Cardiology Diseases, Disorders and Syndromes

All over the world, the death rate continues to increase as a restul of cardiology diseases. It is one of the critical issues in the medical world. Researchers and experts continue to innovate new technology, accessories and infrastructures, to help the increasing number of patients with cardiology diseases. Some common heart diseases and conditions include high cholesterol, Heart Failure, Atrial Fibrillation, Coronary Artery Disease, Mitral Valve Prolapse Syndrome. To provide better medical treatment to patients and to find new ways of treating such diseases, renowned cardiologists and experts organize conferences and seminars and publish authentic reviewed articles and case reports in medical journals.

There are few heart surgeons who have expertise in Endovascular Surgery. These doctors perform major surgeries accessing many regions of the patient’s body and they try to give new life to the patient. The review articles and practice guides on Endovascular Surgery help thousands of professionals acquire a thorough knowledge about the field. Whether a cardiology professional belongs to the USA, UK or any other country, the professional can learn a lot from the authentic journals. The journals found on radcliffecardiology.com are published three times annually and contain theoretical discussions about cardiovascular subjects.

An important area covered by these journals includes original research on Peripheral Stenting and satellite symposia proceedings about Peripheral Stenting. Before any of the articles or case reports are printed in the journals, the expert team members ensure the accuracy of the content. The experts are selected for their clinical expertise and they provide reviews. These journals and conferences are a great source of information for the cardiology fraternity across the world. Many professionals, clinicians and physicians acquire detailed knowledge about medical treatment and surgery on heart problems through these articles and research papers.

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Is CABG getting safer?

Stroke is one of the most devastating complications after coronary artery bypass graft (CABG) surgery, entailing permanent disability, a 3–6 fold increased risk of mortality, an incremental hospital resource consumption and a longer length of hospital stay. Notwithstanding advances in surgical, anaesthetic and medical management across the last 10 years, the risk of stroke after coronary artery bypass graft (CABG) has not significantly declined, likely because an older and sicker population is now deemed suitable to undergo CABG. 

Advances in endovascular surgery have meant that whilst traditional "open heart" procedure is still performed and often preferred in many situations, newer, less invasive techniques have been developed to bypass blocked coronary arteries. "Off-pump" procedures, in which the heart does not have to be stopped, were developed in the 1990's. Other endovascular surgery procedures, such as key-hole surgery (performed through very small incisions) and robotic procedures (performed with the aid of a moving mechanical device), increasingly are being used. 

Risk stratification is of the utmost importance for identifying vulnerable patients. Specifically, pre-existing cerebrovascular disease and atherosclerosis of the ascending aorta are major determinants of the risk of peri-operative stroke, and should be always carefully scrutinised. RCTs and meta-analysis do not clearly support routine implementation of offpump CABG as a strategy to minimise the risk of stroke. Observational studies have suggested that anaortic approaches might reduce the risk of stroke compared with conventional CABG in patients with severe atherosclerosis of the ascending aorta. Further randomised controlled trials are warranted to confirm this hypothesis. Heart stenting is another option for treating patients with CABG. The clinical application of drug-eluting stents (DES) or coronary artery bypass grafting (CABG) for unprotected left main coronary artery disease (ULMCAD) is still controversial. The need for repeat revascularization is significantly lower with CABG, but the risk of stroke is significantly higher, a trade-off that must be taken into account when considering heart stenting for patients with advanced coronary disease.

Read More

Is CABG getting safer?

Stroke is one of the most devastating complications after coronary artery bypass graft (CABG) surgery, entailing permanent disability, a 3–6 fold increased risk of mortality, an incremental hospital resource consumption and a longer length of hospital stay. Notwithstanding advances in surgical, anaesthetic and medical management across the last 10 years, the risk of stroke after coronary artery bypass graft(CABG) has not significantly declined, likely because an older and sicker population is now deemed suitable to undergo CABG.

Advances in endovascular surgery have meant that whilst traditional "open heart" procedure is still performed and often preferred in many situations, newer, less invasive techniques have been developed to bypass blocked coronary arteries. "Off-pump" procedures, in which the heart does not have to be stopped, were developed in the 1990's. Other endovascular surgery procedures, such as key-hole surgery (performed through very small incisions) and robotic procedures (performed with the aid of a moving mechanical device), increasingly are being used.

Risk stratification is of the utmost importance for identifying vulnerable patients. Specifically, pre-existing cerebrovascular disease and atherosclerosis of the ascending aorta are major determinants of the risk of peri-operative stroke, and should be always carefully scrutinised. RCTs and meta-analysis do not clearly support routine implementation of offpump CABG as a strategy to minimise the risk of stroke. Observational studies have suggested that anaortic approaches might reduce the risk of stroke compared with conventional CABG in patients with severe atherosclerosis of the ascending aorta. Further randomised controlled trials are warranted to confirm this hypothesis.

Heart stenting is another option for treating patients with CABG. The clinical application of drug-eluting stents (DES) or coronary artery bypass grafting (CABG) for unprotected left main coronary artery disease (ULMCAD) is still controversial. The need for repeat revascularization is significantly lower with CABG, but the risk of stroke is significantly higher, a trade-off that must be taken into account when considering heart stenting for patients with advanced coronary disease.

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Advances in mitral valve disease treatment

Treatment of mitral valve disease is a very common condition, affecting about 3% of the population. Recent years have seen major advances in minimally invasive mitral valve surgery and several new catheter-based techniques are being clinically evaluated. Indeed, percutaneous therapy has emerged as an option for treatment of mitral valve disease including regurgitation and prolapse for selected, predominantly high-risk patients.

Many patients with symptomatic, severe mitral regurgitation never undergo surgery due to a deemed excessive surgical risk and complete endovascular surgery is therefore an exciting alternative for these patients. Several technologies are being investigated, most of them based on long-standing surgical techniques. Over 1,000 patients have been treated worldwide with the Mitraclip system for leaflet plication, for example. This device has gained the CE mark and there has been a shift in the spectrum of candidates suitable for this technique, as recent experiences have shown that adverse mitral anatomies and functional MR patients may also benefit from this form of complete endovascular surgery and device.

An overview of recent technology for mitral heart disease can be found on Radcliffe Cardiology’s website which has a strong focus on cardiologist education. Anatomic evaluation seems crucial in order to select the most suitable patient for the procedure and cardiac computed tomography angiography is probably the best tool for patient selection. Indeed, mitral regurgitation is a complex disease with many aetiologies and pathophysiologies and therefore it seems unlikely that a single device can fix the problem. The first challenge is in fact to really understand MV disease which is why focus on education for cardiologists is so important, then a combination of techniques will be necessary for a satisfactory MR repair. Close collaboration between interventional cardiologists, cardiac surgeons, imaging cardiologists, basic scientists and the industry is essential for these technologies to progress and become a real alternative for this group of patients.

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