| 1. |
- Ahlsson, Anders, 1962-, et al.
(författare)
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A Swedish consensus on the surgical treatment of concomitant atrial fibrillation
- 2012
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Ingår i: Scandinavian Cardiovascular Journal. - London, United Kingdom : Informa Healthcare. - 1401-7431 .- 1651-2006. ; 46:4, s. 212-218
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Forskningsöversikt (refereegranskat)abstract
- Atrial fibrillation (AF) is a common arrhythmia among patients scheduled for open heart surgery and is associated with increased morbidity and mortality. According to international guidelines, symptomatic and selected asymptomatic patients should be offered concomitant surgical AF ablation in conjunction with valvular or coronary surgery. The gold standard in AF surgery is the Cox Maze III ("cut-and-sew") procedure, with surgical incisions in both atria according to a specified pattern, in order to prevent AF reentry circuits from developing. Over 90% of patients treated with the Cox Maze III procedure are free of AF after 1 year. Recent developments in ablation technology have introduced several energy sources capable of creating nonconducting atrial wall lesions. In addition, simplified lesion patterns have been suggested, but results with these techniques have been unsatisfactory. There is a clear need for standardization in AF surgery. The Swedish Arrhythmia Surgery Group, represented by surgeons from all Swedish units for cardiothoracic surgery, has therefore reached a consensus on surgical treatment of concomitant AF. This consensus emphasizes adherence to the lesion pattern in the Cox Maze III procedure and the use of biatrial lesions in nonparoxysmal AF.
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| 2. |
- Ahlsson, Anders, 1962-, et al.
(författare)
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Kirurgisk behandling av förmaksflimmer i samband med hjärtkirurgi [Surgical treatment of atrial fibrillation in connection with cardiac surgery] : konsensusrapport från Sveriges arytmiansvariga hjärtkirurger [Consensus report from Swedish cardiac surgeons responsible for arrhythmia]
- 2012
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Ingår i: Läkartidningen. - Stockholm : Läkartidningen Förlag AB. - 0023-7205 .- 1652-7518. ; 109:5, s. 214-217
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Tidskriftsartikel (refereegranskat)abstract
- Förmaksflimmer är vanligt och förekommer hos 6–10 procent av de patienter som ska genomgå kranskärlsoperation eller klaffkirurgi. Kirurgisk ablation av förmaksflimmer i samband med kranskärlsoperation eller klaffkirurgi bör erbjudas alla symtomatiska och utvalda asymtomatiska patienter. Cox-maze III (labyrintoperation) är den metod som gett bäst resultat vad avser frihet från förmaksflimmer 1 år efter ingreppet.Under senare år har flera nya metoder utvecklats för att åstadkomma elektriskt isolerande lesioner i hjärtats förmak. Dessa är tekniskt enklare och mindre invasiva. De är dock behäftade med sämre resultat än den ursprungliga Cox-maze III-operationen. Arytmiansvariga kirurger på landets samtliga hjärtkirurgiska kliniker har nått samstämmighet om hur förmaksflimmer bör behandlas i samband med annan hjärtkirurgi. Denna konsensus, vilken presenteras här, betonar vikten av att vid kirurgisk ablation följa lesionsmönstret i Cox-maze III och helst behandla både höger och vänster förmak för bästa långtidsresultat.
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| 3. |
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| 4. |
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| 5. |
- Albåge, Anders, et al.
