Comparison between different tricuspid valve procedures through postoperative inflammation and myocardial enzymes

Abstract Introduction: The thoracoscopic procedure for tricuspid valve (TV) diseases is a minimally invasive method of treatment. This study focuses on comparing the changes in postoperative inflammatory reaction and myocardial injury markers after thoracoscopic and sternotomy/thoracotomy TV procedures. Methods: We retrospectively analyzed 88 patients (53 males, aged 50.9±16.2 years) with TV diseases (single-valve disease) (72 cases of TV plasty) between January 2018 and April 2019. A total of 56 patients underwent thoracoscopic procedure (50 cases of TV plasty). The leukocyte and C-reactive protein (CRP) levels were monitored as indicators of systemic inflammatory reaction. The lactate dehydrogenase, creatine kinase, creatine kinase myocardial band, aspartate aminotransferase, and troponin-T levels were recorded as markers of myocardial injury. Results: The CRP and white blood cells levels of patients in the sternotomy approach group were continuously higher than those in patients in the thoracoscopic approach group. And the levels of myocardial enzymes in patients in the thoracoscopic approach group were significantly lower than those in patients in the sternotomy approach group. Conclusion: Compared with sternotomy/thoracotomy procedures on TV, the thoracoscopic procedure can reduce postoperative myocardial injury significantly and systemic inflammatory reaction to a certain extent. It is technically feasible, safe, effective, and worthy of widespread adoption in clinical practice.

Cirugía mínimamente invasiva de la válvula aórtica. 15 años de experiencia en el Hospital Regional de Temuco, Chile / Ministernotomy for aortic valve surgery: a 15-year experience

Resumen Introducción: La cirugía de la válvula aórtica puede ser efectuada a través de una esternotomía reducida con menos trauma quirúrgico, una recuperación más rápida, mejores resultados cosméticos y excelentes resultados a largo plazo. Objetivo: Comunicar los resultados a largo plazo obtenidos con el abordaje mínimamente invasivo en el Hospital Regional de Temuco. Material y Método: Estudio de cohorte retrospectivo de 286 pacientes operados con técnica mini invasiva comparados con 1161 pacientes operados a través de esternotomía completa para reemplazo valvular aórtico por enfermedad valvular entre 2004 y 2019. La edad promedio fue 62,1±6,4 años. Para la canulación arterial y venosa se utilizaron cánulas de tamaño pequeño. El flujo de circulación extracorpórea promedio fue 4.5 L/min. Se utilizó cardioplejia sanguínea infundida por vía anterógrada y retrograda. Se utilizó estadística descriptiva con medidas de tendencia central y dispersión. Las variables categóricas fueron comparadas con el test de X^2 y las variables continuas con "t" test y ANOVA. La supervivencia actuarial se calculó mediante el método de Kaplan Meier con el programa Stata 14. Resultados: No hubo diferencia en la mortalidad a 30 días entre los grupos. Hallazgos similares se encontraron para arritmias, complicaciones cerebrales y bloqueo AV que requirió marcapasos. Hubo una diferencia estadísticamente significativa a favor del grupo de ministernotomía para reoperación por sangrado, días de estadía en UCI y estadía hospitalaria. El seguimiento promedio fue 101 ± 4 (1169 meses). La mayoría de los pacientes estaban en capacidad funcional I y libre de eventos cardiovasculares y reoperación. En el control post operatorio se hizo un ecocardiograma en el 86% de los pacientes mostrando buen resultado hemodinámico, similar en ambos grupos, y para distintas prótesis utilizadas. La probabilidad de sobrevida actuarial fue de 97% y la probabilidad de estar libre de eventos cardiovasculares fue 93% a 156 meses de seguimiento. Conclusión: La mini esternotomía es una técnica segura para la cirugía valvular aórtica con excelentes resultados en el largo plazo, permitiendo simplificar la cirugía, reducir los costos hospitalarios y permite una recuperación con menos secuelas cosméticas.

