Unilateral pulmonary oedema after minimally invasive cardiac surgery via right anterolateral minithoracotomy.

OBJECTIVES: To investigate the incidence of unilateral pulmonary oedema after minimally invasive cardiac surgery (MICS) requiring unilateral lung collapse has been unknown until now. METHODS: We analysed the data of 484 consecutive patients undergoing minimally invasive cardiac surgery with unilateral lung collapse between January 2008 and December 2013. The clinical regimen was changed in 2010 to a single dose of dexamethasone (approximately 1 mg/kg body weight) administered after anaesthesia induction. RESULTS: Thirty-eight patients developed a radiographically evident unilateral pulmonary oedema within 24 h after surgery. Dexamethasone significantly reduced the incidence of this event [4.0 vs 12.9%; unadjusted odds ratio (OR) 0.28, 95% confidence interval (CI) 0.14-0.58, P < 0.001]. One patient with and six patients without dexamethasone were clinically symptomatic (P = 0.001). Logistic regression analysis identified four variables significantly associated with the development of a unilateral lung oedema: dexamethasone (OR 0.28, 95% CI 0.13-0.58, P = 0.001), diabetes mellitus (OR 3.17, 95% CI 1.04-9.63, P = 0.04), the level of mean pulmonary arterial pressure (OR 1.05 per mmHg, 95% CI 1.004-1.09, P = 0.03) and transfusion of fresh frozen plasma (OR 2.31, 95% CI 1.02-5.25, P = 0.045). CONCLUSIONS: Our data revealed a 7.9% incidence of radiographically evident unilateral pulmonary oedema after MICS with intraoperative collapse of a lung. Of the total number of patients, 1.5% simultaneously developed clinical symptoms. The influence of corticosteroids, as well as the contribution of possible risk factors, needs further evaluation.

Incidence of asymptomatic intracranial embolic events after pulmonary vein isolation: comparison of different atrial fibrillation ablation technologies in a multicenter study.

OBJECTIVES: We compared the safety of different devices by screening for subclinical intracranial embolic events after pulmonary vein isolation with either conventional irrigated radiofrequency (RF) or cryoballoon or multielectrode phased RF pulmonary vein ablation catheter (PVAC). BACKGROUND: New devices specifically designed to facilitate pulmonary vein isolation procedures have recently been introduced. METHODS: This prospective, observational, multicenter study included patients with symptomatic atrial fibrillation referred for pulmonary vein isolation. Ablation was performed using 1 of the 3 catheters. Strict periprocedural anticoagulation, with intravenous heparin during ablation to achieve an activated clotting time >300 s, was ensured in all patients. Cerebral magnetic resonance imaging was performed before and after ablation. RESULTS: Seventy-four patients were included in the study: 27 in the irrigated RF group, 23 in the cryoballoon group, and 24 in the PVAC group. Total procedure times were 198 ± 50 min, 174 ± 35 min, and 124 ± 32 min, respectively (p < 0.001 for PVAC vs. irrigated RF and cryoballoon). Findings on neurological examination were normal in all patients before and after ablation. Post-procedure magnetic resonance imaging detected a single new embolic lesion in 2 of 27 patients in the irrigated RF group (7.4%) and in 1 of 23 in the cryoballoon group (4.3%). However, in the PVAC group 9 of 24 patients (37.5%) demonstrated 2.7 ± 1.3 new lesions each (p = 0.003 for the presence of new embolic events among the 3 groups). CONCLUSIONS: The PVAC is associated with a significantly higher incidence of subclinical intracranial embolic events. Further study of the causes and significance of these emboli is required to determine the safety of the PVAC.