Background-Genetic modulation of ventricular function may offer a novel therapeutic strategy for patients with congestive heart failure. Myocardial overexpression of ␤ 2 -adrenergic receptors (␤ 2 ARs) has been shown to enhance contractility in transgenic mice and reverse signaling abnormalities found in failing cardiomyocytes in culture. In this study, we sought to determine the feasibility and in vivo consequences of delivering an adenovirus containing the human ␤ 2 AR cDNA to ventricular myocardium via catheter-mediated subselective intracoronary delivery. Methods and Results-Rabbits underwent percutaneous subselective catheterization of either the left or right coronary artery and infusion of adenoviral vectors containing either a marker transgene (Adeno-␤Gal) or the ␤ 2 AR (Adeno-␤ 2 AR). Ventricular function was assessed before catheterization and 3 to 6 days after gene delivery. Both left circumflex-and right coronary artery-mediated delivery of Adeno-␤ 2 AR resulted in Ϸ10-fold overexpression in a chamber-specific manner. Delivery of Adeno-␤Gal did not alter in vivo left ventricular (LV) systolic function, whereas overexpression of ␤ 2 ARs in the LV improved global LV contractility, as measured by dP/dt max , at baseline and in response to isoproterenol at both 3 and 6 days after gene delivery. Conclusions-Percutaneous adenovirus-mediated intracoronary delivery of a potentially therapeutic transgene is feasible, and acute global LV function can be enhanced by LV-specific overexpression of the ␤ 2 AR. Thus, genetic modulation to enhance the function of the heart may represent a novel therapeutic strategy for congestive heart failure and can be viewed as molecular ventricular assistance. (Circulation. 2000;101:408-414.)

Robotic mitral valve surgery is a procedure that is gaining widespread popularity. The patient of today and the future will demand minimally invasive operations. Initial clinical experience with robotic systems will allow further developments. Ultimately, this may result in completely endoscopic heart surgery.

Background Cardiovascular disease is the leading cause of morbidity and mortality in patients on hemodialysis. To our knowledge, no studies have examined long-term outcomes of hemodialysis patients following coronary artery bypass grafting (CABG) in a predominately rural, low-income, and racially dichotomous population. Methods Long-term survival of hemodialysis patients undergoing non-emergent, isolated CABG was compared with non-hemodialysis patients. Survival probabilities were computed using the Kaplan-Meier product limit method and stratified by hemodialysis. Hazard ratios (HR) and 95% confidence intervals (95%CI) were computed using a Cox regression model. Results Hemodialysis patients (n=220) had shorter long-term survival than non-hemodialysis patients (median survival=3.3 versus 14 years, p<0.0001). The survival difference remained statistically significant after adjusting for clinically relevant variables (HR=5.2, 95%CI=4.4-6.2). Conclusion Hemodialysis patients had significantly shorter long-term survival compared with non-hemodialysis patients after CABG. Further research is needed to address the cost and policy implications of our findings, especially among priority populations.