Current Opinion in Cardiology最新文献_第3页

Robotic mitral surgery: recent advances and outcomes. 机器人二尖瓣手术：最新进展和结果。

IF 2.3 4区医学

Current Opinion in Cardiology Pub Date : 2024-08-20 DOI: 10.1097/hco.0000000000001174

Makoto Hibino,Douglas A Murphy,Michael E Halkos

{"title":"Robotic mitral surgery: recent advances and outcomes.","authors":"Makoto Hibino,Douglas A Murphy,Michael E Halkos","doi":"10.1097/hco.0000000000001174","DOIUrl":"https://doi.org/10.1097/hco.0000000000001174","url":null,"abstract":"PURPOSE OF REVIEWThis review explores recent advancements in robotic cardiac surgery, specifically focusing on its application in diverse mitral valve surgeries. The aim is to provide an overview of current clinical practices and supporting evidence in this evolving field.RECENT FINDINGSA literature review indicates a 30% surge in robotic mitral valve repair from 2015 to 2021, paralleled by a decline in sternotomy-based repair per the STS database. Robotic mitral valve repair consistently shows effective and safe outcomes, with comparable mortality but lower morbidity risks than sternotomy and thoracotomy. The robotic approach exhibits lower conversion to valve replacement, shorter ICU stays, and reduced 30-day readmissions. For experienced programs, robotic techniques prove versatile in various pathologies, including rheumatic heart valve disease, infective endocarditis, ischemic cardiomyopathy, and mitral annular calcification necessitating valve replacement. Literature supports their selective use in high-risk scenarios, including redo surgeries and elderly patients.SUMMARYRecent evidence supports the growing use of robotic approaches in mitral valve surgery, highlighting their efficacy with comparable mortality rates but lower morbidity risks. Robotic techniques consistently yield positive outcomes across various pathologies and patient profiles, signaling a potential paradigm shift in mitral valve interventions.","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142178810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Lipoprotein(a) is a highly atherogenic lipoprotein: pathophysiological basis and clinical implications. 脂蛋白（a）是一种高度致动脉粥样硬化的脂蛋白：病理生理学基础和临床意义。

IF 2 4区医学

Current Opinion in Cardiology Pub Date : 2024-08-14 DOI: 10.1097/HCO.0000000000001170

Elias Björnson, Martin Adiels, Jan Borén, Chris J Packard

{"title":"Lipoprotein(a) is a highly atherogenic lipoprotein: pathophysiological basis and clinical implications.","authors":"Elias Björnson, Martin Adiels, Jan Borén, Chris J Packard","doi":"10.1097/HCO.0000000000001170","DOIUrl":"10.1097/HCO.0000000000001170","url":null,"abstract":"Purpose of review: Lipoprotein(a) has been identified as a causal risk factor for atherosclerotic cardiovascular disease (ASCVD) and aortic valve stenosis. However, as reviewed here, there is ongoing debate as to the key pathogenic features of Lp(a) particles and the degree of Lp(a) atherogenicity relative to low-density lipoprotein (LDL).Recent findings: Genetic analyses have revealed that Lp(a) on a per-particle basis is markedly (about six-fold) more atherogenic than LDL. Oxidized phospholipids carried on Lp(a) have been found to have substantial pro-inflammatory properties triggering pathways that may contribute to atherogenesis. Whether the strength of association of Lp(a) with ASCVD risk is dependent on inflammatory status is a matter of current debate and is critical to implementing intervention strategies. Contradictory reports continue to appear, but most recent studies in large cohorts indicate that the relationship of Lp(a) to risk is independent of C-reactive protein level.Summary: Lp(a) is a highly atherogenic lipoprotein and a viable target for intervention in a significant proportion of the general population. Better understanding the basis of its enhanced atherogenicity is important for risk assessment and interpreting intervention trials.","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Is it feasible to treat atrial fibrillation at the time of minimally invasive coronary artery bypass grafting? 在微创冠状动脉旁路移植术时治疗心房颤动是否可行？

IF 2 4区医学

Current Opinion in Cardiology Pub Date : 2024-08-14 DOI: 10.1097/HCO.0000000000001173

