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 Heart Wrap May Prevent Enlargement

November 28, 2000 - An Australian medical team has pioneered a surgery that wraps the heart of CHF patients in a mesh bag. This heart "wrap" prevents the heart from enlarging. The Dacron wrap is pulled over the base of the heart and attached with stitches. It is tightened so that it holds - but does not strangle - the heart, said Dr. Jai Raman. This "containment" may slightly improve heart function.
     Seven patients have been in a prospective trial since April of 1999. All are doing well, according to Dr. Raman. The trial is now entering phase II. A Texas team will recruit another 30 patients.
 
Source: Reuters Health

 Five-Year TMLR Results

November 16, 2000 - Five-year follow-up on TMR patients shows sustained angina relief. Dr. Keith Horvath enrolled 78 patients with severe unstable angina who were not candidates for bypass or angioplasty, to get TMR. Average angina class was 3.8, with 74% in class 4 CHF and 26% in class 3 CHF. Average age was 61 years and 93% had previously had at least one bypass surgery.
     An average of 5 years after TMR, the average angina class is now 1.6. Overall, 64% of patients are now class one or class 2, and 17% have no angina at all. The one-year results after TMR showed an average angina class of 1.5, so the effect has lasted.
     No one knows why TMR relieves angina pain. It was originally thought that the channels burned during TMR improve blood flow to the heart muscle. Some TMR-created channels remain open, but not many. Most of the channels close.
     Dr. Horvath believes that TMR improves angina by promoting growth of new blood vessels. He has experimentally used TMR plus VEGF gene therapy, and has seen a "combined effect." MRI shows more heart wall motion after TMR. Dr. Horvath predicts that in the future, "the biggest use of TMR will be in combination with bypass surgery."
 
Source: AHA 2000 Scientific Sessions

 VEGF To Grow New Blood Vessels

November 14, 2000 - One year results of the VIVA trial are in. VEGF injected directly into the heart improved symptoms of patients with end-stage heart failure.
     The trial included 106 patients. Thirty-seven got placebo, 34 got low-dose VEGF and 35 patients got high-dose VEGF. About a year ago, Dr. Timothy Henry said that all 3 groups showed improvement in exercise tolerance and had less angina - even the placebo group.
     Now, placebo patients have gotten worse. Patients getting low-dose VEGF show a small improvement, while 40% of patients getting high-dose VEGF now have little or no angina.
     Concerns are that VEGF might cause cancers or heart attacks as a result of too much new blood vessel growth. So far, 4 patients in the placebo group have developed cancer versus one patient in the low-dose and none in the high-dose VEGF group.
     Overall mortality is 3% in the placebo group, 6% in the low-dose group and 0% in the high dose group. The rate of heart attack is 3% in placebo patients, 0% in the low-dose group and 6% in the high-dose group. "... the results are encouraging," Dr. Henry said.
 
Source: AHA 2000 Scientific Sessions

 Better Bypass Surgery Outcomes

September 30, 1998 - Our aim was to reduce the risks of using a heart-lung bypass machine. Dr. John Gott randomized 400 heart surgery patients to 4 different methods:

  1. standard bypass
  2. standard bypass plus the anti-inflammatory drug aprotinin
  3. standard bypass plus leukocyte (white blood cell) filtering for all blood products
  4. standard bypass but with the internal surfaces of the bypass machine coated with the blood thinner heparin

In low risk patients - those with a predicted mortality of less than 5% - filtering white blood cells reduced average hospital stay by one day and average hospital charges by $2,000 to $6,000.
     In high risk patients - those with a predicted mortality of more than 15% - "aprotinin saved an average of 11 days in the hospital and tens of thousands of dollars," Dr. Gott said. None of the methods had any significant benefit for medium-risk patients.
     All the methods "significantly relieved the inflammatory response to heart bypass machine use." They add that the costs of the added treatments were more than offset by the reduction in risk and hospital costs.
     Dr. Gott says, "This study shows that we can make open-heart surgery safer, and save money at the same time." He added, "A lot of times you do research and it gets tucked on a dusty shelf somewhere but these findings have changed our practice." Dr. Gott said he and his colleagues now use white blood cell filtering for low-risk patients and aprotinin in high-risk patients.
     In addition, he said, "We now use white blood cell filtering for all donated blood products, because it lowers risk of infection." In the study, the investigators say that the ideal time for also giving corticosteroids is 8 to 12 hours before bypass surgery.
 
