Objective: Postoperative atrial fibrillation (POAF) is a frequent complication after coronary artery bypass grafting (CABG) and is linked to increased short-and long-term stroke risk. This study evaluated the prognostic value of the left atrial diameter index (LADI) for predicting cerebrovascular events (CVE) in patients undergoing isolated CABG who developed POAF, had no prior atrial fibrillation (AF), and were discharged in sinus rhythm. Materials and methods: Among 2,094 patients undergoing isolated CABG between June 2015 and June 2022, 392 consecutive patients with POAF and discharge in sinus rhythm met inclusion criteria. LADI was calculated preoperatively, and an optimal cutoff (21.2 mm/m(2)) was determined via receiver operating characteristic curve and Youden index. Patients were classified as low (<= 21.2 mm/m(2)) or high (>21.2 mm/m(2)) LADI. The association between LADI and CVE was assessed over a mean follow-up of 42.4 +/- 20.0 months using Cox proportional hazards modeling. Results: Thirty patients (7.7%) experienced a CVE, including eight in-hospital cases (2.0%). CVE incidence was higher in the high LADI group compared with the low LADI group (19.8 vs. 2.8%). Multivariable analysis identified older age, hypertension, congestive heart failure, and high LADI as independent CVE predictors. Kaplan-Meier analysis confirmed significantly higher CVE rates in the high LADI group (log-rank, p < 0.001). Conclusion: In patients developing POAF after isolated CABG, LADI is a simple, easily obtainable parameter that independently predicts long-term CVE risk and may aid in postoperative risk stratification.
Objective This study aimed to investigate the relationship between postoperative atrial fibrillation (POAF) following lung resection and surgical factors, particularly the extent and location of resection, alongside preoperative electrolyte levels. We also sought to develop and internally validate a composite risk model for identifying high-risk patients. Methods In this single-center retrospective cohort study, 422 patients who underwent lung resection (sublobar, lobar, or major resection) between December 2024 and April 2025 were analyzed. Patients with preexisting atrial substrate, heart failure, or left atrial dilatation (>= 40 mm) were excluded. Independent predictors were identified using multivariable logistic regression. To further address potential confounding, inverse probability of treatment weighting (IPTW) analysis was performed. Results POAF developed in 66 patients (15.6%). In multivariable analysis, lower preoperative potassium levels (odds ratio [OR]: 0.40; 95% confidence interval [CI]: 0.21-0.79; p = 0.008), major resection (OR: 4.10; 95% CI: 1.98-8.49; p < 0.001), and upper lobe resection (OR: 4.23; 95% CI: 2.22-8.05; p < 0.001) were independent predictors of POAF. In the IPTW-adjusted analysis, upper lobe resection remained significantly associated with POAF (OR: 2.08; 95% CI: 1.16-3.75; p = 0.013). The composite model demonstrated moderate discrimination (area under the curve: 0.716; 95% CI: 0.641-0.777), which remained stable after bootstrap validation. POAF was associated with longer intensive care unit stay and higher in-hospital mortality (16.7 vs. 1.4%, p < 0.001). Conclusion POAF after lung resection is a predictable complication associated with the extent of surgery, upper lobe involvement, and preoperative potassium levels. These findings highlight the importance of closer rhythm surveillance and perioperative electrolyte optimization in high-risk patients.
