Annotated Source List

Cardiac procedures and surgeries. (2016, April 1). Retrieved September 14, 2016, from
http://www.heart.org/HEARTORG/Conditions/HeartAttack/PreventionTreatmentofHeart
Attack/Cardiac-Procedures-and-Surgeries_UCM_303939_Article.jsp#.V9ndRnUrLIU
Summary
In this webpage, the many current types of surgeries are highlighted and explained in
general detail. The articles starts with Angioplasty which is when a special tubing with an
attached balloon is put into the coronary arteries. When the balloon expands the shrunken arteries
are opened up. There is a variation of this where a laser is used. Artificial heart valve surgery is
when the surgeon performs a complex surgery to replace a damaged heart valve. Bypass surgery
is when another vein or artery is used to bypass regions where the heart has blockages.
Cardiomyoplasty is when another muscle from the body is placed on the heart and aided with a
pacemaker in order to aid the beating of the heart. Another solution is a complete heart
transplant. The Bypass surgery can also be performed by minimally invasive surgeries. Overall,
there are many problems that occur with the heart that can be prevented with good care of health.
Application to Research
This is a helpful article because it shows the many types of heart surgeries with a general
explanation of each one. This is helpful because it can help focus the type of surgery that I want
to focus on. Also, this is a useful article because it will help shape if I want to do something
dealing with surgery at all. Lastly, this article can be used as background about surgery in the
heart.
Coronary. (n.d.). In Dictionary.com. Retrieved October 29, 2016, from
http://www.dictionary.com/browse/coronary
Summary
This reference defines coronary as blood vessels, nerves or structures in general that
encompass a part or a structure.
Application to Research
This definition can be used in the introduction of my paper because it is a term that
not a lot of people understand. Also, it could be used as a introduction line of the paper to
capture audiences attention.
Drug-eluting stents: Do they increase heart attack risk? Retrieved October 06, 2016, from
http://www.mayoclinic.org/diseases-conditions/coronary-artery-disease/in-depth/drugeluting-stents/art-20044911
Summary
This Webpage delves deeper into the many types of stents and their benefits and
detriments. Specifically it talks about drug-eluting stents which are safe and effective in most
circumstances as long as they are used with the proper medicines that were proscribed. However,
the webpage goes on to emphasize the fact that if the patient doesnt start to change their lifestyle
things will not get better for them. They also go on to state that bare metal stents can be used but
they are much less effective in the heart. So they recommend that it is used in other areas in the
body because the heart is a very sensitive part of the body. The specific medicine you have to

take after stent placements are that the patient should take aspirin of drugs similar to that
prescribed to aspirin as they are blood thinners to prevent further clotting in the blood system.
Other anti-clotting medicine could be used as prescribed by the doctor. The one downfall of the
cardiac procedure is that after the procedure all other procedures have to be postponed to a later
date. Specifically past one year, in order to ensure that the heart doesnt clog again.
Application to Research
The application is that in my internship there is one improvement that can be made and it
would be through the stent. However, in order to know how to improve I could use this
information to further possible fixes. Also, this will be really good in the intro about the
internship and my research topic.
Fornell, D. (2014, September 3). Bioresorbable stents are the way of the future. Retrieved
October 12, 2016, from http://www.dicardiology.com/article/bioresorbable-stents-areway-future
Summary
This Webpage delves deeper into the future of stents. It talks about how polylactic acid is
a possible future stent that is better for the human with the stent. However, there are many
problems that still face scientists that want to mass produce this substitute. One problem is that
because the procedure is completely x-ray based, the stent must be able to be seen to be placed in
the right place. However, the problem with the polymers is that they cannot always be seen on
the x-ray. Also, they are thick so they are hard to maneuver around the heart. This disadvantage
causes the patient to have a lower success rate, not because of reactions, but because of a weak
polymer stent. However, the benefits of the polymer stent is that it has a natural ability to
dissolve, therefore when it dissolves in 2 years after a procedure, the arteries that it opens up will
function properly without any metal objects in the heart. The natural opening of the heart arteries
is very beneficial for both the patient and the doctor. Less side effects.