Title:Modifying risk for extracorporeal circulation: trial of four antiinflammatory strategies.
Authors: Gott JP, Cooper WA, Schmidt FE Jr, et al
Source: Ann Thorac Surg. 1998;66:747-754.

 Stent Failure

1998 - Failure to properly place or "deploy" a stent happens a lot but is rarely mentioned. Stenting trials underestimate the number of failures because they select patients who are most likely to have good results!
     We studied 1303 consecutive stent procedures done in 3 university hospitals (a total of 1756 stents). We studied patient outcomes after stenting failures. All procedures were done by experienced "operators" (cardiologists who do lots of caths). Arteries were cleared with angioplasty before stent placement.
     Deployment failed 8% of the time. Stenting was done as a primary procedure in 40%, as bailout in 18%, and for angioplasty results that alone were not good enough in 42% of cases. In 87% of stenting failures, the operator tried to retrieve the stent from the coronary artery. Stent retrieval was successful in 45%, it blocked the artery in 38%, and in 4% the stent dislodged in the left main artery.
     After hospital discharge, failed stent deployment patients were followed for 7 months. Deployment failure contributed to a poor outcome in 19% of patients, including 16% needing urgent bypass surgery, 5% suffering a non-fatal heart attack, and 3 patients dying in the hospital. At 6-month follow-up, 39% of patients had at least one occurrence of death, heart attack, or repeat angioplasty.
     There were twice as many failures as in past studies. We included all consecutive cases of attempted heart artery stenting. In other studies, patients were carefully selected but we studied them as they came to us. Other studies did not include patients with blockages in several arteries, recent heart attack, or CHF. Some studies only included small blockages in large blood vessels. Our study shows that clinical trial results are often not related to real-life stenting. (Jon's Note: In other words, they stack the deck)
     Failure to deploy stents was usually caused by inability to reach the desired site (83% of cases). It could also be caused by poor guide support, and twisted or stiff blood vessels in the patient. Another important cause of failed deployment is trying to pass a stent through the inside of a previous stent to reach the desired place.
     Most stents used in this study were bare, hand-crimped stents. Bare stents are becoming more common. Manually crimped bare stents are more flexible, cheaper, and can be used with smaller catheters. However, if a bare stent cannot be properly placed for any reason, it cannot be easily withdrawn into the catheter without coming loose and blocking the artery.
 
Title: Failed Coronary Stent Deployment
Authors: Warren J. Cantor, Charles Lazzam, Eric A. Cohen, Kimberley Bowman, Sharon Dolman, Karen Mackie, Madhu K. Natarajan, Bradley H. Strauss
Source: Am Heart J 136(6):1088-1095, 1998

 Stent Type Affects Restenosis

January 12, 2001 - Stent design may play a key role in how blood vessels respond to angioplasty. This is critical to how soon arteries re-clog after the procedure - called restenosis.
     Dr. Adnan Kastrati started with data on 4510 patients who had heart artery stents. Of these patients, 80% had a follow-up cath 6 months later. Data was studied on these 3370 patients, who had a total of over 4000 stents placed.
     Dr. Kastrati found that small blood vessel size was the strongest risk for restenosis. The smaller the blood vessel being stented, the higher the risk of restenosis.
     The second strongest risk factor he found was stent design. Between 20% and 50% of stented vessels re-clogged, depending on the type of stent used. Multi-Link stents had the lowest restenosis rate (20%), followed by Jostent stents (26%), Palmaz-Schatz stents (29%), Pura-A stents (31%), Inflow steel stents (37%), NIR stents (38%) and Inflow gold stents (50%). Gold coated stents may increase risk of restenosis.
 
Source: Am J Cardiol 2001;87:34-39

 The More The Better

March 19, 1997 - We studied whether hospitals doing lots of angioplasties did them safer than hospitals doing fewer procedures. We used the Coronary Angioplasty Reporting System of the New York State Department of Health. That registry contains information on all 62,670 patients who had angioplasty from 1991 to 1994 in the state. The data were adjusted for such medical factors as EF.
     Death rate was 0.95% at hospitals doing less than 600 procedures per year, compared to 0.88% at hospitals doing 600 to 999 procedures, and 0.82% at hospitals doing 1000 or more procedures per year. Death rate was higher (1%) in patients whose cardiologists did less than 75 procedures per year. The highest death rate was in patients who had angioplasty done by low-volume cardiologists at low-volume hospitals.
     Better results come with high-volume cardiologists and high-volume institutions.
 