Stephen D Waterford, Niv Ad

{"title":"Is it feasible to treat atrial fibrillation at the time of minimally invasive coronary artery bypass grafting?","authors":"Stephen D Waterford, Niv Ad","doi":"10.1097/HCO.0000000000001173","DOIUrl":"10.1097/HCO.0000000000001173","url":null,"abstract":"Purpose of review: Coronary artery bypass grafting remains the most common operation performed by cardiac surgeons. As a result, a cardiac surgeon with a typical practice will most commonly encounter atrial fibrillation when performing coronary artery bypass grafting. In this review, we first emphasize the importance of treating atrial fibrillation in patients undergoing coronary bypass grafting. We review benefits of concomitant surgical ablation and its importance relative to complete coronary revascularization. We then discuss options to treat atrial fibrillation in a more minimally invasive manner in these patients, while still preserving treatment efficacy.Recent findings: Surgical ablation at the time of coronary artery bypass grafting surgery could be as important as complete revascularization. Bi-atrial ablation provides superior rhythm control compared to left-sided ablation only.Summary: We highlight various options for surgical ablation at the time of coronary artery bypass grafting surgery, and provide an algorithm for ablation in individual patients.","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

High reliability pediatric heart centers: Always working toward getting better. 高度可靠的儿科心脏中心：不断进步

IF 2.3 4区医学

Current Opinion in Cardiology Pub Date : 2024-07-01 Epub Date: 2024-03-26 DOI: 10.1097/HCO.0000000000001143

Andrea Torzone, Alexandra Birely

{"title":"High reliability pediatric heart centers: Always working toward getting better.","authors":"Andrea Torzone, Alexandra Birely","doi":"10.1097/HCO.0000000000001143","DOIUrl":"10.1097/HCO.0000000000001143","url":null,"abstract":"Purpose of review: The purpose of this review is to examine high reliability through the lens of a contemporary pediatric heart center, noting that continuous improvement, rather than perfection, should be embraced. Aiming to elevate topics with lesser attention, this review elaborates on key concepts and proposed considerations for maintaining a high reliability heart center.Recent findings: As provision of care reaches a new complexity, programs are called upon to evaluate how they can bring their teams into the future of pediatric cardiac care. Although much has been written about high reliability in healthcare, it has not been explored within pediatric heart centers. Practical application of high reliability enables a shared mental model and aligns teams toward eliminating patient harm. Suggested facilitators of high reliability within heart center teams include interprofessional collaboration, recognition of nursing expertise, psychological safety, and structural empowerment void of hierarchy.Summary: As the pediatric cardiac population evolves, care becomes more complex with a narrow margin of error. High reliability can guide continuous improvement. Acknowledging culture as the underpinning of all structure and processes allows teams to rebound from failure and supports the mission of rising to exceptional patient challenges.","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140319949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Double outlet right ventricle - the 50% rule has always been about the conus. 双出口右心室--50% 规则一直与锥体有关。

IF 2.3 4区医学

Current Opinion in Cardiology Pub Date : 2024-07-01 Epub Date: 2024-02-23 DOI: 10.1097/HCO.0000000000001131

Rebecca Josowitz, Lindsay S Rogers

{"title":"Double outlet right ventricle - the 50% rule has always been about the conus.","authors":"Rebecca Josowitz, Lindsay S Rogers","doi":"10.1097/HCO.0000000000001131","DOIUrl":"10.1097/HCO.0000000000001131","url":null,"abstract":"Purpose of review: There has been much variability in the definition of double outlet right ventricle (DORV) spanning the last century. Historically, emphasis has been placed on the assignment of the great arteries to the right ventricle as a definition of DORV. In this review, we aim to underscore the importance of conal muscle, rather than rules surrounding assignment of great arteries to ventricles. We will be outlining the variability in patient anatomy that results from variations in conal muscle development in DORV, which may not fit perfectly into predefined constructs. This anatomic variability directly determines physiology and surgical repair options.Recent findings: There is a growing appreciation of the utility of cross-sectional imaging in complex DORV, and the generation of patient-specific 3D models with virtual reality simulations for surgical planning. These models improve the prediction of candidacy for biventricular repair and allow the mapping of complex baffle pathways preoperatively.Summary: DORV is not a disease entity in itself, but rather a vast spectrum of disorders associated with maldevelopment of conal muscle and often abnormal expansion of one the great vessels. Patient-specific 3D models will be crucial for improved surgical planning and patient outcomes.","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139934305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Hypertrophic cardiomyopathy and competitive sports: let 'em play? 肥厚型心肌病与竞技体育：让他们玩吗？

