Background: Cryoballoon ablation (CBA) is a reliable therapy for paroxysmal atrial fibrillation (pAF). However, the relatively high recurrence rate poses a perplexing challenge for clinicians; thus, a more detailed understanding of the pulmonary vein anatomy and the left atrial (LA)-pulmonary vein (PV) conjunction mode is needed. This study aimed to explore the correlation between the PV anatomy and pAF recurrence in patients who underwent the index CBA. Methods: We included 274 consecutive pAF patients (men: 60%, mean age: 58.8 ± 11.5 years, median AF history: 25 (8, 63) months) with pAF who underwent their first cryoballoon ablation between October 2019 and March 2022. All data were collected from the patient’s medical records. Subsequent post-procedural long-term follow-up and statistical analysis were conducted. Results: Amongst the total patients, 220 (80%) remained AF-free. Multivariate analysis showed that the right inferior PV (RIPV) vertical angle (hazard ratio (HR): 1.097, 95% CI: 1.071–1.124, p < 0.001) and PV variation (HR: 1.905, 95% CI: 1.079–3.362, p = 0.026) correlated with postoperative AF recurrence. The study investigated the effectiveness of the RIPV vertical angle, either alone or in combination with other recognized factors. Conclusions: In patients with pAF who underwent the index CBA, the RIPV vertical angle and PV variation served as reliable prognostic predictors. Specifically, the RIPV vertical angle, either alone or in combination with recognized factors, demonstrated effective predictive performance.
{"title":"Correlation Analysis of Pulmonary Vein Anatomy and Paroxysmal Atrial Fibrillation Recurrence after Cryoballoon Ablation","authors":"Yingmin Wang, Xuan Wu, Na Liu, Hu Tan, Qiming Liu","doi":"10.59958/hsf.7057","DOIUrl":"https://doi.org/10.59958/hsf.7057","url":null,"abstract":"Background: Cryoballoon ablation (CBA) is a reliable therapy for paroxysmal atrial fibrillation (pAF). However, the relatively high recurrence rate poses a perplexing challenge for clinicians; thus, a more detailed understanding of the pulmonary vein anatomy and the left atrial (LA)-pulmonary vein (PV) conjunction mode is needed. This study aimed to explore the correlation between the PV anatomy and pAF recurrence in patients who underwent the index CBA. Methods: We included 274 consecutive pAF patients (men: 60%, mean age: 58.8 ± 11.5 years, median AF history: 25 (8, 63) months) with pAF who underwent their first cryoballoon ablation between October 2019 and March 2022. All data were collected from the patient’s medical records. Subsequent post-procedural long-term follow-up and statistical analysis were conducted. Results: Amongst the total patients, 220 (80%) remained AF-free. Multivariate analysis showed that the right inferior PV (RIPV) vertical angle (hazard ratio (HR): 1.097, 95% CI: 1.071–1.124, p < 0.001) and PV variation (HR: 1.905, 95% CI: 1.079–3.362, p = 0.026) correlated with postoperative AF recurrence. The study investigated the effectiveness of the RIPV vertical angle, either alone or in combination with other recognized factors. Conclusions: In patients with pAF who underwent the index CBA, the RIPV vertical angle and PV variation served as reliable prognostic predictors. Specifically, the RIPV vertical angle, either alone or in combination with recognized factors, demonstrated effective predictive performance.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":"156 20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140414927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jing Zhang, Chengzhi Zhang, Yifan Huang, P. Zeng, Jian Yang
Long QT syndrome (LQTS) is a hereditary disorder that can lead to recurrent syncope, convulsive episodes, and sudden death due to ventricular arrhythmia. In most instances, LQTS remains concealed and primarily presents as unexplained syncope despite have a normal electrocardiogram (ECG) during periods of rest. This characteristic can be highly deceptive and may result in severe and potentially fatal consequences if treated incorrectly. In this report, we present a case of concealed LQTS in an elderly female patient who experienced an initial episode of syncope at the age of 76. Upon admission, the surface ECG showed no abnormalities. However, during the bedside ECG examination, typical manifestations of LQTS were detected, indicating an early stage of the ictal process. Subsequent treatment with βblockers provided symptomatic relief. Genetic testing identified a rare mutation, p. Arg366Trp (with a c.1096C>T variant), in the KCNQ1 gene, confirming the diagnosis of LQTS. Although congenital LQTS cases are more commonly found in young females, the potential for LQTS should not be overlooked in elderly patients who complain of unexplained syncope, even if their ECG normal. The use of an artificial intelligence (AI)-based diagnostic tool has the potential to offer a more precise means of identifying concealed LQTS in the future, but, until now, thorough examination and close observation during admission is necessary to avoid missed diagnoses of the concealed LQTS-syndrome.
