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Khalpey Z, Aslam U, Wilson P, Deckwa J, Kumar U. Prophylactic Left Atrial Appendage Ligation During Coronary Artery Bypass Graft Surgery Allows Safe Avoidance of Anticoagulation Regardless of Postoperative Atrial Fibrillation. Cureus 2024; 16:e59876. [PMID: 38854212 PMCID: PMC11157991 DOI: 10.7759/cureus.59876] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 06/11/2024] Open
Abstract
Background New-onset postoperative atrial fibrillation (POAF) is the most common arrhythmia following cardiac surgery. POAF increases the risk of thromboembolism and stroke, as well as morbidity and mortality more generally. Despite evidence from the landmark PROTECT-AF and PREVAIL trials, left atrial appendage ligation (LAAL) is not routinely performed for thromboembolism prophylaxis in POAF, and anticoagulation remains the standard of care along with dual antiplatelet therapy. This study evaluated the efficacy of concomitant LAAL in eliminating the need for postoperative anticoagulation, regardless of POAF development, in patients undergoing coronary artery bypass grafting (CABG). Methods Between 2019 and 2021, 130 patients were selected to undergo concomitant LAAL while undergoing CABG surgery. Patients were then monitored for the incidence of new-onset POAF, and anticoagulation was strictly avoided for this indication. Demographic and outcome data were collected, with endpoints including transient ischemic attack (TIA) or stroke, death, and readmission within one year, as well as the length of hospital and intensive care unit (ICU) admissions. Results POAF occurred in 37 patients (28.5%), consistent with previous reports. However, none of the POAF patients experienced TIA or stroke during the one-year follow-up period, compared to 2 (2.15%) in the non-POAF group, a typical rate of postoperative stroke in such a patient population. No significant differences were observed between POAF and non-POAF cohorts in one-year stroke, all-cause mortality, readmission rates, or total hospital stay. Interestingly, the POAF cohort had a significantly longer mean ICU stay (4.24 vs 3.37 days, p = 0.0219), possibly due to the time required for arrhythmia control before discharge. The study population had a high mean CHA2DS2-VASc score (2.81), indicating an increased risk of thromboembolism, and a high mean HAS-BLED score, suggesting an elevated bleeding risk with anticoagulation. Conclusions LAAL appears to be an effective adjunct to CABG for thromboembolism prophylaxis in POAF. Formal anticoagulation was avoided in this study, with no significant differences in adverse events between POAF and non-POAF groups, suggesting that LAAL may be a suitable alternative to anticoagulation, especially in high-risk patients (e.g., those with elevated CHA2DS2-VASc or HAS-BLED scores). The safety and efficacy of this approach should be corroborated by larger randomized studies, such as the ongoing LeAAPS trial. LAAL during CABG may help reduce the risk of bleeding complications associated with anticoagulation while maintaining protection against thromboembolic events in patients who develop POAF.
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Affiliation(s)
- Zain Khalpey
- Department of Cardiothoracic Surgery, HonorHealth, Scottsdale, USA
| | - Usman Aslam
- Department of Cardiothoracic Surgery, HonorHealth, Scottsdale, USA
- Department of General Surgery, HonorHealth, Phoenix, USA
| | - Parker Wilson
- Department of Internal Medicine, Baylor University Medical Center, Dallas, USA
| | - Jessa Deckwa
- Department of Research, Nihon Kohden Digital Health Solutions, Irvine, USA
| | - Ujjawal Kumar
- Department of Cardiothoracic Surgery, HonorHealth, Scottsdale, USA
- School of Clinical Medicine, University of Cambridge, Cambridge, GBR
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Alirezaei T, Ansari Aval Z, Karamian A, Hayati A. Effect of preoperative vitamin D on postoperative atrial fibrillation incidence after coronary artery bypass grafting. Gen Thorac Cardiovasc Surg 2024:10.1007/s11748-024-02020-2. [PMID: 38485852 DOI: 10.1007/s11748-024-02020-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/15/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Post-operative atrial fibrillation (POAF) is associated with adverse long-term cardiovascular events. OBJECTIVES This study investigated the effects of a high-dose vitamin D administered preoperatively on the postoperative atrial fibrillation (POAF) incidence in patients with vitamin D deficiency following coronary artery bypass grafting (CABG) surgery. METHODS This randomized controlled clinical trial was conducted on 246 CABG patients with vitamin D deficiency. All patients were randomly divided into intervention and control groups including 123 cases for each group. In the intervention group, from 3 days before surgery, they received a daily dose of 150,000 units of vitamin D orally (50,000 units of Vit D tablet three times a day) and the patients in the control group received placebo tablets before surgery. All patients in the intervention group were assessed continuously for the occurrence of POAF during the recovery period. RESULTS In terms of gender, age, and BMI there were no significant differences between intervention and control groups. Our findings showed that the use of vitamin D supplements did not cause a significant change in the duration of intubation and hospitalization. The ratio of POAF following CABG surgery in the control and treatment groups was 26% and 11.4%, respectively (odds ratio = 0.36; 95% CI = 0.18-0.72; P = 0.003). CONCLUSIONS Our findings revealed that high-dose vitamin D supplementation before CABG surgery significantly reduced the incidence of POAF. Further multicenter randomized trials with larger sample sizes are certainly warranted to confirm our results.
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Affiliation(s)
- Toktam Alirezaei
- Cardiology Department of Shohaday-e-Tajrish Hospital, Shahid Behesti University of Medical Science, Tehran, Iran
| | - Zahra Ansari Aval
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Armin Karamian
- School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Arezoo Hayati
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Magoon R, Shri I, Kashav RC, Dey S, Kohli JK, Grover V, Gupta V. Atrial Fibrillation and Perioperative Inflammation (FIBRILLAMMED Study): A Retrospective Analysis of the Predictive Role of Preoperative Albumin-Adjusted Platelet-Leukocytic Indices in OPCABG. Turk J Anaesthesiol Reanim 2023; 51:331-340. [PMID: 37587676 PMCID: PMC10440484 DOI: 10.4274/tjar.2023.22995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 04/17/2023] [Indexed: 08/18/2023] Open
Abstract
Objective New-onset atrial fibrillation (NOAF), an important postoperative complication, has pertinent inflammatory links. Motivated by the encouraging literature on the prognostic role of hypoalbuminemia, leukocytic indices [LIs: neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR)], systemic inflammation response index (SIRI=NLR×monocyte) and platelet-leukocytic indices [PLIs: platelet-to-lymphocyte ratio (PLR)], systemic immune inflammation index (SII=NLR×platelet), aggregate index of systemic inflammation (AISI=NLR×platelet×monocyte), we sought to investigate the NOAF-predictive value of preoperative albumin-adjusted indices (aa-LIs and aa-PLIs) in an off-pump coronary artery bypass grafting (OPCABG) setting. Methods Of 899 patients, 151 patients (16.79%) developed the primary outcome i.e. NOAF that was analyzed further retrospectively for its predictors instead of the highlighted text perioperative data of 899 patients undergoing elective OPCABG, were retrospectively analyzed. The study participants were categorized into non-NOAF and NOAF groups (defined as new-onset atrial arrhythmia with irregular RR interval with indistinct P wave in the first week postoperatively). Results One hundred and fifty-one patients (16.79%) developed NOAF. On univariate analysis: age, smoker status, The European System for Cardiac Operative Risk Evaluation (EuroSCORE) II, systemic hypertension, diabetes mellitus, prior congestive heart failure (CHF), and a higher preoperative NLR, PLR, SII, and albumin were significant predictors of NOAF. While age, CHF, and EuroSCORE II retained predictive significance in multivariate analysis, LI-PLIs and albumin did not emerge as independent NOAF predictors. Notably, aa-NLR, aa-PLR, and aa-SII independently predicted NOAF on the computation of model-estimates in the regression analysis (Odds ratio; 95% confidence interval: 31.05;15.75-70.61, 1.04;1.02-1.05, 1.12;1.10-1.14, respectively, P < 0.001). aa-NLR ≥1.32, aa-PLR ≥52.64, and aa-SII ≥344.38 predicted NOAF with the respective AUC;sensitivity;specificity of 0.66;63.6%;73.3%, 0.63;66.2%;59.0%, and 0.65;58.3%;78.2%. Preoperative aa-NLR, aa-PLR and aa-SII also positively correlated with CHA2DS2-VASc score (R=0.40, 0.45 and 0.42; P < 0.001). Conclusion The independent NOAF predictive value of aa-NLR, aa-PLR, and aa-SII reiterates the inflammatory relationship of the arrhythmic complication following OPCABG.
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Affiliation(s)
- Rohan Magoon
- Department of Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Iti Shri
- Department of Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Ramesh C. Kashav
- Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Souvik Dey
- Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Jasvinder K. Kohli
- Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Vijay Grover
- Department of Cardiothoracic Vascular Surgery, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Vijay Gupta
- Department of Cardiothoracic Vascular Surgery, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, New Delhi, India
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Biehl JT, Patel R, Lee AJ. Toward the Design of Sensing-Based Medication Adherence Aids That Support Individualized Activities of Daily Living: Survey and Interviews With Patients and Providers. JMIR Hum Factors 2023; 10:e40173. [PMID: 37402141 DOI: 10.2196/40173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 01/29/2023] [Accepted: 05/14/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Nearly half of Americans taking prescription medications do not take them properly. The resulting implications have a broad impact. Nonadhering patients develop worsened medical conditions and increased comorbidity of disease or die. OBJECTIVE Clinical studies have shown that the most effective strategies for addressing adherence are those that are individualized to the context that each patient and situation require. However, existing aids for adherence are relatively ridged and poorly support adaptation to individual behaviors and lifestyles. The aim of our study was to better understand this design tension. METHODS A series of 3 qualitative studies was conducted: a web-based survey of 200 Americans that investigated existing adherence strategies and behaviors and perception of how hypothetical in-home tracking technologies would assist adherence; in-person semistructured interviews with 20 medication takers from Pittsburgh, PA, that investigated personal adherence behaviors, which included demonstration of medication locations and routines as well as an assessment of hypothetical technologies; and semistructured interviews with 6 pharmacists and 3 family physicians to gain a provider perspective on patient adherence strategies, which included feedback on hypothetical technologies in the context of their patient populations. Inductive thematic coding of all interview data was performed. Studies were conducted consecutively, with the results informing the subsequent studies. RESULTS Synthesized, the studies identified key medication adherence behaviors amenable to technological interventions, distilled important home-sensing literacy considerations, and detailed critical privacy considerations. Specifically, 4 key insights were obtained: medication routines are heavily influenced and adapted by and through the physical location and placement of medications relative to activities of daily living, routines are chosen to be inconspicuous to maintain privacy, the value of provider-involved routines is motivated by a desire to build trust in shared decision-making, and the introduction of new technologies can create further burden on patients and providers. CONCLUSIONS There is considerable potential to improve individual medication adherence by creating behavior-focused interventions that leverage emerging artificial intelligence (AI), machine learning (ML), and in-home Internet of Things (IoT) sensing technologies. However, success will be dependent on the technology's ability to learn effectively and accurately from individual behaviors, needs, and routines and tailor interventions accordingly. Patient routines and attitudes toward adherence will likely affect the use of proactive (eg, AI-assistant routine modification) versus reactive (eg, notification of associated behaviors with missed dosages) intervention strategies. Successful technological interventions must support the detection and tracking of patient routines that can adjust to variations in patient location, schedule, independence, and habituation.
