Cardioscopic Trans-septal Cryoablation of Left Atrium in Nonmitral Cases

2005 ◽  
Vol 1 (1) ◽  
pp. 48-50 ◽  
Author(s):  
Toshiya Ohtsuka ◽  
Mikio Ninomiya ◽  
Taisei Maemura
Keyword(s):  
Coronary Artery ◽  
Left Atrium ◽  
Tricuspid Regurgitation ◽  
Left Atrial ◽  
Artery Bypass ◽  
Aortic Disease ◽  
Maze Procedure ◽  
Partial Sternotomy ◽  
The Mean ◽  
Asd Closure

Background A modified maze procedure in which trans-septal cardioscopy was used for cryoablation in the left atrium is described. Methods The technique was used in 11 consecutive patients (9 men and 2 women, 56.5 ± 19.8 years) with permanent atrial fibrillation (Af) and concomitant nonmitral cardiac or aortic disease: aortic valvular disease in 4 patients, atrial septal defect (ASD) in 2 patients, tricuspid regurgitation in 2 patients, acute aortic dissection in 1 patient, arch aneurysm in 1 patient, and coronary artery disease in 1 patient. The mean Af duration detected in 7 cases was 18.5 ± 10.1 months. Partial sternotomy was used in aortic valve replacement, ASD closure, and tricuspid valve plasty, and fullsternotomy was used in aortic graft replacement and coronary artery bypass. Cardiopulmonary bypass was established, aortic cross-clamp was performed, a right atriotomy was created, a cryoablation probe and cardioscope (3 mm) were introduced into the left atrium through a 1-cm cut at the fossa ovalis or ASD, and cardioscopic left-atrial endocardial cryoablation was performed. The right-side maze procedure was conducted directly. The atrial appendages were excised in each case. Results Left-atrial cardioscopic cryoablation required 25.0 ± 5.5 minutes, and no deaths or procedure-related morbidities occurred. The mean follow-up period was 12 ± 8.5 months. One patient with tricuspid regurgitation died of liver failure. With the exception of coronary and acute dissection cases, all patients have maintained a sinus rhythm. Conclusion Although experience is limited, videocardioscopic trans-septal left-atrial cryoablation is a viable method for nonmitral Af cases, and the partial sternotomy approach can be performed.

scholarly journals Role of LA strain assessed by speckle tracking echocardiography in predicting patients who develop POAF after a coronary artery bypass surgery

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
V Rukmani Prabha ◽  
N Rajeshwari ◽  
J Jenifer
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Left Atrial ◽  
Speckle Tracking ◽  
Speckle Tracking Echocardiography ◽  
Artery Bypass ◽  
Coronary Risk Factors ◽  
Global Strain ◽  
The Mean

Abstract Objectives To evaluate the correlation between left atrial dysfunction assessed by speckle tracking echocardiography and development of postoperative atrial fibrillation (POAF) in patients undergoing coronary artery bypass grafting. To determine the role of coronary risk factors in development of POAF. Method Patients undergoing CABG from January 2019 till June 2020 in Apollo institute, fulfilling the inclusion and exclusion criteria were included.Total of 200 patients were followed.They were subjected to LA strain and strain rate analysis by speckle tracking. Results The incidence of POAF in our study was 24% (n=48). The mean age of this study population was 59.13 years. The patients who developed POAF were older (68.5±9.048 vs 58.39±9.74 years, p value=0.05) than those with no POAF. POAF occurred in 2 phases. the highest proportion of POAF occurrence noticed on postoperative day 2. Among the total POAF cases 79.% occurred within the first 48 hours and 20.8% occurred later (p=0.001). Among the 48 patients who developed POAF, 5 of them developed recurrence during their hospital stay. They had reverted to sinus rhythm following anti-arrhythmic medication for a duration of >24 hours, but went on to develop recurrence of AF at a later. 4 among them reverted to sinus rhythm at discharge while 1 continued to remain in AF at discharge.The duration of hospital stay for patients with POAF group was 10.4 days compared with 10.04 days for those without POAF. Similarly the post-operative stay in the hospital was 7.4 days for the POAF group and 7.04 days for the NO POAF.There was no added economic impact secondary to AF.Comparing the values of left atrial volume index of both the groups it was derived that the mean LAVI value of the POAF group was 26.84+3.654 ml/m2 and that for the NO POAF group was 26.6+3.037ml/m2. Though the patients with POAF had larger LA volume, the chi square test analysis did not yield any clinically significant relationship between LAVI and POAF in our study (p=0.3). The mean LA global strain for the patients with POAF was 29.73+3.695%. And for the patients with no POAF was 36.3+4.854%. LA global strain was reduced in patients who developed POAF (P<0.001) which indicated a strong correlation between LA strain and POAF. Conclusion There is significant correlation between Global Left Atrial Strain and POAF in patients undergoing CABG (P<0.001).There is no significant correlation between patient factors like age, BMI, and the conventional coronary risk factors with POAFThere is no significant correlation between the conventional echocardiographic parameters like LA diameter, LAVI, LVDD, LVSD, LVEF and transmitral flow velocities with POAF. To conclude, preoperative speckle tracking assessment of LA has a strong predictive role in determining the occurrence of POAF in patients undergoing Coronary artery bypass grafting surgery. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Predictors of postoperative atrial fibrillation after coronary artery bypass grafting: a prospective observational cohort study

