Surgical ablation of atrial fibrillation: Rationale and technique.

The Cox maze procedure is the most effective treatment for atrial fibrillation with the best long-term success rate compared to any other treatment modality, particularly in persistent and long-standing persistent atrial fibrillation. Cardiac surgeons have an unparalleled opportunity to treat atrial fibrillation as a concomitant operation during the treatment of ischemic or valvular disease. In addition, there are many options for surgical ablation of atrial fibrillation.

Is it feasible to treat atrial fibrillation at the time of minimally invasive coronary artery bypass grafting?

Purpose Of Review: Coronary artery bypass grafting remains the most common operation performed by cardiac surgeons. As a result, a cardiac surgeon with a typical practice will most commonly encounter atrial fibrillation when performing coronary artery bypass grafting. In this review, we first emphasize the importance of treating atrial fibrillation in patients undergoing coronary bypass grafting.

Surgery for Cardiac Arrhythmias: Past, Present, Future.

There is a rich history of surgery for cardiac arrhythmias, spanning from atrial fibrillation and Wolff-Parkinson-White syndrome to inappropriate sinus tachycardia and ventricular tachycardia. This review describes the history of these operations, their evolution over time, and the current state of practice. We devote considerable time to the discussion of atrial fibrillation, the most common cardiac arrhythmia addressed by surgeons.

Institutional Variability in Red Blood Cell Transfusion With Coronary Bypass in a Statewide Database.

Background: The decision to perform transfusion is common but varies among centers and surgeons. This study looked at variables associated with red blood cell (RBC) transfusion in a statewide database. The study aimed to understand discrepancies in transfusion rates among hospitals and to establish whether the hospital itself was a significant variable in transfusion, independent of variables known to affect transfusion in patients undergoing cardiac surgical procedures.

Outcomes of Alternative Access Transcatheter Aortic Valve Replacement Procedures.

Alternative access transcatheter aortic valve replacement (TAVR) consists primarily of 4 different options: transcaval, transaxillary, transcarotid, and transapical. While many centers have a preferred alternative access site, few papers have compared the outcomes of TAVR with each alternative access site. In this review, we examine the outcomes of TAVR at each alternative access site, focusing on mortality, stroke, bleeding, pacemaker insertion, paravalvular leakage, and discharge to home.

How to Do It: Transbrachial Impella Placement to Facilitate Percutaneous Coronary Intervention.

A 64-year-old man with diffusely diseased iliofemoral vessels and an ejection fraction of 20% to 25% presented with a non-ST elevation myocardial infarction and proximal left anterior descending (LAD) and left circumflex (LCx) coronary artery disease, with a chronically occluded right coronary artery. The iliofemoral system was not suitable for Impella placement, and bilateral axillary arteries were heavily calcified. The proximal left brachial artery was chosen for placement of both an Impella CP (Abiomed, Danvers, MA, USA) and percutaneous coronary intervention (PCI) sheath through a graft sewn to the brachial artery in this single-access technique.

Hybrid Positron Emission Tomography/Magnetic Resonance Imaging in Arrhythmic Mitral Valve Prolapse.

Importance: Myocardial replacement fibrosis has been reported to occur in one-third of patients with mitral valve prolapse (MVP) and significant mitral regurgitation (MR). However, it remains unknown whether there are detectable changes in myocardial metabolism suggestive of inflammation or ischemia that accompany the development of fibrosis.

Objectives: To characterize the burden and distribution of fluorine 18-labeled (18F) fluorodeoxyglucose (FDG) uptake and late gadolinium enhancement (LGE) in patients with degenerative MVP and ventricular ectopy.