Clinical and electrophysiological predictors of device-detected new-onset atrial fibrillation during 3 years after cardiac surgery

Postoperative atrial fibrillation (POAF) after cardiac surgery is an independent predictor of stroke and mortality late after discharge. We aimed to determine the burden and predictors of early (up to 5th postoperative day) and late (after 5th postoperative day) new-onset atrial fibrillation (AF) using implantable loop recorders (ILRs) in patients undergoing open chest cardiac surgery Seventy-nine patients without a history of AF undergoing cardiac surgery underwent peri-operative high-resolution mapping of electrically induced AF and were followed 36 months after surgery using an ILR (Reveal XTTM). Clinical and electrophysiological predictors of late POAF were assessed. POAF occurred in 46 patients (58%), with early POAF detected in 27 (34%) and late POAF in 37 patients (47%). Late POAF episodes were short-lasting (mostly between 2 min and 6 h) and showed a circadian rhythm pattern with a peak of episode initiation during daytime. In POAF patients, electrically induced AF showed more complex propagation patterns than in patients without POAF. Early POAF, right atrial (RA) volume, prolonged PR time, and advanced age were independent predictors of late POAF

Can Orthopedic Oncologists Predict Functional Outcome in Patients with Sarcoma after Limb Salvage Surgery in the Lower Limb? A Nationwide Study

Accurate predictions of functional outcome after limb salvage surgery (LSS) in the lower limb are important for several reasons, including informing the patient preoperatively and, in some cases, deciding between amputation and LSS. This study aimed to elucidate the correlation between surgeon-predicted and patient-reported functional outcome of LSS in the Netherlands. Twentythree patients (between six months and ten years after surgery) and five independent orthopedic oncologists completed the Toronto Extremity Salvage Score (TESS) and the RAND-36 physical functioning subscale (RAND-36 PFS). The orthopedic oncologists made their predictions based on case descriptions (including MRI scans) that reflected the preoperative status. The correlation between patient-reported and surgeon-predicted functional outcome was "very poor" to "poor" on both scores ( 2 values ranged from 0.014 to 0.354). Patient-reported functional outcome was generally underestimated, by 8.7% on the TESS and 8.3% on the RAND-36 PFS. The most difficult and least difficult tasks on the RAND-36 PFS were also the most difficult and least difficult to predict, respectively. Most questions had a "poor" intersurgeon agreement. It was difficult to accurately predict the patient-reported functional outcome of LSS. Surgeons' ability to predict functional scores can be improved the most by focusing on accurately predicting more demanding tasks

LUMiC(A (R)) Endoprosthetic Reconstruction After Periacetabular Tumor Resection:Short-term Results

