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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 5, September/October 2016
AFRICA
293
less traumatic and more haemostatic steps such as a purse-
string suture, a smaller hole for clamp insertion, and gentler
manipulation with the finger.
The technique we describe is easy and practical to perform.
While the wire is manipulated with the left index finger, it can
easily be grasped repeatedly with the clamp in the right hand.
Results of our preliminary report indicate that the double-hole
technique could be a safe and effective option for the extraction
of pacemaker leads and catheters from the right atrium. We
suggest that this technique may be especially useful in revision
cases with adhesions. Further research should be performed to
document the efficacy and safety of this method.
The main limitation of this experimental study is that the
right atria of the bovine heart are much smaller than those of
a human heart. Larger atriae may cause more difficulty during
surgery. Secondly, the usefulness of this procedure may in fact be
limited to wires that are partly trapped in the right atrium, and
hence this would include pacer wires and ‘errant’ guidewires.
It may not be appropriate for guidewires having left the right
atrium and travelled to the right ventricle or pulmonary artery.
Conclusion
We believe the double-hole technique has the potential to become
a safe, practical and effective measure in the future. Further
extensive research is necessary to investigate the utility of this
novel technique in contemporary cardiovascular surgery. We
plan to assess this technique in an
in vivo
model to corroborate
its potential as a less-invasive extraction procedure in future
research.
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Cardiovascular disease market set to grow very slowly to
$146.4 billion by 2022, says GBI Research
The cardiovascular disease market, which includes
hypertension, dyslipidaemia and thrombotic events, is set to
grow from $129.2 billion in 2015 to $146.4 billion by 2022,
at a very modest compound annual growth rate of 1.8%,
according to business intelligence provider GBI Research.
The company’s latest report states that this relative
stagnation can be attributed to major product approvals
coinciding with key patent expirations. Within cardiovascular
disease there are a number of blockbuster products that have
recently gone off-patent, and others are expected to in the
coming years, many of which belong to significant players.
For example, the current market leader, AstraZeneca’s
Crestor (rosuvastatin), generated around $7 billion in
2011, with revenues expected to drop sharply following the
expiration of its patent on 8 July 2016. Total annual revenues
are forecast to be around $1.3 billion in 2022.
Thomas Jarratt, associate analyst for GBI Research,
explains: ‘Unlike AstraZeneca, some key players will
experience revenue growth resulting from the introduction
of new products to market. In particular, Sanofi’s Praluent
(alirocumab) is expected to help mitigate losses associated
with falling revenues of its key products Lovenox (enoxaparin)
and Plavix (clopidogrel).
‘Novartis’ heart-failure drug Entresto was introduced to
market in July 2015, and GBI Research expects its revenues
to increase dramatically during the forecast period. Entresto
is a combination drug, which has shown efficacy in clinical
trials. Coupled with a high cost, which amounts to over $4
500 annually per patient, the drug contributes to a very high
revenue forecast of $5.7 billion by 2022.’
The sheer number of expirations and approvals means the
structure of the market will shift significantly. Current market
leader AstraZeneca is set to mitigate the damage associated
with the introduction of generic Crestor through the rising
revenues attributed to its antiplatelet drug Brilinta.
Jarratt continues: ‘the market shares of Sanofi and
Novartis are expected to increase strongly over the forecast
period, leading to Sanofi becoming market leader, and both
brands achieving revenues in excess of $7 billion by 2022.’
Source: AfricaPCR 2016