Clinical research in cardiology supplements
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Clin Res Cardiol Suppl · May 2011
[Transapical aortic valve implantation--indications, risks and limitations].
Calcified aortic stenosis is the predominant valve disease in the western world. Currently, surgical aortic valve replacement is the gold standard procedure for symptomatic severe aortic stenosis that can be performed with low morbidity and mortality. The prevalence of aortic stenosis increases with age, and the incidence of several comorbidities also unavoidably elevates the risk of surgical treatment. ⋯ Due to the restricted long-term data, conventional aortic valve replacement still remains the standard for the treatment of aortic stenosis. Selection of the suitable therapy approach (surgical replacement, transfemoral or transapical aortic valve implantation) must consider each patient's specific risk profile and individual indication. Prospective, randomized trials will be necessary to assess the individual survival benefit of TAVI for various risk populations and to extend the indication.
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Clin Res Cardiol Suppl · May 2011
Review[Anticoagulation in atrial fibrillation. Strategies in special situations].
Morbidity and mortality associated with atrial fibrillation are mainly related to thromboembolic complications, particularly ischemic strokes. The prevention of thromboembolism is an important component of the management of patients with atrial fibrillation. The choice of optimum antithrombotic therapy for a given patient depends on the risk of thromboembolism, on the one hand, and the risk of intracerebral hemorrhage, on the other hand. ⋯ Problems in antithrombotic therapy of atrial fibrillation arise treating those patients undergoing percutaneous coronary intervention and stent implantation, those with contraindication for vitamin K antagonists, or those with persisting left atrial thrombus requiring electrical cardioversion. The optimum therapeutic management of these special patients has not yet been defined by proper studies, leaving only empirically based recommendations for their treatment. Hopefully the development of new antithrombotic agents, that are easier to use and have a superior benefit-to-risk ratio, will extend effective prevention of thromboembolic events to a greater part of the atrial fibrillation population at risk.
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Clin Res Cardiol Suppl · May 2011
[3-year results of the SYNTAX trial--stent or surgery? A surgeon's perspective].
Coronary artery bypass grafting (CABG) is the standard of care for patients with three-vessel or left main coronary artery disease. However, clinical practice has proven to differ substantially with even the most complex coronary lesions being targeted by percutaneous coronary intervention (PCI) today. An abundancy of both large registries and randomized clinical trials has demonstrated superiority of surgery over PCI in advanced coronary artery disease. ⋯ On the other hand, PCI proved to be a viable alternative for less complex forms of left main disease. In conclusion, patients with three-vessel and/or left main coronary artery disease should be discussed in an interdisciplinary heart team consisting of cardiologists and cardiac surgeons within a heart center. Final decision making should be a formal process as recommended in the recently updated guidelines on myocardial revascularization by the European Society of Cardiology.