(författare)
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Long-Term Follow-Up of Cardiac Rhythm in 320 Patients After the Cox-Maze III Procedure for Atrial Fibrillation
- 2016
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Ingår i: Annals of Thoracic Surgery. - : Elsevier BV. - 0003-4975 .- 1552-6259. ; 101:4, s. 1443-1449
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Tidskriftsartikel (refereegranskat)abstract
- Background. The Cox-maze III (CM-III) procedure is the gold standard for surgical treatment of atrial fibrillation (AF). Excellent short-term results have been reported, but long-term outcomes are lesser known. The aim was to evaluate current cardiac rhythm in a nationwide cohort of CM-III patients with very long follow-up.Methods. Perioperative characteristics were retrospectively analyzed in 536 "cut-and-sew" CM-III patients operated on from 1994 to 2009 in 4 centers. Of these, 54 patients had died and 20 were unavailable at follow-up. The remaining 462 patients received a survey concerning arrhythmia symptoms, rhythm, and medication; of these, 320 patients (69%), comprising 252 men, with a mean age of 67 years (range, 47 to 87 years), and 83% with stand-alone CM-III, returned a current 12-lead electrocardiogram. Long-term monitoring was evaluated in 40 sinus rhythm patients. Postoperative stroke/transient ischemic attack was evaluated by register analysis.Results. Mean follow-up was 111 44 months (range, 36-223 months). Electrocardiogram analysis showed sinus rhythm in 219 of 320 patients (68%), and regular supraventricular rhythm (sinus, nodal, or atrial pacing) in 262 (82%), with 75% off class I/III antiarrhythmic medication. This group had lower arrhythmia symptom scores and medication use. Rhythm outcome did not differ by gender, age, type of AF, or stand-alone vs concomitant operation. Patients with more than 10 years of follow-up had a lower rate of regular supraventricular rhythm (69% vs 91%, p = 0.02). Long-term monitoring showed freedom from AF/atrial flutter in 38 of 40 patients (95%). The incidence of stroke/transient ischemic attack was 0.37% per year (11 patients).Conclusions. In a single-moment electrocardiogram evaluation 9 years after the cut-and-sew CM-III, 82% of patients were in sinus rhythm or other regular supraventricular rhythm. These findings support a long-lasting positive effect of the CM-III procedure, which is relevant when evaluating current nonpharmacologic therapies for AF. (C) 2016 by The Society of Thoracic Surgeons
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| 6. |
- Albåge, Anders, et al.
(författare)
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Long-Term Risk of Ischemic Stroke After the Cox-Maze III Procedure for Atrial Fibrillation
- 2017
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Ingår i: Annals of Thoracic Surgery. - : Elsevier BV. - 0003-4975 .- 1552-6259. ; 104:2, s. 523-529
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Tidskriftsartikel (refereegranskat)abstract
- Background The long-term risk of stroke after surgical treatment of atrial fibrillation is not well known. We performed an observational cohort study with long follow-up after the “cut-and-sew” Cox-maze III procedure (CM-III), including left atrial appendage excision. The aim was to analyze the incidence of stroke/transient ischemic attack (TIA) and the association to preoperative CHA2DS2-VASc (age in years, sex, congestive heart failure history, hypertension history, stroke/TIA, thromboembolism history, vascular disease history, diabetes mellitus) score. Methods Preoperative and perioperative data were collected in 526 CM-III patients operated in four centers 1994 to 2009, 412 men, mean age of 57.1 ± 8.3 years. The incidence of any stroke/TIA was identified through analyses of the Swedish National Patient and Cause-of-Death Registers and from review of individual patient records. The cumulative incidence of stroke/TIA and association with CHA2DS2-VASc score was estimated using methods accounting for the competing risk of death. Results Mean follow-up was 10.1 years. There were 29 patients with any stroke/TIA, including 6 with intracerebral bleedings (2 fatal) and 4 with perioperative strokes (0.76%). The remaining 13 ischemic strokes and six TIAs occurred at a mean of 7.1 ± 4.0 years postoperatively, with an incidence of 0.36% per year (19 events per 5,231 patient-years). In all CHA2DS2-VASc groups, observed ischemic stroke/TIA rate was lower than predicted. A higher risk of ischemic stroke/TIA was seen in patients with CHA2DS2-VASc score 2 or greater compared with score 0 or 1 (hazards ratio 2.15, 95% confidence interval: 0.87 to 5.32) but no difference by sex or stand-alone versus concomitant operation. No patient had ischemic stroke as cause of death. Conclusions This multicenter study showed a low incidence of perioperative and long-term postoperative ischemic stroke/TIA after CM-III. Although general risk of ischemic stroke/TIA was reduced, patients with CHA2DS2-VASc score 2 or greater had a higher risk compared with score 0 or 1. Complete left atrial appendage excision may be an important reason for the low ischemic stroke rate.
