Harbinder Virdi

The first randomized, double-blind, placebo-controlled US trial of bone-marrow stem cells in patients with ST-elevation MI (STEMI) has shown the therapy to be safe and to improve left ventricular volume compared with placebo. Dr Jay H Traverse   (Minneapolis Heart Institute, MN) and colleagues report the findings in the September 2010 issue of the   American   Heart Journal . Traverse told   that this small, phase 1 trial differs in some ways from the European trials that have been performed with bone-marrow-derived stem cells in MI, which he admits are "considerably larger." This is the first time all patients have received the same number of cells—100 million—whereas in European studies, for example   REPAIR-AMI , some patients got three times as many cells as others. "Meta-analyses suggest there is a dose-response effect, so if you're giving people different numbers of cells, this introduces another variable that may affect th...

In patients with atrial fibrillation (AF), combinations of warfarin, aspirin, and clopidogrel are associated with increased risks of serious nonfatal and fatal bleeding, with dual warfarin and clopidogrel therapy and triple therapy carrying a more than three-fold higher risk than warfarin alone, a new Danish study shows. But such treatment does not appear to be associated with a significant reduction in ischemic stroke. The study, published in the September 13, 2010, issue of the   Archives   of   Internal   Medicine , was conducted by a team led by   Dr   Morten   Hansen   (University Hospital Gentofte, Copenhagen, Denmark). Hansen noted that this research is similar to a previous study conducted in MI patients, which showed almost identical   results. Hansen told   that "this bleeding risk is extremely hazardous and is leading to many deaths. Physicians need to think more carefully about the bleeding risk before presc...

Dr. Jeff Carstens knows the reaction he'll get when he mentions open heart surgery to a patient. “They say, whoa, ‘I don't want to have that,'” said Carstens, an Omaha cardiologist. Patients may balk, but a new study indicates that heart bypass surgery may be a better option than stents for many people with heart disease. Researchers involved in the major European-American study say that tens or even hundreds of thousands of Americans are having coronary artery angioplasty and stenting every year when they should be having a bypass. Patients and cardiologists frequently prefer angioplasty and the insertion of a stent to keep arteries open because it is quicker and easier. Patients also go home sooner and return to work more quickly. But data from the study on more than 1,800 patients show that three years after the procedure, those who got stents were 28 percent more likely to suffer a major event, such as a heart attack or stroke, and 46 percent more likel...

 Dr V Nandakumar, chief cardiac surgeon at the Kovai Medical Centre in Coimbatore has performed a rare cardiac surgery on Ramaswamy, a chronic renal patient.   "I wanted to make sure that Ramaswamy of Tirupur is perfectly normal before disclosing it to the outside world. Now, more than a month has passed after the surgery and the patient is perfectly normal," Dr Nandakumar, who had worked as a professor at the Kozhikode Medical College, told Express. "After browsing the net, I could not find a similar case anywhere in the world," Dr Nandakumar, who had also served in Melbourne for three-and-a-half years, said.   Ramaswamy, 58, was brought to the Kovai Medical Centre with excruciating back pain. He had undergone kidney transplant 25 years ago and was keeping well all these years. Investigations, including 64 slice CT Angiogram, revealed a long tear in the aorta (aortic dissection), starting from the aortic valve, causing severe valve leak an...

In Consumer Reports, alongside toasters, oven and cars, medical groups that perform heart bypass surgery are now being rated. Data-based ratings of doctors are not available to patients in most parts of the country, data-based except a few states like New York. From 42 states, ratings of 221 surgical groups were published but it should be noted that individual doctors are not rated. Based on complication and survival rates, one, two or three stars are given to the groups. These starts mean below average, average or above average. It is also taken into consideration while giving the ratings that whether the groups used the best surgical technique and whether patients were being sent home with certain medicines. The information that will be available in October is now available to those who buy the magazine or subscribed to Consumer Reports online. Dr Fred H.   Edwards , the chairman of quality and research for the society, and medical director for cardiothoracic surgery ...

Cardiac surgery-associated acute kidney injury (CSA-AKI) contributes to increased morbidity and mortality. However, its pathophysiology remains incompletely understood. We hypothesized that intra-operative mean arterial pressure (MAP) relative to pre-operative MAP would be an important predisposing factor for CSA-AKI. Methods: We performed a prospective observational study of 157 consecutive high-risk patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). The primary exposure was delta MAP, defined as the pre-operative MAP minus average MAP during CPB. Secondary exposure was CPB flow. The primary outcome was early CSA-AKI, defined by a minimum RIFLE class - RISK. Univariate and multivariate logistic regression were performed to explore for association between delta MAP and CSA-AKI. Results: Mean (SD) age was 65.9+/-14.7 years, 70.1% were male, 47.8% had isolated coronary bypass graft (CABG) surgery, 24.2% had isolated valve surgery and 16.6% had combined pro...

Cardiac surgery patients with impaired glucose tolerance or prediabetes have long been thought to suffer more major postoperative adverse events than those with normal glucose tolerance. New evidence suggests that may not be the case. Researchers in Boston have found that the two groups of patients—prediabetics and nondiabetics—experience similar rates of myocardial infarction, renal failure, stroke and death, at least when a cutoff of hemoglobin A 1c  (HbA 1c ) of 6% or greater is used to define impaired glucose tolerance. “Patients with impaired glucose tolerance are a special group,” said Balachundhar Subramaniam, MPH, MD, assistant professor of anaesthesia at Harvard Medical School and Beth Israel Deaconess Medical Center, both in Boston. “They’re not yet diagnosed as diabetics, and [yet] may be prone to more risk than patients who are already diagnosed and well controlled.” To determine the relative adverse event rate for nondi...