April 3rd, 2011
TAVI: PARTNER or Blind Date?
Richard A. Lange, MD, MBA
Almost 700 patients with severe aortic stenosis who were considered “high risk” for conventional valve replacement (AVR) were randomized to transcatheter aortic valve implantation (TAVI) or AVR. In comparison to AVR, TAVI was associated with a higher incidence of stroke (5.1% vs 2.4% at one year), vascular complications (11.0% vs 3.2% at 30 days), and moderate-severe […]
March 30th, 2011
Choosing a PARTNER for Life: A or B?
Richard A. Lange, MD, MBA and L. David Hillis, MD
What is TAVI? During Transcatheter Aortic Valve Implantation (TAVI), a bioprosthetic valve is inserted through a catheter and implanted within the native stenotic aortic valve. The self-expanding CoreValve (Medtronic) and balloon-mounted Edwards SAPIEN (Edwards Lifesciences) valve are approved in Europe and under investigation in the U.S. for TAVI and can be implanted via the transfemoral, subclavian, or transapical route. […]
March 15th, 2011
GRAVITAS Editorial: Why Invite the Fox into the Henhouse?
Richard A. Lange, MD, MBA and L. David Hillis, MD
Results from the GRAVITAS randomized trial, presented at the 2010 American Heart Association conference, have just been published in JAMA. They show that high-dose clopidogrel did not improve outcomes after percutaneous coronary intervention (PCI) in patients with “high on-treatment platelet reactivity” (i.e., during clopidogrel therapy), compared with clopidogrel given at conventional doses. Our interpretation at CardioExchange, reported at […]
February 10th, 2011
What’s Keeping Us from Using FFR?
Richard A. Lange, MD, MBA and L. David Hillis, MD
A recent study of PCI in subjects with multivessel CAD showed that procedure costs were lower when a management strategy based on the results of fractional flow reserve (FFR) measurements was employed. The FFR-based strategy resulted in fewer stents used, which more than offset the cost of the FFR pressure wire. Even though FFR-guided PCI has […]
January 21st, 2011
To Arms! Or, Maybe Not?
Richard A. Lange, MD, MBA and L. David Hillis, MD
According to a recently published opinion piece in a British cardiology journal, enthusiasm for the transradial approach over the femoral approach in primary PCI is not justified. The authors cite numerous problems with the radial approach compared with the femoral approach (i.e., up to a 10% crossover rate, prolonged procedure time, increased radiation exposure for the patient and physician) […]
January 19th, 2011
What PROSPECT Doesn’t Tell Us
Richard A. Lange, MD, MBA and L. David Hillis, MD
The PROSPECT trial provides some interesting insights about the mechanisms of thrombotic coronary artery disease, but how, if at all, should it change practice? Here are what the findings do and do not demonstrate: What the PROSPECT study says: In ACS patients treated with PCI, major adverse cardiovascular events that occurred during a median follow-up of 3.4 years were as […]
January 12th, 2011
Maybe TAVI Is Not All It’s Cracked Up To Be
Richard A. Lange, MD, MBA and L. David Hillis, MD
The PARTNER trial of transcatheter aortic valve implantation (TAVI) for severe aortic stenosis was among the hottest cardiology stories of 2010. Now that the hype is receding, some are questioning whether TAVI is ready for prime time. In three letters to the Editor of the New England Journal of Medicine, our colleagues point out that the […]
January 11th, 2011
Absorbable Stent Approved: Now You See It, Now You Don’t
Richard A. Lange, MD, MBA
Have questions about the new stent that just received CE Mark approval in Europe? Here’s a reality checklist. 1. What’s it called? The bioresorbable vascular scaffold (BVS) from Abbott Laboratories is named ABSORB (clever, huh?). 2. What are its advantages over a drug-eluting stent (DES)? Don’t know yet. It may eliminate the need for long-term intensive antiplatelet […]
January 5th, 2011
Do Sleep-Deprived Invasive Cardiologists Cause Complications?
Richard A. Lange, MD, MBA
In an NEJM perspective, the former president of the Sleep Research Society reports an 83% increase in the risk of surgical complications in patients undergoing elective daytime surgery performed by attending surgeons who had a <6-hour opportunity for sleep between procedures during a previous on-call night. He argues that physicians who have been awake for […]
December 21st, 2010
Rick Lange & David Hillis: Looking Back at 2010 and Ahead to 2011
Richard A. Lange, MD, MBA and L. David Hillis, MD
To celebrate the holiday season, CardioExchange asked several of our contributors to choose the 3 most important cardiology-related events of the past year and to make 3 predictions for 2011. Looking back at 2010: 1. Stenting Versus Endarterectomy for Carotid-Artery Stenosis: In patients with carotid artery stenoses, stenting and endarterectomy were associated with similar rates of the primary […]