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1.
Crit Pathw Cardiol ; 21(2): 77-83, 2022 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-35311757

RESUMO

BACKGROUND: The efficiency of maze is a safe procedure in AF patients who underwent concomitant mitral valve surgery was more than 60%. The aim of this study was to define predictors of early AF recurrence after concomitant maze procedure with valvular surgery. METHODS: In this retrospective study, 234 patients with AF underwent concomitant valvular replacement and maze procedure. Patients were classified into 2 groups of sinus and atrial fibrillation (AF). Baseline characteristics of patients were then compared between 2 groups. RESULTS: Totally, 234 patients were enrolled, 148 of which maintained sinus rhythm during hospitalization. Left atrial diameter and type of valvular surgery were similar in both groups. Age, number of replaced valves, concomitant coronary artery bypass grafting, and history of preoperative persistent AF and beta-blocker therapy were independent predictors of in-hospital AF recurrence. We used these variables to build a model to anticipate early AF recurrence. CONCLUSIONS: Being older, multivalvular surgery, and persistent preoperative AF were the predictors of higher risk of early recurrent AF, whereas concomitant coronary artery bypass grafting and using beta-blocker had a protective effect. This model based on preoperative and operative characteristics can help us to better evaluate if the patient benefits from maze procedure coincide with valvular surgery.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Fibrilação Atrial/complicações , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Humanos , Procedimento do Labirinto , Recidiva , Estudos Retrospectivos , Resultado do Tratamento
2.
Echocardiography ; 39(3): 447-456, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35165935

RESUMO

BACKGROUND: Recurrence of any atrial arrhythmia after surgical ablation is known as a negative predictor of cardiovascular events and total mortality. However, there have been no focused studies for atrial fibrillation (AF) recurrence prediction in patients with significant tricuspid regurgitation (TR), and the risk-benefit estimation of surgical ablation in tricuspid valve (TV) surgery is not fully established. METHOD: We screened 385 patients who underwent a TV operation between 2001 and 2017. After excluding patients who did not undergo a maze operation, 158 patients were enrolled. Enrolled patients were divided by recurrence of AF. We analyzed the difference between the AF recurrence group and no AF recurrence group, and AF recurrence factors in terms of clinical risk factors and echocardiographic risk factors. The hazard ratio (HR) and 95% confidence intervals (CIs) were presented using a Cox proportional hazard model. RESULTS: Among 158 patients, AF recurred in 65 patients within 10 years. For AF prediction, age was most the important clinical factor and right atrium (RA) diameter was the most important echocardiographic parameters. In patients with a larger RA diameter over 49.2 mm, the prevalence of AF recurrence was higher (HR 4.322, 95% CI [2.185-8.549], log rank p value < .001). In clinical outcome, there was no significant difference between the AF recurrence group and the no recurrence group in terms of death, TR recurrence, heart failure, and stroke. However, the risk of permanent pacemaker (PPM) insertion was higher in the AF recurrence group (HR 10.240, 95% CI [1.257-83.480], log rank p value .007) compared to the no recurrence group. CONCLUSION: Age and RA enlargement are key predictors of AF recurrence after TV operation with the CM procedure in patients with significant TR.


Assuntos
Fibrilação Atrial , Procedimento do Labirinto , Insuficiência da Valva Tricúspide , Fatores Etários , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/etiologia , Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Ecocardiografia , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Átrios do Coração/cirurgia , Humanos , Procedimento do Labirinto/efeitos adversos , Procedimento do Labirinto/métodos , Tamanho do Órgão , Recidiva , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/cirurgia , Insuficiência da Valva Tricúspide/complicações , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/cirurgia
3.
BMC Cardiovasc Disord ; 22(1): 45, 2022 02 13.
Artigo em Inglês | MEDLINE | ID: mdl-35152878

