To evaluate the efficacy and safety of different anticoagulation strategies after one-stop surgery in patients with non-valvular atrial fibrillation (AF).
Methods
Patients who underwent one-stop surgery for AF at The first Affiliated Hospital of Xinjiang Medical University from April 2018 to October 2021 were included consecutive. Demographic data such as age and sex, type of AF, liver and renal function, echocardiographic parameters, previous comorbidities and oral anticoagulants of patients were collected. The postoperative period was divided into a group of patients taking novel oral anticoagulants in combination with antiplatelet agents (combined group) and a group taking novel oral anticoagulants alone (anticoagulation group), depending on the different anticoagulation strategies they received. Patients were followed up regularly to collect information on all-cause mortality, major bleeding, any stroke,thromboembolism and device-related thrombosis (DRT), occluder dislodgement and residual shunt ＞5 mm. The safety end point was defined as all-cause death and major bleeding; the effectiveness end point was defined as any stroke, thromboembolism and DRT, and the composite end point was defined as all-cause death, major bleeding, stroke, thromboembolism and DRT.
Results
A total of 126 individuals were included, 63.5% (80/126) were male, with a median age of 68.5 (61.3, 76.0) years, a CHA2DS2-VASc score of 4 (3, 5) and a HAS-BLED score of 2 (1, 3). There were 73 patients in the combined group and 53 patients in the anticoagulation group. Median follow-up was 10 (6, 16) months. In the combined group, there were 2 (2.7%, 2/73) major haemorrhagic events, 1 (1.4%, 1/73) lower limb deep vein thrombosis, 1 (1.4%, 1/73) death, and 15(20.5%, 15/73) recurrences. In the anticoagulation group, there were 1 (1.9%, 1/53) lower limb deep vein thrombosis and 9 (17%, 9/53) recurrences occurred. No events such as stroke, blocker dislodgement, DRT, or residual shunt ＞5 mm occurred in either group. There was no statistically significant difference between the two groups in terms of safety and efficacy endpoint events (P＞0.05). The difference in survival analysis of the composite endpoint between the two groups was not statistically significant (Log-rank P = 0.285).
Conclusion
Novel oral anticoagulants alone are as safe and effective as a combination of novel oral anticoagulants combined with antiplatelet agents in patients with AF after one-stop surgery.
To explore the early outcomes of pulmonary autograft replacement procedure (Ross procedure) in children and adolescents in our center, and the relationship between postoperative outcomes and surgical strategies.
Method
Children and adolescents who underwent Ross surgery in West China Hospital, Sichuan University from January 2019 to September 2023 were continuously included. Baseline data such as the type and severity of patients' aortic valve lesions,intraoperative data such as surgical strategies and time, and postoperative follow-up data such as the degree of aortic regurgitation and transvalvular pressure gradients were retrospectively collected and statistical analyzed.
Results
A total number of 24 children and adolescents received Ross procedure in our center, and their mean age was (12.6 ± 6.4) years, and 12 (50.0%,12/24) of them were male. 17 patients (70.8%,17/24) had a bicuspid aortic valve, and aortic stenosis was the main pathological change of the aortic valve (11/24, 45.8%). 12 patients (50.0%,12/24) received the Ross procedure with the Root replacement technique, and 10 (41.7%,10/24) with the Subcoronary technique, while the other 2 with reinforcement technique and Inclusion technique respectively.There was no perioperative death, the operative time of Root replacement group was significantly longer than that of the Subcoronary group [(487.5 ± 106.7) min vs. (382.1 ± 57.2) min, P=0.027],while the corss-clamp time, bypass time and intensive care unit(ICU), stay were comparable between groups. The mean follow-up time was (20.4 ± 17.9) months, with no late mortality. 17 patients (70.8%,17/24) were classified as New York Heart Association Ⅰ, and 5 (20.8%,5/24) were classified as New York Heart Association(NYHA) Ⅱ, while it was NYHA Ⅲ for the other 2 (8.3%).Postoperative antegrade flow velocity for aortic valve was (1.3 ± 0.4) m/s, and no patient developed moderate or more aortic regurgitation postoperatively. Postoperative antegrade flow velocity for pulmonary valve was (2.3 ± 1.0) m/s, and there were 2 patients who developed moderate or more pulmonary regurgitation postoperatively (both patients' right ventricular outflow tract reconstruction was performed with Gore-Tex valved conduits). Three patients received reoperation due to right ventricle to pulmonary artery conduit failure at 9, 10 and 30 months after surgery respectively.
Conclusion
Ross procedure can achieve a fairly promising early outcome among children and adolescents. Except for the longer surgical time in the Root replacement group, the outcomes of Root replacement group and Subcoronary group are comparable. The material used in right ventricular outflow tract reconstruction should be carefully selected to avoid undesired reoperation.
To guide experiments and catheter ablation for bundle branch or Purkinje-related arrhythmias by anatomical observations of the left ventricular endocardial Purkinje fibers in canines were conducted through macroscopic and microscopic examinations.
Methods
Twelve beagle canines [age (2.90±0.56) years, male for 58.3% (7/12), weight (21.50±3.32) kg] were selected to obtained ex vivo hearts. Lugol's solution was used to stain the endocardial surface of fresh canine hearts for gross observation of the left bundle branch and Purkinje fibers pathways.Histological examination using HE staining, Masson's trichrome staining, and Connexin 40(CX40)immunohistochemistry was performed for microscopic observation of the distribution of bundle branches and Purkinje fibers.
Results
Twelve beagle canines ex vivo heart were successfully obtained, revealing the transverse characteristics of different levels of conduction bundles and Purkinje fibers in the left ventricular endocardium using Lugol's solution, and microscopic observation showed that the conduction system of the left ventricle was composed of multiple conduction bundles that travel together beneath the endocardium, separated into different layers by connective tissues.
Conclusion
The Purkinje fibers in the left ventricle of canines exhibit graded,layered, and networked distribution characteristics, which can guide experimental and ablation treatments for Purkinje-related ventricular arrhythmias.
