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  • 1.
    Ahlsson, Anders
    Örebro University, School of Health and Medical Sciences.
    Atrial fibrillation in cardiac surgery2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Atrial fibrillation (AF) is the most common arrhythmia seen in clinical practice. In cardiac surgery, one-third of the patients experience episodes of AF during the first postoperative days (postoperative AF), and patients with preoperative AF (concomitant AF) can be offered ablation procedures in conjunction with surgery, in order to restore ordinary sinus rhythm (SR). The aim of this work was to study the relation between postoperative AF and inflammation; the long-term consequences of postoperative AF on mortality and late arrhythmia; and atrial function after concomitant surgical ablation for AF.

    In 524 open-heart surgery patients, C-reactive protein (CRP) serum concentrations were measured before and on the third day after surgery. There was no correlation between levels of CRP and the development of postoperative AF.

    All 1,419 patients with no history of AF, undergoing primary aortocoronary bypass surgery (CABG) in the years 1997–2000 were followed up after 8.0 years. The mortality rate was 191 deaths/1,000 patients (19.1%) in patients with no AF and 140 deaths/419 patients (33.4%) in patients with postoperative AF. Postoperative AF was an age-independent risk factor for late mortality, with a hazard ratio (HR) of 1.56 (95% CI 1.23–1.98). Postoperative AF patients had a more than doubled risk of death due to cerebral ischaemia, myocardial infarction, sudden death, and heart failure compared with patients without AF.

    All 571 consecutive patients undergoing primary CABG during the years 1999–2000 were followed-up after 6 years. Questionnaires were obtained from 91.6% of surviving patients and an electrocardiogram (ECG) from 88.3% of all patients. In postoperative AF patients, 14.1% had AF at follow-up, compared with 2.8% of patients with no AF at surgery (p<.001). An episode of postoperative AF was found to be an independent risk factor for development of late AF, with an adjusted risk ratio (RR) of 3.11 (95% CI 1.41–6.87).

    Epicardial microwave ablation was performed in 20 open-heart surgery patients with concomitant AF. Transthoracic echocardiography was performed preoperatively and at 6 months postoperatively. At 12 months postoperatively 14/19 patients (74%) were in SR with no anti-arrhythmic drugs. All patients in SR had preserved left and right atrial filling waves (A-waves) and Tissue velocity echocardiography (TVE) showed preserved atrial wall velocities and atrial strain.

    In conclusion, postoperative AF is an independent risk factor for late mortality and later development of AF. There is no correlation between the inflammatory marker CRP and postoperative AF. Epicardial microwave ablation of concomitant AF results in SR in the majority of patients and seems to preserve atrial mechanical function.

    List of papers
    1. Postoperative atrial fibrillation is not correlated to C-reactive protein
    Open this publication in new window or tab >>Postoperative atrial fibrillation is not correlated to C-reactive protein
    2007 (English)In: Annals of Thoracic Surgery, ISSN 0003-4975, E-ISSN 1552-6259, Vol. 83, no 4, p. 1332-1337Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: The peak incidence of postoperative atrial fibrillation (AF) occurs around the second postoperative day, a time at which serum inflammatory markers are elevated. The aim of this study was to investigate differences between patients with and without postoperative AF with special regard to C-reactive protein (CRP) serum levels. METHODS: The study cohort included all heart surgery patients who had sinus rhythm preoperatively, survived postoperative day 3, and were operated on between July 1, 2004, and June 30, 2005 (n = 524). Any episode of AF during the first 7 postoperative days defined the patient as belonging to the postoperative AF group. Creatine kinase-myocardial band (CK-MB) was measured at postoperative day 1, and CRP was measured preoperatively and at postoperative day 3. Risk factors for postoperative AF were determined using bivariate and multivariate regression analysis. RESULTS: Of 524 patients, 182 had at least one episode of AF (34.7%). Preoperative and postoperative CRP concentrations did not differ between the groups (postoperative CRP 175.4 +/- 64.4 versus 175.3 +/- 60.1 mg/L respectively, p = 0.99). Atrial fibrillation patients were significantly older (p < 0.001) and had higher CK-MB levels (33.6 +/- 53.1 microg/L versus 22.5 +/- 26.7 microg/L, respectively, p = 0.009). The odds ratio for postoperative AF with postoperative CK-MB greater than 70 microg/L was 3.5 (confidence interval: 1.4 to 8.6). CONCLUSIONS: Postoperative AF has no correlation to the inflammatory marker CRP in heart surgery patients. Ischemic myocardial injury might predispose for postoperative AF.

