Infective left atrial dissecting flap after cardiac surgery.
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ABSTRACT:
SUBMITTER: Nabati M
PROVIDER: S-EPMC4192416 | biostudies-literature | 2014 Sep
REPOSITORIES: biostudies-literature
Publications
Infective left atrial dissecting flap after cardiac surgery.
Nabati Maryam M Tabiban Sasan S Ghaemian Ali A Bagheri Babak B Shokri Mojtaba M
Journal of cardiovascular ultrasound 20140929 3
Left atrial dissection (LatD), defined as the forced separation of the left atrial (LA) wall layers by blood, is a rare and severe complication of cardiac surgery. It is most frequently associated with atrioventricular junction injuries. We report a case of infected LatD after coronary artery bypass graft, mitral valve replacement, aortic valve replacement and ascending aortic root replacement. The patient was presented with septicemia and disseminated intravascular coagulation. To the best of o ...[more]
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Project description:Among community cohorts, associations between clinical and metabolite factors and complex left atrial (LA) phasic function assessed by cardiac magnetic resonance (CMR) feature tracking (FT) are unknown. Longitudinal LA strain comprising reservoir strain (?s), conduit strain (?e) and booster strain (?a) and their corresponding peak strain rates (SRs, SRe, SRa) were measured using CMR FT. Targeted mass spectrometry measured 83 circulating metabolites in serum. Sparse Principal Component Analysis was used for data reduction. Among community adults (n?=?128, 41% female) (mean age: 70.5?±?11.6 years), age was significantly associated with ?s (??=?-0.30, p?<?0.0001), ?e (??=?-0.3, p?<?0.0001), SRs (??=?-0.02, p?<?0.0001), SRe (??=?0.04, p?<?0.0001) and SRe/SRa (??=?-0.01, p?=?0.012). In contrast, heart rate was significantly associated with ?a (??=?0.1, p?=?0.001) and SRa (??=?-0.02, p?<?0.0001). Serine was significantly associated with ?s (??=?10.1, p?=?0.015), SRs (??=?0.5, p?=?0.033) and SRa (??=?-0.9, p?=?0.016). Citrulline was associated with ?s (??=?-4.0, p?=?0.016), ?a (??=?-3.4, p?=?0.002) and SRa (??=?0.4, p?=?0.019). Valine was associated with ratio of SRe:SRa (??=?-0.4, p?=?0.039). Medium and long chain dicarboxyl carnitines were associated with ?s (??=?-0.6, p?=?0.038). Phases of LA function were differentially associated with clinical and metabolite factors. Metabolite signals may be used to advance mechanistic understanding of LA disease in future studies.
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Project description:Importance:Surgical occlusion of the left atrial appendage (LAAO) may be performed during concurrent cardiac surgery. However, few data exist on the association of LAAO with long-term risk of stroke, and some evidence suggests that this procedure may be associated with subsequent development of atrial fibrillation (AF). Objective:To evaluate the association of surgical LAAO performed during cardiac surgery with risk of stroke, mortality, and development of subsequent AF. Design, Setting, and Participants:Retrospective cohort study using a large US administrative database that contains data from adult patients (?18 years) with private insurance or Medicare Advantage who underwent coronary artery bypass graft (CABG) or valve surgery between January 1, 2009, and March 30, 2017, with final follow-up on March 31, 2017. One-to-one propensity score matching was used to balance patients on 76 dimensions to compare those with vs without LAAO, stratified by history of prior AF at the time of surgery. Exposures:Surgical LAAO vs no surgical LAAO during cardiac surgery. Main Outcomes and Measures:The primary outcomes were stroke (ie, ischemic stroke or systemic embolism) and all-cause mortality. The secondary outcomes were postoperative AF (AF within 30 days after surgery among patients without prior AF) and long-term AF-related health utilization (event rates of outpatient visits and hospitalizations). Results:Among 75?782 patients who underwent cardiac surgery (mean age, 66.0 [SD, 11.2] years; 2?2091 [29.2%] women, 25?721 [33.9%] with preexisting AF), 4374 (5.8%) underwent concurrent LAAO, and mean follow-up was 2.1 (SD, 1.9) years. In the 8590 propensity score-matched patients, LAAO was associated with a reduced risk of stroke (1.14 vs 1.59 events per 100 person-years; hazard ratio [HR], 0.73 [95% CI, 0.56-0.96]; P?=?.03) and mortality (3.01 vs 4.30 events per 100 person-years; HR, 0.71 [95% CI, 0.60-0.84]; P?<?.001). LAAO was associated with higher rates of AF-related outpatient visits (11.96 vs 10.26 events per person-year; absolute difference, 1.70 [95% CI, 1.60-1.80] events per person-year; rate ratio, 1.17 [95% CI, 1.10-1.24]; P?<?.001) and hospitalizations (0.36 vs 0.32 event per person-year; absolute difference, 0.04 [95% CI, 0.02-0.06] event per person-year; rate ratio, 1.13 [95% CI, 1.05-1.21]; P?=?.002). In patients with prior AF (6438/8590 [74.9%]) with vs without LAAO, risk of stroke was 1.11 vs 1.71 events per 100 person-years (HR, 0.68 [95% CI, 0.50-0.92]; P?=?.01) and risk of mortality was 3.22 vs 4.93 events per 100 person-years (HR, 0.67 [95% CI, 0.56-0.80]; P?<?.001), respectively. In patients without prior AF (2152/8590 [25.1%]) with vs without LAAO, risk of stroke was 1.23 vs 1.26 events per 100 person-years (HR, 0.95 [95% CI, 0.54-1.68]), risk of mortality was 2.30 vs 2.49 events per 100 person-years (HR, 0.92 [95% CI, 0.61-1.37]), and risk of postoperative AF was 27.7% vs 20.2% events per 100 person-years (HR, 1.46 [95% CI, 1.22-1.73]; P?<?.001). The interaction term between prior AF and LAAO was not significant (P?=?.29 for stroke and P?=?.16 for mortality). Conclusions and Relevance:Among patients undergoing cardiac surgery, concurrent surgical LAAO, compared with no surgical LAAO, was associated with reduced risk of subsequent stroke and all-cause mortality. Further research, including from randomized clinical trials, is needed to more definitively determine the role of surgical LAAO.
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