IF 2.3 4区医学

Current Opinion in Cardiology Pub Date : 2024-07-01 Epub Date: 2024-05-10 DOI: 10.1097/HCO.0000000000001148

Mats Steffi Jennifer Masilamani, Bryan Cannon

{"title":"Hypertrophic cardiomyopathy and competitive sports: let 'em play?","authors":"Mats Steffi Jennifer Masilamani, Bryan Cannon","doi":"10.1097/HCO.0000000000001148","DOIUrl":"10.1097/HCO.0000000000001148","url":null,"abstract":"Purpose of review: Hypertrophic cardiomyopathy (HCM) is one of the most common cardiovascular genetic conditions. Although most patients with HCM typically do well clinically, there is a small but real incidence of sudden cardiac death. A diagnosis of HCM was previously a reason for complete exclusion in sports, particularly competitive sports.However, many of these recommendations are based on expert consensus, and much data has been published in the last decade furthering the scientific knowledge in this area, and allowing athletes who may have been previously excluded the potential to participate in strenuous activities and competitive sports.Recent findings: With recent publications on participation in sports with HCM, as well as an emphasis on shared decision-making, more athletes with HCM are participating in competitive sports, even at a professional level. Even contact sports in the presence of an implantable cardioverter-defibrillator are no longer mutually exclusive in the current era.Summary: Previous guidelines were likely overly restrictive for patients with HCM. Although there is a risk of sudden death that cannot be ignored, the potential for shared decision making as well as medical guidance are entering a new era in all aspects of medicine, particularly in sports participation.","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Effects of bempedoic acid on markers of inflammation and Lp(a). 鱼贝多酸对炎症指标和脂蛋白（a）的影响

IF 2.3 4区医学

Current Opinion in Cardiology Pub Date : 2024-07-01 Epub Date: 2024-03-04 DOI: 10.1097/HCO.0000000000001137

Sukhila Reddy, Abhizith Deoker

{"title":"Effects of bempedoic acid on markers of inflammation and Lp(a).","authors":"Sukhila Reddy, Abhizith Deoker","doi":"10.1097/HCO.0000000000001137","DOIUrl":"10.1097/HCO.0000000000001137","url":null,"abstract":"Purpose of review: To study the effect of bempedoic acid on markers of inflammation and lipoprotein (a) to help determine if the drug would be useful to treat patients with elevated cardiovascular risks and residual cardiovascular risk despite optimal low-density lipoprotein cholesterol (LDL-C) levels.Recent findings: Bempedoic acid is found to cause significant reduction in LDL-C and high-sensitivity C-reactive protein (hs-CRP) in various randomized clinical trials. Multiple meta-analyses have also found that bempedoic acid therapy leads to reduction in non-high-density lipoprotein cholesterol (non-HDL-C), total cholesterol (TC) and apolipoprotein B (ApoB) levels. However, it has minimal effect on lipoprotein (a) (Lp(a)) level.Summary: Bempedoic acid is a new lipid-lowering agent that inhibits enzyme ATP-citrate lyase in the cholesterol biosynthesis pathway. Major risk of cardiovascular events and its associated morbidity and mortality are proportional to LDL-C and inflammatory markers levels. It was found that bempedoic acid significantly lowers LDL-C, hs-CRP and other inflammatory markers levels. This drug could potentially be used in patients with elevated cardiovascular risk, in patients with residual cardiovascular risk despite attaining LDL-C goal and in statin intolerant patients.","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140061290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Leaders need to look in the mirror. 领导者需要照照镜子。

IF 2.3 4区医学

Current Opinion in Cardiology Pub Date : 2024-07-01 Epub Date: 2024-03-11 DOI: 10.1097/HCO.0000000000001138

Josh Koch

引用次数: 0

Pemafibrate and other triglyceride-lowering therapies to reduce risk of cardiovascular and metabolic disease. 培马贝特和其他降低甘油三酯的疗法，以降低心血管疾病和代谢疾病的风险。

