New NICE Interventional procedures guidance [IPG613] Percutaneous balloon valvuloplasty for fetal critical aortic stenosis

New NICE Interventional procedures guidance [IPG613] Percutaneous balloon valvuloplasty for fetal critical aortic stenosis
Published date: May 2018 Next review: May 2021


Evidence-based recommendations on percutaneous balloon valvuloplasty for fetal critical aortic stenosis. This involves placing a catheter into the baby’s heart, while the baby is still in the womb. The aim is to help the heart develop properly.


For full guidance https://www.nice.org.uk/guidance/ipg613

NIHR Signal Short-duration dual antiplatelet treatment is possible for older people receiving drug-coated stents

NIHR Signal Short-duration dual antiplatelet treatment is possible for older people receiving drug-coated stents


Drug-eluting stents are more effective than bare-metal stents for preventing repeat procedures to open narrowed heart arteries in older adults with coronary heart disease. In this trial both types of stents were used alongside short courses of dual antiplatelet medication, outcomes for those receiving drug-eluting stents were improved with no difference in bleeding complications or rates of in-stent clots.
Published on 7 March 2018
Read full document at https://discover.dc.nihr.ac.uk/portal/article/4000966/short-duration-dual-antiplatelet-treatment-is-possible-for-older-people-receiving-drug-coated-stents

New NICE: Medical technologies guidance MTG37 Thopaz+ portable digital system for managing chest drains

Thopaz+ portable digital system for managing chest drains


Evidence-based recommendations on Thopaz+ for managing chest drains
Published March 2018
Next review: 2021


Full guidance available at: https://www.nice.org.uk/guidance/mtg37

New NICE Interventional procedures guidance IPG604: Aortic valve reconstruction with processed bovine pericardium

NICE Interventional procedures guidance IPG604: Aortic valve reconstruction with processed bovine pericardium


Evidence-based recommendations on aortic valve reconstruction with processed bovine pericardium. This involves replacing a damaged aortic valve with a new valve made from chemically treated cow pericardium. Published February 2018. Next review: February 2021


Read full guidance at: https://www.nice.org.uk/guidance/ipg604

UHCW publication: Haemodialysis acutely deteriorates left and right diastolic function and myocardial performance: an effect related to high ultrafiltration volumes?

Nephrol Dial Transplant. 2017 Aug 1;32(8):1402-1409. doi: 10.1093/ndt/gfw345.
Haemodialysis acutely deteriorates left and right diastolic function and myocardial performance: an effect related to high ultrafiltration volumes?
Sarafidis PA, Kamperidis V, Loutradis C, Tsilonis K, Mpoutsiouki F, Saratzis A, Giannakoulas G2, Sianos G, Karvounis H.
Read PubMed abstract at https://www.ncbi.nlm.nih.gov/pubmed/27738230

Uncertain benefits of BNP blood tests to monitor heart failure treatment

In specialist clinics, using B-type natriuretic peptide (BNP) blood levels to guide treatment in people with chronic heart failure shows promise but did not improve survival for all groups. In this review, the benefit was only seen in patients aged less than 75, who survived an extra 1.5 years on average, and possibly those with poor heart function (reduced ejection fraction). However, there was a reduction in hospital admissions for heart failure for everyone. 


BNP is a hormone released from the heart muscle, and higher levels may indicate more severe disease. It is currently used for diagnosis, but its use in monitoring treatment has become the subject of recent research interest.


From the NIHR Dissemination Centre

NIHR Signal Direct acting oral anticoagulants likely to be better than warfarin for people taking them for atrial fibrillation

In people with atrial fibrillation needing anticoagulant treatment, deaths were fewer in those who had direct acting oral anticoagulants compared with warfarin. The picture is less clear for the risk of stroke and complications such as bleeding in the brain or gut. Apixaban had the best efficacy and safety profile and was cost-effective compared with warfarin.




From the NIHR Dissemination Centre

UHCW publication: Hemodynamic instability during dialysis

Hemodynamic instability during dialysis: is intra-dialytic exercise the answer?
Scott McGuire, Elizabeth Horton, Derek Renshaw, Alfonso Jimenez, Nithya S. Krishnan, Gordon McGregor
BioMed Research International 2018 Jan


