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Heart and Vascular Health
Media, News & Topics on prevention, diagnosis & treatment of cardiovascular disease
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Bypass Surgery Vs. Drug-Eluting Stents for Patients With Proximal Left Anterior Descending Stenosis

Bypass Surgery Vs. Drug-Eluting Stents for Patients With Proximal Left Anterior Descending Stenosis | Heart and Vascular Health | Scoop.it

Although clinical practice guidelines carry a higher class of recommendation for CABG surgery (Class IIa) than for catheter-based deployment of drug eluting stents (DES) (Class IIb), when revascularization is indicated for patients with ischemia due to significant stenosis in CAD isolated to the PLAD, a comprehensive registry in the state of New York found no differences between these approaches in either mortality rates or the combined rates of mortality, MI, and/or stroke, although CABG was associated with lower rates of repeated revascularization.

Seth Bilazarian, MD's insight:

For many years we have had good evidence that there is not a significant difference in death or other major hazard between bypass surgery or angioplasty with stents.  This information from the New York State registry adds important information because of its size and the use of drug eluting stents.  The one significant difference is that the angioplasty group needed more repeat procedures over 3 years; Repeat procedures were needed in 1 in 17 of the bypass patients and 1 in 9 of the stent patients.  This information is welcome addition to help our patients make an informed decision about whiich option is best for them.

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The passion for procedures to fix ailing arteries and hearts may be misguided

The passion for procedures to fix ailing arteries and hearts may be misguided | Heart and Vascular Health | Scoop.it
How gaps in medical knowledge affect matters of the heart
Seth Bilazarian, MD's insight:

David Jones, medical historian gives a review of the history of coronary bypass (CABG) and angioplasty (PCI). The essay does a good job putting into perspective the growth of these procedures. The medical approach has evolved from a belief that patients are "all fixed" when they receive a stent or have coronary bypass to our current understanding. We now recognize that these procedures need to be part of optimizing patients risk factors so the disease does not continue to worsen.
My concern about headlines like this is that patients will believe that stents are not appropriate under any circumstances and there is strong evidence that treatment for patients in the setting of a heart attack or threatened heart attack is valuable and often life saving.

Stents are not always valuable or appropriate, but a blanket impression that all stent procedures should be avoided puts patients at serious risk.

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Surgical Treatment of Moderate Ischemic Mitral Regurgitation

Surgical Treatment of Moderate Ischemic Mitral Regurgitation | Heart and Vascular Health | Scoop.it

In patients with moderate ischemic mitral regurgitation, the addition of mitral-valve repair to CABG did not result in a higher degree of left ventricular reverse remodeling. Mitral-valve repair was associated with a reduced prevalence of moderate or severe mitral regurgitation but an increased number of untoward events. Thus, at 1 year, this trial did not show a clinically meaningful advantage of adding mitral-valve repair to CABG. Longer-term follow-up may determine whether the lower prevalence of mitral regurgitation translates into a net clinical benefit.

Seth Bilazarian, MD's insight:

When patient were undergoing open heart surgery for coronary bypass (CABG), the addition of mitral-valve repair for a "leaky valve" was associated with a longer bypass time , longer hospital stay after surgery & more neurologic events.

At one year, moderate or severe mitral regurgitation was less common in the combined-procedure group than in the CABG-alone group (11.2% vs. 31.0%). There were no significant between-group differences in major adverse cardiac or cerebrovascular events, deaths, readmissions, functional status, or quality of life at 1 year.

For now, the best recommendation is to improve heart function with bypass and not "fix" the leaky heart valve.

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Benefits of cognitive training after coronary artery bypass

Benefits of cognitive training after coronary artery bypass | Heart and Vascular Health | Scoop.it

My Comment: The idea that the brain needs rehabilitation after major surgery is not been adopted.  It's routine for patient's to have physical rehabilitation after major surgery.  Cognitive & memory training is an area of rapid commercial growth.  Whether this will prove to have real value is uncertian.  Training led to small improvements in time to respond.

Medsacpe's review of this:

The study showed that 65% of the patients showed a cognitive deficit 1 week after surgery, and 41% still showed a deficit 1 month after surgery. However, those who received cognitive training showed significant improvement in performance compared with the control group.

For example, in an assessment of reaction time at 6 months, the mean time for a dual task in the control group was 2108 milliseconds, compared with 1836 for the attention-memory group and 1706 for the memory-attention group.

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Cognitive deficits are frequent after coronary artery bypass graft surgery (CABG) in the elderly population. In fact, memory and attention deficits can persist several months after the surgery. Recent studies with healthy older adults have shown that memory and attention can be improved through cognitive training programs. The present study examined whether memory training (method of loci and story generation) and attentional training (dual-task computerized training) could improve cognitive functions in patients aged 65 years and older who underwent CABG surgery. Participants (n = 51) were assigned to one of three groups: (1) control group (tested at 1, 3 and 6 months after the surgery), (2) attention training followed by memory training, (3) memory training followed by attention training (groups 2 and 3: tested at 1, 2, 3 and 6 months after the surgery). The trainings took place between the 6th and 10th week following the surgery. The three groups were compared before and after each training program using attention and memory tests and neuropsychological tests. The results showed that attention and memory trainings lead to significant improvement in the cognitive domain that was trained. It thus seems that cognitive training can be a promising tool to enhance cognitive functions after a CABG surgery.

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