Subclinical leaflet thrombosis in surgical and transcatheter bioprosthetic aortic valves: an observational study

Use of transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS) has grown rapidly over the last decade and the technology has correspondingly matured. Nevertheless, recent data suggest that subclinical thrombosis may form on some leaflets of the TAVR prostheses following implant. The frequency, implications, and required treatment of this process are largely unknown, […]

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Idarucizumab for Dabigatran Reversal

The first direct oral anticoagulant (DOAC) was approved nearly a decade ago, yet there remains apprehension in transitioning to wide-spread use despite demonstrated efficacy and ease of use. One limitation is the absence of a reversal agent for patients on DOACs who develop significant bleeding or require emergent surgery. Idarucizumab is a humanized monoclonal antibody […]

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Levosimendan for Hemodynamic Support after Cardiac Surgery

Left ventricular dysfunction following cardiac surgery remains a significant perioperative challenge, one often treated with inotropic support, however practice patterns vary widely and there are few outcome data to support a standardized practice. Levosimendan represents a newer class of “inodilators”, calcium sensitizers, thought to improve cardiac output without increasing myocardial oxygen consumption. […]

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Surgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients (SURTAVI Investigators)

Transcatheter aortic valve replacement (TAVR) is superior to medical therapy in inoperable patients with severe, symptomatic aortic stenosis (AS), and may be the preferred option in high-risk surgical patients. The comparative efficacy of TAVR and surgical aortic valve replacement (SAVR) in intermediate risk AS patients has been less well studied. The PARTNER 2 randomized trial […]

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Association Between Achieved Low-Density Lipoprotein Levels and Major Adverse Cardiac Events in Patients With Stable Ischemic Heart Disease Taking Statin Treatment

Current societal guidelines advise differing dosing strategies when it comes to statin usage. The European Society of Cardiology/European Atherosclerosis Society recommends targeting a low-density lipoprotein cholesterol (LDL-C) level less than 70 mg/dL or a 50% LDL-C reduction in very high risk patients while the American College of Cardiology/American Heart Association task force advises high intensity […]

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No benefit from bilateral mammary grafts at 5 years

Coronary artery bypass grafting (CABG) is an established therapy for obstructive cardiovascular disease and ischemic cardiomyopathy. Utilization of the left-internal mammary artery as a graft has been a particularly successful aspect of CABG due to impressively durable patency rates. Despite this, adoption of bilateral mammary artery grafting has lagged in surgical practice.  The Arterial Revascularization […]

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Bleeding versus thromboembolic protection in atrial fibrillation and coronary stent procedures.

Five to 8% of people undergoing percutaneous coronary intervention (PCI) also have atrial fibrillation (AF).  The optimal antiplatelet / anticoagulant regimen in these individuals remains unclear as stroke and stent thrombosis prevention need to be balanced against the risks of major bleeding.  The PIONEER AF-PCI trial (Open-Label, Randomized, Controlled, Multicenter Study Exploring Two Treatment Strategies […]

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No differences in on-pump versus off-pump bypass grafting at 5 years.

Coronary artery bypass grafting (CABG) may significantly improve quality of life and longevity.  As with all therapies, however, these benefits must be weighed against potential risks. Some hypothesize that aortic cross clamping and cardiopulmonary bypass, historically utilized during CABG, increase the potential for certain complications and can be successfully avoided with newer “off-pump” CABG techniques.  […]

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Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis

The use of percutaneous coronary intervention (PCI) for unprotected left main coronary artery stenosis is increasing but it remains unclear whether this approach is non-inferior to coronary artery bypass grafting (CABG). Both the Nordic-Baltic-British left main revascularization study (NOBLE, n=1201) and Evaluation of an everolimus eluting stent versus coronary artery bypass surgery for effectiveness of […]

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Amiodarone and lidocaine in refractory cardiac arrest

Out of hospital cardiac arrest with shock-refractory ventricular tachycardia (VT) or fibrillation (VF) carries a severe prognosis.  Despite their frequent use and guideline inclusion in this scenario, evidence that amiodarone or lidocaine improve survival is lacking. In this large multicenter randomized controlled double-blind trial, 3026 adult patients with spontaneously occurring out-of-hospital cardiac arrest and shock-refractory […]

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