Category: Cardiology Tags: VALVULAR HEART DISEASE: Edited by Subodh Verma and Bobby Yanagawa Source Type: research
Is there a problem with respect? Risk of neochordal rupture
Purpose of review
In this review, we summarize the history of mitral valve repair, discuss the broad principles of neochord preparation and implantation, and highlight comparative outcomes between mitral valve repair strategies while focusing on the risk of neochordal rupture.
Recent findings
There have been several recent studies comparing outcomes been leaflet-resection and nonresection, neochord-based mitral valve repair. Operative mortality was very low regardless of repair strategy; however, the rate of mitral valve reoperation is lower in those that undergo a neochord-based repair with overall lower mean mitral ...
Source: Current Opinion in Cardiology - February 6, 2020 Category: Cardiology Tags: VALVULAR HEART DISEASE: Edited by Subodh Verma and Bobby Yanagawa Source Type: research
Valve sparing root replacement: an update
Purpose of review
Until the year 2000, the publications concerning aortic valve sparing (AVS) did not exceed 20 articles; in the following years almost 300 publications have appeared. Over 35 years from the introduction of valve sparing techniques and 500 years after the death of Leonardo da Vinci, this review highlights the significant steps in modern imaging techniques and the excellent clinical results in the field of reconstructive aortic root surgery.
Recent findings
AVS operations underwent significant modifications over the last few years making it reproducible with satisfactory outcomes. The extraordinary pote...
Source: Current Opinion in Cardiology - February 6, 2020 Category: Cardiology Tags: VALVULAR HEART DISEASE: Edited by Subodh Verma and Bobby Yanagawa Source Type: research
Diagnosis and management of low-flow, low-gradient aortic stenosis
This article summarizes current guidelines and best practices for the management of low-flow, low-gradient aortic stenosis.
Summary
Low-flow, low-gradient aortic stenosis is a difficult entity to diagnose and treat. Various diagnostic modalities are needed to accurately determine the severity of aortic stenosis and potential treatment benefit. True-severe classical and paradoxical low-flow, low-gradient aortic stenosis can be distinguished from pseudo-severe aortic stenosis by dobutamine stress echocardiography and/or multidetector computed tomography. Once the distinction is made, aortic valve replacement results in be...
Source: Current Opinion in Cardiology - February 6, 2020 Category: Cardiology Tags: VALVULAR HEART DISEASE: Edited by Subodh Verma and Bobby Yanagawa Source Type: research
Editorial introductions
No abstract available (Source: Current Opinion in Cardiology)
Source: Current Opinion in Cardiology - February 6, 2020 Category: Cardiology Tags: EDITORIAL INTRODUCTIONS Source Type: research
Screening for prevention of sudden death in the young: what is new?
Purpose of review
The optimal approach to screening young people to decrease the risk of sudden death remains unknown. It deserves the passionate attention that researchers, clinicians and families have given it. The new data from January 2018 to July 2019 are reviewed here.
Recent findings
Cardiac findings associated with a risk of sudden death were reported in 0.4% of screened athletes. Well run programs continue report varying sensitivity for screening ECGs (between 86 and 100%). One major article reported a higher incidence of sudden death in young people than has been previously published (6.8/100 000 athletes)...
Source: Current Opinion in Cardiology - January 1, 2020 Category: Cardiology Tags: PEDIATRICS: Edited by Mitchell Cohen Source Type: research
Cardiac surgical missions: what works, what does not, where we need to go from here
Purpose of review
Although overall neonatal and infant mortality continues to decrease around the world, years of life lost to congenital heart disease (CHD) rank among the top 10 leading causes for that age group in Latin America, Central Asia, Africa and the Middle East. Short-term surgical missions (STSMs) continue to be the only resource available in some areas of the world.
Recent findings
There is a need for better communications between charity organizations and the supported institutions. We observe a raising concern with the limited published information on the results of the STSMs and a call for patient safe...
Source: Current Opinion in Cardiology - January 1, 2020 Category: Cardiology Tags: PEDIATRICS: Edited by Mitchell Cohen Source Type: research
Not just to survive but to thrive: delirium in the pediatric cardiac ICU
Purpose of review
Pediatric delirium has recently been recognized to occur frequently in the pediatric general and cardiac ICU. The purpose of this review is to highlight recent data on the prevalence, prevention, and management of this condition.
Recent findings
Pediatric delirium occurs in the pediatric cardiac ICU (PCICU) in as many as 67% of patients. Validated screening tools are now available to assist clinicians in the diagnosis of this condition. Research has shown a growing relationship between benzodiazepines, mainstays in the realm of sedation, and delirium. The full spectrum of risk factors has yet to be c...
Source: Current Opinion in Cardiology - January 1, 2020 Category: Cardiology Tags: PEDIATRICS: Edited by Mitchell Cohen Source Type: research
Tetralogy of Fallot: risk stratification is straightforward. Or is it?
Purpose of review
Tetralogy of Fallot (TOF) carries a long-term risk of arrhythmias and sudden death after surgical repair. Risk stratification is still less accurate than desired.
Recent findings
Several factors have been studied as risk predictors for ventricular arrhythmias and sudden death. Clinical parameters include age at surgery, time since repair, types of previous surgeries, and symptoms such as syncope and palpitations. Electrocardiographic parameters that have been studied include QRS interval, ventricular arrhythmias assessed with Holter monitors, signal averaged ECG, QRS fragmentation, QRS vector magnitu...
Source: Current Opinion in Cardiology - January 1, 2020 Category: Cardiology Tags: PEDIATRICS: Edited by Mitchell Cohen Source Type: research
Beyond atrial septal defect closure, it is time to start seriously considering closing ventricular septal defects with devices
Purpose of review
The purpose of this review is to discuss the history and current state of transcutaneous device closure of ventricular septal defects.
Recent findings
Newer devices and techniques have expanded the role of transcutaneous device closure of ventricular septal defects. Device closure of ventricular septal defects is a mainstay of therapy in many parts of the world. Device closure in smaller infants has relatively higher risks than larger infants and older children. The potential for the development of complete heart block remains a concern with this procedure.
Summary
Transcutaneous device closure of...
Source: Current Opinion in Cardiology - January 1, 2020 Category: Cardiology Tags: PEDIATRICS: Edited by Mitchell Cohen Source Type: research
