The Heart Surgery Forum

Effect of Post-Ablational Antiarrhythmic Drugs on Atrial Fibrillation Recurrence: A Systematic Review and Meta-Analysis

Yangyang Wang — 2024-08-21

Background: The efficacy of antiarrhythmic drugs in reducing the risk of recurrence of atrial fibrillation (AF) after ablation is still uncertain. Therefore, we conducted a systematic evaluation on post ablation antiarrhythmic drugs (AADs) to reduce the risk of recurrent atrial fibrillation. Methods: The databases of PubMed, Embase, Web of Science (WOS), China Science and Technology Journal (CSTJ) Database, Wanfang Database, China National Knowledge Infrastructure (CNKI), and China Biology Medicine (CBM) were searched from inception to 31 December 2023. Randomized controlled trials (RCTs) investigating the efficacy of AADs in preventing AF recurrence were included. Statistical analysis was performed using Review Manager 5.3 (Copenhagen: The Nordic Cochrane Centre, The Cochrane collaboration, 2014) and Stata18.0 (Stata, College Station, TX, USA). Results: A total of 16 studies, with 3834 patients were included in the final analysis. The use of AADs was found to reduce early risk of recurrence (≤3 months) by 28% (risk ratio (RR) = 0.72, 95% confidence interval (CI): 0.53–0.99, p = 0.04), intermediate risk of recurrence (3–12 months) by 22% (RR = 0.78, 95% CI: 0.67–0.91, p = 0.001), and late risk of recurrence (≥12 months) by 29% (RR = 0.71, 95% CI: 0.47–1.07, p = 0.1). No published bias was detected. In sensitivity analyses, the result is consistent and stable after removal of either study. Conclusions: The use of AADs after ablation can reduce the recurrence of AF, and the effect can last for at least 6 months in the overall population. In subgroup analysis, this protective effect can even last for 12 months in the Asian region. In addition, AADs should be used for at least 3 months after ablation to achieve this protective effect.

A Meta-Analysis of Ultrasound Guided Nerve Blocks for Enhanced Recovery in Adult Cardiac Surgery Patients

Dou Dou — 2024-08-20

Background: Ultrasound-guided nerve blocks can both reduce intraoperative opioid use and pain scores. However, its role in enhancing postoperative recovery for adult cardiac patients requires further investigation. This study examines the impact of ultrasound-guided nerve block on adult cardiac patients' recovery. Methods: We conducted a systematic search for randomized controlled trials (RCTs) published between 2018 to 2022, focusing ultrasound-guided nerve block in adult cardiac surgery. The search included Pubmed, Embase, and Cochrane databases, targeting studies on elective thoracotomy. The outcomes analyzed included postoperative extubation time, intensive care unit (ICU) stay time, and length of hospital stay (LOS), using Review Manager software (Review Manager 5.4, The Cochrane Collaboration, 2020, Beijing, China) for data synthesis and analysis. Results: Out of 26 RCTs, eight studies involving including 424 subjects were included in this meta-analysis. The results showed that ultrasound-guided nerve block significantly reduced postoperative extubation time (odds ratio [OR] = –2.16, 95% confidence interval [CI]: –3.05 to –1.26), ICU stay (OR = –1.17, 95% CI: –1.40 to –0.94), and overall hospitalization duration (OR = –0.96, 95% CI: –1.64 to –0.29). Conclusion: Ultrasound-guided nerve block significantly reduces the postoperative extubation time, ICU stay, and LOS, in adult cardiovascular surgery. These benefits contribute substantially to enhanced recovery after cardiac procedures. Registration: PROSPERO (CRD42023470545).

