Journal of Cardiac Surgery最新文献

Background. Limited randomized controlled studies showed that thoracoscopic surgical left atrial ablation was not superior to catheter ablation (CA) in patients with persistent atrial fibrillation (PerAF). Right atrium might play an important role in triggering and maintaining atrial fibrillation (AF) in patients with PerAF. This study aimed to compare the efficacy of thoracoscopic surgical biatrial ablation versus CA in patients with PerAF. Methods. Patients with PerAF underwent thoracoscopic surgical biatrial ablation or CA were included in this study. Propensity score matching (1 : 2) was applied to select patients in CA group and surgical ablation (SA) group. The primary endpoint was to compare the probability of freedom from atrial tachyarrhythmias between SA and CA. Atrial tachyarrhythmia recurrence was defined as any atrial tachyarrhythmias longer than 30 s documented by 24-hour Holter monitoring after the 3-month blanking period. Results. After propensity score matching, 51 patients in surgical biatrial ablation group and 102 patients in CA group were enrolled (mean left atrial diameter: 45.8 mm). The probability of freedom from atrial tachyarrhythmias on antiarrhythmia drugs was 62.7%, 60.6%, and 60.6% in SA group and 42.0%, 39.6%, and 36.7% in CA group at 12, 24, and 36 months, respectively (p = 0.011), and off antiarrhythmia drugs were 56.9%, 52.5%, and 52.5% in SA group and 36.0%, 31.4%, and 27.5% in CA group at 12, 24, and 36 months, respectively (p = 0.007). After adjustment of age, sex, left atrial diameter, and AF duration history, multivariable Cox regression analysis suggested that SA procedure was an independent factor to reduce the risk of atrial tachyarrhythmia recurrence (HR: 0.589, 95% CI 0.370–0.937, p = 0.025). Conclusion. Compared with CA, thoracoscopic surgical biatrial ablation might achieve superior effectiveness for patients with PerAF.

Aim. The present study sought to characterize the pulmonary arterial morphology and pulmonary blood supply in patients of tetralogy of Fallot and pulmonary atresia (TOF-PA) on CT angiography. Materials and Methods. We retrospectively reviewed our departmental database to identify patients with TOF-PA evaluated using CT angiography. The images were analysed to detect the presence of main and branch pulmonary arteries and pulmonary arterial confluence, presence of major aortopulmonary collateral arteries (MAPCAs), laterality and relation with pulmonary arterial morphology, and presence of patent arterial duct and associated intra- and extracardiac anomalies. Results. TOF-PA was identified in 177 patients (114 (64.4%) males; median age: 9 months). Pulmonary arteries were confluent in 142/177 (80.2%) patients. According to Somerville classification, type II pulmonary atresia was the most frequent pattern seen in 127/177 (71.8%). Based on McGoon’s ratio, pulmonary arteries were adequate for surgery in 123/177 (69.5%) patients. Patent arterial duct was present in 84/177 (47.5%) patients while MAPCAs were present in 124 (70.1%) patients, of which 72/124 (58.1%) patients had at least 1 essential MAPCA supplying either lung. According to Congenital Heart Surgeons’ Society classification, type B pulmonary arterial anatomy was the most prevalent, seen in 103/177 (57.6%) patients. Conclusion. TOF-PA is associated with marked morphologic variability in the pulmonary arterial arborization to supply the lungs. Cardiac CT angiography can accurately delineate the pulmonary arterial morphology, sources of pulmonary blood supply, and associated cardiovascular anomalies in patients with TOF-PA which aids in planning appropriate surgical management including decisions regarding the need for unifocalization of MAPCAs.