    National Category
    Medical and Health Sciences Surgery Surgery
    Research subject
    Surgery esp. Thoracic and Cardivascular Surgery
    Identifiers
    urn:nbn:se:oru:diva-2986 (URN)10.1016/j.athoracsur.2006.11.047 (DOI)17383336 (PubMedID)
    Available from: 2008-09-01 Created: 2008-09-01 Last updated: 2017-12-14Bibliographically approved
    2. Patients with postoperative atrial fibrillation have a doubled cardiovascular mortality
    Open this publication in new window or tab >>Patients with postoperative atrial fibrillation have a doubled cardiovascular mortality
    (English)Manuscript (Other academic)
    National Category
    Surgery
    Research subject
    Surgery
    Identifiers
    urn:nbn:se:oru:diva-2987 (URN)
    Available from: 2008-09-01 Created: 2008-09-01 Last updated: 2017-10-18Bibliographically approved
    3. Postoperative atrial fibrillation as risk factor for late arrhythmia and cardiovascular death: a six-year follow-up after coronary artery bypass surgery
    Open this publication in new window or tab >>Postoperative atrial fibrillation as risk factor for late arrhythmia and cardiovascular death: a six-year follow-up after coronary artery bypass surgery
    (English)Manuscript (Other academic)
    National Category
    Surgery
    Research subject
    Surgery
    Identifiers
    urn:nbn:se:oru:diva-2988 (URN)
    Available from: 2008-09-01 Created: 2008-09-01 Last updated: 2017-10-18Bibliographically approved
    4. Atrial function after epicardial microwave ablation in patients with atrial fibrillation
    Open this publication in new window or tab >>Atrial function after epicardial microwave ablation in patients with atrial fibrillation
    2008 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 42, no 3, p. 192-201Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVES: To study epicardial microwave ablation of concomitant atrial fibrillation and its effects on heart rhythm and atrial function during follow-up. DESIGN: The study included 20 open-heart surgery patients with concomitant atrial fibrillation. Transthoracic echocardiography with flow and tissue Doppler recordings was performed preoperatively and at 6 months postoperatively. Blood samples were obtained preoperatively and postoperatively for analysis of atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and amino terminal precursor of brain natriuretic peptide (NT-proBNP). RESULTS: Fourteen of 19 patients (74%) were in sinus rhythm with no antiarrhythmic drugs at 12 months. All patients in sinus rhythm had preserved left and right atrial-filling waves through atrioventricular valves during atrial contraction. Tissue velocity echocardiography on patients in sinus rhythm showed preserved atrial wall velocities, atrial strain, and atrial strain rate. Levels of natriuretic peptides tended to decrease in patients with stable sinus rhythm at one year compared to patients in atrial fibrillation. CONCLUSIONS: Epicardial microwave ablation results in sinus rhythm in a majority of patients and seems to preserve atrial mechanical function

    Keywords
    Aged, Atrial Fibrillation/metabolism/physiopathology/*surgery/ultrasonography, Atrial Function, Atrial Natriuretic Factor/blood, Biological Markers/blood, Catheter Ablation/adverse effects/*methods, Echocardiography; Doppler, Female, Heart Conduction System/*physiopathology, Humans, Male, Microwaves/*therapeutic use, Middle Aged, Myocardial Contraction, Natriuretic Peptide; Brain/blood, Peptide Fragments/blood, Pericardium/*surgery, Prospective Studies, Time Factors, Treatment Outcome
    National Category
    Medical and Health Sciences Surgery
    Research subject
    Surgery
    Identifiers
    urn:nbn:se:oru:diva-3585 (URN)10.1080/14017430701882418 (DOI)18569951 (PubMedID)
    Available from: 2008-12-11 Created: 2008-12-11 Last updated: 2019-03-26Bibliographically approved
  • 2.
    Ahlsson, Anders
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Billroth och Brahms: en problemfylld vänskap mellan två ikoner2008In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, no 10, p. 755-757Article in journal (Other (popular science, discussion, etc.))
  • 3.
    Ahlsson, Anders
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    eComment. Postoperative atrial fibrillation: a robust human model of atrial fibrillation genesis?2013In: Interactive Cardiovascular and Thoracic Surgery, ISSN 1569-9293, E-ISSN 1569-9285, Vol. 17, no 4, p. 614-615Article in journal (Refereed)
  • 4.
    Ahlsson, Anders
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Exploration of Theoretical Ganglionated Plexi Ablation Technique in Atrial Fibrillation Surgery COMMENTARY2014In: Annals of Thoracic Surgery, ISSN 0003-4975, E-ISSN 1552-6259, Vol. 98, no 5, p. 1604-1605Article in journal (Other academic)
  • 5.
    Ahlsson, Anders
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Dept Cardiothorac & Vasc Surg.
    Postoperative atrial fibrillation and stroke-is it time to act?2014In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 48, no 2, p. 69-70Article in journal (Other academic)
  • 6.
    Ahlsson, Anders
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Universitetssjukhuset, Örebro, Sweden.
    Rädda synen på Bach2014In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 111, no 3-4, p. 100-1Article in journal (Other (popular science, discussion, etc.))
  • 7.
    Ahlsson, Anders
    et al.
    Thoraxkliniken, Universitetssjukhuset, Örebro, Sweden.
    Albåge, Anders
    Karolinska universitetssjukhuset, Stockholm, Sweden.
    Jidéus, Lena
    Akademiska universitetssjukhuset, Uppsala, Sweden.
    Berglin, Eva
    Sahlgrenska universitetssjukhuset, Göteborg, Sweden.
    Kirurgisk behandling av förmaksflimmer i samband med hjärtkirurgi [Surgical treatment of atrial fibrillation in connection with cardiac surgery]: konsensusrapport från Sveriges arytmiansvariga hjärtkirurger [ Consensus report from Swedish cardiac surgeons responsible for arrhythmia]2012In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 109, no 5, p. 214-217Article in journal (Refereed)
    Abstract [sv]

    Förmaksflimmer är vanligt och förekommer hos 6–10 procent av de patienter som ska genomgå kranskärlsoperation eller klaffkirurgi. Kirurgisk ablation av förmaksflimmer i samband med kranskärlsoperation eller klaffkirurgi bör erbjudas alla symtomatiska och utvalda asymtomatiska patienter. Cox-maze III (labyrintoperation) är den metod som gett bäst resultat vad avser frihet från förmaksflimmer 1 år efter ingreppet.