Reconstruction of periacetabular defects after pelvic tumor resection ranks among the most challenging procedures in orthopaedic oncology, and reconstructive techniques are generally associated with dissatisfying mechanical and nonmechanical complication rates. In an attempt to reduce the risk of dislocation, aseptic loosening, and infection, we introduced the LUMiC(A (R)) prosthesis (implantcast, Buxtehude, Germany) in 2008. The LUMiC(A (R)) prosthesis is a modular device, built of a separate stem (hydroxyapatite-coated uncemented or cemented) and acetabular cup. The stem and cup are available in different sizes (the latter of which is also available with silver coating for infection prevention) and are equipped with sawteeth at the junction to allow for rotational adjustment of cup position after implantation of the stem. Whether this implant indeed is durable at short-term followup has not been evaluated. (1) What proportion of patients experience mechanical complications and what are the associated risk factors of periacetabular reconstruction with the LUMiC(A (R)) after pelvic tumor resection? (2) What proportion of patients experience nonmechanical complications and what are the associated risk factors of periacetabular reconstruction with the LUMiC(A (R)) after pelvic tumor resection? (3) What is the cumulative incidence of implant failure at 2 and 5 years and what are the mechanisms of reconstruction failure? (4) What is the functional outcome as assessed by Musculoskeletal Tumor Society (MSTS) score at final followup? We performed a retrospective chart review of every patient in whom a LUMiC(A (R)) prosthesis was used to reconstruct a periacetabular defect after internal hemipelvectomy for a pelvic tumor from July 2008 to June 2014 in eight centers of orthopaedic oncology with a minimum followup of 24 months. Forty-seven patients (26 men [55%]) with a mean age of 50 years (range, 12-78 years) were included. At review, 32 patients (68%) were alive. The reverse Kaplan-Meier method was used to calculate median followup, which was equal to 3.9 years (95% confidence interval [CI], 3.4-4.3). During the period under study, our general indications for using this implant were reconstruction of periacetabular defects after pelvic tumor resections in which the medial ilium adjacent to the sacroiliac joint was preserved; alternative treatments included hip transposition and saddle or custom-made prostheses in some of the contributing centers; these were generally used when the medial ilium was involved in the tumorous process or if the LUMiC(A (R)) was not yet available in the specific country at that time. Conventional chondrosarcoma was the predominant diagnosis (n = 22 [47%]); five patients (11%) had osseous metastases of a distant carcinoma and three (6%) had multiple myeloma. Uncemented fixation (n = 43 [91%]) was preferred. Dual-mobility cups (n = 24 [51%]) were mainly used in case of a higher presumed risk of dislocation in the early period of our study; later, dual-mobility cups became the standard for the majority of the reconstructions. Silver-coated acetabular cups were used in 29 reconstructions (62%); because only the largest cup size was available with silver coating, its use depended on the cup size that was chosen. We used a competing risk model to estimate the cumulative incidence of implant failure. Six patients (13%) had a single dislocation; four (9%) had recurrent dislocations. The risk of dislocation was lower in reconstructions with a dual-mobility cup (one of 24 [4%]) than in those without (nine of 23 [39%]) (hazard ratio, 0.11; 95% CI, 0.01-0.89; p = 0.038). Three patients (6%; one with a preceding structural allograft reconstruction, one with poor initial fixation as a result of an intraoperative fracture, and one with a cemented stem) had loosening and underwent revision. Infections occurred in 13 reconstructions (28%). Median duration of surgery was 6.5 hours (range, 4.0-13.6 hours) for patients with an infection and 5.3 hours (range, 2.8-9.9 hours) for those without (p = 0.060); blood loss was 2.3 L (range, 0.8-8.2 L) for patients with an infection and 1.5 L (range, 0.4-3.8 L) for those without (p = 0.039). The cumulative incidences of implant failure at 2 and 5 years were 2.1% (95% CI, 0-6.3) and 17.3% (95% CI, 0.7-33.9) for mechanical reasons and 6.4% (95% CI, 0-13.4) and 9.2% (95% CI, 0.5-17.9) for infection, respectively. Reasons for reconstruction failure were instability (n = 1 [2%]), loosening (n = 3 [6%]), and infection (n = 4 [9%]). Mean MSTS functional outcome score at followup was 70% (range, 33%-93%). At short-term followup, the LUMiC(A (R)) prosthesis demonstrated a low frequency of mechanical complications and failure when used to reconstruct the acetabulum in patients who underwent major pelvic tumor resections, and we believe this is a useful reconstruction for periacetabular resections for tumor or failed prior reconstructions. Still, infection and dislocation are relatively common after these complex reconstructions. Dual-mobility articulation in our experience is associated with a lower risk of dislocation. Future, larger studies will need to further control for factors such as dual-mobility articulation and silver coating. We will continue to follow our patients over the longer term to ascertain the role of this implant in this setting. Level IV, therapeutic study

Preoperative anaemia and outcome after elective cardiac surgery:a Dutch national registry analysis

Background: Previous studies have shown that preoperative anaemia in patients undergoing cardiac surgery is associated with adverse outcomes. However, most of these studies were retrospective, had a relatively small sample size, and were from a single centre. The aim of this study was to analyse the relationship between the severity of preoperative anaemia and short- and long-term mortality and morbidity in a large multicentre national cohort of patients undergoing cardiac surgery. Methods: A nationwide, prospective, multicentre registry (Netherlands Heart Registration) of patients undergoing elective cardiac surgery between January 2013 and January 2019 was used for this observational study. Anaemia was defined according to the WHO criteria, and the main study endpoint was 120-day mortality. The association was investigated using multivariable logistic regression analysis. Results: In total, 35 484 patients were studied, of whom 6802 (19.2%) were anaemic. Preoperative anaemia was associated with an increased risk of 120-day mortality (adjusted odds ratio [aOR] 1.7; 95% confidence interval [CI]: 1.4–1.9; P<0.001). The risk of 120-day mortality increased with anaemia severity (mild anaemia aOR 1.6; 95% CI: 1.3–1.9; P<0.001; and moderate-to-severe anaemia aOR 1.8; 95% CI: 1.4–2.4; P<0.001). Preoperative anaemia was associated with red blood cell transfusion and postoperative morbidity, the causes of which included renal failure, pneumonia, and myocardial infarction. Conclusions: Preoperative anaemia was associated with mortality and morbidity after cardiac surgery. The risk of adverse outcomes increased with anaemia severity. Preoperative anaemia is a potential target for treatment to improve postoperative outcomes