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Affiliation(s)
- Jacob T Biehl
- School of Computing and Information, University of Pittsburgh, Pittsburgh, PA, United States
| | - Ravi Patel
- School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, United States
| | - Adam J Lee
- School of Computing and Information, University of Pittsburgh, Pittsburgh, PA, United States
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Çiçek ÖF, Esenboğa K, Yalçın MU, Durdu MS, Altunkeser BB, Büyükateş M. Myocardial Blush Grade Predicts Postoperative Atrial Fibrillation following Mitral Valve Replacement: A Novel Perspective. J Cardiovasc Dev Dis 2023; 10:275. [PMID: 37504531 PMCID: PMC10380330 DOI: 10.3390/jcdd10070275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/18/2023] [Accepted: 06/28/2023] [Indexed: 07/29/2023] Open
Abstract
Background: Atrial fibrillation (AF) remains the most common arrhythmia following mitral valve surgery. Although numerous clinical and laboratory indicators and possible mechanisms of postoperative AF (PoAF) have been described, the role of microvascular dysfunction in pathogenesis has not been assessed. We aimed to evaluate the association between microvascular dysfunction and PoAF in patients undergoing isolated mitral valve replacement. Methods: 188 patients undergoing mitral valve replacement were included in this retrospective study. Demographic characteristics of the patients were recorded. Angiographic assessment of microvascular perfusion was performed using the myocardial blush grading technique for each patient. Univariate and multivariate logistic regression analyses were utilized to determine predictors of PoAF. Results: Of 188 patients (56.69 ± 8.9 years, 39.4% male) who underwent mitral valve replacement, 64 (34%) patients developed PoAF. In the PoAF group, a lower basal hemoglobin level (12.64 ± 0.89 vs. 14.46 ± 0.91 g/dL; p < 0.001), a higher left atrial diameter [5.9 (5.2-6.47) vs. 4.9 (4.5-5.8) cm; p < 0.001], and a lower total blush score (TBS) (8.33 ± 0.84 vs. 8.9 ± 0.31; p < 0.001) were detected. Multivariate logistic regression analysis revealed that preoperative LA diameter (OR:2.057; 95% CI: 1.166-3.63; p = 0.013), preoperative hemoglobin (OR:0.12; 95% CI: 0.058-0.245; p < 0.001), and abnormal TBS (OR:15.1; 95% CI: 1.602-142.339; p = 0.018) were independent predictors of PoAF. Conclusions: Our findings demonstrated that TBS at the preoperative period was an independent predictor of PoAF in patients undergoing isolated mitral valve replacement.
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Affiliation(s)
- Ömer Faruk Çiçek
- Department of Cardiovascular Surgery, Medical Faculty, Selçuk University, Konya 42250, Turkey
| | - Kerim Esenboğa
- Department of Cardiology, Medical Faculty, Ankara University, Ankara 06590, Turkey
| | - Muhammed Ulvi Yalçın
- Department of Cardiology, Medical Faculty, Selçuk University, Konya 42250, Turkey
| | - Mustafa Serkan Durdu
- Department of Cardiovascular Surgery, Medical Faculty, Ankara University, Ankara 06590, Turkey
| | | | - Mustafa Büyükateş
- Department of Cardiovascular Surgery, Medical Faculty, Selçuk University, Konya 42250, Turkey
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6
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Samadifar Z, Aslanabadi N, Kazemi Arbat B, Separham A, Javanshir E. Comparison of the Efficacy of Atorvastatin and Rosuvastatin in Preventing Atrial Fibrillation after Coronary Artery Bypass Grafting: A Double-Blind Randomized Comparative Trial. J Tehran Heart Cent 2023; 18:115-121. [PMID: 37637286 PMCID: PMC10459339 DOI: 10.18502/jthc.v18i2.13321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 08/03/2023] [Indexed: 08/29/2023] Open
Abstract
Background Atrial fibrillation (AF) is a supraventricular tachyarrhythmia characterized by disorganized atrial activity and subsequent mechanical atrial failure. Postoperative AF is a frequent complication of coronary artery bypass grafting (CABG). Although there is evidence of decreased AF after CABG with statin usage, information is scarce regarding a direct comparison between atorvastatin and rosuvastatin. The present study was conducted to compare the efficacy of rosuvastatin and atorvastatin in preventing post-CABG AF. Methods The present double-blind randomized comparative clinical trial selected CABG candidates with stable ischemic heart disease or acute coronary syndromes. Atorvastatin (40 mg per day) or rosuvastatin (20 mg per day) was prescribed 1 week before surgery, and the outcomes were compared. Results Two-hundred patients, 100 cases in each group, completed the study. Twenty-five patients in each group were female, and the mean age was 59.30±8.42 years in the rosuvastatin group and 60.13±9.40 years in the atorvastatin group (P=0.513). The frequency of AF was 31% in the atorvastatin group and 27% in the rosuvastatin group (P=0.534). No significant differences existed between the groups concerning the length of hospital and ICU stay (P=0.333 and P=0.161) and in-hospital and 3-month mortality (P=0.315 and P=0.648). A subgroup analysis of only patients with stable ischemic heart disease could not detect a significant difference between the study groups in any of the investigated outcomes. Our logistic regression analysis showed an association only between age and the incidence of AF after CABG (OR, 1.12; 95% CI, 1.05 to 1.20; P<0.01). Conclusion Rosuvastatin and atorvastatin are similar concerning the prevention of post-CABG AF, but there is a need for future well-designed multicenter studies on this topic.
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Affiliation(s)
- Zahra Samadifar
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Naser Aslanabadi
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Babak Kazemi Arbat
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahmad Separham
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elnaz Javanshir
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Dönmez E, Özcan S, Mert B, Özkaynak B, Tuğrul S, Şahin İ, Okuyan E. A Retrospective Study to Evaluate the Association Between the Glasgow Prognostic Score and Atrial Fibrillation, Stroke, and Mortality at 30 Days and at 1 Year After Coronary Artery Bypass Graft Surgery. Med Sci Monit 2023; 29:e939283. [PMID: 36718108 PMCID: PMC9898998 DOI: 10.12659/msm.939283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The Glasgow prognostic score (GPS) consists of a combination of serum C-reactive protein and albumin levels as indicators of systematic inflammatory response and nutritional status, respectively. The present retrospective study aimed to evaluate the association between the GPS and atrial fibrillation, stroke, and mortality at 30 days and 1 year after coronary artery bypass graft (CABG) surgery. MATERIAL AND METHODS Patients with chronic coronary syndromes who underwent CABG surgery between 2012 and 2019 in a single center were included. Preoperative GPS was calculated. Then, patients were grouped according to postoperative atrial fibrillation (POAF) development. Further, groups were formed to evaluate the relationship between GPS and 30-day and 1-year cardiovascular mortality as well as stroke development. RESULTS Patients who developed POAF had higher GPS, higher European System for Cardiac Operative Risk Evaluation (EuroSCORE II) score, advanced age, lower angiotensin converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) use, lower left ventricular ejection fraction, and were more likely to be female and to have a history of carotid artery disease (P<0.05, for all). Additionally, GPS, EuroSCORE II, advanced age, and lower left ventricular ejection fraction were detected as independent risk factors for POAF development. When adverse outcomes were assessed, cardiovascular mortality at 30 days or 1 year, and stroke development at 1 year, were more frequent in patients with POAF. Moreover, POAF development was found to be an independent risk factor for adverse outcomes. Also, GPS was established as an independent risk factor both for 30-day and 1-year cardiovascular mortality (P<0.0001 and P=0.001, respectively). CONCLUSIONS GPS is an easy-to-calculate score that has reasonable diagnostic accuracy in determining the risk of POAF and stroke as well as 30-day and 1-year cardiovascular mortality.
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Affiliation(s)
- Esra Dönmez
- Department of Cardiology, Bagcilar Training and Research Hospital, İstanbul, Turkey
| | - Sevgi Özcan
- Department of Cardiology, Bagcilar Training and Research Hospital, İstanbul, Turkey
| | - Bülent Mert
- Department of Cardiovascular Surgery, Bagcilar Training and Research Hospital, İstanbul, Turkey
| | - Berk Özkaynak
- Department of Cardiovascular Surgery, Bagcilar Training and Research Hospital, İstanbul, Turkey
| | - Sevil Tuğrul
- Department of Cardiology, Bagcilar Training and Research Hospital, İstanbul, Turkey
| | - İrfan Şahin
- Department of Cardiology, Bagcilar Training and Research Hospital, İstanbul, Turkey
| | - Ertuğrul Okuyan
- Department of Cardiology, Bagcilar Training and Research Hospital, İstanbul, Turkey
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8
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Naik KD, Whitson BA, McLaughlin EM, Matre NB, Rozycki AJ. Safety of apixaban and rivaroxaban compared to warfarin after cardiac surgery. J Card Surg 2022; 37:4740-4747. [PMID: 36478440 PMCID: PMC10107629 DOI: 10.1111/jocs.17203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 10/20/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Direct oral anticoagulants (DOACs) are frequently prescribed for the management of atrial fibrillation and venous thrombosis. There is a lack of published data on the utilization of DOACs in individuals who have undergone recent cardiac surgery. The purpose of this study was to evaluate the safety and efficacy of apixaban and rivaroxaban compared to warfarin in patients postcardiac surgery. METHODS In this retrospective cohort study, patients were separated into a DOAC cohort or a warfarin cohort based on the agent they received after cardiac surgery. Patients could be included if they were ≥18 years of age and received or were discharged on either rivaroxaban, apixaban, or warfarin within 7 days after cardiac surgery. The primary outcome for the study was the rate of International Society on Thrombosis and Hemostasis (ISTH) major bleeding during hospitalization and for 30 days following discharge or until first follow-up appointment. RESULTS There were a total of 194 patients included in the analysis, 97 in the DOAC cohort and 97 in the warfarin cohort. Four patients (4.1%) in the DOAC group experienced ISTH major bleeding, while 2 patients (2.1%) in the warfarin cohort experienced ISTH major bleeding (p = 0.68). No patients in the DOAC cohort experienced a thrombotic event, whereas 2 patients (2.1%) in the warfarin cohort experienced a thrombotic complication (p = 0.5). CONCLUSION Apixaban and rivaroxaban demonstrated similar safety when compared to a matched cohort of warfarin patients. Larger prospective randomized studies are needed to confirm these findings.
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Affiliation(s)
- Kushal D Naik
- Department of Pharmacy, Cleveland Clinic Foundation, Columbus, Ohio, USA
| | - Bryan A Whitson
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Eric M McLaughlin
- Department of Biostatistics, The Ohio State University, Columbus, Ohio, USA
| | - Nancy B Matre
- Department of Quality and Operations, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Alan J Rozycki
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Sex-Related Differences in Clinical Outcomes in Patients with Atrial Fibrillation and Coronary Artery Disease: A Sub-Study of the MISOAC-AF Randomized Controlled Trial. J Clin Med 2022; 11:jcm11195843. [PMID: 36233711 PMCID: PMC9571749 DOI: 10.3390/jcm11195843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/23/2022] [Accepted: 09/29/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There is limited "real-world" data on the prognostic role of gender in comorbid atrial fibrillation (AF) and coronary artery disease (CAD). METHODS In this post-hoc analysis of the MISOAC-AF randomized trial (NCT: 02941978), consecutive patients with AF and CAD who were discharged from the cardiology ward between 2015 and 2018 were included. Multivariable Cox-regression analysis was performed for all-cause mortality and cardiovascular (CV) mortality. Competing-risk analysis was performed for the outcomes of stroke or systemic embolism, major bleeding, AF- or heart failure (HF)-related hospitalization, adjusted for the competing risk of all-cause death. RESULTS Of 1098 patients with AF, 461 patients with comorbid CAD were analyzed. Women were older and more likely to have a history of diabetes mellitus and valvular heart disease, while men were more likely to have a history of smoking or myocardial infarction. Over a median follow-up of 31 months, 143 (43.4%) men and 71 (53.7%) women died. Women were at a higher risk for all-cause mortality (adjusted hazard ration [aHR] 1.65; 95% confidence interval [CI] 1.14-2.38) and stroke or systemic embolism (aHR 3.52; 95% CI 1.46-8.49) compared to men. The risks of CV mortality, major bleeding, AF-related hospitalization, and HF-related hospitalization were similar between genders. CONCLUSIONS In recently hospitalized patients with AF and comorbid CAD, the female gender was independently associated with increased all-cause mortality and thromboembolic events.
