Pharmacologic prophylaxis for atrial fibrillation following cardiac surgery: a systematic review

Atrial Fibrillation (AF) is the most common arrhythmia occurring after cardiac surgery. Its incidence varies depending on type of surgery. Postoperative AF may cause hemodynamic deterioration, predispose to stroke and increase mortality. Effective treatment for prophylaxis of postoperative AF is vital as reduces hospitalization and overall morbidity. Beta - blockers, have been proved to prevent effectively atrial fibrillation following cardiac surgery and should be routinely used if there are no contraindications. Sotalol may be more effective than standard b-blockers for the prevention of AF without causing an excess of side effects. Amiodarone is useful when beta-blocker therapy is not possible or as additional prophylaxis in high risk patients. Other agents such as magnesium, calcium channels blocker or non-antiarrhythmic drugs as glycose-insulin - potassium, non-steroidal anti-inflammatory drugs, corticosteroids, N-acetylcysteine and statins have been studied as alternative treatment for postoperative AF prophylaxis

A rare case of epicardial cyst

Objective: We report a recent case of epicardial cyst with constrictive pericarditis. Case report: A male patient aged 20 years presented with the complaint of swelling in both legs for one year. Magnetic resonance imaging of the heart revealed a cystic mass inside the pericardium adjacent to the right ventricle. The patient was operated on by cardiovascular surgeons, with the diagnosis of constrictive pericarditis, and a pericardiectomy was carried out. Discussion: Cardiac cysts originating from the epicardium in the pericardial cavity are extremely rare, with only a few cases reported up to now. We report here on an epicardial cyst occurring coincidentally with constrictive pericarditis for the first time in the literature. © Georg Thieme Verlag KG Stuttgart

Comparison of EuroScore and STS (The Society of Thoracic Surgeons) risk scoring systems in isolated coronary artery bypass surgery [Koroner bypass cerrahi·si·nde EuroScore ve STS (The Society of Thoracic Surgeons) ri·sk skorlama yöntemleri·ni·n karşilaştirilmasi]

Objective: To compare the feasibility of the EuroScore and STS (The Society of Thoracic Surgeons) risk scoring systems for predicting the surgical mortality of isolated coronary artery bypass surgery patients. Materials and Methods: The risk scoring of 148 patients who were operated on between November 2002 and December 2005 was performed prospectively according to the EuroScore and STS risk scoring systems. The predicted and observed mortality rates according to each scoring system were compared. Results: Hospital mortality was 2% (3 patients). The predicted mortality rate according to EuroScore was 3.4±2.2%, whereas it was 3.0±2.1% for STS. There were no significant differences between predicted and observed mortality rates according to either scoring system. The area under the receiver operating characteristic curve was 0.83 for EuroScore and was 0.82 for STS (p>0.05). Conclusion: Both scoring systems were efficient for predicting mortality rates for our patient population. It is an advantage of STS that it also gives valuable information about morbidity

Intraoperative and histochemical comparison of the skeletonized and pedicled internal thoracic artery

Background. Skeletonization of the internal thoracic artery (ITA) has advantages, but the variation of ITA preparation may be traumatic for the arterial wall. We sought to compare intraoperative results and endothelial nitric oxide synthase (e-NOS) expression on the vessel wall after left ITA harvesting with skeletonization and the conventional technique. Methods. A prospective evaluation of 84 consecutive patients undergoing coronary artery bypass grafting was performed: 40 patients with skeletonized and 44 patients with pedicled left ITA. The lengths of ITA and free ITA blood flow were measured. Distal ITA segments were analyzed histopathologically and stained by antibodies against e-NOS. Results. In the skeletonized group, the length of the ITA were significantly longer than in the pedicled group (15.7 ± 0.4 cm versus 19.0 ± 0.6 cm; P = .001). Also, the free-flow capacity of the ITA was significantly higher than in the pedicled group (62.4 ± 4.8 mL/min versus 88.6 ± 6.9 mL/min; P = .001). e-NOS expressions on endothelial cells were similar between the groups. Dense e-NOS immunostaining was observed in vaso vasorum of the adventitia in the pedicled group. However, there was not any e-NOS immunostaining in vaso vasorum of the adventitia in the skeletonized group. Conclusions. Although skeletonization of the ITA is a more technically demanding procedure, it provides some advantages such as increased available graft length and reduced sternal devascularization. This technique did not have any detrimental effects on the endothelial cell lining and e-NOS expressions on the endothelial layer. To reach a definitive judgment for using skeletonized ITA, we need information about the long-term angiographic patency rates. © 2007 Forum Multimedia Publishing, LLC