RESUMO

BACKGROUND AND AIMS: Inflammation plays a key role in the initiation and progression of atrial fibrillation (AF). The systemic inflammation indexes are easily evaluated and predict AF development. However, it's role in prediction of recurrence of AF is unknown. We aim to explore the association between the systemic inflammation indexes and recurrence of AF in patients underwent cryoablation (CryoMaze) concomitant with mitral valve surgery. METHODS: We examined systemic inflammation indexes during perioperative period in 122 patients between 2015 and 2018. Systemic inflammation indexes were developed by systemic immune-inflammation index (SII), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and lymphocytes to monocytes ratio. Univariate and multivariate analyses were performed to examine the association of each markers with recurrence of AF. RESULTS: Of the 122 patients included in this study, 22 patients (18%) experienced AF recurrence after CryoMaze concomitant with mitral valve surgery. There is no significant difference between each systemic inflammation indexes before surgery and recurrence of AF. In univariate analysis, MLR after surgery 3 days, PLR, MPLR, NLR, SII after surgery 7 days were able to predict recurrence of AF. In multivariate analyses, SII ≥ 1696 independently predicted recurrence (OR, 3.719; 95% CI, 1.417-9.760). Interestingly, baseline SII showed no significant in prediction of recurrence. It was sharply elevated after surgery and dropped slowly. In patients of recurrence, SII after 7 days of surgery increased again. CONCLUSIONS: The raised SII again was associated with an increased risk of the postoperative recurrence of AF and independently predicted the late recurrence of AF after CryoMaze concomitant with mitral valve surgery.


Assuntos
Fibrilação Atrial/cirurgia , Criocirurgia/efeitos adversos , Técnicas de Apoio para a Decisão , Doenças das Valvas Cardíacas/cirurgia , Inflamação/diagnóstico , Procedimento do Labirinto/efeitos adversos , Valva Mitral/cirurgia , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/imunologia , Fibrilação Atrial/fisiopatologia , Plaquetas/imunologia , Feminino , Doenças das Valvas Cardíacas/diagnóstico , Doenças das Valvas Cardíacas/imunologia , Doenças das Valvas Cardíacas/fisiopatologia , Humanos , Inflamação/imunologia , Contagem de Linfócitos , Linfócitos/imunologia , Masculino , Pessoa de Meia-Idade , Valva Mitral/fisiopatologia , Monócitos/imunologia , Contagem de Plaquetas , Valor Preditivo dos Testes , Recidiva , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
4.
J Vis Exp ; (180)2022 02 11.
Artigo em Inglês | MEDLINE | ID: mdl-35225283

RESUMO

Atrial fibrillation (AF) is the most common cardiac arrhythmia. The use of ablation technologies made the Cox-Maze IV procedure (CMP-IV) technically easier, faster, becoming the gold standard for the surgical treatment of AF. However, the efficacy and safety of CMP-IV in situs inversus dextrocardia are largely unknown. This paper summarizes the CMP-IV procedure performed concomitantly with valvular surgery in patients with situs inversus dextrocardia at this institution. From February 2016 to September 2020, three dextrocardia patients with persistent AF and valvular diseases were referred to this institution for valvular and CMP-IV surgery. CMP-IV was performed using either cryoablation with a nitrous oxide (N2O)-based cryoprobe or a bipolar radiofrequency clamp and bipolar radiofrequency pen. Mechanical valve replacement or mitral vavuloplasty was performed in another patient in addition to tricuspid annuloplasty. Transmurality of the ablated atrial tissues was evaluated by electron microscopy. Heart function was assessed by transthoracic echocardiography. Cardiac rhythm was monitored by 24 h Holter at 3, 6, 12, 18, 24, and 48 months follow-up. All the AF was successfully eliminated in the ablation procedure without recurrence or other complications during hospitalization. The mean bypass and crossclamp times were similar in all the patients. The postoperative ventilator support time, the duration of stay in the ICU, and postoperative residence time were also not significantly different among the patients. Transmural atrial necrosis was detected in the ablated atrial tissues. Sinus rhythm maintenance was achieved at 3, 6, 12, 18, 24, and 48 months follow-up in all the patients. All valve protheses switched freely; no tricuspid regurgitation was observed. The results of the present study demonstrate that the CMP-IV is safe and effective in eliminating AF in dextrocardia patients concomitant with valvular surgery.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Dextrocardia , Situs Inversus , Fibrilação Atrial/cirurgia , Dextrocardia/complicações , Dextrocardia/cirurgia , Humanos , Procedimento do Labirinto , Situs Inversus/complicações , Situs Inversus/cirurgia , Resultado do Tratamento
6.
J Thorac Cardiovasc Surg ; 163(2): 629-641.e7, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-32563577

