The Annals of thoracic surgery
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Review Meta Analysis Comparative Study
Association between obesity and postoperative atrial fibrillation in patients undergoing cardiac operations: a systematic review and meta-analysis.
In a systematic review and random-effects meta-analysis, we evaluated whether obesity is associated with postoperative atrial fibrillation (POAF) in patients undergoing cardiac operations. We selected 18 observational studies until December 2011 that excluded patients with preoperative AF (n=36,147). ⋯ The association between obesity and POAF did not vary substantially by type of cardiac operation, study design, or year of publication. POAF was significantly associated with a higher risk of stroke, respiratory failure, and operative death.
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Randomized Controlled Trial Comparative Study
Primary endpoints of the biventricular pacing after cardiac surgery trial.
This study sought to determine whether optimized biventricular pacing increases cardiac index in patients at risk of left ventricular dysfunction after cardiopulmonary bypass. Procedures included coronary artery bypass, aortic or mitral surgery and combinations. This trial was approved by the Columbia University Institutional Review Board and was conducted under an Investigational Device Exemption. ⋯ Cardiac index did not increase significantly overall but increased 29% after aortic valve surgery. Mean arterial pressure increased with pacing at 3 time points. Additional studies are needed to distinguish rate from resynchronization effects, emphasize atrioventricular delay optimization, and examine clinical benefits of temporary postoperative pacing.
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Review Case Reports
Severe allergic dermatitis after closure of foramen ovale with Amplatzer occluder.
Allergic reaction to nitinol is rarely reported, and its incidence, symptoms, and course have not been clearly defined. We report an occurrence of severe progressive generalized exanthema 3 days after the implantation of an Amplatzer occluder for a patent foramen ovale, with symptoms disappearing immediately after surgical removal of the device 3 months later. The risks and possible prevention of allergic reaction to nickel and especially to titanium are discussed.
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Multicenter Study Comparative Study
Medium term outcomes of transapical aortic valve implantation: results from the Italian Registry of Trans-Apical Aortic Valve Implantation.
Transcatheter aortic valve implantation (TAVI) has been proposed as a therapeutic option for high-risk or inoperable patients with severe symptomatic aortic valve stenosis. The aim of this multicenter study was to assess early and medium term outcomes of transapical aortic valve implantation (TA-TAVI). ⋯ Transapical TAVI provides good results in terms of early and midterm clinical and hemodynamic outcomes. Thus it appears to be a safe and effective alternative treatment for patients who are inoperable or have high surgical risk.
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Comparative Study
The impact of previous catheter-based ablation on the efficacy of the Cox-maze IV procedure.
Failed catheter-based ablation for the treatment of atrial fibrillation is an indication for the Cox-maze procedure. Many patients are referred for the Cox-maze IV procedure with recurrent atrial fibrillation after a previous catheter-based ablation, but the efficacy and safety of surgical management in these patients remains unclear. ⋯ The Cox-maze IV procedure is safe and effective in treating recurrent atrial fibrillation regardless of previous catheter ablation history. Surgical management should be considered in patients who have failed catheter ablation for the treatment of their atrial fibrillation.