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Hanaa A. El-Gendy ◽  
Mohamed H. Dabsha ◽  
Gamal M. Elewa ◽  
Amr H. Ali
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Valve Replacement ◽  
Left Atrial ◽  
Potassium Level ◽  
Artery Bypass ◽  
Female Gender ◽  
Inotropic Support ◽  
The Mean

Abstract Background This study was conducted to determine the effect of certain predictors on the incidence of postoperative atrial fibrillation (POAF) during ICU stay after coronary artery bypass graft (CABG) surgery. Results We enrolled 123 patients in this study. The mean age was 57.4 ± 8.7 years, and the mean left atrial diameter was 4.1 ± 0.52 cm with male preponderance (76.4%). The incidence of POAF following CABG was 33.3%. There was no statistically significant association between POAF and smoking (P = 0.123). However, POAF was significantly associated with higher CHA2DS2-VASc score (P = 0.002), valve replacement (P < 0.001), and inotropic support (P = 0.005). Moreover, patients with POAF had significantly higher mean age (P = 0.031) and left atrial (LA) diameter (P < 0.001). Logistic regression showed that LA diameter (P < 0.001), potassium level at 36 h (P = 0.016), and female gender (P = 0.001) were independent predictors of POAF. Conclusions We had several significant epidemiological, clinical, and operative variables that were significantly associated with post-CABG AF, including older age, female gender, large LA diameter, valve replacement, higher CHA2DS2-VASc score, and postoperative inotropic support. However, only LA diameter, female gender, and potassium level at 36 h were independent predictors of POAF. Nevertheless, further large-scale studies are needed to confirm our findings.

Surgical Strategy in Patients with Atrial Septal Defect and Severe Pulmonary Hypertension

2012 ◽  
Vol 15 (2) ◽  
pp. 111 ◽  
Author(s):  
Yang Hyun Cho ◽  
Tae-Gook Jun ◽  
Ji-Hyuk Yang ◽  
Pyo Won Park ◽  
June Huh ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Atrial Septal Defect ◽  
Tricuspid Regurgitation ◽  
Septal Defect ◽  
Maze Procedure ◽  
Severe Pulmonary Hypertension ◽  
Tricuspid Annuloplasty ◽  
Pulmonary Arterial ◽  
Asd Closure

The aim of the study was to review our experience with atrial septal defect (ASD) closure with a fenestrated patch in patients with severe pulmonary hypertension. Between July 2004 and February 2009, 16 patients with isolated ASD underwent closure with a fenestrated patch. All patients had a secundum type ASD and severe pulmonary hypertension. Patients ranged in age from 6 to 57 years (mean � SD, 34.9 � 13.5 years). The follow-up period was 9 to 59 months (mean, 34.5 � 13.1 months). The ranges of preoperative systolic and pulmonary arterial pressures were 63 to 119 mm Hg (mean, 83.8 � 13.9 mm Hg) and 37 to 77 mm Hg (mean, 51.1 � 10.1 mm Hg). The ranges of preoperative values for the ratio of the pulmonary flow to the systemic flow and for pulmonary arterial resistance were 1.1 to 2.7 (mean, 1.95 � 0.5) and 3.9 to 16.7 Wood units (mean, 9.8 � 2.9 Wood units), respectively. There was no early or late mortality. Tricuspid annuloplasty was performed in 14 patients (87.5%). The peak tricuspid regurgitation gradient and the ratio of the systolic pulmonary artery pressure to the systemic arterial pressure were decreased in all patients. The New York Heart Association class and the grade of tricuspid regurgitation were improved in 13 patients (81.2%) and 15 patients (93.7%), respectively. ASD closure in patients with severe pulmonary hypertension can be performed safely if we create fenestration. Tricuspid annuloplasty and a Cox maze procedure may improve the clinical result. Close observation and follow-up will be needed to validate the long-term benefits.