IL-6 and HMGB1 Levels for Predicting Major Adverse Vascular Events after Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome

Wujian He — 2024-08-20

Objective: This study aims to investigate the value of interleukin 6 (IL-6) and high-mobility group box 1 (HMGB1) in predicting major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). Methods: Patients with ACS who were treated in our hospital from October 2022 to October 2023 were divided into MACE and no-MACE groups according to the occurrence of MACE after PCI. The baseline data and IL-6 and HMGB1 levels in the two groups were observed, and the influencing factors of MACE in patients with ACS after PCI were evaluated with a logistic regression test. The receiver operator characteristic curve (ROC) values of IL-6 and HMGB1 in the prediction of MACE after PCI in patients with ACS were calculated. Results: No significant differences in age, sex, body mass index (BMI), and other general data were found between the groups. Compared with the patients in the no-MACE group, the patients in the MACE group had a history of smoking (p = 0.011), hypertension (p < 0.001), diabetes (p < 0.001), more coronary lesions (p = 0.013), longer coronary lesions (p = 0.006), higher preoperative Gensini score (p < 0.001), and lower left ventricular ejection fractions (LVEF) (p < 0.001). The levels of IL-6 and HMGB1 in the MACE group were significantly higher than those in the no-MACE group. Coronary lesion length, Gensini score, LVEF, IL-6, and HMGB1 had good predictive value for MACE after PCI. The area under the curve (AUC) scores were 0.683, 0.941, 0.816, 0.878, and 0.737. The sensitivity was 53.13%, 81.25%, 84.37%, 78.12%, and 53.13%, and the specificity was 87.50%, 93.18%, 63.64%, 86.36%, and 86.36%, respectively. Analysis of IL-6 and HMGB1 levels showed that the AUC was 0.922, the sensitivity was 90.62%, the specificity was 82.95%, and the 95% confidence interval (CI) was (0.858–0.963; p < 0.05). Conclusion: IL-6 and HMGB1 have good predictive value for MACE after PCI for patients with ACS and can be used as clinical evaluation indexes.

Influence of Diabetes Mellitus on Changes in Intra-Operative Decision Making in Coronary Artery Bypass Grafting

John P. Duggan — 2024-08-19

Background: We evaluated whether patients with diabetes mellitus experienced more surgical strategy changes than patients without diabetes when undergoing coronary artery bypass graft surgery utilizing a protocol for intraoperative high frequency ultrasound and transit-time flow measurement. Methods: Outcomes of coronary artery bypass grafting (CABG) patients with and without diabetes enrolled in the multicenter prospective Registry for Quality Assessment with Ultrasound Imaging and TTFM in Cardiac Bypass Surgery (REQUEST) study were retrospectively compared. The primary endpoint was frequency of intraoperative surgical strategy changes. We also evaluated the differences in patient characteristics and operative characteristics including graft configuration. Results: We compared 614 non-diabetic patients with 402 diabetic patients, among whom 128 were insulin dependent. Patients with diabetes had higher rates of surgical strategy change for the aortic component of the operation (10.2% vs. 6.4%, odds ratio (OR) = 1.67; 95% confidence interval (CI) = 1.06–2.65; p = 0.026). Surgical strategy changes related to in-situ conduits were more common in on-pump procedures in comparison to off-pump in diabetics (4.0% vs. 0%; p = 0.007). Diabetes was associated with less frequent use of bilateral internal mammary arteries (BIMA) (25.6% vs. 33.7%; p = 0.006), more frequent use of radial artery (31.3% vs. 16.9%; p < 0.001) and multi-arterial configuration (48.3% vs. 39.9%, p = 0.009), and more total grafts (3.1 ± 1.1 vs. 2.8 ± 0.9; p < 0.001). Conclusions: When performing isolated CABG on diabetic patients, surgeons were more likely to change surgical strategy for the aortic component of the operation based on high-frequency ultrasound (HFUS), and more likely to make a change related to in-situ conduits in on-pump procedures in diabetics. Among diabetic patients, there was less frequent use of BIMA, more frequent use of radial artery, more frequent multi-arterial configuration, and more total grafts.