Abstract
Acute haemodynamic instability is a natural consequence of disordered cardiovascular physiology during haemodialysis (HD). Prevalence of intra-dialytic hypotension (IDH) can be as high as 20-30%, contributing to sub-clinical, transient myocardial ischemia. In the long term, this results in progressive, maladaptive cardiac remodelling and impairment of left ventricular function. This is thought to be a major contributor to increased cardiovascular mortality in end stage renal disease (ESRD). Medical strategies to acutely attenuate haemodynamic instability during HD are sub-optimal. Whilst a programme of intra-dialytic exercise training appears to facilitate numerous chronic adaptations, little is known of the acute physiological response to this type of exercise. In particular, the potential for intra-dialytic exercise to acutely stabilise cardiovascular hemodynamics, thus preventing IDH and myocardial ischemia, has not been explored. This narrative review aims to summarise the characteristics and causes of acute haemodynamic instability during HD, with an overview of current medical therapies to treat IDH. Moreover, we discuss the acute physiological response to intra-dialytic exercise with a view to determining the potential for this non-medical intervention to stabilise cardiovascular haemodynamics during HD, improve coronary perfusion and reduce cardiovascular morbidity and mortality in ESRD.

Full text PDF available at http://downloads.hindawi.com/journals/bmri/aip/8276912.pdf (free access)

National Audit of Cardiac Rehabilitation Annual Statistical Report 2017

A national audit of cardiac rehabilitation shows that about 68,000 people who had heart attacks missed out on cardiac rehabilitation in 2015/16, nearly half (49 per cent) of those who were eligible.

Subcutaneous implantable cardioverter defibrillator insertion for preventing sudden cardiac death [IPG603]

New interventional procedures guidance from NICE. This involves placing a device under the skin of the chest, which detects and treats fast heartbeats called tachyarrhythmias.
Recommendations:
Current evidence on the safety and efficacy of subcutaneous implantable cardioverter defibrillator insertion for preventing sudden cardiac death is adequate to support the use of this procedure provided that standard arrangements are in place for clinical governance, consent and audit.

Artificial heart implantation as a bridge to transplantation for end-stage refractory biventricular heart failure [IPG602]

New interventional procedures guidance from NICE.  This involves replacing the 2 lower chambers of the heart with a mechanical device to improve circulation until heart transplantation.

Current evidence on the safety and efficacy of total artificial heart implantation as a bridge to transplantation for end-stage refractory biventricular heart failure is limited in quality and quantity. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research.

Clinicians wishing to do total artificial heart implantation as a bridge to transplantation for end-stage refractory biventricular heart failure should:

• Inform the clinical governance leads in their NHS trusts.
• Ensure that patients understand the uncertainty about the procedure's safety and provide them with clear written information. In addition, the use of NICE's information for the public is recommended.
• Audit and review clinical outcomes of all patients having total artificial heart implantation as a bridge to transplantation for end-stage refractory biventricular heart failure (see section 6.3).
• Clinicians should enter details about all patients having total artificial heart implantation as a bridge to transplantation for end-stage refractory biventricular heart failure onto an appropriate registry and review local clinical outcomes.
• Patient selection should be done by a multidisciplinary team experienced in managing end-stage refractory biventricular heart failure in patients needing a heart transplant, for whom a donor organ is not expected to be available before their own heart fails completely.
• This technically challenging procedure should only be done in centres specialising in heart transplantation. Only cardiothoracic surgeons with specific expertise and training in inserting the device should carry it out.

NIHR Signal Alternative drug may prevent atrial fibrillation following heart surgery

After heart surgery around a third of people have atrial fibrillation, an abnormal heart rhythm, which impedes their recovery and lengthens hospital stay. Colchicine treatment could reduce this complication by about a third.

About 11 people would need this treatment to prevent one of them developing atrial fibrillation. Using amiodarone, an alternative drug commonly used in this situation, other research shows that about seven people would be treated to prevent one person suffering fibrillation.

From the NIHR Dissemination Centre

Effects of a multi-strain probiotic supplement for 12 weeks in circulating endotoxin levels and cardiometabolic profiles of medication naïve T2DM patients: a randomized clinical trial

Journal of Translational Medicine 2017 15:249

The present randomized clinical trial characterized the beneficial effects of a multi-strain probiotics supplementation on improving circulating endotoxin levels (primary endpoint) and other cardiometabolic biomarkers (secondary endpoint) in patients with T2DM.

UHCW Research: Shaun Sabico

NIHR Signal Alternative drug may prevent atrial fibrillation following heart surgery

After heart surgery around a third of people have atrial fibrillation, an abnormal heart rhythm, which impedes their recovery and lengthens hospital stay. Colchicine treatment could reduce this complication by about a third.

About 11 people would need this treatment to prevent one of them developing atrial fibrillation. Using amiodarone, an alternative drug commonly used in this situation, other research shows that about seven people would be treated to prevent one person suffering fibrillation.

