scholarly journals Efficacy, Safety, and Long-term Survival of Concomitant Valve Replacement and Bipolar Radiofrequency Ablation in Patients Aged 70 Years and Older: A Comparative Study With Propensity Score Matching From a Single-Center

2020 ◽  
Author(s):  
Zhi-qin Lin ◽  
Zeng-rong Luo ◽  
Qian-zhen Li ◽  
Liang-wan Chen ◽  
feng lin
Keyword(s):  
Radiofrequency Ablation ◽  
Propensity Score ◽  
Elderly Patients ◽  
Propensity Score Matching ◽  
Valve Replacement ◽  
Untreated Group ◽  
Single Center ◽  
Term Survival ◽  
Bipolar Radiofrequency

Abstract Background: Concomitant bipolar radiofrequency ablation and valve replacement in the elderly remains controversial. We aim to compare the outcomes of concomitant valve replacement and bipolar radiofrequency ablation with valve replacement alone in elderly patients with atrial fibrillation (AF).Methods: This was a retrospective study of patients aged ≥ 70 years who underwent valve replacement with or without bipolar radiofrequency ablation in a single-center between January 2006 and March 2015. Early postoperative results and long-term clinical outcomes were compared after propensity score matching.Results: 34 pairs of patients (73.94±2,64 years old, 34 in the AF ablated group and 34 in the AF untreated group) were enrolled in the propensity score matching analysis. No significant differences between the two matched groups were found about surgical mortality (5.88% vs. 2.94%, P=0.555) and major postoperative morbidity. Kaplan–Meier analysis revealed a significantly better overall survival (P=0.009) in the AF ablated group. Cumulative incidence curves showed a lower incidence of cardiovascular death in the AF ablated group (P=0.025, Gray’s test). Patients in the AF ablated group had a reduced incidence of stroke events compared with patients in the AF untreated group (P=0.009, Gray’s test). Freedom from AF after 5 years was 58.0% in the AF ablated group, compared with 3.0% in the AF untreated group.Conclusions: The addition of bipolar radiofrequency ablation is a feasible and safe procedure even in patients aged ≥ 70 years, with a better long-term survival and a reduced incidence of stroke events compared with valve replacement alone. These findings suggest that bipolar radiofrequency ablation should always be considered as a concomitant procedure for elderly patients with AF presenting for cardiac surgery.

scholarly journals Efficacy, safety, and long-term survival of concomitant valve replacement and bipolar radiofrequency ablation in patients aged 70 years and older: a comparative study with propensity score matching from a single-Centre

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Zhi-qin Lin ◽  
Zeng-rong Luo ◽  
Qian-zhen Li ◽  
Liang-wan Chen ◽  
Feng Lin
Keyword(s):  
Radiofrequency Ablation ◽  
Propensity Score ◽  
Elderly Patients ◽  
Propensity Score Matching ◽  
Valve Replacement ◽  
Single Centre ◽  
Term Survival ◽  
Long Term Survival ◽  
Bipolar Radiofrequency

Abstracts Background Concomitant bipolar radiofrequency ablation and valve replacement in the elderly remains controversial. In the current study, we aimed to compare the outcomes of concomitant valve replacement and bipolar radiofrequency ablation with valve replacement alone in elderly patients with atrial fibrillation (AF). Methods This was a retrospective study of patients aged ≥70 years who underwent valve replacement with or without bipolar radiofrequency ablation in a single-centre between January 2006 and March 2015. The early postoperative results and long-term clinical outcomes were compared after propensity score matching. Results A total of 34 pairs of patients (73.94 ± 2.64 years old; 34 in the AF with ablation group and 34 in the AF without ablation group) were enrolled in the propensity score matching analysis. There were no significant differences between the two matched groups in terms of surgical mortality (5.88% vs. 2.94%, P = 0.555) and major postoperative morbidity. Kaplan–Meier analysis revealed a significantly better overall survival in the AF with ablation group compared to the AF without ablation group (P = 0.009). Cumulative incidence curves showed a lower incidence of cardiovascular death in the AF with ablation group (P = 0.025, Gray’s test). Patients in the AF with ablation group had a reduced incidence of stroke compared to patients in the AF with ablation group (P = 0.009, Gray’s test). The freedom from AF after 5 years was 58.0% in the AF with ablation group and 3.0% in the AF without ablation group. Conclusions The addition of bipolar radiofrequency ablation is a safe and feasible procedure, even in patients aged ≥70 years, with a better long-term survival and a reduced incidence of stroke compared to valve replacement alone. These findings suggest that bipolar radiofrequency ablation should always be considered as a concomitant procedure for elderly patients with AF who require cardiac surgery. However, a large-scale, prospective, multi-centre, randomized study should be performed in the future to fully validate our findings.

