The Beck operation in the treatment of angina pectoris.

Sandler, Gerald; Slesser, B. V.; Lawson, Cathy

doi:10.1136/thx.22.1.34

Cited by 20 publications

(5 citation statements)

References 13 publications

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“…It stands as a substantial public health concern, adversely affecting patients’ quality of life and imposing a notable strain on healthcare resources [ 17 ]. It was in the 1950s and 1960s when Claude Beck introduced the concept of coronary sinus narrowing and performed the first surgical procedure to effectively redirect blood flow to ischemic areas of the myocardium with remarkable effectiveness [ 18 , 19 ]. Since then, the CSR has emerged as a viable therapeutic option for individuals suffering from debilitating angina, especially those who have exhausted conventional medical treatments and are not suitable candidates for further revascularization procedures.…”

Section: Discussionmentioning

confidence: 99%

The Efficacy of Coronary Sinus Reducer in Patients with Refractory Angina: A Systematic Review and Meta-Analysis

Theofilis,

Vlachakis,

Sagris

et al. 2024

Rev. Cardiovasc. Med.

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Background: Refractory angina is a frequently encountered phenomenon in patients with coronary artery disease, often presenting therapeutic challenges to the clinical cardiologist. Novel treatment methods have been explored in this direction, with the coronary sinus reducer (CSR) being among the most extensively-investigated. Methods: We conducted a systematic review of the literature for studies assessing the efficacy of CSR in patients with refractory angina. The primary endpoints of interest were procedural success and the improvement in angina according to the Canadian Cardiovascular Society (CCS) by at least one class. Secondary endpoints were the rate of periprocedural adverse events, the improvement by at least 2 CCS classes, and the mean change in CCS class. A random-effects meta-analysis of proportions (procedural success, improvement by 1 or 2 classes, periprocedural adverse events) or means (mean CCS class change) were performed. was chosen as the metric for between-study heterogeneity. Publication bias was assessed by the inspection of funnel plots and Egger’s regression test. We examined the risk of bias according to the Newcastle-Ottawa Scale. Results: From a total of 515 studies identified from the original search, 12 studies were finally included for data extraction. Based on their meta-analysis, we observed a high CSR procedural success (98%, 95% confidence interval (CI) 96 to 99%) with a low rate of periprocedural complications (6%, 95% CI 5 to 7%), while most patients exhibited an improvement by at least 1 CCS class (75%, 95% CI 66 to 83%) after the intervention. A significant proportion of patients demonstrated an improvement by at least 2 CCS classes (39%, 95% CI 34 to 45%), with a mean change of –1.24 CCS class (95% CI –1.40 to –1.08). Conclusions: CSR is associated with high implantation success rates and significant improvements in angina symptoms for patients with refractory angina.

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Section: Discussionmentioning

confidence: 99%

The Efficacy of Coronary Sinus Reducer in Patients with Refractory Angina: A Systematic Review and Meta-Analysis

Theofilis,

Vlachakis,

Sagris

et al. 2024

Rev. Cardiovasc. Med.

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“…Beck used this technique to treat angina pectoris in humans and attempted the first cardiomyopexy in 1935. 4 …”

Section: Cabg: a Brief Historymentioning

confidence: 99%

Coronary Artery Surgery: Past, Present, and Future

Ghandakly,

Iacona,

Bakaeen

2024

Rambam Maimonides Med J

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Coronary artery bypass grafting (CABG) is the most commonly performed and studied major cardiac operation worldwide. An understanding of the evolution of CABG, including the early days of cardiac surgery, the first bypass operation, continuous improvements in techniques, and streamlining of the operation, is important to inform current trends and future innovations. This article will examine how CABG evolved—from techniques to conduits – describing current trends in the field and exploring what lies on the horizon for the future of CABG.

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“…The physiological concept of the reducer device was based on key aspects of the surgical Beck procedure, first described in 1954, in which the coronary sinus (CS) is surgically narrowed to 3 mm to improve collateral blood flow to ischemic myocardium 1 . Initial success of the procedure was most likely driven by elevated CS pressure, which led to improved perfusion of ischemic territories.…”

Section: The Neovasc Reducer Systemmentioning

confidence: 99%

Overview of the virtual 2020 FDA's circulatory system devices advisory panel on Neovasc reducer system

Medranda

Torguson

Waksman

2021

Cathet Cardio Intervent

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Refractory angina is considered a devastating condition with limited medical and therapeutic options. The Neovasc Reducer device, when implanted in the coronary sinus, is designed to alleviate anginal symptoms. However, the available clinical data are sparse. The US Food and Drug Administration (FDA) assembled the Circulatory Systems Devices Panel to discuss the Reducer's safety and effectiveness. Because of the coronavirus disease 2019 pandemic, this meeting was held virtually. In this manuscript, we detail the deliberation and discussion among the circulatory panel members, including their final vote. K E Y W O R D S coronary artery disease, interventional devices/innovation, new devices (in general) 1 | INTRODUCTION On October 27, 2020, the United States (US) Food and Drug Administration (FDA) convened the first ever virtual meeting of the Circulatory System Devices Panel of the Medical Devices Advisory Committee during the coronavirus disease 2019 pandemic, to consider a de novo premarket approval application for the Neovasc Reducer System (Neovasc, Richmond, Canada). | THE NEOVASC REDUCER SYSTEM | Reducer device designThe physiological concept of the reducer device was based on key aspects of the surgical Beck procedure, first described in 1954, in which the coronary sinus (CS) is surgically narrowed to 3 mm to improve collateral blood flow to ischemic myocardium. 1 Initial success of the procedure was most likely driven by elevated CS pressure, which led to improved perfusion of ischemic territories. This resulted in complete resolution of symptoms in most patients. 2 The Neovasc Reducer System is a stainless steel, hourglass-shaped, implantable reducer device, pre-mounted on a balloon catheter for implantation in the CS (Figure 1). It is made in a single device size, designed to fit a range of anatomies (compatible with CS diameters of 9.5-13 mm) with inflation of a semi-compliant balloon. The delivery catheter is inserted through a puncture in the internal jugular vein through the right atrium and into the CS. The reducer device is implanted 2-4 cm distal to the ostium of CS. This reducer device is designed to establish a narrowing in the CS, which is believed to result in an increase in back pressure. Therefore, the reducer's proposed mechanism would redistribute blood flow from non-ischemic territories of myocardium to improve perfusion to ischemic myocardium in the presence of reversible ischemia. 32.2 | Breakthrough device designation Refractory angina is a common problem faced in cardiology, afflicting nearly 2 million patients in the US. 4 Many patients with coronary artery disease who are not candidates for revascularization have refractory angina despite efforts to control symptoms with medical therapy, leaving an unmet need. Neovasc requested and received the first breakthrough device designation under the Breakthrough Devices Program (Section 515B of the federal Food, Drug, and Cosmetic Act

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The Beck operation in the treatment of angina pectoris.

Cited by 20 publications

References 13 publications

The Efficacy of Coronary Sinus Reducer in Patients with Refractory Angina: A Systematic Review and Meta-Analysis

The Efficacy of Coronary Sinus Reducer in Patients with Refractory Angina: A Systematic Review and Meta-Analysis

Coronary Artery Surgery: Past, Present, and Future

Overview of the virtual 2020 FDA's circulatory system devices advisory panel on Neovasc reducer system

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