{"title":"Concealed Long-QT Syndrome with Rare KCNQ1 Gene Mutation in an Elderly Female: A Case Report","authors":"Jing Zhang, Chengzhi Zhang, Yifan Huang, P. Zeng, Jian Yang","doi":"10.59958/hsf.6803","DOIUrl":"https://doi.org/10.59958/hsf.6803","url":null,"abstract":"Long QT syndrome (LQTS) is a hereditary disorder that can lead to recurrent syncope, convulsive episodes, and sudden death due to ventricular arrhythmia. In most instances, LQTS remains concealed and primarily presents as unexplained syncope despite have a normal electrocardiogram (ECG) during periods of rest. This characteristic can be highly deceptive and may result in severe and potentially fatal consequences if treated incorrectly. In this report, we present a case of concealed LQTS in an elderly female patient who experienced an initial episode of syncope at the age of 76. Upon admission, the surface ECG showed no abnormalities. However, during the bedside ECG examination, typical manifestations of LQTS were detected, indicating an early stage of the ictal process. Subsequent treatment with βblockers provided symptomatic relief. Genetic testing identified a rare mutation, p. Arg366Trp (with a c.1096C>T variant), in the KCNQ1 gene, confirming the diagnosis of LQTS. Although congenital LQTS cases are more commonly found in young females, the potential for LQTS should not be overlooked in elderly patients who complain of unexplained syncope, even if their ECG normal. The use of an artificial intelligence (AI)-based diagnostic tool has the potential to offer a more precise means of identifying concealed LQTS in the future, but, until now, thorough examination and close observation during admission is necessary to avoid missed diagnoses of the concealed LQTS-syndrome.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140415521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jianrui Ma, Hailong Qiu, Miao Tian, Wen Xie, Ying Li, Zichao Tujia, T. Tan, Linjiang Han, Ziqin Zhou, S. Wen, Jimei Chen, Zhuang Jian, Haiyun Yuan, Xiaobing Liu
The reconstruction of the right ventricle outflow tract in truncus arteriosus remains challenging. The use of valved conduit based on polytetrafluoroethylene has been increasingly popular since the 1990s. Albeit with verified long-term durability, the previous techniques for manufacturing polytetrafluoroethylene valved conduit were relatively cumbersome and time-cost, which at least in part limited its further application. We reported the first successful truncus arteriosus case using a modified and simplified technique for hand-sewing the polytetrafluoroethylene pulmonary bicuspid valved conduit. Eventually, the patient completed the surgery successfully and showed a satisfactory outcome during the 17-month follow-up. Therefore, this technique is a time-saving, reproducible, and reliable approach in truncus arteriosus on the reconstruction of the right ventricle outflow tract.
