Left atrial function after standalone totally thoracoscopic left atrial appendage exclusion in atrial fibrillation patients with absolute contraindication to oral anticoagulation therapy.

Background: Left atrial appendage (LAA) is a common source of thrombi in patients with atrial fibrillation (AF). The effect on left atrial (LA) function of the Totally Thoracoscopic (TT)-LAA exclusion with epicardial clip is currently unknown. This study aims at evaluating the effect of TT-LAA exclusion on LA function. Methods: Standalone TT-LAA exclusion with the clip device was performed in 26 patients with AF and contraindication to oral anticoagulation (OAC). A 3D CT scan, trans-esophageal echocardiography, spirometry and cerebrovascular doppler ultrasound were performed preoperatively. Clip positioning and LAA exclusion were guided and confirmed by intraoperative trans-esophageal echo. To evaluate LA function, standard transthoracic echocardiography and 2D strain of LA were performed before surgery, at discharge and at 3-month follow-up. Results: The mean CHA2DS2-VASc and HASBLED scores were 4.6 and 2.4 respectively. There were no major complications during the procedure. At median follow-up of 10.3 months, 1 (3.8%) non-cardiovascular death, 1 (3.8%) stroke and 4 (15.4%) cardiovascular hospitalizations occurred. At 2D strain of LA, the reservoir function decreased significantly at discharge, compared to baseline and recovered at 3-months follow-up. Furthermore, NT-proBNP increased significantly after the procedure with a return to baseline after 3 months. Changes in E/A were persistent at 3 months. Conclusion: Our data in a small cohort suggest that TT-LAA exclusion with epicardial clip can be a safe procedure with regards to the atrial function. The LAA amputation impairs the reservoir LA function on the short term, that recovers over time.

[Risk assessment and early predictors of survival after out-of-hospital cardiac arrest in the province of Trento, Italy]. / La valutazione del rischio e predittori precoci di sopravvivenza dopo arresto cardiaco extraospedaliero in provincia di Trento.

BACKGROUND: Early prognostication of patients experiencing out-of-hospital cardiac arrest (OHCA) remains difficult, with no recommended risk assessment tool. The aim of this study was to determine and assess the association between available variables with survival at discharge of patients with OHCA in our regional reality. METHODS: We conducted a retrospective observational study in a single-center cohort of 236 consecutive patients with OHCA and return of spontaneous circulation admitted to the S. Chiara Hospital (Trento, Italy) from 2012 to 2015. We applied a backward stepwise multivariable logistic regression performed on 26 variables significantly related to outcome to identify predictors. The final model was evaluated for discrimination with area under the curve (AUC) of a receiver operating characteristic curve and for calibration with Hosmer-Lemeshow test and with calibration belt. RESULTS: We identified four independent factors predictive of outcome: age, arterial blood pH, coronary angiography execution and intervention of helicopter. The final model presented good discrimination with an average AUC of 0.78 (95% confidence interval 0.72-0.84) and was well calibrated, as confirmed by the Hosmer-Lemeshow test (p=0.45) and the calibration belt plot (p=0.597). CONCLUSIONS: Age, arterial blood pH, coronary angiography execution and intervention of helicopter were variables predictive of outcome. Identified predictors are in agreement with the literature and relate to local reality. Accurate prognostic assessment would facilitate an earlier identification of patients who may benefit from intensive advanced post-resuscitation care.

Traumatic avulsion of the tricuspid valve after gas bottle explosion.

UNLABELLED: SummaryWe present a very rare example of chronic right heart failure caused by torrent tricuspid regurgitation. Massive right heart dilatation and severe tricuspid regurgitation due to avulsion of the tricuspid valve apparatus occurred as a result of a blunt chest trauma following the explosion of a gas bottle 20 years before admission, when the patient was a young man in Vietnam. After this incident, the patient went through a phase of severe illness, which can retrospectively be identified as an acute right heart decompensation with malaise, ankle edema, and dyspnea. Blunt chest trauma caused by explosives leading to valvular dysfunction has not been reported in the literature so far. It is remarkable that the patient not only survived this trauma, but had been managing his chronic heart failure well without medication for over 20 years. LEARNING POINTS: Thorough clinical and physical examination remains the key to identifying patients with relevant valvulopathies.With good acoustic windows, TTE is superior to TEE in visualizing the right heart.Traumatic avulsion of valve apparatus is a rare but potentially life-threatening complication of blunt chest trauma and must be actively sought for. Transthoracic echocardiography remains the method of choice in these patients.