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https://www.readbyqxmd.com/read/28074817/extracorporeal-membrane-oxygenation-for-refractory-cardiac-arrest
#1
REVIEW
Steven A Conrad, Peter T Rycus
Extracorporeal cardiopulmonary resuscitation (ECPR) is the use of rapid deployment venoarterial (VA) extracorporeal membrane oxygenation to support systemic circulation and vital organ perfusion in patients in refractory cardiac arrest not responding to conventional cardiopulmonary resuscitation (CPR). Although prospective controlled studies are lacking, observational studies suggest improved outcomes compared with conventional CPR when ECPR is instituted within 30-60 min following cardiac arrest. Adult and pediatric patients with witnessed in-hospital and out-of-hospital cardiac arrest and good quality CPR, failure of at least 15 min of conventional resuscitation, and a potentially reversible cause for arrest are candidates...
January 2017: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/28065490/burnout-among-cardiologists
#2
EDITORIAL
Jeffrey B Michel, Denisse M Sangha, John P Erwin
Burnout is a loss of enthusiasm for work, cynicism, and a low sense of accomplishment. Loss of autonomy and authority, complex regulatory requirements, report cards, quality metrics, the rise of large integrated health care systems, and the demise of solo practice are just a few realities of medical practice that contribute to physician burnout. Physicians suffering burnout often focus on compensation and perceived status as antidotes, although evidence suggests they play no role. Randomized controlled trials suggest that interventions designed to improve coping and resiliency including cognitive behavioral therapy and physical and mental relaxations to reduce stress can be effective...
December 18, 2016: American Journal of Cardiology
https://www.readbyqxmd.com/read/28041859/impact-of-robotics-and-a-suspended-lead-suit-on-physician-radiation-exposure-during-percutaneous-coronary-intervention
#3
Ryan D Madder, Stacie VanOosterhout, Abbey Mulder, Matthew Elmore, Jessica Campbell, Andrew Borgman, Jessica Parker, David Wohns
BACKGROUND: Reports of left-sided brain malignancies among interventional cardiologists have heightened concerns regarding physician radiation exposure. This study evaluated the impact of a suspended lead suit and robotic system on physician radiation exposure during percutaneous coronary intervention (PCI). METHODS: Real-time radiation exposure data were prospectively collected from dosimeters worn by operating physicians at the head- and chest-level during consecutive PCI cases...
December 16, 2016: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/28038808/recurrent-in-stent-restenosis-certainty-of-its-origin-uncertainty-about-treatment
#4
REVIEW
Davide Piraino, Giuliana Cimino, Dario Buccheri, Gregory Dendramis, Giuseppe Andolina, Bernardo Cortese
Treatment of recurrent in-stent restenosis is a real brainteaser for the interventional cardiologist who cannot resort to the guidelines to have indications about the type of treatment to be preferred. The use of intracoronary imaging may provide insights into the underlying mechanisms of this complication and use of drug-coated balloons may be a valid alternative and especially a thoughtful treatment when the repeated and perseverant use of drug-eluting stents clearly fails. In this setting, we present a review of the literature about this interesting topic, going deep into the heart of the problem, its origin and possible treatment options...
December 22, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/28031686/successful-percutaneous-retrieval-of-a-guiding-catheter-tip-that-had-unexpectedly-become-detached-using-a-two-wire-technique
#5
Kiyoshi Kume, Yoshinori Yasuoka, Tatsuya Sasaki
Device dislodgement during percutaneous coronary intervention (PCI) is a rare but potentially life-threatening complication. We herein report the successful retrieval of a guiding catheter tip that had unexpectedly become detached in the right coronary artery during PCI in a 68-year-old man. Interventional cardiologists must be familiar with a safer and more reliable retrieval technique.