RESUMO

OBJECTIVE: Surgical ablation of atrial fibrillation (AF) is indicated both in patients with AF undergoing concomitant cardiac surgery and in those who have not responded to medical and/or catheter-based ablation therapy. This study examined our long-term outcomes following the Cox-Maze IV procedure (CMP-IV). METHODS: Between May 2003 and March 2018, 853 patients underwent either biatrial CMP-IV (n = 765) or a left-sided CMP-IV (n = 88) lesion set with complete isolation of the posterior left atrium. Freedom from atrial tachyarrhythmia (ATA) was assessed for up to 10 years. Rhythm outcomes were compared in multiple subgroups. Predictors of recurrence were determined using Fine-Gray regression, allowing for death as the competing risk. RESULTS: The majority of patients (513/853, 60%) had nonparoxysmal AF. Twenty-four percent of patients (201/853) had not responded to at least 1 catheter-based ablation. Prolonged monitoring was used in 76% (647/853) of patients during their follow-up. Freedom from ATA was 92% (552/598), 84% (213/253), and 77% (67/87) at 1, 5, and 10 years, respectively. By competing risk analysis, incidence of first ATA recurrence was 11%, 23%, and 35% at 1, 5, and 10 years, respectively. On Fine-Gray regression, age, peripheral vascular disease, nonparoxysmal AF, left atrial size, early postoperative ATAs, and absence of sinus rhythm at discharge were the predictors of first ATA recurrence over 10 years of follow-up. CONCLUSIONS: The CMP-IV had an excellent long-term efficacy at maintaining sinus rhythm. At late follow-up, the results of the CMP-IV remained superior to those reported for catheter ablation and other forms of surgical ablation for AF. Age, left atrial size, and nonparoxysmal AF were the most relevant predictors of late recurrence.


Assuntos
Fibrilação Atrial/cirurgia , Átrios do Coração/cirurgia , Procedimento do Labirinto , Potenciais de Ação , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Função do Átrio Esquerdo , Bases de Dados Factuais , Feminino , Átrios do Coração/fisiopatologia , Frequência Cardíaca , Humanos , Masculino , Procedimento do Labirinto/efeitos adversos , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
7.
J Thorac Cardiovasc Surg ; 163(3): 980-993, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-32653280

RESUMO

OBJECTIVE: To compare both the beneficial and adverse effects of catheter ablation (CA) and surgical ablation (SA) on patients with atrial fibrillation (AF). METHODS: We searched MEDLINE and 4 additional databases for randomized controlled trials that compared CA with SA. Following data extraction, we conducted a meta-analysis to estimate the efficacy and safety of CA relative to SA. The primary end point of this study was the absence of AF during a 12-month follow-up period without the use of antiarrhythmic drugs. RESULTS: Seven trials comparing SA with CA met the inclusion criteria for efficacy outcome assessments. Following the meta-analysis, we obtained a summary odds ratio (OR) of achieving success 1 year after CA relative to SA was 0.37:1 (95% confidence interval [CI], 0.20-0.69). The result was robust in the subgroup analysis. CA was associated with a greater incidence of femoral vascular complications (OR, 5.81; 95% CI, 1.03-32.71), but a lower incidence of pneumothorax (OR, 0.09; 95% CI, 0.01-0.74) than SA. Statistically significant differences in the other safety outcomes were not observed between CA and SA. CONCLUSIONS: SA confers a moderate advantage over CA in 1-year efficacy outcomes and may be safely performed by experienced surgeons.


