1:30 p.m. SCIENTIFIC SESSION
Room 6, San Diego Convention
Center
Moderators: D. Glenn Pennington, M.D.
Douglas J. Mathisen, M.D.
6. HETEROTOPIC CARDIAC TRANSPLANTATION
IN INFANTS AND CHILDREN.
Francesco Santini, M.D.*, Cornelius Dyke, M.D.*, Rosemary Radley-Smith,
FRCP*, Asghar Khaghani, FRCS* and Magdi H. Yacoub, FRCS
Harefield, Middlesex, United
Kingdom
Discussant: Charles B.
Huddleston, M.D.
Children with advanced heart
failure, particularly those with elevated pulmonary vascular resistance, pose a
difficult management problem because of the fact that normal donor right
ventricle cannot cope with the high pulmonary resistance, and the relative
shortage of donor organs of an appropriate size for this age group. To address
these issues, in the period between January 1, 1991 and October 31, 1995, 11
children, 6 boys and 5 girls, ranging in age between 11 months to 15 years
(mean 7.2 years), and having a mean weight of 24.4 kg (range, 7.6 to 56.8 kg)
underwent heterotopic heart transplantation (HHTx). Seven patients had dilated
and 4 restrictive cardiomyopathy. Seven patients (63.6%) had significant
elevation of pulmonary artery pressure (PAsys 68.7 ± 7.4, mean transpulmonary
gradient = 20.3 ± 2.4). In all patients the donor pulmonary artery was
anastomosed to the right atrium, avoiding the use of any prosthetic material.
Ischemic time varied between 135 and 255 min (mean, 181.3 min).
Immunosuppression regiment included cyclosporin and azathioprine. Steroids were
not routinely used. One patient died in the hospital of acute rejection
(p.o.d.=16). One patient developed right middle lobe collapse, treated
successfully. Ten survivors (90.9%) are alive and active with a normal pattern
of growth at a mean follow-up time of 20.8 months (range 2 to 52 months). Repeated
cardiac catheterization performed in 4 patients showed slow progressive drop in
pulmonary vascular resistance. Echocardiogram at 6 months postoperatively
showed a mean donor heart shortening fraction of 38.7 ± 4.3%. There was no
significant change in the function of the recipient hearts.
It is concluded that HHTx
in children is feasible for a selected group of patients with good median term
results, notably regression of pulmonary vascular disease, normal growth, and
lack of chest complications.
1995-96 Graham Fellow
*By invitation
7. NEUROPHYSIOLOGICAL MONITORING FOR
OPTIMAL BRAIN PROTECTION DURING RETROGRADE CEREBRAL PERFUSION.
Brian L. Ganzel, M.D.*, Harvey L.
Edmonds, Jr., Ph.D.* and John R. Pank, M.D.*
Louisville, Kentucky
Sponsored by: Laman A. Gray,
Jr., M.D., Louisville, Kentucky
Discussant: Randall B. Griepp,
M.D.
Purpose: Selective RCP has
been recently advocated as a means of protecting the brain during aortic
surgery requiring hypothermic circulatory arrest. To aid in the establishment
of optimal conditions for producing RCP, we here report on the electrical,
hemodynamic and metabolic changes occurring before, during and after effective
retroperfusion of the middle cerebral arteries. The results are compared with
arrest using no RCP.
Methods: Monitoring was
performed on 25 patients requiring aortic surgery (7 without RCP). Cerebral
electrical activity was monitored by EEG and brainstem auditory evoked
potentials, while transcranial Doppler ultrasound (TCD) measured the direction
and velocity of cerebral blood flow bilaterally in the middle cerebral
arteries. Metabolic activity was assessed continuously by regional
cerebrovenous oxygen saturation (CVOS) using transcranial near-infrared
spectroscopy. In all cases, patients were cooled to electrocerebral silence
(ECS) prior to circulatory arrest.