Right coronary system grafts: Alone or together with left system grafts - Angiographic results

Purpose: The aim of this study is to compare the long-term graft patency between patients who had sequential or individual right posterior descending artery (RPDA) anastomosis. Materials and Methods: Two hundred and forty-two patients underwent coronary artery bypass grafting (CABG) between June 1994 and December 2003. They were examined retrospectively with respect to coronary angiograghic data. [Group 1] Individually right system grafts in RPDA position (n=139). [Group 2] RPDA anastomosis sequentially with left system (n=103). Patency rates for posterior descending arteries in each group were separately calculated for each vessel quality category. Results: The mean interval from operation to angiography was 50.6±48.9 months in group 1 vs 57.5±39.2 months in group 2 respectively. The overall patency rate was 66.2% (92/139) in group 1 and 78.6% (81/103) in group 2 (p=0.04). When the RPDA has good run-off capacity, the patency rate was 69.1% in group 1 and 85.2% in group 2. Conclusion: When the RPDA has good run-off capacity, snake grafts show excellent results and right and left coronary systems could be anastomosed sequentially

Experience with the Edwards MIRA mechanical bileaflet valve: In the aortic and mitral positions

The Edwards MIRA bileaflet mechanical prosthesis, a heart valve not yet available in the United States, is designed with a unique hinge mechanism, curved leaflets, and thin titanium housing. We performed this study to investigate its clinical performance and postoperative hemodynamic results. We implanted 58 Edwards MIRA prostheses in 51 patients in the aortic (n=18), mitral (n=26), and aortic and mitral (n=7) positions. Patients' ages ranged from 25 to 84 years (mean age, 53.7 ± 13.6). Operative mortality was 2% (n=1), and late mortality was 4% (n=2). Thromboembolic events were observed in 2 patients (valve thrombosis in 1 and a cerebrovascular event in 1). There were no complications related to anticoagulation. No signs of valvular dysfunction or paravalvular leakage were observed. Peak transvalvular gradients of the aortic prostheses ranged from 24.25 ± 5.32 mmHg for the 21-mm valve to 11 ± 1.41 mmHg for the 25-mm valve. The effective orifice area ranged from 1.99 ± 0.12 cm2 for the 21-mm valve to 2.44 ± 0.17 cm2 for the 25-mm valve. The mean transvalvular gradients of the mitral prostheses ranged from 5.85 ± 2.91 mmHg for the 27-mm valve to 4.5 ± 0 mmHg for the 31-mm valve. The effective orifice area ranged from 2.31 ± 0.03 cm2 for the 27-mm valve to 2.64 ± 0.05 cm2 for the 33-mm valve. These preliminary data suggest good hemodynamic function and a low rate of valve-related complications in the use of the Edwards MIRA mechanical prosthesis. © 2006 by the Texas Heart® Institute

St. Jude Medical and CarboMedics mechanical heart valves in the aortic position: Comparison of long-term results

We designed this study to compare long-term results of St. Jude Medical and CarboMedics mechanical heart valves in the aortic position. We retrospectively analyzed the results of 174 consecutive patients who received either a St. Jude (n=80) or a CarboMedics (n=94) mechanical aortic valve from March 1992 through October 2004. The follow-up rate was 97.7%. The mean follow-up duration for the St. Jude group was 79.3 ± 35.0 and for the CarboMedics group, 70.0 ± 34.3 months. The cumulative follow-up was 523.8 and 530.1 patient-years, respectively. The 30-day mortality rates for the St. Jude and CarboMedics patients were 1.3% and 3.2%, respectively. The actuarial survival rate for the St. Jude group at 138.0 ± 4.7 months was 75.9% ± 0.1% and for the CarboMedics group at 130.8 ± 4.8 months was 69.8% ± 0.1% (P=NS). There was no structural valve deterioration in either group. Freedom from thromboembolic events was 87.7% for the St. Jude group and 83.0% for the CarboMedics group (P=NS). Freedom from bleeding events for the St. Jude group was 93.6% and for the CarboMedics group, 89.7% (P=NS). The results obtained from this study indicate that standard St. Jude Medical and CarboMedics aortic valve prostheses offer similar excellent clinical performance. Definitive judgment must await trials that are extensive, randomized, and prospective. © 2006 by the Texas Heart® Institute