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Wyler von Ballmoos MC, Hui DS, Mehaffey JH, Malaisrie SC, Vardas PN, Gillinov AM, Sundt TM, Badhwar V. The Society of Thoracic Surgeons 2023 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation. Ann Thorac Surg 2024; 118:291-310. [PMID: 38286206 DOI: 10.1016/j.athoracsur.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/08/2024] [Accepted: 01/13/2024] [Indexed: 01/31/2024]
Abstract
The Society of Thoracic Surgeons 2023 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation incorporate the most recent evidence for surgical ablation and left atrial appendage occlusion in different clinical scenarios. Substantial new evidence regarding the risks and benefits of surgical left atrial appendage occlusion and the long-term benefits of surgical ablation has been produced in the last 5 years. Compared with the 2017 clinical practice guideline, the current update has an emphasis on surgical ablation in first-time, nonemergent cardiac surgery and its long-term benefits, an extension of the recommendation to perform surgical ablation in all patients with atrial fibrillation undergoing first-time, nonemergent cardiac surgery, and a new class I recommendation for left atrial appendage occlusion in all patients with atrial fibrillation undergoing first-time, nonemergent cardiac surgery. Further guidance is provided for patients with structural heart disease and atrial fibrillation being considered for transcatheter valve repair or replacement, as well as patients in need of isolated left atrial appendage management who are not candidates for surgical ablation. The importance of a multidisciplinary team assessment, treatment planning, and long-term follow-up are reiterated in this clinical practice guideline with a class I recommendation, along with the other recommendations from the 2017 guidelines that remained unchanged in their class of recommendation and level of evidence.
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Affiliation(s)
| | - Dawn S Hui
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - J Hunter Mehaffey
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
| | - S Chris Malaisrie
- Division of Cardiac Surgery, Department of Surgery, Northwestern University, Chicago, Illinois
| | - Panos N Vardas
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - A Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Thoralf M Sundt
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
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Sakurai Y, Mehaffey JH, Kuno T, Yokoyama Y, Takagi H, Denning DA, Kaneko T, Badhwar V. The impact of permanent pacemaker implantation on long-term survival after cardiac surgery: A systematic review and meta-analysis. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00368-4. [PMID: 38657782 DOI: 10.1016/j.jtcvs.2024.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/29/2024] [Accepted: 04/13/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES The long-term impact of permanent pacemaker (PPM) implantation on survival after cardiac surgery remains ill defined. We aimed to investigate the effect of PPM on survival and explore factors driving outcomes using meta-regression according to the type of surgery. METHODS MEDLINE, EMBASE, and the Cochrane Library Central Register of Controlled Trials were searched through October 2023 to identify studies reporting the long-term outcomes of PPM implantation. The primary outcome was all-cause mortality during follow-up. The secondary outcome was heart failure rehospitalization. The subgroup analysis and meta-regression analysis were performed according to the type of surgery. RESULTS A total of 28 studies met the inclusion criteria. 183,555 patients (n = 6298; PPM, n = 177,257; no PPM) were analyzed for all-cause mortality, with a weighted median follow-up of 79.7 months. PPM implantation was associated with increased risks of all-cause mortality during follow-up (hazard ratio, 1.22; confidence interval, 1.08-1.38, P < .01) and heart failure rehospitalization (hazard ratio, 1.24; confidence interval, 1.01-1.52, P = .04). Meta-regression demonstrated the adverse impact of PPM was less prominent in patients undergoing mitral or tricuspid valve surgery, whereas studies with a greater proportion with aortic valve replacement were associated with worse outcomes. Similarly, a greater proportion with atrioventricular block as an indication of PPM was associated with worse survival. CONCLUSIONS PPM implantation after cardiac surgery is associated with a greater risk of long-term all-cause mortality and heart failure rehospitalization. This impact is more prominent in patients undergoing aortic valve surgery or atrioventricular block as an indication than those undergoing mitral or tricuspid valve surgery.
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Affiliation(s)
- Yosuke Sakurai
- Department of Surgery, Marshall University Joan Edwards School of Medicine, Huntington, WVa
| | - J Hunter Mehaffey
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa.