Results: There was a wide
variation in the nasopharyngeal temperature required to maintain complete ECS
(21-8°C). Arrest times were similar in groups with (35 ± 17 min) and without
(28 ± 16) RCP. Retrograde flow was verified by TCD in 13/18 patients during
RCP. In the other 5, no middle cerebral arterial flow was evident at the onset
of retrograde perfusion. TCD signals indicating reversed flow subsequently
appeared in 2 of these patients after adjustment of the superior vena caval
snare or increasing perfusion pressure. Corrective measures were ineffective in
producing a TCD signal in the other 3 patients despite the effux of dark blood
from the carotid arteries. In the RCP group with TCD-documented flow reversal,
the CVOS decreased by 3 ±4% during retroperfusion. In contrast, CVOS decreased
by 19 ± 14% in the arrest group (P = 0.03). The magnitude of cerebral oxygen
desaturation in the 3 RCP patients without TCD-documented retrograde flow
likewise decreased 19 ± 14%. Cerebral electrical activity returned in 17 ± 8
min in the RCP group with adequate flow compared with 60 ± 43 min in the arrest
group (P = 0.007). The EEG in RCP patients without evidence of cortical flow
returned in 36 ± 21 min (P - 0.03).
Conclusions: 1) The EEG
defined the degree of hypothermia required for effective cerebral cooling prior
to arrest. 2) TCD documented the establishment and maintenance of retrograde
cerebral, as opposed to cranial, flow. 3) Optimally-adjusted RCP prevented
further cerebral oxygen desaturation and facilitated the return of cerebral
electrical activity with antegrade perfusion.
*By invitation
8. HEMODYNAMIC BENEFITS OF THE TORONTO
STENTLESS PORCINE AORTIC VALVE PROSTHESIS.
Dario Del Rizzo, M.D.*, Bernard S. Goldman, M.D.,
George T. Christakis, M.D. and Tirone E. David, M.D.
Toronto, Ontario, Canada
Discussant: Delos M. Cosgrove,
M.D.
The Toronto SPV is a stentless porcine heterograft
used for replacement of the human aortic valve. Our institutions are
participating in an ongoing multicentre international Phase II clinical trial
to assess the efficacy of this valve. We report herein the hemodynamic benefits
of this bioprosthesis. To assess valve function, echo Doppler studies were
performed after operation, at 3-6 months, at 12 months, and annually
thereafter. We previously demonstrated in 118 patients operated upon between
March 1992 and December 1993, that effective orifice area (EOA) increased on
average by 40% over a 1-year follow-up period while mean transvalvular gradient
decreased by a similar 40%. With 3 year data now available, we report that
these trends are persistent. Mean transvalvular gradient has continued to
decrease such that at three years the average gradient is 2 mmHg for all valve
sizes (23 mm to 29 mm) implanted. By repeated measures analysis with Wilks'
Lambda (MANOVA), we showed that the regression of transvalvular gradient was
significant in all valve sizes at all follow-up intervals, and that the rate of
regression was independent of valve size.
|
Valve size (mm)
|
N
|
Time post operation
(months)
|
Mean gradient
(mmHg)
|
EOA
(cm2)
|
|
23
|
9
|
post operative
|
7.7 ± 2.9
|
1.4 ± 0.4
|
|
|
|
36 months
|
2.2 ± 0.9
|
2.2 ± 0.8
|
|
25
|
26
|
post operative
|
7.0 ± 3.0
|
1.4 ± 0.6
|
|
|
|
36 months
|
1.4 ± 1.2
|
3.5 ± 1.6
|
|
27
|
43
|
post operative
|
5.9 ± 2.4
|
1.6 ± 0.4
|
|
|
|
36 months
|
2.5 ± 1.5
|
2.8 ± 1.3
|
|
29
|
37
|
post operative
|
4.4 ± 2.1
|
2.0 ± 0.5
|
|
|
|
36 months
|
2.1 ± 0.4
|
3.1 ± 1.8
|
In the next phase of this study
we investigated the relationship between changes in gradient and changes in
left ventricular (LV) mass. We looked at 71 patients (50 males and 21 females;
age 59.8 ± 11.9 years [range: 33-80]) between March 4, 1992 and June 30, 1995
(all operated upon at one centre). Valve pathology was stenosis in 44,
insufficiency in 11, and mixed disease in 16 patients. In 90% of patients there
was 0 or trace insufficiency, while there was minimal insufficiency (1+) in the
remaining 10% of cases. No patient had moderate insufficiency (2+) and there
was no deterioration in valve performance during the follow-up period. Again,
we demonstrated an average 36% reduction in mean transvalvular gradient (10.8 ±
4.6 mmHg to 6.9 ± 3.6 mmHg) in the initial follow-up. Regression analysis
revealed that Ag (change in gradient) was dependent on changes in transvalvular
velocity (V2) (R = 0.93, p < 0.0001). Mean LV mass was 363.8 ±
96.8 gm postoperative and decreased to 220.2 ± 76.8 gm at 3-6 months. Scatter
plot analysis showed correlation between AV2 and LV mass regression;
we found congruency in 70% of patients (p < 0.0001) and LV mass regression
in 80% of patients (p < 0.0001). The highest congruency was in aortic
stenosis where LV mass regression occurred in 90% of cases. LV mass index (LV
mass/body surface area) was found to decrease over time in all valve sizes.
