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Tiny staples may fix aneurysms

Researchers at Georgetown University Hospital are conducting a clinical trial of tiny corkscrew-shaped staples to repair abdominal aortic aneurysms (AAAs). About 15,000 Americans die each year from ruptured AAAs.


Surgeons can use an endovascular patch to wall off an aneurysm from the abdominal aorta, reducing the risk of rupture. However, these patches can work loose and may need replacing in younger patients. The new procedure combines an endovascular patch with a tiny staple that's threaded into healthy aortic tissue, anchoring the patch.


The procedure was tried last year on two patients in Venezuela, who are still doing well. The clinical trial will enroll patients from Georgetown, Emory University in Atlanta, and the University of Pennsylvania in Philadelphia.


Permanent implantable artificial heart gets nod from FDA

The Food and Drug Administration (FDA) has approved the first totally implanted artificial heart for patients with advanced heart failure who aren't eligible for heart transplant or other treatment and who aren't expected to live more than 30 days without intervention.


The AbioCor Implantable Replacement Heart is made by Abiomed, Inc., of Danvers, Mass. The mechanical heart replaces the patient's heart, which is removed during the implantation procedure. Its internal battery, which can be recharged through the skin, frees the patient from external connections for up to 1 hour at a time. When two external batteries are used, the patient can go wireless for up to 2 hours. During sleep and when batteries are recharged, the system is plugged into an electrical outlet.


In a small clinical study, the artificial heart extended survival time by several months, and one patient was able to go home from the hospital.


Do bone marrow cells help the heart after MI?

Injecting progenitor cells derived from bone marrow into the heart may help improve contractile function and clinical outcomes after myocardial infarction (MI), according to two recent studies. A third study found no benefit to the therapy.


In a study of 187 patients conducted in Frankfurt, Germany, progenitor cells were injected into the infarcted myocardial tissue of patients who'd had acute ST-segment-elevation MIs and whose left ventricular ejection fraction was 45% or less after MI. After 4 months, patients in the study group had ejection fractions 2.5% higher than those in the control group. After 1 year, death rates, MI recurrence, and coronary revascularization rates also were lower in the study group compared with the control group.


The second study followed 92 patients with persistent left ventricular dysfunction after MI. After 3 months, patients who'd received progenitor cells had significantly higher left ventricular ejection fractions than those who'd received blood cells or no injections.


However, a Norwegian study of 101 patients found no difference in left ventricular ejection fraction, end-diastolic volume, or infarct size between study and control groups after 6 months.


The therapy is still under investigation.


Source: Assmus B, et al., Transcoronary transplantation of progenitor cells after myocardial infarction, The New England Journal of Medicine, September 21, 2006.


AMIs often missed in the ED

Health care providers miss high-risk ECG abnormalities in about one in eight patients who arrive at the ED with acute myocardial infarction (AMI), according to a recent study.


The Emergency Department Quality in Myocardial Infarction study examined 1,684 patients with confirmed AMI who were admitted to five EDs in California and Colorado from July 1, 2000, through June 30, 2002. In 201 patients, high-risk ECG findings, such as ST-segment depression or elevation or T-wave inversion, weren't documented. These patients were less likely to receive aspirin, beta-blockers, and reperfusion therapy. Almost 8% of these patients died, compared with 4.9% of patients whose abnormal ECG findings were documented. (Patients with left bundle-branch block were excluded from the study.)


Although the study was small and results can't be generalized to all EDs, the researchers said that ED health care providers need additional training in ECG interpretation. The researchers also called for more collaboration between emergency medicine and cardiology-for example, providing ED personnel with feedback about patient outcomes. Women, elderly patients, and those with diabetes or heart failure are more likely to have atypical signs and symptoms.


Source: Masoudi FA, et al., Emergency Department Quality in Myocardial Infarction Study Investigators, Implications of the failure to identify high-risk electrocardiogram findings for the quality of care of patients with acute myocardial infarction: Results of the Emergency Department Quality in Myocardial Infarction (EDQMI) Study, Circulation, October 10, 2006.