Cardiac cell therapy: A realistic concept for elderly patients?

Established therapeutic concepts for heart failure in elderly patients aim at long-term medical and/or surgical palliation. Heart transplantation is limited to younger individuals, and permanent mechanical assist devices are not yet widely used. In this situation, myocardial cell therapy offers fascinating new perspectives, the ultimate goal being the complete regeneration of heart muscle and blood vessel cells. In small animal models, myocardial cell therapy often leads to a striking improvement of heart function, but the success in man has so far been modest. A possible explanation for the problems with bench-to-bedside translation of cardiac cell therapy is that mainly autologous cell products from aged patients with chronic diseases have been used so far. The aim of this paper is to summarize the current state of development of clinical cardiac cell therapy, to outline how autologous regenerative cells are subject to ageing processes, and to discuss whether the cardiac cell therapy in its present form is a realistic concept for elderly patients.     

Conscious sedation for TAVR: A wave of the future?

• As indications for TAVR continue to grow, experienced centers strive to adopt further minimally invasive techniques and continue to improve outcomes.
• Meta‐analysis of the available data demonstrate that conscious sedation is associated with decreased ICU and hospitalization time, and is not associated with decreased procedural efficacy or safety.
• Randomized Controlled clinical Trial data will be needed to confirm observational findings suggesting decreased mortality with conscious sedation versus general anesthesia.

     

A pill for HCV – myth or foreseeable future?

Weekly injections with pegylated‐IFNa (PegIFN) combined with daily ribavirin (RBV) are still the standard of care for chronic hepatitis C in most of the world. Sustained virological response (SVR) of 40–50% for patients infected with HCV genotypes (GT) 1 or 4 and 70–90% for genotypes 2–3 are achieved with this regimen. Triple therapy, registered in both the EU and USA, utilizing the first‐generation direct protease inhibitors is able to increase the SVR rates to 75%, but its use is restricted to patients infected with HCV GT1. Additional limitations include challenging dosing schedules, complex treatment algorithms, limited efficacy in patients with previous null response to PegIFN/RBV therapy and additional side effects. There is also an important need for more effective antiviral therapy for difficult‐to‐treat populations with PEG‐IFN intolerance, particularly those with cirrhosis and non‐responders to previous therapies. All‐oral, IFN‐free therapies are an evolutionary step for future anti‐HCV therapies. Initial results of clinical studies conducted during the last year give hope for ‘a pill for HCV’ at least in selected CHC populations. In 2013 several clinical trials of all‐oral anti‐HCV therapies had been completed, first all‐oral combination submitted for registration and some conclusions could be drawn. However, there is not yet a clear direction for IFN‐free therapies in treatment naïve patients or more complex non‐responders.