Circulation. 2007;116:1755
doi: 10.1161/CIRCULATIONAHA.107.185635
(Circulation. 2007;116:1755.)
© 2007 American Heart Association, Inc.
Issue Highlights
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PROSPECTIVE RANDOMIZED COMPARISON OF CORONARY BYPASS GRAFTING WITH MINIMAL EXTRACORPOREAL CIRCULATION SYSTEM (MECC) VERSUS OFF-PUMP CORONARY SURGERY, by Mazzei et al
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Two approaches have been developed as attempts to retain the
positive features of cardiopulmonary bypass, especially in the
area of completeness and durability of coronary revascularization,
while avoiding some of its negative features. The latter can
include systemic inflammatory response as well as untoward neurological
events resulting from the manipulation of the aorta required
by the procedure. Off-pump coronary bypass grafting (OPCABG),
in experienced hands, has demonstrated benefits in certain patient
groups in terms of hospital length of stay, short-to-intermediate
term survival, and neurologic complications. Mini-bypass circuits,
minimal extracorporeal circulation (MECC), have been developed
in an attempt to retain the beneficial features of cardiopulmonary
bypass while limiting the undesirable features of OPCABG, namely,
systemic inflammatory response, coagulopathy, and hemodilution.
In this issue of
Circulation, Mazzei and colleagues report a
prospective randomized study comparing OPCABG and MECC in a
series of nearly 400 patients. The study demonstrates comparable
operative mortality and morbidity and similar release of inflammatory
markers, length of hospital stay, and use of blood products.
Residual perfusion defects and occluded/stenotic bypass grafts
at 1 year are similar between groups, and coronary revascularization
was performed with equal efficacy by experienced surgeons employing
either MECC or OPCABG. Thus, these results suggest that MECC
may achieve the benefits of OPCABG while facilitating more complete
revascularization. See p
1761.
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TWENTY-FIVE–YEAR EXPERIENCE WITH THE MEDTRONIC-HALL VALVE PROSTHESIS IN THE AORTIC POSITION, by Svennevig et al
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This study is a retrospective analysis of 816 patients who underwent
aortic valve replacement with the Medtronic-Hall valve prosthesis
between 1977 and 1987 at Rikshospitalet in Oslo, Norway. Svennevig
and colleagues followed up with each of the patients using written
questionnaires or telephone surveys. In addition, the data were
checked against hospital databases and medical records, and
dates of death were verified by the Norwegian civil registry.
The rate of survival at 25 years was 24.9%. No mechanical failures
occurred, and the rate of complications was relatively low.
Age, female gender, and the need for concomitant coronary bypass
surgery significantly reduced survival. Overall, the results
of the study suggest that the Medtronic-Hall valve is durable
and reliable. See p
1795.
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NITRITE INFUSION IN HUMANS AND NONHUMANS PRIMATES: ENDOCRINE EFFECTS, PHARMACOKINETICS, AND TOLERANCE FORMATION, by Dejam et al
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Nitroglycerin, as a source of bioavailable nitric oxide, has
been utilized widely as a therapeutic agent to provide relief
for symptoms associated with atherosclerotic coronary artery
disease. Despite its vasodilator effects, the long-term clinical
efficacy of nitroglycerin is limited by the development of tolerance,
leading investigators to evaluate other organic nitric oxide
generating compounds for therapeutic use. Nitrite, initially
believed to be an inert oxidation end-product of nitric oxide
metabolism, has recently been shown to function as a potent
vasodilator as well as limit ischemia-reperfusion injury at
physiological concentrations. Importantly, nitrite is not subject
to conventional enzymatic tolerance and, therefore, may overcome
many of the limitations associated with nitroglycerin use. Despite
this promising profile, data pertaining to the kinetics, potency,
and mechanisms of bioactivation of nitrite remain unknown. In
this issue of
Circulation, Dejam et al provide data that address
each of these questions and lay the foundation for the development
of nitrite as a clinical therapy for symptomatic coronary artery
disease. See p
1821.
Visit http://circ.ahajournals.org
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Clinician Update
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Coronary Stents and Noncardiac Surgery. See p
e378.
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Images in Cardiovascular Medicine
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Pericardial Effusion With Beginning Cardiac Tamponade Caused
by a Spontaneous Coronary Artery Rupture. See p
e383.
Left Ventricular Bronchogenic Cyst. See p e385.
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Correspondence
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See p
e388.
Related Articles:
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Coronary Stents and Noncardiac Surgery
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Circulation 2007 116: e378-e382.
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Pericardial Effusion With Beginning Cardiac Tamponade Caused by a Spontaneous Coronary Artery Rupture
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Circulation 2007 116: e385-e387.
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Letter by Agostini et al Regarding Article, "Stent Thrombosis Late After Implantation of First-Generation Drug-Eluting Stents: A Cause for Concern"
- Pierfrancesco Agostoni, Giuseppe M. Sangiorgi, and Giuseppe G.L. Biondi-Zoccai
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Twenty-Five–Year Experience With the Medtronic-Hall Valve Prosthesis in the Aortic Position: A Follow-Up Cohort Study of 816 Consecutive Patients
- Jan L. Svennevig, Michel Abdelnoor, and Sigurd Nitter-Hauge
Circulation 2007 116: 1795-1800.
[Abstract]
[Full Text]
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Prospective Randomized Comparison of Coronary Bypass Grafting With Minimal Extracorporeal Circulation System (MECC) Versus Off-Pump Coronary Surgery
- Valerio Mazzei, Giuseppe Nasso, Giovanni Salamone, Filippo Castorino, Antonello Tommasini, and Amedeo Anselmi
Circulation 2007 116: 1761-1767.
[Abstract]
[Full Text]
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Nitrite Infusion in Humans and Nonhuman Primates: Endocrine Effects, Pharmacokinetics, and Tolerance Formation
- André Dejam, Christian J. Hunter, Carole Tremonti, Ryszard M. Pluta, Yuen Yi Hon, George Grimes, Kristine Partovi, Mildred M. Pelletier, Edward H. Oldfield, Richard O. Cannon, III, Alan N. Schechter, and Mark T. Gladwin
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