Effectiveness of the IKAP Nursing Mode in Improving the Prognosis of Patients after Spontaneous Pneumothorax Single-Hole Thoracoscopy: Retrospective Study

Dan Wu — 2024-08-19

Purpose: This study aimed to evaluate the effectiveness of the information-knowledge-attitude-practice (IKAP) nursing mode in improving the prognosis of patients after spontaneous pneumothorax single-hole thoracoscopy. Methods: A retrospective analysis was conducted on the clinical data of patients with spontaneous pneumothorax who underwent single-hole thoracoscopy from June 2020 to June 2023. Among these patients, 59 received traditional nursing care and 52 received care under the IKAP nursing mode. Data on patient demographics, intraoperative variables, rehabilitation time, complications, adverse events, pain scores, quality of life, psychological status, and sleep quality 72 hours after surgery were collected and compared between the two groups. Results: Compared with the traditional nursing group, the IKAP nursing group exhibited significantly shorter chest tube retention time (55.46 ± 9.26 hours vs. 60.74 ± 10.13 hours; p = 0.005), gas stop escape time (50.92 ± 8.73 hours vs. 55.13 ± 7.68 hours; p = 0.009), and overall hospitalization time (4.15 ± 1.53 days vs. 5.17 ± 2.46 days; p = 0.009); significantly lower rates of pleural infection (1.92% vs. 16.95%; p = 0.008) and bleeding events (1.92% vs. 16.95%; p = 0.008); and lower pain scores at 12 hours (4.56 ± 1.57 vs. 5.19 ± 1.14; p = 0.020) and 72 hours after surgery (2.84 ± 0.48 vs. 3.07 ± 0.45; p = 0.010). The patients under the IKAP nursing care also exhibited statistically significant improvements in somatization (81.72 ± 3.98 vs. 79.53 ± 4.02, p = 0.005) and emotion management (81.14 ± 5.26 vs. 78.10 ± 4.78, p = 0.002) compared with those under traditional nursing. Significantly lower levels of anxiety (10.37 ± 2.21 vs. 11.82 ± 2.53, p = 0.002), depression (9.37 ± 2.06 vs. 10.61 ± 2.35, p = 0.004), and stress (21.68 ± 4.16 vs. 23.54 ± 4.78, p = 0.032) were observed under the IKAP nursing mode compared with those under traditional nursing at 72 hours post-surgery. The IKAP nursing group exhibited better sleep quality as measured by the Pittsburgh sleep quality index (PSQI) score (7.94 ± 1.56 vs. 8.64 ± 1.95, p = 0.041) but longer sleep duration (7.45 ± 1.37 vs. 6.72 ± 1.29, p = 0.005) compared with the traditional nursing group. Conclusion: Compared with traditional nursing, the IKAP nursing mode demonstrated favorable outcomes including shorter rehabilitation times, reduced rates of postoperative complications, and improved pain management, emotion management, and sleep quality. This comprehensive and patient-centered approach shows potential to optimize the postoperative care, outcomes, and overall prognosis of patients undergoing thoracoscopy for spontaneous pneumothorax. Owing to its retrospective nature, the potential for selection bias and confounding variables in this work cannot be discounted. Future prospective studies with large and diverse cohorts are warranted to validate these findings.

Effect of KAP-Based Nursing Intervention on Patients Undergoing Coronary Artery Computed Tomography Angiography Review after Percutaneous Coronary Intervention