Abstract: Background: Aortic valve surgery can be performed through a reduced ministernotomy with less surgical trauma, improved cosmetics, faster recovery and excellent long-term results. Aim: To report the long-term results obtained with the minimally invasive approach technique in Southern Chile. Methods: A retrospective cohort study of 286 patients operated with the less invasive technique compared to 1161 patients operated on with full sternotomy for aortic valve replacement between 2004 and 2019 was performed. Arterial and venous cannulation was performed using small cannulas. Mean extracorporeal circulation flow was 4.5 L/min. Antegrade and retrograde cold cardioplegia was used. Statistical Analysis: Data are reported with measures of central tendency and dispersion. Categorical variables were compared with the X^2 test and ANOVA. Actuarial survival rate was calculated by Kaplan Meier method. The Stata 14 package was used for data analysis. Results: Demographic characteristics are shown in Table 1. Mean age of the whole cohort was 62.1 y/o (SD 6.4). There was no difference in 30 day mortality between groups. Incidence of arrhythmia, cerebral complications and AV block requiring pacemaker was similar between groups. There were no significant statistical differences in reoperation for bleeding, days of stay at the ICU and overall hospital stay. Mean follow up was 101 ± 4 (1169) months. After surgery most patients are in FC I and free from cardiac events and reoperation. In the postoperative period echocardiographic assessment was performed in 86% of patients showing similar hemodynamic function of the implanted valve. Actuarial survival rate was 97% and probability of freedom from cardiac events was 93% at 156 months of follow up. Conclusions: Ministernotomy is an excellent approach for aortic valve surgery which can be performed with very good results not inferior to those obtained with full sternotomy thus simplifying the surgical technique and reducing local hospital costs.

Does decreased snx10 serve as a novel risk factor in atrial fibrillation of the valvular heart disease? - a case-control study

Abstract Introduction: Atrial fibrillation (AF) is the most common sustained arrhythmia. Sorting nexin 10 (SNX10) has been reported to be an important regulator in embryonic development and human diseases, however, little is known about its role in cardiac disease. The aim of this study was to investigate the clinical significance of SNX10 expression in AF. Methods: Nineteen valvular heart disease patients with AF and nine valvular heart disease patients with sinus rhythm (SR) were enrolled. Atrial tissue samples from patients undergoing open heart surgery were examined. Atrial tissues of normal hearts were obtained from two cases' autopsies. The SNX10 expression and its associations with the degree of fibrosis were analyzed by immunohistochemistry and Masson's trichrome staining. Results: SNX10 expression was detected in the cytoplasm of cardiac cells in human myocardial tissue. The SNX10 expression level was higher in the SR group than in the AF group (P=0.023). SNX10 expression was negatively associated with the degree of fibrosis (P=0.017, Spearman rho=-0.447), the New York Heart Association degree (P=0.003, Spearman rho=-0.545), left atrial diameter (P=0.038, Spearman rho=-0.393), right atrial diameter (P=0.043, Spearman rho=-0.386), and the brain natriuretic peptide (BNP) level 24 hours after surgery (P=0.030, Spearman rho=-0.426), but not the BNP level before surgery and 72 hours after surgery. No statistical significance was observed between SNX10 and the level of troponin T and C-reactive protein. Conclusion: Decreased SNX10 might serve as a potential risk factor in AF of the valvular heart disease.

Impacto da doença valvar nas atividades cotidianas de pacientes no período pré-operatório / Impact of valvular heart disease on activities of daily living during the preoperative period

Objetivo: avaliar o impacto da valvopatia no cotidiano dos pacientes em pré-operatório de cirurgia cardíaca. Métodos: estudo transversal, observacional, descritivo, com amostra de conveniência. Utilizado o instrumento "Impacto da Doença no Cotidiano do Valvopata", composto por uma questão geral e 14 itens, distribuídos em quatro domínios: "Impacto físico da doença", "Impacto da doença nas atividades cotidianas", "Impacto social e emocional da doença" e "Adaptação à doença". Obtém-se um escore para cada domínio e um escore total, por meio da soma de todos os escores (14 a 350), quanto maior o valor, maior a percepção negativa do impacto. Resultados: participaram do estudo 73 pacientes. O domínio "Impacto da doença nas atividades cotidianas" apresentou a maior média (82,79; DP=21,35), seguido pelo "Impacto social e emocional da doença" (61,24; DP=22,7). A média do escore total foi 210,55 (DP=51,7). Conclusão: os pacientes avaliaram o impacto da valvopatia como negativo no pré-operatório de cirurgia cardíaca.

