Expert review of cardiovascular therapy
-
Expert Rev Cardiovasc Ther · Jul 2011
ReviewBeating heart valve surgery with lung perfusion/ventilation during cardiopulmonary bypass: do we need to break the limits?
Myocardial and pulmonary ischemia during cardiopulmonary bypass is associated with cardiac and pulmonary dysfunction that may result in poor outcomes after cardiac surgery. Beating heart valve surgery, utilizing continuous coronary perfusion with warm oxygenated blood, together with continuous pulmonary artery perfusion and alveolar ventilation during cardiopulmonary bypass, represents an emerging and exciting novel strategy for myocardial and pulmonary protection. In this article, we present preliminary clinical results, as well as basic and clinical evidence, indications, contraindications and limitations of these new evolving techniques.
-
Expert Rev Cardiovasc Ther · Jul 2011
Randomized Controlled TrialOral rivaroxaban after symptomatic venous thromboembolism: the continued treatment study (EINSTEIN-extension study).
Over recent years, research on anticoagulant drugs has been guided by the requirement for convenient administration and a wide therapeutic window to allow fixed dosing without the need for coagulation monitoring. Rivaroxaban is the first of a new class of anticoagulant drugs, the direct, selective inhibitors of Factor Xa. ⋯ Overall, these results suggest that rivaroxaban can be a valid alternative to warfarin for patients requiring long-term secondary prevention of VTE. However, additional data are needed for special populations including the elderly, patients with cancer, renally impaired patients and morbidly obese patients, all of whom were scarcely represented in this trial.
-
Expert Rev Cardiovasc Ther · Jul 2011
ReviewRecognition and management of complications during transcatheter aortic valve implantation.
In the field of interventional cardiology, transcatheter aortic valve implantation is the newest and most exciting development of recent years. With a growing evidence base for both prognostic and symptomatic benefit, more and more interventionalists are keen to learn the procedure. However, the concomitant risk associated with a technically challenging procedure in a high-risk patient population is significant, and complications can arise suddenly and often unexpectedly. ⋯ We have significant experience with transcatheter aortic valve implantation, through the implantation of 260 devices, which brings first-hand experience of most major complications. This article provides insight into the potential for complications, offering advice on effective treatment, recognition, and ultimately, prevention. It also suggests a number of procedural and technical modifications, which might improve outcomes in the future.