Kexin Jing — 2024-08-19

Objective: This study aimed to analyze the impact of nursing intervention based on knowledge, belief, and action theory (KAP) on patients undergoing coronary computed tomography angiography (CTA) review after percutaneous coronary intervention (PCI). Methods: The research subjects were post-PCI patients who underwent coronary CTA review in our hospital from July 2021, to July 2023. A total of 123 review patients were divided into two groups in accordance with whether they had experienced KAP-based care. The observation and control groups consisted of 65 and 58 cases, respectively (n = 58). The self-rating anxiety scale (SAS), heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP), CTA image quality, examination cooperation, and nursing satisfaction were compared between the two groups. Results: Compared with those of before nursing, the SAS scores of both groups after nursing were significantly reduced (p < 0.05). Compared with the control group, the observation group had significantly reduced SAS scores (p < 0.05). Compared with those before nursing, the HR, SBP, and DBP of both groups after nursing were significantly reduced (p < 0.05). Compared with the control group, the observation group showed significantly reduced HR, SBP, and DBP (p < 0.05). The grade I rate of the observation group significantly increased, the grade III rate was significantly reduced, and the image quality significantly improved compared with those of the control group (p < 0.05). No statistically significant difference was observed in the incidence of grade II between the two groups (p > 0.05). The total cooperation degree of the observation group was 93.86% (61/65), which was significantly increased compared with the total cooperation degree of 81.03% (47/58) in the control group (p < 0.05). The total satisfaction of patients in the observation group was 96.92% (63/65), which was significantly increased compared with the total satisfaction of 74.14% (43/58) in the control group (p < 0.001). Conclusion: Nursing based on the KAP model during coronary CTA review after PCI can significantly alleviate patients' negative emotions and improve CTA image quality. It can also improve patients' examination cooperation and nursing satisfaction.

Internet-Based Telerehabilitation Guidance Brings Additional Benefits to Patients after Percutaneous Coronary Intervention: A Retrospective Cohort Study

Hua Sun — 2024-08-18

Purpose: This study aimed to analyze the value of remote rehabilitation guidance based on Internet technology in patients undergoing percutaneous coronary intervention. Methods: We retrospectively analyzed the clinical data of 253 patients who underwent percutaneous coronary intervention in our hospital from June 2022 to March 2023. According to different nursing methods, they were divided into a study group (remote rehabilitation guidance based on Internet technology) and a control group (routine follow-up management) with 124 and 129 cases, respectively. The compliance left ventricular diastolic dysfunction (LVDD), left ventricular end-systolic diameter (LVDS), left ventricular ejection fraction (LVEF), Seattle Angina Questionnaire (SAQ), self-rating depression scale (SDS), self-rating anxiety scale (SAS), self-care ability, quality of life (SF-36), and satisfaction of the two groups were compared. Results: The compliance of the study group was 94.35%, which was higher than that of the control group (77.52%; n = 100, χ² = 14.683, p < 0.001). We found no difference in cardiac function between the groups before the intervention (z = –0.783, p > 0.05). After the intervention, the LVDD and LVDS of the study group were lower than those of the control group, but LVEF was higher than that of the control group (z = –9.645, p < 0.001). Before the intervention, there was no difference in the SAQ scores between the groups (z = –0.180, –1.260, and –0.543, p > 0.05). After the intervention, the scores of angina pectoris attack, disease stability, and disease cognition in the study group were higher than those in the control group (z = –13.679, –10.644, and –11.448, p < 0.001). There was no difference in SDS and SAS scores between the groups before the intervention (z = –0.008 and –0.717, p > 0.05). After the intervention, the scores of the research group were lower than those of the control group (z = –13.709 and –8.041, p < 0.001). Before the intervention, we found no difference in self-care ability between the groups (z = –0.675, p > 0.05). After the intervention, the scores of health knowledge, self-responsibility, self-concept, and self-care skills in the study group were higher than those in the control group (z = –11.644, –9.387, –12.612, and –12.012, p < 0.001). There was no difference in the SF-36 scores between the groups before the intervention (z = –0.682, –0.189, –1.124, and –0.018, p > 0.05). After the intervention, the scores of the study group were higher than those of the control group (z = –12.323, –12.163, –12.066, and –12.054, p < 0.001). The satisfaction rate of the research group was 91.94%, which was significantly higher than that of the control group (70.54%; n = 91, χ² = 18.822, p < 0.001). Conclusions: The effect of remote rehabilitation guidance based on Internet technology is evident. It can effectively improve patients' cardiac function, enhance self-care ability, and result in high compliance with nursing care. Moreover, it can effectively reduce negative emotions and improve their quality of life. Given that satisfaction is high, it is a procedure worth promoting.