scholarly journals Influence of Body Temperature on Bispectral Index-Guided Anesthetic Management in Off-Pump Coronary Artery Bypass Grafting

2020 ◽  
Vol 4 (02) ◽  
pp. 079-085
Author(s):  
Muralidhar Kanchi ◽  
Priya Nair ◽  
Rudresh Manjunath ◽  
Kumar Belani
Keyword(s):  
Coronary Artery ◽  
Body Temperature ◽  
Artery Bypass ◽  
Anesthetic Depth ◽  
Off Pump ◽  
Anesthetic Concentration ◽  
The Mean ◽  
Anesthetic Requirement ◽  
Pump Coronary Artery Bypass ◽  
End Tidal

Abstract Background Perioperative hypothermia is not uncommon in surgical patients due to anesthetic-induced inhibition of thermoregulatory mechanisms and exposure of patients to cold environment in the operating rooms. Core temperature reduction up to 35°C is often seen in off-pump coronary artery bypass graft (OP-CABG) surgery. Anesthetic depth can be monitored by using bispectral (BIS) index. The present study was performed to evaluate the influence of mild hypothermia on the anesthetic depth using BIS monitoring and correlation of BIS with end-tidal anesthetic concentration at varying temperatures during OP-CABG. Materials and Methods In a prospective observational study design in a tertiary care teaching hospital, patients who underwent elective OP-CABG under endotracheal general anesthesia, were included in the study. Standard technique of anesthesia was followed. BIS, nasopharyngeal temperature, and end-tidal anesthetic concentration of inhaled isoflurane was recorded every 10 minutes. The BIS was adjusted to between 45 and 50 during surgery. Results There were 40 patients who underwent OP-CABG during the study period. The mean age was 51.2 ± 8.7 years, mean body mass index 29.8 ± 2.2, and mean left ventricular ejection fraction was 55.4 ± 4.2%. Anesthetic requirement as guided by BIS between 45 and 50 correlated linearly with core body temperature (r = 0.999; p < 0.001). The mean decrease in the body temperature at the end of 300 minutes was 2.2°C with a mean decrease in end-tidal anesthetic concentration of 0.29%. The reduction in end-tidal anesthetic concentration per degree decrease in temperature was 0.13%. None of the patients reported intraoperative recall. Conclusion In this study, BIS monitoring was used to guide the delivery concentration of inhaled anesthetic using a targeted range of 45 to 50. BIS monitoring allowed the appropriate reduction of anesthetic dosing requirements in patients undergoing OP-CABG without risk of awareness. There was a significant reduction in anesthetic requirements associated with reduction of core temperature. The routine use of BIS is recommended in OP-CABG to titrate anesthetic requirement during occurrence of hypothermia and facilitate fast-track anesthesia in this patient population.

scholarly journals Minimally invasive direct coronary artery bypass versus off-pump coronary surgery through sternotomy

2013 ◽  
Vol 95 (7) ◽  
pp. 481-485 ◽  
Author(s):  
R Birla ◽  
P Patel ◽  
G Aresu ◽  
G Asimakopoulos
Keyword(s):  
Coronary Artery ◽  
Blood Transfusion ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Off Pump ◽  
Opcab Group ◽  
Significant Difference ◽  
The Mean

