Dr. Dale Mueller M.D.

GLG News by Dr. Dale Mueller M.D., Vice-Chairman of Cardiovascular Medicine

GLG News is now G+ Insights

G+ is a community for professionals, academics and entrepreneurs to connect through online discussions and in-person meetings. You will continue to see G+ Insights (formerly GLG News) here as well as on the G+ website, where you can share and discuss the G+ Insights you read.

Surgery does it better

December 4, 2006

Analysis of:Endarterectomy versus Stenting in Patients with Symptomatic Severe Carotid Stenosis | content.nejm.org

This study investigated carotid endarterectomy versus carotid stenting in patients with severe carotid stenosis. The study was stopped prematurely due to safety and futility. The 30-day incidence of stroke or death was 3.9% versus 9.6% for endarterectomy versus carotid stenting. This data implies that carotid stenting with cerebral protection is inferior to surgical endarterectomy, and therefore will not be as widely adopted as previous thought.

The forecast clears for drug eluding stents.

December 4, 2006

Analysis of:Trading restenosis for Thrombosis? New questions about drug-eluding stents. | content.nejm.org

This is a general commentary regarding coronary stent thrombosis and highlights the difficulties which Medtronic (Endeavor), Abbott (Xience V and Conor Medsystem (CoStar) may soon face with FDA approval of their new stents which are currently unavailable in the US. It also highlights that drug-coated stent sales have decreased while bare metal stents sales have accelerated.

Increased use of ventricular assist devices

December 4, 2006

Analysis of:Left Ventricular Assist Device and Drug Therapy for the Reversal of Heart Failure | content.nejm.org

In a series of 15 patients, the Thoratec ventricular assist device was utilized with associated medical treatment for severe non-ischemic heart failure. Eleven of the fifteen patients recovered and avoided transplantation. Key implications include increased utilization of ventricular assist devices for the indication: "bridge to recovery." This could allow patients to avoid transplantation by temporary use of a left ventricular assist device.

Percutaneous valves: the future is upon us!

December 4, 2006

Analysis of:AHA Scientific Sessions - Percutaneous Devices for Aortic Valve Disease | www.cardiosource.com

Percutaneous valves are technically feasible.

Complications are currently not comparable to the traditional open valve replacement/repair.

Less is more

September 19, 2006

Analysis of:NEJM Articles on DES in MI | content.nejm.org

Implications:

- primary percutaneous interventions provide improved reperfusion therapy for acute myocardial infarction compared to thrombolysis

- many medical centers are focusing on the time it takes to actually perform PCI as a major focus for both patient care and a marketing technique

- Data are limited regarding the safety and efficacy of drug eluding stents in this setting, but they are clearly associated with an improved restenosis rate vs. uncoated bare metal stents

- The primary end point (target-vessel failure at 1 year after the procedure) was significantly reduced in the sirolimus-stent group compared to the uncoated stent group

- Drug eluding stents significantly reduce the risks of both restenosis and target-vessel revascularization after PCI due to acute myocardial infarction which could greatly expand the use of drug eluding stents    

Daptomycin. A one hit wonder?

August 18, 2006

Analysis of:Daptomycin versus standard therapy for bacteremia and endocarditis caused by staphylococcus aureus | www.nejm.org

Daptomycin which is essentially the sole agent made by Cubist was recently evaluated for blood stream and heart infections caused by staph. and found to be as effective as traditional antibiotics used.  The medication was also found to have less side effects when used for this indication.  More patients who received the standard treatment compared to daptomycin also had kidney problems including kidney failure. 
Abstract

Bioglue: Another indication strikes again

July 31, 2006

Analysis of:A prospective, randomized trial of the effectiveness of BioGlue in treating alveolar air leaks | vascsurg.org

Pulmonary air leaks after lung resection remain an indicator for prolonged hospitalizations.  Efforts are constantly made to decrease length of stay after pulmonary resections.  This study demonstrates that use of BioGlue can decrease the duration of air leaks and hospital stay with bioGlue usage.

