Previous Articles of the Month

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Transcatheter Aortic-Valve Replacement for Asymptomatic Severe Aortic Stenosis | NEJM

For patients with asymptomatic severe aortic stenosis and preserved left ventricular ejection fraction, current guidelines recommend routine clinical surveillance every 6 to 12 months. Data from ra...

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Comprehensive non-invasive haemodynamic assessment in acute decompensated heart failure-related cardiogenic shock: a step towards echodynamics

AbstractAims. Haemodynamic assessment can be determinant in phenotyping cardiogenic shock (CS) and guiding patient management. Aim of this study was to eva

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Role of 3D transoesophageal echocardiography in the study of infective endocarditis. Demonstration in a case collection

Abstract. Infective endocarditis (IE) is a condition that predominantly affects native or prosthetic heart valves, which is currently on the rise due to th

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Self-Expanding or Balloon-Expandable TAVR in Patients with a Small Aortic Annulus | NEJM

Patients with severe aortic stenosis and a small aortic annulus are at risk for impaired valvular hemodynamic performance and associated adverse cardiovascular clinical outcomes after transcatheter...

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Hypertonic saline for fluid resuscitation in ICU patients post-cardiac surgery (HERACLES): a double-blind randomized controlled clinical trial

Intensive Care Medicine - Recent evidence questions a liberal approach to fluid resuscitation in intensive care unit (ICU) patients. Here, we assess whether use of hypertonic saline applied as...

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Antiplatelet therapy after coronary artery bypass surgery: five year follow-up of randomised DACAB trial

Objective To assess the effect of different antiplatelet strategies on clinical outcomes after coronary artery bypass grafting. Design Five year follow-up of randomised Different Antiplatelet Therapy Strategy After Coronary Artery Bypass Grafting (DACAB) trial. Setting Six tertiary hospitals in China; enrolment between July 2014 and November 2015; completion of five year follow-up from August 2019 to June 2021. Participants 500 patients aged 18-80 years (including 91 (18.2%) women) who had elective coronary artery bypass grafting surgery and completed the DACAB trial. Interventions Patients were randomised 1:1:1 to ticagrelor 90 mg twice daily plus aspirin 100 mg once daily (dual antiplatelet therapy; n=168), ticagrelor monotherapy 90 mg twice daily (n=166), or aspirin monotherapy 100 mg once daily (n=166) for one year after surgery. After the first year, antiplatelet therapy was prescribed according to standard of care by treating physicians. Main outcome measures The primary outcome was major adverse cardiovascular events (a composite of all cause death, myocardial infarction, stroke, and coronary revascularisation), analysed using the intention-to-treat principle. Time-to-event analysis was used to compare the risk between treatment groups. Multiple post hoc sensitivity analyses examined the robustness of the findings. Results Follow-up at five years for major adverse cardiovascular events was completed for 477 (95.4%) of 500 patients; 148 patients had major adverse cardiovascular events, including 39 in the dual antiplatelet therapy group, 54 in the ticagrelor monotherapy group, and 55 in the aspirin monotherapy group. Risk of major adverse cardiovascular events at five years was significantly lower with dual antiplatelet therapy versus aspirin monotherapy (22.6% v 29.9%; hazard ratio 0.65, 95% confidence interval 0.43 to 0.99; P=0.04) and versus ticagrelor monotherapy (22.6% v 32.9%; 0.66, 0.44 to 1.00; P=0.05). Results were consistent in all sensitivity analyses. Conclusions Treatment with ticagrelor dual antiplatelet therapy for one year after surgery reduced the risk of major adverse cardiovascular events at five years after coronary artery bypass grafting compared with aspirin monotherapy or ticagrelor monotherapy. Trial registration NCT03987373ClinicalTrials.gov [NCT03987373][1]. All data that underlie the results reported in this article will be provided on reasonable request. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT03987373&atom=%2Fbmj%2F385%2Fbmj-2023-075707.atom

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Mechanical Circulatory Support in Cardiogenic Shock — Persistence and Progress | NEJM

Acute myocardial infarction–related cardiogenic shock (AMI-CS) is characterized by systemic hypoperfusion due to cardiomyocyte necrosis and ventricular dysfunction.1 Cardiogenic shock affects 5 to ...

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Prothrombin Complex Concentrates in Cardiac Surgery—Is it Time to Call the Pharmacy Instead of the Blood Bank?

PERIOPERATIVE COAGULOPATHY and bleeding in patients undergoing cardiac surgery are common, particularly among those undergoing complex surgery. The etiology of microvascular bleeding in some patients is complex and related to blood exposure to cardiopulmonary bypass components, surgical, and/or patient-specific factors. Treatment of clinically significant microvascular bleeding requires laboratory evaluation to help guide targeted therapy. When coagulation factor deficiency–associated bleeding is the culprit, historic therapy has been with allogeneic plasma transfusion.

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