December 2016: International Journal of Angiology: Official Publication of the International College of Angiology, Inc
https://www.readbyqxmd.com/read/28025191/fractional-flow-reserve-to-guide-and-to-assess-coronary-artery-bypass-grafting
#6
REVIEW
Mariano Pellicano, Bernard De Bruyne, Gabor G Toth, Filip Casselman, William Wijns, Emanuele Barbato
The aim of this review is to highlight the role of invasive functional evaluation in patients in whom coronary artery bypass graft (CABG) is indicated, and to examine the clinical evidence available in favour of fractional flow reserve (FFR) adoption in these patients, outline appropriate use, as well as point out potential pitfalls. FFR after CABG will also be reviewed, highlighting its correct interpretation and adoption when applied to both native coronary arteries and bypass grafts. Practice European guidelines support the use of FFR to complement coronary angiography with the highest degree of recommendation (Class IA) for the assessment of coronary stenosis before undertaking myocardial revascularization when previous non-invasive functional evaluation is unavailable or not conclusive...
December 23, 2016: European Heart Journal
https://www.readbyqxmd.com/read/28011798/stepwise-mass-screening-for-atrial-fibrillation-using-n-terminal-pro-b-type-natriuretic-peptide-the-strokestop-ii-study-design
#7
Johan Engdahl, Emma Svennberg, Leif Friberg, Faris Al-Khalili, Viveka Frykman, Katrin Kemp Gudmundsdottir, Tove Fredriksson, Mårten Rosenqvist
AIM: Atrial fibrillation (AF) is the most prevalent clinical arrhythmia and a major risk factor for ischaemic stroke. Treatment with oral anticoagulants (OACs) reduces the risk of stroke by two thirds in AF patients with risk factors. Due to its often paroxysmal and asymptomatic presentation, AF is sometimes challenging to diagnose. So far, AF screening studies have applied opportunistic or systematic screening, most often using a single 12-lead electrocardiogram (ECG) recording or ambulatory ECG...
December 23, 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/27999129/ascending-aortic-dissection-presented-as-inferior-myocardial-infarction-a-clinical-and-diagnostic-mimicry
#8
Ali A Alsaad, Olufunso W Odunukan, John Norman Patton
Acute ST segment elevation myocardial infarction (STEMI) is typically associated with acute coronary thrombosis or plaque rupture. Rarely, STEMI can be associated with ascending aortic dissection, which represents the majority of acute aortic syndrome aetiologies and carries dreadful outcomes. Routine cardiac intervention with emergent cardiac catheterisation may lead to a higher mortality rate in this group of patients. We present a case of painless inferior STEMI in the setting of ascending aortic dissection...
December 20, 2016: BMJ Case Reports
https://www.readbyqxmd.com/read/27998846/suction-catheter-for-enhanced-control-and-accuracy-of-transseptal-access
#9
Matthew S Sulkin, Zachary C Berwick, James B Hermiller, Jose A Navia, Ghassan S Kassab
AIMS: Percutaneous structural heart therapies, such as mitral value repair, require site-specific transseptal access (TSA). This can be challenging for interventional cardiologists. We describe a TSA catheter (TSAC) that utilises suction for enhanced control and puncture accuracy. Here, we aim to evaluate the safety and efficacy of the device. METHODS AND RESULTS: Ex vivo interatrial septum preparations were dissected from swine (n=8) and diseased human hearts (n=6) to quantify TSAC suction and needle puncture force...
December 20, 2016: EuroIntervention
https://www.readbyqxmd.com/read/27998838/emergency-percutaneous-implantation-of-veno-arterial-extracorporeal-membrane-oxygenation-in-the-catheterisation-laboratory
#10
Tomaz Goslar, Rihard Knafelj, Peter Radsel, Misa Fister, Alenka Golicnik, Klemen Steblovnik, Vojka Gorjup, Marko Noc
AIMS: Our aim was to describe our protocol for emergency percutaneous implantation of femoral veno-arterial extracorporeal membrane oxygenation (VA ECMO) in the catheterisation laboratory and to compare its effectiveness and safety with implantation in the intensive care unit and the operating room. METHODS AND RESULTS: Our retrospective observational study enrolled 56 consecutive patients undergoing VA ECMO implantation in the catheterisation laboratory (n=23), the intensive care unit (n=8) and the operating room (n=25)...