Introduction Although it is not a new technique, minimally invasive direct coronary artery bypass (MIDCAB) is employed only by a few surgeons in the UK. We compared our experience with MIDCAB with that of single vessel off-pump coronary artery bypass (OPCAB) graft surgery through a standard median sternotomy. Methods Patients who underwent either MIDCAB or OPCAB between April 2008 and July 2011 were reviewed. Exclusion criteria included patients with an ejection fraction of <0.5 or previous cardiac surgery. Data were obtained retrospectively from our prospective database, medical records and through general practitioners. Results Overall, 74 patients were analysed in the MIDCAB group and 78 in the OPCAB group. Their demographics and EuroSCORE (European System for Cardiac Operative Risk Evaluation) values were comparable (p>0.05). There was no statistically significant difference in the two groups in terms of mortality, recurrent myocardial infarction, postoperative stroke, wound infection, atrial fibrillation or need for reintervention. The MIDCAB group had six conversions to a sternotomy. Eight patients in each group required blood transfusion, with the average transfusion being 1.8 units in the MIDCAB group and 3.2 units in the OPCAB group. The mean duration of ventilation and intensive care unit stay was 5.0 hours and 38.4 hours in the MIDCAB group and 5.4 and 47.8 hours in the OPCAB group. The mean hospital stay was significantly reduced in the MIDCAB population (6.1 vs 8.5 days, p<0.05). Conclusions MIDCAB can be performed safely in appropriately selected patients with outcomes comparable with OPCAB. The potential benefits include shorter hospital stay, reduced need for blood transfusion and faster recovery.

scholarly journals Left Atrial Shape and Function after Endovascular Device and Surgical Closure of ASDs in Children

2021 ◽  
Author(s):  
Alexander Sokolov ◽  
Viktor Varvarenko ◽  
Evgeny Krivoshchekov ◽  
Andrey Smorgon
Keyword(s):  
Left Atrium ◽  
Left Atrial ◽  
Surgical Correction ◽  
Control Group ◽  
Surgical Closure ◽  
Younger Age ◽  
Asd Closure ◽  
And Function ◽  
Endovascular Device

Retrospective analysis of echocardiograms was performed in 756 children who received endovascular device or surgical ASD closure from 2006 to 2016 in the Cardiac Center in Tomsk Russia. 564 patients had an endovascular closure and 192 had surgical correction. Follow-up duration was from 1 day to 10 years, mean 3.6 yrs for the device group and 4.2 yrs for the surgery group. The control group consisted of 3393 age-matched healthy patients. In patients with endovascular closure of an ASD, 35% had a change in the shape of the left atrium in early follow-up. Changes in the shape of the left atrium at early follow-up were more often observed in the device group and in children of a younger age. The left atrial changes were a decrease in sphericity and an increase in ellipsoidy. Changes in the shape of the left atrium persisted in 22% after transcatheter correction in the long-term. The change in shape of the left atrium after the placement of ASD devices was accompanied by activation of the mechanical function of the atrium and an increase in the filling pressure of the left ventricle. These changes were not accompanied by any disturbance in the contractility and volume of the heart chambers. In the group with surgical correction of ASD, the contractility and volume of the heart chambers did not significantly differ from those in the device closure group

Intravascular Ultrasound: Potential Tool to Assess Coronary Anastomosis Quality

2003 ◽  
Vol 11 (2) ◽  
pp. 143-146
Author(s):  
Piergiorgio Tozzi ◽  
Antonio F Corno ◽  
Ludwig K von Segesser
Keyword(s):  
Coronary Artery ◽  
Intravascular Ultrasound ◽  
Left Internal Mammary Artery ◽  
Artery Bypass ◽  
Ultrasound Images ◽  
Cross Sectional ◽  
Flow Measurements ◽  
Off Pump ◽  
The Mean ◽  
Macroscopic Examination

Coronary angiography and Doppler flow measurements are most commonly used to assess the patency of anastomoses in the operating theater. Intravascular ultrasound might be another means of monitoring the surgical procedure during coronary artery bypass. Five sheep underwent off-pump bypass of the left anterior descending coronary artery using the left internal mammary artery. The running suture was evaluated by intraoperative fluoroscopy and a coronary intravascular ultrasound probe inserted into the target artery proximal to the anastomosis. Macroscopic examination of the anastomosis was performed to validate the angiographic and intravascular ultrasound images. The diameter, cross-sectional area, and compliance of each anastomosis were calculated in systole and diastole. All anastomoses were patent without signs of stenosis. In one case, intravascular ultrasound showed an intimal flap, which was confirmed by macroscopic examination. The mean major anastomotic diameter was 4.5 ± 0.5 mm on angiography and 4.0 ± 0.5 mm on intravascular ultrasound. From the ultrasound data, the mean cross-sectional anastomotic area was calculated as 6.21 ± 0.1 mm2 in systole and 5.49 ± 0.1 mm2 in diastole, and these data were used to calculate the cross-sectional anastomosis compliance. Coronary intravascular ultrasound can visualize intima-to-intima apposition and provide reliable calculations of anastomosis compliance.

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