Assuntos
Fibrilação Atrial/cirurgia , Procedimentos Cirúrgicos Cardíacos , Ablação por Cateter , Sistema de Condução Cardíaco/cirurgia , Potenciais de Ação , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Ablação por Cateter/efeitos adversos , Sistema de Condução Cardíaco/fisiopatologia , Frequência Cardíaca , Humanos , Procedimento do Labirinto , Complicações Pós-Operatórias/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
8.
J Thorac Cardiovasc Surg ; 164(2): 519-527.e4, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-33129501

RESUMO

OBJECTIVES: The Cox Maze IV operation is commonly performed concomitant with other cardiac operations and effectively reduces the burden of atrial fibrillation. Prospective randomized trials have reported outcomes early and at 12 months, but only single-center late durability results are available. As part of the postapproval process for a bipolar radiofrequency ablation system, we sought to determine early and midterm outcomes of patients undergoing the Cox Maze IV operation. METHODS: A prospective, multicenter, single-arm study of 363 patients (mean age, 70 years, 82% valve surgery) with nonparoxysmal atrial fibrillation (mean duration, 60 months, 94% Congestive heart failure, Hypertension, Age ≥ 75, Diabetes, Stroke, VAScular disease, Age 65-74, Sex category ≥2) undergoing concomitant Maze IV atrial fibrillation ablation at 40 sites with 70 surgeons was performed between June 2010 and October 2014. Compliance with the study lesion set was 94.5%, and 99% had left atrial appendage closure. Freedom from atrial fibrillation was determined by extended monitoring, with a 48-hour Holter monitor minimum. RESULTS: There were no device-related complications. Freedom from atrial fibrillation off antiarrhythmic medications at 1, 2, and 3 years was 66%, 65%, and 64%, respectively, and including those using antiarrhythmics was 80%, 78%, and 76%, respectively. Warfarin was used in 49%, 44%, and 40%, respectively. CONCLUSIONS: In patients with nonparoxysmal atrial fibrillation, compliance with the protocol was high, and freedom from atrial fibrillation off antiarrhythmics was high and sustained to 3 years. The safety and effectiveness of the system and Cox Maze IV procedure support the Class I guideline recommendation for concomitant atrial fibrillation ablation in patients undergoing cardiac surgery.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Idoso , Antiarrítmicos/uso terapêutico , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Humanos , Procedimento do Labirinto , Estudos Prospectivos , Resultado do Tratamento
9.
J Cardiol ; 79(2): 219-225, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34625314

RESUMO

BACKGROUND: Minimally invasive Maze procedure via right mini-thoracotomy approach is reportedly a promising option for paroxysmal and non-paroxysmal atrial fibrillation (AF), although it is not widely performed. This study aimed to validate feasibility and safety of minimally invasive stand-alone Maze procedure in an institutional first case series. METHODS: This study enrolled an institutional consecutive series of 20 cases who underwent minimally invasive Maze procedure between November 2018 and January 2021. Concomitant tricuspid annuloplasty was performed in five cases who showed moderate tricuspid regurgitation preoperatively. RESULTS: Minimally invasive Maze procedure using cryo-energy source was successfully accomplished with sinus rhythm being restored at the intensive care unit entry in all cases without conversion to the sternotomy approach. All cases were discharged home, while one case was complicated with stroke postoperatively. Nineteen cases (95%) showed sinus rhythm at the last follow-up, whereas one case, who had large left atrium, showed recurrent persistent AF despite optimum medical therapy. Catheter ablations were performed for residual conductions at box lesions and/or mitral/tricuspid isthmus in three cases, who showed medically refractory atrial tachycardia post-Maze procedure. Consequently, these three cases showed sinus rhythm restoration at the last follow-up Conclusions: Minimally invasive stand-alone Maze procedure with or without tricuspid annuloplasty was feasible and safe for AF in the institutional first case series. Catheter ablations for recurrent AF post-Maze procedure would be warranted.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Ablação por Cateter/métodos , Humanos , Procedimento do Labirinto , Valva Mitral , Resultado do Tratamento
10.
Acta Chir Belg ; 122(2): 99-106, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33571418