December 20, 2016: EuroIntervention
https://www.readbyqxmd.com/read/27993217/comparing-industry-compensation-of-cardiothoracic-surgeons-and-interventional-cardiologists
#11
Joshua Parreco, Elie Donath, Robert Kozol, Cristiano Faber
BACKGROUND: The purpose of this study was to compare payment trends between cardiothoracic surgeons and interventional cardiologists using the Open Payments website made available for the public by the Center for Medicare and Medicaid Services. MATERIAL AND METHODS: Data were extracted from the second release of the Open Payments database, which includes payments made between August 1, 2013 and December 31, 2014. Total payments to individual physicians were aggregated based on specialty, region of the country, and payment type...
February 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/27989078/intravenous-recombinant-tissue-plasminogen-activator-therapy-for-acute-basilar-artery-ischemic-stroke-following-transfemoral-transcatheter-aortic-valve-implantation
#12
Nicholas J Montarello, Adam J Nelson, Samuel L Sidharta, Stephen G Worthley
Transcatheter aortic valve implantation (TAVI) can now be considered a standard of care for inoperable and high-risk surgical patients with severe aortic stenosis, and its uptake worldwide is rapidly increasing. Indeed, many centers performing the procedure have now moved towards treating intermediate-risk patients with TAVI rather than referring them for surgical aortic valve replacement. Although the incidence of peri-procedural acute and subacute stroke following TAVI has fallen to 2-5%, its occurrence can be life-threatening and life-changing, and every effort must be made to improve patient outcome should stroke occur...
January 2016: Journal of Heart Valve Disease
https://www.readbyqxmd.com/read/27986963/eye-lens-radiation-exposure-in-greek-interventional-cardiology-article
#13
Zoi Thrapsanioti, Panagiotis Askounis, Ioannis Datseris, Ramza Anastasia Diamanti, Miltiadis Papathanasiou, Eleftheria Carinou
The lens of the eye is one of the radiosensitive tissues of the human body; if exposed to ionizing radiation can develop radiation-induced cataract at early ages. This study was held in Greece and included 44 Interventional Cardiologists (ICs) and an unexposed to radiation control group of 22 persons. Of the note, 26 ICs and the unexposed individuals underwent special eye examinations. The detected lens opacities were classified according to LOCS III protocol. Additionally, the lens doses of the ICs were measured using eye lens dosemeters...
December 15, 2016: Radiation Protection Dosimetry
https://www.readbyqxmd.com/read/27986487/the-disproportionate-growth-of-office-based-atherectomy
#14
Dipankar Mukherjee, Homayoun Hashemi, Brian Contos
OBJECTIVE: The purpose of this study was to evaluate the trends in procedure volume, clinical sites of care, and Medicare expenditure for peripheral vascular interventions (PVIs) for lower extremity occlusive disease since the Centers for Medicare and Medicaid Services instituted reimbursement policy changes that broadened payment for procedures performed in physician-owned office-based laboratories (OBLs). METHODS: We analyzed fee-for-service Medicare claims data from 2011 to 2014 to obtain the frequency of use of PVI by type, care setting, and physician specialty...
December 13, 2016: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/27976541/radial-artery-catheterization-which-is-right%C3%A2-i-mean-correct
#15
EDITORIAL
Ari J Mintz, Michael S Levy
The radial artery has gained favor as the access of choice for many operators due to a lower risk of vascular complications. The vascular anatomy of the left upper extremity may be more conducive to cardiac catheterization given reduced subclavian tortuosity. The left radial artery continues to be an arrow in the quiver of modern interventional cardiologist and may provide less radiation exposure when compared to the right radial artery.
