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Deaths Following Cardiac Surgery and Invasive Interventions
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
Different surgical techniques, each with its own advantages and disadvantages, have been used to reverse adverse left ventricular remodelling due to postinfarction left ventricular aneurysm. Surgery is indicated when concomitant, persistent angina, refractory heart failure, thromboembolism or life-threatening tachyarrhythmias occur. Myocardial revascularization is typically performed at the time of aneurysmectomy. The most appropriate surgical technique depends on the location and size of the aneurysm. However, these operative procedures have generally been considered high risk with high peri-operative morbidity and mortality. Infected aneurysms may develop at the site of ventricular vents for previous aortic valve replacement surgery.17
Direct Myocardial Revascularization Sequential Grafting Techniques
Published in Waldemar L. Olszewski, CRC Handbook of Microsurgery, 2019
The critical analysis of the cineangiograms is a reliable index for the proper selection of patients for whom direct myocardial revascularization is suitable. Direct myocardial revascularization is mainly indicated among individuals with multiple obstructions, good distal runoff, and normal or mildly altered left ventricular function.3
Mitochondrial Transplantation in Myocardial Ischemia and Reperfusion Injury
Published in Shamim I. Ahmad, Handbook of Mitochondrial Dysfunction, 2019
David Blitzer, Borami Shin, Alvise Guariento, Pedro J. del Nido, James D. McCully
Various modes of delivery have been investigated for mitochondrial transplantation. These include direct injection into myocardium and intracoronary delivery. Initial studies utilized direct injection into multiple sites of an ischemic left ventricular free wall, and these demonstrated significant reductions in infarct size and improvements in myocardial function. More recently, in similar models, intracoronary infusion was validated as a delivery model. Distribution of transplanted mitochondria by intravascular delivery was confirmed using positron emission tomography, microcomputed tomography, and magnetic resonance imaging with 18F-rhodamine 6G and iron oxide labeled mitochondria [143]. While intracoronary delivery resulted in a more widespread distribution, direct injection resulted in higher mitochondrial concentrations in the targeted region. Intracoronary delivery demonstrated equivalent cardioprotection by functional measures and by infarct size [142]. Intracoronary delivery, via a catheter, expands the potential applications of mitochondrial transplantation as it provides an easy avenue for global delivery of mitochondria and one that is readily applicable at the time of other coronary interventions such as PCI for myocardial revascularization.
Cardiac CT findings in patients with family history of premature CAD: an observational study
Published in Acta Cardiologica, 2022
Overall, the pre-test probability of CAD was low (<10% in 60%). Remarkably, the SCORE was <5% in all patients and the FRS was <10% in 88 percent of cases. By contrast, The PROCAM score which introduces a family history of myocardial infarction at precocious age was >10% in 32 percent of cases. Regarding cardiac CT findings, the prevalence of subclinical CAD defined by abnormal CCTA findings was not negligible (76%). While CAC scoring was low in most patients (<100% in 68%), only 12 patients (24%) presented normal CT angiograms. Interestingly, in patients with abnormal CCTA findings (n = 38), the PROCAM score was higher than the FRS in 20 patients (53%). After coronary angiography, most patients presented no significant lesions (55%). Only eight patients (16%) underwent myocardial revascularization. Strikingly, six of them (75%) presented CAC scoring >100 and four of them (50%) presented CAC scoring >400. Importantly, our investigations helped improve preventive therapy with lipid-lowering medications in a significant proportion of the population (66%).
Clinical practice patterns in revascularization of diabetic patients with coronary heart disease: nationwide register study
Published in Annals of Medicine, 2020
Hanna-Riikka Lehto, Arto Pietilä, Teemu J. Niiranen, Jyri Lommi, Veikko Salomaa
The optimal method of myocardial revascularization in diabetic patients has been debated for decades. Numerous randomised trials have been conducted on this topic, with the conclusion that the operative treatment of choice for diabetic patients’ coronary heart disease should be CABG rather than PCI [1–4]. After the advent of drug-eluting stents (DES) and the development of second-generation DES’s, the difference in mortality between PCI and CABG has narrowed [5–7]. Although the treatment guidelines are still in favour of CABG in diabetic patients with complex CHD, PCI has become an alternative for diabetic patients with less complex CHD [2]. Potential advantages of PCI with stenting also include lower risk of stroke complications when compared to CABG [8–10].
Pedicled or skeletonized bilateral internal mammary artery harvesting - a meta- analysis and trial sequential analysis
Published in Expert Review of Cardiovascular Therapy, 2021
Sashini Iddawela, Sophie L Mellor, Syeda Anum Zahra, Yuti Khare, Amer Harky
Coronary artery bypass grafting (CABG) is the gold standard for myocardial revascularization in patients with complex coronary artery diseases. The use of internal mammary arteries (IMA) has been associated with excellent long-term patency, reduced symptoms of ischemic heart disease and improved survival [1]. Total arterial revascularization (TAR) has demonstrated significantly improved outcomes in long-term mortality and myocardial infarction compared to conventional single arterial grafts [2]. The use of bilateral internal mammary arteries (BIMA) is a key development in progressing TAR. BIMA may be particularly useful in patients with diabetes, with superior long-term results compared to transluminal angioplasty [3].