    Under senare år har flera nya metoder utvecklats för att åstadkomma elektriskt isolerande lesioner i hjärtats förmak. Dessa är tekniskt enklare och mindre invasiva. De är dock behäftade med sämre resultat än den ursprungliga Cox-maze III-operationen. Arytmiansvariga kirurger på landets samtliga hjärtkirurgiska kliniker har nått samstämmighet om hur förmaksflimmer bör behandlas i samband med annan hjärtkirurgi. Denna konsensus, vilken presenteras här, betonar vikten av att vid kirurgisk ablation följa lesionsmönstret i Cox-maze III och helst behandla både höger och vänster förmak för bästa långtidsresultat

  • 8.
    Ahlsson, Anders
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Cardiothoracic Surgery and Anesthesiology, Örebro University Hospital, Örebro, Sweden.
    Bodin, Lennart
    Örebro University, Örebro University School of Business. Department of Statistics and Epidemiology, Örebro University Hospital, Örebro, Sweden.
    Fengsrud, Espen
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
    Englund, Anders
    Örebro University, School of Health and Medical Sciences. Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
    Patients with postoperative atrial fibrillation have a doubled cardiovascular mortality2009In: Scandinavian cardiovascular journal : SCJ, ISSN 1651-2006, Vol. 43, no 5, p. 330-336Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To investigate the impact of postoperative AF on late mortality and cause of death in CABG patients.

    DESIGN: All CABG patients without preoperative AF surgically treated between January 1, 1997 and June 30, 2000 were included (N = 1419). Altogether, 419 patients (29.5%) developed postoperative AF. After a median follow-up of 8.0 years, survival data were obtained, causes of death were compared and Cox proportional hazard analysis was used to determine predictors of late mortality.

    RESULTS: The total mortality was 140 deaths/419 patients (33.4%) in postoperative AF patients and 191 deaths/1 000 patients (19.1%) in patients without AF. Death due to cerebral ischemia (2.6% vs. 0.5%), myocardial infarction (7.4% vs. 3.0%), sudden death (2.6% vs. 0.9%), and heart failure (6.7% vs. 2.7%) was more common among postoperative AF patients. Postoperative AF was an age-independent risk indicator for late mortality with a hazard ratio (HR) of 1.56 (95% confidence interval 1.23-1.98).

    CONCLUSIONS: Postoperative AF is an age-independent risk factor for late mortality in CABG patients, explained by an increased risk of cardiovascular death.

  • 9.
    Ahlsson, Anders
    et al.
    Örebro University, School of Health and Medical Sciences.
    Bodin, Lennart
    Fengsrud, Espen
    Englund, Anders
    Patients with postoperative atrial fibrillation have a doubled cardiovascular mortalityManuscript (Other academic)
  • 10.
    Ahlsson, Anders
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Dept Cardiothorac & Vasc Surg, Örebro University Hospital, Örebro, Sweden.
    Fengsrud, Espen
    Dept Cardiol, Örebro University Hospital, Örebro, Sweden.
    Axelsson, Birger
    Örebro University Hospital. Dept Cardiothorac & Vasc Surg, Örebro University Hospital, Örebro, Sweden.
    Positioning of the ablation catheter in total endoscopic ablation2014In: Interactive Cardiovascular and Thoracic Surgery, ISSN 1569-9293, E-ISSN 1569-9285, Vol. 18, no 1, p. 125-127Article in journal (Refereed)
    Abstract [en]

    Minimally invasive ablation of atrial fibrillation is an option in patients not suitable for or refractory to catheter ablation. Total endoscopic ablation can be performed via a monolateral approach, whereby a left atrial box lesion is created. If the ablation is introduced from the right side, the positioning of the ablation catheter on the partly hidden left pulmonary veins is of vital importance. Using thoracoscopy in combination with multiplane transoesophageal echocardiography, the anatomical position of the ablation catheter can be established. Our experience in over 60 procedures has confirmed this to be a safe technique of total endoscopic ablation.

  • 11.
    Ahlsson, Anders
    et al.
    Örebro University, School of Health and Medical Sciences.
    Fengsrud, Espen
    Bodin, Lennart
    Englund, Anders
    Postoperative atrial fibrillation as risk factor for late arrhythmia and cardiovascular death: a six-year follow-up after coronary artery bypass surgeryManuscript (Other academic)
  • 12.
    Ahlsson, Anders
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Cardiothoracic Surgery and Anesthesiology, Örebro University Hospital, Örebro, Sweden.
    Fengsrud, Espen
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
    Bodin, Lennart
    Department of Statistics and Epidemiology, Örebro University Hospital, Örebro, Sweden.
    Englund, Anders
    Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
    Postoperative atrial fibrillation in patients undergoing aortocoronary bypass surgery carries an eightfold risk of future atrial fibrillation and a doubled cardiovascular mortality2010In: European Journal of Cardio-Thoracic Surgery, ISSN 1010-7940, E-ISSN 1873-734X, Vol. 37, no 6, p. 1353-1359Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: This article presents a study of postoperative atrial fibrillation (AF) and its long-term effects on mortality and heart rhythm.

