Abstract: Objective [WTBZ]To evaluate the longterm effects of preoperative glucocorticoid treatment on postoperative complications and survival rates for patients receiving cardiac surgery. Methods [WTBZ] We selected 57 patients including 22 males and 35 females at an average age of 52.3±11.2 years in the First Hospital of China Medical University who took steroids for a long time because of various combined diseases from September 2002 to August 2009 in the trial group, and we chose another 171 patients including 62 males and 109 females at an average age of 53.6±9.2 years who were hospitalized at the same time and had comparative basic features in the control group. There was no statistical difference between the two groups in age, gender, and organ function. Different kinds of surgeries including coronary artery bypass grafting, heart valvuloplasty or valve replacement, coronary artery bypass grafting combined with heart valve replacement, and congenital heart disease surgery were performed on the patients. The proportion of surgeries carried out was similar in the two groups. Postoperative complications were compared between the two groups, and survival rates at the end of 6 months and one year followup were observed. Results [WTBZ]There was no statistical difference between the two groups in complications with respect to cardiopulmonary bypass (CPB) time (t=1.27, Pgt;0.05), reoperation for excessive postoperative bleeding (χ2=0.03, P=0.87), sternal and mediastinal infection (χ2=0.04, P=0.84), stroke (χ2=0.07, P=0.79), and gastrointestinal tract complications (χ2=2.89, P=0.09). The incidence of ventricular arrhythmia and requirement for intraaortic balloon pump in the trial group was higher, but no statistical difference was detected (χ2=2.24, P=0.13; χ2=2.20, P=0.14, respectively). Patients in the trial group were more likely to require prolonged ventilation (t=2.32, Plt;0.05), had higher rate of atrial fibrillation (χ2=4.09, P=0.04), and higher inhospital mortality (χ2=5.35, P=0.02). The sixmonth and oneyear survival rates were 0.79±0.10 and 0.73±0.12, respectively for the trial group, 0.94±0.09 and 0.86±0.10, respectively for the control group. Conclusion Longterm steroid treatment leads to higher atrial fibrillation incidence, longer ventilation time and increases the mortality rate following cardiac surgery.
ObjectiveTo investigate whether lysyl oxidase(LOX) has significant relation to persistent atrial fibrillation(AF) with mitral valvular diseases.
MethodsWe included 184 consecutive lone mitral valvular disease patients who needed surgery in our hospital between March 2012 and February 2014. Patients who had persistent AF formed the AF group, and those who still kept sinus rhythm(SR) comprised the SR group. In the AF group, patients were separated into two groups by the subgroup of mitral valvular disease(mitral stenosis and mitral regurgitation), then formed a MS+AF group and a MR+AF group. There were 97 patients with 44 males and 53 females at age of 52.76±11.35 years in the AF group and 90 patients with 48 males and 42 females at age of 47.95±14.22 years in the SR group. Blood specimens were obtained from patients for the first time peripheral venous blood after admitted to hospital. LOX levels were measured by ELISA test kits of LOX.
ResultsAF was diagnosed in 51.87%(97/187) of lone mitral valvular disease patients. Mitral stenosis patients were easy to have AF(60.31% vs. 34.43%, P<0.05). The plasma level of LOX was significantly higher in the AF group than that in the SR group(73.78±25.42 IU/L vs. 51.05±18.96 IU/L，P<0.05). In the AF group, the LOX level in the mitral stenosis group was higher than that in the mitral regurgitation group(84.21±32.15 IU/L vs. 59.74±35.21 IU/L， P<0.05). Mitral stenosis patients more frequently had a history of stroke than mitral regurgitation patients did. AF correlated significantly with the level of LOX(r=0.124， P=0.036) and left atrial dimension(r=0.531，P=0.042).
ConclusionWe validate and extend the hypothesis that increasing LOX level predicts an increasing risk of AF in mitral valvular diseases. Lysine oxidase is a potential diagnostic biomarker for AF. It is expressed significantly in mitral stenosis patients with AF especially.