Objectives The optimal perfusion strategy for open repair of descending and thoracoabdominal aortic pathologies remains controversial. Although hypothermic circulatory arrest (HCA) is established in arch surgery, concerns about neurologic and systemic complications limit its use. This study aimed to evaluate whether HCA adversely affects early outcomes in distal aortic repair. Methods A retrospective analysis was conducted on 90 patients who underwent open repair of descending and thoracoabdominal aortic pathologies between January 2005 and June 2024. Patients were grouped by perfusion strategy as HCA ( n = 35) or non-HCA ( n = 55). Preoperative, intraoperative, and postoperative variables were compared for 30-day mortality and major postoperative morbidity, including neurological, cardiac, renal, respiratory, and infectious complications. Incremental mortality risk factors were assessed using univariate analysis only. Results Thirty-day mortality did not differ significantly between the HCA and non-HCA groups (11.4% vs. 7.3%, p = 0.387). Transient cerebral neurologic dysfunction was more frequent in the HCA group (11.4% vs. 0%, p = 0.003), whereas permanent neurologic injury was infrequent. Renal, respiratory, infectious, and cardiac complications were not statistically different between groups. Intensive care unit (ICU) and hospital stay were similar, while postoperative packed red blood cell (PRBC) transfusion requirements were higher in the HCA group ( p = 0.016). In univariate analysis, early mortality was associated with urgent/emergent surgery, postoperative cardiac complications, and higher PRBC transfusion requirements. Conclusion In this single-center, retrospective experience, HCA was used mainly in anatomically challenging distal aortic repairs requiring proximal control. Although the study does not establish equivalence or superiority between perfusion strategies, HCA remains an important surgical adjunct when safe proximal clamping or distal perfusion is not feasible.
Abstract Mechanical aortic valve replacement (mAVR) with the St. Jude Medical (SJM) prosthesis is an established treatment. However, data on prosthesis-related adverse events in patients with congenital heart disease (CHD) and aortic valve pathology are scarce. This single-center, retrospective, observational study included all CHD patients aged ≤ 45 years who underwent mAVR with an SJM prosthesis between 1993 and 2020. Survival and valve-related complications, including thromboembolism, bleeding, endocarditis, stenosis, regurgitation, and reoperation, were assessed. Kaplan–Meier analyses were performed to estimate time-dependent freedom from events. A total of 54 patients (mean age at surgery: 21 ± 9 years; 80% male) with a mean follow-up of 8.9 ± 6.6 years were included. Survival was 95.5% at 5 years and 91.9% at 10 and 15 years postoperatively. Relevant, interestingly often only transient, valvular dysfunction defined as peak gradient ≥ 50 mm Hg and/or ≥ moderate regurgitation occurred in 22% of patients. Freedom from prosthesis explantation was 97.4% at 5 and 10 years and 93.1% at 15 years. Freedom from anticoagulation-related events at 5, 10, and 15 years was 95.3%, 88.9%, and 84.9%, respectively. Freedom from prosthetic valve endocarditis was 97.4% at 5 years, 94.7% at 10 years, and 90.4% at 15 years. SJM mechanical aortic valve replacement in pediatric and young adult patients with CHD demonstrated favorable midterm survival, low reoperation rates, and acceptable prosthesis-related morbidity. Prosthetic valve dysfunction was frequently transient and rarely required reoperation, supporting SJM valves as a durable option with appropriate prosthesis sizing, anticoagulation, and long-term follow-up.
Abstract Tracheal resection with primary end-to-end anastomosis is the definitive treatment for benign tracheal stenosis, yet anastomotic complications remain clinically important, and their risk markers are incompletely defined. We evaluated patient- and surgery-related variables associated with anastomotic outcomes and described these associations in primary versus surgically altered operative fields. This retrospective single-center cohort study included all consecutive adults undergoing tracheal resection for benign tracheal stenosis between 2007 and 2024. Sixty-nine patients were included, and 18 stenoses were critical at diagnosis. Operative fields were predefined as primary when no prior airway intervention and no pre-resection restenosis were present and as surgically altered otherwise. Anastomotic complications were classified as severe when requiring airway securing under general anesthesia and as mild when requiring prolonged or repeated hospitalization with bronchoscopic intervention only. Clinically significant granulation was analyzed as a distinct phenotype. Univariable associations were assessed using Firth logistic regression. Segmental resection was associated with lower odds of severe complications than cricotracheal resection (OR 0.2, p = 0.046). Mild complications were associated with prior T-tube insertion (OR 12.8, p = 0.002) and pre-resection restenosis (OR 15.2, p = 0.004). Granulation was associated with pre-resection restenosis (OR 27.0, p < 0.001) and prior T-tube insertion (OR 8.5, p = 0.008). Analyses suggested that severe complications were mostly associated with resection type, whereas mild complications and granulation were associated mainly with previous T-tube treatment and pre-resection restenosis, especially in surgically altered operative fields.