    METHODS: The study cohort consisted of 571 patients with no history of AF who underwent primary aortocoronary bypass surgery from 1999 to 2000. Postoperative AF occurred in 165/571 patients (28.9%). After a median follow-up of 6 years, questionnaires were obtained from 91.6% of surviving patients and an electrocardiogram (ECG) from 88.6% of all patients. Data from hospitalisations due to arrhythmia or stroke during follow-up were analysed. The causes of death were obtained for deceased patients.

    RESULTS: In postoperative AF patients, 25.4% had atrial fibrillation at follow-up compared with 3.6% of patients with no AF at surgery (p<0.001). An episode of postoperative AF was the strongest independent risk factor for development of late AF, with an adjusted risk ratio of 8.31 (95% confidence interval (CI) 4.20-16.43). Mortality was 29.7% (49 deaths/165 patients) in the AF group and 14.8% (60 deaths/406 patients) in the non-AF group (p<0.001). Death due to cerebral ischaemia was more common in the postoperative AF group (4.2% vs 0.2%, p<0.001), as was death due to myocardial infarction (6.7% vs 3.0%, p=0.041). Postoperative AF was an age-independent risk factor for late mortality, with an adjusted hazard ratio of 1.57 (95% CI 1.05-2.34).

    CONCLUSIONS: Postoperative AF patients have an eightfold increased risk of developing AF in the future, and a doubled long-term cardiovascular mortality.

  • 13.
    Ahlsson, Anders
    et al.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Friberg, Örjan
    Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden; School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Källman, Jan
    Örebro University, School of Medical Sciences. Department of Infectious Diseases, Örebro University Hospital, Örebro, Sweden.
    An angry cat causing Pasteurella multocida endocarditis and aortic valve replacement: A case report2016In: International journal of surgery case reports, ISSN 2210-2612, E-ISSN 2210-2612, Vol. 24, p. 91-93Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Cat bite infections usually involve a mix of anaerobic and aerobic bacteria including species of Pasteurella, Streptococcus, Staphylococcus, Bacteroides, and Fusobacterium. We report a case of Pasteurella multocida infection from cat bites leading to endocarditis and subsequent aortic valve replacement.

    PRESENTATION OF CASE: A 70-year-old male was admitted because of fever, tachycardia, and malaise. He had a history of alcohol abuse and was living alone with a cat in a rural area. A sepsis of unknown origin was suspected, and intravenous treatment with gentamicin and cefotaxime was initiated. Blood cultures yielded Pasteurella multocida, and the patient history revealed repeated cat bites. After four days, the patient was discharged with oral penicillin V treatment. Two weeks later, the patient returned with fever and a new systolic murmur. An aortic valve endocarditis was diagnosed, and it became clear that the patient had not completed the prescribed penicillin V treatment. The patient underwent a biological aortic valve replacement with debridement of an annular abscess, and the postoperative course was uneventful.

    DISCUSSION: Endocarditis due to Pasteurella is extremely rare, and there are only a few reports in the literature. Predisposing factors in the present case were alcohol abuse and reduced compliance to treatment.

    CONCLUSION: Cat bites are often deep, and in rare circumstances can lead to life-threatening endocarditis. Proper surgical revision, antibiotic treatment, and patient compliance are necessary components in patient care to avoid this complication.

  • 14.
    Ahlsson, Anders J.
    et al.
    Örebro University, School of Health and Medical Sciences.
    Bodin, Lennart
    Lundblad, Olof H.
    Englund, Anders G.
    Örebro University, School of Health and Medical Sciences.
    Postoperative atrial fibrillation is not correlated to C-reactive protein2007In: Annals of Thoracic Surgery, ISSN 0003-4975, E-ISSN 1552-6259, Vol. 83, no 4, p. 1332-1337Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The peak incidence of postoperative atrial fibrillation (AF) occurs around the second postoperative day, a time at which serum inflammatory markers are elevated. The aim of this study was to investigate differences between patients with and without postoperative AF with special regard to C-reactive protein (CRP) serum levels. METHODS: The study cohort included all heart surgery patients who had sinus rhythm preoperatively, survived postoperative day 3, and were operated on between July 1, 2004, and June 30, 2005 (n = 524). Any episode of AF during the first 7 postoperative days defined the patient as belonging to the postoperative AF group. Creatine kinase-myocardial band (CK-MB) was measured at postoperative day 1, and CRP was measured preoperatively and at postoperative day 3. Risk factors for postoperative AF were determined using bivariate and multivariate regression analysis. RESULTS: Of 524 patients, 182 had at least one episode of AF (34.7%). Preoperative and postoperative CRP concentrations did not differ between the groups (postoperative CRP 175.4 +/- 64.4 versus 175.3 +/- 60.1 mg/L respectively, p = 0.99). Atrial fibrillation patients were significantly older (p < 0.001) and had higher CK-MB levels (33.6 +/- 53.1 microg/L versus 22.5 +/- 26.7 microg/L, respectively, p = 0.009). The odds ratio for postoperative AF with postoperative CK-MB greater than 70 microg/L was 3.5 (confidence interval: 1.4 to 8.6). CONCLUSIONS: Postoperative AF has no correlation to the inflammatory marker CRP in heart surgery patients. Ischemic myocardial injury might predispose for postoperative AF.