Title: Coronary angioplasty volume-outcome relationships for hospitals and cardiologists.
Authors: Hannan EL et al
Source: JAMA 1997 Mar 19; 279:892-898

 Warm Versus Cold Heart Surgery

This is based on an article from Dr. Mark Levinson's site: The Heart Surgery Forum, 1998

As many as 79% of patients having bypass surgery suffer losses in attention span, motor speed, short-term memory and new learning ability. We studied how body temperature during surgery affects these problems.
     Neuropsychologic tests were done before surgery and after surgery in 40 bypass patients. The 20 patients in group one had standard 28°C bypass with intermittent antegrade cold blood cardioplegia. The 20 patients in Group 2 had "normothermic" bypass, allowing body temperature to go no lower than 34°C, with continuous warm retrograde blood cardioplegia.
     There was a lot of deterioration after surgery in both groups in attention span, memory, concentration and motor skills. However, the group that had the warmer surgery (group 2) suffered less in new learning ability and short-term memory.
     Warm heart surgery patients woke up from anesthesia faster and were more quickly oriented. They often followed up on conversations that had begun before surgery and had good ability to recognize small objects immediately, like coins placed in their hand. These patients better understood complex descriptions of their surgery, discharge instructions and in general appeared "sharper" sooner.
     The areas that suffer most after heart surgery are attention span, short-term memory and new learning ability. This happens in 20% to 79% of heart surgery patients. This impairment does not completely disappear even 5 years after surgery. Importantly, the exact areas that are least likely to improve with time are the areas that suffered less with warm heart surgery.
 
Title: Improved Neuropsychologic Performance After Warm vs. Cold Heart Surgery
Authors: Steven Weiss MD, Terri Morris Ph.D, Frederick Levine, MD

 Waiting For Surgery Dangerous

June 4, 1999 - Waiting for heart surgery can hurt you - the longer the wait, the greater the risk. Dr. M. Seddon studied New Zealand's policy of making patients wait for bypass surgery. Since May of 1996, patients waiting for bypass surgery have been assigned points for certain characteristics. Patients must have 35 points to get on the waiting list. The team studied records for 701 outpatients who were referred for bypass surgery between January of 1993 and January of 1996.
     Average wait time was 146 days, and 28% waited for more than a year; 9% waited 2 years. Average waiting time for those with left main blockage was 63 days. Mortality on the outpatient list was 3%. Nineteen percent of patients waiting at home were readmitted, 76% with unstable angina and 12% with heart attack.
     Another paper by Dr. J. Plomp about deaths in The Netherlands in patients waiting for heart surgery confirms the high risk of waiting. In an editorial, Dr. Ben Bridgewater wondered whether patients placed on a waiting list for heart surgery should be told about the danger of waiting. He notes that, according to the study findings, the risk associated with waiting is as high as the risk of the surgery itself.
 
Source: Heart 1999;81:563,564,586-592,593-597

 Beta-blocker Reduces Surgery Risk

December 10, 1999 - The beta-blocker bisoprolol reduces risk of death and nonfatal heart attack in high-risk patients having major vascular surgery.
     Dr. Don Poldermans used dobutamine echo and physical exam to decide which patients having major vascular surgery were at high risk for heart-related death. He had 59 high-risk patients take 5 to 10mg bisoprolol once a day plus standard care, while 53 other patients got standard care only.
     In the bisoprolol group, 3% died within 30 days, compared with 17% of those who got standard care only. No patients in the bisoprolol group versus 17% of the standard care group had non-fatal heart attacks. The combined rate of cardiac events was 3% in the bisoprolol group and 34% in the standard care group. Dr. Poldermans' team recommends that high-risk surgical patients start taking beta-blockers one to 2 weeks before surgery.
     In an editorial, Dr. Thomas Lee advises that if at all possible, beta-blockers should be given to high-risk patients before surgery.
 
