Background-Optimal management strategy of acute aortic dissection (AD) with retrograde extension from entry tear in the descending aorta into the ascending aorta remains undetermined. Methods and Results-Of the 538 patients who were diagnosed as having acute AD from 1999 through 2011, 49 patients (37 men; 52.5±13.1 years) were identified as having entry tear in the descending aorta with retrograde extension of AD into the ascending aorta. Sixteen patients who were clinically stable with thrombosed false lumen in the ascending aorta were treated medically (MED group), whereas 33 patients underwent aortic replacement (SURG group) on an intentionto-treat basis. In the MED group, 1 patient was converted to urgent aortic surgery and 2 patients underwent endovascular stent grafting in the descending aorta during the initial hospitalization. The early (30-day or in-hospital) mortality rates were 0% and 9.1% in the MED and SURG group, respectively (P=0.54).

The use of DN in adult valve surgery including complex procedures may confer acceptable outcomes comparable to or even superior to those obtained with the use of blood cardioplegia.

Valve repair in well-selected patients with severe rheumatic MV disease led to comparable survival, but superior valve-related outcomes compared with valve replacement surgery.

Objective: Efficacy of atrial fibrillation ablation in rheumatic mitral valve disease has been regarded inferior to that in nonrheumatic diseases. This study aimed to evaluate net clinical benefits by the addition of concomitant atrial fibrillation ablation in rheumatic mitral valve surgery.Methods: Among 1229 consecutive patients with atrial fibrillation from 1997 to 2016 (54.4 AE 11.7 years; 68.2% were female), 812 (66.1%) received concomitant ablation of atrial fibrillation (ablation group), and 417 (33.9%) underwent valve surgery alone (no ablation group). Death and thromboembolic events were compared between these groups. Mortality was regarded as a competing risk to evaluate thromboembolic outcomes. To reduce selection bias, inverse probability of treatment weighting methods were performed.Results: Freedom from atrial fibrillation occurrence at 5 years was 76.5% AE 1.8% and 5.3% AE 1.1% in the ablation and no ablation groups, respectively (P<.001). The ablation group had significantly lower risks for death (hazard ratio [HR], 0.69; 95% confidence interval [CI], 0.52-0.93) and thromboembolic events (HR, 0.49; 95% CI, 0.32-0.76) than the no ablation group. Time-varying Cox analysis revealed that the occurrence of stroke after surgery was significantly associated with death (HR, 3.97; 95% CI, 2.36-6.69). In subgroup analyses, the reduction in the composite risk of death and thromboembolic events was observed in all mechanical (n ¼ 829; HR, 0.53; 95% CI, 0.39-0.73), bioprosthetic replacement (n ¼ 239; HR, 0.67; 95% CI, 0.41-1.08), and repair (n ¼ 161; HR, 0.17; 95% CI, 0.06-0.52) subgroups (P for interaction ¼ .47).Conclusions: Surgical atrial fibrillation ablation during rheumatic mitral valve surgery was associated with a lower risk of long-term mortality and thromboembolic events. Therefore, atrial fibrillation ablation for rheumatic mitral valve disease may be a reasonable option. (

Background— The long-term benefits of the maze procedure in patients with chronic atrial fibrillation undergoing mechanical valve replacement who already require lifelong anticoagulation remain unclear. Methods and Results— We evaluated adverse outcomes (death; thromboembolic events; composite of death, heart failure, or valve-related complications) in 569 patients with atrial fibrillation–associated valvular heart disease who underwent mechanical valve replacement with (n=317) or without (n=252) a concomitant maze procedure between 1999 and 2010. After adjustment for differences in baseline risk profiles, patients who had undergone the maze procedure were at similar risks of death (hazard ratio, 1.15; 95% confidence interval, 0.65–2.03; P =0.63) and the composite outcomes (hazard ratio, 0.82; 95% confidence interval, 0.50–1.34; P =0.42) but a significantly lower risk of thromboembolic events (hazard ratio, 0.29; 95% confidence interval, 0.12–0.73; P =0.008) compared with those who underwent valve replacement alone at a median follow-up of 63.6 months (range, 0.2–149.9 months). The effect of superior event-free survival by the concomitant maze procedure was notable in a low-risk EuroSCORE (0–3) subgroup ( P =0.049), but it was insignificant in a high-risk EuroSCORE (≥4) subgroup ( P =0.65). Furthermore, the combination of the maze procedure resulted in superior left ventricular ( P <0.001) and tricuspid valvular functions ( P <0.001) compared with valve replacement alone on echocardiographic assessments performed at a median of 52.7 months (range, 6.0–146.8 months) after surgery. Conclusion— Compared with valve replacement alone, the addition of the maze procedure was associated with a reduction in thromboembolic complications and improvements in hemodynamic performance in patients undergoing mechanical valve replacement, particularly in those with low risk of surgery.

Outcomes of ECMO in refractory septic shock patients were poor with a very low probability of survival. This finding raises questions concerning the utility of applying ECMO for medically refractory septic shock. Elevated arterial lactate levels pre- and post-ECMO were associated with risk of in-hospital death. Further large-scale studies are needed to validate the results of this study.

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