Permanent atrial fibrillation ablation surgery in patients with advanced age

Background: Even if permanent atrial fibrillation (pAF) is a frequent concomitant problem in patients undergoing open heart surgery and particularly in those with advanced age, data of pAF ablation surgery in older aged patients are scarce. This study was performed to assess early and late results of combined open heart surgery and pAF ablation procedures in patients with advanced aged, compared to young patients. Material and Methods: A selective group of 126 patients (Group A: age ≥70 [76.4±4.8] years, n=70; Group B: age <70 [62.0±6.2] years: n=56) with pAF (≥6 months) underwent either monopolar (Group A, B: n=51 vs. n=44) or bipolar (Group A, B: n=19 vs. n=12) radiofrequency (RF) ablation procedures concomitant to open heart surgery. Regular follow-up was performed 3 to 36 months after surgery to assess survival, New York Heart Association (NYHA) class and conversion rate to stable sinus rhythm (SR). Results: Early mortality (<30 days) was 2.9% in Group A (Group B: 0%), cumulative survival at long-term follow up was 0.78 vs. 0.98 (p=0.03) and NYHA-class improved significantly in both groups, particularly in cases with stable SR. At 12-months follow-up 73% of Group A patients were in stable SR (Group B 78%). Conclusions: Concomitant mono- and bipolar RF ablation surgery represents a safe option to cure pAF during open heart surgery with a very low risk, even in patients with advanced age

Modified Bentall operation with bioprosthetic valve and Valsalva graft conduit:the "slit skirt" technique

We elucidated the efficacy of the slit skirt technique to prevent bleeding from the proximal anastomosis between the graft and aortic annulus. Between September 2008 and September 2014, 15 patients underwent a modified Bentall operation with the slit skirt technique at our institution. No patients had bleeding from the proximal anastomosis. No re-thoracotomy for bleeding was required. During midterm follow-up (median period, 21 months), no patient had pseudoaneurysms at the proximal suture line. We conclude that the slit skirt technique is useful to prevent bleeding from the proximal anastomosis after the Bentall operation

Effect of off-pump coronary surgery with right ventricular assist device on organ function and inflammatory response: a randomized controlled trial.

BACKGROUND: Right ventricular assist devices (RVADs) have been proposed to improve exposure of the coronary arteries in off-pump surgery. In this study we investigated the impact of the A-Med RVAD on inflammatory response and organ function in patients undergoing coronary artery bypass grafting. METHODS: Sixty patients were prospectively randomized to conventional surgery with cardiopulmonary bypass (CPB) and cardioplegic arrest, beating heart surgery (off-pump), or beating heart surgery with the RVAD. Serial blood samples were collected postoperatively, for analysis of inflammatory markers, troponin I, protein S100, and free hemoglobin. Renal tubular function was assessed by measuring urine N-acetyl-glucosaminidase activity. RESULTS: No hospital deaths or major postoperative complications occurred in the study population. Interleukin-6, interleukin-8, C3a, and troponin I levels after surgery were significantly higher in the CPB group compared with the off-pump and RVAD groups. Free hemoglobin levels immediately after the operation, peak and total S100 levels, and N-acetyl-glucosaminidase activity were also significantly higher in the CPB group. CONCLUSIONS: Off-pump coronary revascularization, with or without RVAD, reduces inflammatory response, myocardial, neurologic, and renal injury, and decreases hemolysis when compared with conventional surgery with CPB and cardioplegic arrest

News in Brief

Alec Beekley, MD, FACS (Division of Acute Care Surgery), and John Entwistle, MD, FACS (Division of Cardiothoracic Surgery), have each been promoted to Professor of Surgery. Howard Todd Massey, MD, has joined the Division of Cardiothoracic Surgery as the Surgical Director of Cardiac Transplant. Dr. Massey completed his general surgery residency at the University of Louisville and his thoracic and cardiovascular surgical residency at the University of Texas Southwestern. He then completed a fellowship in Heart and Lung Transplantation and Adult Cardiac Surgery at the Duke University Medical Center. Dr. Massey is dualcertified in Surgery and Thoracic Surgery. Under the leadership of Dr. Massey and Andrew Boyle, MD, Medical Director of Advanced Heart Failure, Jefferson has reactivated its Heart Transplant Program with the United Network for Organ Sharing (UNOS). On March 1, the Jefferson Center for Injury Research and Prevention (JCIRP) proudly hosted the 2017 Vision Zero for Philadelphia Conference presented by the Bicycle Coalition of Greater Philadelphia and Uber. Stanton B. Miller, MD, MPH, Founding Director of JCIRP, welcomed an audience including urban designers, transportation planners, and representatives from AAA, AARP and several city and state agencies. Participants will collaborate and implement research-based initiatives to eliminate traffic fatalities and serious injuries by 2030, through education, engineering and enforcement. JCIRP was established in 2013 within the Division of Acute Care Surgery, led by Murray J. Cohen, MD, FACS, Director of the Level I Regional Resource Trauma Center at Jefferson. Charles J. Yeo, MD, FACS, Samuel D. Gross Professor and Chair of Surgery, has been named Senior Vice President and Chair – Enterprise Surgery for Jefferson Health, and Editor-in-Chief of the new Journal of Pancreatic Cancer. On April 29, Theresa Pluth Yeo, PhD, MPH, ACNP, Adjunct Associate Professor in the Jefferson College of Nursing and Co-Director of the Jefferson Pancreas Tumor Registry received the 2017 Distinguished Alumni Award from Cornell University – New York Hospital School of Nursing. Save the Date: Jefferson will host the 12th Annual Pancreatic Cancer and Related Diseases Symposium on Saturday, November 11, 2017 from 9 am to 2 pm. The event gives patients and their loved ones an opportunity to connect with expert physicians, scientists and staff and learn about the latest developments in research and treatment. Seating is limited for this free event. Registration is required. Please contact, Kelly Austin at 215-955-6383 to request an invitation. For more information, visit Jefferson.edu/PancreasEven