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Geurts S, Mens MMJ, Bos MM, Ikram MA, Ghanbari M, Kavousi M. Circulatory MicroRNAs in Plasma and Atrial Fibrillation in the General Population: The Rotterdam Study. Genes (Basel) 2021; 13:genes13010011. [PMID: 35052352 PMCID: PMC8775308 DOI: 10.3390/genes13010011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 01/07/2023] Open
Abstract
Background: MicroRNAs (miRNAs), small non-coding RNAs regulating gene expression, have been shown to play an important role in cardiovascular disease. However, limited population-based data regarding the relationship between circulatory miRNAs in plasma and atrial fibrillation (AF) exist. Moreover, it remains unclear if the relationship differs by sex. We therefore aimed to determine the (sex-specific) association between plasma circulatory miRNAs and AF at the population level. Methods: Plasma levels of miRNAs were measured using a targeted next-generation sequencing method in 1999 participants from the population-based Rotterdam Study. Logistic regression and Cox proportional hazards models were used to assess the associations of 591 well-expressed miRNAs with the prevalence and incidence of AF. Models were adjusted for cardiovascular risk factors. We further examined the link between predicted target genes of the identified miRNAs. Results: The mean age was 71.7 years (57.1% women), 98 participants (58 men and 40 women) had prevalent AF at baseline. Moreover, 196 participants (96 men and 100 women) developed AF during a median follow-up of 9.0 years. After adjusting for multiple testing, miR-4798-3p was significantly associated with the odds of prevalent AF among men (odds ratio, 95% confidence interval, 0.39, 0.24–0.66, p-value = 0.000248). No miRNAs were significantly associated with incident AF. MiR-4798-3p could potentially regulate the expression of a number of AF-related genes, including genes involved in calcium and potassium handling in myocytes, protection of cells against oxidative stress, and cardiac fibrosis. Conclusions: Plasma levels of miR-4798-3p were significantly associated with the odds of prevalent AF among men. Several target genes in relation to AF pathophysiology could potentially be regulated by miR-4798-3p that warrant further investigations in future experimental studies.
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11
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Tzoumas A, Nagraj S, Tasoudis P, Arfaras-Melainis A, Palaiodimos L, Kokkinidis DG, Kampaktsis PN. Atrial fibrillation following coronary artery bypass graft: Where do we stand? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 40:172-179. [PMID: 34949543 DOI: 10.1016/j.carrev.2021.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/30/2021] [Accepted: 12/09/2021] [Indexed: 01/29/2023]
Abstract
Atrial fibrillation (AF) is the most common atrial arrhythmia following coronary artery bypass graft (CABG). Its prevalence is 15-45% and is associated with poor long-term prognosis. Risk factors can be patient-related, intraoperative, and/or postoperative. Therapeutic and preventive strategies have been developed to curtail AF burden. Cardioversion is recommended for unstable or symptomatic patients and rate control if asymptomatic. Anticoagulation is challenging with risk of thromboembolism and bleeding. However, patients should be anticoagulated after cardioversion or if AF persists >48 h and risk factors of stroke exist. A minimum of 4 weeks is recommended but longer duration should be considered in patients at high risk of stroke irrespective of recurrence of AF.
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Affiliation(s)
- Andreas Tzoumas
- Aristotle University of Thessaloniki, Thessaloniki 541 24, Greece
| | - Sanjana Nagraj
- Jacobi Medical Center/Albert Einstein College of Medicine, 1400 Pelham parkway S, The Bronx, NY, USA..
| | | | - Angelos Arfaras-Melainis
- Jacobi Medical Center/Albert Einstein College of Medicine, 1400 Pelham parkway S, The Bronx, NY, USA
| | - Leonidas Palaiodimos
- Jacobi Medical Center/Albert Einstein College of Medicine, 1400 Pelham parkway S, The Bronx, NY, USA
| | - Damianos G Kokkinidis
- Section of Cardiovascular Medicine, Yale University School of Medicine, Yale New Haven Hospital, 333 Cedar St, New Haven, CT, USA
| | - Polydoros N Kampaktsis
- Division of Cardiology, New York University Langone Medical Center, 550 1st Ave, New York, NY, USA
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12
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Brener MI, George I, Kosmidou I, Nazif T, Zhang Z, Dizon JM, Garan H, Malaisrie SC, Makkar R, Mack M, Szeto WY, Fearon WF, Thourani VH, Leon MB, Kodali S, Biviano AB. Atrial Fibrillation Is Associated With Mortality in Intermediate Surgical Risk Patients With Severe Aortic Stenosis: Analyses From the PARTNER 2A and PARTNER S3i Trials. J Am Heart Assoc 2021; 10:e019584. [PMID: 33754803 PMCID: PMC8174321 DOI: 10.1161/jaha.120.019584] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The impact of atrial fibrillation (AF) in intermediate surgical risk patients with severe aortic stenosis who undergo either transcatheter or surgical aortic valve replacement (AVR) is not well established. Methods and Results Data were assessed in 2663 patients from the PARTNER (Placement of Aortic Transcatheter Valve) 2A or S3i trials. Analyses grouped patients into 3 categories according to their baseline and discharge rhythms (ie, sinus rhythm [SR]/SR, SR/AF, or AF/AF). Among patients with transcatheter AVR (n=1867), 79.2% had SR/SR, 17.6% had AF/AF, and 3.2% had SR/AF. Among patients with surgical AVR (n=796), 71.7% had SR/SR, 14.1% had AF/AF, and 14.2% had SR/AF. Patients with transcatheter AVR in AF at discharge had increased 2-year mortality (SR/AF versus SR/SR; hazard ratio [HR], 2.73; 95% CI, 1.68-4.44; P<0.0001; AF/AF versus SR/SR; HR, 1.56; 95% CI, 1.16-2.09; P=0.003); patients with SR/AF also experienced increased 2-year mortality relative to patients with AF/AF (HR, 1.77; 95% CI, 1.04-3.00; P=0.03). For patients with surgicalAVR, the presence of AF at discharge was also associated with increased 2-year mortality (SR/AF versus SR/SR; HR, 1.93; 95% CI, 1.25-2.96; P=0.002; and AF/AF versus SR/SR; HR, 1.67; 95% CI, 1.06-2.63; P=0.027). Rehospitalization and persistent advanced heart failure symptoms were also more common among patients with transcatheter AVR and surgical AVR discharged in AF, and major bleeding was more common in the transcatheter AVR cohort. Conclusions The presence of AF at discharge in patients with intermediate surgical risk aortic stenosis was associated with worse outcomes-especially in patients with baseline SR-including increased all-cause mortality at 2-year follow-up. Registration URL: https://www.clinicaltrials.gov; Unique identifiers: NCT01314313 and NCT03222128.
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Affiliation(s)
- Michael I Brener
- Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY
| | - Isaac George
- Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY
| | - Ioanna Kosmidou
- Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY.,Cardiovascular Research Foundation New York NY
| | - Tamim Nazif
- Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY
| | | | - Jose M Dizon
- Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY
| | - Hasan Garan
- Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY
| | | | - Raj Makkar
- Cedars-Sinai Medical Center Los Angeles CA
| | | | | | | | | | - Martin B Leon
- Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY.,Cardiovascular Research Foundation New York NY
| | - Susheel Kodali
- Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY
| | - Angelo B Biviano
- Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY
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13
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Nantsupawat T, Wongcharoen W, Chattipakorn SC, Chattipakorn N. Effects of metformin on atrial and ventricular arrhythmias: evidence from cell to patient. Cardiovasc Diabetol 2020; 19:198. [PMID: 33234131 PMCID: PMC7687769 DOI: 10.1186/s12933-020-01176-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 11/15/2020] [Indexed: 12/23/2022] Open
Abstract
Metformin has been shown to have various cardiovascular benefits beyond its antihyperglycemic effects, including a reduction in stroke, heart failure, myocardial infarction, cardiovascular death, and all-cause mortality. However, the roles of metformin in cardiac arrhythmias are still unclear. It has been shown that metformin was associated with decreased incidence of atrial fibrillation in diabetic patients with and without myocardial infarction. This could be due to the effects of metformin on preventing the structural and electrical remodeling of left atrium via attenuating intracellular reactive oxygen species, activating 5′ adenosine monophosphate-activated protein kinase, improving calcium homeostasis, attenuating inflammation, increasing connexin-43 gap junction expression, and restoring small conductance calcium-activated potassium channels current. For ventricular arrhythmias, in vivo reports demonstrated that activation of 5′ adenosine monophosphate-activated protein kinase and phosphorylated connexin-43 by metformin played a key role in ischemic ventricular arrhythmias reduction. However, metformin failed to show anti-ventricular arrhythmia benefits in clinical trials. In this review, in vitro and in vivo reports regarding the effects of metformin on both atrial arrhythmias and ventricular arrhythmias are comprehensively summarized and presented. Consistent and controversial findings from clinical trials are also summarized and discussed. Due to limited numbers of reports, further studies are needed to elucidate the mechanisms and effects of metformin on cardiac arrhythmias. Furthermore, randomized controlled trials are needed to clarify effects of metformin on cardiac arrhythmias in human.
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Affiliation(s)
- Teerapat Nantsupawat
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Chiang Mai, 50200, Thailand.,Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
| | - Wanwarang Wongcharoen
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Chiang Mai, 50200, Thailand.,Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
| | - Siriporn C Chattipakorn
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Chiang Mai, 50200, Thailand.,Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
| | - Nipon Chattipakorn
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Chiang Mai, 50200, Thailand. .,Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand. .,Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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14
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Bostan C, Kaya A, Yiğit Z. Changes in pentraxin 3 and oxidative parameters during coronary bypass grafting and factors affecting postoperative atrial fibrillation. J Int Med Res 2020; 48:300060520967561. [PMID: 33147418 PMCID: PMC7780577 DOI: 10.1177/0300060520967561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective The performance of coronary bypass grafting (CBG) induces a type of subclinical systemic inflammatory response syndrome. The present study was performed to examine the changes in pentraxin 3 (PTX3) and oxidative parameters during cross-clamping in patients undergoing CBG. We also examined factors affecting the development of postoperative atrial fibrillation (POAF). Method This study involved 40 patients who underwent elective on-pump CBG (33 men, 7 women; mean age, 60.8 ± 8.0 years). Blood specimens were drawn before anaesthesia and after aortic cross-clamping. POAF was detected by analysing the rhythm records of telemetry units for 96 hours postoperatively. Results The mean PTX3 concentration prior to surgery was 176.3 ± 148.4 pg/mL. After cross-clamping, it increased to 947.7 ± 377.2 pg/mL. The increase was statistically significant. Twelve patients had POAF. The leucocyte count and change in the oxidative stress index were significantly higher in patients without than with POAF. Although the increase in PTX3 was higher in patients without POAF, the difference was not statistically significant. Conclusion The PTX3 concentration significantly increases during CBG. A significant change in the oxidative stress index and a more intense increase in the PTX3 concentration were seen in patients without POAF.
