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Pick AW, Kotschet E, Healy S, Adam D, Bittinger L. Hybrid Totally Thoracoscopic Maze and Catheter Ablation for Persistent Atrial Fibrillation: Initial Experience. Heart Lung Circ 2023; 32:1107-1114. [PMID: 37460351 DOI: 10.1016/j.hlc.2023.06.002] [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: 02/08/2023] [Revised: 04/29/2023] [Accepted: 06/06/2023] [Indexed: 10/06/2023]
Abstract
Atrial fibrillation is now a pandemic in our ageing community. Although James L. Cox devised a surgical procedure with near-universal curative success in 1987, catheter-based interventions have flourished. For persistent atrial fibrillation (AF), however, an isolated endocardial approach has limitations: procedural times are long, carry risk, and the outcomes are not durable. By combining left atrial endocardial and epicardial interventions with staged mapping, we optimise the benefits of both approaches. Our initial series of hybrid ablation for persistent atrial fibrillation reports excellent early outcomes, freedom from complications and excellent success at follow-up.
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Affiliation(s)
- Adrian W Pick
- Victorian Heart Hospital, Melbourne, Vic, Australia; Cabrini Medical Centre, Melbourne, Vic, Australia; Peninsula Private Hospital, Melbourne, Vic, Australia.
| | - Emily Kotschet
- Victorian Heart Hospital, Melbourne, Vic, Australia; Cabrini Medical Centre, Melbourne, Vic, Australia
| | - Stewart Healy
- Victorian Heart Hospital, Melbourne, Vic, Australia; Cabrini Medical Centre, Melbourne, Vic, Australia
| | - David Adam
- Victorian Heart Hospital, Melbourne, Vic, Australia
| | - Logan Bittinger
- Victorian Heart Hospital, Melbourne, Vic, Australia; Peninsula Private Hospital, Melbourne, Vic, Australia
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Pragliola C, Hassan E, Ismail H, Al Otaibi K, Alfonso JJ, Algarni KD. del Nido Cardioplegia in Adult Patients: A Propensity-Matched Study of 102 Consecutive Patients. Heart Lung Circ 2020; 29:1405-1411. [DOI: 10.1016/j.hlc.2019.08.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/30/2019] [Accepted: 08/19/2019] [Indexed: 10/25/2022]
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Lawton JS. Commentary: Easier is not always better than better. J Thorac Cardiovasc Surg 2020; 160:1486-1487. [PMID: 31898956 DOI: 10.1016/j.jtcvs.2019.09.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 09/25/2019] [Accepted: 09/25/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Jennifer S Lawton
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University, Baltimore, Md.
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Luo H, Qi X, Shi H, Zhao H, Liu C, Chen H, Peng R, Yu Z, Hu K, Wang C, Li X. Single-dose del Nido cardioplegia used in adult minimally invasive valve surgery. J Thorac Dis 2019; 11:2373-2382. [PMID: 31372274 DOI: 10.21037/jtd.2019.05.78] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To analyze the protective effect of single-dose del Nido cardioplegia (DNC) in adult minimally invasive valve surgery. Methods From January to December 2017, 165 consecutive adult patients who underwent minimally invasive valve surgery by the same team of surgeons were divided into two cohorts based on the type of cardioplegia administered during surgery: (I) single-dose DNC (DNC group (n=76, male 41, female 35) used in patients from May to December, 2017 and (II) intermittent standard 4:1 blood cardioplegia based on St.Thomas solution (SBC group, n=89, male 45, female 44) used in patients from January to April, 2017. Preoperative baseline demographics, preoperative comorbidities, operative variables, postoperative complications, and patient outcomes were collected and compared between the two groups. Results Preoperative characteristics were shown to be similar between the two groups before and after propensity matching. Patients in the DNC group required a significantly lower volume of cardioplegia. The volume of ultrafiltration in the DNC group was substantially higher than that in the SBC group. The spontaneous return of heartbeat rate in the DNC group was considerably higher than that in the SBC group (97.0% vs. 78.8%, P=0.006). The Euroscore II in the DNC group was markedly lower than that in the SBC group (2.00 vs. 3.00, P<0.05). The level of blood urea nitrogen (BUN) in the DNC group was significantly lower than that in the SBC group (6.20 vs. 6.95, P<0.05). There were no differences in surgery procedure, cross-clamp time, bypass time, Apache score, troponin T (cTnT), brain natriuretic peptide (BNP), liver and renal function, postoperative complications or patient outcomes between two groups. Regression analysis showed that cTnT increased with the prolongation of myocardial ischemia time, and was closely related to the type of operation, but had no significant correlation with the type of cardioplegia. Conclusions In our initial experience, single-dose DNC in adult minimally invasive valve surgery in which the cross-clamp time was mostly less than 90 min, achieved equivalent myocardial protection and clinical outcomes when compared with standard whole blood cardioplegia. In addition, single-dose DNC made the minimally invasive valve surgery procedure progress in a smoother and more convenient fashion.
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Affiliation(s)
- Haiyan Luo
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xiaomin Qi
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Hui Shi
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Hui Zhao
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Chaoqi Liu
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Hongsong Chen
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Runsheng Peng
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Zhangsheng Yu
- Department of Bioinformatics and Biostatistics, SJTU-Yale Joint Center for Biostatistics, Jiao Tong University, Shanghai 200240, China
| | - Kejian Hu
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Chunsheng Wang
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xin Li
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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