March-April 2012

Digital Edition
‘Heartless’ Politician Re-Elected, Performs Duties of Office With Artificial Heart
Jack Miller, 62, is probably the only politician in America who smiles when people call him “heartless.” Four months ago, doctors at Virginia Commonwealth University (VCU) Medical Center in Richmond removed his dying heart and replaced it with the SynCardia temporary Total Artificial Heart.
The Economics of Hybrid ORs
Hospitals that have built multimillion-dollar, specialized cardiovascular hybrid operating rooms (ORs) are hoping to make a return on investment (ROI) by attracting more referrals with the latest technology. However, many hospitals with hybrid rooms say it takes more than new, cutting-edge technology to be successful — the real secret is collaboration of several specialties to decide what is best for the patient.
The Future of Coronary Stenting
April 15, 2012, will mark the 10th anniversary of the approval of the first drug-eluting stent (DES). Ten years ago, the mood surrounding the new anti-restinotic silver bullet stent was one of jubilance. The approval of the new drug-eluting stent completely revolutionized coronary stenting. Ten years later, the first company to win approval for a DES, ironically, has become one of the first to leave the product behind.
High-Quality, Low-Dose CTA Is Possible
We are at an inflection point with many aspects of medicine, not the least of which concerns choosing the correct tool to discover and manage coronary artery disease.  The American landscape of clinical and imaging service providers is going through a major reshuffle. Coronary computed tomography angiography (CTA) is growing in utilization, taking its place as an established modality with AHA, ACC and ACR society-derived appropriate use standards. However, this growth in CT utilization and the resultant growth in per capita radiation exposure have elevated a public debate about the risk of causing cancer versus the value of its information.
Mayo Clinic’s Valve Program Ranks Among the Most Innovative Heart Centers
Transcatheter heart valves are viewed as the poster children devices representing the latest in cutting-edge cardiac therapy technology. For this reason, it is not surprising nearly all the readers’ nominations for DAIC’s “Most Innovative Heart Centers” included hospitals that created minimally invasive structural heart programs using the Edwards Sapien aortic valve and the Medtronic Melody pulmonary valve. Implementation of these programs usually involves the creation of a hybrid operating room (OR) and close collaboration of numerous specialists using a team approach to evaluate patients and determine the best course of treatment. Various therapy approaches are used, which can all be performed in the hybrid OR in a single surgical session.
Sudden Death Risk Stratification Using T-Wave Alternans
While risk for sudden death is increased four- to six-fold in patients who have experienced myocardial infarction, it remains challenging to identify the specific patients who will benefit from the standard-of-care therapy, namely, implantation of an implantable cardioverter defibrillator (ICD).
Cardiology PACS and Consolidation: Will a Leader Emerge?
Cardiology departments have hosted a variety of software solutions in the past to meet varying demands. A recent report from KLAS reveals that the cardiology IT market is moving toward consolidation. The report, “Cardiology 2012: Will the Complete Cardiovascular Information System (CVIS) Please Stand Up?” explains a result of this consolidation trend is that providers are looking for a technology leader to step up and meet their needs.
When to Consider Revascularization of Coronary Chronic Total Occlusions
Management of coronary chronic total occlusion (CTO) is individualized depending on the severity of symptoms, ischemia and on the severity of concomitant coronary artery disease (CAD). Treatment should include anti-anginal and other therapies to promote vascular health. Patients who remain symptomatic or have a large burden of ischemia despite maximal medical therapy can be considered for revascularization.
Hybrid ORs Are the Way of the Future
There has been a convergence of expertise, deciding what is the best approach for patients and combining skill sets, imaging systems and tools of both interventionalists and surgeons, is the recent trend of hybrid ORs.