  • 15.
    Ahlsson, Anders
    et al.
    Örebro University Hospital, Örebro, Sweden.
    Jidéus, Lena
    Uppsala University Hospital, Uppsala, Sweden.
    Albåge, Anders
    Karolinska University Hospital, Stockholm, Sweden.
    Källner, Göran
    Karolinska University Hospital, Stockholm, Sweden.
    Holmgren, Anders
    Umeå University Hospital, Umeå, Sweden.
    Boano, Gabriella
    Linköping University Hospital, Linköping, Sweden.
    Hermansson, Ulf
    Linköping University Hospital, Linköping, Sweden.
    Kimblad, Per-Ola
    Lund University Hospital, Lund, Sweden.
    Scherstén, Henrik
    Sahlgrenska University Hospital, Göteborg, Sweden.
    Sjögren, Johan
    Lund University Hospital, Lund, Sweden.
    Ståhle, Elisabeth
    Uppsala University Hospital, Uppsala, Sweden.
    Åberg, Bengt
    Blekinge Hospital, Karlskrona, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden.
    Berglin, Eva
    Sahlgrenska University Hospital, Göteborg, Sweden.
    A Swedish consensus on the surgical treatment of concomitant atrial fibrillation2012In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 46, no 4, p. 212-218Article, review/survey (Refereed)
    Abstract [en]

    Atrial fibrillation (AF) is a common arrhythmia among patients scheduled for open heart surgery and is associated with increased morbidity and mortality. According to international guidelines, symptomatic and selected asymptomatic patients should be offered concomitant surgical AF ablation in conjunction with valvular or coronary surgery. The gold standard in AF surgery is the Cox Maze III ("cut-and-sew") procedure, with surgical incisions in both atria according to a specified pattern, in order to prevent AF reentry circuits from developing. Over 90% of patients treated with the Cox Maze III procedure are free of AF after 1 year. Recent developments in ablation technology have introduced several energy sources capable of creating nonconducting atrial wall lesions. In addition, simplified lesion patterns have been suggested, but results with these techniques have been unsatisfactory. There is a clear need for standardization in AF surgery. The Swedish Arrhythmia Surgery Group, represented by surgeons from all Swedish units for cardiothoracic surgery, has therefore reached a consensus on surgical treatment of concomitant AF. This consensus emphasizes adherence to the lesion pattern in the Cox Maze III procedure and the use of biatrial lesions in nonparoxysmal AF.

  • 16.
    Ahlsson, Anders
    et al.
    Örebro University, School of Health and Medical Sciences.
    Linde, Peter
    Rask, Peter
    Englund, Anders
    Örebro University, School of Health and Medical Sciences.
    Atrial function after epicardial microwave ablation in patients with atrial fibrillation2008In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 42, no 3, p. 192-201Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To study epicardial microwave ablation of concomitant atrial fibrillation and its effects on heart rhythm and atrial function during follow-up. DESIGN: The study included 20 open-heart surgery patients with concomitant atrial fibrillation. Transthoracic echocardiography with flow and tissue Doppler recordings was performed preoperatively and at 6 months postoperatively. Blood samples were obtained preoperatively and postoperatively for analysis of atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and amino terminal precursor of brain natriuretic peptide (NT-proBNP). RESULTS: Fourteen of 19 patients (74%) were in sinus rhythm with no antiarrhythmic drugs at 12 months. All patients in sinus rhythm had preserved left and right atrial-filling waves through atrioventricular valves during atrial contraction. Tissue velocity echocardiography on patients in sinus rhythm showed preserved atrial wall velocities, atrial strain, and atrial strain rate. Levels of natriuretic peptides tended to decrease in patients with stable sinus rhythm at one year compared to patients in atrial fibrillation. CONCLUSIONS: Epicardial microwave ablation results in sinus rhythm in a majority of patients and seems to preserve atrial mechanical function

