Identification of new-onset atrial fibrillation after cardiac surgery in Vietnam. A feasibility study of a novel screening strategy in a limited-resource setting: study protocol.

INTRODUCTION: Atrial fibrillation (AF) developing after cardiac surgery is the most common postoperative complication with an incidence up to 50%. The presence of postoperative AF is associated with significant morbidity, mortality and economic burden. However, in Vietnam, data on AF postcardiac surgery are limited, in part due to a shortage of screening equipment. This project aims to identify the incidence, risk factors and postoperative complications of new-onset postoperative AF after cardiac surgery, and the feasibility of introducing a novel screening strategy using the combination of two portable devices to detect AF. METHODS AND ANALYSIS: This is a feasibility study examining patients who are (1) ≥18 years old; (2) undergoing coronary artery bypass graft and/or valve surgery and (3) in normal sinus rhythm prior to their operation. Patients with congenital heart disease, a prior history of AF or those who require a pacemaker after surgery will be excluded. All patients will be followed up for the duration of their hospitalisation. The screening strategy will include monitoring the continuous ECG tracing in the intensive care unit, and if AF is suspected, a 30 s lead-1 ECG will be recorded using the smartphone-based AliveCor Kardia Mobile. On the postoperative wards, blood pressure will be measured three times daily using a modified blood pressure device (Microlife BP200 Afib): and if AF is suspected a 30 s ECG will be recorded using the AliveCor Kardia Mobile. A 12-lead ECG may be ordered subsequently if clinically indicated. The primary outcome is the incidence of postoperative AF. Secondary outcomes include establishing the risk factors and complications associated with postoperative AF; and the barriers and facilitators of the screening strategy. ETHICS AND DISSEMINATION: Ethics approval was granted by Scientific Board of Cardiovascular Centre, E Hospital on 28 September, 2017. Study results will be disseminated through local and international conferences and peer-reviewed publications.

Totally Endoscopic Resection of Giant Left Atrial Myxoma Without Robotic Assistance.

There was no report on the application of totally endoscopic surgery for giant atrial myxoma resection. A 62-year-old female patient with giant atrial myxoma causing severe mitral stenosis and acute pulmonary edema underwent a successful operation by totally endoscopic techniques without the assistance of robotic systems using four small trocar ports (three 5-mm trocars and one 12-mm trocar). The patient recovered uneventfully and was satisfied with cosmetic results.

Totally Endoscopic Cardiac Surgery for Atrial Septal Defect Repair on Beating Heart Without Robotic Assistance in 25 Patients.

OBJECTIVE: The aim of the study was to investigate the effectivity and safety of totally endoscopic cardiac surgery without robotic assistance for atrial septal defect (ASD) closure on beating hearts. METHODS: Twenty-five patients (adults/children: 15/10) underwent ASD closure using nonrobotically assisted totally endoscopic approach on beating heart. Three 5-mm trocars and one 12-mm trocar were used, only the superior vena cava is snared, filling the pleural and pericardial cavities with CO2, and the heart was beating during the surgery. Twenty-three patients had isolated secundum ASD (2 of which had severe tricuspid regurgitation) and two patients had ASD combined with partial anomalous pulmonary venous connection. All ASDs were closed using artificial patch, continuous suture; tricuspid regurgitations were repaired and the anomalous pulmonary veins were drained to the left atrium. RESULTS: No postoperative complications or deaths occurred. Mean ± SD operation time and mean cardiopulmonary bypass time were 267.2 ± 44.6 and 156.1 ± 33.6 min, respectively. These patients were extubated within the first 5 hours, and the volume of blood drainage on the first day was less than 80 mL. Four days after surgery, patients did not need analgesics and were able to return to normal activities 1 week postoperatively. CONCLUSIONS: Totally endoscopic operation for ASD closure on beating heart is safe, with short recovery period, and surgical scars are of high cosmetic value, especially in a woman and girl.