Objective To evaluate the efficacy of preoperative low-dose oral amiodarone for the prevention of atrial fibrillation （AF） after off-pump coronary artery bypass grafting （OPCAB） in patients older than 70 years. Methods A total of 156 patients older than 70 years who underwent OPCAB in Qingdao Fuwai Cardiovascular Disease Hospital from January 2011 to June 2012 were included in this prospective，double-blind and placebo controlled study. Preoperatively，all the 156 patients were randomly divided into amiodarone group and control group. In the amiodarone group，there were 80 patients including 38 male and 42 female patients who were given oral amiodarone （trade name： Cordarone） 200 mg，three times a day，3-5 days before surgery，and amiodarone was stopped on the OPCAB day and postoperatively. Preoperative duration of amiodarone intake was 4.0±1.2 days，and total amiodarone dosage was 2.6±0.5 g. In the control group，there were 76 patients including 35 male and 41 female patients who were given oral placebo as the same medication schedule，and preoperative duration of placebo intake was 4.0±1.4 days. Operation time，graft number，postoperative AF incidence，AF duration，hospital stay and readmission rate for cardiovascular events within 6 postoperative months were compared between the two groups. Results There was no in-hospital death in either group. There was no statistical difference in graft number，operation time，AF duration of patients who had postoperative AF，or postoperative hospital stay between the two groups. Postoperative AF incidence of the amiodarone group was significantly lower than that of the control group ［18.7% （15/80） vs. 34.2% （26/76），P=0.028］. Seventy-three patients in the amiodarone group （91.3%） and 66 patients in the control group （86.8%） were followed up for 8-24 months. During follow-up，2 patients in the amiodarone group died of acute myocardial infarction and cerebral hemorrhage respectively. There was no statistical difference in readmission rate for cardiovascular events within 6 postoperative months between the 2 groups ［6.8% （5/73） vs. 6.1% （4/66），P=0.860］ .Conclusion Preoperative low-dose oral amiodarone can significantly reduce the incidence of postoperative AF in patients older than 70 years undergoing OPCAB.
Atrial fibrillation is one of the most common arrhythmia. Cardiac mapping technology, an important method to study the electrophysiological mechanism of atrial fibrillation, can determine the abnormal origin and record the distribution and transmission way of these atrial electrical signals. This technology offers a new way for research the electrophysiological mechanism of atrial fibrillation. The purpose of this study is to review the research progress of cardiac mapping in the electrophysiological mechanism of atrial fibrillation and clinical application.
ObjectiveTo analyze the global status, hotspots, and trends in atrial fibrillation anticoagulation research.MethodsWe searched Web of Science Core Collection to collect relevant literature on atrial fibrillation anticoagulation from 2006 to 2020. The visualization software CiteSpace and VOSviewer were used to analyze co-citation, co-occurrence, and emergence analysis on publishing organizations, journals, and keywords and to explore the research hotspots and frontiers.ResultsA total of 11764 related studies were retrieved. In recent years, research on anticoagulation of atrial fibrillation has become increasingly popular. Most of the published researches were from North America, and the primary institution was the University of Birmingham. Research hotspots mainly focused on warfarin, stroke prevention, new oral anticoagulants, antithrombotic and anticoagulants, and complicating diseases. The research frontiers were the new oral anticoagulants, and the antithrombotic management of atrial fibrillation with coronary heart disease.ConclusionsThe global hotspot in atrial fibrillation anticoagulant research is warfarin, stroke prevention, new oral anticoagulants, antithrombotic and antiplatelet therapy, and complicated diseases. The research focuses on the study of novel oral anticoagulants and the antithrombotic management of atrial fibrillation complicated with coronary heart disease.
Objective
To summarize safety and effectiveness of cryomaze ablation procedure concomitant with valve surgery.