Objective: to assess the impact of valvular heart disease on the daily life of patients in the preoperative period of heart surgery. Methods: we conducted a descriptive cross-sectional study using consecutive sampling. We used the assessment instrument "Impact of Valvular Heart Disease on the Daily Life of Patients", consisting of 14 items divided into four domains: "Physical impact - symptoms", "Impact on activities of daily living", "Social and emotional impact" and "Adaptation to the disease". Each domain is scored and an overall score is calculated based on the sum of all items, ranging from 14 to 350. The higher the score, the more negative the perceived impact. Results: 73 patients participated in the study. The domain that obtained the highest mean score was "Impact on activities of daily living" (82.79; SD = 21.35), followed by "Social and emotional impact" (61.24; SD = 22.7). The mean overall score was 210.55 (SD = 51.7). Conclusion: the patients rated the impact of valvular heart disease during the preoperative period of heart surgery as negative.

Determinants of Aortic Prosthesis Mismatch in a Brazilian Public Health System Hospital: Big Patients or Small Prosthesis? / Determinantes da Desproporção de Prótese Aórtica em Hospital de Atendimento de Saúde Pública Brasileiro: Pacientes Grandes ou Próteses Pequenas?

Abstract Background: Prosthesis-patient mismatch (PPM) is associated with worse outcomes. Objective: Determine the frequency and evaluate preoperatory variables independently associated with severe PPM in a tertiary hospital focused on Public Health Care. Methods: A total of 316 patients submitted to aortic valve replacement, who had echocardiography performed within the first 30 days after surgery, were retrospectively analyzed. The indexed effective orifice area (iEOA) of the prosthesis was used to classify the patients into three groups, according to PPM, considering body mass index (BMI): severe PPM (iEOA) < 0.65 cm2/m2), mild to moderate PPM (iEOA, 0.65 cm2/m2 - 0.85 cm2/m2) and without PPM (iEOA > 0.85 cm2/m2) for a BMI < 30 kg/m2 and severe PPM (iEOA) < 0.55 cm2/m2), mild to moderate (iEOA, 0.55 cm2/m2- 0.70 cm2/m2) and without PPM (iEOA > 0.7 cm2/m2) for a BMI > 30 kg/m2. Statistical significance was considered when p < 0.05. Results: iEOA was obtained in 176 patients. The frequency of severe and moderate PPM was 33.4% and 36.2%, respectively. Severe PPM patients were younger and had larger BMI, but smaller left ventricular outflow tract diameter (LVOTD). The independent variables used to predict severe PPM were male gender, BMI > 25 kg/m2, age < 60 years, LVOTD < 21 mm, and rheumatic etiology with an area under the ROC curve of 0.82. Conclusion: The frequency of severe PPM is high in a Brazilian population representative of the Public Health System, and it is possible to predict PPM from preoperative variables such as rheumatic valvular disease, gender, BMI, age and LVOTD.

Resumo Fundamento: A desproporção entre o tamanho da prótese aórtica-paciente (DPP) está associada a maior mortalidade. Objetivo: Determinar a frequência e avaliar variáveis ​​pré-operatórias associadas à DPP acentuada no cenário da saúde pública em hospital terciário. Métodos: 316 pacientes submetidos à troca valvar aórtica (TVA), com ecocardiograma realizado nos primeiros 30 dias após cirurgia, foram analisados retrospectivamente. A área de orifício efetivo indexado (AOEi) da prótese foi utilizada para classificar os pacientes em três grupos de acordo com a DPP, considerando o índice de massa corporal (IMC): DPP acentuada (AOEi) < 0,65 cm2/m2, DPP discreta a moderada (AOEi, 0,65 cm2/m2 - 0,85 cm2/m2) e sem DPP (iEOA > 0,85 cm2/m2) para IMC < 30 kg/m2 e DPP acentuada (AOEi) < 0,55 cm2/m2), discreta a moderada (AOEi, 0,55 cm2/m2 - 0,70 cm2/m2) e sem DPP (AOEi > 0,7 cm2/m2) para IMC > 30 kg/m2. Significância estatística foi considerada com p < 0,05. Resultados: A AOEi foi obtida em 176 pacientes. A frequência de DPP acentuada foi de 33,4% e moderada de 36,2%. Pacientes com DPP acentuada foram mais jovens e com maior IMC, mas menor diâmetro da via de saída do ventrículo esquerdo (DVSVE). As variáveis independentes que podem predizer DPP acentuada são: gênero masculino, IMC > 25 kg/m2, idade < 60 anos, DVSVE < 21 mm e etiologia reumática com área sob a curva ROC de 0,82. Conclusão: A frequência de DPP acentuada é alta em uma população brasileira submetida à TVA no Sistema Público de Saúde. Os principais determinantes de DPP acentuada são: valvopatia reumática, gênero masculino, IMC alto, idade < 60 anos e menor DVSVE.

