Mortality from pneumonia is mediated, in part, through extrapulmonary causes. Epidermal growth factor (EGF) has broad cytoprotective effects, including potent restorative properties in the injured intestine. The purpose of this study was to determine the efficacy of EGF treatment following Pseudomonas aeruginosa pneumonia. FVB/N mice underwent intratracheal injection of either Pseudomonas aeruginosa or saline and were then randomized to receive either systemic EGF or vehicle beginning immediately or 24 hours after the onset of pneumonia. Systemic EGF decreased seven-day mortality from 65% to 10% when initiated immediately after the onset of pneumonia and to 27% when initiated 24 hours after the onset of pneumonia. Even though injury in pneumonia is initiated in the lungs, the survival advantage conferred by EGF was not associated with improvements in pulmonary pathology. In contrast, EGF prevented intestinal injury by reversing pneumonia-induced increases in intestinal epithelial apoptosis and decreases in intestinal proliferation and villus length. Systemic cytokines, kidney and liver function were unaffected by EGF therapy although EGF decreased pneumonia-induced splenocyte apoptosis. To determine whether the intestine was sufficient to account for extrapulmonary effects induced by EGF, a separate set of experiments were done using transgenic mice with enterocyte-specific overexpression of EGF (IFABP-EGF mice) which were compared to WT mice subjected to pneumonia. IFABP-EGF mice had improved survival compared to WT mice following pneumonia (50% vs. 28% respectively, p<0.05) and were protected from pneumonia-induced intestinal injury. Thus, EGF may be a potential adjunctive therapy for pneumonia, mediated in part by its effects on the intestine.

Objectives The Cox-Maze IV has the best results for the surgical treatment of atrial fibrillation. It has been traditionally performed through sternotomy with excellent outcomes, but this has been felt to be too invasive. An alternative approach is to perform a less invasive right anterolateral minithoracotomy. This series compared these approaches at a single center in consecutive patients. Methods Patients receiving Cox-Maze IV (n=356) were retrospectively reviewed from January 2002 to February 2014. Patients were stratified into two groups: right mini-thoracotomy (RMT: n=104) and sternotomy (ST: n=252). Preoperative and perioperative variables were compared as well as long term outcomes. Patients were followed for up two years and rhythm was confirmed with electrocardiogram or prolonged monitoring. Results Freedom from atrial tachyarrhythmias off antiarrhythmic drugs was 81% and 74% at 1 and 2 year respectively using a RMT approach and was not significantly different from the ST group at these same time points. Overall complication rate was lower in the RMT group (6% vs. 13%, p=0.044) as was 30 day morality (0% vs. 4%, p=0.039). Median ICU length of stay was lower in the RMT group (2 days [range 0-21] vs. 3 days [range 1-61], p=0.004) as was median hospital length of stay (7 days [range 4-35] vs. 9 days [range 1-111], p<0.001). Conclusions The Cox-Maze IV performed through a right mini-thoracotomy is as effective as sternotomy in the treatment of atrial fibrillation. This approach was associated with fewer complications and decreased mortality and decreased ICU and hospital length of stays.

Background Current guidelines recommend at least 24-hour Holter monitoring at 6-month intervals to evaluate the recurrence of atrial fibrillation (AF) following surgical ablation. In this prospective multicenter study, conventional intermittent methods of AF monitoring were compared to continuous monitoring using an implantable loop recorder (ILR). Methods From 8/2011 to 1/2014, 47 patients receiving surgical treatment for AF at two institutions had an ILR placed at the time of surgery. Each atrial tachyarrhythmia (ATA) of two or more minutes was saved. Patients transmitted ILR recordings bimonthly or following any symptomatic event. Up to 27 minutes of data was stored before files were overwritten. Patients also received ECG and 24-hour Holter monitoring at 3, 6, and 12-months. ILR compliance was defined as any transmission between 0–3 months, 3–6 months, or 6–12 months. Freedom from ATAs were calculated and compared. Results ILR compliance at 12-months was 93% compared to ECG and Holter compliance of 85% and 76% respectively. ILR devices reported a total of 20,878 ATAs. Of these, 11% of episodes were available for review and 46% were confirmed as AF. Freedoms from ATAs were no different between continuous and intermittent monitoring at one year. Symptomatic events accounted for 187 episodes. However, only 10% were confirmed as AF. Conclusions ILR was equivalent at detecting ATAs compared to Holter or ECG. However, the high rate of false positives and limited number of events available for review present barriers to broad implementation of this form of monitoring. Very few symptomatic events were AF upon review.