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| 7. |
- Albåge, Anders
(författare)
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Postoperative chylothorax : a cause for concern
- 2017
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Ingår i: Acta Neurochirurgica. - : Springer Science and Business Media LLC. - 0001-6268 .- 0942-0940. ; 159:10, s. 2023-2024
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 8. |
- Albåge, Anders, et al.
(författare)
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Surgical aspects of valve replacement in carcinoid heart disease
- 2021
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Ingår i: Journal of cardiac surgery. - : John Wiley & Sons. - 0886-0440 .- 1540-8191. ; 36:1, s. 290-294
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Tidskriftsartikel (refereegranskat)abstract
- Tricuspid and pulmonary valve replacement in patients with advanced carcinoid heart disease (CaHD) reduces right heart failure and improves prognosis. The surgical literature is limited concerning description of technical aspects of valve replacement in CaHD. Although a dedicated multidisciplinary care is required for these frail patients, optimization of surgical technique is important and may lead to better postoperative outcomes.
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| 9. |
- Albåge, Anders
(författare)
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Surgical treatment of atrial fibrillation : clinical, hormonal and electrophysiological aspects of the maze operation
- 2003
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Atrial fibrillation (AF) is the most common arrhythmia, associated with significant mortality and morbidity, due to hemodynamic impairment and the increased risk of stroke. Traditional pharmacological treatment may be insufficient or cause intolerable side-effects. The Maze operation is an open-heart procedure, developed to cure AF by restoring permanent sinus rhythm, atrio-ventricular synchrony and atrial contraction. Associated concerns have been efficacy in combined cases, excessive postoperative fluid retention and damage to the cardiac conduction system. The aims of this thesis were to: 1) Evaluate the reproducibility, safety and local clinical results of the Maze operation for treatment of symptomatic and medically refractory AF during a 4-year period; 2) Evaluate the benefits and risks of the combined operation of mitral valve (MV) surgery and the Maze operation, in comparison with mitral valve surgery alone; 3) Examine perioperative plasma levels of atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), antidiuretic hormone (ADH), aldosterone and angiotensin II, in patients undergoing the isolated Maze operation, and to assess hormonal changes in relation to postoperative fluid retention; 4) Examine the plasma levels of ANP, BNP, ADH, aldosterone and angiotensin 11 preoperatively and long-term postoperatively in patients undergoing the isolated Maze operation; and 5) Evaluate by standardized electrophysiological methods (EPS), the pre- and postoperative function of the sinus node and other parts of the cardiac conduction system, in patients undergoing the Maze operation. Patients, methods and results: 1) Twenty-six patients with medically refractory AF, mean age off 55 (33-75) years, underwent the isolated Maze operation (65%) or combined procedures (35%). Follow-up was 3-55 (median 18) months. No mortality or neurological complications occurred. Twenty-four patients (92%) were free of AF and in sinus or atrially paced rhythm, of whom 23 were in NYHA class I or If. No further antiarrhythmic or anticoagulant therapy was needed in 90% of the patients after surgery; 2) Forty-seven patients with MV disease and long-standing AF, underwent combined Maze and MV repair or bioprosthetic valve replacement. They were matched with 47 patients undergoing MV surgery alone, for age, gender, NYHA class, left ventricular function and type of MV surgery. There were no differences in perioperative morbidity and mortality, despite increased procedure complexity in the Maze group. Although no difference in survival, follow-up showed increased return of sinus rhythm (75 vs 36%, p=0.0004), lower incidence of thromboembolic events (p=0.03) and reduced needs for antiarrhythmic and anticoagulant medication (p=0.005) in the Maze group; 3) Sixteen Maze patients were assessed perioperatively for levels of neurohormones in relation to hemodynamic variables. Ten patients undergoing coronary bypass surgery served as