Bioprosthetic aortic valve replacement in <50 years old patients - where is the evidence?

Abstract Aortic valve disease is one of the most common valvular heart diseases in the cardiovascular category. Surgical replacement of the diseased aortic valve remains the definitive intervention for most diseases. There is a clear consensus that in young patients who require aortic valve replacement, a mechanical prosthesis is the preferred choice due to its durable prosthesis without fear of wear and tear over time. However, this comes at the expense of increased risk of bleeding and thromboembolic events; in addition, there is a lack of strict evidence in using bioprosthesis in patients younger than 50 years. The objective of this review article is to assess the current evidence behind using bioprosthetic aortic valve in this young cohort.

The Russian conduit - combining bentall and ozaki procedures for concomitant ascending aorta replacement and aortic valve neocuspidization

Abstract In aortic valve disease cases, prosthetic valves have been used for valve replacement, however, these prostheses have inherent problems, and their quality in some countries is lower comparing to new-generation models, causing shorter durability. Aortic valve neocuspidization (AVNeo) has emerged as an option, which can be applied to a wide spectrum of these diseases. Despite the promising results, this procedure is not widely spread among cardiac surgeons yet. We developed a surgical technique combining Bentall and Ozaki procedures to treat patients with concomitant ascending aorta replacement and AVNeo and we describe it in this paper.

Replacement of the native mitral valve due to endocarditis caused by stenotrophomonas maltophilia

Abstract We report a case of a 59-year-old female patient with vegetative native mitral valve endocarditis caused by Stenotrophomonas maltophilia (SM). She had hemodialysis-dependent chronic renal failure, but no immunosuppressive disease. Echocardiography showed mobile vegetation on her native mitral valve. Right femoral artery embolectomy and mitral valve replacement were performed simultaneously. She awakened from anesthesia, but she passed away due to septic shock complications. To the best of our knowledge, this was the first case in whom native mitral valve endocarditis caused by SM was observed (despite of absence of any immunosuppressive event) and needed to undergo valve replacement.

Aortic valve neocuspidization with glutaraldehyde-treated autologous pericardium (ozaki procedure) - a promising surgical technique

Abstract In cases of aortic valve disease, prosthetic valves have been increasingly used for valve replacement, however, there are inherent problems with prostheses, and their quality in the so-called Third World countries is lower in comparison to new-generation models, which leads to shorter durability. Recently, transcatheter aortic valve replacement has been explored as a less invasive option for patients with high-risk surgical profile. In this scenario, aortic valve neocuspidization (AVNeo) has emerged as another option, which can be applied to a wide spectrum of aortic valve diseases. Despite the promising results, this procedure is not widely spread among cardiac surgeons yet. Spurred on by the last publications, we went on to write an overview of the current practice of state-of-the-art AVNeo and its results.

Symptomatic aortic valve mass - cardiac work-up challenges and role of computed tomography angiography: a case report

Abstract Cardiac papillary fibroelastoma are rare, benign cardiac tumors that may lead to lethal complications from embolization or valvular dysfunction if left untreated. When working up symptomatic tumors with concomitant angina, traditional diagnostic studies such as cardiac catheterization may predispose the patient to embolic complications if the mass is located in the path of the catheter. Newer, non-invasive diagnostic testing, such as cardiac magnetic resonance imaging or dynamic computed tomography angiography, may be considered in lieu of invasive approaches to avoid potentially devastating complications. We herein present a case report of a 77-year-old female with a symptomatic aortic valve tumor and describe our diagnostic strategy and management.