{"title":"Modified Hand-Sewn Polytetrafluoroethylene Bicuspid Valved Conduit for the Reconstruction of Right Ventricle Outflow Tract in Truncus Arteriosus in Infancy: A Case Report","authors":"Jianrui Ma, Hailong Qiu, Miao Tian, Wen Xie, Ying Li, Zichao Tujia, T. Tan, Linjiang Han, Ziqin Zhou, S. Wen, Jimei Chen, Zhuang Jian, Haiyun Yuan, Xiaobing Liu","doi":"10.59958/hsf.6383","DOIUrl":"https://doi.org/10.59958/hsf.6383","url":null,"abstract":"The reconstruction of the right ventricle outflow tract in truncus arteriosus remains challenging. The use of valved conduit based on polytetrafluoroethylene has been increasingly popular since the 1990s. Albeit with verified long-term durability, the previous techniques for manufacturing polytetrafluoroethylene valved conduit were relatively cumbersome and time-cost, which at least in part limited its further application. We reported the first successful truncus arteriosus case using a modified and simplified technique for hand-sewing the polytetrafluoroethylene pulmonary bicuspid valved conduit. Eventually, the patient completed the surgery successfully and showed a satisfactory outcome during the 17-month follow-up. Therefore, this technique is a time-saving, reproducible, and reliable approach in truncus arteriosus on the reconstruction of the right ventricle outflow tract.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":"68 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140424116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Radiofrequency ablation is a critical therapeutic method used in the management of atrial fibrillation (AF). This study systematically evaluates the effectiveness and safety of two catheter radio frequency ablation approaches: high-power short-duration (HPSD) and traditional low-power long-duration (LPLD), in treating AF. Methods: Four databases were searched for prospective studies (eight cohort studies and three randomised controlled trials) that evaluated the effect of HPSD treatment on AF recurrence, occurrence rate of complications and procedural time in patients with AF from the establishment of the databases to March 2023. We utilised RevMan 5.20 and Stata 11.0 statistical software to conduct a meta-analysis, and publication bias was assessed using funnel plots and Egger's test. The effect estimates were synthesised as relative risks (RRs) or standardised mean differences (SMDs) along with their corresponding 95% confidence intervals (CIs). Results: A total of 536 relevant studies were retrieved, and 11 prospective studies were collected. The combined value of the estimated effect of HPSD versus LPLD treatment on AF recurrence in patients with AF had an RR of 0.59 (95% CI: 0.45–0.78; p < 0.001), the effects of HPSD versus LPLD treatment on procedural time in patients with AF had an SMD of –1.17 (95% CI: –1.56– –0.77; p < 0.001), and the effect of HPSD versus LPLD treatment on oesophageal thermal injury in patients with AF had an RR of 0.84 (95% CI: 0.22–3.28; p = 0.80). Notably, the estimated combined effects of HPSD and LPLD on other major complications (steam pop) in patients with AF had an RR of 0.57 (95% CI: 0.22–1.47; p = 0.24). Conclusions: HPSD is more effective than traditional LPLD and has a lower AF recurrence rate after surgery. Meanwhile, HPSD treatment can improve surgical efficiency and has a shorter procedural time than LPLD treatment.
{"title":"Efficacy and Safety of High-power Short-duration Radio Frequency Ablation in the Treatment of Atrial Fibrillation: A Meta-analysis of Prospective Study","authors":"Guohua Ma, Weijiang Zhang","doi":"10.59958/hsf.6853","DOIUrl":"https://doi.org/10.59958/hsf.6853","url":null,"abstract":"Background: Radiofrequency ablation is a critical therapeutic method used in the management of atrial fibrillation (AF). This study systematically evaluates the effectiveness and safety of two catheter radio frequency ablation approaches: high-power short-duration (HPSD) and traditional low-power long-duration (LPLD), in treating AF. Methods: Four databases were searched for prospective studies (eight cohort studies and three randomised controlled trials) that evaluated the effect of HPSD treatment on AF recurrence, occurrence rate of complications and procedural time in patients with AF from the establishment of the databases to March 2023. We utilised RevMan 5.20 and Stata 11.0 statistical software to conduct a meta-analysis, and publication bias was assessed using funnel plots and Egger's test. The effect estimates were synthesised as relative risks (RRs) or standardised mean differences (SMDs) along with their corresponding 95% confidence intervals (CIs). Results: A total of 536 relevant studies were retrieved, and 11 prospective studies were collected. The combined value of the estimated effect of HPSD versus LPLD treatment on AF recurrence in patients with AF had an RR of 0.59 (95% CI: 0.45–0.78; p < 0.001), the effects of HPSD versus LPLD treatment on procedural time in patients with AF had an SMD of –1.17 (95% CI: –1.56– –0.77; p < 0.001), and the effect of HPSD versus LPLD treatment on oesophageal thermal injury in patients with AF had an RR of 0.84 (95% CI: 0.22–3.28; p = 0.80). Notably, the estimated combined effects of HPSD and LPLD on other major complications (steam pop) in patients with AF had an RR of 0.57 (95% CI: 0.22–1.47; p = 0.24). Conclusions: HPSD is more effective than traditional LPLD and has a lower AF recurrence rate after surgery. Meanwhile, HPSD treatment can improve surgical efficiency and has a shorter procedural time than LPLD treatment.