In this trial, patients with atrial fibrillation undergoing mitral-valve surgery were assigned to surgical ablation of AF or no ablation. At 6 and 12 months, more patients in the ablation group were ...free from AF, but more patients in that group required permanent pacemakers.
Atrial fibrillation, which is associated with reduced survival and increased risk of stroke, is present in 30 to 50% of patients presenting for mitral-valve surgery.
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The development of open surgical procedures for the ablation of atrial fibrillation has led to their widespread application during cardiac operations, but their effectiveness and safety have not been rigorously established. It is hypothesized that long-term outcomes can be improved by successful ablation in patients with preexisting persistent or long-standing persistent atrial fibrillation who are undergoing mitral-valve surgery.
The Cox maze III operation (sometimes called the “cut-and-sew” maze operation) is a complex surgical procedure . . .
In a randomized trial involving patients undergoing mitral-valve surgery for degenerative mitral regurgitation, the addition of tricuspid repair resulted in a lower risk of the primary outcome, a ...composite of reoperation for tricuspid regurgitation, progression of tricuspid regurgitation, or death. Tricuspid repair resulted in more frequent permanent pacemaker implantation.
Mediastinal infections are a potentially devastating complication of cardiac operations. This study analyzed the frequency, risk factors, and perioperative outcomes of mediastinal infections after ...cardiac operations.
In 2010, 5,158 patients enrolled in a prospective study evaluating infections after cardiac operations and their effect on readmissions and mortality for up to 65 days after the procedure. Clinical and demographic characteristics, operative variables, management practices, and outcomes were compared for patients with and without mediastinal infections, defined as deep sternal wound infection, myocarditis, pericarditis, or mediastinitis.
There were 43 mediastinal infections in 41 patients (cumulative incidence, 0.79%; 95% confidence interval CI 0.60% to 1.06%). Median time to infection was 20.0 days, with 65% of infections occurring after the index hospitalization discharge. Higher body mass index (hazard ratio HR 1.06; 95% CI, 1.01 to 1.10), higher creatinine (HR, 1.25; 95% CI, 1.13 to 1.38), peripheral vascular disease (HR, 2.47; 95% CI, 1.21 to 5.05), preoperative corticosteroid use (HR, 3.33; 95% CI, 1.27 to 8.76), and ventricular assist device or transplant surgery (HR, 5.81; 95% CI, 2.36 to 14.33) were associated with increased risk of mediastinal infection. Postoperative hyperglycemia (HR, 3.15; 95% CI, 1.32 to 7.51) was associated with increased risk of infection in nondiabetic patients. Additional length of stay attributable to mediastinal infection was 11.5 days (bootstrap 95% CI, 1.88 to 21.11). Readmission rates and mortality were five times higher in patients with mediastinal infection than in patients without mediastinal infection.
Mediastinal infection after a cardiac operation is associated with substantial increases in length of stay, readmissions, and death. Reducing these infections remains a high priority, and improving post-operative glycemic management may reduce their risk in patients without diabetes.
The Fe(III) spin-switching complexes Fe(qsal-5-Y)2X (where Y = F, Cl, Br, I or OMe; X = NCS–, Cl–, OTf–, NO3 –, BF4 –, PF6 –, or BPh4 –) display a variety of thermal spin transition profiles, ...including abrupt, stepped, and hysteretic, with potential applications as temperature- or gas-dependent switches or memory/storage devices. Here, the complex Fe(qsal-OMe)2NCS is encased within discrete anionic supramolecular motifs in cocrystalline Fe(qsal-OMe)2(1,3,5-triiodotrifluorobenzene)(NCS)·MeOH/H2O (1·IFB·solvent). The MeOH and H2O solvate within these robust crystals can be reversibly exchanged, giving an artificial triple hysteresis, with six different stable magnetic states and a ΔT 1/2 of 95 K (MeOH versus H2O solvatomorphs), which represent the workings of a stimulated logic gate that can be reset with heat or vacuum. Variable-temperature single-crystal X-ray diffraction (VT-SCXRD) elucidated the entire spin transition profile of the parent complex Fe(qsal-OMe)2(NCS)·MeCN (1·MeCN) and the anionic supramolecular framework-like adducts Fe(qsal-OMe)2(1,3,5-triiodotrifluorobenzene)(NCS) (1·IFB), Fe(qsal-OMe)2(1,3,5-triiodotrifluorobenzene)(NCS)·MeOH (1·IFB·MeOH) and Fe(qsal-OMe)2(1,3,5-triiodotrifluorobenzene)(NCS)·H2O (1·IFB·H 2 O), with full structures collected every 5 or 10 K (total of 202 individual structures) over a temperature range of 100–450 K. The reversible solvent exchange and magnetic changes suggest that crystalline 1·IFB may be used as a specialized molecular magnetic sensor for MeOH and H2O.