Application to Research
The application is that in my internship there is one improvement that can be made and it
would be through the biological stent. However, in order to know how to improve I could use
this information to further possible fixes. Also, this will be really good in the intro about the
internship and my research topic. Also, it would be a good start to my research questions as it has
a strong base but has many possible improvements and innovations which could significantly
help the cardiology field.
Giorgi, A. (2015, December 25). Laparoscopy. Retrieved September 29, 2016, from
http://www.healthline.com/health/laparoscopy#Purpose2
Summary
This webpage talks about specific information on how laparoscopy is performed. This is
important information because in order to prove that a new strategy is necessary, the old one has
to be proven wrong. In this specific case, the so called minimally invasive surgery requires for
the body to be cut open on the side and the ribs to be opened up to allow access to the heart.
Currently laparoscopy is generally used to examine areas like the appendix, gallbladder, liver,
pancreas, etc. to find abdominal mass or tumors, fluid in the abdominal cavity liver disease, the
effectiveness of certain treatments, and the degree to which a particular cancer has progressed.

Application to Research
This article is useful because it highlights a potential future of cardiac surgery that I plan
to research. This article gave me a better understanding of the fundamentals of the procedure in
laparoscopy which would be useful as a source of modern techniques which could be improved.
Also, it will help narrow my idea of thought to something more specific, or may make me
disregard the idea about laparoscopy completely. Also, it made me think about the fact that the
only problem with current heart surgery is that the ribs must be cut open as well as muscles. But
if Laparoscopy is used, the muscles will be minimally cut and the ribs wouldnt have to be cut.
However, the surgeon will still have access to the chest heart artery. The only problem is how to
get the chest artery to the heart artery.
Healthwise Staff. (2014, March 12). Coronary stent [Digital image]. Retrieved October 29,
2016, from http://www.webmd.com/heart-disease/coronary-stent
Summary
This Image shows the three step method of placing as stent in a coronary artery. The
image uses a tannish color to signify the clotting that occurs in the heart. Uses a silver to
show the stent. However, when the stent is small, a blue balloon shape is used to inflate the
stent to increase blood flow in the artery.
Application to Research
This image could be used as a visual source for the reader of the paper as stents are
not the easiest to picture with little experience with them.
Heart bypass surgery - minimally invasive: MedlinePlus Medical Encyclopedia. (2014, June 2).
Retrieved September 21, 2016, from https://medlineplus.gov/ency/article/007012.html
Summary
This webpage talks about specific information on how bypass surgery is performed. This
is important information because in order to prove that a new strategy is necessary, the old one
has to be proven wrong. In this specific case, the so called minimally invasive surgery requires
for the body to be cut open on the side and the ribs to be opened up to allow access to the heart.
Then, the surgeon uses a chest artery to connect back to the heart past where the clot is, this way
the heart will be relieved but the surgeon is also using an artery created for the purpose of
carrying blood near the heart, making a longer lasting surgery.
Application to Research
This article is useful because it highlights a potential future of cardiac surgery that I plan
to research. This article gave me a better understanding of the fundamentals of the procedure in
bypass surgery which would be useful as a source of modern techniques which could be
improved. Also, it will help narrow my idea of thought to something more specific, or may make
me disregard the idea about bypass surgery completely. Also, it made me think about the fact that
the only problem with current heart surgery is that the ribs must be cut open as well as muscles.
But if Laparoscopy is used, the muscles will be minimally cut and the ribs wouldnt have to be
cut. However, the surgeon will still have access to the chest heart artery. The only problem is
how to get the chest artery to the heart artery.