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Yujiro Yokoyama
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - David A Denning
- Department of Surgery, Marshall University Joan Edwards School of Medicine, Huntington, WVa
| | - Tsuyoshi Kaneko
- Division of Cardiothoracic Surgery, Washington University in St Louis, St Louis, Mo
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
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Nitta T, Wai JWW, Lee SH, Yii M, Chaiyaroj S, Ruaengsri C, Ramanathan T, Ishii Y, Jeong DS, Chang J, Hardjosworo ABA, Imai K, Shao Y. 2023 APHRS expert consensus statements on surgery for AF. J Arrhythm 2023; 39:841-852. [PMID: 38045465 PMCID: PMC10692856 DOI: 10.1002/joa3.12939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 09/14/2023] [Accepted: 10/02/2023] [Indexed: 12/05/2023] Open
Affiliation(s)
| | | | - Seung Hyun Lee
- Cardiovascular SurgeryYonsei University College of MedicineSeoulSouth Korea
| | - Michael Yii
- Cardiothoracic Surgery, Epworth Eastern Hospital, and St Vincent's Hospital MelbourneUniversity of MelbourneMelbourneVictoriaAustralia
| | | | | | | | - Yosuke Ishii
- Cardiovascular SurgeryNippon Medical SchoolTokyoJapan
| | - Dong Seop Jeong
- Thoracic and Cardiovascular Surgery, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
| | - Jen‐Ping Chang
- Thoracic and Cardiovascular SurgeryKaohsiung Chang Gung Memorial HospitalKaohsiungTaiwan
| | | | - Katsuhiko Imai
- Heart Center of National Hospital Organization Kure Medical Center and Chugoku Cancer CenterKure, HiroshimaJapan
| | - Yongfeng Shao
- Cardiovascular Surgery, Jiangsu Province HospitalNanjing Medical UniversityNanjingChina
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Kakuta T, Fukushima S, Minami K, Kainuma S, Kawamoto N, Tadokoro N, Ikuta A, Tonai K, Saiki Y, Fujita T. Outcomes and residual gap analysis after the modified cryomaze procedure performed via right minithoracotomy versus sternotomy. JTCVS OPEN 2023; 15:176-187. [PMID: 37808062 PMCID: PMC10556826 DOI: 10.1016/j.xjon.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/28/2023] [Accepted: 04/12/2023] [Indexed: 10/10/2023]
Abstract
Objectives Developments in both technique and technology have enabled surgeons to perform the maze procedure via right minithoracotomy (RMT) to treat atrial fibrillation (AF). This study aimed to clarify the outcomes of the modified cryomaze procedure via the RMT approach compared with the sternotomy approach. Methods The study cohort comprised 803 consecutive patients who underwent a modified cryomaze procedure (130 via RMT and 673 via sternotomy) for paroxysmal AF and persistent AF from January 2001 to March 2022. The Gray test was applied to compare the incidence of recurrent atrial tachyarrhythmias. Additionally, residual electrical gaps were investigated in the patients who underwent additional catheter ablation for recurrent atrial tachyarrhythmias. Results The respective 1-, 2-, and 3-year cumulative incidences of recurrent atrial tachyarrhythmias were 13.1%, 19.5%, and 23.1% in the RMT group, and 9.3%, 10.9%, and 12.8% in the sternotomy group (Gray test P = .036). All 31 patients with recurrent atrial tachyarrhythmias underwent additional catheter ablation, comprising 14 (10.8%) in the RMT group and 17 (2.5%) in the sternotomy group. There was a significant intergroup difference in the site of residual electrical gaps; the RMT group more frequently had residual gaps in the tricuspid annulus than the sternotomy group (6.2% vs 0.4%; P < .001). Conclusions In the modified cryomaze procedure via the RMT approach, ablation failure is more likely to occur at the tricuspid annulus, where the surgical field of view is relatively poor compared with the sternotomy approach. Therefore, surgical ablation should be performed with caution when the RMT approach is used.
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Affiliation(s)
- Takashi Kakuta
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Research Center, Suita, Osaka, Japan
- Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan
| | - Satsuki Fukushima
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Research Center, Suita, Osaka, Japan
| | - Kimito Minami
- Department of Surgical Intensive Care, National Cerebral and Cardiovascular Research Center, Suita, Osaka, Japan
| | - Satoshi Kainuma
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Research Center, Suita, Osaka, Japan
| | - Naonori Kawamoto
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Research Center, Suita, Osaka, Japan
| | - Naoki Tadokoro
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Research Center, Suita, Osaka, Japan
| | - Ayumi Ikuta
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Research Center, Suita, Osaka, Japan
| | - Kohei Tonai
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Research Center, Suita, Osaka, Japan
| | - Yoshikatsu Saiki
- Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
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McCarthy PM, Churyla A, Kruse J, Cox JL. Reducing Permanent Pacemaker Requirements Following Concomitant Surgery for Atrial Fibrillation. J Cardiovasc Electrophysiol 2022; 33:1978-1982. [DOI: 10.1111/jce.15632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 07/07/2022] [Accepted: 07/18/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Patrick M. McCarthy
- Division of Cardiac Surgery, Department of SurgeryNorthwestern University, Northwestern MedicineChicagoIL
| | - Andrei Churyla
- Division of Cardiac Surgery, Department of SurgeryNorthwestern University, Northwestern MedicineChicagoIL
| | - Jane Kruse
- Division of Cardiac Surgery, Department of SurgeryNorthwestern University, Northwestern MedicineChicagoIL
| | - James L. Cox
- Division of Cardiac Surgery, Department of SurgeryNorthwestern University, Northwestern MedicineChicagoIL
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