RESUMO

OBJECTIVE: The Maze IV (M-IV) procedure is regarded as the golden standard in treatment for surgical ablation of atrial fibrillation (AF); however, long-term follow-up results are scarce. We present our institutional 10-year experience. METHODS: We collected data of 117 consecutive patients who have undergone a concomitant M-IV procedure between April 2006 and April 2016. Primary endpoints are freedom of atrial arrhythmias and freedom of atrial arrhythmias off antiarrhythmic drugs (AAD). RESULTS: Forty-seven patients (40.2%) had paroxysmal AF. Two-thirds of the procedures included mitral valve surgery. The average follow-up time per patient was 3.8 years (SD 2.8). Freedom of AF at 1 year was 79%, at 5 years freedom of AF was 69% and freedom of AF off AAD was 56%. Predictors of AF recurrence in multivariate analysis were age, preoperative pacemakers, redo cardiac surgery and in-hospital AF. Preoperative PVI ablation was found to be a protective factor. CONCLUSIONS: The long-term outcomes of the M-IV procedure are good and remain stable over the years. Results could be improved if follow-up were to be intensified and recurrences dealt with aggressively. Key question: How many patients are free from AF in a 10-year period after concomitant M-IV surgical ablation? Key findings: In the long term around 70% of patients are free of AF with an increasing need for anti-arrhythmic drugs. Take home message: Early to midterm freedom from AF after concomitant M-IV procedure is high and remains stable after 3 years.


Assuntos
Fibrilação Atrial , Procedimentos Cirúrgicos Cardíacos , Ablação por Cateter , Fibrilação Atrial/complicações , Fibrilação Atrial/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Ablação por Cateter/métodos , Humanos , Procedimento do Labirinto , Resultado do Tratamento
11.
Ann Thorac Surg ; 113(1): 109-117, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33662312

RESUMO

BACKGROUND: In patients with hypertrophic obstructive cardiomyopathy, atrial fibrillation is associated with heart failure and increased late mortality. However, the role of surgical ablation in these patients is not well defined. The aim of this study was to evaluate the efficacy of the concomitant Cox-Maze IV procedure in patients undergoing septal myectomy for hypertrophic obstructive cardiomyopathy. METHODS: Between 2005 and 2019, 347 patients who underwent septal myectomy at a single institution (Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, MO) were retrospectively reviewed. For patients with hypertrophic obstructive cardiomyopathy and atrial fibrillation who underwent a concomitant Cox-Maze IV procedure, freedom from atrial tachyarrhythmias (ATAs) on or off antiarrhythmic drugs (AADs) was evaluated annually. Predictors of ATA recurrence were identified using Fine-Gray regression, with death as a competing risk. RESULTS: A total of 42 patients underwent concomitant septal myectomy and Cox-Maze IV procedures. The majority of patients, 69% (29 of 42), had paroxysmal atrial fibrillation with a 2.5-year median duration. Operative mortality was 7% (3 of 42). New York Heart Association functional class was reduced after surgery (P < .01). Rates of freedom from recurrent ATAs at 1- and 5-year intervals were 93% (27 of 29) and 100% (14 of 14), respectively. Rates of freedom from ATAs and AADs were 83% (24 of 29) and 100% (14 of 14) at the same time points, respectively. Increased left atrial diameter predicted first ATA recurrence (P < .01). Cerebrovascular accident risk was lower in patients with atrial fibrillation who underwent concomitant Cox-Maze IV and septal myectomy relative to myectomy only (P = .02). CONCLUSIONS: Late freedom from ATAs on or off AADs was excellent after Cox-Maze IV and septal myectomy. Although there was a higher than expected rate of perioperative complications, the study results suggest that concomitant surgical ablation should be considered in selected patients with hypertrophic obstructive cardiomyopathy and atrial fibrillation.