Objective. The aim of this study is to investigate the predictive value of fetal and neonatal echocardiographic parameters for neonatal coarctation repair in fetuses suspected of coarctation of the aorta (CoA), establish a prediction model for neonatal coarctation repair, and verify its predictive effectiveness and clinical applicability. Methods. From September 2017 to September 2022, fetuses suspected with CoA were enrolled. They were divided into two groups based on the need for neonatal coarctation repair. Fetal and neonatal echocardiographic parameters and clinical characteristics were collected retrospectively. Univariate and multivariate logistic regressions were applied to select significant predictors, which were further used to establish the nomogram prediction model. The area under the curve (AUC) of the receiver operating characteristic (ROC) was employed to quantify its discrimination ability. The calibration curve was drawn for internal verification, and the decision curve analysis (DCA) and clinical impact curve (CIC) were used to evaluate the clinical applicability of the prediction model. Results. This study included 50 infants suspected of CoA prenatally, of which 16 (32%) received aortic coarctation repair in the neonatal period and 34 (68%) did not. Multivariable logistic regression analysis revealed that the fetal echocardiographic parameter aortic isthmus/ductus arteriosus (AoI/DA) diameter ratio and the neonatal echocardiographic parameters such as the distance from left common carotid to left subclavian artery (LCSA) and the diameter of distal transverse aortic arch (DTAA) were independent predictors for neonatal coarctation repair. The ROC curve of the model showed excellent predictive value (AUC = 0.943). The calibration curve of the prediction model exhibited good fitness. The DCA and CIC demonstrated that the model had good clinical utility. Conclusion. The prediction model, which combines the fetal echocardiographic parameter AoI/DA diameter ratio and the neonatal echocardiographic parameters distance of LCSA and DTAA diameter, has an exceptional level of clinical value and prediction accuracy.

Objective. Predicting risk factors for acute kidney injury (AKI) after total arch replacement via modified triple-branched stent graft (MTBSG) implantation in patients with acute type A aortic dissection (AAAD) by conducting a nomogram. Methods. We collected the clinical data of 254 patients with AAAD who underwent MTBSG implantation surgery in our center. The independent risk factors of postoperative AKI were screened by univariate and multivariate logistic regression analysis and combined into a nomogram. We use receiver operating characteristic (ROC) curves, decision curve analysis (DCA), clinical impact curve (CIC), and calibration plots to evaluate the accuracy of the nomogram model. Results. Multiple logistic regression analysis showed that the risk factors of AKI after MTBSG implantation were age, malperfusion syndrome, preoperative serum creatinine, cardiopulmonary bypass time, and amount of red blood cell (RBC) transfusion. Based on these five risk factors, we established a nomogram model. The good accuracy and clinical applicability of the model were verified by drawing ROC curve (area under the curve (AUC) = 0.854), DCA curve, CIC curve, and calibration curve. Conclusions. Using perioperative clinical data to establish a nomogram model of AKI in patients with AAAD who received MTBSG implantation can be used as a tool to predict the occurrence of AKI after operation.

Background. The aim of this study was to clarify the incidence and risk factors for acute kidney injury (AKI) in patients undergoing hemiarch replacement (HAR) under moderate hypothermic circulatory arrest (MHCA) with retrograde cerebral perfusion (RCP). Methods. We retrospectively analyzed patients who underwent HAR under MHCA with RCP at our institution between April 2015 and July 2022. Exclusion criteria were preoperative dialysis, single kidney, and lack of preoperative plasma creatinine data. The study endpoint was the incidence of postoperative AKI, defined using the Kidney Disease: Improving Global Outcomes criteria. Multivariate logistic regression analysis was performed to identify the risk factors for postoperative AKI. Results. One hundred and seventy-nine patients were included in this study. The most common indications for HAR were thoracic aortic aneurysm (n = 107) and acute aortic dissection (n = 57). Concomitant procedures, most frequently aortic valve surgery, were performed in 104 (60.5%) patients. Median circulatory arrest time and minimum rectal temperature were 15 minutes (interquartile range, 11 to 19) and 27.4°C (interquartile range, 25.9 to 28.1), respectively. Operative mortality was 1.1%. The incidence of postoperative AKI was 37.8%. Multivariate analysis showed that acute aortic dissection (odds ratio, 4.57; 95% confidence interval (CI), 2.13–10.14; P < 0.001) and longer operating time (odds ratio, 1.01; 95% CI, 1.00-1.01; P = 0.001) were independent predictors for postoperative AKI. Conclusions. Acute aortic dissection and longer operating time were risk factors for postoperative AKI in patients undergoing HAR under MHCA with RCP. In contrast, neither circulatory arrest time nor minimum rectal temperature was a risk factor for AKI. This may be due to the short duration of circulatory arrest.