  • 17.
    Ahlsson, Anders
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Dept Cardiothorac & Vasc Surg, Örebro University Hospital, Örebro, Sweden.
    Sandin, Mathias
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Dept Cardiothorac & Vasc Surg, Örebro Univ Hosp, Örebro, Sweden.
    Souza, Domingos S. R.
    Örebro University Hospital. Dept Cardiothorac & Vasc Surg, Örebro University Hospital, Örebro, Sweden.
    Annular abscess leading to free wall rupture2014In: European Journal of Cardio-Thoracic Surgery, ISSN 1010-7940, E-ISSN 1873-734X, Vol. 45, no 2, p. E39-E39Article in journal (Other academic)
  • 18.
    Ahlsson, Anders
    et al.
    Department of Thoracic and Cardiovascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Sobrosa, Claudio
    Department of Thoracic and Cardiovascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Kaijser, Lennart
    Division of Clinical Physiology and Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
    Jansson, Eva
    Division of Clinical Physiology and Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
    Bomfim, Vollmer
    Department of Thoracic and Cardiovascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Adenosine in cold blood cardioplegia: a placebo-controlled study2012In: Interactive Cardiovascular and Thoracic Surgery, ISSN 1569-9293, E-ISSN 1569-9285, Vol. 14, no 1, p. 48-55Article in journal (Refereed)
    Abstract [en]

    Objective: Adenosine as an additive in blood cardioplegia is cardioprotective in animal studies, but its clinical role in myocardial protection remains controversial. The aim of this study was to investigate whether the addition of adenosine in continuous cold blood cardioplegia would enhance myocardial protection.

    Methods: In a prospective double-blind study comparing adenosine 400 μmol l(-1) to placebo in continuous cold blood cardioplegia, 80 patients undergoing isolated aortic valve replacement were randomized into four groups: antegrade cardioplegia with adenosine (n = 19), antegrade cardioplegia with placebo (n = 21), retrograde cardioplegia with adenosine (n = 21) and retrograde cardioplegia with placebo (n = 19). Myocardial arteriovenous differences in oxygen and lactate were measured before, during and after aortic occlusion. Myocardial concentrations of adenine nucleotides and lactate were determined from left ventricular biopsies obtained before aortic occlusion, after bolus cardioplegia, at 60 min of aortic occlusion and at 20 min after aortic occlusion. Plasma creatine kinase (CK-MB) and troponin T were measured at 1, 3, 6, 9, 12 and 24 h after aortic occlusion. Haemodynamic profiles were obtained before surgery and 1, 8 and 24 h after cardiopulmonary bypass. Repeated-measures analysis of variance was used for significance testing.

    Results: Adenosine had no effects on myocardial metabolism of oxygen, lactate and adenine nucleotides, postoperative enzyme release or haemodynamic performance. When compared with the antegrade groups, the retrograde groups showed higher myocardial oxygen uptake (17.3 ± 11.4 versus 2.5 ± 3.6 ml l(-1) at 60 min of aortic occlusion, P < 0.001) and lactate accumulation (43.1 ± 20.7 versus 36.3 ± 23.0 µmol g(-1) at 60 min of aortic occlusion, P = 0.052) in the myocardium during aortic occlusion, and lower postoperative left ventricular stroke work index (27.2 ± 8.4 versus 30.1 ± 7.9 g m m(-2), P = 0.034).

    Conclusions: Adenosine 400 μmol l(-1) in cold blood cardioplegia showed no cardioprotective effects on the parameters studied. Myocardial ischaemia was more pronounced in patients receiving retrograde cardioplegia.

  • 19.
    Fengsrud, Espen
    et al.
    Örebro University, School of Health Sciences. Departments of Cardiology and Cardiothoracic Surgery, Örebro University Hospital, Örebro, Sweden.
    Englund, Anders
    Department of Clinical Sciences, South Hospital and Arrhythmia Center, Karolinska Institute, Stockholm, Sweden.
    Ahlsson, Anders
    Örebro University, School of Medical Sciences. Departments of Cardiology and Cardiothoracic Surgery, Örebro University Hospital, Örebro, Sweden.
    Pre- and postoperative atrial fibrillation in CABG patients have similar prognostic impact2017In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 51, no 1, p. 21-27Article in journal (Refereed)
    Abstract [en]

    Objectives: To study pre- and postoperative atrial fibrillation and its long-term effects in a cohort of aortocoronary bypass surgery patients.

    Design: Altogether 615 patients undergoing aortocoronary bypass graft surgery in 1999-2000 were studied. Forty-four (7%) had preoperative atrial fibrillation. Postoperative atrial fibrillation occurred in 165/615 patients (27%) while 406/615 patients (66%) had no atrial fibrillation. After a median follow-up of 15 years, symptoms and medication in survivors were recorded, and cause of death in the deceased was obtained.

    Results: Death due to cerebral ischaemia was most common in the pre- and postoperative atrial fibrillation groups (7% and 5%, respectively, v. 2% among those without atrial fibrillation, p = 0.038), as were death due to heart failure (18% and 14%, v. 7%, p = 0.007) and sudden death (9% and 5%, v. 2%, p = 0.029). The presence of pre- or postoperative atrial fibrillation was an independent risk factor for late mortality (hazard ratios 1.47 (1.02-2.12) and 1.28 (1.01-1.63), respectively).

    Conclusions: Patients with pre- or postoperative atrial fibrillation undergoing aortocoronary bypass surgery have increased long-term mortality and risk of cerebral ischemic and cardiovascular death compared with patients in sinus rhythm.