Assuntos
Cardiomiopatia Hipertrófica/cirurgia , Septos Cardíacos/cirurgia , Procedimento do Labirinto , Adulto , Idoso , Fibrilação Atrial/cirurgia , Cardiomiopatia Hipertrófica/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia
12.
Heart Surg Forum ; 24(4): E731-E733, 2021 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-34473019

RESUMO

BACKGROUND: Few cases have been reported about coronary artery spasm after a mitral valve replacement and concomitant Cox-Maze IV procedure. We report the case of an adult male who developed right coronary artery (RCA) spasm after a mitral valve replacement with tricuspid valve repair and Cox-Maze IV procedure. CASE REPORT: A 66-year-old male, complaining of progressive exertional shortness of breath, was diagnosed with severe mitral stenosis, moderate tricuspid regurgitation, complete right bundle branch block, and persistent atrial fibrillation (AF) in our clinic. The patient underwent elective mitral valve replacement, tricuspid valve repair, and Cox-Maze IV procedure. Four hours after surgery, a 12-lead electrocardiogram (ECG) showed progressive elevation of ST-segment in the avF and III leads and Troponin-T was over 7000 pg/mL. After one hour, Troponin-T increased to over 10000 pg/mL, and ECG still showed persisted ST-segment elevation in inferior leads. Emergent angiography was performed, and intra-coronary administration of nitroglycerin completely relieved the spasm. CONCLUSION: Potential risks of coronary injury after valvular surgery and Cox-Maze IV procedure need further aggressive investigation and postoperative ischemia should prompt an emergent coronary angiography to identify the cause and apply immediate therapy.


Assuntos
Vasoespasmo Coronário/etiologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/métodos , Procedimento do Labirinto/efeitos adversos , Estenose da Valva Mitral/cirurgia , Insuficiência da Valva Tricúspide/cirurgia , Idoso , Fibrilação Atrial/complicações , Bloqueio de Ramo/complicações , Humanos , Masculino , Estenose da Valva Mitral/complicações , Complicações Pós-Operatórias , Fatores de Risco , Insuficiência da Valva Tricúspide/complicações
13.
J Cardiothorac Surg ; 16(1): 270, 2021 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-34565413

RESUMO

OBJECTIVE: To evaluate the occurrence and risk factors of bradycardia after the Maze procedure in patients with atrial fibrillation and tricuspid regurgitation. METHODS: All patients underwent mitral valve (MV) replacement and concomitant bi-atrial cut-and-sew Maze procedure along with other cardiac surgical procedures were recruited from the Department of Cardiovascular Surgery at the First Affiliated Hospital of Medical College of Xi'an Jiaotong University. According to the severity of tricuspid regurgitation, all patients were divided into mild tricuspid regurgitation group and moderate-to-severe tricuspid regurgitation group. The general clinical data, biochemical indexes, intraoperative and postoperative data were collected. The relationship between tricuspid regurgitation and sinus bradycardia after the Maze procedure was analyzed by multivariate logistic regression model. RESULTS: We enrolled 82 patients, including 24 males and 58 females. The patients had an average age of 56 ± 10 years old. There were 50 cases in mild tricuspid regurgitation group and 32 cases in moderate-to-severe tricuspid regurgitation group. Compared with the mild tricuspid regurgitation group, postoperative bradyarrhythmia (41% vs. 14%), pre-discharge bradyarrhythmia (63% vs. 14%), postoperative sinus bradycardia (34% vs. 10%) and pre-discharge sinus bradycardia (63% vs. 10%) in moderate-to-severe tricuspid regurgitation group were significantly increased (P < 0.01). In moderate-to-severe tricuspid regurgitation, the risk of sinus bradycardia increased after the Maze procedure (OR = 1.453, 95% CI 1.127-1.874), area under ROC curve was 0.81, the Jordan index was 0.665. CONCLUSION: The severity of tricuspid regurgitation may be an important factor affecting sinus bradycardia after the Maze procedure. It can be considered as a factor to predict sinus bradycardia after the Maze procedure.