A Study on Ejection Fraction in Patients with Mitral and Aortic Regurgitation Based on Cardiovascular Models

Xuehua Xing — 2024-08-18

Background: Whether it is healthy or patients with mitral and aortic regurgitation, clinicians cannot measure the regurgitation of the valve when using two-dimensional echocardiography to measure ejection fraction. Whether the mitral valve and aortic valve are in a healthy state or in a reflux state, there is a reflux volume. The actual stroke output will be less than the stroke output measured by echocardiography, making the calculated ejection fraction higher. Methods: This article proposes for the first time the concept of net ejection fraction (NEF) as the percentage of net stroke output to left ventricular end diastolic volume. The net stroke output is the integral of aortic valve flow during one cardiac cycle at the same time. Using a systemic arterial circulation model, investigate the relationship between ejection fraction and net ejection fraction through numerical simulation methods. Results: The final results showed a strong linear correlation between mitral regurgitation volume (VR_mi), aortic regurgitation volume (VR_ao), and the difference between ejection fraction and net ejection fraction (DEF). The net ejection fraction of the moderate mitral regurgitation group decreased by an average of 26.3% ± 9.95% compared to the ejection fraction measured by echocardiography. The severe mitral regurgitation group showed a decrease of 31.9% ± 9.3%. Moderate descent of aortic valve by 25.8% ± 11.1%. Severe aortic valve descent of 30.9% ± 10.3%. Conclusions: Clinical doctors can evaluate the left ventricular systolic function of patients based on the ejection fraction measured by echocardiography combined with valve regurgitation. The net ejection fraction avoids overestimation of left ventricular systolic function and has high reliability. It can accurately reflect the left ventricular systolic function of patients with mitral and aortic regurgitation, and has certain guiding significance for clinical doctors to grasp the patient's condition.

Impact of Different Emergency Treatment Methods on Prognosis of Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention: Retrospective Study

Fang Xiao — 2024-08-15

Purpose: This study aimed to investigate the impact of different emergency treatment methods on the prognosis of patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). Methods: A retrospective study was conducted involving 114 patients admitted to the hospital between January 2022 and December 2022. The patients were divided into two groups based on their emergency treatment methods: First Transport and Then Treatment Group (n = 56) and Treatment Before Transport Group (n = 58). Baseline characteristics, biomarker levels, echocardiographic findings, curative effects, and 1-year follow-up outcomes were compared between the two groups. Results: Biomarker levels and echocardiographic parameters differed significantly between the two groups, thus indicates potential variations in disease severity and prognosis. Moreover, the 1-year follow-up outcomes showed higher rates of all-cause mortality (16.07% vs. 3.45%, p = 0.022), recurrent myocardial infarction (19.64% vs. 5.17%, p = 0.019), rehospitalization for cardiovascular causes (25.05% vs. 8.62%, p = 0.019), and PCI for new lesions (23.21% vs. 6.92%, p = 0.014) in the First Transport and Then Treatment Group compared with the Treatment Before Transport Group. Conclusion: The timing of emergency treatment methods in patients with AMI undergoing PCI appeared to significantly impact clinical outcomes, echocardiographic parameters, and 1-year follow-up outcomes. Immediate administration of treatment before transport showed potential benefits in mitigating myocardial damage and improving long-term prognosis compared with the approach of transporting the patient to the healthcare facility before initiating treatment.

Efficacy and Safety of Canagliflozin in STEMI Patients with Type 2 Diabetes after PCI: A Retrospective Study

