Left atrial Appendage Rupture Following Intraoperative Hypertensive Crisis

The acute and severe rise in systemic blood pressure during or after cardiac operations may be life-threatening and result in end-organ injury. This case is the first report of spontaneous left atrial appendage rupture following the hypertensive crisis in cardiac surgery

Risk Assessment of Hemodynamically Significant Arrhythmias after Elective Cardiac Operations with Cardiopulmonary Bypass Using the Modified Nomogram (Retrospective Study)

Aim of the study was to evaluate the feasibility of using a modified nomogram (the M nomogram) to predict the occurrence of new postoperative hemodynamically significant arrhythmias after elective cardiac surgery with cardiopulmonary bypass within 30 days post operation.Materials and methods. This was a retrospective cohort study. The prognostic value of the model using ROC-analysis of the modified nomogram was estimated based on the medical records of 144 patients who underwent elective cardiac surgery with cardiopulmonary bypass.Results. The incidence of new postoperative hemodynamically significant arrhythmias was 13.9% (20 of 144 patients). For the modified nomogram, the AUC was 0.777 [95% CI: 0.661–0.892] (P<0.001); at a cutoff of 12 points, the sensitivity was 60.0% and specificity was 89.52%. The odds ratio was 10.26 (95% CI: 3.63–29.06) (P<0.001). Conclusion. The modified nomogram has an acceptable prognostic value for the occurrence of new hemodynamically significant arrhythmias after elective cardiac operations with cardiopulmonary bypass based on AUC 0.777 [0.661–0.892] (P<0.001), and is currently the best model for predicting the outcome.

Preliminary Results of Cryoablation for Surgical Treatment of Arrhythmias in Adults With Congenital Heart Disease

Background: Arrhythmias in adult congenital heart disease (ACHD) are responsible for the majority of hospital admissions and 20–25% of late deaths. Since need for further cardiac operations is frequent in ACHD, concomitant arrhythmia surgery represents a strategic treatment modality.Material and Methods: A two-center retrospective study was undertaken on cryoablation of supraventricular arrhythmias in 25 conescutive ACHD patients (16/9, M/F, median age 38.5 years, IQR 38–60) operated between 01/2017 and 12/2020. Nineteen (76%) had undergone one or more previous cardiac operations and 8 (32%) one or more trans-catheter ablations. Indications included Fontan conversion in seven patients, septal defect repair in 6, pulmonary valve replacement in 10 and tricuspid surgery in 2. Open-heart cryoablation included: 4 cavotricuspid isthmus ablations, 19 right-sided Maze for atrial tachycardia/flutter, and 2 Cox-Maze III for atrial fibrillation.Results: There were 2 (8%) hospital deaths, unrelated to cryoablation, due to low cardiac output syndrome. There were no intraoperative complications related to cryoablation. Seven (28%) patients required pace-maker implantation due to post-operative atrioventricular block. All patients were discharged on oral antiarrhythmic and anticoagulantion for 6 months. After a median follow-up of 14 months (IQR 7–27) no late mortality was observed. At follow-up, 16/23 (69%) patients are in stable sinus rhythm, 12 without anti-arrhythmic therapy. Two (8.6%) patients had relapse of arrhythmia. Freedom from arrhythmia was 90.9% and cumulative risk of recurrence was 9.6%.Conclusions: Intraoperative cryoablation is safe and effective procedure. Surgical treatment of arrhythmias should always be considered in ACHD, whenever further open-heart repair is needed.

Takotsubo syndrome following pericardiectomy

Background: Takotsubo cardiomyopathy (TC) is defined as a temporary and reversible systolic abnormality of the left ventricle’s apical area resembling myocardial infarction (MI) in the nonexistence of coronary artery disease (CAD)[1].Only a few cases have been reported after cardiac operations or after pericardiocentesis. Aims: To emphasize the need to be aware of the possibility of the occurrence of this potentially fatal complication after cardiac surgery. Materials and methods: A-66-year old man underwent pericardiectomy.Postoperative he endured TC and progressed exacerbation of hemodynamic instability.finally, he had to be supported by intra-aortic balloon pump（IABP),extracorporeal membrane oxygenation（ECMO). Results: Patient’s left ventricle function recovered fully in two weeks. Discussion: we discussed the pathogenesis and treatment of postoperative TC. Conclusion:TC has to be carefully considered in differential diagnosis in case of acute left ventricle dysfunction following cardiac surgery. Keywords: pericardiectomy; takotsubo cardiomyopathy.

J-ministernotomy for aortic valve replacement: a retrospective cohort study

Background The advantage of minimally invasive sternotomy (MS) over full sternotomy (FS) for isolated aortic valve replacement (AVR) is still controversial. We aimed to examine if J-shaped MS is a safe alternative to FS in patients undergoing primary isolated AVR. This study is a retrospective and restricted cohort study that included 137 patients who had primary isolated AVR from February 2013 to June 2015. Patients with previous cardiac operations, low ejection fraction (< 40%), infective endocarditis, EuroSCORE II predicted mortality > 10%, and patients who had inverted T or inverted C-MS or right anterior thoracotomy were excluded. Patients were grouped into the FS group (n=65) and MS group (n=72). Preoperative variables were comparable in both groups. The outcome was studied, balancing the groups by propensity score matching. Results Seven (9%) patients in the MS group were converted to FS. Cardiopulmonary bypass (98.5 ± 29.3 vs. 82.1 ± 13.95 min; p ≤ 0.001) and ischemic times (69.1 ± 23.8 vs. 59.6 ± 12.2 min; p = 0.001) were longer in MS. The MS group had a shorter duration of mechanical ventilation (10.1 ± 11.58 vs. 10.9 ± 6.43 h; p = 0.045), ICU stay (42.74 ± 40.5 vs. 44.9 ± 39.3; p = 0.01), less chest tube drainage (385.3 ± 248.6 vs. 635.9 ± 409.6 ml; p = 0.001), and lower narcotics use (25.14 ± 17.84 vs. 48.23 ± 125.68 mg; p < 0.001). No difference was found in postoperative heart block with permanent pacemaker insertion or atrial fibrillation between groups (p = 0.16 and 0.226, respectively). Stroke, renal failure, and mortality did not differ between the groups. Reintervention-free survival at 1, 3, and 4 years was not significantly different in both groups (p = 0.73). Conclusion J-ministernotomy could be a safe alternative to FS in isolated primary AVR. Besides the cosmetic advantage, it could have better clinical outcomes without added risk.