Long-term outcome of right ventricular outflow tract reconstruction with bicuspidalized homografts

Objective: Given the shortage of small-sized cryopreserved homografts for right ventricle (RV) to pulmonary artery (PA) reconstructions, more readily available larger-sized homografts can be used after size reduction by bicuspidalization. The aim of our study was to determine and compare function over time of standard and bicuspidalized homografts in infants younger than 12 months, including patients with a Ross or extended Ross procedure. Methods: All consecutives infants under the age of 1 year, who underwent a surgical procedure in which a homograft was placed in the RV-PA position between January 1994 and April 2009, were included. Prospectively collected data from serial, standardized echocardiography from all patients were extracted from the database, and hospital records were retrospectively reviewed. Results: A total of 40 infants had a valved homograft conduit placed in the RV-PA position. In 20 of those patients, a bicuspidalized homograft was used. Twelve patients underwent a Ross procedure, of whom seven had an additional Konno-type aortic annulus enlargement. Median follow-up was 146 months (interquartile range (IQR), 117-170; total patient years: 178) in the group with standard use of the homograft and 95 months (IQR, 11-104; total patient years: 78) in the group with bicuspidalized conduits. Freedom from re-intervention (re-operation or percutaneous) was not different in the standard and bicuspidalized groups for all and Ross or Konno-Ross procedures (Tarone-Ware, p = 0.65 and p = 0.47, respectively). Consecutive echocardiographic maximum velocities in the right ventricular outflow tract were similar in the standard and bicuspidalized groups. Conclusion: When proper sized cryopreserved homografts for placement in the RV-PA position in Ross, Konno-Ross, and other procedures in infants under the age of 1 year are not readily available, bicuspidalized homografts provide an acceptable alternative. (C) 2011 European Association for Cardio-Thoracic Surgery. Published by Elsevier B. V. All rights reserved

Functional outcome after surgery in patients with bone sarcoma around the knee; results from a long-term prospective study

Background and Objectives: In a previous conducted study functional outcome of young patients with bone sarcoma located around the knee was longitudinally evaluated during the first 2 years postoperatively. Functional outcome improved significantly over the first 2 years. The purpose of this descriptive study was to evaluate the functional outcome of these patients at long-term follow-up of 7 years. Methods: Functional outcome was assessed with the TESS, MSTS, Baecke questionnaire, and three functional performance tests: time up and down stairs (TUDS), various walking activities (VWA), and the 6-min walking test (6MWT). Linear Mixed Model has been employed fo

The Impact of New-Onset Postoperative Atrial Fibrillation on Mortality After Coronary Artery Bypass Grafting

Background. New-onset postoperative atrial fibrillation (POAF) is a frequent rhythm disturbance after coronary artery bypass grafting (CABG). This study investigated the independent effect of POAF on early and late mortality after isolated CABG. Methods. Data of patients who consecutively underwent isolated CABG between January 2003 and December 2007 were prospectively collected. The analysis included 5098 patients with preoperative sinus rhythm and no history of atrial fibrillation. Logistic regression analysis for early mortality and Cox regression analysis for late mortality were performed. Propensity score matching was performed to eliminate the effect of confounders. Results. Median follow-up was 2.5 years. POAF was documented in 1122 patients (22.0%). Early mortality was more frequent in POAF patients (3.1%) vs non-POAF patients (1.6%, p = 0.002), but multivariate logistic regression analysis could not identify POAF as an independent predictor of early mortality (p = 0.169). This outcome did not change after adjusting for quintiles of the propensity score of POAF (p = 0.100). Multivariate Cox proportional hazard analyses demonstrated POAF was an independent predictor of overall and late mortality with hazard ratios of 1.35 (p = 0.012 and p = 0.039, respectively). Analyses after propensity score matching showed that patients with POAF had similar hazard ratios of 1.36 for overall mortality and 1.34 for late mortality (p = 0.009 and p = 0.042, respectively). Conclusions. POAF is an independent predictor of overall and late mortality after isolated CABG but not of early mortality