Background. Monitored anesthesia care (MAC) may offer better outcomes than general anesthesia (GA) in transcatheter aortic valve implantation (TAVI). We compared TAVI outcomes between patients who received MAC versus GA. Methods. We retrospectively reviewed data from all patients (N = 659), as well as 216 propensity-matched patients, who underwent TAVI at our institution during 2014–2019. Results. MAC and GA did not differ significantly in mortality (1.6% MAC vs. 4.2% GA, p = 0.05) or stroke (2.2% MAC vs. 2.4% GA, p = 0.96); however, median length of stay (LOS) was shorter in the MAC group (2 d MAC vs. 7 d GA, p < 0.0001). In propensity-matched patients, mortality (2.8% MAC vs. 4.6% GA, p = 0.7) and stroke (3.7% MAC vs. 1.9% GA, p = 0.7) did not differ significantly between groups. LOS remained shorter in the MAC group (2 d MAC vs. 7 d GA, p < 0.0001). Conclusions. In this large, single-center, retrospective study, MAC was associated with shorter hospital stay after TAVI.

For over forty years, coronary artery bypass grafting (CABG) has been recommended to patients with triple vessel disease (TVD) with the aim of providing a survival benefit compared to medical therapy. Generally, the survival benefit of CABG is determined by (a) the volume of myocardium at risk of infarction according to the extent of coronary artery disease (CAD), (b) the impairment of coronary flow reserve according to severity of coronary stenoses, severity of symptoms, or objective evidence of regional ischemia, and (c) the impairment of myocardial reserve according to left ventricular function and viability. The most frequently used index of survival benefit is the extent of CAD as described by the terms of the left main coronary stenosis and TVD. However, TVD has been inconsistently defined in randomised controlled trials. Furthermore, international guidelines do not provide a specific definition of TVD. This impacts a substantially sized and high-risk population. Here, we argue that the definition of TVD should include diseases in the major artery in each of the three coronary territories in order to estimate the survival benefit provided by CABG.

Objective. To establish risk factors for predicting preoperative ruptures in patients with acute type A aortic dissection (ATAAD) based on computed tomography angiography (CTA) imaging features alone. Methods. We retrospectively reviewed patients with ATAAD treated between January 2017 and December 2021 in Fujian Medical University Union Hospital, China. The primary outcome was preoperative rupture after admission. Multivariate logistic regression analysis was performed based on basic characteristics and CTA imaging variables selected by the application of the least absolute shrinkage and selection operator. Results. A total of 564 patients were enrolled. The rate of preoperative rupture was 14.2% (n = 80). Patients who experienced rupture were significantly older (P = 0.002) and had a higher rate of DeBakey II (P = 0.016), syncope (P = 0.003), ventilator-assisted ventilation (P = 0.008), preoperative shock (P = 0.040), hypotensive state (P = 0.009), hepatic insufficiency (P = 0.002), acute kidney injury (P = 0.045), and moderate or massive pericardial effusion (P = 0.007). Multivariate analysis identified the following independent risk factors for preoperative rupture based on CTA imaging features: DeBakey II (odds ratio (OR) = 1.988, 95% confidence interval (CI) 1.211–3.676, P = 0.009), ascending aorta diameter (OR = 2.077, 95% CI 1.335–4.045, P < 0.001), ascending aorta false lumen diameter (OR = 2.988, 95% CI 2.055–4.291, P < 0.001), ascending aorta false lumen/true lumen diameter ratio >4 : 1 (OR = 3.129, 95% CI 2.031–6.225, P < 0.001), and number of branch arteries involved in dissection >6 (OR = 1.154, 95% CI 1.036–2.006, P = 0.036). Conclusions. CTA imaging features are one of the most convenient indicators for the early prediction of preoperative rupture in patients with ATAAD.

