Heart, Lung and Circulation最新文献

Aim: This study aims to assess the safety, feasibility, and short-term outcomes of a modified right vertical infra-axillary thoracotomy (MRVIAT) technique, using a 2-5 cm incision without peripheral cannulation in patients of all ages with doubly committed subarterial ventricular septal defects (DCVSDs) and summarise associated surgical techniques.

Method: A retrospective review was performed on 171 patients with DCVSDs of all ages who underwent the MRVIAT procedure between 2022 and 2024.

Results: The procedure was successfully completed in all 171 patients without conversion to median sternotomy or in-hospital mortality. The median age was 1.3 years (range, 0.1-39.0 years), with seven patients (4.1%) aged ≥18 years. The median weight was 10.2 kg (range, 3.8-86.6 kg). Among them, nine patients (5.3%) weighed ≤5 kg, 83 (48.5%) weighed ≤10 kg, 81 (47.4%) weighed 10-50 kg, and seven (4.1%) weighed ≥50 kg. Complications included mild residual shunting in two cases (1.2%), incision infection in one case (0.6%), and pulmonary infection in one case (0.6%). Over a median follow-up of 1.3 years (range, 0.3-2.5 years), no thoracic deformities or moderate-to-severe valvular regurgitation were observed.

Conclusions: The MRVIAT technique is a safe and viable option for the surgical treatment of DCVSD in patients across all age groups. It provides a minimally invasive approach with a small, inconspicuous incision and avoids peripheral cannulation, making it a promising alternative to median sternotomy.

Background & aim: Photoplethysmography (PPG) enables mobile health (mHealth) heart rhythm monitoring (HRM). We aimed to assess patient experience and detection rates of arrhythmia recurrence with a mHealth HRM after repeat ablation of atrial fibrillation (AF).

Methods: Patients undergoing repeat ablation of AF were instructed to perform three rhythm recordings daily using a PPG-based smartphone application over a follow-up (FU) period of 6 months. Compliance was assessed as the number of actual measurements per number of expected measurements. Motivation was calculated as the ratio of the total number of days where the expected measurements were performed to the total number of monitoring days. Arrhythmia recurrence was compared between mHealth and conventional HRM comprising of 12-lead- and Holter-ECGs at 3 and 6 months after ablation.

Results: A total of 58 patients (37.9% female; median age 66.0 years, interquartile range [IQR] 59.8-72.3) were enrolled and participated in FU. A total of 21,985 PPG recordings have been performed (27.7% symptomatic). The median compliance for performing three measurements per day was 73.8% (IQR 43.8-99.9) and the motivation rate was 33.6% (IQR 12.6-79.8). Freedom from AF/atrial flutter was observed in 58.6% of the patients in the mHealth HRM and 82.8% in the conventional HRM (HR 3.140; 95%CI 1.593-6.188; p=0.0012). Of the PPG measurements indicating AF or atrial flutter, symptoms were reported in only 43.0%.

Conclusions: Patients undergoing repeat ablation of AF have high compliance for participating in a prolonged mHealth HRM over 6 months. The detection rate of atrial arrhythmia recurrences was higher in the mHealth compared to conventional FU.

Aim: This study aimed to assess the characteristics, transfusion events, and clinical outcomes of cardiac surgery patients treated with three-factor prothrombin complex concentrate (3F-PCC).

Method: A retrospective observational study was performed in three cardiac surgery centres in Australia. We studied sequential cardiac surgeries and collected data on 3F-PCC, fresh frozen plasma (FFP) and red blood cell (RBC) use from blood banks and clinical outcomes from the Australian Society of Cardiothoracic Surgery database. We compared 3F-PCC treated to PCC-untreated patients.

Results: For 1,698 patients, 254 (15%) received 3F-PCC, with a median dose of 2,000 IU (Interquartile range [IQR]: 1,000 to 2,000), administered almost exclusively in the operating theatre. After adjustment by overlap weighting, 3F-PCC was associated with a reduction in post-surgical FFP transfusions (Relative risk [RR]: 0.47; 95% confidence interval [CI] 0.29 to 0.77). Similarly, 14% of 3F-PCC patients needed ≥2 RBC units after surgery compared to 21% in controls (RR: 0.63; 95% CI 0.45 to 0.88). Both groups displayed similar safety profiles and clinical outcomes. However, pulmonary embolism occurred in 1.8% of 3F-PCC patients versus 0.8% of controls.

Conclusions: In a multicentre study, 3F-PCC use during cardiac surgery was independently associated with a significantly reduction of postoperative FFP and RBC transfusions. A phase III trial of early PCC at 2,000 IU appears justified.

