Expert Opinions on the Debate of Pericardial Reconstruction in Cardiovascular Surgery: To Close or Not to Close?

Background: As of 2019, pericardial closure was performed in only a small portion of the over 320,000 cardiac surgeries performed annually. However, evidence regarding the benefits of pericardial closure or reconstruction has been accruing, particularly with the publication of the RECON study in 2019.  Methods: This group of authors convened to try to arrive at consensus expert opinion regarding pericardial reconstruction.

Multiinstitutional Evaluation of a Debate-Style Journal Club for Cardiothoracic Surgery Trainees.

Background: Traditional journal clubs address individual articles and are limited in terms of breadth and depth of content covered. The present study describes the outcomes of a novel debate-style journal club in a multiinstitutional setting.

Methods: Participating institutions were recruited through the Thoracic Education Cooperative Group.

Surgical Treatment of Atrial Fibrillation.

The surgical treatment of atrial fibrillation (AF) has evolved significantly over the last 20 years and even more so in the last 5 years. There are now many clinically successful surgical procedures focused on eliminating AF and AF-related stroke. This review discusses the current types of surgical AF procedures, including minimally invasive and hybrid, and may assist clinicians in understanding the various surgical AF options available to patients today.

Saphenous vein grafts in contemporary coronary artery bypass graft surgery.

Myocardial ischaemia resulting from obstructive coronary artery disease is a major cause of morbidity and mortality in the developed world. Coronary artery bypass graft (CABG) surgery is the gold-standard treatment in many patients with complex multivessel coronary artery disease or left main disease. Despite substantial improvements in the outcome of patients undergoing CABG surgery in the past decade, graft patency remains the 'Achilles' heel' of this procedure.

Novel Debate-Style Cardiothoracic Surgery Journal Club: Results of a Pilot Curriculum.

Background: Traditional journal clubs addressing single articles are limited by the lack of a standardized process for conduct and evaluation. We developed a novel, debate-style journal club for trainees to use best available evidence to address controversial topics in cardiothoracic surgery through discussion of realistic patient scenarios.

Methods: After implementation of our new curriculum, trainee knowledge acquisition and retention were assessed by a summative test of published literature and standardized debate scoring.

A Structured, Debate-Style Cardiothoracic Surgery Journal Club for Trainee Acquisition and Application of Seminal Literature.

Introduction: The acquisition of specialty-specific seminal literature and its application to daily, clinical patient-care decisions are critical components of clinical training. This structured, debate-style cardiothoracic surgery journal club module engages trainees in discussion of realistic patient scenarios, incorporating an extensive body of literature identified as the best evidence for the practice of cardiothoracic surgery.

Methods: We designed the structured, debate-style cardiothoracic surgery journal club and delivered it to University of Texas MD Anderson Cancer Center cardiothoracic surgery trainees.

Treatment of lone atrial fibrillation: minimally invasive pulmonary vein isolation, partial cardiac denervation and excision of the left atrial appendage.

Since 1999, my colleagues and I have diligently pursued a minimally invasive surgical, beating-heart, left atrial isolation technique that is offered to patients with lone atrial fibrillation (AF). We began clinical cases in 2003. In 2005, we reported our initial experience with video-assisted bilateral pulmonary vein (PV) isolation and left atrial appendage (LAA) exclusion for the minimally invasive treatment of AF (Wolf technique).

Surgical ablation for atrial fibrillation in cardiac surgery: a meta-analysis and systematic review.

Objectives: : This meta-analysis sought to determine whether surgical ablation improves clinical outcomes and resource utilization compared with no ablation in adult patients with persistent and permanent atrial fibrillation (AF) undergoing cardiac surgery.

Methods: : A comprehensive search was undertaken to identify all randomized (RCT) and nonrandomized (non-RCT) controlled trials of surgical ablation versus no ablation in patients with AF undergoing cardiac surgery up to April 2009. The primary outcome was sinus rhythm.

Surgical Ablation for Atrial Fibrillation in Cardiac Surgery: A Consensus Statement of the International Society of Minimally Invasive Cardiothoracic Surgery (ISMICS) 2009.

Objective: : This purpose of this consensus conference was to determine whether surgical atrial fibrillation (AF) ablation during cardiac surgery improves clinical and resource outcomes compared with cardiac surgery alone in adults undergoing cardiac surgery for valve or coronary artery bypass grafting.

Methods: : Before the consensus conference, the consensus panel reviewed the best available evidence, whereby systematic reviews, randomized trials, and nonrandomized trials were considered in descending order of validity and importance. Evidence-based statements were created, and consensus processes were used to determine the ensuing recommendations.

