Credit: Original article published here.In part two of an informative discussion, DocWire News partner Dr. Hady Lichaa continues his discussion with Dr. Matthew Bunte, a world-renowned expert on vascular and cardiac interventions. The topic at hand is deep venous arterialization (DVA), which is a technique that provides a limb-saving option for patients with chronic limb-threatening ischemia. In part one, Dr. Bunte broke down the technical nuances of the procedure. Here, Dr. Bunte details the clinical aspects of DVA procedures, recommendations he gives his patients post-DVA, what percentage of limbs are saved due to DVA, and much more. Dr. Hady Lichaa: So now, getting out of the technical aspect to the kind of program development aspect, tell us how you started. Who are the players in your program? And how do you collaborate? And how do you…? Let’s start with that. Dr. Matthew Bunte: Yeah. As a cardiologist, I have really come to appreciate how important it is to thinking about these patients almost like a transplant patient. I’m thinking about my heart failure colleagues and how there are many different clinical aspects to the case that lead you to offering these really complex solutions. But also, there’s that psychosocial dynamic,

Credit: Original article published here.A recent publication in JAMA Network Open explores two clinical questions related to antiphospholipid antibodies (aPL): (1) what is the prevalence of aPL positivity at a single time point, and (2) are aPL antibodies associated with future atherosclerotic cardiovascular disease (ASCVD) risk? [1].  Antiphospholipid syndrome (APS) is an acquired condition that is characterized by a thromboinflammatory state, with arterial or venous thrombotic events and/or obstetric complications, in the presence of persistently circulating aPL antibodies.  Arterial thrombotic events in APS include stroke or myocardial infarction (MI). With a recent study suggesting autoantibodies can be present in up to 18-32% of individuals [2], the authors of this study postulated whether presence of these autoantibodies may put individuals at higher risk for ASCVD morbidity than is currently recognized.  Previous studies have demonstrated aPL are acutely present in up to 17.4% of patients with cardiovascular events such as stroke and transient ischemic attack, and some incidental positive aPL can be present in 1-12% of otherwise healthy individuals.  Thus, this study sought to determine association of aPL and future ASCVD events and investigate association of sex, race, and ethnicity with aPL prevalence [1]. Zuo et al performed this population-based cohort study

Credit: Original article published here.There are no solutions, only tradeoffs. In acute myocardial infarction, we have tradeoffs between coronary supply and myocardial demand. In terms of supply, we have made significant progress by reducing ischemic time but see a plateau of benefit at 90 minutes. In terms of demand, we currently utilize pharmacotherapy which may be too little too late, especially in patients with large infarct size who have progressed to cardiogenic shock and cannot tolerate these therapies. We see these trends in the outcomes data. While advances in restoring supply have led to high short-term survival rates, long-term outcomes remain challenging due to the incidence of heart failure which reaches nearly 75% at 5 years (1). In-hospital mortality for cardiogenic shock remains abysmal despite advances in reperfusion. Thus, it is paramount that we find therapies capable of limiting infarct size without compromising systemic perfusion. Mechanical unloading is one option that has been shown to reduce infarct size in preclinical studies since the 1980s. Translating the efficacy of preclinical studies to effectiveness in the real world, however, remains a work in progress. The initial roadblock was inadequate technology. In 2008, the FDA approved the Impella, a percutaneous transaxial flow pump,

Credit: Original article published here.Dr. Hady Lichaa:  Hello, everyone. This is Hady Lichaa, Interventional Cardiovascular Specialist from DocWire News, and I have the pleasure of having Dr. Matthew Bunte with me today. He is a world expert on vascular interventions and cardiac interventions. Extremely accomplished, had the opportunity to start building a deep venous arterialization program within their limb salvage program, and we’re kind of wanting to discuss this with him today. How are you, Dr. Bunte? Dr. Matthew Bunte: I’m great, Hady. Thanks so much for having me today, and looking forward to the discussion. Dr. Hady Lichaa: Yes, sir. So, if you can let the audience know about what you do mostly, especially on the endovascular side, and then we can delve into the topic. Dr. Matthew Bunte: Yeah. Well, hello, everybody. I’m Matt Bunte. I’m from the Saint Luke’s Mid America Heart Institute in Kansas City, Missouri. I also am an associate professor at the University of Missouri Kansas City School of Medicine, and I’m the Director of Vascular Medicine for our health system. And my endovascular practice includes both artery and venous interventions, but more heavily focused on peripheral artery disease and chronic limb-threatening ischemia, which

