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    <recommendedItem id="20100101_19_278"
                     title="FDA Okays First Percutaneous Heart Valve"
                     score="0.003"
                     href="http://www.medpagetoday.com/ProductAlert/DevicesandVaccines/tb/18135?impressionId=1265818233671"
                     
      &lt;p&gt;WASHINGTON  --  The FDA has approved the Melody Transcatheter Pulmonary Valve and Ensemble Delivery System, the first heart valve designed for implantation through a catheter in a leg vein.&lt;/p&gt;
&lt;p&gt;The device gives congenital heart defect patients with poorly functioning pulmonary valve conduits new treatment options without requiring open heart surgery.&lt;/p&gt;
&lt;p&gt;The valve does not cure the condition and may wear to the point of needing replacement over time, but a tissue valve in the device maintains proper blood flow-direction, which allows the valve to function longer than usual, an FDA statement said.&lt;/p&gt;
&lt;p&gt;Approval was based on clinical studies of 99 U.S. patients and 68 European patients.&lt;/p&gt;
&lt;p&gt;Participants showed improved heart function, and a majority noted improvements in clinical symptoms, the statement said.&lt;/p&gt;
&lt;p&gt;The limited durability of the device was similar to other existing treatments in the trial, with 21% of U.S. patients experiencing a stent fracture, the release said.&lt;/p&gt;
&lt;p&gt;Device manufacturer Medtronic must complete two postapproval studies to test long-term risks and benefits, including one study with 150 participants from the original clinical trials and more than 100 additional patients, who will each undergo a five-year evaluation.&lt;/p&gt;
&lt;p&gt;An additional condition of the device&apos;s approval is a review of healthcare professional specialization required for device implantation. The manufacturer must also maintain a database of valve recipients.&lt;/p&gt;
&lt;p&gt;The transcatheter valve was approved under the Humanitarian Device Exception (HDE) program, which supports device development for conditions affecting fewer than 4,000 people and allows approval for limited use with reasonable assurances that the device health benefit outweighs risk of injury or illness.&lt;/p&gt;
&lt;p&gt;Products with HDE approval can only be used at medical institutions under an institutional review board and cannot be sold for more than the cost of research, development, fabrication, and distribution.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_232"
                     title="FDA Gives Approval to New Heart Device"
                     score="-0.001"
                     href="http://www.medpagetoday.com/ProductAlert/DevicesandVaccines/tb/18089?impressionId=1265818233671"
                     
      &lt;p&gt;WASHINGTON -- The FDA has granted premarket approval to a second left ventricular assist system (HeartMate II).&lt;/p&gt;
&lt;p&gt;The device can now be used as destination cardiac support for patients with advanced-stage heart failure who are ineligible for transplantation. It was previously approved as an interim device for those awaiting transplantation.&lt;/p&gt;
&lt;p&gt;The approval was based on data from a two-year cohort study of 200, which randomized patients to the HeartMate II or the HeartMate XVE, the only other device approved for destination therapy, on a two-to-one basis, according to a statement from the device manufacturer Thoratec.&lt;/p&gt;
&lt;p&gt;Endpoints included survival at two years, free of debilitating stroke, and reoperation to repair or replace the device. The new device showed a 58% versus 24% two-year survival rate. Patients also experienced shorter hospital stays, lower rates of rehospitalization, and fewer reoperations annually.&lt;/p&gt;
&lt;p&gt;Patients with the HeartMate II noted an 80% increase in quality of life based on a 0% baseline, the release said.&lt;/p&gt;
&lt;p&gt;The device showed a lower rate of infection, renal failure, right heart and respiratory failure, and cardiovascular arrhythmia than its predecessor.&lt;/p&gt;
&lt;p&gt;As part of the premarket approval, Thoratec must complete a postmarket study and measure adverse effects, functional status, and quality-of-life data.&lt;/p&gt;
&lt;p&gt;The company also agreed to a second study to gather data on the relationship between bleeding, thrombosis, von Willebrand syndrome, and anticoagulation in left ventricular assist system patients.&lt;/p&gt;
&lt;p&gt;&quot;What this approval does do for the field of engineered solutions to healthcare problems is perhaps the most important aspect of this outcome. Innovation and improvements in technology continue to be made, and I am convinced that even better designs are on the horizon,&quot; Robert L. Kormos, MD, director of the Artificial Heart Program at McGowan Institute for Regenerative Medicine, said.&lt;/p&gt;
&lt;p&gt;The small size of the device allows it to be implanted in smaller patients, including many women.&lt;/p&gt;
&lt;p&gt;The device originally received premarket approval as the second bridge-to-transplantation device, after the HeartMate XVE, in 2008.&lt;/p&gt;
&lt;p&gt;Thoratec is located in Pleasanton, Ca.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_231"
                     title="FDA Adds Cardio Warnings to Weight-Loss Drug"
                     score="-0.001"
                     href="http://www.medpagetoday.com/ProductAlert/DevicesandVaccines/tb/18088?impressionId=1265818233671"
                     