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":"15 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140442175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: This study aimed to evaluate the effectiveness of a cardiac rehabilitation program based on self-efficacy theory in patients with acute myocardial infarction (AMI) undergoing percutaneous transluminal coronary intervention (PCI). Methods: A retrospective analysis was conducted on the medical records of 417 patients with AMI who underwent PCI at our hospital from May 2020 to May 2022. Patients were categorized into a control group (210 patients following a cardiac rehabilitation program) and an observation group (207 patients following a cardiac rehabilitation scheme based on self-efficacy theory). Data on demographics, diseases, and 1-year follow-up information were collected from the participants. Comparisons between the groups were made in terms of left ventricular ejection fraction (LVEF), six-minute walk distance test (6MWD), hospitalization duration, the 36-item short-form health survey (SF-36) score, and the incidence of angina pectoris and AMI recurrence within one-year post-management. Results: Initially, the groups had no significant difference in LVEF and 6MWD (p > 0.05). However, after 1 and 3 months of management, the observation group exhibited higher LVEF and 6MWD than the control group (p < 0.001). The observation group had a significantly shorter hospitalization duration (p < 0.001) and higher SF-36 scores post-management (p < 0.001). Furthermore, the incidence of angina pectoris and AMI recurrence within a year post-management was lower in the observation group (p < 0.05). Conclusion: The cardiac rehabilitation program grounded in self-efficacy theory significantly improves cardiac function in patients with AMI, accelerates their post-PCI rehabilitation, improves quality of life, and reduces the recurrence of angina pectoris and AMI. This approach offers new directions for cardiac rehabilitation management of AMI.
{"title":"Clinical Application of Cardiac Rehabilitation Program Based on Self-efficacy Theory in Patients with Acute Myocardial Infarction Undergoing Percutaneous Transluminal Coronary Intervention","authors":"Zhongqin Yu, Qinghua Zhao","doi":"10.59958/hsf.7115","DOIUrl":"https://doi.org/10.59958/hsf.7115","url":null,"abstract":"Objective: This study aimed to evaluate the effectiveness of a cardiac rehabilitation program based on self-efficacy theory in patients with acute myocardial infarction (AMI) undergoing percutaneous transluminal coronary intervention (PCI). Methods: A retrospective analysis was conducted on the medical records of 417 patients with AMI who underwent PCI at our hospital from May 2020 to May 2022. Patients were categorized into a control group (210 patients following a cardiac rehabilitation program) and an observation group (207 patients following a cardiac rehabilitation scheme based on self-efficacy theory). Data on demographics, diseases, and 1-year follow-up information were collected from the participants. Comparisons between the groups were made in terms of left ventricular ejection fraction (LVEF), six-minute walk distance test (6MWD), hospitalization duration, the 36-item short-form health survey (SF-36) score, and the incidence of angina pectoris and AMI recurrence within one-year post-management. Results: Initially, the groups had no significant difference in LVEF and 6MWD (p > 0.05). However, after 1 and 3 months of management, the observation group exhibited higher LVEF and 6MWD than the control group (p < 0.001). The observation group had a significantly shorter hospitalization duration (p < 0.001) and higher SF-36 scores post-management (p < 0.001). Furthermore, the incidence of angina pectoris and AMI recurrence within a year post-management was lower in the observation group (p < 0.05). Conclusion: The cardiac rehabilitation program grounded in self-efficacy theory significantly improves cardiac function in patients with AMI, accelerates their post-PCI rehabilitation, improves quality of life, and reduces the recurrence of angina pectoris and AMI. This approach offers new directions for cardiac rehabilitation management of AMI.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":"40 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140438390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pulsed field ablation (PFA) is a novel technology to treat atrial fibrillation (AF) utilizing electric fields to induce nonthermal irreversible electroporation of electrically active cardiac tissue to induce cardiac cell death. PFA offers improved safety benefits compared to traditional radiofrequency ablation (RFA) and cryoablation by specifically ablating only cardiac tissue. However, there are avenues for further optimization including neurological risk associated with microbubble formation and left atrial function post ablation. Various PFA devices with different electric pulse waveforms have been studied and tested in human trials, with the majority utilizing microsecond duration pulses. Shorter nanosecond duration pulses, or nanosecond PFA, is beginning to be studied for AF ablation. In this review we will delve into current waveforms used for PFA, areas for improvement, mechanisms behind nanosecond PFA, and its clinical impact for cardiac ablation.