December 2016: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/27940784/parental-refusal-of-surgery-in-an-infant-with-tricuspid-atresia
#16
Alexander A Kon, Angira Patel, Steven Leuthner, John D Lantos
We present a case of a fetal diagnosis of tricuspid atresia (TA). The pregnant woman and her husband requested that the baby be treated with only palliative care. The cardiologist did not think it would be appropriate to withhold life-prolonging surgery once the infant was born. The neonatologist argued that outcomes for TA are similar to those for hypoplastic left heart syndrome, and the standard practice at the institution was to allow parents to choose surgery or end-of-life care for those infants. The team requested an ethics consultation to assist in determining whether forgoing life-prolonging interventions in this case would be ethically supportable...
November 2016: Pediatrics
https://www.readbyqxmd.com/read/27931592/the-rationale-for-performance-of-coronary%C3%A2-angiography-and-stenting-before-transcatheter-aortic-valve-replacement-from-the-interventional-section-leadership-council-of-the-american-college-of-cardiology
#17
REVIEW
Stephen Ramee, Saif Anwaruddin, Gautam Kumar, Robert N Piana, Vasilis Babaliaros, Tanveer Rab, Lloyd W Klein
Transcatheter aortic valve replacement (TAVR) is an effective, nonsurgical treatment option for patients with severe aortic stenosis. The optimal treatment strategy for treating concomitant coronary artery disease (CAD) has not been tested prospectively in a randomized clinical trial. Nevertheless, it is standard practice in the United States to perform coronary angiography and percutaneous coronary intervention for significant CAD at least 1 month before TAVR. All existing clinical trials were designed using this strategy...
December 12, 2016: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/27922829/a-methodology-to-split-the-total-cumulative-hp-10-dose-into-the-hp-10-i-doses-received-during-various-procedures-performed-by-interventional-cardiologist
#18
Joanna Domienik
The methodology describing how to split the cumulative Hp(10) dose of interventional cardiologists into Hp(10) i doses received during procedures of various types based on procedure-specific ELDO coefficients and Hp(3) doses per procedure is presented. The appropriate equations for Hp(10) i (Hp(10) for procedure type i), depending on the number of various procedure types (i  =  1 … 4) performed by a particular physician, are derived. The methodology can be applied to whole-body doses measured on the lead apron and therefore can be used for optimisation of work practices in those catheterisation labs where routine dosimeter is worn above the apron...
December 6, 2016: Journal of Radiological Protection: Official Journal of the Society for Radiological Protection
https://www.readbyqxmd.com/read/27921167/the-real-world-in-the-clinic-before-and-after-the-establishment-of-guidelines-for-coronary-artery-spasm-a-questionnaire-for-members-of-the-japanese-cine-angio-association
#19
Shozo Sueda, Hiroaki Kohno, Hideaki Yoshino
We investigated the clinical situations and the present knowledge of Japanese cardiologists about coronary artery spasm before and after the establishment of guidelines for this condition in the real world. A questionnaire was developed regarding the number of cases of coronary angiography, percutaneous coronary intervention, and invasive/non-invasive spasm provocation tests before (2008) and after (2014) the establishment of the Japanese Circulation Society (JCS) guidelines for coronary artery spasm and the status of spasm provocation tests...
December 5, 2016: Heart and Vessels
https://www.readbyqxmd.com/read/27919333/radiation-and-cataract-risk-impact-of-recent-epidemiologic-studies-on-icrp-judgments
#20
Roy E Shore
In its 2012 report on tissue reactions, the International Commission on Radiological Protection (ICRP) made several key assumptions regarding radiation risk to the lens of the eye, including that radiation-related minor opacities will progress to become vision-impairing cataracts, that protracted irradiation confers as much risk per unit dose as an acute exposure, and that there is a dose threshold for cataract effects at about 0.5Gy. The few studies available provide only limited support for the ICRP assumption that radiation-related minor opacities are predictive of vision-impairing cataracts; further longitudinal data are clearly needed...
October 2016: Mutation Research
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