controls. The Maze group required more of diuretic therapy (p<0.05), and levels of ADH and aldosterone were significantly elevated (p<0.001) as compared to controls. ANP levels were similar and in parallell to atrial pressures in both patient groups; 4) Fifteen Maze patients were assessed before and 6 months after surgery for neurohormones in relation to hemodynamic variables. All patients were free of AF. Cardiac output was higher (p<0.001) and plasma levels of BNP, ANP and angiotensin If were reduced (p=0.03) after surgery, as possible hormonal indicators of improved ventricular function after restoring sinus rhythm. The ANP response to hemodynamic challenge by ventricular pacing was reduced postoperatively (p<0.001), possibly due to atrial scarring; and 5) Thirty-seven Maze patients underwent EPS before, and 6 and 15 months after surgery. The Maze operation did not cause permanent dysfunction of the sinus node, the AV-node or of other parts of the conduction system. No postoperative pacemaker demands were caused by the surgical effects per se on sinus node function. Follow-up (mean 45, range 16-93 months) showed sinus or paced rhythm in 86%, and recurrence of AF necessitating alternative therapy in 14% of patients. Induction of sustained atrial arrhythmias during EPS after surgery was possible in 5 patients, of whom 4 eventually had permanent recurrences off AF. Conclusions: The Maze operation as surgical treatment for medically refractory AF, is reproducible and has very good clinical results with acceptable risks, performed either isolated or as a combined procedure. The operation may prevent thromboembolic events and reduce the need for AF-associated medication. Excessive postoperative fluid retention may be caused by elevations in water-retaining neurohormones. Reductions in natriuretic hormones after restoring sinus rhythm may indicate improved ventricular function. Based on EPS, the Maze operation does not permanently damage the cardiac conduction system. EPS-findings in Maze patients may prognosticate the need for postoperative pacemaker and convey further therapeutic guidance.
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| 10. |
- Albåge, Anders, et al.
(författare)
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The Berglin apical stitch : a simple technique to straighten things out in atrial fibrillation surgery
- 2014
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - : Oxford University Press (OUP). - 1569-9293 .- 1569-9285. ; 19:4, s. 685-686
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Tidskriftsartikel (refereegranskat)abstract
- In the Cox-Maze IV procedure, or in endocardial left atrial ablation, correct positioning of the surgical ablation probe within the left atrium might be difficult due to bulging or folds in the posterior left atrial wall. The Berglin apical stitch is a simple trick of the trade to create a smooth surface in the posterior left atrium that facilitates performing a safe transmural lesion and, consequently, may increase antiarrhythmic efficiency.
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| 11. |
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| 12. |
- Baron, Tomasz, et al.
(författare)
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Cardiac Imaging in Carcinoid Heart Disease
- 2021
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Ingår i: JACC Cardiovascular Imaging. - : American College of Cardiology. - 1936-878X .- 1876-7591. ; 14:11, s. 2240-2253
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Tidskriftsartikel (refereegranskat)abstract
- Carcinoid disease is caused by neuroendocrine tumors, most often located in the gut, and leads in approximately 20% of cases to specific, severe heart disease, most prominently affecting right-sided valves. If cardiac disease occurs, it determines the patient's prognosis more than local growth of the tumor. Surgical treatment of carcinoid-induced valve disease has been found to improve survival in observational studies. Cardiac imaging is crucial for both diagnosis and management of carcinoid heart disease; in the past, imaging was accomplished largely by echocardiography, but more recently, imaging for carcinoid heart disease has increasingly become multimodal and warrants awareness of the particular diagnostic challenges of this disease. This paper reviews the pathophysiology and manifestations of carcinoid heart disease in light of the different imaging modalities.
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| 13. |
- Bergsten, Johannes, et al.