The use of topical vancomycin in the reduction of sternal wound infection (SWI) risk has become a point of contention. The earlier literature consists of observational studies and 1 unblinded trial. ...Hence, the objective of this study was to assess whether vancomycin reduces the incidence of SWI in a double-blind randomized controlled trial.
Patients were randomized 1:1 to either vancomycin-soaked (vancomycin) or saline-soaked (control) sponges. The sponges were applied once the sternum was opened and were removed just before sternal closure. Patients were followed up at 3 months and at 1 year postoperatively to determine the incidence of SWI in each group. Results were analyzed according to the modified intention-to-treat principle.
This study assessed 1038 patients for eligibility and enrolled 1037 patients. There were 517 patients randomized to the vancomycin group and 520 patients randomized to the control group. Analysis was performed on 1021 patients. At 3 months postoperatively, there was no significant difference in the incidence of SWI between the vancomycin and control groups (2.7% vs 4.1%; P = .23). There was also no significant difference between the vancomycin and control groups in the risk of superficial, deep, and organ-space infections. Similar findings were observed 1 year postoperatively. The most common organism isolated was coagulase-negative Staphylococcus.
The use of vancomycin applied to the sternum during cardiac surgery does not reduce the incidence of SWI.
BACKGROUND:In ischemic mitral regurgitation (IMR), ring annuloplasty is associated with a significant rate of recurrent MR. Ring size is based on intertrigonal distance without consideration of left ...ventricular (LV) size. However, LV size is an important determinant of mitral valve (MV) leaflet tethering before and after repair. We aimed to determine whether LV-MV ring mismatch (mismatch of LV size relative to ring size) is associated with recurrent MR in patients with IMR after restrictive ring annuloplasty.
METHODS:Patients with moderate or severe IMR from the 2 Cardiothoracic Surgical Trials Network IMR trials who received MV repair were examined at 1 year after surgery. Baseline LV size was assessed by LV end-diastolic dimension and LV end-systolic dimension (LVESd). LV-MV ring mismatch was calculated as the ratio of LV to ring size (LV end-diastolic dimension/ring size and LVESd/ring size).
RESULTS:At 1 year after ring annuloplasty, 45 of 214 patients with MV repair (21%) had moderate or greater MR. In univariable logistic regression analysis, larger LVESd (P=0.02) and LVESd/ring size (P=0.007) were associated with recurrent MR. In multivariable models adjusted for age, sex, baseline LV ejection fraction, and severe IMR, only LVESd/ring size (odd ratio per 0.5 increase, 2.20; 95% confidence interval, 1.05–4.62; P=0.038) remained significantly associated with 1-year MR recurrence.
CONCLUSIONS:LV-MV ring size mismatch is associated with increased risk of MR recurrence. This finding may be helpful in guiding choice of ring size to prevent recurrent MR in patients undergoing MV repair and in identifying patients who may benefit from MV repair with additional subvalvular intervention or MV replacement rather than repair alone.
CLINICAL TRIAL REGISTRATION:URL:http://clinicaltrials.gov. Unique identifiersNCT00806988 and NCT00807040.
Objective: Overweight and obesity are often assumed to be risk factors for postprocedural mortality in patients with coronary artery disease (CAD). However, recent studies have described an “obesity ...paradox”—a neutral or beneficial association between obesity and mortality postcoronary revascularization. We reviewed the effect of overweight and obesity systematically on short‐ and long‐term all‐cause mortality post‐coronary artery bypass grafting (CABG) and post‐percutaneous coronary intervention (PCI).
Methods: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Scopus, and Web of Science to identify cohort, case control, and randomized controlled studies evaluating the effect of obesity on in‐hospital/short‐term (within 30 days) and long‐term (up to 5 years) mortality. Full‐text, published articles reporting all‐cause mortality between individuals with and without elevated BMI were included. Two reviewers independently assessed studies for inclusion and performed data extraction.