Ling Chen — 2024-08-15

Objective: To assess the effectiveness and safety of canagliflozin in the management of ST segment elevation myocardial infarction (STEMI) patients with type 2 diabetes mellitus (T2DM) post-percutaneous coronary intervention (PCI). Methods: A retrospective analysis on data of patients diagnosed with STEMI and T2DM who underwent PCI treatment at our hospital was performed from June 2020 to September 2023. The patients were divided into two groups based on the exposure factor: the canagliflozin and conventional treatment groups and the canagliflozin and routine treatment groups. Various parameters, such as demographic characteristics, cardiac function indicators, and insulin-related factors, were collected and compared postprocedure. In addition, evaluation of the insulin sensitivity index (ISI), lipid profile parameters, and safety outcomes was conducted. A balanced baseline characteristics of patients was achieved via propensity score matching (PSM) at a 1:1 ratio. Statistical analyses were performed through t-tests, nonparametric tests, and chi-square tests. Results: This work included data on 156 patients, including 63 and 93 patients in the canagliflozin and routine treatment groups, respectively. Later, each group comprised 63 patients after 1:1 matching by PSM. After treatment, the canagliflozin treatment group exhibited notably reduced levels of N-terminal B-type natriuretic peptide, cardiac troponin T (cTnT), and creatine kinase-MB and a significantly higher level of left ventricular ejection fraction in comparison with the routine treatment group (p < 0.05). In addition, following treatment, the canagliflozin treatment group exhibited a significant decrease in homeostatic model assessment (HOMA)-insulin resistance levels and a significant increase in HOMA-β levels (p < 0.05). Conversely, the groups manifested no significant variances in terms of major adverse cardiovascular events, hypoglycemia, diabetic ketoacidosis, acute kidney injury, and urinary tract infection (p > 0.05). Conclusion: The concurrent administration of canagliflozin following PCI improves cardiac function, insulin sensitivity, and lipid profile in patients with STEMI and T2DM, which ultimately lowers the likelihood of cardiovascular incidents. Canagliflozin demonstrates favorable clinical safety profiles in such individuals and displays promising prospects for clinical utility.

Preoperative Malnutrition Calculated Using the Geriatric Nutritional Risk Index in Off-Pump Coronary Artery Bypass Grafting

Sho Takagi — 2024-08-14

Background: The Geriatric Nutritional Risk Index (GNRI), which assesses nutritional status using the ideal body weight ratio and albumin level, is a useful predictor of long-term cardiovascular disease prognosis. This study aimed to investigate the impact of preoperative GNRI on off-pump coronary artery bypass (OPCAB) surgical outcomes. Methods: We analyzed 632 elective OPCAB procedures performed between July 2008 and July 2018. GNRI was calculated as 14.89 × albumin level (g/dL) + 41.7 × (current body weight [kg]/ideal body weight [kg]). Patients were divided into two groups: the low GNRI (≤98, L group, n = 155) and high GNRI (>98, H group, n = 477) groups. We compared perioperative variables and mid-term outcomes, particularly survival rates and freedom from major adverse cardiac or cerebrovascular events (MACCE). Results: Patients in the L group were older (72.4 ± 8.6 vs. 67.9 ± 10.1 years, p < 0.001) and had lower GNRI scores (90.9 ± 5.8 vs. 106.0 ± 4.8, p < 0.001) than patients in the H group. Perioperative results, including operation time and number of anastomoses, were similar between the groups, with no significant differences in 30-day mortality, perioperative intra-aortic balloon pump use, bleeding, stroke, or mediastinitis rates were observed. However, patients in the L group had a longer postoperative hospital stay than those in the H group (15.4 ± 13.5 vs. 12.6 ± 5.8 days, p = 0.01). Analyses of long-term outcomes revealed a significant difference in 5-year survival rates (70.9% for the L group vs. 83.3% for the H group, p = 0.002) but no significant difference in 5-year MACCE rates (84.1% for the L group vs. 80.3% for the H group, p = 0.19). Conclusions: Despite the longer hospital stay for patients in the L group, other perioperative outcomes were similar between the groups, suggesting that a low GNRI should not preclude patients from undergoing OPCAB surgery.