  • 20.
    Fengsrud, Espen
    et al.
    Örebro University, School of Medical Sciences. Department of Cardiology.
    Wickbom, Anders
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Ahlsson, Anders
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Total endoscopic ablation of atrial fibrillation2015In: Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery, ISSN 1813-9175Article in journal (Refereed)
    Abstract [en]

    Total endoscopic ablation of atrial fibrillation is a treatment option in symptomatic patients after unsuccessful catheter ablation or when catheter ablation is considered inappropriate. We describe a technique of endoscopic ablation of the left atrium using temperature-controlled unipolar or bipolar radiofrequency. A left atrial box lesion encircling the pulmonary veins is created using three ports in the right hemithorax. The technical aspects and preliminary results of the procedure are discussed.

  • 21.
    Fengsrud, Espen
    et al.
    Örebro University, School of Medical Sciences. Department of Cardiology.
    Wickbom, Anders
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Almroth, Henrik
    Department of Cardiology, Örebro University, Örebro, Sweden; Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Englund, Anders
    Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Arrhythmia Centre, South General Hospital, Stockholm, Sweden.
    Ahlsson, Anders
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Total endoscopic ablation of patients with long-standing persistent atrial fibrillation: a randomized controlled study2016In: Interactive Cardiovascular and Thoracic Surgery, ISSN 1569-9293, E-ISSN 1569-9285, Vol. 23, no 2, p. 292-298Article in journal (Refereed)
    Abstract [en]

    Objectives: Total endoscopic ablation of atrial fibrillation is an alternative to catheter ablation, but its clinical role needs further evaluation. The aim of this study was to compare total endoscopic ablation with rate control in patients with long-standing persistent atrial fibrillation and to examine the effect of endoscopic ablation on heart rhythm, symptoms, physical working capacity and myocardial function during 1 year of follow-up.

    Methods: In a prospective controlled study, 36 patients aged >50 years with symptomatic long-standing persistent atrial fibrillation were randomized to either total endoscopic ablation (n = 17, after two drop-outs before ablation n = 15) or rate control therapy (n = 19). In the ablation group, a box lesion encircling the pulmonary veins was performed, using temperature-controlled radiofrequency energy. Loop recorders were implanted in all patients. Echocardiography and quality-of-life assessment were performed at 6 and 12 months, and physical working capacity assessment at 6 months.

    Results: There was no mortality or thromboembolic event. In the control group, all patients were in permanent atrial fibrillation during 12 months of follow-up. In the ablation group, the proportion of patients in sinus rhythm without antiarrhythmic drugs was 12/15 (80%) at 12 months. The median freedom of atrial fibrillation at 3-12 months was 95% in the ablation group and the proportion of patients with an atrial fibrillation burden of <5% at 3-12 months was 8/15 (53%). The left ventricular ejection fraction increased during follow-up in the ablation group compared with the control group (from 53.7 ± 8.6 to 58.8 ± 6.5%, P = 0.003), combined with a reduction in the left atrial area (from 29.2 ± 5.5 to 27.2 ± 6.3 cm(2), P = 0.002). The physical working capacity increased in the ablation group compared with the control group (from 94 ± 21.4 to 102.9 ± 14.4%, P = 0.011). The subjective physical and mental capacity scale also improved during follow-up in the ablation group, but not in the control group (P =0.003 and 0.018, respectively).

    Conclusions: Total endoscopic ablation in patients with long-standing persistent atrial fibrillation significantly reduced atrial fibrillation burden 12 months after intervention compared with controls. The left ventricular function, physical working capacity and subjective physical and mental health were improved. These results need to be confirmed in larger randomized trials.

  • 22.
    Geirsson, Arnar
    et al.
    Faculty of Medicine, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland.
    Ahlsson, Anders
    Örebro University, School of Medical Sciences. Örebro University Hospital, Örebro, Sweden.
    Franco-Cereceda, Anders
    Karolinska University Hospital, Stockholm, Sweden.
    Fuglsang, Simon
    Aarhus University Hospital, Skejby, Denmark.
    Gunn, Jarmo
    Turku University Hospital, Turku, Finland.
    Hansson, Emma C.
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Hjortdal, Vibeke
    Aarhus University Hospital, Skejby, Denmark.
    Jarvela, Kati
    Tampere University Hospital, Tampere, Finland.
    Jeppsson, Anders
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Mennander, Ari
    Tampere University Hospital, Tampere, Finland.
    Nozohoor, Shahab
    Skåne University Hospital, Lund, Sweden.
    Olsson, Christian
    Karolinska University Hospital, Stockholm, Sweden.
    Wickbom, Anders
    Karolinska University Hospital, Stockholm, Sweden.
    Zindovic, Igor
    Skåne University Hospital, Lund, Sweden.
    Gudbjartsson, Tomas
    Faculty of Medicine, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland.
    The Nordic Consortium for Acute type A Aortic Dissection (NORCAAD): objectives and design2016In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 50, no 5-6, p. 334-340Article in journal (Refereed)
    Abstract [en]

    Objectives: The Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD) is a collaborative effort of Nordic cardiac surgery centers to study acute type A aortic dissection (ATAAD). Here, we outline the overall objectives and the design of NORCAAD.

    Design: NORCAAD currently consists of eight centers in Denmark, Finland, Iceland and Sweden. Data was collected for patients undergoing surgery for ATAAD from 2005 to 2014. A total of 194 variables were retrospectively collected including demographics, past medical history, preoperative medications, symptoms at presentation, operative variables, complications, bleeding and blood transfusions, need for late reoperations, 30-day mortality and long-term survival.