Methods
We retrospectively investigated the clinical data of 62 patients (24 males and 38 females) with mean age of 49.4±14.2 years who underwent cryomaze ablation procedure concomitant with valve surgery in our hospital from August 2013 through July 2015. The heart rhythm of the patients after surgery was supervised by 12-leads electrical cardiogram respectively.
Results
The rate of sinus rhythm restored right after surgery was 98.4%. The rate of sinus rhythm restored at the time of discharge was 93.4%. The rate of sinus rhythm restored 3 months, 6 months, 12 months, 18 months after surgery was 90.2%, 87.3%, 85.0%, 83.3% respectively. The one-year post-operation rate of sinus rhythm restored for the group of right minimal invasive thoracoscopic assisted mitral valve surgery was 90.5%. Longer duration for atrial fibrillation (>7 years) was a risk factor for the reoccurrence of atrial fibrillation 1 year after surgery (P<0.05).
Conclusion
Cryomaze ablation procedure concomitant with valve surgery is quite effective in treatment of rheumatic valve disease and atrial fibrillation. This approach is associated with fewer complications, comparable atrial fibrillation reoccurrence for short-term follow-up.
Objective To investigate the effect of monocyte count to high density lipoprotein ratio (MHR) on early complications after off-pump coronary artery bypass grafting and to explore the predictive factors for early complications in patients after off-pump coronary artery bypass grafting. Methods The clinical data of patients who underwent simple off-pump coronary artery bypass grafting from October 2021 to September 2023 in our hospital were retrospectively analyzed. The patients were divided into a low value group and a high value group according to the median MHR value. The clinical data of the two groups were compared, and binary logistic regression analysis was used to explore the and predictors of atrial fibrillation (AF) and acute kidney injury (AKI) after coronary artery bypass grafting. Results A total of 220 patients were included, with a median MHR of 0.48. There were 108 patients in the low value group (MHR<0.48), including 71 males and 37 females, with an average age of 65.28±7.85 years. There were 112 patients in the high-value group (MHR≥0.48), including 84 males and 28 females, with an average age of 64.57±8.75 years. There was no statistical difference between the two groups in terms of general basic data such as gender or age (P>0.05). The incidence of postoperative AF and AKI in the high-value group was significantly higher than that in the low-value group (P<0.05), and no statistical difference in terms of other postoperative complications was observed. Binary logistic regression analysis showed that MHR was a risk factor for postoperative AKI and postoperative AF (P<0.05). Conclusion The study shows that MHR is a risk factor for new-onset AF and AKI after coronary artery bypass grafting.
Objective
To evaluate the clinical effects of bi-polar radiofrequency ablation (BRFA) for the surgical treatment of atrial fibrillation (AF) in rheumatic heart disease (RHD) patients.
Methods
We involved 96 RHD patients who underwent valve replacement in Department of Cardiovascular Surgery, West China Hospital from July 2014 through May 2015. There were 74 patients with AF, 22 in sinus rhythm. All patients with AF were fully informed of BRFA, in which 40 of the 74 patients received while the other 34 patients refused. The 40 patients with AF who received BRFA were classified into a treatment group and the other 34 patients were classified into a control group. The 20 patients with sinus rhythm were classified into a blank group as well. The clinical effect and quality of life of the patients were analyzed.
Results
Left atrial diameter (LAD), pulmonary arterial systolic pressure (PASP), and conversion rate of sinus rhythm at discharge, maintenance rate of sinus rhythm during follow-up in patients with AF were significantly higher than those in the patients in sinus rhythm. No difference was found in terms of survival rate, mortality, major complications among the three groups. The treatment group experienced higher scores in physical functioning (PF), role-physical (RP), general health (GH), vitality (VT), social functioning (SF), mental health (MH), physical component summary (PCS), mental component summary(MCS) and total score compared with the control group both at postoperative 3-month and 6-month . At postoperative 12-month, the treatment group experienced higher scores in PF, RP, GH, PCS, and total score compared with the control group.