Background In patients with atrial fibrillation(AF), the addition of surgical ablation to aortic valve replacement(AVR) does not increase procedural morbidity or mortality. However, efficacy in this population has not been carefully evaluated. This study compared outcomes between patients undergoing stand-alone Cox-Maze IV to those undergoing surgical ablation and concomitant AVR. Methods From January 2002 to May 2014, 188 patients received a stand-alone Cox-maze IV(n=113) or surgical ablation with concomitant AVR(n=75). In the concomitant AVR group, patients underwent Cox-maze IV(n=58), left-sided Cox-maze IV(n=3), or pulmonary vein isolation(n=14). Thirty-one perioperative variables were compared. Freedoms from AF on and off antiarrhythmic drugs were evaluated at 3, 6, 12, and 24 months. Results Follow up was available in 97% of patients. Freedom from AF on and off antiarrhythmic drugs in patients receiving a stand-alone Cox-maze IV vs. concomitant AVR was not significantly different at any time point. The concomitant AVR group had more comorbidities, paroxysmal AF, pacemaker implantations(24% vs. 5%, p=0.002), and complications(25% vs. 5%, p<0.001). Freedoms from AF off antiarrhythmic drugs for patients receiving an AVR and pulmonary vein isolation at 1 year was only 50%, which was significantly lower than patients receiving an AVR and Cox-maze IV(94%, p=0.001). Conclusions A Cox-maze IV with concomitant AVR is as effective as a stand-alone Cox-maze IV in treating AF, even in an older population with more comorbidities. Pulmonary vein isolation was not as effective and is not recommended in this population. A Cox-maze IV should be considered all in patients undergoing AVR with a history of AF.

The SIS-ECM valved conduit implanted into a piglet demonstrated cellular infiltration with vascular remodeling and an increase in diameter. Conduit stenosis was a result of slower rates of size increase than native tissue. Suboptimal leaflet performance requires design modifications.

A large deficit exists in the total QoL of pediatric patients supported by a VAD compared with outpatient management of severe heart disease or postheart transplant patients; however, VAD patients do represent a group with more severe heart failure. Improvements in QoL must be made, as time spent with a VAD will likely continue to increase.

Objective The impact of prolonged episodes of atrial fibrillation on atrial and ventricular function has been incompletely characterized. The purpose of this study was to investigate the influence of atrial fibrillation on left atrial and ventricular function in a rapid paced porcine model of atrial fibrillation. Methods A control group of pigs (group 1, n = 8) underwent left atrial and left ventricular conductance catheter studies and fibrosis analysis. A second group (group 2, n = 8) received a baseline cardiac magnetic resonance imaging to characterize left atrial and left ventricular function. The atria were rapidly paced into atrial fibrillation for 6 weeks followed by cardioversion and cardiac magnetic resonance imaging. Results After 6 weeks of atrial fibrillation, left atrial contractility defined by atrial end-systolic pressure-volume relationship slope was significantly lower in group 2 than in group 1 (1.1 ± 0.5 vs 1.7 ± 1.0; P = .041), whereas compliance from the end-diastolic pressure-volume relationship was unchanged (1.5 ± 0.9 vs 1.6 ± 1.3; P = .733). Compared with baseline, atrial fibrillation resulted in a significantly higher contribution of left atrial reservoir volume to stroke volume (32% vs 17%; P = .005) and lower left atrial booster pump volume contribution to stroke volume (19% vs 28%; P = .029). Atrial fibrillation also significantly increased maximum left atrial volume (206 ± 41 mL vs 90 ± 21 mL; P < .001). Left atrial fibrosis in group 2 was significantly higher than in group 1. Atrial fibrillation decreased left ventricular ejection fraction (29% ± 9% vs 58 ± 8%; P < .001), but left ventricular stroke volume was unchanged. Conclusions In a chronic model of atrial fibrillation, the left atrium demonstrated significant structural remodeling and decreased contractility. These data suggest that early intervention in patients with persistent atrial fibrillation might mitigate against adverse atrial and ventricular structural remodeling.

The use of surgical lesion sets for the treatment of atrial fibrillation has been increasing, particularly in patients with complicated anatomical substrates and those undergoing concomitant surgery. Preferences in terms of lesion set, surgical approach and ablation technology vary by center. This review discusses both the surgical techniques and the outcomes for the most commonly performed procedures in the context of recent consensus guidelines. The Cox-Maze IV, pulmonary vein isolation, extended left atrial lesion sets, the hybrid approach and ganglionated plexus ablation are each reviewed in an attempt to provide insight into current clinical practice and patient selection