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Affiliation(s)
- Cem Bostan
- Department of Cardiology, Istanbul University-Cerrahpasa Institute of Cardiology, Istanbul, Turkey
| | - Ayşem Kaya
- Department of Cardiology, Biochemistry Laboratory, Istanbul University-Cerrahpasa Institute of Cardiology, Istanbul, Turkey
| | - Zerrin Yiğit
- Department of Cardiology, Istanbul University-Cerrahpasa Institute of Cardiology, Istanbul, Turkey
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15
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Watt TM, Kleeman KC, Brescia AA, Seymour EM, Kirakosyan A, Khan SP, Rosenbloom LM, Murray SL, Romano MA, Bolling SF. Inflammatory and Antioxidant Gene Transcripts: A Novel Profile in Postoperative Atrial Fibrillation. Semin Thorac Cardiovasc Surg 2020; 33:948-955. [DOI: 10.1053/j.semtcvs.2020.11.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/17/2020] [Indexed: 01/11/2023]
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16
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Manuel L, Fong LS, Ang ZH, Grant P. Comparison of novel oral anticoagulants versus warfarin for post-operative atrial fibrillation after coronary artery bypass grafting. Ann Med Surg (Lond) 2020; 58:130-133. [PMID: 32983432 PMCID: PMC7493037 DOI: 10.1016/j.amsu.2020.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 11/04/2022] Open
Abstract
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was ‘Does the use of Novel Oral Anticoagulants (NOACs) result in more complications than Warfarin for treatment of post-operative atrial fibrillation (AF) following coronary artery bypass grafting (CABG)?’ Altogether more than 93 papers were found using the reported search with 4 studies representing the best evidence to answer the clinical question, including 1 randomised trial and 3 retrospective case-control studies. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated. Timing for initiation of anticoagulation was similar across the studies, with both demonstrating longer hospital stays and greater time to reach therapeutic anticoagulation in the warfarin cohort. Three studies reported similar safety between the two groups. One study revealed significantly more invasive interventions for pleural or pericardial effusions in the NOAC group, whilst in contrast another study demonstrated a higher rate of major bleeding in the warfarin cohort. Cost-analysis revealed that NOACs were overall more cost-effective compared to warfarin despite the higher cost for the medication itself. In conclusion, the use of NOACs after CABG for post-operative AF can be used as an alternative to warfarin, however, one should remain vigilant for possible pericardial or pleural effusions which may require reintervention. Further dedicated research and larger appropriately powered randomised control trials are needed to confirm the safety of NOACs in post-cardiac surgery patients. Atrial fibrillation (AF) is the most common arrhythmia post cardiac surgery. While usually self-limiting, AF has increased morbidity and mortality to patients. Anticoagulation is warranted if AF is persistent or recurrent. Warfarin has been the mainstay of therapy, however, NOACs have gained popularity. The safety of NOACs in post-cardiac surgery patients is so far poorly defined.
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Affiliation(s)
- Lucy Manuel
- Department of Cardiothoracic Surgery, Prince of Wales Hospital, Sydney, Australia
| | - Laura S Fong
- Department of Cardiothoracic Surgery, Prince of Wales Hospital, Sydney, Australia
| | - Zhen Hao Ang
- Department of Cardiothoracic Surgery, Prince of Wales Hospital, Sydney, Australia
| | - Peter Grant
- Department of Cardiothoracic Surgery, Prince of Wales Hospital, Sydney, Australia
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17
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The Role of Oxidative Stress in Cardiac Disease: From Physiological Response to Injury Factor. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:5732956. [PMID: 32509147 PMCID: PMC7244977 DOI: 10.1155/2020/5732956] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/11/2020] [Accepted: 04/22/2020] [Indexed: 02/07/2023]
Abstract
Reactive oxygen species (ROS) are highly reactive chemical species containing oxygen, controlled by both enzymatic and nonenzymatic antioxidant defense systems. In the heart, ROS play an important role in cell homeostasis, by modulating cell proliferation, differentiation, and excitation-contraction coupling. Oxidative stress occurs when ROS production exceeds the buffering capacity of the antioxidant defense systems, leading to cellular and molecular abnormalities, ultimately resulting in cardiac dysfunction. In this review, we will discuss the physiological sources of ROS in the heart, the mechanisms of oxidative stress-related myocardial injury, and the implications of experimental studies and clinical trials with antioxidant therapies in cardiovascular diseases.
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18
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Katsi V, Georgiopoulos G, Oikonomou D, Aggeli C, Grassos C, Papadopoulos DP, Thomopoulos C, Marketou M, Dimitriadis K, Toutouzas K, Nihoyannopoulos P, Tsioufis C, Tousoulis D. Aortic Stenosis, Aortic Regurgitation and Arterial Hypertension. Curr Vasc Pharmacol 2020; 17:180-190. [PMID: 29295699 DOI: 10.2174/1570161116666180101165306] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 12/19/2017] [Accepted: 12/21/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Hypertension (HT) is an important risk factor for cardiovascular disease and might precipitate pathology of the aortic valve. OBJECTIVE To investigate the association of HT with aortic dysfunction (including both aortic regurgitation and stenosis) and the impact of antihypertensive treatment on the natural course of underlying aortic disease. METHODS We performed a systematic review of the literature for all relevant articles assessing the correlation between HT and phenotype of aortic disease. RESULTS Co-existence of HT with aortic stenosis and aortic regurgitation is highly prevalent in hypertensive patients and predicts a worse prognosis. Certain antihypertensive agents may improve haemodynamic parameters (aortic jet velocity, aortic regurgitation volume) and remodeling of the left ventricle, but there is no strong evidence of benefit regarding clinical outcomes. Renin-angiotensin system inhibitors, among other vasodilators, are well-tolerated in aortic stenosis. CONCLUSION Several lines of evidence support a detrimental association between HT and aortic valve disease. Therefore, HT should be promptly treated in aortic valvulopathy. Despite conventional wisdom, specific vasodilators can be used with caution in aortic stenosis.
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Affiliation(s)
- V Katsi
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - G Georgiopoulos
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - D Oikonomou
- Department of Cardiology, 'Evaggelismos' General Hospital, Athens, Greece
| | - C Aggeli
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - C Grassos
- Department of Cardiology, 'KAT' General Hospital, Athens, Greece
| | - D P Papadopoulos
- Department of Cardiology, 'Laiko' General Hospital, Athens, Greece
| | - C Thomopoulos
- Department of Cardiology, Helena Venizelou Hospital, Athens, Greece
| | - M Marketou
- Department of Cardiology, Heraklion University Hospital, Crete, Greece
| | - K Dimitriadis
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - K Toutouzas
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - P Nihoyannopoulos
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - C Tsioufis
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - D Tousoulis
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
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19
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Abd Allah E, Bakr MA, Abdallah Abdelrahman S, Taha AM, Kamel EZ. Preoperative left stellate ganglion block: Does it offer arrhythmia-protection during off-pump CABG surgery? A randomized clinical trial. EGYPTIAN JOURNAL OF ANAESTHESIA 2020. [DOI: 10.1080/11101849.2020.1819110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Essam Abd Allah
- Departments of Anesthesia and ICU, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | | | - Ahmed M. Taha
- Cardiothoracic Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Emad Zarief Kamel
- Departments of Anesthesia and ICU, Faculty of Medicine, Assiut University, Assiut, Egypt
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20
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Nambiar P, Kumar S, Mittal CM, Sarkar IC. Outcomes of Bilateral Internal Thoracic Arteries in Minimally Invasive Coronary Artery Bypass Grafting With Analogy to the SYNTAX Trial. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 14:227-235. [PMID: 31203737 DOI: 10.1177/1556984519837391] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Minimally invasive CABG is making positive strides in the evolution of coronary artery bypass surgery. We carried out a retrospective study of the efficacy and outcomes of the usage of bilateral internal thoracic arteries in MICS CABG patients over a 6 year period using primary (MACCE) and secondary outcome measures and also carried out a subgroup analysis of patients with diabetes and methodology of revascularization, and with analogy to the SYNTAX trial of the relative risk. METHODS Nine hundred and forty patients underwent multivessel MICS CABG via a left mini-thoracotomy from August 2011 to September 2017 and complete revascularization was done using the left internal thoracic artery-right internal thoracic artery Y (LITA-RITA Y) composite conduit. Efficacy and outcomes were evaluated by primary (MACCE) and secondary outcome measures including total length of stay, return to full physical activity, and quality of life. Propensity score matched analyses were carried out in diabetics, in the methodology of revascularization (MICS OPCABG vs. MICS ONCABG), and by comparison to the SYNTAX trial for relative risk. Mean follow-up was 2.9 years (maximum was 5.6 years). RESULTS Out of the 940 patients, 843 (89.6%) were diabetic and 97 (10.4%) were nondiabetic. Average grafts were 3.2. There were 9 mortalities (0.9%). The average ICU and hospital stay was 40 ± 12 hours and 3.1 days. Ten patients (1.06%) required reintervention by angioplasty. A total of 99.3% patients were free from major adverse cardiac and cerebrovascular events (MACCE) at follow-up. Mean follow-up was 33 months and 846 (90%) of the patients were followed up. Based on propensity score-matched groups, patients who had their surgery done by MICS ONCABG (beating heart technique) had greater mean number of grafts and hospital length of stay and had significantly longer ICU stay, extubation in OR and blood loss in comparison to patients who had their CABG done by the MICS OPCABG technique. The new technique has shown favorable risk reduction in comparison to both the arms of the SYNTAX trial. CONCLUSIONS The safety, efficacy and outcomes of minimally invasive CABG evaluated by primary (MACCE) and secondary outcomes and quality-of-life measures have been good in this study, especially in diabetics, and have shown results better than conventional CABG. The learning curve can be safely negotiated by using peripheral cardiopulmonary bypass assistance and comparison with the SYNTAX trial has shown a relative reduction in all-cause risk.
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Affiliation(s)
- Pradeep Nambiar
- 1 Cardiac Surgery, National Heart Institute, New Delhi, India
| | - Sanjay Kumar
- 2 Cardiothoracic Surgery, Institute of Medical Sciences, Benares Hindu University. BBC Heart Institute, Jalandhar, India
| | - Chander Mohan Mittal
- 2 Cardiothoracic Surgery, Institute of Medical Sciences, Benares Hindu University. BBC Heart Institute, Jalandhar, India
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21
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Kumar A, Singh H, Shariff M. Remote ischemic preconditioning and its role in the prevention of new onset atrial fibrillation post-cardiac surgery. A meta-analysis of randomized control trials. J Arrhythm 2019; 35:789-794. [PMID: 31844467 PMCID: PMC6898524 DOI: 10.1002/joa3.12252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 09/07/2019] [Accepted: 09/22/2019] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The denouement of remote ischemic preconditioning on new onset atrial fibrillation (NOAF) post-cardiac surgery is not well-established. An updated meta-analysis of randomized control trials was performed by comparing remote ischemic preconditioning with controls and the outcome of interest was NOAF. METHODS The systemic review was performed in accordance with the PRISMA (Preferred reporting items for systemic review) and AHA (American Heart Association) guidelines. PubMed database was searched to include relevant randomized control trials from inception to July 2019. We used Mantel-Haenzsel method with random error model to calculate risk ratio (RR) with 95% confidence interval (CI). Heterogeneity was assessed using the I 2 test> 50% or χ 2 P < .05. Publication bias was visually assessed using a funnel plot. RESULTS Twelve randomized control trials were included in the final analysis. Remote ischemic preconditioning did not alter the risk of NOAF post-cardiac surgery [RR: 0.95, CI: 0.83-1.09, P = .48, I 2 = 37%, χ 2 P = .09]. CONCLUSION In conclusion, the present meta-analysis failed to provide any evidence for the beneficial effect of remote ischemic preconditioning in the prevention of NOAF.
