RESUMEN
BACKGROUND: Evaluating outcomes of concurrent Cox-Maze procedures in elderly patients undergoing high-risk cardiac surgery. MEHODS: We retrospectively identified patients aged over 70 years with Atrial Fibrillation (AF) from 2011 to 2017 who had two or more other cardiac procedures. They were subdivided into two groups: 1. Cox-Maze IV AF ablation. 2. No-Surgical AF treatment. A propensity match score was used to generate a homogeneous cohort and to eliminate confounding variables. Heart rhythm was assessed from Holter reports or 12-lead ECG. Follow-up data was collected through telephone consultations and medical records. RESULTS: There were 239 patients. Median follow up was 61 months. 70 patients had Cox-Maze IV procedures (29.3%). Demographic, intra- and post-operative outcomes were similar between groups although duration of pre-operative AF was shorter in Cox-Maze group (p = 0.001). There was no significant 30-day mortality difference in propensity matched cohorts (n = 84. P = 0.078). Sinus rhythm at annual and latest follow-up was 84.9% and 80.0% respectively in Maze group - 160 patients (66.9%) were alive at long-term follow-up with good survival outcomes in Cox Maze group. There was a high proportion of patients in NYHA 1 status in Cox-Maze group. No differences observed in freedom from stroke (p = 0.80) or permanent pacemaker (p = 0.33) between the groups. CONCLUSIONS: Surgical ablation is beneficial in elderly patients undergoing high-risk surgery - promoting excellent long-term freedom from AF and symptomatic / prognostic benefits, without added risk. Therefore, surgical risk should not be reason to deny benefits of concomitant AF-ablation. CLINICAL TRIAL REGISTRATION: Not required.
Asunto(s)
Fibrilación Atrial , Procedimientos Quirúrgicos Cardíacos , Humanos , Fibrilación Atrial/cirugía , Masculino , Anciano , Femenino , Estudios Retrospectivos , Procedimientos Quirúrgicos Cardíacos/métodos , Anciano de 80 o más Años , Ablación por Catéter/métodos , Procedimiento de Laberinto , Resultado del Tratamiento , Estudios de Seguimiento , Factores de RiesgoRESUMEN
Subarachnoid and intraparenchymal haemorrhages due to cerebral mycotic aneurysms are rare and associated with high mortality. Streptococcus agalactiae, is a rare cause of endocarditis and there are no reported cases of cerebral mycotic aneurysms secondary to this organism. We report a rare case of streptococcus agalctiae induced intracranial mycotic aneurysm.
Asunto(s)
Aneurisma Infectado/microbiología , Endocarditis Bacteriana/complicaciones , Aneurisma Intracraneal/microbiología , Infecciones Estreptocócicas , Streptococcus agalactiae , Adulto , Humanos , Masculino , Tomografía Computarizada por Rayos XRESUMEN
Cardiac tumours are rare in occurrence. The authors report a patient who presented with a history of recurrent transient ischemic attacks and cerebrovascular accidents. During rehabilitation he was incidentally diagnosed with a large left ventricular mass which was excised successfully with good clinical outcome. On histopathology it was a papillary fibroelastoma.