{"title":"Pulsed Field Ablation for the Treatment of Atrial Fibrillation: A Review and a Look into its Future","authors":"Pavithran Guttipatti, N. Saadallah, Elaine Y. Wan","doi":"10.59958/hsf.7141","DOIUrl":"https://doi.org/10.59958/hsf.7141","url":null,"abstract":"Pulsed field ablation (PFA) is a novel technology to treat atrial fibrillation (AF) utilizing electric fields to induce nonthermal irreversible electroporation of electrically active cardiac tissue to induce cardiac cell death. PFA offers improved safety benefits compared to traditional radiofrequency ablation (RFA) and cryoablation by specifically ablating only cardiac tissue. However, there are avenues for further optimization including neurological risk associated with microbubble formation and left atrial function post ablation. Various PFA devices with different electric pulse waveforms have been studied and tested in human trials, with the majority utilizing microsecond duration pulses. Shorter nanosecond duration pulses, or nanosecond PFA, is beginning to be studied for AF ablation. In this review we will delve into current waveforms used for PFA, areas for improvement, mechanisms behind nanosecond PFA, and its clinical impact for cardiac ablation.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140438693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Biling Ye, Junping Gan, Yongtang Han, Li Yu, Yan Huang, Biling Ye
Background: The platelet-to-lymphocyte ratio (PLR) could be a convenient method to predict atrial fibrillation (AF) likelihood and, in turn, to determine the patients' postoperative trajectory. This study aimed to evaluate the prognostic effect of pre-intervention PLR in predicting the occurrence of AF after surgery. Methods: PubMed, Embase, and the Cochrane library were searched for available papers published up to October 2023. The primary outcome was the odds ratio (OR) of numerical PLR in the model predicting AF occurrence. The random-effects model was used in all analyses. Results: Six studies were included. There were 1197 patients with AF and 1998 patients without AF. The combined analysis of all six studies showed that PLR was associated with AF after surgery (OR = 1.01, 95% confidence interval (CI): 1.00–1.01, p = 0.000; I2 = 43.4%, pheterogeneity = 0.116). Three studies examined PLR before coronary artery bypass graft (CABG), and the meta-analysis showed that PLR was associated with AF after CABG (OR = 1.01, 95% CI: 1.00–1.02, p = 0.002; I2 = 0.0%, pheterogeneity = 0.894). The sensitivity analysis showed that the results were not robust. There was no obvious publication bias. Conclusions: Pre-intervention PLR was significantly associated with post-intervention AF in patients who underwent CABG or other surgeries. Elevated PLR is a risk factor for postoperative atrial fibrillation.
{"title":"Relationship between Prediction of Platelet-Lymphocyte Ratio and Atrial Fibrillation in Perioperative Patients: A Systematic Review and Meta-Analysis","authors":"Biling Ye, Junping Gan, Yongtang Han, Li Yu, Yan Huang, Biling Ye","doi":"10.59958/hsf.6851","DOIUrl":"https://doi.org/10.59958/hsf.6851","url":null,"abstract":"Background: The platelet-to-lymphocyte ratio (PLR) could be a convenient method to predict atrial fibrillation (AF) likelihood and, in turn, to determine the patients' postoperative trajectory. This study aimed to evaluate the prognostic effect of pre-intervention PLR in predicting the occurrence of AF after surgery. Methods: PubMed, Embase, and the Cochrane library were searched for available papers published up to October 2023. The primary outcome was the odds ratio (OR) of numerical PLR in the model predicting AF occurrence. The random-effects model was used in all analyses. Results: Six studies were included. There were 1197 patients with AF and 1998 patients without AF. The combined analysis of all six studies showed that PLR was associated with AF after surgery (OR = 1.01, 95% confidence interval (CI): 1.00–1.01, p = 0.000; I2 = 43.4%, pheterogeneity = 0.116). Three studies examined PLR before coronary artery bypass graft (CABG), and the meta-analysis showed that PLR was associated with AF after CABG (OR = 1.01, 95% CI: 1.00–1.02, p = 0.002; I2 = 0.0%, pheterogeneity = 0.894). The sensitivity analysis showed that the results were not robust. There was no obvious publication bias. Conclusions: Pre-intervention PLR was significantly associated with post-intervention AF in patients who underwent CABG or other surgeries. Elevated PLR is a risk factor for postoperative atrial fibrillation.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":"76 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140438242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pasquale Totaro, Filippo Amoroso, Martina Musto, Antonella Degani, Stefano Pelenghi