Minimally invasive surgical treatment of atrial fibrillation.

Surgical ablation for atrial fibrillation (AF) can now be successfully performed utilizing minimally invasive techniques, as surgeon experience with these approaches has increased, and technologic advances in minimally invasive instrumentation have been made. Surgical management of atrial fibrillation, as well as our minimally invasive approach, will be discussed in depth.

Atrial fibrillation after cardiac transplantation: experience in 498 consecutive cases.

Background: Some contemporary surgical treatments for atrial fibrillation involve creating only a subset of the lesions made in the classic Cox Maze procedure. This subset often consists of pulmonary vein isolation and partial cardiac denervation. Orthotopic heart transplantation, by necessity, results in pulmonary vein isolation, albeit with total cardiac denervation.

Partial cardiac denervation and sinus node modification for inappropriate sinus tachycardia.

We describe a case of inappropriate sinus tachycardia refractory to medical therapy and catheter sinus node ablation, which was successfully treated by surgery with approaches on both the sinus node and cardiac autonomic ganglia.

Impact of Preoperative 64-Slice CT Scanning on Mini-Maze Atrial Fibrillation Surgery.

Background: : Multidetector computed tomography (MDCT) is emerging as a powerful noninvasive diagnostic tool. The appropriate role of this technique in the preoperative evaluation of cardiovascular disease has yet to be fully defined. Atrial fibrillation is the most common sustained cardiac arrhythmia, and novel minimally invasive surgical techniques have been developed to treat this condition by electrically isolating the pulmonary veins.

Absence of correlation between symptoms and rhythm in "symptomatic" atrial fibrillation.

Background: Symptoms are widely used as a means of assessment and follow-up of patients with atrial fibrillation. This study assessed the correlation between symptoms and cardiac rhythm in patients being evaluated for operative therapy for atrial fibrillation.

Methods: Seven days of preoperative continuous outpatient home electrocardiographic monitoring was performed on 50 patients with symptomatic atrial fibrillation.

Outcomes associated with the use of secondary prevention medications after coronary artery bypass graft surgery.

Background: Secondary prevention medications are beneficial after acute coronary syndromes, but these benefits are less clear after coronary artery bypass graft surgery. We investigated whether greater use of secondary prevention medications after coronary artery bypass graft surgery is associated with improved clinical outcomes.

Methods: Patients undergoing coronary artery bypass graft surgery in the PREVENT IV trial (n = 2970) were surveyed for use of antiplatelet agents, beta-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and lipid-lowering agents after hospital discharge and at 1 year.

Intraoperative epicardial electrophysiologic mapping and isolation of autonomic ganglionic plexi.

Background: Autonomic ganglionic plexi (GPs) have been implicated as triggers in lone atrial fibrillation (AF). The purpose of this study was to describe the technique and results of epicardial electrophysiologic mapping and the early effects of GP isolation.

Methods: Intraoperative epicardial electrophysiologic mapping was performed on 41 consecutive patients during a stand-alone minimally invasive operation for AF.

Surgical ablation of atrial fibrillation.

Surgical ablation of atrial fibrillation (AF) is the most effective means of curing this arrhythmia, with the classic Maze procedure eliminating AF in more than 90% of patients. A complex but safe operation, the Maze procedure has been applied by relatively few surgeons. However, recent advances in the understanding of the pathogenesis of AF and development of new ablation technologies enable surgeons to perform pulmonary vein ablation, create linear left atrial lesions, and remove the left atrial appendage rapidly and safely.

The PRoject of Ex-vivo Vein graft ENgineering via Transfection IV (PREVENT IV) trial: study rationale, design, and baseline patient characteristics.

Background: Coronary artery bypass graft (CABG) surgery with autologous vein graft (VG) conduit is one of the most frequently performed operations in the United States. Unfortunately, many VGs become occluded during long-term follow-up largely because of neointimal hyperplasia. A novel approach to preventing neointimal hyperplasia is with the double-stranded oligonucleotide edifoligide (Corgentech Inc, South San Francisco, Calif).

Video-assisted bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation.

Objective: Pulmonary vein isolation is curative in selected patients with atrial fibrillation. The objective of this study was to assess the feasibility and safety (midterm results) of video-assisted thoracoscopic epicardial pulmonary vein isolation.

Methods: Twenty-seven patients (22 male patients) with atrial fibrillation (18 paroxysmal, 4 persistent, and 5 permanent; average age, 57 years) underwent bilateral video-assisted thoracoscopic off-pump epicardial pulmonary vein isolation and exclusion of the left atrial appendage.