Heart Editorials

Coronary bypass grafting with bilateral internal thoracic arteries

Falk, V. — 2013-05-13T22:40:08-07:00

In 1999, a seminal paper from the Cleveland Clinic demonstrated that patients treated with two versus one internal thoracic artery (ITA) coronary grafts have better long-term survival and freedom from reoperation.1 This finding was later confirmed in a systematic review2 and in a number of more recent studies.3–5 Puskas and colleagues3 have reported an impressive (35%) reduction in the long-term hazard of death in patients with and without diabetes undergoing bilateral internal thoracic artery (BITA) grafting. In a propensity-matched analysis of 1856 patients Grau et al4 showed a 10% survival benefit at 10 years, and 18% at 15 years for BITA grafting. Glineur et al5 showed that the survival benefit following BITA grafting is sustained up to 25 years. The available data consistently show better survival with two ITA grafts, especially when the second...

Transcatheter aortic valve implantation: what's the bleeding problem?

Khawaja, M. Z., Redwood, S. R. — 2013-05-13T22:40:08-07:00

The importance of bleeding and its sequelae have been increasingly recognised by interventional cardiologists. We are undertaking increasingly complex percutaneous interventions, performed upon higher-risk patients, who are more elderly with a greater range of comorbidities,1 and using multiple anticoagulant pharmacotherapies,2 which may all increase susceptibility to bleeding. The advent of transcatheter aortic valve implantation (TAVI) has allowed cardiologists and surgeons to offer treatment for aortic valve disease to a similarly high-risk cohort of patients. The PARTNER randomised trial having demonstrated a survival benefit,3 the challenge is now to improve the safety profile of the procedure, and addressing the risk of bleeding is paramount to this.

Borz et al4 present data from a single centre using the Edwards bioprosthesis (Edwards Lifesciences, Irvine, California, USA). They report notable bleeding and life-threatening bleeding (LTB) rates of 27.6% and 13.2%, respectively. Their survival...

Can NICE prevent diabetes?

Gale, E. A. M. — 2013-05-13T22:40:08-07:00

The rising tide

Diabetes (diagnosed or undiagnosed) currently affects 7.4% of the UK population, and is projected to reach 10% by 2030.1 Conventional wisdom (with just a hint of moral censure) attributes the rising prevalence of diabetes to obesity and physical inactivity. It would however be just as true to lay the blame on increasing longevity, for glucose tolerance deteriorates with age, and we live much longer than we did. By their ninth decade, 55% of European males and 74% of females will have diabetes, undiagnosed diabetes or some form of glucose intolerance.2 Diabetes is also on the increase because of simpler diagnostic tests, lower diagnostic thresholds and health policies that reward primary care physicians for finding new cases. Last but not least, those with diabetes now live longer following diagnosis, whether due to better care or lead-time bias,3 thus adding to...