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In this article, Professors Yacoub and Miller review the current status of left-ventricular-assist-device (LVAD) therapy for patients with chronic heart failure. The authors discuss the advantages and disadvantages of the available devices, how the indications for LVADs have evolved, and address the question 'are LVADs ready for long-term use?'
Cardiogenic shock is the leading cause of death in patients with acute ST-segment elevation myocardial infarction. In this Viewpoint, Drs Henriques and de Mol introduce the AMC MACH (Academic Medical Center Mechanical support for Acute Congestive Heart failure in STEMI patients) program and discuss how newly available percutaneous left ventricular assist devices used in this scheme could provide a bridge to heart transplantation or recovery in patients who would otherwise be unlikely to survive.
Marvin J Slepian and Jack G Copeland present their Viewpoint on the University of Arizona's experience with the CardioWest™total artificial heart (TAH-t) in patients with protracted refractory cardiogenic shock accompanying acute myocardial infarction. The authors assert that the TAH-t could provide a lifeline to patients whose prognosis would otherwise be bleak.
The percutaneous repair of mitral regurgitation is a new and rapidly evolving field, offering a less-invasive alternative to surgery. Written by two leaders in percutaneous, nonsurgical repair of heart valves, this Review examines the elements influencing patient selection for percutaneous valve repair, such as underlying valve pathology and the characteristics of the various percutaneous devices.
Rapid stabilization and regression of atherosclerosis, even for advanced complex plaques, has been achieved experimentally in both animals and humans. In this insightful Review, Kevin Williams, Jonathan Feig and Edward Fisher examine the successes and failures of many established and experimental interventions to induce plaque regression, and discuss how regression of atheromata could become a realistic therapeutic goal.
In this update on the cardiac manifestations of hypertension and the aging process, Susic and Frohlich discuss the distinct pathophysiological mechanisms behind these two closely related entities, examine the clinical correlates, and outline future hypertension therapies.
In this month's Case Study, Kataoka and colleagues report a patient who experienced three episodes of syncope over the course of 2 years. Electrocardiography and 24h Holter monitoring revealed occasional premature ventricular complexes arising from the right ventricular outflow tract which, on a subsequent occasion, triggered an arrhythmic episode that degenerated into ventricular fibrillation. She was treated with radiofrequency catheter ablation and was fitted with an implantable cardioverter-defibrillator.