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Affiliation(s)
- Ashish Kumar
- Department of Critical Care MedicineSt John’s Medical College HospitalBangaloreIndia
| | | | - Mariam Shariff
- Department of Critical Care MedicineSt John’s Medical College HospitalBangaloreIndia
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22
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Case R, George J, Li Q, Arnaoutakis GJ, Keeley EC. Unplanned 30-Day Readmission after Coronary Artery Bypass in Patients with Acute Myocardial Infarction. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:518-521. [PMID: 31434634 DOI: 10.1016/j.carrev.2019.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/08/2019] [Accepted: 08/09/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND/PURPOSE The Centers for Medicare and Medicaid services penalizes hospitals with higher than expected readmissions for coronary artery bypass graft surgery (CABG). Little information exists regarding outcomes in patients who sustain an acute myocardial infarction (MI) and undergo CABG as the primary revascularization strategy. Our goal was to determine the unplanned 30-day readmission rate in this high-risk population and predictors of readmission. MATERIALS/METHODS An institutional database was queried to identify patients from 2011 to 2017 who were admitted with an acute MI and underwent CABG within 30 days. Chart review was performed to collect demographics, medical comorbidities and clinical information related to hospital course and readmission status. RESULTS A total of 150 patients were included. The 30-day unplanned readmission rate was 23%, and the majority (80%) were non-cardiac related. Predictors of unplanned readmission included female sex (OR 2.61, 95% CI 1.042-6.549, p = 0.041), CABG performed <7 days following MI (OR 2.82, 95% CI 1.21-6.59, p = 0.017), and post-operative atrial fibrillation (OR 3.25, 95% CI 1.07-9.87, p = 0.038). Complications were identified in 32% of clinic visits in patients who did not require readmission. CONCLUSIONS Patients who undergo CABG following MI are a high-risk population with nearly one-quarter readmitted within 30 days. Female sex, <7 days between the index MI and CABG, and post-operative atrial fibrillation are strong predictors for readmission. Early outpatient follow-up may be an effective intervention to reduce hospital readmissions by reassuring patients that non-cardiac symptoms are in line with anticipated post-operative pain and healing.
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Affiliation(s)
- Robert Case
- Department of Medicine, University of Florida, Gainesville, FL, United States of America
| | - Jerin George
- Department of Medicine, University of Florida, Gainesville, FL, United States of America
| | - Qian Li
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States of America
| | - George J Arnaoutakis
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, FL, United States of America
| | - Ellen C Keeley
- Division of Cardiology, University of Florida, Gainesville, FL, United States of America; Department of Medicine, University of Florida, Gainesville, FL, United States of America.
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23
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Chaudhary R, Garg J, Turagam M, Chaudhary R, Gupta R, Nazir T, Bozorgnia B, Albert C, Lakkireddy D. Role of Prophylactic Magnesium Supplementation in Prevention of Postoperative Atrial Fibrillation in Patients Undergoing Coronary Artery Bypass Grafting: a Systematic Review and Meta-Analysis of 20 Randomized Controlled Trials. J Atr Fibrillation 2019; 12:2154. [PMID: 31687067 DOI: 10.4022/jafib.2154] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/14/2018] [Accepted: 12/20/2018] [Indexed: 01/22/2023]
Abstract
Background Several randomized trials have evaluated the efficacy of prophylactic magnesium (Mg) supplementation in prevention of post-operative atrial fibrillation (POAF) in patients undergoing cardiac artery bypass grafting (CABG). We aimed to determine the role of prophylactic Mg in 3 different settings (intraoperative, postoperative, intraoperative plus postoperative) in prevention of POAF. Methods A systemic literature search was performed (until January 19, 2019) using PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials to identify trials evaluating Mg supplementation post CABG. Primary outcome of our study was reduction in POAF post CABG. Results We included a total of 2,430 participants (1,196 in the Mg group and 1,234 in the placebo group) enrolled in 20 randomized controlled trials. Pooled analysis demonstrated no reduction in POAF between the two groups (RR 0.90; 95% CI, 0.79-1.03; p=0.13; I2=42.9%). In subgroup analysis, significant reduction in POAF was observed with postoperative Mg supplementation (RR 0.76; 95% CI, 0.58-0.99; p=0.04; I2=17.6%) but not with intraoperative or intraoperative plus postoperative Mg supplementation (RR 0.77; 95% CI, 0.49-1.22; p = 0.27; I2=49% and RR 0.92; 95% CI, 0.68-1.24; p = 0.58; I2=51.8%, respectively). Conclusions Magnesium supplementation, especially in the postoperative period, is an effective strategy in reducing POAF following CABG.
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Affiliation(s)
| | - Jalaj Garg
- Division of Cardiology, Cardiac Arrhythmia Service, Medical College of Wisconsin Milwaukee, WI
| | - Mohit Turagam
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | | | - Rahul Gupta
- Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Talha Nazir
- Division of Cardiology, Lehigh Valley Health Network, Allentown, PA
| | - Babak Bozorgnia
- Division of Cardiology, Lehigh Valley Health Network, Allentown, PA
| | - Christine Albert
- Division of Cardiology, Lehigh Valley Health Network, Allentown, PA
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Mahmoud K, M. Al-Azizi K, Mahmoud M, Pallekonda V, Cardozo S. Massive right atrial tamponade early after coronary artery bypass grafting. Proc (Bayl Univ Med Cent) 2019; 32:259-260. [DOI: 10.1080/08998280.2019.1582262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 02/10/2019] [Accepted: 02/11/2019] [Indexed: 10/27/2022] Open
Affiliation(s)
- Karim Mahmoud
- Division of Cardiology, Department of Internal Medicine, Wayne State University, Detroit, Michigan
| | - Karim M. Al-Azizi
- Division of Interventional Cardiology, Baylor Scott & White, The Heart Hospital, Plano, Texas
| | - Mona Mahmoud
- Division of Cardiology, Department of Internal Medicine, Wayne State University, Detroit, Michigan
| | - Vinay Pallekonda
- Department of Anesthesiology, Detroit Medical Center, Detroit, Michigan
| | - Shaun Cardozo
- Division of Cardiology, Department of Internal Medicine, Wayne State University, Detroit, Michigan
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Lee J, Jang I. Predictors Affecting Postoperative Atrial Fibrillation in Patients After Coronary Artery Bypass Graft. Clin Nurs Res 2018; 29:543-550. [PMID: 30378449 DOI: 10.1177/1054773818809285] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The aim of this study is to investigate the differences in POAF (postoperative atrial fibrillation) and non-POAF patients using demographic and clinical characteristics and identify predictors affecting POAF after coronary artery bypass grafts in South Korea. This retrospective cohort study included 999 patients followed-up for at least 1 year after coronary artery bypass graft, between January 2011 and December 2015. Multivariate logistic regression was performed to assess risk factors based on demographics, as well as preoperative and postoperative characteristics. The adjusted multivariate analysis demonstrated that risk factors for POAF were old age (⩾65 years; odds ratio [OR] = 3.022, p < .001), ejection fraction less than 45% (OR = 1.489, p = .036), electrolyte potassium level after surgery (OR = 1.765, p = .003), and the average pain score on Postoperative Day 1 (OR = 1.253, p < .001). The incidence of atrial fibrillation after coronary artery bypass graft surgery can be reduced through the screening of preoperative risk factors, strict potassium monitoring, and pain management strategies.
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Parikh K, Dizon J, Biviano A. Revisiting Atrial Fibrillation in the Transcatheter Aortic Valve Replacement Era. Interv Cardiol Clin 2018; 7:459-469. [PMID: 30274612 DOI: 10.1016/j.iccl.2018.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Atrial fibrillation (AF) is a known complication of many cardiac procedures, including those undergoing surgical aortic valve replacement (SAVR). In the transcatheter aortic valve replacement (TAVR) era, AF has been noted not only to be present in these patients but also associated with morbidity and mortality. In this article, we first outline the significance of AF in general and then more specifically in patients undergoing cardiac surgery. We then compare and contrast specific clinical issues related to AF in patients with aortic stenosis undergoing aortic valve replacement, traditionally with SAVR, but now increasingly more common with TAVR.
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Affiliation(s)
- Kinjan Parikh
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital, Columbia University Medical Center, 177 Fort Washington Avenue, Milstein 5-435, New York, NY 10032, USA
| | - Jose Dizon
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital, Columbia University Medical Center, 177 Fort Washington Avenue, Milstein 5-435, New York, NY 10032, USA
| | - Angelo Biviano
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital, Columbia University Medical Center, 177 Fort Washington Avenue, Milstein 5-435, New York, NY 10032, USA.
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27
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Hu WS, Lin CL. Increased risk of atrial fibrillation in patients with benign prostatic hyperplasia: A population-based cohort study. Clin Cardiol 2018; 41:1374-1378. [PMID: 30144121 DOI: 10.1002/clc.23063] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/22/2018] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE The objective was to compare the rate of onset of atrial fibrillation (AF) in patients with benign prostatic hyperplasia (BPH) as compared with controls. METHODS We performed a retrospective study on national health registry comparing the incidence of AF between a cohort of 15 670 BPH patients and a propensity-matched cohort of 15 670 control patients. Univariable and multivariable Cox proportional hazards models were performed to estimate the hazard ratios (HR) and 95% confidence intervals (CI) of incident AF associated with BPH. A subgroup analysis was performed to evaluate the risk of AF among BPH patients whether they received a BPH surgery or not as compared with those without BPH. RESULTS We found a 4.77 incidence rate per 1000 person-years in the BPH group, compared to 3.76 in the control group. After controlling for the confounders, a significant association between BPH and risk of incident AF was shown with an adjusted HR = 1.19, 95% CI = 1.11-1.28) and this association was attenuated once surgical intervention for BPH has been applied (adjusted HR = 0.86, 95% CI = 0.76-0.97). CONCLUSIONS This study supported the notion that BPH is associated with greater AF occurrence.
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Affiliation(s)
- Wei-Syun Hu
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
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Barman M, Tantawy M, Sopher M, Lennerz C. Cost-effectiveness of colchicine treatment on post-operative atrial fibrillation events in patients of major cardiac surgery. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2018; 4:126-131. [PMID: 29121194 DOI: 10.1093/ehjqcco/qcx043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 11/06/2017] [Indexed: 11/14/2022]
Abstract
Aims Post-operative atrial fibrillation (POAF) occurs in 20-50% of patients amid post-operative stay after Cardiac Surgery. We intend to determine whether colchicine therapy in patients undergoing cardiac surgery is a cost-effective strategy for prevention of POAF. To undertake cost utility analysis and calculate incremental cost utility ratio (ICUR) for colchicine therapy in these subgroup of patients. Methods and results Design Decision tree model to calculate the ICUR comparing two treatment strategies in patients undergoing cardiac surgery. One wherein patients received colchicine along with usual care and second where they received placebo or just usual care. Cost utility analysis was undertaken using relevant data from the systematic review and meta-analysis of the available randomized controlled trials till June 2016 and mean cost calculations from validated available sources across various jurisdictions. Results Colchicine treatment based on mean costs for life expectancy calculated at 10 years' post-surgery using recommended discounting rates of 3.5% was € 17544.80 cheaper per quality-adjusted life-year (QALY) gained. The incremental cost is negative and the incremental effect (QALY) is positive (South East quadrant), Hence the intervention of colchicine treatment is unequivocally cost-effective, meaning it is dominant and achieves better outcomes at a lower cost. Conclusion Our findings provide a benchmark for current and future analyses relating to effectiveness of colchicine on POAF events after cardiac surgery. Currently, there are few reports that provide cutting edge estimates of the higher expenses associated with POAF. Future analyses should likewise explore the impact of added costs from using pharmacologic efforts to prevent and treat POAF after cardiac surgery.