These results are consistent with the hypothesis that LV remodeling occurs
following AVR with the SPV valve.
In conclusion, these observations suggest the
Toronto SPV valve is an excellent substitute in patients deemed appropriate
candidates for a tissue bioprosthesis, especially in those patients with marked
LVH and in those in whom a mismatch between valve size and patient size might be
anticipated. The reduction in LV mass and transvalvular gradient and the
potential anticoagulation free durability may have beneficial prognostic
implications.
*By invitation
9. ADENOID CYSTIC CARCINOMA OF THE
AIRWAY: A THIRTY-TWO YEAR EXPERIENCE.
Donna E. Maziak, MDCM, FRCSC*, Thomas R.J. Todd, M.D., FRCSC, Shafique H.
Keshavjee, M.D., FRCSC*, Timothy L. Winton, M.D., FRCSC*, Peter Van Nostrand,
M.D.* and F. Griffith Pearson, M.D., FRCSC
Toronto, Ontario, Canada
Discussant: Douglas Wood, M.D.
We have reviewed our experience
in 36 patients with adenoid cystic carcinoma of the upper airway seen during a
32 year period (1963-1995). The average age was 45 years (range: 15 - 80) with
a male:female ratio of 1.1:1. Of these 36 patients, 30 were managed by resection
and reconstruction (primary anastomosis 25; marlex prosthesis 5) of whom 25
received adjuvant radiotherapy. Six were managed with radiotherapy only.
Pathology revealed local invasion
in all cases beyond the outer wall of the trachea. In most cases, microscopic
extension was found in submucosal and perineural lymphatics, well beyond
grossly viable or palpable tumour. Lymphatic metastases were rare: 4 of 30
(13.3%) resected cases. Subsequent haematogenous metastases occurred in 15 of
36 patients (41.6%). Twelve of 36 cases (35%) had pulmonary metastases.
Thirteen of 30 resections were
complete and potentially curative. There were 2 operative deaths, and the mean
survival in 11 surviving patients was 7.8 years (range: 6 months-18 years).
Seventeen of 30 resections were incomplete (residual tumour at final
pathology), with one operative death and a mean survival of 7.7 years (range: 9
months - 29 years). The 6 patients treated with radiation only had a mean
survival of 3.3 years (range: 2 months -10 years). In the 12 patients with
pulmonary metastases, mean survival was 3 years (range: 6 months - 6 years)
following its identification.
Adenoid cystic carcinoma is a rare tumour, which is
always locally invasive but frequently amenable to resection. Although late
local recurrence following resection is common (up to 29 years) excellent
long-term palliation is commonly achieved following both complete and
incomplete resection. There was little difference in survival between complete
and incompletely resected cases. Pulmonary metastases are common, usually slow
growing, and are not necessarily a contraindication to palliative resection of
the primary tumour. Long periods of control can be obtained with radiotherapy
alone. The best results, however, are obtained by resection. Adjuvant
radiotherapy is assumed to favourably influence survival.
*By invitation
10. CRICOPHARYNGEAL MYOTOMY FOR NEUROGENIC
OROPHARYNGEAL DYSPHAGIA.
Nancy Claire Poirier, M.D.*, Luigi Bonavina, M.D.*, Raymond Taillefer,
M.D.*, Attilio Nosadini, M.D.*, Alberto Peracchia, M.D. and Andre C.H.
Duranceau, M.D
Montreal, Quebec, Canada and
Milan, Italy
Discussant: Mark B. Orringer,
M.D.