Minimally invasive video-assisted mitral valve replacement with a right chest small incision in patients aged over 65 years

Abstract Objective: To analyze and summarize the clinical safety and feasibility of minimally invasive video-assisted mitral valve replacement via a right thoracic minimal incision in patients aged over 65 years. Methods: The clinical data of 45 patients over 65 years old who had mitral valve disease were analyzed retrospectively from January 2014 to January 2017 at Union Hospital, Fujian Medical University. The patients were divided into two groups; 20 patients in group A, who underwent minimally invasive video-assisted mitral valve replacement via a right thoracic minimal incision, and 25 patients in group B, who underwent conventional mitral valve replacement. We collected and analyzed their relevant clinical data. Results: The operation was completed successfully in both groups. Compared with group B, group A was clearly superior for postoperative analgesia time, postoperative hospital length of stay, thoracic drainage liquid, blood transfusion, and length of incision. There were no differences between the two groups in postoperative severe complications and mortality. More patients in group B had pulmonary infections and poor incision healing, while more patients in group A had postoperative pneumothorax and subcutaneous emphysema. Conclusion: In patients aged over 65 years, minimally invasive video-assisted mitral valve replacement with a small incision in the right chest had the same clinical safety and efficacy as the conventional method.

Comparison of Biological and Mechanical Prostheses for Heart Valve Surgery: A Systematic Review of Randomized Controlled Trials / Comparação de Próteses Biológicas e Mecânicas para Cirurgia de Válvula Cardíaca: Revisão Sistemática de Estudos Controlados Randomizados

Abstract Background: The choice of a mechanical (MP) or biological prosthesis (BP) for patients with valvular heart disease undergoing replacement is still not a consensus. Objective: We aimed to determine the clinical outcomes of MP or BP placement in those patients. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) that compared biological prostheses and mechanical prostheses in patients with valvular heart diseases and assessed the outcomes. RCTs were searched in the MEDLINE, EMBASE, LILACS, CENTRAL, SCOPUS and Web of Science (from inception to November 2014) databases. Meta-analyses were performed using inverse variance with random effects models. The GRADE system was used to rate the quality of the evidence. A P-value lower than 0.05 was considered significant. Results: A total of four RCTs were included in the meta-analyses (1,528 patients) with follow up ranging from 2 to 20 years. Three used old generation mechanical and biological prostheses, and one used contemporary prostheses. No significant difference in mortality was found between BP and MP patients (risk ratio (RR = 1.07; 95% CI 0.99-1.15). The risk of bleeding was significantly lower in BP patients than MP patients (RR = 0.64; 95% CI 0.52-0.78); however, reoperations were significantly more frequent in BP patients (RR = 3.60; 95% CI 2.44-5.32). There were no statistically significant differences between BP and MP patients with respect to systemic arterial embolisms and infective endocarditis (RR = 0.93; 95% CI 0.66-1.31, RR = 1.21; CI95% 0.78-1.88, respectively). Results in the trials with modern and old prostheses were similar. Conclusions: The mortality rate and the risk of thromboembolic events and endocarditis were similar between BP and MP patients. The risk of bleeding was approximately one third lower for BP patients than for MP patients, while the risk of reoperations was more than three times higher for BP patients.