Impact of Combined Exercise Rehabilitation and Continuous Health Education on the Quality of Life and Mental Health of Patients Post-Coronary Stent Implantation

Jia Xu — 2024-08-13

Objective: To evaluate the impact of patient-centered exercise rehabilitation combined with continuous health education on the quality of life and mental health of patients after coronary stent implantation to provide effective rehabilitation intervention strategies and scientific evidence for clinical practice. Methods: This retrospective cohort investigation involved patients who underwent coronary stent implantation at our hospital between January 2021 to December 2022. The control group (n = 81) received routine post-operative follow-up and health education, while the observation group (n = 68) additionally received personalized exercise rehabilitation and continuous health education. The short form-36 (SF-36) scale was used to assess quality of life, while the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) were used to evaluate mental health. The Exercise of Self-Care Agency Scale (ESCA) was used to assess self-care ability. Results: At 6 months post-operation, the observation group showed significantly higher scores than the control group across all dimensions of the SF-36 scale, SAS, SDS, and ESCA (p < 0.05). The observation group exhibited significantly improved quality of life, mental health, and enhanced self-care ability. Conclusion: Patient-centered exercise rehabilitation combined with continuous health education significantly positively impacts the quality of life and mental health of patients after coronary stent implantation. This comprehensive rehabilitation intervention strategy should be adopted in clinical practice to improve patient prognosis and quality of life.

Early and Mid-Term Follow-up Results of Device Closure of Secundum Atrial Septal Defects Using Transesophageal Echocardiogram Guidance: A Comparison of Percutaneous Versus Peratrial Approaches

Jinshu Sun — 2024-08-13

Background: Percutaneous closure of secundum atrial septal defects (ASDs) under only transesophageal echocardiogram (TEE) guidance is less invasive and avoids exposure to radiation, but the treatment of choice is controversial. Methods: One hundred and forty-four patients with a secundum ASD were included in this study. The patients received percutaneous device closure (PCDC/TEE) (n = 74) or peratrial device closure (PDC/TEE) (n = 70). A double-disk ASD occluder was used in both groups. The treatment was performed under only TEE guidance in both groups. Physical exams, electrocardiography, and echocardiography were performed immediately after device release, and at discharge, 3, 6, 12 months, and at yearly intervals after the procedure. Results: In ASD with a maximum diameter less than 20 mm, the successful closure rate was 100% for all PCDC/TEE and PDC/TEE. When the ASD diameter was between 20 mm and 25 mm, the success rate was 84% for PCDC/TEE and 100% for PDC/TEE. The average intracardiac manipulation time was 19.4 ± 6.4 minutes for PCDC/TEE and 5.7 ± 7.0 minutes for PDC/TEE (p < 0.001). The average procedure time was 23.1 ± 6.8 minutes for PCDC/TEE and 51.1 ± 8.2 minutes for PDC/TEE (p < 0.001). The postoperative hospital stay was 3 ± 1 days for PCDC/TEE and 5 ± 1 days for PDC/TEE (p < 0.001). For the mean follow-up of 520 ± 256 days, there no cardiac deaths or significant residual shunts were documented in either group. Conclusions: In patients with an ASD less than 25 mm, PCDC/TEE is a safe and effective method of ASD closure. Additionally, PCDC/TEE is less traumatic, provides better cosmetic results, and decreases hospital stays. However, when the ASD diameter is greater than 20 mm and the aortic rim of ASD is less than 3 mm, the peratrial approach may be a better choice.

A Clinical Study on the Treatment of Adult Atrial Septal Defect Using Thoracoscopic-Assisted Right Vertical Infra-Axillary Thoracotomy, Total Thoracoscopic, and Median Sternotomy Approaches