Background & aims: Mavacamten, a first-in-class, cardiac-specific myosin inhibitor, has recently been approved in Australia as second-line therapy in patients with obstructive hypertrophic cardiomyopathy (oHCM) and New York Heart Association (NYHA) class II-III symptoms. Mavacamten reduces left ventricular (LV) outflow tract (LVOT) gradients and improves angina and heart failure symptoms. Several international studies have demonstrated the profound clinical benefit of mavacamten in patients with oHCM. However, there has been no reported "real-world" Australian data. This study aimed to assess the impact and safety of mavacamten in an Australian cohort with symptomatic oHCM.

Method: In this single-centre observational study, we assessed baseline characteristics, at rest and Valsalva LVOT gradients, LV ejection fraction (LVEF), LV global longitudinal function, and NYHA class in patients with symptomatic oHCM treated with mavacamten over 24 weeks.

Results: A total of 23 patients received mavacamten. Baseline characteristics are the following: mean age was 63±11 years, 52% were male, and 21 of 23 (91%) were on beta blockers. The mean gradients across the LVOT were 56±28 mmHg at rest and 92±29 mmHg with Valsalva manoeuvre. The mean LVEF was 66%, and 52% of patients reported NYHA class III symptoms at entry. At 24 weeks, mean at rest and Valsalva LVOT gradients showed statistically significant reduction (at rest, 16±13 mmHg; Valsalva, 37±36 mmHg; both p<0.001). Although statistically significant, the LVEF drop does not appear clinically significant (66% to 62%; p=0.02). LV global longitudinal function remained largely static across 24 weeks (-15.3% to -15.6%; p=0.6). A total of 70% of patients experienced at least one NYHA class improvement. Patient adherence was high, with 99% of all scheduled appointments attended. A total of 39 treatment-emergent adverse events occurred, of which 38% were cardiac-related. Over 24 weeks, three of 23 (13%) patients permanently discontinued mavacamten.

Conclusions: Our results provide novel real-world Australian data on the use of mavacamten in patients with oHCM. Approximately 70% of patients experienced significant clinical and echocardiographic improvement in first 6 months after drug initiation, with a tolerable safety profile.

Background: In regional settings, early hospital discharge after primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) could improve efficiency of healthcare systems.

Aim: This study aimed to assess the characteristics of patients after STEMI and PCI based on hospital length of stay and compare the differences in outcomes of patients according to their length of hospital stay.

Method: We performed a retrospective analysis of consecutive patients presenting with STEMI to our 24/7 PCI centre in regional Victoria, Australia between January 2022 and December 2022. Baseline patient characteristics, procedural data, and outcome data including 30-day hospital readmission, major adverse cardiovascular events, and mortality rates were collected. Patient data were compared between three groups: early discharge (<72 hours), standard discharge (3-5 days), and late discharge (>5 days).

Results: The early hospital discharge group had higher rates of a right coronary artery or left circumflex culprit vessel, with lower incidences of left ventricular systolic dysfunction. The major adverse cardiovascular event rate in the early discharge group was 1.5% compared with the standard and late discharge groups with 1.2% and 4.2%, respectively (p=0.616). The rates of hospital readmission of any type were similar between early discharge group and standard discharge group (13.2% and 14.8%, respectively; p=0.411).

Conclusions: In patients treated successfully with PCI after non-left anterior descending artery STEMI with an uncomplicated postprocedural course, early discharge may be safely achieved.

Background: Fulminant myocarditis (FM) is still associated with a high mortality in children. This study aims to provide clinical indicators that will enable early identification of children with FM at high risk of death and predict the mortality.

Method: A total of 40 children diagnosed with FM from January 2014 to March 2024 at our hospital were retrospectively analysed. Baseline demographic characteristics and relevant clinical data including basic vital signs, clinical presentation, and clinical findings were collected at admission and follow-up. Binary logistic regression analysis and receiver operating characteristic curves were used to screen for factors with clinical predictive value. Spearman correlation analysis was used to detect the correlation between interleukin-6 (IL-6) and disease severity.

