Surgical Treatment for Stand-Alone Atrial Fibrillation in North America

Publication date: Available online 17 August 2019Source: The Annals of Thoracic SurgeryAuthor(s): Niv Ad, Sari D. Holmes, Harold G. Roberts, J. Scott Rankin, Vinay BadhwarAbstractBackgroundSurgical treatment of symptomatic atrial fibrillation (AF) has been performed for three decades. We reviewed trends and outcomes of surgical ablation (SA) for stand-alone AF using the Society of Thoracic Surgeons Adult Cardiac Surgical Database (STS-ACSD).MethodsThe STS-ACSD was reviewed from 2011-2017 (N=7,187) for trends. Contemporary data from 2014-2017 (N=3,893) were used to compare three subgroups: off-pump (n=3,252), on-pump (n=491), and patients with incision conversion or conversion from off-pump to on-pump (n=150). Propensity score matching was conducted to balance groups.ResultsAnnual growth of stand-alone SA was 7%. Median age was 64 (57–70) years (30% female). Overall 30-day mortality was 0.8% and perioperative stroke incidence was 0.8%. Most SA procedures were off-pump (84%), with 12% greater odds for off-pump per year (OR=1.12, P
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research

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This study compares outcomes of conventional and LI-AVR using the STS database. METHODS: Between 2011-2017, 122474 patients undergoing isolated primary AVR were identified. Patients were categorized into 3 groups: 1) full sternotomy (FS,N=98549, 78%), 2) partial sternotomy (PS,N=17306,15%), and 3) right thoracotomy (RT, N =6619,7%). RESULTS: The rate of LI-AVR increased from 17% in 2011 to 23% in 2016 (P
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Ann Thorac Surg Source Type: research
Atrial Fibrillation After Cardiac Surgery (AFACS) is associated with increased morbidity, including thromboembolic stroke, renal failure, gastrointestinal complications, infections, and prolonged ventilation, and a significant increase in the risk of subsequent chronic atrial fibrillation.1-4 Furthermore, it is associated with an increase in mortality and hospital and intensive care unit length of stay.1,3 It has a persistently high incidence, ranging from 30% to more than 50%, depending on the type of surgery.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Special Article Source Type: research
Abstract BACKGROUND: Our objective was to compare national mitral repair rates and outcomes after less invasive mitral surgery (LIMS) versus conventional sternotomy across the spectrum of mitral pathologies and repair techniques. METHODS: Patients undergoing isolated primary mitral valve surgery in the Society of Thoracic Surgeons Adult Cardiac Surgery Database from July 2014 - December 2018 were evaluated. Propensity score models were constructed non-parsimoniously, and prediction models used to compute adjusted effects of surgical approach. Hypothesis tests were adjusted for propensity score with inverse-pr...
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Ann Thorac Surg Source Type: research
Atrial fibrillation (AF) is strongly linked to chronic kidney disease (CKD) and both of these conditions contribute to poor cardiovascular outcomes. We evaluated the impact of renal failure on major adverse cardiovascular events (MACE) in AF, and predictive value of the 2MACE score in this post-hoc analysis of the AMADEUS trial. The primary endpoint was MACE (composite of myocardial infarction, cardiac revascularisation and cardiovascular mortality). Secondary endpoints included the composite of stroke, major bleeding and non-cardiovascular mortality, and each of the specific outcomes separately.
Source: The American Journal of Cardiology - Category: Cardiology Authors: Source Type: research
CONCLUSION: ICHRON predicted ChrD diagnosis at 3-years among an external, geographically distant validation cohort. These findings show the value of ICHRON for primary care patients in distinct locales. Additionally, electronic calculation of ICHRON empowers the clinical use of this tool to identify and differentially manage and treat high-risk patients. PMID: 32563688 [PubMed - as supplied by publisher]
Source: European Journal of Internal Medicine - Category: Internal Medicine Authors: Tags: Eur J Intern Med Source Type: research
ConclusionsPostoperative complications are associated with an increased risk of both early and late mortality and all-cause rehospitalization, particularly during the “value” window within 90 days of CABG. These findings underscore the need to develop avoidance strategies as well as cost-adjustment methods for each of these complications.
Source: American Heart Journal - Category: Cardiology Source Type: research
Abstract Dabigatran etexilate is a direct oral anticoagulant (thrombin inhibitor) used for the prevention of stroke and systemic thromboembolic events in patients with permanent atrial fibrillation; prevention of venous thromboembolic events and deep veins thrombosis; treatment and prevention of pulmonary embolism. Dabigatran is a relatively new drug, and as a result, its interactions with other medications and their significance are not fully known. A 72 years old male, having a medical history of heart and renal failure, was hospitalized for pneumonia treatment. The patient was taking several drugs, including da...
Source: Medicina (Kaunas) - Category: Universities & Medical Training Authors: Tags: Medicina (Kaunas) Source Type: research
ConclusionsSeptal myectomy, performed in a tertiary referral center, had a 30-day mortality rate of 0% and low morbidity rate. There was no difference between observed myectomy mortality and STS Calculator predicted risk for AVR and MV repair. It is possible that a larger sample could reveal lower mortality than STS prediction.
Source: American Heart Journal - Category: Cardiology Source Type: research
Publication date: Available online 2 November 2019Source: Heart &LungAuthor(s): Rajkumar Doshi, Sailaja Pisipati, Mohamed Taha, Mihir Dave, Jay Shah, Devina Adalja, Nageshwara GullapalliAbstractIntroductionNew onset Atrial Fibrillation (NOAF) is frequently seen post transcatheter aortic valve replacement (TAVR). NOAF in the setting of TAVR has also been recognized as predictor of worse outcomes, including higher readmission rates. Data assessing the effect and predictors of NOAF on 30-day readmission rates post TAVR is limited.ObjectiveTo assess the incidence, 30-day readmission rate and predictors of NOAF in patients ...
Source: Heart and Lung: The Journal of Acute and Critical Care - Category: Respiratory Medicine Source Type: research
Post cardiac surgery AF – Cardiology MCQ – Answer Peak incidence of atrial fibrillation after cardiac surgery is on:  Correct answer: 2. Day 2 Peak incidence of post cardiac surgery AF is on second post operative day [1]. European guidelines on the prevention of post operative AF after cardiac surgery give a class I recommendation with level of evidence A for perioperative administration of beta blockers [2]. It may be noted that AF is one of the most common complications after cardiac surgery and it can increase morbidity and mortality. They may need prolonged ventilatory support and increase length of ho...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Cardiac Surgery Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
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