Duk Hyun Kang

Atrial fibrillation surgery simplified with cryoablation to improve left atrial function.

BACKGROUNDnThe Maze procedure restores atrial fibrillation to normal sinus rhythm. However, concurrent left atrial functional recovery is not always achieved. To address this limitation, a modification using linear cryoablation is described.nnnMETHODSnBetween July 1997 and December 1999, 83 patients received atrial fibrillation surgery in association with mitral valve surgery with or without additional concurrent procedures by either the conventional technique, group I (n = 30) or the modified technique, group II (n = 53). Onset of sinus conversion and echocardiographic assessment of postoperative left ventricular function, left atrial size, and mitral A-wave velocity were compared in the early postoperative period and 6 months after surgery.nnnRESULTSnSinus conversion occurred significantly earlier in group II, 2.4 +/- 5 days versus group I, 7.0 +/- 10 days. The mean transmitral A-wave velocity and the incidence of A-wave appearance in the early postoperative period and 6 months postoperatively were greater in group II than group I.nnnCONCLUSIONSnWith the current modification, restoration of sinus rhythm and superior left atrial contractile function occurred earlier than with the standard Maze III technique.

Impact of the Maze operation on the progression of mild functional tricuspid regurgitation

OBJECTIVESnIn patients having mitral valve surgery, concomitant surgery for mild functional tricuspid regurgitation remains the subject of debate. This study examined the effect of Maze operation and tricuspid valve repair on postoperative functional tricuspid regurgitation progression.nnnMETHODSnThe study retrospectively analyzed 250 patients (86 men, 164 women) with mild functional tricuspid regurgitation (grade 2) who had mitral valve surgery between January 1994 and July 2006. Based on follow-up data, patients were defined as either stable (n = 209, 83.6%) or aggravated (n = 41, 16.4%). Predictors for significant tricuspid regurgitation development were identified using Cox regression analysis.nnnRESULTSnThe mean follow-up time was 62.6 +/- 39.8 months after surgery. Although most mitral valve procedures were successful, there was an increase in the incidence of significant functional tricuspid regurgitation overall from immediately postoperative to final assessment (5.2% to 16.4%, P < 0.01). Univariate analysis showed that old age, shorter aortic crossclamping time, and omission of Maze operation were associated with functional tricuspid regurgitation progression. Multivariate analysis showed that older age (adjusted hazard ratio, 1.05; 95% confidence interval, 1.02 to 1.08), a rheumatic etiology of the mitral valve disease (adjusted hazard ratio, 2.31; 95% confidence interval, 1.21 to 4.42), and no Maze operation (adjusted hazard ratio, 7.90; 95% confidence interval, 1.90 to 32.86) were independent predictors of mild functional tricuspid regurgitation progression. For the 168 patients with preoperative atrial fibrillation, Maze operation improved the tricuspid regurgitation-free survival significantly (P < .01) but tricuspid valve repair showed no significant difference.nnnCONCLUSIONSnMild functional tricuspid regurgitation can progress postoperatively despite successful mitral valve surgery. Although tricuspid valve repairs alleviate progression of functional tricuspid regurgitation, concomitant Maze operation is a more powerful protective factor against mild functional tricuspid regurgitation progression.

Long-Term Results of Early Surgery versus Conventional Treatment for Infective Endocarditis Trial

Background and Objectives Compared with conventional treatment, early surgery significantly reduced the composite end point of all-cause death and embolic events during hospitalization, but long-term data in this area are lacking. This study sought to compare long-term outcomes of early surgery with a conventional treatment strategy in patients with infective endocarditis (IE) and large vegetations. Subjects and Methods The Early Surgery versus Conventional Treatment in Infective Endocarditis (EASE) trial randomly assigned patients with left-sided IE, severe valve disease and large vegetation to early surgery (37 patients) or conventional treatment groups (39 patients). The pre-specified end points were all-cause death, embolic events, recurrence of IE and repeat hospitalizations due to the development of congestive heart failure occurring during follow-up. Results There were no significant differences between the early surgery and the conventional treatment group in all-cause mortality at 4 years (8.1% and 7.7%, respectively; hazard ratio [HR] 1.04; 95% CI, 0.21 to 5.15; p=0.96). The rate of the composite end point of death from any cause, embolic events or recurrence of IE at 4 years was 8.1% in the early surgery group and 30.8% in the conventional treatment group (HR, 0.22; 95% CI, 0.06-0.78; p=0.02). The estimated actuarial rate of end points at 7 years was significantly lower in the early surgery group than in the conventional treatment group (log-rank p=0.007). Conclusion There was a substantial benefit in having early surgery for patients with IE and large vegetations whose health was sustained up to 7 years, and late clinical outcome after surgery was excellent in survivors of IE. (EASE clinicaltrials.gov identifier: NCT00750373)

A multicenter, non-comparative study to evaluate the efficacy and safety of fixed-dose olmesartan/amlodipine in Korean patients with hypertension who are naïve or non-responders to anti-hypertensive monotherapy (ACE-HY study).

Abstract The purpose of this study was to evaluate the efficacy of a fixed-dose combination (FDC) of olmesartan and amlodipine in Korean hypertensive patients who were naïve to or uncontrolled by amlodipine or losartan monotherapy. This was a prospective, open-label, multi-center, non-comparative study with a planned treatment period of 12 weeks. The primary outcome was changed in seated diastolic blood pressure (SeDBP) from baseline to week 12. Secondary outcomes were changed in seated systolic blood pressure (SeSBP), the proportion of patients achieving target blood pressure (BP), and 24-h ambulatory BP. Safety and tolerability were also evaluated. A total of 376 patients were enrolled from 20 centers in Korea. The age of the patients was 52.4u2009±u200911.7 years, and 224 (59.6%) were male. Full analysis set included 110 naïve (group 1), 132 previously amlodipine-treated (group 2) and 134 previously losartan-treated (group 3) patients. The SeDBP decreased at 12 weeks in all three groups: by 23.1u2009±u20097.8u2009mmu2009Hg (103.3u2009±u20093.0 to 80.2u2009±u20098.1u2009mmu2009Hg) in group 1, 14.3u2009±u20098.2u2009mmu2009Hg (94.6u2009±u20095.1 to 80.3u2009±u20098.6u2009mmu2009Hg) in group 2, and 15.7u2009±u20096.8u2009mmu2009Hg (94.6u2009±u20094.8 to 78.9u2009±u20097.0u2009mmu2009Hg) in group 3 (all pu2009<u20090.001). Furthermore, the SeSBP and 24-h ambulatory BP decreased significantly in all three groups, andu2009>u200980% of patients achieved their target BP. Overall, the olmesartan/amlodipine FDC was well tolerated, and there were no serious adverse events associated with medication. In conclusion, the olmesartan/amlodipine FDC showed efficacy and safety in Korean patients with hypertension, who had never been treated or were uncontrolled with monotherapy.