Results: A total of 40 children with FM were included in this study and were divided into a survival group (n=34) and a death group (n=6). The most common clinical symptom was circulatory disorders (n=28; 70.0%). There were significant differences between the two groups in creatine kinase (CK) (p=0.031), serum IL-6 (p<0.001), left ventricular end-systolic diameters (p=0.041), and ventricular tachycardia (VT) (p=0.019). The multivariate logistic regression analysis of serum IL-6 and VT showed that IL-6 (odds ratio [OR] 1.094; 95% confidence interval [CI] 1.027-1.166; p=0.006), and VT (OR, 0.096; 95% CI 0.010-0.920; p=0.042) were independently associated with mortality. The results of receiver operating characteristic curve analysis showed that serum IL-6 (area under the curve [AUC] 0.975; 95% CI 0.894-1), VT (AUC 0.755; 95% CI 0.541-0.868), with a cut-off value of IL-6 of 24.60 pg/mL, a sensitivity of 100%, a specificity of 97.1%, and a Youden index of 0.971, suggesting that high levels of serum IL-6 (>24.60 pg/mL) and an electrocardiogram manifesting as VT have a predictive value for mortality, in which serum IL-6 has a very high accuracy. Spearman correlation analysis showed that CK, CK-MB, and aspartate aminotransferase were positively correlated with IL-6 levels, whereas left ventricular ejection fraction was negatively correlated with IL-6 levels, indicating that IL-6 levels are related to disease severity.

Conclusions: Serum IL-6 levels and VT manifestations on electrocardiogram at admission enable accurate early identification of children with FM at high mortality risk.

Aim: Whether aortic valve sparing (valve sparing root replacement [VSRR]) and Bentall surgery differently affect myocardial dysfunction is not clear. This study aimed to clarify whether the type of aortic root surgery, in case of at least grade 2 aortic regurgitation associated with myocardial dysfunction, affects the outcomes.

Method: Extraction from the Heart Valve Society aortic valve database (Aortic Valve Insufficiency and ascending aorta Aneurysm InternATiOnal Registry [AVIATOR]) was performed and two groups of patients operated between July 2007 and December 2022 were identified: Group 1 including patients undergoing VSRR with ejection fraction (EF) ≤50% (n=279) and Group 2 including patients undergoing Bentall with EF ≤50% (n=46). All patients had at least grade 2 aortic regurgitation.

Results: Similar cardiopulmonary bypass and cross-clamping time were reported. No statistically significant difference was reported between the groups in terms of postoperative bleeding, transfusion rate, reoperations, pacemaker rate implantation, ischaemic complications, and acute kidney injury. Follow-up mortality was similar between the groups, without any significant differences, and the weighted mixed-effect linear models showed improvement in EF in both groups; progressive inverse left ventricular remodelling is significantly higher in Group 2.

Conclusions: While both techniques can improve left ventricular function in patients with reduced EF, the Bentall procedure offers marginally better results in terms of left ventricular inverse remodelling. However, the choice between Bentall and VSRR should ultimately be determined by the surgeon's expertise and familiarity with each technique.

Background/aims: High-output heart failure (HOHF) is an under-recognised and understudied variant form of cardiac failure characterised by increased cardiac output (CO), low systemic vascular resistance, and higher filling pressures. This study aimed to compare mortality, morbidity, and haemodynamic profiles of patients with HOHF with those of patients with heart failure with preserved ejection fraction (HFpEF).

Method: Patients diagnosed with HFpEF who underwent invasive haemodynamic assessment in the United States Veterans Affairs (VA) health system between 2007 and 2022 were divided into two groups based on the cardiac index (CI)/output-to-HOHF group and control group, respectively. We compared all-cause mortality, any hospitalisation, heart failure hospitalisations, and a composite outcome including mortality and rehospitalisations (within and outside the VA Health Care System) from the date of right heart catheterisation (RHC) to 1-year post-RHC or end of follow-up. Haemodynamics and clinical characteristics were also compared.

Results: A total of 116,229 patients with RHC were screened, and 13,422 were included for analysis. A total of 450 patients had CO ≥8 L/min and CI >4 L/min/m² (study group); 12,972 had CO <8 L/min or CI ≤4 L/min/m² (control group). There were no noticeable differences in the described outcomes between groups. Patients who died were older or had a higher prevalence of obstructive lung disease, alcohol abuse, tobacco abuse, atrial fibrillation, or liver disease.

Conclusions: Despite distinct differences in pathophysiology and haemodynamics, our novel study findings suggest that HOHF is not associated with a noticeable difference in morbidity or mortality from that in patients with HFpEF.

Serial two-dimensional transthoracic echocardiograms (TTE) are critical for accurate diagnosis, observation of disease progression and therapeutic response for patients with hypertrophic cardiomyopathy (HCM). The first cardiac myosin ATPase inhibitor, mavacamten has recently been listed on the Pharmaceutic Benefit Scheme (PBS) in Australia. On the basis of the EXPLORER-HCM study and as part of the PBS requirements, protocolised imaging for baseline and regular serial follow-up are required for ongoing PBS approval due to the risk of inducing left ventricular dysfunction. Full echocardiograms are not required for surveillance nor are they time- or cost-effective. Therefore, we propose an abbreviated 15-minute protocol for use in this setting.