Heqi Zhang — 2024-08-08

Background: To compare the clinical outcomes of three surgical approaches for treating adult atrial septal defects (ASD): Thoracoscopic-assisted right vertical infra-axillary thoracotomy (TARVIAT) under central cardiopulmonary bypass (CPB), totally thoracoscopic (TT), and median sternotomy (MS) approaches, and to assess the feasibility and safety of the TARIAVT approach. Methods: This study reviewed 62 cases patients of repairing atrial septal defects via a TARVIAT and central extracorporeal circulation from 2019 to 2023. The patients included 22 males, aged between 18 and 59 years, with a mean age of 33.35 ± 10.97 years. The surgical indications were adult patients with moderate to severe tricuspid regurgitation and who were unsuitable for interventional closure of atrial septal defects. Exclusion criteria included patients diagnosed with severe pulmonary hypertension or Eisenmenger syndrome. Additionally, 67 patients who underwent TT approach repair of ASD and 72 patients who underwent MS approach repair of ASD were selected as the control groups. Operative time, CPB time, aortic clamping time, postoperative Intensive care unit (ICU) stay, postoperative mechanical ventilation time, 24-hour postoperative chest drainage, incision length, postoperative hospital stay, hospital costs, and postoperative complications were compared to assess statistical differences. Results: There were no deaths or major complications observed in any of the three groups. Statistically significant differences were found among the three groups in terms of extracorporeal circulation time, aortic clamping time, surgical time, 24-hour postoperative chest drainage, postoperative mechanical ventilation time, postoperative ICU stay, incision length, and postoperative hospital stay (p < 0.05). The TT group exhibited longer CPB and aortic clamping times compared to the TARVIAT and MS groups, while demonstrating lower 24-hour postoperative chest drainage volumes compared to the TARIAVT and MS groups. Both the TARVIAT and TT groups showed shorter surgical times, postoperative mechanical ventilation times, postoperative ICU stay, incision lengths, and postoperative hospital. However, there were no statistically significant differences among the three groups regarding hospital costs, postoperative left ventricular ejection fraction (LVEF) values, and the incidence of postoperative complications (p > 0.05). Conclusions: TARVIAT under central CPB is feasible and safe for adult patients. This approach presents lower invasiveness, shorter operative duration, and faster recovery compared to other methods. In conclusion, the TARVIAT approach for repairing adult ASD is both safe and effective, offering a viable surgical option for this condition.

Atypical Presentation of a Cardiac Lipoma

Anthony D. Kostacos — 2024-08-07

Cardiac masses can have atypical presentations and diagnosis can be difficult because of limitations in imaging modalities. We report the case of a 69-year-old man with a history of hypertension and hyperlipidemia who presented with several months of dyspnea with exertion. There was a soft systolic murmur on exam. Transthoracic echocardiogram showed a large right atrial mass that appeared to be adherent to the interatrial septum. Considering the size and apparent attachment to the interatrial septum the suspicion was a myxoma. After further imaging however, including transesophageal echocardiogram, cardiac computed tomography (CT) and cardiac magnetic resonance imaging (MRI) the diagnosis changed to a lipoma. The patient had surgical resection of the mass which confirmed the diagnosis. A multi-imaging approach may be helpful and required to accurately diagnose cardiac masses.

Very Delayed Surgical Bleeding after Coronary Artery Bypass Graft Causing Cardiac Tamponade and Cardiogenic Shock: A Rare Case Report

Wei-Ting Kuo — 2024-08-07

Delayed surgical bleeding from the left internal mammary artery (LIMA) bed following coronary artery bypass grafting (CABG) is a rare yet potentially fatal condition that can lead to cardiac tamponade and life-threatening cardiogenic shock. We present a case of extremely delayed active bleeding from the LIMA bed, occurring 5 weeks after conventional CABG, resulting in cardiac tamponade and cardiogenic shock. The 73-year-old patient presented to the emergency room with a 2-day history of general weakness and hypotension. He had undergone CABG 5 weeks ago. Optimal inotropic agents and vasopressors were used for the treatment of shock. In the emergency room, real-time bedside echocardiography showed severe external compression of the right ventricle by a homogeneous, hyperechoic mass. Veno-arterial (V-A) mode extracorporeal membrane oxygenation (ECMO) was promptly instituted to stabilize hemodynamics. Subsequent chest re-exploration, involving blood clot evacuation, was performed, and the bleed from the distal LIMA bed was ligated. Delayed LIMA bed bleeding causing cardiac tamponade and cardiogenic shock is an infrequent occurrence, and the use of V-A mode ECMO successfully provided a window of time for chest exploration.