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WMF-4K7T5SW-W&_coverDate=07%2F31%2F2006&_alid=429284858&_rdoc=1&_fmt=&_orig=search&_qd=1&_cdi=6933&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=fe61a671ccaa2280636fd338d1df4f87

Percutaneous valve replacement: Are we there yet?

July 28, 2006

Analysis of:Transapical aortic valve implantation: An animal feasibility study | ats.ctsnetjournals.org

Intense interest is abound for percutaneous valve replacement while other minimally invasive approaches are being developed in conjunction with this technique.  Most poor results with percutaneous valve implantation are due to technical difficulties.  This technique allows for an alternative delivery route.

http://ats.ctsnetjournals.org/cgi/reprint/82/1/110?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=transapical&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT

Endovascular treatment of thoracic aneurysms

June 8, 2006

Analysis of:Midterm outcomes in 158 consecutive gore tag thoracic endoprothesis: Single Center experience | www.ctsnetjournal.org

This manuscript demonstrates the safety and effacacy of endografting the thoracic aorta in high risk patients.  The gore tag endoprosthesis was succcessfully delivered with low morbidity and mortality in a group of patients who were so ill that they could not tolerate a open surgical intervention.  The next step would allow expansion of the eligible patient pool to include all descending thoracic aneurysms, disruptions, dissections, and ruptured atherosclerotic plaques and possibly extending the patient pool to include all locations in the thoracic aorta. 

Increased use of minimally invasive surgery for chest aneurysms

June 8, 2006

Analysis of:Complex thoracoabdominal aortic aneurysms: Endovascular exclusion with visceral revascularization | www.jvascsurg.org

Patients with complex chest and abdominal aortic aneurysms have high morbidity and mortality approaching 31%.  This study demonstrates a hybrid procedure in which endovascular (minimally invasvive surgery) is combined with open surgery (visceral revascularization) in an attempt to decrease the morbidity and mortality of this patient population.  This study demonstrated a mortality reduction from 31 to 13%, a significant finding in an ill patient population.  This hybrid procedure also demonstrated no paraplegia which would be approximately 7-13% in open cases.

Totally Robotic: Is this the future?

June 5, 2006

Analysis of:Results of the prospective multicenter trial of robotically assisted totally endoscopic coronary artery bypass grafting | ctsnet.org

Coronary artery bypass graafting remains a prevalent procedure despite recent declines in cases due to cornary stenting.  Robotic technology has been proven safe and efficacious in the performance of mitral valve repair and atrial septal defect repair. This report describes a Food and Drug Administration-sanctioned multicenter study of the safety and efficacy of the da Vinci system (Intuitive Surgical, Inc, Mountain View, CA) for totally endoscopic coronary artery bypass (TECAB) surgery.  Succesful bypasses were performed with a reasonable patency rate.  Despite this only the left anterior descending coronary artery was bypassed suggesting that some additional time and effort are required prior to possible widespread use of robotics for most coronary bypass grafting.

 

Pas-Port Connector: Do we really want it?

June 5, 2006

Analysis of:Six-Month angiographic follow-up of the pas-port II clinical trial | ctsnet.org

The six-month angiographic patency rates for the pas-port proximal conncector is reported to be excellent.  Previous devices including the St. Jude Medical Symetry Aortic Connector also reported good results with what turned out to be less than adequate.  Similar findings as with the St. Jude connector have been reported with pas-port in ICVTS 2004. 104752.  Despite these results many cardiac surgeons are relunctant to use a device due to past experience and the technical rewards that occur with hand-sewn anastomosis.

Coronary artery bypass superior to stenting

June 5, 2006

Analysis of:Coronary artery bypass is superior in multivessel coronary artery disease | ctsnet.org

Coronary artery disease has been treated by both coronary stenting and bypass surgery.  Recently, the number of coronary artery bypass grafting cases has dramatically reduced as the number of coronary stent deployments have increased.  Since the introduction of drug eluding stents this has made even more of an impact on the number of bypass cases.  This editorial comments on the improved survival of patients with multivessel coronary artery disease who undergo bypass rather than stenting which may have implications on drug eluding stent usage.

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