Inova heart & vascular. (n.d.). Retrieved September 29, 2016, from
http://www.inovaheart.org/heart-education-and-wellness/heart-specialists#Non-invasive
cardiologist
Summary
In this webpage, the authors break down the basics of what is a highly complicated job
known as internal cardiology. The doctor aims to help early diagnose and intervention of many
cardiac diseases. His job is strictly non-surgical but is focused on re-establishing blood flow to
the heart when it is damaged. They use techniques like balloon angioplasty, balloon vavuloplasty,
implantation of coronary stents, etc. This article also goes on to elaborate the many other fields
of cardiology. The variety range from non-invasive to vascular surgery. Non-invasive surgery
helps patients prevent and manage potential heart problems. They do not performs surgeries but
are experts in other methods. Vascular surgery is where the surgeon is specialized on procedures
in the vascular system. The vascular system consists of arteries, veins and capillaries, also known
as, the systems that move blood through the body from the heart.
Application to Research
This is a helpful article because it shows the many types of jobs that a cardiologist may
be pursuing. But it also elaborates on intervention cardiology which is what my doctor does for a
living. Learning about the basics of the job of my mentor is essential to better understand the
work that I am going to aid with daily. Also, it will help shape my research project so that it
better fits my mentors expertise.
Kern, M., Dr. (2012, June). Bioabsorbable stents where are we now? Retrieved October 27,
2016, from http://www.cathlabdigest.com/articles/Bioabsorbable-Stents--Where-AreWe-Now
Summary
This Webpage talks about the history of biological stents, how they were initially created
and how efficient the stents were at preventing reclotting. It then goes on to elaborate that the
metallic stents have many problems. Some include that they have been associated with acute and
late thrombosis, needs for long-term dual antiplatelet therapy and lasting impart of a metal
scaffold in the artery interfering with adequate computed tomography. The article also goes on to
talk about the invention of bio absorbable stents which have been made to reduce the downsides
of metallic stents. The article also cites sources of dat used to back up the fact that bioabsorbable
stents are not efficient enough to be used at the moment, but have the ability to overtake the other
stents with further research. Bottom line, bio absorbable stents will overtake drug-eluting and
bar-metal dents but they are still being developed because they have many issues in their design
or efficiency.
Application to Research
The application is that in my internship there is one improvement that can be made and it
would be through the biological stent. However, in order to know how to improve I could use
this information to further possible fixes. Also, this will be really good in the intro about the
internship and my research topic. Also, it would be a good start to my research questions as it has
a strong base but has many possible improvements and innovations which could significantly

help the cardiology field. Also, it cites many lab results that can be used in the data part of my
research paper.
Krans, B., & Watson, K. (2015, November 30). Heart bypass surgery. Retrieved September 21,
2016, from http://www.healthline.com/health/heart-bypass-surgery#Overview1
Summary
In this webpage, the authors break down the basics of what is a highly complicated
surgery known as Bypass surgery. The formal name is coronary artery bypass surgery which
aims to replace the damaged arteries in the heart in order to ensure that someone could live. This
surgery is required when plaque builds up in the arteries in the heart. Around 395,000 bypass
surgeries occur in the United States every year. The blocking up of the arteries makes the heart
more likely to fail, this is a problem because it is the organ that your body relies on to survive.
The need for bypass surgery is determined by if it is safe to do surgery. The alternatives to Heart
Bypass Surgery is balloon angioplasty when a balloon that is deflated is inserted into the artery
and then expanded in order to increase the size of the flow of blood to the heart. Another possible
procedure is Enhanced External Counter pulsation (EECP). This is where the blood vessels in the
lower limbs are compressed to increase blood flow to the heart, this helps make a natural bypass
of the artery in the heart.
Application to Research
This is a helpful article because it shows the many risks and basics of Heart Bypass
surgery. This is helpful because it can help focus the type of surgery that I want to focus on. Also,
this is a useful article because it will help shape if I want to do something dealing with surgery at
all. Lastly, this article can be used as background about bypass surgery in the heart. This article
showed that if I was to study bypass there was little to actually study because many better
alternatives have been created.
