Del-Nido cardioplegia in cardiac surgery for elderly patients: a propensity score-matched analysis.

OBJECTIVES: To compare the safety and efficacy of del-Nido cardioplegia (DNC) with traditional 4:1 cold blood cardioplegia (CBC) in coronary artery bypass grafting and/or valve surgeries in elderly patients. METHODS: The present study is a retrospective case-series study that included 302 consecutive patients aged 70 years and over who underwent on-pump valve surgery and/or coronary artery bypass graft (CABG). DNC was administered to 90 patients and CBC to 212 patients. After propensity-score matching, 89 pairs were compared. The safety and efficacy were analyzed between the two groups. RESULTS: The DNC group had a similar mortality (3.4% vs. 5.6%, OR = 0.79, P = 0.720) and extracorporeal membrane oxygenation (ECMO) implantation rate (1.1% vs. 2.2%, OR = 0.75, P = 1.000) to the CBC group, a lower incidence of postoperative intra-aortic balloon pump (IABP) implantation (1.1% vs. 9.0%, OR = 0.54, P = 0.034) and a higher left ventricular ejection fraction (LVEF) at discharge (60 (56-64) % vs. 57 (51-62)%, P = 0.007). The estimated glomerular filtration rate (eGFR) in the DNC group was higher when the patient was transferred to the intensive care unit (79.4 (65.0-94.3) ml/min/1.73m2 vs. 77.2 (59.8-88.7) ml/min/1.73m2, P = 0.014), but no significant differences were identified after 24 h. The serum lactate values of the DNC group were significantly lower than those of the CBC group (0 h: 2.7 (2.0-3.2) vs. 3.2 (2.4-4.4), P = 0.001; 3 h: 3.2 (2.0-4.8) vs. 4.8 (2.8-6.6), P < 0.001; 6 h: 3.5 (2.2-5.4) vs. 5.8 (3.4-8.4), P < 0.001; 9 h: 3.4 (2.0-7.0) vs. 5.5 (2.9-8.3), P = 0.005). There were no differences between the two groups in respect of lactate levels at 12 h and thereafter. Postoperative creatinine kinase-MB concentrations were similar between the two groups. CONCLUSIONS: Del-Nido cardioplegia is safe and effective in elderly patients undergoing CABG and/or valve surgery.

Stand-alone surgical ablation for atrial fibrillation: a novel bilateral double-port approach.

BACKGROUND: To explore an effective, reproducible and less invasive surgical approach for lone atrial fibrillation (AF). METHODS: A modified "mini-maze" including pulmonary vein isolation (PVI), box-lesion and left atrial appendage (LAA) resection was applied for AF patients in our center from January 2016 to June 2017. A 2.5 cm thoracotomy extended with tissue retractor was made as working port in the fourth intercostal space on each anterior side of the chest. The thoracoscope was inserted in another port lateral to main port for observing. During PVI, the tip of the clamp could be adjusted to reach as superior as the roof of left atrium for transmural lesions. The floor line was made by linear ablation pen. The LAA was removed by stapler before PVI for better exposure of the roof. RESULTS: This modified "mini-maze" was successfully completed in 53 non-paroxysmal AF patients except 1 was converted to sternotomy due to intraoperative hemorrhage. All patients recovered uneventfully. Seven-day Holter was accessed in 3, 6 and 12 months respectively in all patients. The mean follow-up was 14 (range, 3-30) months. Sinus rhythm was achieved in 48.1%, 64.8% before discharge and 3 months after surgery respectively, Twenty-eight patients in sinus rhythm or not, underwent catheter mapping and ablation three months after the operation to conform the lesion set made by this procedure. Sinus rhythm reached 87.0% after subsequent catheter ablation without any anti-arrhythmia treatment at 12 months. All patients survived without stroke, hemorrhage and pulmonary vein stenosis. CONCLUSIONS: Modified "mini-maze" procedure is safe, less invasive and highly reproducible for lone AF. Sequential hybrid procedure will shape the treatment of non-paroxysmal AF.

[Endovascular repair of an iliac artery aneurysm after endovascular aneurysm repair with handmade iliac branch device: a case report].

An involved internal iliac artery is usually embolized when performing endovascular aneurysm repair for aortoiliac or isolated iliac artery aneurysm.This can lead to complications such as buttock claudication,colon ischaemia and erectile dysfunction.Iliac branch device (IBD) is an endograft designed specifically for iliac bifurcation to preserve internal iliac flow. It was performed with high technical success rates and encouraging mid-term patency. Here we report a case of right iliac aneurysm developed 3 years after endovascular aneurysm repair for an aortoiliac aneurysm, with the patient's left internal artery been sacrificed then. Using a handmade IBD, we excluded the aneurysm without occlusion of the ipsilateral internal iliac artery or any type of endoleak. Both the design and deployment of this IBD are distinctive that we would like to share our experience with all the colleagues.