Credit: Original article published here.The implantable cardioverter defibrillator (ICD) is frequently utilized in patients with heart failure for primary and secondary prevention and treatment of unstable arrhythmias. This device is a unique medical intervention that may improve survival for select patients but does not necessarily improve quality of life and may even lead to detrimental impacts. At the 2023 Houston Shock Symposium, Dr. Haider Warraich – director of the heart failure program at VA Boston Healthcare, assistant professor at Brigham and Women’s Hospital and prolific author highlighted the psychological stress that can impact ICD recipients and the physician role in addressing these stressors with our patients. Psychological stressors can present in many ways in ICD recipients; ranging from feeling phantom shocks to avoiding engagements due to fear of shock and persistent hyper-vigilance. Identified risk factors for increased psychosocial distress in ICD recipients include younger age less than 50 years old, female gender, low social support, premorbid psychiatric diagnosis, and greater than 5 appropriate or inappropriate defibrillations.1 Dr. Warraich challenged healthcare providers at the Houston Shock Symposium to consider the physician role in empowering patients to shift their mindset after an ICD shock from victimhood thinking with poor coping skills to

Credit: Original article published here.There is increasing recognition that left ventricle (LV) unloading is important for patients in cardiogenic shock supported by venous-arterial extracorporeal membrane oxygenation (VA-ECMO) – particularly, those in shock due to acute myocardial infarction (CS-AMI).1 Unloading the LV is commonly performed by inserting additional temporary mechanical circulatory support (tMCS), including devices like a percutaneous left ventricular assist device (pVAD, i.e., Impella®), CentriMag®, or an intra-aortic balloon pump.2 One approach to unload the LV during VA-ECMO that is infrequently used involves placement of a left-atrial drainage catheter that is placed via interatrial transseptal puncture. This would allow for direct left atrial drainage, thereby reducing pulmonary capillary wedge pressure and left ventricular preload thereby unloading the LV. This strategy is described as left atrial VA-ECMO or “LAVA-ECMO”. During the 2023 Houston Shock Symposium, Dr. William W. O’Neill presented a case report about a patient with severe aortic regurgitation resulting in cardiogenic shock requiring the use of LAVA-ECMO as a bridge to definitive repair. Dr. Jeffrey Wang had a poster presentation on a case report on a patient with refractory cardiogenic shock initially cannulated with VA-ECMO as a bridge to heart transplant. However, the patient developed worsening pulmonary edema requiring

Credit: Original article published here.CardioNerds correspondents Drs. Shiva Patiolla and Jeff Wang are covering The Houston Shock Symposium 2023. They are joined by the founder and director of the Houston Shock Symposium, Dr. Marwan Jumean, and Dr. Anju Bhardwaj, who currently serves as an assistant professor of medicine in the section of cardiology at the McGovern Medical School. The group discusses the theme of this year’s symposium, which is Breaking Boundaries, and will focus on the five areas of cardiogenic shock management, which are: Cardiac ICU, Cath Lab, Medical ICU, Operating Room, and Surgical ICU. See what these thought leaders had to say! Dr. Shiva Patiolla: Hello, everyone and thank you for joining us today. I am Shiva Patiolla. I’m a cardiology fellow at Baylor University Medical Center in Dallas, Texas, and a CardioNerds FIT Trialist. Dr. Jeff Wang: All right. Hi, everyone. My name is Jeff Wang, and I am a cardiology fellow at Emory University and a CardioNerds FIT Trialist as well. And we are really excited to serve as CardioNerds Conference Scholars for the 2023 Houston Shock Symposium with mentorship from Dr. Andrew Higgins. Dr. Shiva Patiolla: It is our great pleasure to be joined by the

Credit: Original article published here.In this episode of Healthcare Unfiltered:How do you design clinical trials in the era of precision oncology? Are prospective randomized controlled trials necessary anymore? Drs. Ray Kurzrock, Vivek Subbiah, and Christopher Booth join Dr. Chadi Nabhan to answer these important questions.

Credit: Original article published here.In this engaging episode, The Oncology Brothers welcome Dr. Jason Mouabbi, a breast medical oncologist from the MD Anderson Cancer Center, to better understand different histologies in hormone receptor-positive breast cancers, with a specific focus on invasive lobular carcinoma. This subtype of breast cancer, which is very different from the more common ductal carcinoma, as stated by Dr. Mouabbi, “is a very important [breast cancer subtype], that is largely misunderstood and understudied.”

Credit: Original article published here.DocWire News Medical Lead Dr. Payal Kohli reviewed the REDUCE-IT trial, which demonstrated that icosapent ethyl intervention twice daily is superior to placebo in reducing triglycerides (TGs), cardiovascular events, as well as CV mortality in patients with high TGs and either known CVD or individuals with known CVD or at high risk for developing it, and patients on statin therapy with relatively well-controlled LDL levels. The study was presented at the American College of Cardiology’s 72nd Annual Scientific Session Together with World Congress of Cardiology (ACC.23/WCC).