Between 1976 and 1994, 40 patients with neurological
disorders associated with incapacitating upper esophageal sphincter (UES)
dysfunction underwent a cricopharyngeal myotomy. Etiology for the dysphagia was
a cerebrovascular accident (65%), amyotrophic lateral sclerosis (5%), trauma
(5%), pseudobulbar palsy (7.5%), iatrogenic (2.5%), peripheral nerve disorders
(IX-X-XII) (7.5%), Parkinson's disease (2.5%), Arnold Chiari (2.5%), and
multiple sclerosis (2.5%). Patients were assessed pre- and post-operatively
with a mean follow-up period of 48 months (1-255 months).
|
|
|
Preop
|
Postop
|
p value
|
SYMPTOMS
|
Dysphagia
|
40/40
|
33/39
|
0.03
|
|
|
Regurgitation
|
|
|
|
|
|
Pharyngooral
|
15
|
8
|
0.16
|
|
|
Pharyngonasal
|
12
|
7
|
0.32
|
|
|
Aspiration
|
33/40
|
13/39
|
<0.01
|
|
RADIOLOGY
|
Pharyngeal
stasis
|
21/40
|
17/39
|
0.57
|
|
|
UES
incoordination
|
27/40
|
5/39
|
<0.01
|
|
|
Aspiration
|
17/40
|
14/39
|
0.71
|
|
UES
MANOMETRY
|
Resting
pressure (mmHg)
|
64.9 ± 33.0
|
18.1 ± 14.5
|
<0.01
|
|
|
Contraction
pressure (mmHg)
|
69.1 ± 337.4
|
22.3 ± 26.8
|
<0.01
|
|
|
Coordination
|
0.35 ± 0.40
|
0.48 ± 0.45
|
0.33
|
|
SCINTISCAN
|
Retention
at 120 sec
|
8/8
|
8/8
|
|
The mortality was 2.5% (1 patient) and resulted from
aspiration pneumonia. Seven patients are asymptomatic, 23 patients are improved
and 10 patients report no change in symptoms. Radiological evidence of
functional obstruction at the pharyngoesophageal junction is reduced. UES
resting and contraction pressures are significantly decreased in the UES but
the coordination abnormalities are unchanged. Single liquid bolus radionuclide
emptying studies of the pharynx show persistant stasis in all patients where
this study was obtained.
3:15 p.m. INTERMISSION - VISIT EXHIBITS
*By invitation
4:00 p.m. SCIENTIFIC SESSION
Room 6, San Diego Convention
Center
Moderators: Andrew S. Wechsler, M.D.
Bruce A. Reitz,
M.D.
11. WHAT IS THE APPROPRIATE SIZE CRITERION
FOR RESEARCH OF THORACIC AORTIC ANEURYSMS?
John A. Elefteriades, M.D., Michael
A. Coady, M.D.*, John A. Rizzo, Ph.D.*, Kevin Johnson, M.D.*, Umer Darr, M.D.*,
Ellen Frank, M.D., M.P.H.* and Gary S. Kopf, M.D.
New Haven, Connecticut
Discussant: O. Wayne Isom,
M.D.
Although many papers have
described techniques for resection of thoracic aortic aneurysms (TAA), limited
information on the natural history is available to aid in defining criteria for
surgical intervention.
Data on 225 patients with TAA at one center from
1985 to 1995 were analyzed. This computerized database included 638 imaging
studies (MRI, CT, ECHO). Overall survival at 1 and 5 years was 88% and 65%,
respectively. Patients having aortic dissection had markedly lower survival
(83%, 1 year; 31%, 5 year) than the non-dissected cohort (90%, 1 year; 70%, 5
year).
Mean size of the thoracic aorta
in these patients was 5.1 cm. The mean growth rate was 0.15 cm/year.
Multivariate regression analysis to isolate risk factors for aortic expansion
revealed a size of > 6.0 cm to be a significant predictor (p<0.0001).
Median size at time of rupture or
dissection was 6.1 cm (5.9 cm for ascending; 7.0 cm for descending). The
incidence of dissection or rupture increased with aneurysm size, as illustrated
below.
Seventy-four patients underwent
surgery for their TAA. For elective operations, the mortality was 9.7%;
emergent operations had a mortality of 30.2%.
If the median value at the time
of dissection or rupture were used as the intervention criterion, half of the
patients would have suffered a devastating complication prior to surgery.
Accordingly, a criterion lower than the median is appropriate. We recommend 5.5
cm as an acceptable size for elective resection of ascending aortic aneurysms,
as these can be performed with relatively low mortality. For aneurysms of the
descending aorta, where peri-operative complications are greater and the median
size at time of complication is larger, we recommend intervention at 6.5 cm.