Objectives: Since early nineties axillary artery has been proposed as alternative to femoral artery for peripheral arterial cannulation during cardiopulmonary bypass (CPB) in aortic surgery. The aim of this study is to report our single-centre experience using direct axillary artery cannulation during aortic surgery. Methods: One hundred consecutive patients, undergoing aortic surgery using direct axillary artery cannulation were enrolled. Patient population ranged between 29 to 87 years and mean age was 65 ± 13 years. Seventy-seven patients (77%) underwent scheduled complex surgical procedure and 23 patients (23%) underwent emergent surgical procedure. Sixteen patients, furthermore, have had a previous cardiac surgery procedure. Results: CPB management using direct axillary artery cannulation was satisfactory in all cases. No case of malperfusion (cerebral and/or visceral) was reported. Out of 100 patients undergoing direct cannulation of axillary artery, no major complications related to the site or the technique of the cannulation were recorded. Local minor complications were reported in 6 patients (6%). In all 6 patients such complications were transitory and there was no residual compromission at the discharge. Overall 30-days mortality was 16%. Twenty-two patients (22%) conversely were discharged directly from intensive care unit (ICU) to chronic rehabilitation center. Sixty-seven patients (67%) were successfully discharged home. Conclusions: Our experience clearly shows that direct axillary artery cannulation is a safe, effective and reproducible technique for arterial cannulation during complex surgical procedures involving thoracic aorta. We do support such approach as a first choice strategy in such circumstances.
{"title":"Direct Right Axillary Artery Cannulation as First Choice Strategy during Aortic Surgery Procedures: Results from a Single Experienced Surgical Centre","authors":"Pasquale Totaro, Filippo Amoroso, Martina Musto, Antonella Degani, Stefano Pelenghi","doi":"10.59958/hsf.7173","DOIUrl":"https://doi.org/10.59958/hsf.7173","url":null,"abstract":"Objectives: Since early nineties axillary artery has been proposed as alternative to femoral artery for peripheral arterial cannulation during cardiopulmonary bypass (CPB) in aortic surgery. The aim of this study is to report our single-centre experience using direct axillary artery cannulation during aortic surgery. Methods: One hundred consecutive patients, undergoing aortic surgery using direct axillary artery cannulation were enrolled. Patient population ranged between 29 to 87 years and mean age was 65 ± 13 years. Seventy-seven patients (77%) underwent scheduled complex surgical procedure and 23 patients (23%) underwent emergent surgical procedure. Sixteen patients, furthermore, have had a previous cardiac surgery procedure. Results: CPB management using direct axillary artery cannulation was satisfactory in all cases. No case of malperfusion (cerebral and/or visceral) was reported. Out of 100 patients undergoing direct cannulation of axillary artery, no major complications related to the site or the technique of the cannulation were recorded. Local minor complications were reported in 6 patients (6%). In all 6 patients such complications were transitory and there was no residual compromission at the discharge. Overall 30-days mortality was 16%. Twenty-two patients (22%) conversely were discharged directly from intensive care unit (ICU) to chronic rehabilitation center. Sixty-seven patients (67%) were successfully discharged home. Conclusions: Our experience clearly shows that direct axillary artery cannulation is a safe, effective and reproducible technique for arterial cannulation during complex surgical procedures involving thoracic aorta. We do support such approach as a first choice strategy in such circumstances.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":"129 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140446702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The perioperative outcomes of del Nido cardioplegia (DNC) as a single-dose solution have been investigated in cardiac surgical procedures. However, the optimal redosing interval for multiple doses of DNC remains an area of ongoing debate. The purpose of this study is to evaluate the safety and efficacy of multidose DNC administered according to our protocol in comparison to intermittent cold blood cardioplegia (BC) in isolated coronary artery bypass grafting (CABG) patients. Methods: A retrospective analysis was conducted on 79 consecutive isolated CABG patients between January 2022 and March 2023. The Patients were divided into two groups: the DNC group (n = 35), and the BC group (n = 44). Perioperative clinical characteristics, cardiac enzyme levels, and postoperative complications were compared between the groups. DNC was applied in a 1:4 (crystalloid:blood) ratio, with an initial dose of 20 mL/kg. Maintenance doses of 10 mL/kg were given every 45 to 50 minutes. A half dose was given if the aortic cross-clamp was expected to last less than 60 minutes. Warm blood was applied before releasing the aortic cross-clamp. Results: Both groups demonstrated comparable mean aortic cross-clamp and cardiopulmonary bypass times. At 24 hours postoperatively, troponin T levels were significantly lower in the DNC group (p ˂ 0.001), while creatine kinase-myocardial band (CK-MB) levels were higher (p ˂ 0.001). The DNC group required lower defibrillation rates than the BC group (p = 0.008). Multivariate logistic regression analysis revealed that the requirement for defibrillation (odds ratio (OR) = 10.9, 95% confidence interval (CI): 2.9–41.8, p < 0.001), cross-clamp time (OR = 1.04, 95% CI: 1.02–1.1, p = 0.002) and body mass index (BMI) (OR = 0.8, 95% CI: 0.7–0.9, p = 0.030) were independent risk factors for low cardiac output syndrome. DNC and left ventricle ejection fraction >40% were associated with a return to sinus rhythm (OR = 3.6, 95% CI: 1.3–10.1, p = 0.013 and OR = 3.1, 95% CI: 1.1–8.7, p = 0.035, respectively). No significant differences were found in terms of postoperative adverse events, and in-hospital mortality. Conclusion: Multidose DNC in CABG patients provides equivalent clinical outcomes and myocardial protection compared to BC. In addition, the findings suggest that the redosing interval strategy employed in the DNC protocol is acceptable.