Resumo Fundamento: A escolha de próteses mecânicas ou biológicas para pacientes com doença de válvula cardíaca ainda não é um consenso. Objetivo: Determinar os desfechos clínicos de próteses mecânicas e biológicas nesses pacientes. Métodos: Conduzimos uma revisão sistemática e metanálise e estudos controlados randomizados (RCTs) que compararam próteses mecânicas e biológicas em pacientes com doenças de válvulas cardíaca, e avaliamos seus resultados. A busca por RCTs foi feita nas bases de dados MEDLINE, EMBASE, LILACS, CENTRAL, SCOPUS e Web of Science (do início a novembro de 2014). As metanálises foram realizadas usando variação inversa com modelos de efeitos aleatórios. Usamos o sistema GRADE para avaliar a qualidade da evidência. Um valor menor que 0,05 foi considerado significativo. Resultados: Um total de quatro RCTs foi incluído na metanálise (1528 pacientes) com acompanhamento de 2 a 20 anos. Em três estudos, foram utilizadas próteses mecânicas e biológicas mais antigas, e em um estudo próteses contemporâneas. Não foi observada diferença de mortalidade entre os pacientes que receberam próteses mecânicas e biológicas (risco relativo, RR = 1,07; IC95% 0,99-1,15). O risco de sangramento foi significativamente mais baixo nos pacientes que receberam próteses biológicas que naqueles com próteses mecânicas (RR = 0,64; IC95% 0,52-0,78). Contudo, as reoparações foram mais frequentes em pacientes com próteses biológicas (RR = 3,60; IC95% 2,44-5,32). Não houve diferenças estatisticamente significativas entre pacientes com próteses biológicas e mecânicas em relação à embolia arterial sistêmica e endocardite infecciosa (RR = 0,93; IC95% 0,66-1,31; RR = 1,21; IC95% 0,78-1,88, respectivamente). Resultados entre os estudos com próteses modernas e antigas foram similares. Conclusões: A taxa de mortalidade e o risco de eventos tromboembólicos e endocardite foram similares entre os pacientes que receberam próteses biológicas e mecânicas. O risco de sangramentos foi aproximadamente um terço menor nos pacientes com próteses biológicas que mecânicas, ao passo que o risco de reoperação foi mais que três vezes maior nos pacientes com próteses biológicas.

Accidente cerebrovascular embólico secundario a fibroelastoma papilar de válvula mitral / Embolic stroke secondary to a mitral valve fibroelastoma: case report

Embolic stroke secondary to cardiac tumors is uncommon. However, 25-30% of cardiac tumors may cause systemic emboli. We report a 29-year-old male consulting for a sudden episode of aphasia and right hemiparesis, compatible with infarct of the left middle cerebral artery territory. Transthoracic echocardiography reported an ovoid tumor of 8 × 7 × 7 mm in relation to the sub valvular apparatus of the mitral valve. After neurologic stabilization, surgical treatment was performed. Approached by median sternotomy and in cardiopulmonary bypass, the mitral valve was explored. A macroscopic tumor consistent with a papillary fibroelastoma curled in sub valvular chordae was found. It was deployed and resected from its base, while the anterior mitral leaflet was preserved intact. Histopathological examination confirmed the intraoperative macroscopic diagnosis. The patient recovered uneventfully postoperatively and was discharged on the fifth day after surgery. He currently is in functional capacity I without cardiovascular symptoms at five years follow-up.

Fatores de risco associados à mortalidade hospitalar em reoperação valvar mitral / Risk factors associated with hospital mortality in mitral valve reoperation

RESUMO Objetivo: identificar os fatores associados à mortalidade em reoperação valvar mitral, criar um modelo preditivo de mortalidade e avaliar o EuroSCORE. Métodos: foram avaliados 65 pacientes submetidos à reoperação de valva mitral no período de janeiro de 2008 a dezembro de 2017. Foi verificada a associação das variáveis com o óbito e criado um modelo de regressão logística múltiplo para estratificar os pacientes. Resultados: a mortalidade hospitalar foi de 13,8% e, neste grupo, o EuroSCORE foi de 12,33±8,87 (p=0,017), a fração de ejeção do ventrículo esquerdo (FEVE) foi de 45,33±5,10 (p=0,000), a creatinina foi 1,56±0,29 (p=0,002), o tempo de atividade da protrombina (TAP): 1,64±0,15 (p=0,001), pressão sistólica da artéria pulmonar (PSAP): 66,1±13,6 (p=0,002), sexo feminino: 88% (p=0,000), desnutrição: 77,7% (p=0,007), doença tricúspide associada: 44,4% (p=0,048), presença de arritmia ventricular: 77,7% (p=0,005), implante de prótese biológica: 55,5% (p=0,034), broncopneumonia e sepse: 33,3% (p=0,048), síndrome da resposta inflamatória sistêmica (SIRS): 55,5% (p=0,001), síndrome do baixo débito cardíaco: 88,8% (p=0,000). Conclusão: os fatores associados à mortalidade foram: EuroSCORE, FEVE, creatinina, TAP, PSAP, sexo feminino, desnutrição, doença tricúspide, arritmia ventricular, implante de prótese biológica, SIRS, SBDC, broncopneumonia e sepse. As variáveis explicativas de óbito do modelo foram: EuroSCORE, creatinina, TAP, FEVE, tempo de internamento na unidade de terapia intensiva (UTI), intervalo entre cirurgias e presença de arritmia ventricular. O EuroSCORE elevado está relacionado à maior mortalidade.