*By invitation
12. ONE STAGE COMPLETE UNIFOCALIZATION IN
INFANTS: WHEN NOT TO CLOSE THE VENTRICULAR SEPTAL DEFECT.
Frank L. Hanley, M.D., V. Mohan Reddy, M.D.*, Edwin Petrossian, M.D.*,
Phillip Moore, M.D.* and David F. Teitel, M.D.*
San Francisco, California
Discussant: Hillel Laks, M.D.
Background: The decision
to close the ventricular septal defect at the time of unifocalization in
patients with pulmonary atresia with ventricular septal defect and major
aortopulmonary collaterals (PA.VSD.MAPCAS) may be difficult. Standard indices
of true pulmonary arteries cannot be used since reconstruction using the collaterals
makes the preoperative values meaningless. We have developed an index of total
pulmonary vascular cross-sectional area which systematically evaluates true
pulmonary arteries and all collateral vessels to be unifocalized. The purpose
of this study is to determine if this new index is predictive of peak right
ventricular systolic pressure following complete repair.
Patients and methods: Since
July 1992, 17 infants (age: mean ± SD = 4.1 ± 3.3 months) with PA.VSD.MAPCAS
have been managed at our institution. Complete unifocalization (n=16) from a
midline approach and VSD closure (n=12) was the procedure of choice. In 4
patients the VSD was left open and only one patient with severe distal
collateral artery stenosis was staged. The preoperative angiograms were
evaluated to estimate the size of the true pulmonary arteries and size of the
collaterals. The indexed cross-sectional areas of the true pulmonary arteries
(PAI), of the MAPCAS (CAI), and the total bed (TI = PAI + CAI) were calculated.
True pulmonary arteries were measured just proximal to the first branching
point and the collaterals were measured at the narrowest point beyond the site
of surgical unifocalization and proximal to any branches. The ratio of the peak
systolic pressure in the right ventricle (pRV) to that in the left ventricle
(pLV) was estimated from the absolute pressures obtained in the operating room.
Results: The median PAI
was 40.5 mm2/M2 (range = 0 to 294.4 mm2/M2),
the median CAI was 72.9 mm2/M2 (range = 22.5 to 422.1 mm2/M2),
and the median TI was 174.7 mm2/M2 (range = 50.5 to 422.1
mm2/M2). The median pRVipLV was 0.63 (range = 0.29 to
0.85). By unpaired /-Test there was a significant difference (p = 0.011) in the
TI between the two groups. By linear regression there was a significant
correlation (p = 0.023) between the TI and VSD closure. In addition, the
pRV:pLV ratio appeared to be lower in patients with higher TI and approached
significance (p = 0.07).
Conclusion: The total
pulmonary vascular index appears to correlate with postrepair pRV:pLV. This
index is useful in deciding when not to close the VSD.
*By invitation
13. DOES SUCCESSFUL BRIDGING WITH THE
IMPLANTABLE LEFT VENTRICULAR ASSIST DEVICE AFFECT CARDIAC TRANSPLANTATION
OUTCOME?
Malek G. Massad, M.D.*, Patrick
M. McCarthy, M.D., Nicholas G. Smedira, M.D.*, Daniel J. Cook, Ph.D.*, Norman
B. Ratliff, M.D.*, Marlene Goormastic, M.P.H.*, Jose Navia, M.D.*, James B.
Young, M.D.* and Robert W. Stewart, M.D.*
Cleveland, Ohio
Discussant: Eric A. Rose, M.D.
Purpose: We sought
to determine if cardiac transplant recipients who required a
bridge-to-transplant with an implantable LVAD had a different outcome than
patients (pts) who had primary cardiac transplants.
Methods: A
retrospective study of 238 primary cardiac transplants at our institution
between January 1992 and October 1995 included 44 pts who received the HeartMate®
LVAD and 194 pts who had no LVAD support. LVAD transplant rate was 77%.
Comparison of demographic and clinical factors was performed and associations
were analyzed using Chi square test. Distribution of continuous factors was
compared using Wilcoxon Rank Sum test. Kaplan-Meier survival estimates were
compared using log-rank test.
