Future cardiology
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Current guidelines recommend interrupting anticoagulation and bridging therapy with heparin or low-molecular-weight heparin for cardiac rhythm device surgeries in patients with high thrombotic risk. However, there are some studies that suggest continuing warfarin may be safe. The study by Birnie et al. investigates this important clinical question in a randomized controlled trial setting. ⋯ Clinically significant device-pocket hematoma was noted in 12 out of 343 patients (3.5%) in the uninterrupted warfarin group, compared with 54 out of 338 (16.0%) in the heparin-bridging group (relative risk: 0.19; 95% CI: 0.10-0.36; p < 0.001). Uninterrupted warfarin was associated with better patient satisfaction, and there was no significant difference in thromboembolic or surgical complications between the two groups. These results demonstrate that device surgeries can be safely performed with continued warfarin, and bridging with heparin is associated with high risk of device-pocket hematoma.
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The 47th annual meeting of the Association for European Paediatric and Congenital Cardiology was held on 22-25th May 2013 in London, UK. This is one of the largest scientific meetings in Europe within the field of congenital cardiac disease and was held in association with the Japanese Society of Pediatric Cardiology and Cardiac Surgery, and Asia Pacific Pediatric Cardiology Society. There were 900 submitted abstracts and over 1000 delegates from 57 countries attended. We have summarized some of the highlights of the meeting below.
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Pittl U, Schratter A, Desch S et al. Invasive versus non-invasive cooling after in- and out-of-hospital cardiac arrest: a randomized trial. Clin. ⋯ The neurological outcome and neuron-specific enolase level were not different in the two groups at 72 h after cardiac arrest. The efficacy of the two cooling methods were similar. This study underlines the fact that the type of cooling method is not the most important thing to consider in therapeutic hypothermia, but the need of a progressive and soft rewarming may make the difference in the future between different devices.
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Peripheral venoarterial extracorporeal membrane oxygenation support provides prolonged support in the event of acute or acute-on-chronic cardiac and/or respiratory failure. This support serves as a bridge to recovery, decision-making, heart transplantation or ventricular-assist device implantation. ⋯ Among them, limb ischemia requires prompt diagnosis and management to avoid limb amputation. In the case of peripheral artery cannulation, ipsilateral distal limb perfusion to prevent acute limb ischemia can be performed via a single lumen catheter through the artery or via the 'chimney graft' technique during extracorporeal membrane oxygenation implantation.
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Following the initiation of an ischemic insult, reperfusion injury (RI) can result in numerous deleterious cardiac effects, including cardiomyocyte death. Experimental data have suggested that ischemic conditioning, when delivered either before or after the ischemic event, can provide considerable cardioprotection against RI. Ischemic conditioning involves delivering brief repetitive cycles of ischemia to the myocardium (local) or to another distal organ or structure (remote). This review will discuss recent advances in the molecular mechanisms involved in RI, the signaling pathways recruited by ischemic conditioning and conclude with an appraisal of the evidence for the use of ischemic conditioning in current clinical practice.