IF 2.3 4区医学

Current Opinion in Cardiology Pub Date : 2024-07-01 Epub Date: 2024-03-11 DOI: 10.1097/HCO.0000000000001136

Michael Miller

{"title":"Pemafibrate and other triglyceride-lowering therapies to reduce risk of cardiovascular and metabolic disease.","authors":"Michael Miller","doi":"10.1097/HCO.0000000000001136","DOIUrl":"10.1097/HCO.0000000000001136","url":null,"abstract":"Purpose of review: Although high triglycerides are consistently associated with elevated risk of cardiovascular disease (CVD), therapies that reduce triglyceride levels have inconsistently translated into reduced CVD risk.Recent findings: To date, three clinical trials have tested triglyceride-lowering therapies in patients with hypertriglyceridemia (HTG) and elevated risk of incident/recurrent CVD. In REDUCE-IT (Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial), assignment to IPE, a highly purified eicosapentanoic acid (EPA), resulted in a 25% reduction in nonfatal myocardial infarction), nonfatal stroke, cardiovascular death, coronary revascularization and hospitalization for unstable angina. By contrast, the combination of EPA and docosahexanoic acid (DHA) carboxylic fatty acids used in the STRENGTH trial (Statin Residual Risk With Epanova in High Cardiovascular Risk Patients With Hypertriglyceridemia) failed to reduce CVD risk. Most recently, PROMINENT (Pemafibrate to Reduce Cardiovascular Outcomes by Reducing Triglycerides in Patients with Diabetes) also failed to demonstrate reduction in CVD events despite use of a potent triglyceride-lowering, fibric-acid derivative. However, improvement in HTG-associated metabolic complications (e.g. nonalcoholic fatty liver disease) was observed with pemafibrate as well as with another potent triglyceride-lowering therapy (i.e. pegozafermin). Moreover, trials are underway evaluating whether the most fatal metabolic complication of HTG, pancreatitis, may be reduced with highly potent triglyceride-lowering therapies (e.g. apolipoprotein C3 inhibitors).Summary: Taken together, HTG is associated with increased risk of CVD and attendant adverse metabolic sequalae. To this end, a potentially promising and evidence-based landscape is emerging for treating a clinical phenotype that in the past has been insufficiently addressed.","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11150088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140121464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Management of hypertension in heart transplant recipients: an ongoing conundrum. 心脏移植受者的高血压管理：一个持续的难题。

IF 2.3 4区医学

Current Opinion in Cardiology Pub Date : 2024-07-01 Epub Date: 2024-03-27 DOI: 10.1097/HCO.0000000000001145

Juan Duarte Torres, Selim R Krim

{"title":"Management of hypertension in heart transplant recipients: an ongoing conundrum.","authors":"Juan Duarte Torres, Selim R Krim","doi":"10.1097/HCO.0000000000001145","DOIUrl":"10.1097/HCO.0000000000001145","url":null,"abstract":"Purpose of review: Hypertension remains one of the most common clinical problems leading to significant posttransplant complications. This study reviews the pathophysiology of hypertension in the postcardiac transplant phase and provides an update on currently available antihypertensive therapies for heart transplant patients.Recent findings: The true prevalence of hypertension in the heart transplant population remains unknown. Effective blood pressure (BP) control is key to prevent left ventricular remodeling, diastolic dysfunction and stroke. Calcium channel blockers (CCBs) are the most commonly and preferred agents in the early posttransplant phase and may have renal protective effects. Angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs) can all be used as second line antihypertensive agents and may have a role in preventing other long-term complications such as calcineurin-inhibitor induced nephropathy. Although more data are needed, sodium-glucose co-transporter 2 inhibitors (SGLT2i) appeared to be well tolerated and could be considered especially in the presence of type diabetes and chronic kidney disease. Conversely, angiotensin receptor-neprilysin inhibition (ARNI) have not been studied in the heart transplant population therefore cannot be recommended at this time.Summary: Hypertension is very common after heart transplant. Early steroid wean and traditional risk factor modification play an important part in the management of post-heart transplant hypertension. CCB, ACEI, ARB are the preferred antihypertensive agents to improve postcardiac transplant complications. Novel therapies such as SGLT2i appear well tolerated and may have benefits in both BP and glycemic control in heart transplant; however, larger trials are needed.","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140319950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0