scholarly journals Efficacy, safety, and long-term survival of concomitant valve replacement and bipolar radiofrequency ablation in patients aged 70 years and older: A comparative study with propensity score matching from a single-centre

2020 ◽  
Author(s):  
Zhi-qin Lin ◽  
Zeng-rong Luo ◽  
Qian-zhen Li ◽  
Liang-wan Chen ◽  
feng lin
Keyword(s):  
Radiofrequency Ablation ◽  
Propensity Score ◽  
Elderly Patients ◽  
Propensity Score Matching ◽  
Valve Replacement ◽  
Single Centre ◽  
Term Survival ◽  
Long Term Survival ◽  
Bipolar Radiofrequency

Abstract Background Concomitant bipolar radiofrequency ablation and valve replacement in the elderly remains controversial. In the current study, we aimed to compare the outcomes of concomitant valve replacement and bipolar radiofrequency ablation with valve replacement alone in elderly patients with atrial fibrillation (AF). Methods This was a retrospective study of patients aged ≥ 70 years who underwent valve replacement with or without bipolar radiofrequency ablation in a single-centre between January 2006 and March 2015. The early postoperative results and long-term clinical outcomes were compared after propensity score matching. Results A total of 34 pairs of patients (73.94 ± 2.64 years old; 34 in the AF with ablation group and 34 in the AF without ablation group) were enrolled in the propensity score matching analysis. There were no significant differences between the two matched groups in terms of surgical mortality (5.88% vs. 2.94%, P = 0.555) and major postoperative morbidity. Kaplan–Meier analysis revealed a significantly better overall survival in the AF with ablation group compared to the AF without ablation group (P = 0.009). Cumulative incidence curves showed a lower incidence of cardiovascular death in the AF with ablation group (P = 0.025, Gray’s test). Patients in the AF with ablation group had a reduced incidence of stroke compared to patients in the AF with ablation group (P = 0.009, Gray’s test). The freedom from AF after 5 years was 58.0% in the AF with ablation group and 3.0% in the AF without ablation group. Conclusions The addition of bipolar radiofrequency ablation is a safe and feasible procedure, even in patients aged ≥ 70 years, with a better long-term survival and a reduced incidence of stroke compared to valve replacement alone. These findings suggest that bipolar radiofrequency ablation should always be considered as a concomitant procedure for elderly patients with AF who require cardiac surgery. However, a large-scale, prospective, multi-centre, randomized study should be performed in the future to fully validate our findings.

scholarly journals Comparison of Long-term outcomes between Lynch sydrome and sporadic colorectal cancer: a propensity score matching analysis

2020 ◽  
Author(s):  
Yun Xu ◽  
Cong Li ◽  
Charlie Zhi-Lin Zheng ◽  
Yu-Qin Zhang ◽  
Tian-An Guo ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Control Group ◽  
Sporadic Colorectal Cancer ◽  
Long Term Outcomes ◽  
Term Survival ◽  
Long Term Survival ◽  
Tumor Stages