{"title":"Efficacy and Safety of Multidose del Nido Cardioplegia for Optimal Myocardial Protection in Isolated Coronary Artery Bypass Grafting Surgery: A Comparative Retrospective Cohort Study","authors":"Sameh Alagha, F. Çiçekçioğlu","doi":"10.59958/hsf.7095","DOIUrl":"https://doi.org/10.59958/hsf.7095","url":null,"abstract":"Background: The perioperative outcomes of del Nido cardioplegia (DNC) as a single-dose solution have been investigated in cardiac surgical procedures. However, the optimal redosing interval for multiple doses of DNC remains an area of ongoing debate. The purpose of this study is to evaluate the safety and efficacy of multidose DNC administered according to our protocol in comparison to intermittent cold blood cardioplegia (BC) in isolated coronary artery bypass grafting (CABG) patients. Methods: A retrospective analysis was conducted on 79 consecutive isolated CABG patients between January 2022 and March 2023. The Patients were divided into two groups: the DNC group (n = 35), and the BC group (n = 44). Perioperative clinical characteristics, cardiac enzyme levels, and postoperative complications were compared between the groups. DNC was applied in a 1:4 (crystalloid:blood) ratio, with an initial dose of 20 mL/kg. Maintenance doses of 10 mL/kg were given every 45 to 50 minutes. A half dose was given if the aortic cross-clamp was expected to last less than 60 minutes. Warm blood was applied before releasing the aortic cross-clamp. Results: Both groups demonstrated comparable mean aortic cross-clamp and cardiopulmonary bypass times. At 24 hours postoperatively, troponin T levels were significantly lower in the DNC group (p ˂ 0.001), while creatine kinase-myocardial band (CK-MB) levels were higher (p ˂ 0.001). The DNC group required lower defibrillation rates than the BC group (p = 0.008). Multivariate logistic regression analysis revealed that the requirement for defibrillation (odds ratio (OR) = 10.9, 95% confidence interval (CI): 2.9–41.8, p < 0.001), cross-clamp time (OR = 1.04, 95% CI: 1.02–1.1, p = 0.002) and body mass index (BMI) (OR = 0.8, 95% CI: 0.7–0.9, p = 0.030) were independent risk factors for low cardiac output syndrome. DNC and left ventricle ejection fraction >40% were associated with a return to sinus rhythm (OR = 3.6, 95% CI: 1.3–10.1, p = 0.013 and OR = 3.1, 95% CI: 1.1–8.7, p = 0.035, respectively). No significant differences were found in terms of postoperative adverse events, and in-hospital mortality. Conclusion: Multidose DNC in CABG patients provides equivalent clinical outcomes and myocardial protection compared to BC. In addition, the findings suggest that the redosing interval strategy employed in the DNC protocol is acceptable.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":"52 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140445775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hongqin Huang, Min Xu, Yuxia Miao, Chaohua Qiang, Zhenni Yang, Ling Yang
Purpose: To construct a predictive model for the recurrence of atrial fibrillation (AF) based on P-wave duration (PWD) in patients with early persistent AF (PeAF) who underwent radiofrequency catheter ablation (RFCA), with the aim of helping clinicians accurately adjust clinical strategies. Methods: Data from patients with early PeAF, who were admitted to the Department of Cardiology at the authors' hospital were collected. Based on predefined inclusion and exclusion criteria, only those who successfully underwent RFCA for the first time were included in the analysis. Pre- and postoperative clinical, echocardiographic, and electrocardiographic data were collected and recorded. Multivariate logistic regression was used to construct a predictive model for AF recurrence based on PWD. The predictive efficacy of each continuous variable and the predictive model were compared using the area under the receiver operating characteristic (ROC) curve. The corresponding nomogram for the predictive model was constructed. Interaction tests were performed to evaluate the predictive efficacy of the model for AF recurrence. Results: A total of 237 patients were enrolled and divided into two