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Affiliation(s)
- Manish Barman
- Department of Social Policy, London School Of Economics, Houghton St, London WC2A 2AE, UK
- Cardiology Department, Al Ahli Hospital, Ahmed Bin Ali St, Doha, Qatar
| | - Mahmoud Tantawy
- Department of Social Policy, London School Of Economics, Houghton St, London WC2A 2AE, UK
- Cardiology Department, Misr University for Science and Technology, 26th of July Corridor, Giza Governorate, Egypt
| | - Mark Sopher
- Department of Social Policy, London School Of Economics, Houghton St, London WC2A 2AE, UK
- Cardiology, Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Castle Ln E, Bournemouth BH7 7DW, UK
| | - Carsten Lennerz
- Department of Social Policy, London School Of Economics, Houghton St, London WC2A 2AE, UK
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung Elektrophysiologie, Technische Universität München, Lazarettstraße 36, 80636 Munich, Germany
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29
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Rajabi M, Safarpoor G, Borzou SR, Farhadian M, Arabi A, Moeinipour A, Manafi B. Association between incidence of atrial fibrillation and duration of cardiopulmonary bypass in coronary artery bypass graft surgery (CABG): a cohort study. Electron Physician 2018; 10:6624-6630. [PMID: 29881524 PMCID: PMC5984016 DOI: 10.19082/6624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 12/22/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Open heart surgery is one of the most common and valuable treatment methods for cardiovascular diseases, a common side effect of which is atrial fibrillation that occurs due to various reasons. OBJECTIVE To determine the relationship between incidence of atrial fibrillation (AF) and duration of cardiopulmonary bypass (CPB) in patients after open heart surgery. METHODS The present retrospective cohort study was conducted on 330 patients in Farshchian Heart Center through census. The required data were collected from medical records of the patients undergoing coronary bypass surgery using data collection between April 2015 and March 2015. Then, data analysis was performed using SPSS software (ver.16) at error level of p<0.05. The tests used in this study included independent-samples t-test, Mann-Whitney, and chi-squared tests. RESULTS Based on the results, mean age of the patients was 61.76±9.2, the majority of the patients (70.1%) were male. The association between Incidence of Atrial Fibrillation and cardiopulmonary pump time (minute) was not meaningful. Incidence of atrial fibrillation had statistically significant relationship with variables of mean age, BMI, PAC, PVC, creatinine and duration of hospitalization (p<0.05); on the other hand, variables of gender, cross clamp time (minute), intubation time (hour), and clinical history had no effect on atrial fibrillation incidence rate (p>0.05). CONCLUSION Since the pathogenesis of AF after cardiac surgery is believed to be multifactorial, including clinical variables and technical intraoperative factors, the relation between incidence of AF with mean age, BMI, PAC, PVC, creatinine and duration of hospitalization was significant. But AF was not related to cardiopulmonary pump time (minute). It is necessary to conduct further research on factors affecting incidence of atrial fibrillation.
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Affiliation(s)
- Maryam Rajabi
- M.Sc. in Nursing, Nursing and Midwifery School, Hamedan University of Medical Sciences, Hamedan, Iran
| | - Gholamreza Safarpoor
- Assistant Professor, Department of Cardiac Surgery, Faculty of Medical Sciences, Farshchian Heart Center, Hamedan University of Medical Sciences, Hamedan, Iran
| | - Seyed Reza Borzou
- Assistant Professor, Department of Medical Surgical Nursing, Member of Chronic Disease (Home Care) Research Center, School of Nursing and Midwifery, Hamedan University of Medical Sciences, Hamedan, Iran
| | - Maryam Farhadian
- Assistant Professor of Biostatistics, Modeling of Non Communicable Diseases Research Center, Department of Biostatistics, School of Public Health, Hamedan University of Medical Sciences, Hamedan, Iran
| | - Arezo Arabi
- Master of Epidemiology, Hamedan University of Medical Sciences, Hamedan, Iran
| | - Aliasghar Moeinipour
- Assistant Professor of Cardiovascular Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Babak Manafi
- Assistant Professor of Cardiovascular Surgery, Faculty of Medicine, Hamedan University of Medical Sciences. Iran
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Geng J, Qian J, Si W, Cheng H, Ji F, Shen Z. The clinical benefits of perioperative antioxidant vitamin therapy in patients undergoing cardiac surgery: a meta-analysis. Interact Cardiovasc Thorac Surg 2018. [PMID: 28645181 DOI: 10.1093/icvts/ivx178] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The clinical benefits of perioperative antioxidant vitamin therapy in cardiac patients remain controversial. Here, we conducted a meta-analysis to determine the strength of the evidence supporting the perioperative use of antioxidant vitamins in patients undergoing cardiac surgery. We searched 4 databases (PubMed, EMBASE, Science Citation Index and Cochrane Library) for randomized controlled trials that reported the effects of antioxidant vitamin therapy on patients undergoing cardiac surgery until 6 June 2016. Risk ratio (RR) or mean difference (MD) and its 95% confidence interval (95% CI) served as the summarized results. Heterogeneity among included studies was evaluated using the I2 statistic, which help determine which effect model to apply. We constructed a funnel plot to assess the existence of publication bias. Sensitivity analyses were also conducted to evaluate the robustness of the outcomes. Twelve trials with 1584 cardiac patients were included. Compared with placebo or no antioxidant vitamin therapy, administration of antioxidant vitamin therapy resulted in a reduction in postoperative atrial fibrillation (POAF) (RR 0.55, 95% CI 0.42, 0.73, P < 0.0001), duration of hospital stay (MD -0.68, 95% CI -0.98, -0.39, P < 0.00001), intensive care unit length of stay (MD -0.21, 95% CI -0.30, -0.12, P < 0.00001) and intubation time (MD -2.41, 95% CI -3.83, -0.98, P = 0.001). Our results also showed a trend towards a decrease in postoperative complications (RR 0.72, 95% CI 0.48, 1.08, P = 0.11) and duration of POAF (MD -1.950, 95% CI -3.28, 0.29, P = 0.10). This meta-analysis demonstrated that perioperative antioxidant vitamin therapy in patients undergoing cardiac surgery can reduce the incidence of POAF, duration of hospital stay, intensive care unit length of stay and intubation time.
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Affiliation(s)
- Jun Geng
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Ju Qian
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Weijun Si
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Hao Cheng
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Fuhai Ji
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zhenya Shen
- Jiangsu Province's Key Medical Center for Cardiovascular Surgery, Suzhou, Jiangsu, China
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Siddiqui KM, Samad K, Jonejo F, Khan MF, Ahsan K. Factors affecting reintubations after cardiac and thoracic surgeries in cardiac intensive care unit of a tertiary care hospital. Saudi J Anaesth 2018; 12:256-260. [PMID: 29628837 PMCID: PMC5875215 DOI: 10.4103/sja.sja_631_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Reintubation and readmission after cardiothoracic surgeries are not uncommon, and its reasons are multifactorial. The study goal was to identify the factors that contribute reintubation after cardiac and thoracic surgery in tertiary care hospital and to compare the outcome with international benchmark. Methodology A prospective, observational study was planned in Cardiac Intensive Care Unit (CICU). The study included all those patients who required readmission in CICU due to endotracheal intubation following cardiac and thoracic surgeries. The study was conducted from January to December 2016. The primary focus was to identify the reasons for reintubation within 72 h of extubation after CICU discharge and its association with outcome. Results Out of 750 patients who shifted out from CICU following successful extubation, only 32 were readmitted and among them in 25 patients (3.33%) were reintubated and their reasons reintubation were noted. Patients underwent a coronary artery bypass grafting (CABG) with valve replacement had a higher incidence of reintubation 3/39 (7.69%) when compared with CABG 13/517 (2.51%) and 4/135 (2.96%) valve procedure alone. Single cause of endotracheal reintubation was observed in 7 patients (28%), in which 5 patients (20%) had respiratory and 2 patients had (8%) cardiac reason while 18 patients (72%) were observed with multisystem involvement, in which 7 patients (28%) had both respiratory and cardiovascular causes, and 2 (8%) had both respiratory and neurological causes. More than 70% cause of endotracheal reintubation was both respiratory and cardiovascular. The CICU stay after reintubations was 12.88 ± 16.88 days and the hospital stay prolonged to 23.84 ± 21.61 days. Conclusion Reasons of reintubation were mainly respiratory and cardiac. The rate of reintubations is high when multisystem involvement is there. CICU, hospital stay, and mortality are increases after reintubation.
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Affiliation(s)
| | - Khalid Samad
- Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan
| | - Faisal Jonejo
- Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan
| | | | - Khalid Ahsan
- Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan
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32
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Connors CW, Craig WY, Buchanan SA, Poltak JM, Gagnon JB, Curry CS. Efficacy and Efficiency of Perioperative Stellate Ganglion Blocks in Cardiac Surgery: A Pilot Study. J Cardiothorac Vasc Anesth 2017; 32:e28-e30. [PMID: 29162313 DOI: 10.1053/j.jvca.2017.10.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Christopher W Connors
- Department of Anesthesiology and Pain Management, Maine Medical Center/Spectrum Medical Group, Portland, ME
| | - Wendy Y Craig
- Maine Medical Center Research Institute, Scarborough, ME
| | - Scott A Buchanan
- Department of Cardiac Surgery, Maine Medical Center, Portland, ME
| | - Justin M Poltak
- Department of Anesthesiology and Pain Management, Maine Medical Center/Spectrum Medical Group, Portland, ME
| | - James B Gagnon
- Department of Anesthesiology and Pain Management, Maine Medical Center/Spectrum Medical Group, Portland, ME
| | - Craig S Curry
- Department of Anesthesiology and Pain Management, Maine Medical Center/Spectrum Medical Group, Portland, ME
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Biviano AB, Nazif T, Dizon J, Garan H, Abrams M, Fleitman J, Hassan D, Kapadia S, Babaliaros V, Xu K, Rodes-Cabau J, Szeto WY, Fearon WF, Dvir D, Dewey T, Williams M, Kindsvater S, Mack MJ, Webb JG, Craig Miller D, Smith CR, Leon MB, Kodali S. Atrial Fibrillation is Associated with Increased Pacemaker Implantation Rates in the Placement of AoRTic Transcatheter Valve (PARTNER) Trial. J Atr Fibrillation 2017; 10:1494. [PMID: 29250217 DOI: 10.4022/jafib.1494] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 12/02/2016] [Accepted: 05/06/2017] [Indexed: 01/13/2023]
Abstract
Atrial fibrillation (AF) is associated with worse outcomes in many cardiovascular diseases. There are few data examining pacemaker implantation rates and indications in patients with AF who undergo transcatheter aortic valve replacement (TAVR). To examine the impact of AF on the incidence of and indications for pacemakers in patients undergoing TAVR, we evaluated data of 1723 patients without pre-existing pacemakers who underwent TAVR in the Placement of AoRTic TraNscathetER Valve (PARTNER) trial. Permanent pacemaker implantation rates and indications were compared in groups based on baseline and discharge heart rhythm: sinus rhythm (SR) vs. AF. 1211 patients manifested SR at baseline/SR at discharge (SR/SR), 105 SR baseline/AF discharge (SR/AF), and 407 AF baseline/AF discharge (AF/AF). Patients who developed and were discharged with AF (SR/AF) had the highest rates of pacemaker implantation at 30 days (13.7% SR/AF vs. 5.4% SR/SR, p=0.0008 and 5.9% AF/AF, p=0.008) and 1 year (17.7% SR/AF vs. 7.1% SR/SR, p=0.0002 and 8.1% AF/AF, p=0.0034). Conversion from SR to AF by discharge was an independent predictor of increased pacemaker implantation at 30 days (HR 2.19 vs. SR/SR, 95% CI 1.23-3.93, p=0.008) and 1 year (HR 1.91 vs. SR/SR, 95% CI 1.33-3.80). Pacemaker indications differed between groups, with relatively more implanted in the AF groups for sick sinus syndrome (SSS) versus AV block. In conclusion, conversion to AF is an independent predictor of permanent pacemaker implantation in TAVR patients. Indications differ depending on heart rhythm, with patients in AF manifesting clinically significant tachy-brady syndrome versus AV block.