      &lt;p&gt;WASHINGTON  --  The FDA said the weight-loss drug sibutramine (Meridia) should not be taken by patients with history of cardiovascular disease following a review of additional data showing an increased risk of heart attack and stroke among that population.&lt;/p&gt;
&lt;p&gt;The agency said the manufacturer, Abbott, has agreed to add the contraindication to its labeling, which will be expanded to include patients with a history of the following: &lt;ul&gt; &lt;li&gt;Coronary artery disease (i.e., heart attack, angina)&lt;/li&gt; &lt;li&gt;Stroke or transient ischemic attack&lt;/li&gt; &lt;li&gt;Heart arrhythmia&lt;/li&gt; &lt;li&gt;Congestive heart failure&lt;/li&gt; &lt;li&gt;Peripheral arterial disease&lt;/li&gt; &lt;li&gt;Uncontrolled hypertension (&amp;gt;145/90 mmHg)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The initial review of sibutramine began in November 2009 when the FDA received preliminary data from the SCOUT study suggesting patients using the drug had a higher risk for cardiovascular events. (See &lt;a href=&quot;http://www.medpagetoday.com/ProductAlert/Prescriptions/17147&quot; mce_href=&quot;http://www.medpagetoday.com/ProductAlert/Prescriptions/17147&quot; target=&quot;_blank&quot;&gt;Early Data Link Diet Drug to MI, Stroke, and Cardiac Death&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;Prior to review, the product label included a warning for patients with cardiovascular disease.&lt;/p&gt;
&lt;p&gt;Healthcare professionals should monitor patients for increase in blood pressure and heart rate and should discontinue therapy if either increase is observed, an FDA statement said.&lt;/p&gt;
&lt;p&gt;Patients should also discontinue use of sibutramine if they do not lose 5% of their baseline body weight within the first three to six months of treatment, as the drug may not be effective and puts the patient at unnecessary risk, the release said.&lt;/p&gt;
&lt;p&gt;The FDA said its review of SCOUT study data, as well as other information related to the drug&apos;s risks and benefits, is ongoing and will be followed by an open public advisory committee meeting to determine if it requires additional regulatory action.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20090101_19_1541"
                     title="HRS: Minimum Standards Set for Lead and Device Extraction"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/HRS/tb/14255?impressionId=1265818233671"
                     
       BOSTON, May 18 -- Safe extraction of pacemaker and implantable defibrillator leads is not a task for tyros -- it requires a minimum of 40 extractions under the supervision of a fully-qualified training physician, according to a consensus statement released by the Heart Rhythm Society.
              &lt;p&gt; 
              &lt;p&gt;Moreover, once a physician has been trained in proper technique, he or she should perform a minimum of 20 extractions a year to maintain skills at a safe level, said Bruce Wilkoff, M.D., director of cardiac pacing and tachyarrhythmia devices at the Cleveland Clinic Foundation and a vice president of the Heart Rhythm Society.
              &lt;p&gt; 
              &lt;p&gt;The bar defining &quot;fully-qualified training physician&quot; was also set high: he or she must have performed at least 75 extractions as the lead operator and must have a safety and efficacy record at least as good as published norms.
              &lt;p&gt; 
              &lt;p&gt;Dr. Wilkoff said that &quot;more than 80% of the panel&apos;s time was spent on discussion of indications for lead extraction.&quot;
              &lt;p&gt; 
              &lt;p&gt;The lengthy discussion indicates the difficulty in evaluating risks versus benefits of what is &quot;an invasive procedure,&quot; Dr. Wilkoff said. 
              &lt;p&gt; 
              &lt;p&gt;The statement made recommendations for four specific indications -- infection, chronic pain, thrombosis or venous stenosis, and &quot;leads that are no longer clinically useful.&quot;
              &lt;p&gt; 
              &lt;p&gt;According to the statement, both the device and the lead should be removed &quot;in all patients with definite [cardiovascular implantable electronic device] system infection as evidenced by valvular endocarditis, lead endocarditis, or sepsis.&quot;
              &lt;p&gt; 
              &lt;p&gt;Likewise, both the device and the leads should be removed in patients with &quot;occult gram positive bacteremia (not contaminant) device pocket infection and in patients &quot;with valvular endorcarditis without definite involvement of the leads and/or device.&quot; 
              &lt;p&gt; 
              &lt;p&gt;Device and lead removal are not, however, indicated for &quot;a superficial or incisional infection without involvement of the device and/or leads,&quot; nor is removal recommended to treat chronic bacteremia when the source is not the device or leads.
              &lt;p&gt; 
              &lt;p&gt;When chronic pain is the complaint, device removal is considered reasonable when pain at the device or lead insertion site is not manageable by medical or surgical techniques.
              &lt;p&gt; 
              &lt;p&gt;Device and lead removal is recommended for thrombosis or venous stenosis but the level of evidence is weaker than the evidence in support of removing devices when infection is present.
              &lt;p&gt; 
              &lt;p&gt;In most cases, the panel recommended removal for nonfunctioning leads, but said removal is not necessary in patients who have a life expectancy of less than a year.
              &lt;p&gt; 
              &lt;p&gt;The panel listed a series of scenarios in which functional leads should be removed, including &quot;patients with life threatening arrhythmias secondary to retained leads,&quot; or when device design or device failure &quot;may pose an immediate threat to the patients if left in place (e.g., Teletronics ACCUFIX J wire fracture with protrusion).&quot;
              &lt;p&gt; 
              &lt;p&gt;The panel also recommended removal of functional leads when the leads interfere with cancer treatment.
              &lt;p&gt; 
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt; Dr. Wilkoff has disclosed that he has received grant/research support from Medtronic, St. Jude Medical, Boston Scientific, Spectranetics, and Biotronik. He is a consultant for Medtronic, St. Jude Medical, Boston Scientific, Spectranetics, Cook, and LifeWatch.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
    </recommendedItem>
    <recommendedItem id="20090101_1_791"
                     title="ANA: Cortical Stimulation Returns Function to Chronic Stroke Patients"
                     score="-0.005"
                     href="