AKI is common in low-birth-weight patients after aortic arch repair surgery. However, patients recover from AKI after conservative management. Requiring PD increases the morbidity associated with AKI.

Introduction: Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) catheter ablation. However, a PVI alone has been considered insufficient for persistent AF. This study aimed to evaluate the efficacy of persistent AF ablation targeting complex fractionated atrial electrogram (CFAE) areas within low voltage zones identified by high-resolution mapping in addition to the PVI.Methods: We randomized 50 patients (mean age 58.4 ± 9.5 years old, 86.0% males) with persistent AF to a PVI + CFAE group and PVI only group in a 1:1 ratio. CFAE and voltage mapping was performed simultaneously using a Pentaray Catheter with the CARTO3 CONFIDENSE module (Biosense Webster, CA, USA). The PVI + CFAE group, in addition to the PVI, underwent ablation targeting low voltage areas (<0.5 mV during AF) containing CFAEs.Results: The mean persistent AF duration was 24.0 ± 23.1 months and mean left atrial dimension 4.9 ± 0.5 cm. In the PVI + CFAE group, AF converted to atrial tachycardia (AT) or sinus rhythm in 15 patients (60%) during the procedure. The PVI + CFAE group had a higher 1-year AF free survival (84.0% PVI + CFAE vs 44.0 PVI only, P = .006) without antiarrhythmic drugs. However, there was no difference in the AF/AT free survival (60.0% PVI + CFAE vs 40.0% PVI only, P = .329). Conclusion:Persistent AF ablation targeting CFAE areas within low voltage zones using high-density voltage mapping had a higher AF free survival than a PVI only. Although recurrence with AT was frequent in the PVI+CFAE group, the sinus rhythm maintenance rate after redo procedures was 76%. Abbreviations: AF = atrial fibrillation, AT = atrial tachycardia, CFAE = complex fractionated atrial electrogram, CTI = cavotricuspid isthmus, ECG = electrocardiogram, ICL = interval confidence level, LA = left atrium, PeAF = persistent AF, PVI = pulmonary vein isolation, RA = right atrium, SCI = shortest complex interval.

Bronchoscopy-guided aortopexy is a surgical management option for patients with central airway obstruction after congenital heart surgery. This study aimed to evaluate the usefulness of bronchoscopy-guided aortopexy based on midterm follow-up evaluation with computed tomography (CT) and clinical outcome. From January 2004 to August 2011, bronchoscopy-guided aortopexy was performed for 16 patients (median age 0.5 years, M:F = 10:6) who had central airway obstruction caused by extrinsic compression (13 in the left main bronchus, 2 in the trachea, 1 in the diffuse trachea and bronchus) after congenital heart surgery. The surgical site for aortopexy was determined by the anatomic relationship between the aorta and the compressed bronchus according to preoperative CT and intraoperative bronchoscopy. The median follow-up period was 2.3 years. The ratios of the diameter and area of stenosis at the narrowed point were estimated using pre- and postoperative CT. Almost all the patients (15/16) showed relief of their preoperative symptoms. The median extubation time was 18 h. The stenosis diameter and area ratios significantly improved, as shown by with the immediate postoperative CT (7.7-48.5%, p = 0.003; 54.8-80.5%, p = 0.006). Airway stenosis of more than 75% (p = 0.013), immediate diameter ratio improvement of <50% (p = 0.015), preoperative severe respiratory insufficiency (p = 0.038), and male sex (p = 0.024) were associated with recurrent minor respiratory susceptibility. Bronchoscopy-guided aortopexy is a safe and reliable surgical management choice for central airway obstruction after congenital heart surgery. Furthermore, airway improvement after aortopexy was maintained during the midterm follow-up evaluation, according to CT measurements.

Fontan conversion with antiarrhythmia surgery and permanent pacemaker implantation is safe and improves the clinical outcome and arrhythmias.

Background: An enlarged left atrium (LA) is a well-known risk factor for ablation failure of atrial fibrillation (AF). We analyzed the result of concomitant AF ablation in patients with a giant LA and evaluated the effect of LA volume reduction.Methods: Between 2000 and 2011, 116 patients with a giant LA (antero-posterior dimension ≥70 mm) who underwent surgical AF ablation during MV surgery were retrospectively reviewed. Among these, 28 patients received aggressive LA volume reduction procedure (reduction group) while the other 88 patients received the surgery without LA volume reduction (non-reduction group). Mean follow-up duration was 6.8±3.0 years.Results: Aortic clamping and cardio-pulmonary bypass times were significantly longer in reduction group than non-reduction group (P<0.001 and 0.025, respectively). There were no significant differences in early mortality rates (3.7% vs. 5.7%, P>0.99) and major complication rates. Rates of freedom from AF at 1, 3 and 5 years were 84.2%, 74.3% and 54.5%, respectively in reduction group and 49.0%, 33.2% and 28.4%, respectively in non-reduction group (P=0.013). Multivariable analysis revealed severe pulmonary hypertension as an independent risk factor for AF recurrence (HR, 15.9; 95% CI, 1.69-149.54, P=0.015) while LA volume reduction (HR, 0.50; 95% CI, 0.28-0.89, P=0.018) and the use of cryoablation instead of radiofrequency (HR, 0.11; 95% CI, 0.01-0.95, P=0.045) were found to be protective against AF recurrence.Conclusions: Aggressive LA volume reduction was found to improve rhythm outcomes in patients with a giant LA undergoing surgical AF ablation.