Objective. We aimed to investigate outcomes in transcatheter versus surgical mitral valve repair in patients with secondary mitral regurgitation (MR) by leveraging a global, multi-institutional federated network database. Methods. Using validated ICD-10 and CPT codes, the TriNetX Analytics Research Data Network (a global federated database of electronic health records from 58 healthcare organizations) was queried to identify patients diagnosed with chronic, severe, ischemic MR and undergoing either transcatheter mitral valve repair (TMVr) or surgical mitral valve repair (SMVr) between January 1, 2015 and December 31, 2020. To adjust for baseline differences, 1 : 1 propensity score matching was performed via logistic regression using the nearest-neighbor approach and matching for 29 covariates including demographics, comorbidities, surgical history, preoperative medications, left ventricular function and heart failure status. We compared 1- and 3-year mortality rates and 1- and 3-year mitral valve reoperation rates in the matched cohorts using Kaplan-Meier estimates and adjusted Cox proportional hazards models. Results. A total of 2,352 patients met inclusion criteria (1,392 in the surgical mitral valve repair group and 960 in the TMVr group). After 1 : 1 propensity score matching, a total of 550 patients undergoing surgical mitral valve repair (SMVr) were compared to 550 patients undergoing TMVr. All characteristics were adequately matched between the cohorts (standardized mean difference <0.1). At 1- and 3-years respectively, mortality rate was 13.4% and 20.7% for surgical patients and 19.8% and 40.3% for TMVr patients. When compared to TMVr, patients undergoing SMVr were significantly less likely to face mortality at 3 years (HR: 0.42, 95% CI: 0.31–0.56, p  <  0.0001). At 1- and 3-years respectively, mitral valve reoperation was 2.2%, and 2.4% for surgical patients and 6.6% and 7.8% for TMVr patients. When compared to TMVr, patients undergoing SMVr were significantly less likely to undergo mitral valve reintervention at 3 years (HR: 0.29, 95% CI: 0.14–0.58, p = 0.0002). Conclusion. In a real-world, propensity score matching analysis of a large cohort of patients with chronic ischemic MR, surgical mitral valve repair had significantly better survival rates and significantly lower reintervention rates at 1- and 3-years compared to TMVr.

Objective. The study evaluates the safety and efficacy of hypothermic cardiac arrest (HCA) at various temperatures in aortic arch surgeries. Methods. We conducted a literature search in PubMed, Google Scholar, and Embase databases. For single proportion assessments, we employed fixed-effect and random-effect models in the general linear mixture model and the inverse variance model for other computations. We analyzed factors such as age, sex, operation time, and postoperative complications, with subgroup and metaregression analyses. We used funnel plots to depict potential publication bias. Results. Our research incorporated 43 papers with 34,797 cases. HCA temperatures were divided into five groups (A: 30–32°C, B: 28–30°C, C: 26–28°C, D: 24–26°C, and E: <24°C). There is no statistically significant difference in myocardial ischemia time (P = 0.90) and isolated cerebral perfusion (ICP) time (P = 0.95). Groups A and C have the best performance in avoiding postoperative complications including transient nerve injury (TNI), permanent nerve injury (PNI), renal failure (RF), and mortality occurrence rate. Group A has the lowest occurrence rate in PNI (3%) and mortality (3%). Group C has the lowest RF incidence (5%). Conclusion. Maintaining temperatures of 30–32°C in en bloc anastomosis or 26–28°C during arch replacement with separate grafts can significantly reduce complications including PNI, RF, and in-hospital mortality.