Results: LVAD
transplants constituted 7.5% of all primary transplants in 1992 (n=67), 17% in
1993 (n=58) and 1994 (n=63), and 36% in 1995 (n=50, YTD). LVAD and non-LVAD pts
had similar age distribution (median 52 yrs) and female gender (16% vs 26%,
NS). LVAD recipients had greater weight (81 kg vs 70 kg, p = 0.003) and body
surface area (1.94 m2 vs 1.81 m2, p = 0.05). They were
more likely to have type O blood group (52% vs 34%, p = 0.07), and ischemic
cardiomyopathy (70% vs 42%, p = 0.001). All LVAD pts and 41% of non-LVAD pts
had previous cardiac operations (mean number per pt: 1.3 vs 0.3, p < 0.001).
LVAD related sepsis occurred in 20/44 pts (45%) during support. More pts in the
LVAD group had anti-HLA antibodies prior to transplant (T-cell PRA level
>10% in 66% of LVAD pts vs 15% of non-LVAD pts, p < 0.0001). Blood
utilization during LVAD support of more than 96 units of blood products
(median) results in significantly higher anti-HLA antibody levels. Sixty-one
percent of non-LVAD pts were UNOS status I. Time on the waiting list was longer
for LVAD pts compared to non-LVAD status I pts (median 88 days vs 33 days, p =
0.002). There was no difference in the length of post-transplant hospital stay
(median 15 days for each) and operative mortality (4.6% LVAD vs 5.2% non-LVAD).
No significant difference was found in the Kaplan-Meier survival curves. One
year survival was 93% in the LVAD group and 88% in the non-LVAD group (NS).
Two-year survival was 82% vs 84% (NS). Comparison of post-transplant events
showed no significant difference in CMV infection rates (23% vs 16%), or the
incidence of vascular rejection (20% vs 15%) or moderate/severe cellular
rejection (79% vs 71%) at one-year follow-up.
Conclusions: LVAD
support intensified donor shortage by including recipients who otherwise would
not have survived to transplant. Bridging affected transplant demographics
favoring pts who are larger, have ischemic cardiomyopathy, have had previous
cardiac surgery, are HLA sensitized, and have blood group O. Successfully
bridged pts wait longer for transplant but have similar post-transplant
hospital stay and operative mortality and achieve survival similar to that of
pts not requiring LVAD support.
*By invitation
14. THE DISCHARGE OF PATIENTS WITH
NEW-ONSET ATRIAL FIBRILLATION AFTER HEART SURGERY IN ATRIAL FIBRILLATION IS
SAFE AND COST-EFFECTIVE.
Robert L. Hannan, M.D.*, Allen J. Solomon, M.D.*, Peter C. Kouretas,
M.D.*, Richard A. Hopkins, M.D., Nevin M. Katz, M.D. and Robert B. Wallace,
M.D.
Washington, DC
Discussant: Renee S. Hartz,
M.D.
Atrial fibrillation is a frequent complication of
open heart surgery and leads to prolonged hospitalization and increased cost.
We retrospectively reviewed our experience over a one year period to determine
if patients in new-onset atrial fibrillation (AF) could safely be discharged in
atrial fibrillation after ventricular rate had been controlled and
anticoagulation initiated. In the year ending in August 1995, 505 adult
patients underwent heart surgery utilizing cardiopulmonary bypass. Of the 488
survivors (96.6%), 93 (19%) developed AF postoperatively. Of these 93 patients,
82 (88%) were discharged in sinus rhythm (NSR) and 11 (12%) were discharged in
AF. Results are summarized in the table below: age is mean age in years, risk
is by the modified Parsonnett score, postop LOS is length of stay
postoperatively, and mean hospital cost and charge are normalized to 1.00 in
patients without AF.
|
|
N
|
age
|
risk
|
LOS
|
cost
|
charge
|
|
No AF
|
385
|
59
|
12.5
|
6.2
|
1.00
|
1.00
|
|
AF,
discharged NSR
|
82
|
65
|
15.7
|
11.6
|
1.75
|
1.71
|
|
AF,
discharged AF
|
11
|
72
|
19.4
|
8.9
|
1.00
|
1.11
|
At mean follow-up period of 222 days, all 11
patients discharged in AF were alive and well: 9 patients were in sinus rhythm.
Outpatient cardioversions were performed on 3 patients, one of whom remained in
sinus rhythm. No systemic emboli or other complications were noted in any of the
patients discharged in AF. Patients discharged in AF had similar cost and
charges to patients without AF: patients with AF discharged in NSR had
increased cost and charges. We suggest that the discharge of patients in
persistent AF after heart surgery is safe and cost-effective, and hypothesize
that earlier discharge of patients in AF may be appropriate.
*By invitation