Lotan, C., MD. (n.d.). What exactly is a bio active stent (B.A.S)? [Scholarly project]. Retrieved
October 12, 2016, from http://www.puro-klima.cz/admin/Files/Lotan_Chaim.pdf
Summary
This PowerPoint summaries what a biological stent is. The PowerPoint elaborates on the
reasons that a certain type of biological substance was used in the stent. Titanium was used
because it was more effective in reducing inflammation. Titanium Oxide reduces platelet
aggregation and fibrinogen binding which is better for the heart. This study is backed up by
clinical evidence. In clinical studies the TiNO coated stent has 47 percent less inflammation than
the normal metal stent. In conclusion, the research shows that overall the natural stent is the most
effective and can be used in humans as an alternative stent. However, because they are newer
products, they are not yet confirmed to be safe for certain types of patients.
Application to Research
This is important because it is what my intern does every day therefore it is important to
have a good background on the equipment he uses. It will also help to better shape my research
topic to better suit my intern. Also, it would be beneficial to have a good background on other
types of stents that could be improved. Then, I could also better tailor my project to the strengths
of my mentor. While also shaping the intro of my future paper.

Lusher, T. F., Steffel, J., Eberli, F. R., Joner, M., Nakazawa, G., Tanner, F. C., & Virmani,
R. (2007, February 26). Drug-eluting stents and coronary thrombosis. Circulation.
Retrieved October 29, 2016, from http://circ.ahajournals.org/content/115/8/1051.full
Summary
In this Journal the researchers look at the drug-eluting stent, the stent created
before the biological stent, and its relation to coronary thrombosis. They conclude that the
thrombosis reduced but there were many problems that affected the data. This included
procedure related like stent length, or patient related, like diabetes or a low ejection
fraction.
Application to Research
This journal can be used in the data section of the research as it is a journal that
contains data in relation to medicated stents. Also, the journal has much background
information that can be used in the introduction or later in the paper.
Pdriscoll. (2009, June 11). Materials used in stent construction advanced medical ... Retrieved
October 20, 2016, from http://blog.mediligence.com/2009/06/11/materials-used-in-stentconstruction/
Summary
This Webpage delves deeper into the problems associated with stents in general. Stents
have a problem because they are a foreign object being placed into a highly sensitive body. If the
stent is not biologically compatible, the body will reject the stent by causing trauma,
inflammation, immune response and eventual healing or scarring. Normal metallic stents are
made using stainless steel. However, stainless steel is not fully compatible, so the procedure is
usually followed by restenosis and thrombosis. Stainless steel stents also have the problem that
they have imaging problems, so many alternatives are being looked at in order to make it easier
for the doctor and safer for the patient. Some polymers that reduce the inflammation and tissue
trama include, silicone. However, silicone is problematic for other reasons like biodurability,
tensile and coil strength, and inner-to-outer diameter.
Application to Research
The application is that in my internship there is one improvement that can be made and it
would be through the biological stent. However, in order to know how to improve I could use
this information to further possible fixes. Also, this will be really good in the intro about the
internship and my research topic. Also, it would be a good start to my research questions as it has
a strong base but has many possible improvements and innovations which could significantly
help the cardiology field.
Schuessler, A., Bayer, U., Siekmeyer, G., Steegmueller, R., Strobel, M., & Schuessler, A. (n.d.).
Manufacturing of stents: Optimize the stent with new manufacturing technologies [PDF].
Summary
This digital file is a written paper by a group of researchers on the basics of the
practicality of medicated and polymer stents by comparing it to a normal metal stent. The biggest
problem that they find with the two newer stents is that they are hard to see during the procedure.
This is problematic because viewing what the doctor is doing during a procedure is essential to

make sure that the stent goes to right place and can actually help the patient. The second problem
that they expand on is that the polymer stents have many problems associated with them. They
have challenges is their radial force, recoil, large profile, degradation rate and products,
biocompatibility and radiopacity. All of which are essential to a stent to make sure the stent
function as well as the older metallic stent. Another problem they examine is the price issues.