Assuntos
Fibrilação Atrial , Insuficiência da Valva Mitral , Insuficiência da Valva Tricúspide , Fibrilação Atrial/complicações , Bradicardia/epidemiologia , Bradicardia/etiologia , Feminino , Humanos , Recém-Nascido , Masculino , Procedimento do Labirinto , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Insuficiência da Valva Tricúspide/cirurgia
14.
Innovations (Phila) ; 16(5): 434-440, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34180299

RESUMO

OBJECTIVE: Obesity is a strong and independent factor for the development of atrial fibrillation (AF), and adversely impacts the success of catheter ablation procedures for AF. This study evaluated the impact of body mass index (BMI) on the outcomes following surgical ablation of AF. METHODS: Between 2003 and 2019, 236 patients underwent a stand-alone biatrial Cox maze IV procedure (CMP-IV) for refractory AF. Obesity was defined as BMI ≥30 kg/m2. Patients were divided into two groups: BMI <30 kg/m2 (n = 100) and BMI ≥30 kg/m2 (n = 136). Freedom from atrial tachyarrhythmia (ATA) was determined using electrocardiography, Holter, or pacemaker interrogation at 1 year and annually thereafter. Recurrence was defined as any documented ATA lasting ≥30 s. Predictors of recurrence were determined using multivariable logistic regression. Preoperative and procedural outcomes were compared between groups. RESULTS: Obese patients had a higher rate of diabetes (16% vs 7%, P = 0.044) and larger left atrial diameter (4.9 ± 1.1 cm vs 4.6 ± 1.0 cm, P = 0.021) when compared to non-obese patients. There was no difference in major complication rate between the groups (4% vs 7%, P = 0.389). There was no operative mortality in either group. During 4.1 ± 2.4 years of follow-up, there was no significant difference in freedom from ATA with or without antiarrhythmic drugs in obese patients when compared to the non-obese group (P > 0.05). Absence of sinus rhythm at discharge predicted AF recurrence up to 7 years postoperatively. CONCLUSIONS: As opposed to catheter ablation, obesity did not adversely impact the short and long-term outcomes of stand-alone surgical ablation with CMP-IV, and BMI was not a predictor of AF recurrence. Additionally, there was no significant increase in major complications in obese patients.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/cirurgia , Humanos , Procedimento do Labirinto , Obesidade/complicações , Obesidade/epidemiologia , Resultado do Tratamento
15.
Methodist Debakey Cardiovasc J ; 17(1): 56-64, 2021 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-34104322

RESUMO

The surgical treatment of atrial fibrillation (AF) has evolved significantly over the last 20 years and even more so in the last 5 years. There are now many clinically successful surgical procedures focused on eliminating AF and AF-related stroke. This review discusses the current types of surgical AF procedures, including minimally invasive and hybrid, and may assist clinicians in understanding the various surgical AF options available to patients today.


Assuntos
Técnicas de Ablação , Fibrilação Atrial/cirurgia , Denervação Autônoma , Sistema Nervoso Autônomo/cirurgia , Átrios do Coração/inervação , Frequência Cardíaca , Acidente Vascular Cerebral/prevenção & controle , Técnicas de Ablação/efeitos adversos , Potenciais de Ação , Antiarrítmicos/uso terapêutico , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Denervação Autônoma/efeitos adversos , Sistema Nervoso Autônomo/fisiopatologia , Humanos , Procedimento do Labirinto , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia , Resultado do Tratamento
16.
J Cardiovasc Electrophysiol ; 32(10): 2884-2894, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34041815

RESUMO

INTRODUCTION: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, and results in significant morbidity and mortality. The Cox-Maze IV procedure (CMP-IV) has been shown to have excellent efficacy in returning patients to sinus rhythm, but there have been few reports of late follow-up in sizable cohorts of patients with longstanding persistent AF, the most difficult type of AF to treat. METHODS AND RESULTS: Between May 2003 and March 2020, 174 consecutive patients underwent a stand-alone CMP-IV for longstanding persistent AF. Rhythm outcome was assessed postoperatively for up to 10 years, primarily via prolonged monitoring (Holter monitor, pacemaker interrogation, or implantable loop recorder). Fine-Gray regression was used to investigate factors associated with atrial tachyarrhythmia (ATA) recurrence, with death as a competing risk. Median duration of preoperative AF was 7.8 years (interquartile range: 4.0-12.0 years), with 71% (124/174) having failed at least one prior catheter-based ablation. There were no 30-day mortalities. Freedom from ATAs was 94% (120/128), 83% (53/64), and 88% (35/40) at 1, 5, and 7 years, respectively. On regression analysis, preoperative AF duration and early postoperative ATAs were associated with late ATAs recurrence. CONCLUSION: Despite the majority of patients having a long-duration of preoperative AF and having failed at least one catheter-based ablation, the stand-alone CMP-IV had excellent late efficacy in patients with longstanding persistent AF, with low morbidity and no mortality. We recommend consideration of stand-alone CMP-IV for patients with longstanding persistent AF who have failed or are poor candidates for catheter ablation.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/cirurgia , Átrios do Coração , Humanos , Procedimento do Labirinto , Recidiva , Resultado do Tratamento
19.
Eur J Cardiothorac Surg ; 59(6): 1218-1225, 2021 06 14.
Artigo em Inglês | MEDLINE | ID: mdl-33550393