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Affiliation(s)
- Angelo B Biviano
- Columbia University Medical Center/ New York Presbyterian Hospital, New York, NY
| | - Tamim Nazif
- Columbia University Medical Center/ New York Presbyterian Hospital, New York, NY
| | - Jose Dizon
- Columbia University Medical Center/ New York Presbyterian Hospital, New York, NY
| | - Hasan Garan
- Columbia University Medical Center/ New York Presbyterian Hospital, New York, NY
| | - Mark Abrams
- Columbia University Medical Center/ New York Presbyterian Hospital, New York, NY
| | - Jessica Fleitman
- Columbia University Medical Center/ New York Presbyterian Hospital, New York, NY
| | - Dua Hassan
- Columbia University Medical Center/ New York Presbyterian Hospital, New York, NY
| | | | | | - Ke Xu
- Cardiovascular Research Foundation, New York, NY
| | - Josep Rodes-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | - Wilson Y Szeto
- Hospital of the University of Pennsylvania, Philadelphia, PA
| | | | - Danny Dvir
- St. Paul's Hospital, Vancouver, BC, Canada
| | - Todd Dewey
- HCA Medical City Dallas Hospital, Dallas, TX
| | | | | | | | | | | | - Craig R Smith
- Columbia University Medical Center/ New York Presbyterian Hospital, New York, NY
| | - Martin B Leon
- Columbia University Medical Center/ New York Presbyterian Hospital, New York, NY.,Cardiovascular Research Foundation, New York, NY
| | - Susheel Kodali
- Columbia University Medical Center/ New York Presbyterian Hospital, New York, NY
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da Costa MAC, Lirani W, Wippich AC, Lopes L, Tolentino EDS, Zampar B, Schafranski MD. Comparison of Two Central Venous Pressure Control Strategies to Prevent Atrial Fibrillation After Coronary Artery Bypass Grafting. Arq Bras Cardiol 2017; 108:297-303. [PMID: 28538759 PMCID: PMC5421468 DOI: 10.5935/abc.20170044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 06/03/2016] [Accepted: 11/01/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND: Atrial fibrillation (AF) takes place in 10-40% of patients undergoing coronary artery bypass grafting (CABG), and increases cardiovascular mortality. Enlargement of atrial chambers is associated with increased AF incidence, so patients with higher central venous pressure (CVP) are expected to have larger atrial distension, which increases AF incidence. OBJECTIVE: To compare post-CABG AF incidence, following two CVP control strategies. METHODS: Interventional, randomized, controlled clinical study. The sample comprised 140 patients undergoing CABG between 2011 and 2015. They were randomized into two groups, G15 and G20, with CVP maintained ≤ 15 cmH2O and ≤ 20 cmH2O, respectively. RESULTS: 70 patients were included in each group. The AF incidence in G15 was 8.57%, and in G20, 22.86%, with absolute risk reduction of 14.28%, and number needed to treat (NNT) of 7 (p = 0.03). Mortality (G15 = 5.71%; G20 = 11.42%; p = 0.07), hospital length of stay (G15 = 7.14 days; G20 = 8.21 days; p = 0.36), number of grafts (median: G15 = 3, G2 = 2; p = 0.22) and cardiopulmonary bypass use (G15 = 67.10%; G20 = 55.70%; p = 0.22) were statistically similar. Age (p = 0.04) and hospital length of stay (p = 0.001) were significantly higher in patients who developed AF in both groups. CONCLUSION: Keeping CVP low in the first 72 post-CABG hours reduces the relative risk of AF, and may be useful to prevent AF after CABG. FUNDAMENTO: A fibrilação atrial (FA) ocorre em 10-40% dos pacientes submetidos a cirurgia de revascularização miocárdica (RM), e eleva a mortalidade cardiovascular. Como o aumento dos átrios está associado ao aumento da incidência de FA, espera-se que pacientes com pressão venosa central (PVC) mais alta tenham maior distensão atrial, o que eleva a incidência dessa arritmia. OBJETIVO: Comparar a incidência de FA em pós-operatório de RM, seguindo duas estratégias de controle de PVC. MÉTODOS: Estudo clínico randomizado controlado intervencionista. A amostra foi composta por 140 pacientes submetidos a RM entre 2011 e 2015. Os pacientes foram randomizados em dois grupos, G15 e G20, mantidos com PVC máxima de 15 cmH2O e 20 cmH2O, respectivamente. RESULTADOS: Foram incluídos 70 pacientes em cada grupo. A incidência da arritmia em G15 foi de 8,57% e, no G20, de 22,86%, com redução de risco absoluto de 14,28% e número necessário para tratar (NNT) de 7 (p = 0,03). Mortalidade (G15 = 5,71%; G20 = 11,42%; p = 0,07), tempo de internamento (G15 = 7,14 dias; G20 = 8,21 dias; p = 0,36), número de enxertos (medianas: G15 = 3, G2 = 2; p = 0,22) e uso de circulação extracorpórea (G15 = 67,10%; G20 = 55,70%; p = 0,22) mostraram-se estatisticamente semelhantes. A idade (p = 0,04) e o tempo de internamento (p = 0,001) foram significativamente maiores nos pacientes que desenvolveram FA nos dois grupos. CONCLUSÃO: Manter a PVC com valores mais baixos nas primeiras 72h após a cirurgia de RM reduz o risco relativo de FA e pode ser uma ferramenta útil na prevenção da FA após RM.
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Affiliation(s)
| | - Wesley Lirani
- Universidade Estadual de Ponta Grossa, Ponta Grossa, PR - Brazil
| | | | - Luana Lopes
- Universidade Estadual de Ponta Grossa, Ponta Grossa, PR - Brazil
| | | | - Beatriz Zampar
- Universidade Estadual de Ponta Grossa, Ponta Grossa, PR - Brazil
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Poffo R, Toschi AP, Pope RB, Montanhesi PK, Santos RS, Teruya A, Hatanaka DM, Rusca GF, Fischer CH, Vieira MC, Makdisse MR. Robotic cardiac surgery in Brazil. Ann Cardiothorac Surg 2017; 6:17-26. [PMID: 28203537 DOI: 10.21037/acs.2017.01.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Brazil, the largest country and economy in South America, is a major driving force behind the development of new medical technologies in the region. Robotic cardiac surgery (RCS) has been evolving rapidly since 2010, when the first surgery using the DaVinci® robotic system was performed in Latin America. The aim of this article is to evaluate short and mid-term results in patients undergoing robotic cardiac surgery in Brazil. METHODS From March 2010 to December 2015, 39 consecutive patients underwent robotic cardiac surgery. Twenty-seven patients were male (69.2%), with the mean age of 51.3±17.9 years. Participants had a mean ejection fraction of 62±5%. The procedures included in this study were mitral valve surgery, surgical treatment of atrial fibrillation, atrial septal defect closure, resection of intra-cardiac tumors, totally endoscopic coronary artery bypass and pericardiectomy. RESULTS The mean time spent on cardiopulmonary bypass (CPB) during RCS was 154.9±94.2 minutes and the mean aortic cross-clamp time was 114.48±75.66 minutes. Thirty-two patients (82%) were extubated in the operating room immediately after surgery. The median intensive care unit (ICU) length of stay was 1 day (ranging from 0 to 25) and the median hospital length of stay was 5 days (ranging from 3 to 25). For each type of procedure, endpoints were individually reported. There were no conversions to sternotomy and no intra-operative complications. Patient follow-up was complete in 100% of the participants, with two early deaths unrelated to the procedures and no re-operations at mid-term. CONCLUSIONS Despite the heterogeneity of this series, RCS appears to be feasible, safe and effective when used for the correction of various intra- and extra-cardiac pathologies. Adopting the robotic system has been a challenge in Brazil, where its limited clinical application may be related to the lack of specific training and the high cost of technology.
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Affiliation(s)
- Robinson Poffo
- Centro de Cirurgia Cardíaca Minimamente Invasiva e Robótica, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Alisson P Toschi
- Centro de Cirurgia Cardíaca Minimamente Invasiva e Robótica, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Renato B Pope
- Centro de Cirurgia Cardíaca Minimamente Invasiva e Robótica, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Paola K Montanhesi
- Centro de Cirurgia Cardíaca Minimamente Invasiva e Robótica, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Ricardo S Santos
- Centro de Cirurgia Cardíaca Minimamente Invasiva e Robótica, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Alexandre Teruya
- Centro de Cirurgia Cardíaca Minimamente Invasiva e Robótica, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Dina M Hatanaka
- Centro de Cirurgia Cardíaca Minimamente Invasiva e Robótica, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Gabriel F Rusca
- Centro de Cirurgia Cardíaca Minimamente Invasiva e Robótica, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Claudio H Fischer
- Centro de Cirurgia Cardíaca Minimamente Invasiva e Robótica, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Marcelo C Vieira
- Centro de Cirurgia Cardíaca Minimamente Invasiva e Robótica, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Marcia R Makdisse
- Centro de Cirurgia Cardíaca Minimamente Invasiva e Robótica, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Horikoshi Y, Goyagi T, Kudo R, Kodama S, Horiguchi T, Nishikawa T. The suppressive effects of landiolol administration on the occurrence of postoperative atrial fibrillation and tachycardia, and plasma IL-6 elevation in patients undergoing esophageal surgery: A randomized controlled clinical trial. J Clin Anesth 2017; 38:111-116. [PMID: 28372647 DOI: 10.1016/j.jclinane.2017.01.036] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 01/12/2017] [Accepted: 01/21/2017] [Indexed: 12/20/2022]
Abstract
STUDY OBJECTIVE To determine whether perioperative landiolol administration suppresses postoperative atrial fibrillation (AF) and the plasma cytokines elevation in patients undergoing esophageal cancer surgery. DESIGN A prospective, randomized controlled trial. SETTING Akita University Hospital, Akita, Japan, from April 2012 to January 2015. PATIENTS Forty American Society of Anesthesiologists grade I-II patients undergoing elective esophagectomy. INTERVENTIONS Patients were randomly divided into two groups, landiolol group (landiolol: 5μg/kg/min) and control group (the same volume of covered saline). Landiolol or saline was infused continuously from the induction of anesthesia until next morning. MEASUREMENTS We examined the new onset of AF and sinus tachycardia, and measured plasma concentrations of cytokines (IL-1β, IL-6, IL-8, IL-10, and TNF-α) just before surgery, at the end of surgery, the next day, and 2days after surgery. Data (mean±SD) were analyzed using two-way ANOVA followed by the Bonferroni"s test for post hoc comparison; a P<0.05 was considered statistically significant. MAIN RESULTS Demographic data were similar between the landiolol and the control groups. The incidence of AF was significantly lower in the landiolol group (1/19=5.3%) compared with the control group (7/20=35%) as well as sinus tachycardia (landiolol group, 0/19=0% vs. control group, 5/20=25%). Plasma IL-6 level at the end of surgery was significantly lower in the landiolol group compared with the control group, but the other plasma cytokines levels were similar between the two groups during the entire study period. CONCLUSIONS Perioperative landiolol administration suppressed the incidence of new-onset of AF as well as sinus tachycardia, and the plasma IL-6 elevation in patients undergoing esophageal cancer surgery.