Source: N Engl J Med 1999;341:1789-1794,1838-1840

 Cath Entry Seal An Improvement

1998 - Heart cath and angioplasty can cause bleeding. This risk increases to 14% for patients getting a stent, who need high doses of blood thinner at first. We studied a mechanical system called the AngioSeal for sealing the entry wound caused by cath. This closing system consists of a small absorbable anchor and a collagen pad connected to a suture thread. At the end of the procedure, the system is positioned under the skin at the site of the puncture.
     We used the system in 411 consecutive patients: 302 men and 109 women, average age 59, who had successful angioplasty with a stent. All patients got blood thinner (500mg ticlopidine per day and 150mg aspirin per day) for 3 to 4 days before the procedure and for one month afterward. During the angioplasty, they were given IV heparin sodium (10,000 IU), followed by injected heparin (12,500 IU/day) for 21 days.
     With the AngioSeal, bleeding was successfully controlled in 96% of patients. In 4%, the AngioSeal did not stop all bleeding. Eight failed due to AngioSeal malfunction. Complications happened in 5% of patients; 18 were minor bleeding or bruising which occurred in the first 4 hours. In one percent, surgery was necessary to repair blood clots in, or bruising of, the groin artery. One patient suffered a severe blockage in the groin artery caused by wrong positioning of the anchor.
     The average time to patients being able to walk around was 9 hours. Ninety-three percent of patients were discharged 18 to 24 hours after angioplasty.
     We compared this AngioSeal use to 387 consecutive patients who got pressure to stop bleeding after angioplasty. Patients bled less, were able to walk sooner, use the rest room sooner, and leave earlier.
     More patient info about the Angio Seal can be found here.
 
Title:Femoral Arterial Hemostasis using the Angio-SealTM System after Coronary and Vascular Percutaneous Angioplasty and Stenting
Authors: Alberto Cremonesi, Fausto Castriota, Fabio Tarantino, Emidio Troiani, Enrico Ricci, Bilal El Jamal, Chiara Grattoni, Giorgio Noera
Source: J Invas Cardiol 10(8):464-469, 1998

 RFA for Arrhythmia

January 18, 1999 - A widely used treatment for irregular or rapid heart rhythms is safe and effective for children and adults, according to a study by Johns Hopkins doctors. "This is the first large study to show that RFA (radiofrequency ablation) is safe and effective," says Dr. Hugh Calkins. "The technology has advanced to where we can do the procedure on an outpatient basis, curing some patients in a matter of hours and sending them home the same day."
     RFA destroys part of the heart's electrical pathways - the part that causes the arrhythmia. A doctor guides a catheter with an electrode at its tip to the problem place inside the heart. Then a painless burst of energy - similar to microwave heat - destroys the small area of heart tissue containing the bad pathway. This stops electrical misfirings in that part of the heart.
     Researchers followed 1050 patients with 3 types of RFA between 1992 and 1995. The study included 439 males and 561 females from 8 months of age to 90 years. Catheter ablation showed a 95% success rate, a 6% recurrence rate, and a 3% rate of major complications. The one-year survival rate after catheter ablation was 98%.
 
Title: Study Affirms Value of Non-Surgical Treatment for Arrhythmia
Source: Johns Hopkins

 Basket Catheter Improves RFA

May 18, 1999 - German researchers have developed a new basket-shaped catheter that finds the exact part of the heart causing abnormal heart rhythms - and does it quickly.
     Defective nerves in the heart can disrupt the heart beat. These disrupted heart rhythms are called arrhythmias. Arrhythmia increases risk of fainting, stroke, and sudden death but can be treated by destroying heart tissue that is the source of the abnormal rhythm - a procedure called RFA or RadioFrequency Ablation. However, locating the exact spot to treat is difficult.
     Dr. Claus Schmitt mapped the heart's electrical activity in 31 arrhythmia patients using the new device. Standard catheters use one electrode, and surgeons must keep moving the tool around inside the heart to get readings. The new "basket catheter" holds 64 electrodes and can map the heart's electrical activity all at once.
     All the patients suffered from a type of arrhythmia called atrial tachycardia - attacks of rapid heart beats in the upper heart chambers. These fast-paced flutters raise the risk of stroke because blood may pool in the heart. The standing blood may then clot from sitting still too long. Clots can then pass into the brain and cause a stroke.
     In this first study of the basket catheter, there were no bad side effects. The device is inserted just like a regular catheter, through a groin artery. It is maneuvered into the heart's chambers, where it unfolds like an umbrella, putting its electrodes in contact with the heart walls. By stimulating the heart with drugs, the researchers cause (induce) an arrhythmia and map its exact location. This can take several hours with a regular catheter. The basket catheter "almost instantly" identified the locations.
 