From the NIHR Dissemination Centre

NHS England outlines future of congenital heart disease services

NHS England has set out plans to implement exacting new standards that will ensure patients with congenital heart disease (CHD) receive the best possible care.

Hospitals that do not currently fulfil these standards, which have been developed by specialists and patients, must either show that they have a programme to do so and meet strict milestones, or stop providing treatment.

A prospective study examining the role of myocardial Fibrosis in outcome following mitral valve repair IN DEgenerative mitral Regurgitation: rationale and design of the mitral FINDER study

BMC Cardiovascular Disorders 2017 17:282 https://doi.org/10.1186/s12872-017-0715-y

The optimal management of chronic severe primary degenerative mitral regurgitation (MR) is to repair the valve but identification of the optimal timing of surgery remains challenging. Current guidelines suggest ‘watchful waiting’ until the onset of symptoms or left ventricular (LV) dysfunction but these have been challenged as promoting ‘rescue surgery’. Better predictors are required to inform decision-making in relation to the necessity and timing of surgery. Chronic volume overload is a stimulus for adverse adaptive LV remodelling. Subclinical reduction in LV strain before mitral repair predicts a fall in LV ejection fraction following surgery and is thought to reflect the development of myocardial fibrosis in response to chronic volume overload. Myocardial fibrosis can be detected non-invasively using cardiac magnetic resonance (CMR) imaging techniques as an expansion of the extracellular volume (ECV).

UHCW Research: Thomas Barker and Ramesh Patel

Fat Hormones, Adipokines

Endocrinology of the Heart in Health and Disease in Integrated, Cellular, and Molecular Endocrinology of the Heart 2017, Pages 167–205

Adipose tissue functions as a dynamic endocrine organ secreting multiple proteins, factors, and hormones into the systemic circulation that are collectively described as adipokines. Adipokines exert pleiotropic effects on target tissues/organs thereby regulating energy homeostasis, metabolism, and insulin sensitivity, as well as immune and cardiovascular functions. Expanding adipose tissue in obesity undergoes a change in the adipokine secretion profile characterized by an increase of proinflammatory adipokines and suppression of anti-inflammatory adipokines increasing proinflammatory pathways within adipose tissue depots and creating an adverse circulating adipokine profile, resulting in a chronic, low-grade, systemic inflammatory state. Compelling evidence directly links the adverse proinflammatory adipokine profile in obesity with a spectrum of detrimental cardio-metabolic effects including hepatic, skeletal muscle, and myocardial insulin resistance, hypertension, atherosclerosis, hypercoagulability, thrombosis, and endothelial and cardiac dysfunction. This chapter presents a brief overview of the nature of adipose tissue in obesity and focuses on selected adipokines that have direct and indirect effects on the heart and cardiovascular system.

UHCW Research: I Kyrou, H. S. Mattu and H. S. Randeva

Minimising the risk of Mycobacterium chimaera infection during cardiopulmonary bypass by the removal of heater-cooler units from the operating room

Perfusion First Published November 7, 2017 https://doi.org/10.1177/0267659117739103

Mycobacterium chimaera (M. chimaera) is a recently characterised bacterium that can cause life-threatening infections in small numbers of patients who undergo cardiopulmonary bypass during cardiac surgery. The likely mode of transmission is thought to occur through aerosolisation from contaminated water reservoirs. The airborne bacteria then contaminate the surgical field, leading to an infection months or even years later. The preferred practical solution to disrupt the transmission of these airborne bacteria to the patient is to remove the heater-cooler units (HCUs) from the operating room (OR). We describe a process of achieving this in order to provide information to guide other institutions who wish to do a similar thing.

UHCW Research: Thomas A. Barker, Uday Dandekar, Nina Fraser, Lincoln Dawkin, Paul Sweeney, Fraser Heron, Jacqui Simmons and Jitendra Parmar

NIHR Signal Being overweight or obese is linked with heart disease even without other metabolic risk factors

People with certain metabolic risk factors who are obese are two and a half times as likely to develop heart disease as healthy people of normal weight. But those who are obese without these other risk factors still have a 28% increased risk of heart disease compared with healthy people of normal weight.

This suggests excess weight should be seen as an independent risk factor, challenging the idea that people can be “fat but fit”.

From the NIHR Dissemination Centre

Eight reasons why we need to think differently about cardiovascular disease in England

Despite significant success in reducing premature mortality from cardiovascular disease (CVD), it remains a major cause of death and disability in England.The British Heart Foundation looks at eight reasons why tackling undiagnosed medical risk factors, improving quality of care and reducing variation can change millions of lives.