scholarly journals Artery Bypass Versus PCI Using New Generation DES

Artery Bypass ◽  
10.5772/54029 ◽  
2013 ◽  
Author(s):  
Mohammed Balghith
Keyword(s):  
Author(s):  
Benyamin Rahmani ◽  
Hossein Ghanbari ◽  
Spyridon Tzamtzis ◽  
Gaetano Burriesci ◽  
Alexander M. Seifalian

Aortic valve replacement (AVR) is the second most common cardiac procedure after coronary artery bypass grafting, accounting for more than 200,000 transplantations annually worldwide [1]. Currently available mechanical and bioprosthetic heart valve replacements are not ideal as they are associated with relevant complications. The tri-leaflet polymeric heart valves (PHVs) have been widely investigated as possible alternative to these substitutes. However, the clinical application of PHVs has been limited by their suboptimal design and poor durability of available polymeric materials. This study presents a new concept of surgical aortic valve using a novel nanocomposite polymer.


2019 ◽  
Vol 56 (5) ◽  
pp. 911-918 ◽  
Author(s):  
Vasileios F Panoulas ◽  
Charles J Ilsley ◽  
Konstantinos Kalogeras ◽  
Habib Khan ◽  
Maria Monteagudo Vela ◽  
...  

Abstract OBJECTIVES The intermediate-term all-cause mortality rate of real-world patients with multivessel disease (MVD) treated with percutaneous coronary intervention (PCI) with new-generation drug-eluting stents or coronary artery bypass grafting (CABG) remains unknown. We sought to compare the intermediate-term all-cause mortality rates of real-world patients with MVD including left main stem disease, treated with CABG or PCI. METHODS All consecutive all-comer patients with MVD undergoing CABG or PCI with second/third generation drug-eluting stents from 2007 to 2015 in Harefield Hospital, UK were included in this study. The revascularization modality was based on heart team discussions. Primary outcome was all-cause mortality. Mean follow-up of the study was 3.3 years. Cox regression analysis and propensity matching were used. RESULTS Of 6383 patients with MVD, 4230 underwent CABG, whereas 2153 had PCI with new-generation stents. In the CABG group, the mean age was 66.4 ± 10 years, whereas in the PCI group it was 65.3 ± 12.1 years (P < 0.001). Fewer female patients with MVD were treated with CABG than were treated with PCI (18.5% vs 20.5%; P = 0.026). There was a higher 5-year estimated survival rate among patients having CABG (88% vs 78.3%; Plog-rank < 0.001). The adjusted hazard ratio (HR) for PCI over CABG was 1.74 [95% confidence interval (CI) 1.41–2.16; P < 0.001]. A total of 653 patients having CABG and 653 having PCI were included in the propensity-matched groups. At mean follow-up, PCI was associated with a higher adjusted HR for all-cause mortality (2.18, 95% CI 1.54–3.1; P < 0.001). CONCLUSIONS In this contemporary cohort of real-world patients with MVD, CABG was associated with increased intermediate-term survival compared to PCI with new-generation drug-eluting stents.


2017 ◽  
pp. 194-225
Author(s):  
Brandon W. Calenda ◽  
Umesh K. Gidwani

Acute coronary syndrome (ACS) is a common and sometimes lethal event, usually precipitated by sudden rupture and thrombosis of an atherosclerotic plaque. Patients presenting with ACS can be rapidly risk stratified based on signs, symptoms, electrocardiogram, and biomarkers. There is a new generation of potent and reliable antiplatelet drugs, which in concert with anticoagulation and rapid revascularization, can preserve myocardium and save lives. When choosing how to revascularize, hemodynamically stable patients with diabetes mellitus and complex coronary disease benefit more from coronary artery bypass grafting rather than percutaneous coronary intervention. Despite optimal treatment, ACS can result in deadly complications such as cardiogenic shock. Supportive care is paramount, but despite its widespread use, the utility of intraaortic balloon counterpulsation is uncertain. In the future, advanced coronary imaging may enhance preventative care, novel molecular targets will help expand treatment options, and cell-based regenerative therapies may aid myocardial recovery after acute coronary syndrome.


Author(s):  
Brandon W. Calenda ◽  
Umesh K. Gidwani

Acute coronary syndrome (ACS) is a common and sometimes lethal event, usually precipitated by sudden rupture and thrombosis of an atherosclerotic plaque. Patients presenting with ACS can be rapidly risk stratified based on signs, symptoms, electrocardiogram, and biomarkers. There is a new generation of potent and reliable antiplatelet drugs, which in concert with anticoagulation and rapid revascularization, can preserve myocardium and save lives. When choosing how to revascularize, hemodynamically stable patients with diabetes mellitus and complex coronary disease benefit more from coronary artery bypass grafting rather than percutaneous coronary intervention. Despite optimal treatment, ACS can result in deadly complications such as cardiogenic shock. Supportive care is paramount, but despite its widespread use, the utility of intraaortic balloon counterpulsation is uncertain. In the future, advanced coronary imaging may enhance preventative care, novel molecular targets will help expand treatment options, and cell-based regenerative therapies may aid myocardial recovery after acute coronary syndrome.


Author(s):  
D. Cherns

The use of high resolution electron microscopy (HREM) to determine the atomic structure of grain boundaries and interfaces is a topic of great current interest. Grain boundary structure has been considered for many years as central to an understanding of the mechanical and transport properties of materials. Some more recent attention has focussed on the atomic structures of metalsemiconductor interfaces which are believed to control electrical properties of contacts. The atomic structures of interfaces in semiconductor or metal multilayers is an area of growing interest for understanding the unusual electrical or mechanical properties which these new materials possess. However, although the point-to-point resolutions of currently available HREMs, ∼2-3Å, appear sufficient to solve many of these problems, few atomic models of grain boundaries and interfaces have been derived. Moreover, with a new generation of 300-400kV instruments promising resolutions in the 1.6-2.0 Å range, and resolutions better than 1.5Å expected from specialist instruments, it is an appropriate time to consider the usefulness of HREM for interface studies.


Author(s):  
Jorge Perdigao

In 1955, Buonocore introduced the etching of enamel with phosphoric acid. Bonding to enamel was created by mechanical interlocking of resin tags with enamel prisms. Enamel is an inert tissue whose main component is hydroxyapatite (98% by weight). Conversely, dentin is a wet living tissue crossed by tubules containing cellular extensions of the dental pulp. Dentin consists of 18% of organic material, primarily collagen. Several generations of dentin bonding systems (DBS) have been studied in the last 20 years. The dentin bond strengths associated with these DBS have been constantly lower than the enamel bond strengths. Recently, a new generation of DBS has been described. They are applied in three steps: an acid agent on enamel and dentin (total etch technique), two mixed primers and a bonding agent based on a methacrylate resin. They are supposed to bond composite resin to wet dentin through dentin organic component, forming a peculiar blended structure that is part tooth and part resin: the hybrid layer.


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