Source: Circulation (1999;99:2414-2422)

 CoQ10 Helps Heart Surgery

1993 - CoQ10 is an essential nutrient in the heart. In this study, the protective effects of CoQ10 on the heart were tested in 10 high-risk patients during heart surgery, compared to 10 patients taking placebo. In both groups, there was a lower than usual level of CoQ10 in the blood and an ejection fraction less than 35%.
     100mg per day CoQ10 was given for 14 days before and fot 30 days after surgery. After surgery, blood and tissue CoQ10 levels stayed in the normal range for the CoQ10 patients. The heart's pumping and ejection fraction improved. Recovery was short (3 to 5 days) and uncomplicated.
     In placebo patients, blood and tissue levels of CoQ10 - as well as heart function - were depressed after surgery. Recovery was longer (15 to 30 days) and more complicated. Blood and heart levels of CoQ10 were related to heart function and surgery recovery time in both groups. This shows the benefits of CoQ10 in preserving the heart during cardiac surgery.
 
Title: Myocardial preservation by therapy with coenzyme Q10 during heart surgery
Author: Judy WV, Stogsdill WW, Folkers K
Source: Clin Investig 71 (8 Suppl): S155-S161
PMID: 8241702, MUID: 94060612

 Non-Bypass Valve Repair

November 14, 1997 - (Jon's Note: This is now an accepted valve repair technique) A new technique for repairing leaky mitral heart valves - using only one stitch - is in trials at Columbia-Presbyterian Medical Center. It may soon be possible to do the repair without open-heart surgery and without heart-lung bypass. Two studies of the new "bow-tie repair," named for the shape of the valve opening with the suture in place, were presented at the annual meeting of the American Heart Association. This is also called the "Alfieri Repair," after the surgeon who invented it. See it here.
     The mitral valve controls blood flow from the left atrium into the left ventricle. When the valve's 2 leaflets do not completely close (mitral valve prolapse), there is backflow (regurgitation) of blood. The heart then has to work harder to pump enough blood for the body, which can lead to heart damage.
     This "prolapse" is common, seen in 7% of the population. Most cases are mild and symptoms can usually be controlled with drugs. In serious cases, the valve can be repaired with an annuloplasty, which causes proper closing by shrinking the size of the opening. In some cases, the valve must also be replaced.
     The underlying problem is usually not in the valve itself but in the papillary muscles - cone shaped muscles coming from the heart walls and connecting to tendon-like chords underneath the valve leaflets. When these tiny muscles fail, the leaflets don't close properly. So by putting a ring around the valve, you're fixing the problem, but not in a direct way.
     The bow-tie repair may be better. A single suture is placed at the point where the 2 leaflets first touch when the ventricle contracts. The suture is like a catch on a zipper - once contact is made, the rest of the valve closes right up. The repair also connects the unhealthy chordae to the healthy chordae, which then do the work of closing the valve tight. The valve still opens, on either side of the suture, permitting normal blood flow.
     The technique was invented by an Italian surgeon and introduced in the USA by Dr. Oz. In a paper presented today, Dr. Oz reported that he and his team have done this surgery in 10 patients. In all of them, valve backflow was much reduced and the patients' overall condition improved. There were no deaths and no complications related to the bow-tie suture.
     Results of another study done in Italy, show that the repair can last at least 3 years. Researchers are developing a way to make the valve repair without doing open-heart surgery. They have invented a tiny grasper than can hold the chordae together while a U-shaped clip is stapled around the ends of the leaflets - all done via catheter.
 
Sent by a reader

 Surgeries For Heart Failure - 2000

September 2, 2000 - DCM patients with mitral valve regurgitation usually have poor outcomes. Despite being high-risk patients for surgery, mitral valve replacement can improve their heart function.
     Mitral regurgitation changes heart "geometry" (size and shape). These changes prevent heart valves from completely closing like they should. Repairing the valve can improve heart size and function.
     Dr. Stephen Bolling reported findings from 119 patients with DCM or ischemic cardiomyopathy. These patients were an average of 62 years old, with an average ejection fraction of 14%. All patients were class 4 and had 4+ mitral regurgitation.
     Patients had mitral valve reconstruction with an undersized flexible ring and "lots of stitches" to reduce the size of the mitral valve. About one-third of the patients also needed tricuspid valve repair.
     Results were encouraging. Ten percent of patients needed an intra-aortic balloon pump. No patients needed LVADs. At 30 days after surgery, there had been 5 deaths: 2 heart-related, one from stroke, and 2 lung-related. Patients required milrinone and norepinephrine while being weaned from the heart-lung bypass machine.
     One-year survival was 82%, and 71% of patients survived at least 2 years after surgery. Improvements in these patients included:

During surgery on these patients, it is important to undersize the ring and overcorrect the leakage. This helps restore normal heart geometry. Treatment with ACE inhibitors and other heart failure drugs should continue. In summary, Dr. Bolling has shown that mitral valve repair is safe and effective in heart failure patients with mitral regurgitation.

Dr. Soichiro Kitamura described his experience with different treatments for end-stage CHF. Heart transplant was done in 2 patients, 13 were treated with other surgeries, and 28 got an LVAD. Conventional surgeries included the Batista procedure in 7 patients, the Dor procedure in 2, and mitral repair in 4.
     Dr. Kitamura also described 90 other patients treated with the Batista procedure. Patients had 50% one-year survival. Overall survival was worse with the Batista Procedure than with heart transplant.
     He also described experience with LVADs. Of the 28 patients treated with an LVAD, 12 died, 3 were weaned off the device, and 2 ended up having a heart transplant. The 3 "weaned" patients recovered within 2 to 3 months. Echo showed improved heart function in these 3 patients.

The Dor and Batista Procedures - Changes caused by heart attack result in remodeling, which then affects both ventricles - the heart's pumping chambers. This greatly worsens heart failure.
     Dr. Smedira gave an overview of the Dor procedure, which involves making a lengthwise cut and then stitching to isolate the area affected by a heart attack. If the scarred section is too large, a patch is used. The result is an oval, (normal-shaped) ventricle. Vincent Dor - who pioneered the procedure - recommends that it be done with the patient's heart not beating. It can be hard to tell good muscle from scar tissue when doing this procedure.
     Dr. Smedira described results in 80 patients who had the Dor procedure. Patients were 75% male, with an average age of 61 years. Ejection fraction averaged 23%, and scar tissue averaged 39%. Seventy-six percent of patients had the Dor procedure without a patch, 86% also had bypass, and 44% also had mitral valve repair.
     End-diastolic heart volume improved from 200 mL to 130 mL and stroke volume improved from 45 mL to 50 mL. Follow-up currently averages 8 months. The average length of intensive care was 2 days and average hospital stay was 12 days. Only one patient required an LVAD; 9% required an intra-aortic balloon pump. The rate of death in-hospital was 3%. Dr. Smedira said that it is never too late to use the Dor procedure, but questioned whether it could be used too soon.
     In summary, Dr. Smedira recommends the Dor procedure for patients with ischemic cardiomyopathy. He no longer does the Batista procedure. At Cleveland Clinic, the death rate in 63 Batista procedure patients was 60% at 3 years, and event-free survival was poor (49% at one year, 35% at 2 years, and 26% at 3 years). He recommends mitral valve repair for dilated or ischemic cardiomyopathy..
 
Source: 20th Annual Scientific Sessions of the International Society for Heart and Lung Transplantation
Title: Surgical Alternatives to Transplantation in the Patient With Heart Failure
By Kathleen Grady, RN, PhD

 Low Dose Aspirin For Carotid Procedure

1999 - Low-dose aspirin is safer and more effective than high dose aspirin for preventing stroke and death after having your carotid artery cleared out (carotid endarterectomy). "For 20 years we have known that aspirin reduces the risk of stroke, but until now we didn't know the best dose," said Dr. Wayne Taylor.
     A total of 2805 patients scheduled for carotid endarterectomy took either 81mg, 325mg, 650mg or 1300mg of aspirin a day, starting one to 7 days before surgery and continuing for 3 months afterward. Strokes, heart attacks and death were recorded at 30 days and than again at 3 months after surgery.
     At 30 days after surgery, low-dose patients (81mg and 325mg) had fewer bad outcomes (5%) compared to the high-dose groups (7%). At 3 months, 6% of the low-dose groups had bad events, compared to 8% of the high-dose groups.
 