Surgeon Speaks

Like every surgeon, I started my residency training in General Surgery. Then I specialized in Thoracic and Cardiovascular Surgery and finally sub-specialized with a Fellowship in Heart and Lung Transplantation and Adult Cardiac Surgery at Duke University Medical Center. At the time I went through training, we didn’t have a lot of good options to help patients with advanced heart failure. I was working with very sick patients, many of whom died. Back then, many of my colleagues questioned why I would choose this as my focus. They were right that the treatments weren’t great at the time. But over the past 25 years or so, I have not only witnessed but also been part of incredible innovations. Today, we have some excellent solutions and we’ve made a huge impact. It’s incredible both to look back at our progress and to look ahead and imagine how much more we can achieve. H. Todd Massey, MD Surgical Director, Cardiac Transplantation and Mechanical Circulatory Support Professor, Cardiothoracic Surger

Impaired cardiac autonomic nervous control after cardiac bypass surgery for congenital heart disease

We undertook a study to describe changes in heart rate variability (HRV) postoperatively in children undergoing cardiac bypass surgery for congenital heart disease (CHD). HRV was recorded for a 1-h period preoperatively and a 24-h period postoperatively in 20 children with CHD. We found a highly significant reduction in HRV in both time and frequency domain indices compared to preoperative values, which was sustained throughout the 24-h study period. There was a negative correlation between both time and frequency domain HRV measurements and length of cardiac bypass. HRV is reduced postoperatively and correlates with cardiac bypass time. Length of cardiac bypass time may be one mechanism whereby HRV is reduced following surgery

An asymptomatic 11 year child with ruptured sinus of Valsalva

Ruptured sinus of Valsalva (RSOV) is a rare lesion in a paediatric age group. A right sinus of Valsalva aneurysm usually ruptures into the right ventricle, while aneurysms of non-coronary sinus do so into the right atrium. RSOV usually presents in the third decade of life with congestive heart failure and is more common among Asians with male predominance. It may present as acute cardiogenic shock and sudden death or may remain completely asymptomatic with incidental detection by a murmur. Surgery is indicated as early as possible, once the diagnosis is made as without surgery, most cases will eventually succumb to uncontrollable congestive heart failure. This article reports an 11 year old child with the diagnosis of ruptured sinus of Valsalva.peer-reviewe

Hemoglobin Level Decrease after Open Heart Surgery in a Tertiary Hospital in Indonesia

Background: Open heart surgery is usually performed by connecting the heart to a cardiopulmonary bypass (CPB) machine. The use of the CPB machine may decrease the hemoglobin level and a very low hemoglobin levelcould cause seriouscomplications.This study aimed to explore the decrease in hemoglobin level after open heart surgery.Methods: A cross-sectional retrospective descriptive study was conducted on medical records of patients underwent coronary artery bypass graft (CABG) surgery and heart valve surgery in a tertiary hospital in Indonesia in  2018. The total sampling method was deployed to all medical records of patients underwent CABG surgery (n=25) and patients underwent heart valve surgery (n=3).Results: The decrease in hemoglobin level among young-adult female patients after heart valve surgery was 6.8 g/dl. The average decrease in mid-adult male and female patients after CABG surgery were 6 g/dl and 5.8 g/dl, respectively, and, after the heart valve surgery, the levels were 8.5 g/dl and 5.4 g/dl, respectively. The average decrease in Hb level among late-adult male and female patients after CABG surgery was 6.1 g/dl and 5.4 g/dl, respectively.Conclusion: Hemoglobin level decreases after an open heart surgery. Therefore, observation on the hemoglobin level to prevent complications and to facilitate early treatment is necessary

The Role of Perceived Uncertainty, Ego Identity, and Perceived Behavioral Control in Predicting Patient's Attitude Toward Medical Surgery

Medical surgery has sometimes become the only best choice for a patient's well-being. Unfortunately, not all patients have the willingness to live it. Often, therapeutic failure is caused by uncooperative attitudes of the patients which originate from their negative attitudes toward the surgery. This research is aimed at finding a theoretical model to explain psychological factors forming the patient's attitudes. This predictive correlational research was conducted on 99 patients suffering heart disease and cancer continuum who require medical surgery in DKI Jakarta, Indonesia. Research results showed that a commitment aspect of ego identity is able to indirectly predict attitude toward medical surgery through mediation of perceived uncertainty. Perceived behavioral control directly predicts the attitude in a negative direction. This research concludes that patients' commitment towards their identity plays a significant role as they deal with medical surgery