Effect of Age on Heart Rate Variability in Patients with Mitral Valve Prolapse: An Observational Study.

Age is an important determinant of heart rate variability (HRV) in healthy individuals. The incidence of arrhythmia is high in patients with mitral valve prolapse (MVP). However, the correlation of HRV in patients with MVP in different age groups is not well established. We presumed that increasing age would be prospectively associated with declining HRV measurement in MVP. Sixty patients with MVP and 120 control individuals were included and underwent 24 h HRV analysis. No significant difference was found in all parameters calculated in the time domain or in the frequency domain between the two groups. However, as patients' age increased, a significant time domain (SDNN, RMSSD, NN50, and pNN50) decline was found in the MVP group, but not in the control group. This suggests that patients with MVP may have autonomic nervous system involvement that increases the risk of arrhythmia and heart disease with increasing age.

Experience of endovascular repair of thoracic aortic dissection after blunt trauma injury in a district general hospital.

BACKGROUND: Traumatic thoracic aortic dissection is uncommon in clinical practice; however, it is associated with high morbidity and mortality. Thoracic aortic dissection is usually caused by sudden deceleration resulting from a traffic accident or fall. Aortic injury after blunt trauma is a critical condition. This study reported the outcomes of endovascular repair of acute traumatic aortic dissection in patients at a district general hospital. METHODS: In this study, we retrospectively reviewed the clinical data of eight patients with acute traumatic aortic dissection after a blunt trauma who had undergone thoracic endovascular aortic repair (TEVAR) between January 2012 and December 2015 at a district general hospital in Taiwan. RESULTS: The median age of the patients was 49±22 years (range, 20-77 years), and 6 of the 8 (75%) patients were men. Five patients were involved in traffic accidents, and 3 patients had fallen from heights. The injury severity score (ISS) of the patients ranged from 17 to 66. In all patients, the aortic injury was located near the origin of the left subclavian artery (LSA). Four patients had seal ostium of subclavian artery, left. None of the patients developed paraplegia or lower extremity ischemia. Moreover, all patients had concomitant injuries, and no patients died postoperatively. CONCLUSIONS: Endovascular repair is a rapid and minimally invasive therapy for patients with traumatic aortic injury and is associated with favorable technical results.

Use of a Perclose ProGlide device for percutaneous endovascular aortic aneurysm repair in a general hospital experience.

BACKGROUND: This study evaluated the safety and efficacy of percutaneous endovascular aortic aneurysm repair (EVAR) with a Perclose ProGlide device compared with endovascular aortic repair with surgical cutdown of common femoral artery in patients at a general hospital. METHODS: A retrospective clinical study was conducted using data on 10 patients with elective EVAR, 7 patients with percutaneous EVAR, and 9 patients with consecutive rupture abdominal aortic aneurysm treated with emergency EVAR from January 2010 to December 2014. RESULTS: The median length of intensive care unit stay for elective EVAR, percutaneous EVAR, and emergency EVAR cases: 1.80±0.92 days, 1.67±1.21 days, and 10.00±13.27 days, respectively; hospital days: 11.10±4.28 days, 11.00±4.10 days, and 21.89±18.35 days, respectively. Seven patients have no calcification in common femoral artery, and the use of a Perclose ProGlide device was under the guidance of sonography for percutaneous EVAR. The operative times of elective EVAR, percutaneous EVAR, and emergency EVAR were 192.3±52.0 minutes, 169.2±67.5 minutes, and 227.1±59.9 minutes, and blood loss volumes were 150.0±77.5 ml, 95.0±78.6 ml, and 422.2±276.3 ml, respectively. Technical success rate of Perclose ProGlide was 100%. CONCLUSIONS: Selective percutaneous access of the femoral arteries for EVAR is safe and effective in the studied cases. The complications can be avoided with careful selection of patients based on preoperative imaging. Using Perclose ProGlide for select cases may reduce blood loss and operative time.

Clinical outcomes of infrarenal abdominal aortic aneurysms that underwent endovascular repair in a district general hospital.

BACKGROUND: The purpose of this study was to compare the outcomes of elective endovascular abdominal aortic aneurysm repair (EVAR) and ruptured abdominal aortic aneurysm (rAAA) in patients at a district general hospital. METHODS: A retrospective clinical study was conducted using data on 16 patients with elective abdominal aortic aneurysm (AAA) and nine patients with consecutive rAAA treated with EVAR from January 2010 to December 2014 in a district general hospital in Taiwan. RESULTS: The preoperative characteristics of the two groups are listed. Thirty-six percent (9/25) of the patients were referred from other hospitals that did not offer surgical services. The percentage of patients with rAAA that were transferred from other hospitals was 55.5% (5/9). The stay durations in the intensive care unit for elective EVAR cases were shorter than those for emergent EVAR (1.75±1 d elective vs. 10±13.37 d emergent; P<0.019). The hospitalization days (11.06±4.07 d elective vs. 21.89±18.36 d emergent; P<0.031), operative time (183.63±57.24 min elective vs. 227.11±59.92 min emergent; P<0.009), and blood loss volumes (115.63±80.41 mL elective vs. 422.22±276.26 mL emergent; P<0.005) are shown; statistics for use of Perclose ProGlide(®) (7 cases elective vs. 0 case emergent; P<0.024) are compared. The overall 30-d mortality rate was 11.11% (1/9). CONCLUSIONS: The results confirm that EVAR surgery can be safely performed in a district general hospital with an integrated health care system. Using Perclose ProGlide(®) for selected cases may reduce blood loss and operative time.