Title: Low-Dose Aspirin Best After Carotid Procedure;
The ACE study (Aspirin Carotid Endarterectomy), a 4-year trial
Author: Kate Johnson
Source: Medical Tribune 40 (1):17, 1999

 Regular Muscle Transplanted Into MI Victim

November 14, 2000 - Jon's note: Since bypass was also done, the real benefit of this procedure is unknown at this time.
     Five months after the procedure, French researchers reported on the transplant of skeletal muscle cells called myoblasts into the heart of a 72 year old man with advanced heart failure.
     Dr. Philippe Menasche removed muscle cells from the patient's thigh and cultured them in the lab. Two weeks later, the cells were injected into multiple areas of the patient's left ventricle, which was scarred from a heart attack. At the same time, surgeons did a double bypass to restore blood flow to the patient's heart.
     Dr. Menasche said the patient has increased exercise tolerance and ejection fraction. The French researcher emphasized that the cells will not change into heart muscle. "They keep their skeletal type," he said, "but this may not be a problem since the cells can contract and relax." The transplanted cells are not behaving like heart cells but they are helping his heart to pump. This is a phase one trial.
 
Source: Reuters Health

 Cell Transplant - Arm Muscle Cells Into Heart

May 30, 2001 - Trying to repair his damaged heart, researchers have implanted arm muscle cells into a man's heart. Dr. Mark Sussman said, "The challenge now is to find out just how well these cells can perform in their new home." The patient is Edward Cooper, who had heart attacks in 1977 and 1984, eventually sending him into heart failure.
     Doctors removed a small amount of tissue from Cooper's left arm bicep. They grew that tissue into hundreds of millions of muscle cells. A few weeks later Dr. Fardad Esmailian did a quadruple bypass on Cooper, and while the chest was open for surgery, he injected the arm muscle cells into the back wall of Cooper's badly scarred heart. The injection took about 3 minutes.
     The bypass - not the muscle cell implant - have improved Cooper's health, says Dr. Robb MacLellan, the main researcher. It will take time before they can tell if the new cells have strengthened the heart. The UCLA team plans to do the procedure on 12 patients.
     MacLellan says, "We will follow these patients for 2 years. They will have PET scans and other tests to see if the transplanted cells become part of the heart and to see how long they live. Patients will also have echocardiograms and MRIs to measure heart function." The Cleveland Clinic and University of Pittsburgh are also participating in this trial.
 
Sources: Associated Press & Reuters Health

 Adult Stem Cell Therapy Study 2003

April 2, 2003 - Dr. Massimo Mariani presented study results of 4 male patients averaging 59 years of age. Stem cells were harvested from their bone marrow and surgically implanted into their damaged hearts during off-pump bypass surgery. Each patient got from 10 to 23 areas implanted with their own adult stem cells.
     Sites in the heart getting the cells were heavily scarred, lacked blood flow, and showed abnormal wall motion due to previous heart attack. Target sites were identified with gated SPECT and echo.
     Scars shrunk by 12% and were 34% less severe after the procedure in 2 patients (50%). The two patients who did not improve had the most extensive heart damage to begin with. Improved blood flow in the heart was seen on contrast echo in 3 patients, and wall motion improved in one patient.
 
Source: Reuters Health

 Off-Pump Bypass Slightly Easier On Brain

March 18, 2002 - Dr. Cor Kalkman randomly assigned 281 patients with an average age of 61 years, having their first bypass surgery, to off-pump or on-pump surgery.
     At 3 months, 248 patients were available for testing mental function. Mental function had declined from study start in 21% of patients in the off-pump group versus 29% of the on-pump group. At one year, 31% of the off-pump patients still showed mental decline compared to 34% of on-pump patients. During the trial there was no difference in quality of life, stroke risk, or all-cause mortality between the patient groups.
     Dr. Kalkman concludes that "patients who had their first CABG surgery without heart-lung bypass had better mental outcomes 3 months after the procedure, but the effects were limited at 12 months."
 
Source: JAMA 2002;287:1405-1412,1448-1450

All information on this site is opinion only. All concepts, explanations, trials, and studies have been re-written in plain English and may contain errors. I am not a doctor. Use the reference information at the end of each article to search MedLine for more complete and accurate information. All original copyrights apply. No information on this page should be used by any person to affect their medical, legal, educational, social, or psychological treatment in any way. I am not a doctor. This web site and all its pages, graphics, and content copyright © 1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005 Jon C.

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