In conjunction with World Heart Day today, we take a look at some of these outstanding innovations in cardiology.
1. Bioresorbable stents
Bioresorbable stents, which are mesh tubes, would gradually dissolve in approximately one year, and would solve a major issue relating to cardio-surgery.
An artery-opening angioplasty would involve placing a stent to release drugs into the artery to keep it open. Over time, clots would form inside stents, estimated to occur in 1% to 2% of patients, blocking the passageway and causing stroke, heart failure, and is life-threatening. Currently, prevention requires a patient to be on long-term medications.
Not only that, they are also able to enable treated vessels to restore their ability to constrict and expand.
In a recent clinical trial of the first of its kind stent – the ABSORB II by Abbott – showed the everolimus-eluting stent was comparable to the best current generation metallic drug-eluting stent on the market.
Despite these benefits, today’s bioresorbable stents are less flexible and harder to place inside arteries than metal stents, limiting their applicative potential. Cardiologists believe this newly developed stents would be a worthy replacement of the current gold standard of drug-eluting metallic stents with further research.
2. Leadless pacemakers
The leadless pacemaker is a marked improvement over traditional pacemakers. It is a small, self-contained device, placed on the inside wall of the heart through a thin, flexible catheter.
Such devices are better as they do not contain lead wires to deliver electrical impulse that aid with proper heart function; the leads are the weakest link in current devices, and often are the reasons for complications, such as broken lead, or infection at the point of insertion. Furthermore, difference in anatomy between individuals brings about difficulties in implantation of the lead.
From one clinical trial, the retrieval of the leadless pacemaker was successful 100% of the time without complications. The duration of service is also impressive, with the battery projected to last an average of 15 years, and as high as 21 years, dependent on frequency of usage.
In another clinical trial, 96% experienced no major complications, and represented more than 50% reduction of risk as compared to current devices.
In 1997, there were more than 200 pacemaker implantations, or 69 implantations per million. As of 2008, there were more than 3,000 people living with pacemakers in Singapore, corresponding with 91 implantations per million.
3. Improved heart valve technologies
New heart valve technologies are also being developed. For instance, there are now valves made from animal tissues, known as bioprosthetic valves, which are implanted with a minimally invasive procedure - transcatheter aortic valve placement (TAVR).
Researchers are experimenting with newer heart valves fashioned from animal tissue, known as bioprosthetic valves, andhave the wide potential for widespread implementation for the replacement of stiff, narrowed aortic valves.
These valves have a lower risk of clot formation, minimising the need for patients to be on long-term anticoagulants, and lowers the risk of death from clots, resultant from stroke, and heart attacks.
However, these bioprosthetic valves do not have as long of a lifespan, requiring a patient to undergo another surgery to replace the valve. To solve this issue, doctors have invented a new procedure for implantation known as transcatheter aortic valve placement (TAVR), in which a new bioprosthetic valve is implanted into the heart via a catheter at the site of the failing device.
TAVR has many benefits, such as a lower risk of infection, lesser trauma to the chest and heart muscle tissue. Patients can also potentially save cost with a reduced length of stay – from three to five days – in the hospital, and be reintegrated back into their life with decreased recovery duration. A clinical trial of TAVR showed a lower one-year mortality rate of 14%, as compared to 19% for conventional surgery.
4. Heart attack monitor
Scientists have invented the world’s first heart attack monitor, known as the AngelMed Guardian System, can alert patients to ST segment shifts in their ECGs, which is an indicator of coronary ischemia.
This new development can reduce the symptom-to-door times for patients with prior acute coronary syndrome events who are at risk for recurrent heart attacks.
These times are currently about two to three hours, the time taken to re-vacularise the blockages, is inversely proportional to the patient’s prognosis. The system serves as an early warning system, alerting patients should anything is amiss with their heart. MIMS
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