Conclusion
AF would enhance the negative impact on structure remodeling in RHD patients. BRFA is beneficial for the conversion and maintaining of sinus rhythm in RHD patients and the decreasing of LAD & PASP parameter as well. BRFA is more beneficial for the improvement of quality of life in RHD patients with AF during one-year follow-up.
Objective
To investigate the preliminary experience, the evolution of surgical approach of multidisciplinary therapy for atrial fibrillation and the advantages and disadvantages of each procedure.
Methods
We retrospectively analyzed the clinical data of 69 patients with stand-alone surgical ablation with or without transcatheter radiofrequency ablation for atrial fibrillation in our center from January 2015 to May 2017. There were 50 males and 19 females at average age of 57.2 years. The patients were divided into three groups according to the surgical approach including a median sternotomy group (n=9), a left unilateral thoracoscopy group (n=7) and a bilateral thoracoscopy group (n=53). One (11.1%) patient, 3 (42.9%) patients and 26 (49.1%) patients received transcatheter mapping and radiofrequency ablation after surgical ablation in each group, respectively.
Results
The mean follow-up time in the median sternotomy group was 10.2 months. All 9 patients maintained sinus rhythm. The mean follow-up time of the left unilateral thoracoscopy group was 7.4 months. Five (71.4%) patients maintained sinus rhythm. While the mean follow-up time of the bilateral thoracoscopy group was 5.0 months. Forty-seven (88.7%) patients maintained sinus rhythm. There was no perioperative death, or death, stroke, major bleeding nor pulmonary vein stenosis during follow-up.
Conclusion
The classic Cox-Maze Ⅳ procedure with high success rate is still the basic operation for the surgical treatment of atrial fibrillation, while the thoracoscopic mini maze procedure has the advantages of minimally invasiveness, repeatibility, and can achieve similar results as Cox-Maze Ⅳ procedure when combined with transcatheter radiofrequency ablation. Multidisciplinary therapy could be the best solution for non-paroxysmal atrial fibrillation.
ObjectiveTo investigate the technique and efficacy of left atrial appendage (LAA) occlusion during off-pump coronary artery bypass grafting (OPCABG) in elderly patients with coronary artery disease (CAD) and atrial fibrillation (AF).MethodsFrom 2013 to 2018, 84 elderly patients with CAD and AF with reduced left ventricular ejection fraction (LVEF< 50%) underwent OPCABG in our department. There were 54 males and 30 females at age of 70-82 years. They were divided into a left atrial appendage (LAA) occlusion group (n=56) and a non-LAA occlusion group (n=28). Postoperative antithrombotic therapy: the LAA occlusion group was given warfarin + aspirin + clopidogrel “triple antithrombotic therapy” for 3 months after operation, then was changed to aspirin + clopidogrel “dual antiplatelet” for long-term antithrombotic; the non-LAA occlusion group was given warfarin + aspirin + clopidogrel “triple antithrombotic” for long-term antithrombotic after operation. The clinical effectiveness of the two groups was compared.ResultsAll patients underwent the surgery successfully. There were 56 patients in the LAA occlusion group, including 44 patients of LAA exclusion and 12 patients of LAA clip. The time of LAA occlusion was 3 to 8 minutes. There was no injury of graft vessels and anastomotic stoma. Early postoperative death occurred in 2 patients (2.4%). There was no statistical difference between the two groups in postoperative hospital stay (P=0.115). Postoperative LVEF of the two groups significantly improved compared with that before operation (P<0.05). There was no stroke or bleeding in important organs during hospitalization. During follow-up of 1 year, no cerebral infarction occurred in both groups, but the incidence of bleeding related complications in the LAA occlusion group was significantly lower than that in the non-LAA occlusion group (3.6% vs. 18.5%, P=0.036).ConclusionFor elderly patients with CAD and AF with reduced LVEF, LAA occlusion during OPCABG can effectively reduce the risk of stroke and bleeding related complications, and without increasing the risk of surgery.