ABSTRACT Objective: to identify the factors associated with mortality in mitral valve reoperation, to create a predictive model of mortality and to evaluate the EuroSCORE. Methods: a total of 65 patients were evaluated from January 2008 to December 2017. It was verified the association of variables with death and a multiple logistic regression model was used to stratify patients. Results: hospital mortality was 13.8% and in the Death Group: EuroSCORE was 12.33±8.87 (p=0.017), the left ventricular ejection fraction (LVEF) was 45.33±5.10 (p=0.000), the creatinine was 1.56±0.29 (p=0.002), the prothrombin time (TAP) was 1.64 (p=0.001), pulmonary artery systolic pressure (PSAP): 66.1±13.6 (p=0.002), female: 88% (p=0.000), malnutrition: 77.7% (p=0.007), associated tricuspid disease: 44,4% (p=0.048), presence of ventricular arrhythmia: 77.7% (p=0.005), implantation of a biological prosthesis: 55.5% (p=0.034), bronchopneumonia and sepsis: 33,3% (p=0.048), systemic inflammatory response syndrome (SIRS): 55.5% (p=0.001), low cardiac output syndrome (LCOS): 88.8% (p=0.000). Conclusion: the factors associated with mortality were: EuroSCORE, LVEF, creatinine, TAP, PSAP, female, malnutrition, tricuspid disease, ventricular arrhythmia, implantation of biological prosthesis, SIRS, SBDC, bronchopneumonia and sepsis. The explanatory variables of death of the model were: EuroSCORE, creatinine, TAP, LVEF, length of stay in the intensive care unit (ICU), interval between surgeries and presence of ventricular arrhythmia. The high EuroSCORE is related to higher mortality.

Which method to use for surgical ablation of atrial fibrillation performed concomitantly with mitral valve surgery: radiofrequency ablation versus cryoablation

Abstract Objective: The effects of energy source on the maintenance of sinus rhythm and the contribution of demographic characteristics to the case selection in patients submitted to ablation performed concurrently with mitral valve surgery were analyzed. Methods: Cryothermal (n=42; 43.8%) and radiofrequency (n=54; 56.3%) energy were employed in 96 patients submitted to mitral valve replacement and Cox maze IV procedure. Patients were called for control visits between 15 days and 12 months after discharge. The causal relationship between recurrence of atrial fibrillation and factors such as left atrial diameter, C-reactive protein, hypertension, left ventricular ejection fraction, chronic obstructive pulmonary disease, and body mass index was determined. Results: Maintenance rates of the sinus rhythm with radiofrequency and cryoablation were 97.6% and 96.3%, respectively, in the first postoperative month, whereas at the 12th postoperative month were 88.1% and 83.3%. No significant difference was found between groups in relation to the energy source. Sensitivity and specificity for left atrial diameter with a cut-off value of 50.5 mm were 85.7% and 70.7%, respectively. Sensitivity and specificity for C-reactive protein with a cut-off value of 12 mg/dL on the 15th postoperative day were 83.3% and 88.9%, respectively. The effect of body mass index on atrial fibrillation recurrence was 3.2 times. Sensitivity and specificity for left ventricular ejection fraction 37% cut-off value were 96.3% and 11.4%, respectively. Atrial fibrillation in hypertensive cases was 5.3 times more. In patients with chronic obstructive pulmonary disease, recurrence of atrial fibrillation was 40%. The causal relation between recurrence of atrial fibrillation and the studied factors was established. Conclusion: Demographic characteristics have a significant impact on ablation efficiency, while the type of energy source does not.