Abstract Background Lynch syndrome (LS) is the most common hereditary colorectal cancer (CRC) syndrome. Comparison of prognosis between LS and sporadic CRC (SCRC) were rare,with conflicting results. This study aimed to compare the long-term outcomes between patients with LS and SCRC. Methods Between June 2008 and September 2018, a total of 47 patients were diagnosed with LS by genetic testing at Fudan University Shanghai Cancer Center. A 1:2 propensity score matching was performed to obtain homogeneous cohorts from SCRC group. Thereafter, 94 SCRC patients were enrolled as control group. The long-term survival rates between the two groups were compared, and the prognostic factors were also analyzed. Results The 5-year OS rate of LS group was 97.6%, which was significantly higher than of 82.6% for SCRC group (p = 0.029). The 5-year PFS rate showed no significant differences between the two groups (78.0% for LS group vs. 70.6% for SCRC patients; p = 0.262). The 5-year TFS rates in LS group was 62.1% for LS patients, which were significantly lower than of 70.6% for SCRC group (p = 0.039). By multivariate analysis, we found that tumor progression of primary CRC and TNM staging were independent risk factors for OS. Conclusion LS patients have better long-term survival prognosis than SCRC patients. Strict regular follow-up monitoring, detection at earlier tumor stages, and effective treatment are key to ensuring better long-term prognosis.

scholarly journals Comparison of Outcomes Between McKeown and Sweet Esophagectomy in the Elderly Patients for Esophageal Squamous Cell Carcinoma: A Propensity Score-Matched Analysis

2020 ◽  
Vol 27 (1) ◽  
pp. 107327482090470
Author(s):  
Dongni Chen ◽  
Yihuai Hu ◽  
Youfang Chen ◽  
Jia Hu ◽  
Zhesheng Wen
Keyword(s):  
Squamous Cell Carcinoma ◽  
Propensity Score ◽  
Esophageal Squamous Cell Carcinoma ◽  
Elderly Patients ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
The Elderly ◽  
Perioperative Outcomes ◽  
Term Survival

The aim of this study was to compare the perioperative outcomes and long-term survival rates of the McKeown and Sweet procedures in patients with esophageal cancer younger than 70 years or older than 70 years. A total of 1432 consecutive patients with esophageal squamous cell carcinoma (ESCC) who received surgery at Sun Yat-sen University Cancer Center from January 2009 to October 2012 were analyzed. Propensity score matching was used to balance the clinical characteristics of the patients who underwent different surgical approaches, and 275 and 71 paired cases were matched among those younger and older than 70 years, respectively. The prognosis and postoperative outcomes were compared between the McKeown and the Sweet esophagectomy. For patients younger than 70 years, those who underwent the McKeown procedure had better overall survival (OS) than those in the Sweet group (log rank = 4.467; P = .035). However, no significant difference in disease-free survival and OS was observed between two approaches for the elderly patients (log rank = 1.562; P = .211 and log rank = 0.668; P = .414, respectively). Cox regression analysis revealed that McKeown approach was a positive prognostic factor compared to the Sweet approach for patients younger than 70 years in univariable analysis (HR = 0.790; 95% CI, 0.625-0.997; P = .047), whereas the surgical approach was not significantly related to the prognosis in the elderly patients. For patients older than 70 years, the occurrence of anastomotic fistula increased in those who underwent the McKeown procedure (23.9% vs 11.3%, P = .038, for the McKeown and Sweet esophagectomy, respectively). The McKeown approach increases the OS in younger patients with ESCC. However, for patients older than 70 years, the Sweet approach was proven to be an effective therapy, given the better perioperative outcomes and similar long-term survival compared with patients in the McKeown group.

scholarly journals Long-Term Survival After Aortic Valve Replacement Among High-Risk Elderly Patients in the United States

Circulation ◽  
2012 ◽  
Vol 126 (13) ◽  
pp. 1621-1629 ◽  
Author(s):  
J. Matthew Brennan ◽  
Fred H. Edwards ◽  
Yue Zhao ◽  
Sean M. O'Brien ◽  
Pamela S. Douglas ◽  
...  
Keyword(s):  
United States ◽  
High Risk ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Elderly Patients ◽  
Valve Replacement ◽  
The United States ◽  
Term Survival ◽  
Long Term Survival

scholarly journals CLASSICAL MONOPOLAR RADIOFREQUENCY ABLATION IN TREATMENT OF LONG-Standing persistent Atrial FIBRILLATION: PROPENSITY SCORE MATCHING ANALYSIS