The medicated stent has problems with price because the price of magnesium is increasing, but
the old stents dont have that problem because their inputs are overall decreasing or remaining
the same.
Application to Research
This source is helpful because it highlights the many issue with polymer stents and
medicated stents, so it gives a topic for me to focus my research toward and to improve my
introduction of my paper. It is also very helpful because it can help direct the focus of future
research.
Stent research [Telephone interview]. (2016, October 24).
Summary
This interview is a phone interview with Dr. Martin Albornoz who does stent procedures daily.
He talks about how each stent has advantages (and disadvantages) compared to what has come
before. Additionally, he talks about how no stent has been shown to reduce mortality, prolong
life, or lessen the risk of future heart attack compared to treatment with optimal medical therapy
except when they are implanted in the setting of a true heart attack or STEMI where they do help
survival and in this situation they are all equally good. Each type of stent represents a
generational progression trying to overcome the limitations of what came before. Bare metal
stents were better than balloon alone reducing the risk of need for emergency bypass surgery
from about 5% to much less than 1%. The incidence of restenosis was reduced from 40% in the
first 6 months to 20%. He also states that if he had a heart attack I would want a latest
generation DES as this represents the state of the art. Lowest renarrowing rate, thinnest struts,
disappearing polymer. In time the dissolving stents may become stars but right now they are very
clunky. They are MUCH thicker than the latest DES making them more difficult to deliver.
Application to Research
This source is helpful because it highlights the many issue with polymer stents and
medicated stents, while also highlighting the many problems with biological stents. Also, it is an
interview with a professional in the cardiac stent field, so it is a strong source to sight.
Types of stents and their uses: Coronary artery stents. (n.d.). Retrieved October 06, 2016, from
http://www.webmd.com/heart-disease/guide/stents-types-and-uses#1
Summary
This website summaries the many uses and risks that are associated with stints. As a
cardiologist, you are faced with many issues in the heart. One of the many minimally invasive
cures are stents. They open narrowed, or blocked arteries in the heart that can relieve any chest
symptoms or help treat a heart attack. Angioplasty, the used of a balloon to open a stent to open
up arteries in the heart, is performed local anesthesia and mild sedation. It is minimally invasive
and can have many benefits because it took so little time to perform. There are two types of

stents, there is one that is medicated and one that is not. The medicated one has less of a chance
of future clogging in that area but has a longer time to use blood thinners, while the nonmedicated stent has a less chance of success but requires less time of medicine to recover.
Application to Research
This is important because it is what my intern does every day therefore it is important to
have a good background on the work that he does. It will also help to better shape my research
topic to better suit my intern. Also, it would be beneficial to have a good background on other
types of procedures that could be improved. Then, I could also better tailor my project to the
strengths of my mentor.
What is laparoscopic surgery. (n.d.). Retrieved September 14, 2016, from
http://www.surgery.usc.edu/divisions/tumor/pancreasdiseases/web pages/laparoscopic
surgery/WHAT IS LAP SURGERY.html
Summary
This webpage talks about general information about cardiac surgery which is a possible
alternative to breaking open the patients chest which causes a lot of problems later in their life.
Laparoscopic surgery is referred as a minimally invasive surgery because it requires a small
incision in one to two places. The incisions are used to insert the tools that the surgeon requires
to complete the surgery along with a video camera so that the surgeon would not complete the
surgery blind. The benefits of laparoscopy are that there is less side effects in the future as there
are less incision which are much smaller, quicker recovery times, earlier return to full activities
and much smaller scars. The article goes on to show that in the future laparoscopy may go in the
direction of being aided by robots which would help both the surgeon be more accurate, and
ensure better safety of the patients.
Application to Research
This article is useful because it highlights a potential future of cardiac surgery that I plan
to research. This article gave me a better understanding of the fundamentals of laparoscopic
surgery which would be useful as an introduction into my paper when the time comes to write it.
Also, it will help narrow my idea of thought to something more specific, or may make me
disregard the idea about laparoscopy completely.