(författare)
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A 33-year follow-up after valvular surgery for carcinoid heart disease
- 2022
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Ingår i: European Heart Journal Cardiovascular Imaging. - : Oxford University Press (OUP). - 2047-2404 .- 2047-2412. ; 23:4, s. 524-531
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: Valvular surgery has improved long-term prognosis in severe carcinoid heart disease (CaHD). Experience is limited and uncertainty remains about predictors for survival and strategy regarding single vs. double-valve surgery. The aim was to review survival and echocardiographic findings after valvular surgery for CaHD at our institution.METHODS AND RESULTS: Between 1986 and 2019, 60 consecutive patients, median age 64 years, underwent valve surgery for severe CaHD. Operations involved combined tricuspid valve replacement (TVR) and pulmonary valve replacement (PVR) in 42 cases, and TVR-only or TVR with pulmonary valvotomy (no PVR) in 18 patients. All implanted valves were bioprosthetic. Preoperative echocardiography, creatinine, NT-pro-brain natriuretic peptide (NT-pro-BNP), and 24-h urinary 5-hydroxyindoleacetic acid (5-HIAA) were obtained. 30-Day mortality was 12% (n=7), and 8% for the most recent decade 2010-2019. Median survival was 2.2 years and maximum survival 21 years. Patients undergoing combined TVR and PVR had significantly higher survival compared with operations without PVR (median 3.0 vs. 0.9 years, P = 0.02). Preoperative levels of NT-pro-BNP and 5-HIAA in the top quartile predicted poor survival. On preoperative echocardiograms, pulmonary regurgitation was severe in 51% and indeterminate in 17%. Postoperative echocardiography confirmed relatively good durability of bioprostheses, relative to the patients' limited oncological life expectancy.CONCLUSION: Valvular surgery in CaHD has an acceptable perioperative risk. Survival for combined TVR and PVR was significantly higher compared with operations without PVR. Bioprosthetic valve replacement appears to have adequate durability. Preoperative echocardiography may underestimate pulmonary pathology. Combined TVR and PVR should be considered in most patients.
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| 14. |
- Flam, Benjamin, et al.
(författare)
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Large Inferolateral Left Ventricular Aneurysm
- 2018
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Ingår i: Annals of Cardiac Anaesthesia. - : MEDKNOW PUBLICATIONS & MEDIA PVT LTD. - 0971-9784 .- 0974-5181. ; 21:1, s. 68-70
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Tidskriftsartikel (refereegranskat)abstract
- The majority of cardiac left ventricular aneurysms involve the anterior and/or apical wall. We present a case of a 50-year-old man with heart failure caused by a large inferolateral left ventricular aneurysm and associated mitral regurgitation, managed by aneurysmectomy, mitral valvuloplasty, and surgical revascularization.
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| 15. |
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| 16. |
- Hopfgarten, Johan, et al.
(författare)
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Spontaneous Coronary Artery Dissection and Papillary Muscle Rupture in Patient With Undiagnosed Vascular Ehler-Danlos Syndrome.
- 2022
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Ingår i: JACC. - : Elsevier. - 2666-0849. ; 4:14, s. 902-905
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Tidskriftsartikel (refereegranskat)abstract
- We present the case of a woman with acute coronary syndrome on the basis of spontaneous coronary artery dissection causing a papillary muscle rupture with severe mitral regurgitation and acute heart failure. The patient subsequently underwent successful emergent surgery of both the mitral and tricuspid valves. Postoperatively, the patient was diagnosed with vascular Ehlers-Danlos syndrome. (Level of Difficulty: Advanced.).
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| 17. |
- Sartipy, Ulrik, et al.
(författare)
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Left ventricular reconstruction as an alternative to heart transplantation : a case report
- 2006
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Ingår i: Heart Surgery Forum. - 1098-3511 .- 1522-6662. ; 9:3, s. E638-E640
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Tidskriftsartikel (refereegranskat)abstract
- A 57-year-old man with dilated cardiomyopathy was referred to our institution to be assessed for heart transplantation. He had symptoms of severe heart failure and left ventricular dysfunction. We proposed surgical ventricular restoration (the Dor procedure) as an alternative to heart transplantation. The patient underwent successful surgery and an uneventful postoperative course. Pre- and postoperative investigations are presented. One year after surgery, the patient is in good clinical and functional condition. This case illustrates that surgical ventricular restoration can be an alternative to heart transplantation.
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