Del Nido cardioplegia in adult cardiac surgery: Clinical outcomes in a single center all-comer study.

INTRODUCTION: The use of Del Nido Cardioplegia (DNC) has been extended in the latest years from pediatrics to adult cardiac surgery with encouraging results. We sought to investigate clinical and biochemical outcomes in adult patients who underwent cardiac surgery with different degrees of complexity who received DNC for myocardial protection. METHODS: Data on one-thousand patients were retrospectively collected from 2020 to 2022. The only exclusion criteria was off-pump adult cardiac surgery. Surgical procedures weight was categorized according EuroSCORE II in six groups: Single-CABG(G1), isolated non-CABG(mitral) (G2), isolated non-CABG(aortic) (G3), isolated non-CABG(any) (G4), 2-procedures(G5), 3/more-procedures(G6). Primary endpoint was to identify a binomial correlation between hs-TnT/CK-MB and the cross-clamp time (X-Clamp). A secondary endpoint was the comparison between the treatment groups of the vasoactive-inotropic score (VIS) and the need of mechanical circulatory support (MCS). RESULTS: A linear correlation was identified between hs-TnT and X-clamp in the overall population (rho:0.447, p< .001) and in the treatment groups (G1:rho=0.357, p< .001/G2:rho=0.455, p< .001/G3:rho=0.307, p= .001/G4:rho=0.165, p= .257/G5:rho=0.157, p= .031/G6:rho=0.226, p= .015). Similarly, a linear correlation between CK-MB and X-clamp in the overall population (rho=0.457, p< .001) and treatment group (G1:rho=0.282, p< .001/G2:rho=0.287, p= .025/G3:rho=0.211, p= .009/G4:rho=0.0878, p= .548/G5:rho=0.309, p< .001/G6: rho=0.212, p= .024) was identified. As regard for the secondary endpoint, no differences were reported between the treatment groups in terms of VIS and MCS (VIS G1:7; G2:4; G3:7; G4:7, G5:5.5, G6:6, p-value= .691) (MCS G1: 4.5%; G2:4.8%; G3:3.3%; G4:3.1%; G5:1.4%; G6:5.3%; p-value= .372). CONCLUSIONS: Del Nido Cardioplegia is a safe and useful tool in adult cardiac surgery allowing operators to achieve a stable and durable cardioplegic arrest. Despite accounting with different types of surgery, the six subgroups of our study population showed similar perioperative results.

Prognostic implications of nonsustained ventricular tachycardia morphology in high-risk patients with hypertrophic cardiomyopathy.

INTRODUCTION: The prognostic impact of nonsustained ventricular tachycardia (NSVT) morphology has never been explored in hypertrophic cardiomyopathy (HCM). In a single-center cohort of consecutive HCM patients implanted with an implanted cardioverter-defibrillator (ICD), we assessed NSVT morphology patterns and their prognostic implications. METHODS: A cohort of consecutive HCM patients implanted with an ICD was followed from ICD implantation to last follow-up visit. Patients were assessed for NSVT as stored events in ICD memory. Ventricular tachycardias (VTs) were classified as monomorphic (MM) or polymorphic according to intracardiac electrogram morphology. RESULTS: One hundred nine consecutive HCM patients (68 males; mean age: 45 ± 17 years) composed the study population. During follow-up (71 ± 48 months), 7 polymorphic NSVT in 4 patients and 370 MM NSVT in 42 patients were retrieved from ICD memory. Among patients with only MM NSVT, 19 (45%) had one morphology, 17 (41%) had two morphologies, 3 (7%) had three morphologies, and 3 (7%) had four morphologies. Patients with polymorphic NSVT had the highest risk of ICD interventions (HR, 5.04; 95% CI, 1.26-20.19; P = .02). A stepwise increase of the risk of ICD interventions in patients with two, three, and four NSVT morphologies was observed. Out of 16 patients with both NSVT and ICD-treated VTs, 13 (81%) had at least one ICD-treated VT with the same morphology of a previous long-lasting NSVT. CONCLUSIONS: In high-risk HCM patients, the occurrence of polymorphic NSVT and of NSVT with multiple morphologies carries a high risk for ICD interventions. Sustained VTs tend to recur with the same morphology of previous long-lasting NSVTs.

Assessing Atrial Fibrillation Substrates by P Wave Analysis: A Comprehensive Review.

Atrial fibrillation (AF) is the most common cardiac arrhythmia. Pharmacologic and non-pharmacologic rhythm control strategies impact on AF-related symptoms, while leaving largely unaffected the risk of stroke. Moreover, up to 20% of AF patients are asymptomatic during paroxysmal relapses of arrhythmia, thus underlying the need for early markers to identify at-risk patients and prevent cerebrovascular accidents. Indeed, non-invasive assessment of pre-clinical substrate changes that predispose to AF could provide early identification of at-risk patients and allow for tailored care paths. ECG-derived P wave analysis is a simple-to-use and inexpensive tool that has been successfully employed to detect AF-associated structural and functional atrial changes. Beyond standard electrocardiographic techniques, high resolution signal averaged electrocardiography (SAECG), by recording microvolt amplitude atrial signals, allows more accurate analysis of the P wave and possibly AF risk stratification. This review focuses on the evidence that support P wave analysis to assess AF substrates, predict arrhythmia relapses and guide rhythm-control interventions.