Concomitant ablation for non-paroxysmal atrial fibrillation: combined energy versus cryoablation alone

BackgroundSurgical ablation of atrial fibrillation has been the most efficient treatment for atrial fibrillation (AF). Combined energy (CE) ablation and cryoablation alone (CA) are the most common energy modes used for ablation, however, comparative data is lacking.ObjectivesTo compare the efficacy of CE ablation with CA in the setting of concomitant biatrial ablation for non-paroxysmal AF.MethodsA retrospective analysis of 453 patients with non-paroxysmal AF undergone concomitant biatrial ablation from November 2007 to December 2022 during elective cardiac surgery using either combined bipolar radiofrequency with cryoenergy or cryoenergy alone was performed. Propensity score matching was conducted to balance the covariates in the groups.ResultsThere were 157 patients per group after matching. CE ablation was associated with lower odds of atrial tachyarrhythmia recurrence (OR = 0.13, 95% CI 0.02–0.91, p = 0.040), a significantly lower rate of hospital readmissions due to rhythm disruption (HR = 0.34, 95% CI 0.18–0.65, p < 0.001), and lower cumulative incidence of stroke (SHR = 0.38, 95% CI 0.15–0.97, p = 0.043). No significant difference in permanent pacemaker implantation was observed between the two groups.ConclusionsIn the setting of concomitant biatrial ablation for non-paroxysmal AF, combined bipolar radiofrequency and cryoablation appear to be a superior treatment modality compared to cryoablation alone in achieving long-term freedom from atrial arrhythmias, in reducing arrhythmia-related hospital readmissions and ischemic strokes

Current Models of Transcatheter Aortic Valves: Comparative Analysis of Design, Clinical Outcomes and Development Prospects

Objectives: Transcatheter aortic valve implantation (TAVI) has become the standard of care for severe aortic stenosis across all surgical risk categories. Continuous innovation in prosthesis technology necessitates a comprehensive and clinically oriented analysis of contemporary TAVI systems to guide device selection and understand evolving trends. This review aims to provide a practical, device-specific decision-making framework for TAVI prosthesis selection, synthesizing the latest evidence (2023–2025) to address the challenge of individualized choice in an era of device proliferation. We conducted a detailed review of current TAVI models from leading manufacturers (Medtronic, Abbott, Boston Scientific, Biotronik, etc.), examining their technical specifications, design innovations, and data from recent international clinical trials and registries. A comparative analysis was performed based on key parameters: delivery profile, resheathability/repositionability, sealing mechanisms, hemodynamic performance, and complication rates. Modern TAVI prostheses demonstrate significant advancements. Self-expanding nitinol frames offer superior adaptability and lower profiles (as low as 14 Fr). Innovations in sealing technology have drastically reduced the incidence of moderate-to-severe paravalvular leak (PVL) to below 2–3%. Supra-annular leaflet designs provide superior hemodynamics. Clinical outcomes show excellent 30-day mortality rates (1.1–2.0%) and durability estimates of 10–15 years. Variation exists between devices in rates of permanent pacemaker implantation and coronary access. The current generation of TAVI prostheses represents a mature technology offering high safety and efficacy. The key development vectors are focused on further device miniaturization, enhancing long-term durability, and expanding indications. This analysis provides a novel, clinically oriented comparison that moves beyond technical specifications to guide optimal device selection based on specific patient anatomy and clinical characteristics

Transapical Approach to Septal Myectomy for Hypertrophic Cardiomyopathy

A 63-year-old symptomatic female with apical hypertrophic cardiomyopathy and diastolic disfunction was admitted to the hospital. What is the best way to manage this patient? This study is a literature review that was performed to answer this question. The following PubMed search strategy was used: ‘Hypertrophic obstructive cardiomyopathy’ [All Fields] OR ‘apical myectomy’ [All Fields], NOT ‘animal [mh]’ NOT ‘human [mh]’ NOT ‘comment [All Fields]’ OR ‘editorial [All Fields]’ OR ‘meta-analysis [All Fields]’ OR ‘practice-guideline [All Fields]’ OR ‘review [All Fields]’ OR ‘pediatrics [mh]’. The natural history of the disease has a benign prognosis; however, a watchful strategy was associated with the risk of adverse cardiovacular events. Contrastingly, transapical myectomy was associated with low surgical risk and acceptable outcomes. In our case, the patient underwent transapical myectomy with an unconventional post-operative period. Control echocardiography showed marked left ventricular (LV) cavity enlargement: LV end-diastolic volume, 74 mL; LV ejection fraction, 65%; and LV stroke volume index increased to 27 mL/m2. The patient was discharged 7 days after myectomy. At 6 months post-operation, the patient was NYHA Class I, with a 6 min walk test score of 420 m. Therefore, transapical myectomy may be considered as a feasible procedure in patients with apical hypertrophic cardiomyopathy and progressive heart failure

Risk Factors for Deep Sternal Wound Infection after Off-Pump Coronary Artery Bypass Grafting:a Case-Control Study

INTRODUCTION: The objective of this study was to identify risk factors for deep sternal wound infection (DSWI) after off-pump coronary artery bypass (OPCAB) grafting surgery.METHODS: A total of 8,442 patients undergoing OPCAB from April 1, 2009 to December 31, 2018 were retrospectively analyzed. A total of 956 were eventually enrolled on this study based on our exclusion criteria. All subjects were divided into two groups: group 1 (n=63) - DSWI; group 2 (n=893) - without DSWI. Patients were excluded if they had one of the following: acute coronary syndrome, conversion to OPCAB grafting surgery, redo procedure, concomitant cardiac surgery procedures.RESULTS: The prevalence of body mass index (BMI) ≥40 kg/m2 (7.9% vs. 1.9%, respectively; P=0.01), lower extremity atherosclerotic artery disease (23.8% vs. 7.2%, respectively; P=0.001) and use of bilateral internal thoracic artery (19.5% vs. 2.5%, respectively; P=0.008) was significantly higher in patients with DSWI. The incidence of morbidities, including reoperation for bleeding (26.4% vs. 2.1%, respectively; P&lt;0.001), stroke (4.8% vs. 0.8%, respectively; P=0.02), acute renal failure (7.9% vs. 0.8%, respectively; P=0.001), delirium (7.9% vs. 1.7%, respectively; P=0.008) and blood transfusion (30.6% vs. 9.8%, respectively; P&lt;0.001) was significantly higher in patients with DSWI.CONCLUSIONS: A BMI of &gt;40 kg/m2, lower extremity artery disease, use of bilateral internal thoracic artery (BITA) graft, postoperative stroke, sepsis, reoperation due to postoperative complications and blood product requirement significantly increased the risk of sternal infection after OPCAB.</p