2018 ◽  
Vol 33 (3) ◽  
pp. 46-56
Author(s):  
A. V. Evtushenko ◽  
V. V. Evtushenko ◽  
E. N. Pavlyukova ◽  
I. O. Kurlov ◽  
V. Kh. Vaizov ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Heart Surgery ◽  
Persistent Atrial Fibrillation ◽  
Early Postoperative Period ◽  
Control Group ◽  
Propensity Score Matching Analysis

The article is devoted to the evaluation of the results of clinical application of penetrating radiofrequency ablation techniques on atrial myocardium.Material and Methods. A total of 298 patients with valvular heart disease complicated with atrial fibrillation were operated. All operations were performed under cardiopulmonary bypass and cardioplegia. The main group consisted of 198 patients who were operated using penetrating technique radiofrequency exposure. The control group consisted of 100 patients who underwent surgery with the use of «classical» monopolar radiofrequency-ablation technique. Both groups did not significantly differ in any parameter before surgery, but to increase confidence in the results, pseudo-randomization was performed using the Propensity score matching technique.Results. Patients with previous heart surgery were excluded during the selection of candidates for the procedure because of the presence of adhesions in the pericardium that did not allow good visualization of the left atrium, sufficient to perform the procedure. Penetrating technique had significantly higher efficiency compared to the «classic» technique in the early and long-term postoperative periods. The efficiency was 93% in the early postoperative period and 88% in the long term. The efficacy of «classical» monopolar procedure was lower: 86 and 68%, respectively.

scholarly journals The impact of mild renal dysfunction on isolated cardiopulmonary coronary artery bypass grafting: a retrospective propensity score matching analysis

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Xian Wang ◽  
Yifan Zhu ◽  
Wen Chen ◽  
Liangpeng Li ◽  
Xin Chen ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Artery Bypass ◽  
Term Survival ◽  
Group A ◽  
Group B ◽  
The Impact ◽  
New Onset

Abstract Background Mild preoperative renal dysfunction (RD) is not rare in patients receiving isolated cardiopulmonary coronary artery bypass grafting (CCABG). However, there are not too many studies about the impact of mild preoperative RD on in-hospital and follow-up outcomes after isolated CCABG. This single-centre, retrospective propensity score matching study designed to study the impact of mild preoperative RD on in-hospital and long-term outcomes after first isolated CCABG. Methods After propensity score matching, 1144 patients with preoperative estimated glomerular filtration rate (eGFR) of more than 60 ml/min/1.73 m2 receiving first isolated CCABG surgery from January 2012 to December 2015 entered the study, who were divided into 2 groups: A group (eGFR ≥90 ml/min/1.73 m2, n = 572) and B group (eGFR of 60–89 ml/min/1.73 m2, n = 572). The in-hospital and long-term outcomes were recorded and analyzed. The mean follow-up time was 54.4 ± 10.7 months. Acute kidney injury (AKI) was defined and classified according to the Acute Kidney Injury Network (AKIN) criteria. Results The 2 propensity score-matched groups had similar baseline and procedure except the baseline eGFR. There were 8 patients died in A group (mortality is 1.4%) and 14 died in B group (mortality is 2.5%) during the in hospital and 30-day postoperatively(χ2 = 1.159, p = 0.282). There were totally 38 patients lost to follow-up, 18 in group A and 20 in group B. 21 patients died in group A and 37 died in group B during the follow-up, and long-term survival in group A was higher than in group B (96.2% vs 93.1%, χ2 = 4.336, p = 0.037). Comparing with group A, group B was associated with an increased rates and severity of AKI postoperatively (total AKI: 62 vs 144. AKIN stageI: 54 vs 113; AKIN stageII: 6 vs 22; AKIN stageIII: 2 vs 9, p<0.0001). During follow-up, group B also had a higher rate of new onset of dialysis (0 vs 6, χ2 = 4.432, p = 0.039). Multivariable logistic regression showed that comparing with A group, the HR for long-term mortality and new onset of dialysis in B group was 1.67 and 1.52 respectively (95%CI 1.09–2.90, p = 0.035; 95%CI 1.14–2.49, p = 0.027). Conclusions Comparing with normal preoperative renal function, patients with mild preoperative RD had a similar in-hosptial mortality, but with an increased in-hosptial rates and severity of AKI, and with a decreased long-term survival and increased long-term new onset of dialysis.

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