Heart, lung & circulation
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Heart, lung & circulation · Oct 2019
ReviewThe Prophylactic Chimney Snorkel Technique for the Prevention of Acute Coronary Occlusion in High Risk for Coronary Obstruction Transcatheter Aortic Valve Replacement/Implantation Cases.
Coronary occlusion (immediate or delayed) is an uncommon but potentially devastating complication of transcatheter aortic valve replacement/implantation (TAVR/TAVI). Several patient-related, anatomical, device and procedural risk factors can be assessed to risk-stratify patients and assist in procedural planning. ⋯ In the highest risk patients, consideration should be given to prophylactic techniques to prevent coronary occlusion. This how-to-do-it report provides a framework for risk assessment for coronary occlusion followed by a step-wise description of the emerging chimney snorkel coronary stenting technique as a predictable procedural approach for the management of this potentially challenging clinical scenario.
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Heart, lung & circulation · Jun 2019
Meta Analysis Comparative StudyUnilateral Versus Bilateral Antegrade Cerebral Perfusion: A Meta-Analysis of Comparative Studies.
Antegrade cerebral perfusion (ACP) is an essential adjunct for prolonged hypothermic circulatory arrest (HCA) during aortic arch surgery. However, it has yet to be established whether ACP should be delivered unilaterally or bilaterally. The aim of the present meta-analysis is to investigate outcomes of unilateral ACP (uACP) compared to bilateral ACP (bACP) in comparative studies. ⋯ For patients undergoing aortic arch surgery, the available evidence supports either uACP or bACP as an adjunct to HCA. However, there is insufficient comparative evidence available to determine the benefit of either modalities in patients with longer durations of circulatory arrest.
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Heart, lung & circulation · Apr 2019
ReviewAdult Congenital Heart Disease in Australia and New Zealand: A Call for Optimal Care.
Adult congenital heart disease (ACHD) is a relatively new subspecialty in the cardiology field. The prevalence of ACHD is estimated at ∼ 3,000 per million adult population. The ACHD patient group is estimated to grow at ∼ 5% per year and in the next decade it is forecast that 1 in 150 young adults will carry some form of ACHD diagnosis. These estimates translate to ∼ 72,000 ACHD patients in Australia and ∼ 14,000 in New Zealand, although no current numbers are available. The Cardiac Society of Australia and New Zealand (CSANZ) has recently published Recommendations for Standards of Care for Adult Congenital Heart Disease (ACHD) in 2016. There is currently no long-term plan or proposal to address this huge health care burden within the federal government. This document details the size of the problem insofar as it is known and recommends solutions to be implemented. ⋯ The authorship group comprised participants in the CSANZ adult CHD standards of care recommendations from 2013 with the inclusion of some newly trained ACHD cardiologists, who represented most states and territories across ANZ. None of the authors has any academic or professional conflict of interest.
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Right heart catheterisation (RHC) is a minimally invasive procedure that provides direct haemodynamic measurement of intracardiac and pulmonary pressures. It is the gold standard investigation for the diagnosis and management of pulmonary hypertension. This article will describe how to perform right heart catheterisation, indications and contraindications.
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Heart, lung & circulation · Apr 2019
ReviewThe Australian and New Zealand Cardiac Implantable Electronic Device Survey: Calendar Year 2017.
A cardiac implantable electronic device (CIED) survey was undertaken in Australia and New Zealand for calendar year 2017 and involved pacemakers (PMs) and implantable cardioverter-defibrillators (ICDs). ⋯ For 2017, there were 17,971 (15,203 in 2013) new PMs sold in Australia and 1,811 (1,641 in 2013) implanted in New Zealand. The number of new PM implants per million population was 745 for Australia (652 in 2013) and 384 for New Zealand (367 in 2013). In both Australia and New Zealand, the number of PM replacements fell as a result of improved power source service life. Pulse generator types implanted were predominantly dual chamber; Australia 73% (74% in 2013) and New Zealand 68% (59% in 2013). There were 1,247 biventricular PMs implanted in Australia (661 in 2013) and 118 in New Zealand (83 in 2013). Transvenous pacing leads were overwhelmingly active fixation in both the atrium and ventricle. In Australia there was an increase in ICD usage with 4,212 new implants (3,904 in 2013), but a small fall in New Zealand to 396 (423 in 2013). The new ICD implants per million population were 175 for Australia (167 in 2013) and 90 for New Zealand (95 in 2013). There was a small reduction in biventricular ICDs in both Australia (2,195) and New Zealand (111).