Left ventricular mass index as a prognostic factor in patients with severe aortic stenosis and ventricular dysfunction.

Ventricular dysfunction and high hypertrophy may influence surgical outcome in aortic stenosis. Our aim was to determine whether an excessive left ventricular mass index (LVMI) discriminates different risk profiles in aortic stenosis with low ventricular ejection fraction (LVEF). Three hundred and thirty-nine patients with severe aortic stenosis underwent valve replacement (Mar-1994 and Nov-2001). LVMI values over the superior quartile were considered increased. Mortality models were constructed in global and LVEF

[Ablation of permanent atrial fibrillation in cardiac surgery. Short-term and mid-term results]. / Ablación de la fibrilación auricular permanente en la cirugía cardíaca. Resultados a corto y medio plazo.

INTRODUCTION: Surgical ablation of atrial fibrillation is currently a simple procedure that can be done during cardiac surgery in most patients. A number of different energy sources now available allow to easily create ablation lines in the atria. We describe our experience during the previous three years. PATIENTS AND METHOD: In 93 patients with cardiac problems treated with surgery and permanent atrial fibrillation (longer than 3 months), surgical ablation of the arrhythmia was done at the same time. Mean duration of the atrial fibrillation was 6 years (range 0.3 to 24 years). Mean (SD) preoperative size of the atrium as measured echocardiographically was 51.7 (8.8) mm (range 35 to 77 mm). RESULTS: Five patients died in the hospital (5.3% in-hospital mortality). After a mean follow-up of 10 months, 83.8% of the patients had recovered and maintained sinus rhythm, and 16.1% of the patients remained in atrial fibrillation. A permanent pacemaker was implanted in 3 of these patients. Among the 82 patients followed for more than 6 months, the prevalence of sinus rhythm was 84.1%. Echocardiographically documented contractility in both atria was observed in 50% of the patients. Major complications related to the ablation procedure occurred in 3.5% of the patients, and consisted of a perivalvular leak 2 months after surgery, a circumflex artery spasm, and an atrio-esophageal fistula. CONCLUSIONS: Surgical ablation of permanent atrial fibrillation is a simple procedure associated with low morbidity and mortality, and with recovery of sinus rhythm in most patients. The main problem with the procedure is the incidence of early postoperative arrhythmias.