RESUMO

OBJECTIVES: This study aimed to develop a novel risk score model for quantitative prediction of the rate of atrial fibrillation (AF) recurrence after the Cryo-Maze procedure in patients with persistent AF. METHODS: We enrolled 450 consecutive patients who underwent the Cryo-Maze procedure for persistent AF concomitant with other cardiac procedures in our institute between 2001 and 2019. We randomly divided the cohort into two groups. We derived a model in a 'development cohort' (270 patients; 60%) and validated it in a 'test cohort' (180 patients; 40%) by receiver operating characteristic curve analysis. RESULTS: The median follow-up was 5.2 (interquartile range: 2.0-9.9) years. The 1-, 5-, 10- and 15-year rates of freedom from AF recurrence in the entire cohort were 91.4%, 83.5%, 76.2% and 57.1%, respectively. Risk factors for AF recurrence examined by logistic regression analysis included F-wave voltage in V1 < 0.2 mV, preoperative AF duration >5 years and left atrial volume index >100 ml/m2. Points were assigned to each risk factor according to its odds ratio. A novel risk score model was developed using these three variables and age, with a range up to 10 points. High score (>7) predicted high rates of AF recurrence after the Cryo-Maze procedure. The area under the receiver operating characteristic curve of the novel risk model score was 0.78 (95% confidence interval: 0.65-0.91) in the test cohort. CONCLUSIONS: Use of the Cryo-Maze procedure should be carefully considered in patients with a higher model score because of a higher risk of AF recurrence.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Fibrilação Atrial/cirurgia , Humanos , Procedimento do Labirinto , Recidiva , Fatores de Risco , Resultado do Tratamento
20.
Gen Thorac Cardiovasc Surg ; 69(2): 230-237, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32720242

RESUMO

OBJECTIVES: We investigated the effect of the maze procedure with intensive pulmonary vein isolation (PVI) guided by ganglionated plexus (GP) mapping (the Maze with GP ablation group) on a long-term postoperative maintenance of sinus rhythm in patients with permanent atrial fibrillation (AF) and compared with that in patients undergoing the maze procedure with the conventional PVI (the Maze group). METHODS AND RESULTS: We investigated 48 patients who underwent the maze procedure with GP ablation for persistent AF and 43 patients who underwent the maze procedure. The Maze procedure was conducted by the endocardial application of bipolar radiofrequency ablation and cryoablation. Conventional PVI was applied three times for the entrance of right and left PVs, respectively. Intensive PVI for GP ablation was repeated six-to-eight times for both sides of PVs to cover the bilateral GP regions identified by GP mapping. The duration of permanent AF, the prevalence of concomitant primary heart diseases, and the postoperative follow-up period were comparable between the two groups. At discharge, 1 year, 5 years after the surgery, sinus rhythm was maintained in 74.4%, 61%, and 40.5% of the Maze group. In contrast, it was maintained in 93.7%, 88.9%, and 75.7% of the Maze with GP ablation group. The cumulative freedom rate from AF at 10 years after surgery was significantly higher in the Maze with GP ablation group. CONCLUSIONS: More intense PV isolation including adjacent GP may improve long-term results of maze procedure in patients with permanent AF.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Veias Pulmonares , Fibrilação Atrial/cirurgia , Humanos , Procedimento do Labirinto , Período Pós-Operatório , Veias Pulmonares/cirurgia , Resultado do Tratamento
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