groups: recurrence (n = 59); and sinus rhythm (n = 178). PWD was greater and left atrial appendage emptying velocity (LAAV) was lower in the recurrence group; these differences were statistically significant (p <0.001). The ROC curve for univariate prediction of AF recurrence revealed that the area under the ROC curve (AUC) for PWD and LAAV were 0.7912 and 0.7713, respectively, which were greater than those of other continuous variables. Compared with PWD alone, the multivariate predictive model containing PWD, left ventricular ejection fraction, and LAAV demonstrated no statistically significant difference in AUC (p = 0.0553) but improved the prediction efficiency of correctly reclassifying recurrence rates, net reclassification improvement 14.13% (95% confidence interval: 0.19–28.07%; p = 0.0469). The interaction effect did not significantly alter the effectiveness of the predictive models. Conclusions: The multivariate model based on PWD measured after RFCA demonstrated better predictive efficacy than the univariate model in patients with early PeAF. These results may contribute to evidence supporting the formulation of personalised treatments for patients with AF.
{"title":"A Predictive Model for Recurrence of Atrial Fibrillation Based on P-Wave Duration in Patients with Early Persistent Atrial Fibrillation Who Underwent Radiofrequency Catheter Ablation","authors":"Hongqin Huang, Min Xu, Yuxia Miao, Chaohua Qiang, Zhenni Yang, Ling Yang","doi":"10.59958/hsf.6993","DOIUrl":"https://doi.org/10.59958/hsf.6993","url":null,"abstract":"Purpose: To construct a predictive model for the recurrence of atrial fibrillation (AF) based on P-wave duration (PWD) in patients with early persistent AF (PeAF) who underwent radiofrequency catheter ablation (RFCA), with the aim of helping clinicians accurately adjust clinical strategies. Methods: Data from patients with early PeAF, who were admitted to the Department of Cardiology at the authors' hospital were collected. Based on predefined inclusion and exclusion criteria, only those who successfully underwent RFCA for the first time were included in the analysis. Pre- and postoperative clinical, echocardiographic, and electrocardiographic data were collected and recorded. Multivariate logistic regression was used to construct a predictive model for AF recurrence based on PWD. The predictive efficacy of each continuous variable and the predictive model were compared using the area under the receiver operating characteristic (ROC) curve. The corresponding nomogram for the predictive model was constructed. Interaction tests were performed to evaluate the predictive efficacy of the model for AF recurrence. Results: A total of 237 patients were enrolled and divided into two groups: recurrence (n = 59); and sinus rhythm (n = 178). PWD was greater and left atrial appendage emptying velocity (LAAV) was lower in the recurrence group; these differences were statistically significant (p <0.001). The ROC curve for univariate prediction of AF recurrence revealed that the area under the ROC curve (AUC) for PWD and LAAV were 0.7912 and 0.7713, respectively, which were greater than those of other continuous variables. Compared with PWD alone, the multivariate predictive model containing PWD, left ventricular ejection fraction, and LAAV demonstrated no statistically significant difference in AUC (p = 0.0553) but improved the prediction efficiency of correctly reclassifying recurrence rates, net reclassification improvement 14.13% (95% confidence interval: 0.19–28.07%; p = 0.0469). The interaction effect did not significantly alter the effectiveness of the predictive models. Conclusions: The multivariate model based on PWD measured after RFCA demonstrated better predictive efficacy than the univariate model in patients with early PeAF. These results may contribute to evidence supporting the formulation of personalised treatments for patients with AF.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":"536 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140446661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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