Results: Twenty‐two cohort publications were identified, reporting results in ten post‐PCI and twelve post‐CABG populations. Compared to individuals with non‐elevated BMI levels, obese patients undergoing PCI had lower short‐ (odds ratio (OR) 0.63; 95% confidence interval (CI) 0.54–0.73) and long‐term mortality (OR 0.65; 95% CI 0.51–0.83). Post‐CABG, obese patients had lower short‐term (OR 0.63; 95% CI 0.56–0.71) and similar long‐term (OR 0.88; 95% CI 0.60–1.29) mortality risk compared to normal weight individuals. Results were similar in overweight patients for both procedures.
Conclusions: Compared to non‐obese individuals, overweight and obese patients have similar or lower short‐ and long‐term mortality rates postcoronary revascularization. Further research is needed to confirm the validity of these findings and delineate potential underlying mechanisms.
Left ventricular assist device (LVAD) use in patients with dilated cardiomyopathy (DCM) can lead to a differential response in the LV and right ventricle (RV), and RV failure remains the most common ...complication post-LVAD insertion. We assessed transcriptomic signatures in end-stage DCM, and evaluated changes in gene expression (mRNA) and regulation (microRNA/miRNA) following LVAD. LV and RV free-wall tissues were collected from end-stage DCM hearts with (
= 8) and without LVAD (
= 8). Non-failing control tissues were collected from donated hearts (
= 6). Gene expression (for mRNAs/miRNAs) was determined using microarrays. Our results demonstrate that immune response, oxygen homeostasis, and cellular physiological processes were the most enriched pathways among differentially expressed genes in both ventricles of end-stage DCM hearts. LV genes involved in circadian rhythm, muscle contraction, cellular hypertrophy, and extracellular matrix (ECM) remodelling were differentially expressed. In the RV, genes related to the apelin signalling pathway were affected. Following LVAD use, immune response genes improved in both ventricles; oxygen homeostasis and ECM remodelling genes improved in the LV and, four miRNAs normalized. We conclude that LVAD reduced the expression and induced additional transcriptomic changes of various mRNAs and miRNAs as an integral component of the reverse ventricular remodelling in a chamber-specific manner.
Coordination cages can be used for enantio‐ and regioselective catalysis and for the selective sensing and separation of isomeric guest molecules. Here, stereoisomers of a family of coordination ...cages are resolved using ultra‐high‐resolution cyclic ion‐mobility mass spectrometry (cIM‐MS). The observed ratio of diastereomers is dependent on both the metal ion and counter ion. Moreover, the point groups can be assigned through complementary NMR experiments. This method enables the identification and interrogation of the individual isomers in complex mixtures of cages which cannot be performed in solution. Furthermore, these techniques allow the stability of individual isomers within the mixture to be probed, with the T‐symmetric isomers in this case shown to be more robust than the C3 and S4 analogues.
Isomeric coordination cages are separated and individually investigated using ultra‐high‐resolution ion‐mobility mass spectrometry. Alongside iron(II), supramolecular species containing cobalt(II) and nickel(II) were also investigated, successfully demonstrating a new approach for the investigation of paramagnetic complexes.
ARHGAP42 encodes Rho GTPase activating protein 42 that belongs to a member of the GTPase Regulator Associated with Focal Adhesion Kinase (GRAF) family. ARHGAP42 is involved in blood pressure control ...by regulating vascular tone. Despite these findings, disorders of human variants in the coding part of ARHGAP42 have not been reported. Here, we describe an 8-year-old girl with childhood interstitial lung disease (chILD), systemic hypertension, and immunological findings who carries a homozygous stop-gain variant (c.469G>T, p.(Glu157Ter)) in the ARHGAP42 gene. The family history is notable for both parents with hypertension. Histopathological examination of the proband lung biopsy showed increased mural smooth muscle in small airways and alveolar septa, and concentric medial hypertrophy in pulmonary arteries. ARHGAP42 stop-gain variant in the proband leads to exon 5 skipping, and reduced ARHGAP42 levels, which was associated with enhanced RhoA and Cdc42 expression. This is the first report linking a homozygous stop-gain variant in ARHGAP42 with a chILD disorder, systemic hypertension, and immunological findings in human patient. Evidence of smooth muscle hypertrophy on lung biopsy and an increase in RhoA/ROCK signaling in patient cells suggests the potential mechanistic link between ARHGAP42 deficiency and the development of chILD disorder.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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