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Affiliation(s)
- Yuta Horikoshi
- Department of Anesthesia and Intensive Care Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Toru Goyagi
- Department of Anesthesia and Intensive Care Medicine, Akita University Graduate School of Medicine, Akita, Japan.
| | - Ryohei Kudo
- Department of Anesthesia and Intensive Care Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Sahoko Kodama
- Department of Anesthesia and Intensive Care Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Takashi Horiguchi
- Department of Anesthesia and Intensive Care Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Toshiaki Nishikawa
- Department of Anesthesia and Intensive Care Medicine, Akita University Graduate School of Medicine, Akita, Japan
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Biviano AB, Nazif T, Dizon J, Garan H, Fleitman J, Hassan D, Kapadia S, Babaliaros V, Xu K, Parvataneni R, Rodes-Cabau J, Szeto WY, Fearon WF, Dvir D, Dewey T, Williams M, Mack MJ, Webb JG, Miller DC, Smith CR, Leon MB, Kodali S. Atrial Fibrillation Is Associated With Increased Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement: Insights From the Placement of Aortic Transcatheter Valve (PARTNER) Trial. Circ Cardiovasc Interv 2016; 9:e002766. [PMID: 26733582 DOI: 10.1161/circinterventions.115.002766] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study sought to evaluate the impact of atrial fibrillation (AF) on clinical outcomes in patients undergoing transcatheter aortic valve replacement. METHODS AND RESULTS Data were evaluated in 1879 patients with baseline and discharge ECGs who underwent transcatheter aortic valve replacement in the Placement of AoRTic TraNscathetER Valve (PARTNER) trial. A total of 1262 patients manifested sinus rhythm (SR) at baseline/SR at discharge, 113 SR baseline/AF discharge, and 470 AF baseline/AF discharge. Patients who converted from SR to AF by discharge had the highest rates of all-cause mortality at 30 days (P<0.0001 across all groups; 14.2% SR/AF versus 2.6% SR/SR; adjusted hazard ratio [HR]=3.41; P=0.0002) and over 2-fold difference at 1 year (P<0.0001 across all groups; 35.7% SR/AF versus 15.8% SR/SR; adjusted HR=2.14; P<0.0001). The presence of AF on baseline or discharge ECG was a predictor of 1-year mortality (adjusted HR=2.14 for SR/AF group and HR=1.88 for AF/AF groups; P<0.0001 for both groups versus SR/SR). For patients discharged in AF, those with lower ventricular response (ie, <90 bpm) experienced less 1-year all-cause mortality (HR=0.74; P=0.04). CONCLUSIONS After transcatheter aortic valve replacement, the presence of AF at discharge, and particularly, the conversion to AF by discharge and higher ventricular response are associated with increased mortality. These data underscore the deleterious impact of AF, as well as the need for targeted interventions to improve clinical outcomes, in patients undergoing transcatheter aortic valve replacement. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00530894.
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Affiliation(s)
- Angelo B Biviano
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.).
| | - Tamim Nazif
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
| | - Jose Dizon
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
| | - Hasan Garan
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
| | - Jessica Fleitman
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
| | - Dua Hassan
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
| | - Samir Kapadia
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
| | - Vasilis Babaliaros
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
| | - Ke Xu
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
| | - Rupa Parvataneni
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
| | - Josep Rodes-Cabau
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
| | - Wilson Y Szeto
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
| | - William F Fearon
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
| | - Danny Dvir
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
| | - Todd Dewey
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
| | - Mathew Williams
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
| | - Michael J Mack
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
| | - John G Webb
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
| | - D Craig Miller
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
| | - Craig R Smith
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
| | - Martin B Leon
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
| | - Susheel Kodali
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
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Yamac AH, Kucukbuzcu S, Ozansoy M, Gok O, Oz K, Erturk M, Yilmaz E, Ersoy B, Zeybek R, Goktekin O, Kilic U. Altered expression of micro-RNA 199a and increased levels of cardiac SIRT1 protein are associated with the occurrence of atrial fibrillation after coronary artery bypass graft surgery. Cardiovasc Pathol 2016; 25:232-236. [DOI: 10.1016/j.carpath.2016.02.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 01/28/2016] [Accepted: 02/09/2016] [Indexed: 10/22/2022] Open
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Sersar SI. eComment. Posterior pericardiotomy may reduce atrial fibrillation after coronary artery bypass grafting. Interact Cardiovasc Thorac Surg 2015; 21:492. [PMID: 26392581 DOI: 10.1093/icvts/ivv227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Zakkar M, Ascione R, James AF, Angelini GD, Suleiman MS. Inflammation, oxidative stress and postoperative atrial fibrillation in cardiac surgery. Pharmacol Ther 2015; 154:13-20. [PMID: 26116810 DOI: 10.1016/j.pharmthera.2015.06.009] [Citation(s) in RCA: 134] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 06/18/2015] [Indexed: 01/24/2023]
Abstract
Postoperative atrial fibrillation (POAF) is a common complication of cardiac surgery that occurs in up to 60% of patients. POAF is associated with increased risk of cardiovascular mortality, stroke and other arrhythmias that can impact on early and long term clinical outcomes and health economics. Many factors such as disease-induced cardiac remodelling, operative trauma, changes in atrial pressure and chemical stimulation and reflex sympathetic/parasympathetic activation have been implicated in the development of POAF. There is mounting evidence to support a major role for inflammation and oxidative stress in the pathogenesis of POAF. Both are consequences of using cardiopulmonary bypass and reperfusion following ischaemic cardioplegic arrest. Subsequently, several anti-inflammatory and antioxidant drugs have been tested in an attempt to reduce the incidence of POAF. However, prevention remains suboptimal and thus far none of the tested drugs has provided sufficient efficacy to be widely introduced in clinical practice. A better understanding of the cellular and molecular mechanisms responsible for the onset and persistence of POAF is needed to develop more effective prediction and interventions.
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Affiliation(s)
- M Zakkar
- Bristol Heart Institute, University of Bristol, Level 7, Bristol Royal Infirmary, Upper Maudlin Street, Bristol BS2 8HW, UK
| | - R Ascione
- Bristol Heart Institute, University of Bristol, Level 7, Bristol Royal Infirmary, Upper Maudlin Street, Bristol BS2 8HW, UK
| | - A F James
- School of Physiology & Pharmacology, University of Bristol, Medical Sciences Building, University Walk, Bristol, BS8 1TD, UK
| | - G D Angelini
- Bristol Heart Institute, University of Bristol, Level 7, Bristol Royal Infirmary, Upper Maudlin Street, Bristol BS2 8HW, UK
| | - M S Suleiman
- Bristol Heart Institute, University of Bristol, Level 7, Bristol Royal Infirmary, Upper Maudlin Street, Bristol BS2 8HW, UK.
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Drummond LW, Torborg AM, Rodseth RN, Biccard BM. Postoperative atrial fibrillation in patients on statins undergoing isolated cardiac valve surgery: a meta-analysis. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2015. [DOI: 10.1080/22201181.2014.983726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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The effects of posterior pericardiotomy on pericardial effusion, tamponade, and atrial fibrillation after coronary artery surgery. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2014; 11:113-8. [PMID: 26336406 PMCID: PMC4283862 DOI: 10.5114/kitp.2014.43835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 02/13/2014] [Accepted: 03/20/2014] [Indexed: 11/17/2022]
Abstract
Introduction Pericardial effusion and atrial fibrillation occur commonly after coronary artery surgery. Aim of the study A prospective randomized clinical trial was conducted to evaluate the effects of posterior pericardiotomy on the occurrence of pericardial effusion, tamponade, and atrial fibrillation. Material and methods The study group consisted of 96 patients (77 male and 19 female) at a mean age of 58.1 ± 9.8 years. The patients were randomly assigned to one of three study groups: patients undergoing posterior pericardiotomy (group I, n = 30), controls (group II, n = 33), and patients with additional posterior pericardial drainage tubes (28 mm) who did not undergo posterior pericardiotomy (group III, n = 33). Results Postoperative hospitalization (p = 0.03; 11.56 ± 10.64) and reoperation due to tamponade (p = 0.019; 12.1%) were significantly higher in group II. Extensive pericardial effusions were detected in one patient on the first postoperative day (group II, n = 1), in one patient on the fifth postoperative day (group III, n = 1), and in one patient on the 30th day after the operation (group III, n = 1). Pericardial effusion exhibited regression in group I on postoperative day 30 (p = 0.028). A higher rate of postoperative atrial fibrillation was noted in group I, but no significant differences were found between the groups with regard to postoperative atrial fibrillation. Conclusions Patients who did not undergo posterior pericardiotomy or did not receive posterior chest tubes exhibited residual pericardial effusion, required longer hospitalization, and had to be reoperated due to tamponade. Both posterior pericardiotomy and the use of posterior tubes are effective in the early postoperative period.
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Impact of coronary collateral circulation and severity of coronary artery disease in the development of postoperative atrial fibrillation. Interact Cardiovasc Thorac Surg 2014; 19:394-7. [DOI: 10.1093/icvts/ivu158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Poffo R, Toschi AP, Pope RB, Celullare AL, Benício A, Fischer CH, Vieira MLC, Teruya A, Hatanaka DM, Rusca GF, Makdisse M. Robotic surgery in cardiology: a safe and effective procedure. EINSTEIN-SAO PAULO 2014; 11:296-302. [PMID: 24136755 PMCID: PMC4878587 DOI: 10.1590/s1679-45082013000300007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 08/28/2013] [Indexed: 11/21/2022] Open
Abstract
Objective: To evaluate the short and medium-term outcomes of patients undergoing robotic-assisted minimally invasive cardiac surgery. Methods: From March 2010 to March 2013, 21 patients underwent robotic-assisted cardiac surgery. The procedures performed were: mitral valve repair, mitral valve replacement, surgical correction of atrial fibrillation, surgical correction of atrial septal defect, intracardiac tumor resection, totally endoscopic coronary artery bypass surgery and pericardiectomy. Results: The mean age was 48.39±18.05 years. The mean cardiopulmonary bypass time was 151.7±99.97 minutes, and the mean aortic cross-clamp time was 109.94±81.34 minutes. The mean duration of intubation was 7.52±15.2 hours, and 16 (76.2%) patients were extubated in the operating room immediately after the procedure. The mean length of intensive care unit stay was 1.67±1.46 days. There were no conversions to sternotomy. There was no in-hospital death or deaths during the medium-term follow-up. Patients mean follow up time was 684±346 days, ranging from 28 to 1096 days. Conclusion: Robotic-assisted cardiac surgery proved to be feasible, safe and effective and can be applied in the correction of various intra and extracardiac pathologies.
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