    Results: Information was gathered in the database for 1159 patients, of which 67.6% were male. The mean age was 61.5 +/- 12.1 years. The mean follow-up was 3.1 +/- 2.9 years with a total of 3535 patient years.

    Conclusions: NORCAAD provides a foundation for close collaboration between cardiac surgery centers in the Nordic countries. Substudies in progress include: short-term outcomes, long-term survival, time interval from diagnosis until operation, effects of surgical techniques, malperfusion syndrome, renal failure, bleeding and neurological complications on outcomes and the rate of late reoperations.

  • 23.
    Geirsson, Arnar
    et al.
    Section of Cardiac Surgery, Yale University School of Medicine, New Haven CT, USA.
    Shioda, Kayoko
    Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven CT, USA.
    Olsson, Christian
    Department of Thoracic and Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Ahlsson, Anders
    Department of Thoracic and Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Gunn, Jarmo
    Heart Center, Turku University Hospital and University of Turku, Turku, Finland.
    Hansson, Emma C.
    Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Hjortdal, Vibeke
    Department of Thoracic and Cardiovascular Surgery, Aarhus University Hospital, Skejby, Denmark.
    Jeppsson, Anders
    Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Mennander, Ari
    Heart Center Tampere University Hospital, Tampere, Finland.
    Wickbom, Anders
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Zindovic, Igor
    Department of Cardiothoracic Surgery, Skane University Hospital, Lund, Sweden.
    Gudbjartsson, Tomas
    Landspitali University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
    Differential outcomes of open and clamp-on distal anastomosis techniques in acute type A aortic dissection2019In: Journal of Thoracic and Cardiovascular Surgery, ISSN 0022-5223, E-ISSN 1097-685X, Vol. 157, no 5, p. 1750-1758Article in journal (Refereed)
    Abstract [en]

    Objectives: Open-distal anastomosis is the preferred technique over clamp-on technique for surgical repair of acute type A aortic dissection (ATAAD). The aim of this study was to define how outcomes of ATAAD were affected by the use of either technique.

    Methods: Nordic Consortium for Acute Type A Aortic Dissection includes 8 academic cardiothoracic hospitals in 4 Nordic countries. The cohort consisted of 1134 patients, 153 clamp-on and 981 open-distal, from 2005 to 2014.

    Results: Patients who underwent operation with the clamp-on were younger, more frequently had coronary artery disease, bicuspid aortic valve, hypotension/shock or syncope, and a greater PennClass than open-distal patients. Postoperative cerebral vascular accident occurred less frequently in clamp-on (14/153, 10%) compared with the open-distal group (190/981, 20%). Clamp-on had greater 30-day mortality (39/153, 25%) than the open-distal group (158/981, 16%), and 5-year survival was also worse in clamp-on (61.8% +/- 4.4%) compared with the open-distal group (73.0% +/- 1.6%). The open-distal technique was used more frequently in greater-volume hospitals but was not independently associated with 30-day mortality. Preoperative condition was an independent risk factor whereas hospital volume and later year of operation were beneficial in regard to short-term outcome. Open-distal was independently associated with improved mid-term survival.

    Conclusions: Patients who underwent operation with the clamp-on were sicker on presentation and had worse short-and mid-term survival compared with the open-distal group. Patients in the open-distal group had greater rates of cerebrovascular complications. The results support the routine use of open-distal anastomosis as the primary operative strategy for ATAAD, although clamp-on can be performed successfully in select cases.

  • 24.
    Jönsson, Anders
    et al.
    Department of Cardiology, Linköping University Hospital, Linköping, Sweden.
    Lehto, Mika
    Department of Cardiology, Helsinki University Hospital, Helsinki, Finland.
    Ahn, Henrik
    Department of Cardiothoracic Surgery, Linköping University Hospital, Linköping, Sweden.
    Hermansson, Ulf
    Department of Cardiothoracic Surgery, Linköping University Hospital, Linköping, Sweden.
    Linde, Peter
    Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
    Ahlsson, Anders
    Örebro University Hospital. Department of Cardiothoracic Surgery.
    Koistinen, Juhani
    Department of Cardiology, Turku University Hospital, Turku, Finland.
    Savola, Jukka
    Department of Cardiothoracic Surgery, Turku University Hospital, Turku, Finland.
    Raatikainen, Pekka
    Heart Center, Tampere University Hospital, Tampere, Finland.
    Lepojärvi, Martti
    Department of Cardiothoracic Surgery, Oulu University Hospital, Oulu, Finland.
    Sahlman, Antero
    Department of Cardiothoracic Surgery, Helsinki University Hospital, Helsinki, Finland.
    Werkkala, Kalervo
    Department of Cardiothoracic Surgery, Helsinki University Hospital, Helsinki, Finland.
    Toivonen, Lauri
    Department of Cardiology, Helsinki University Hospital, Helsinki, Finland.
    Walfridsson, Håkan
    Department of Cardiology, Linköping University Hospital, Linköping, Sweden.
    Microwave Ablation in Mitral Valve Surgery for Atrial Fibrillation (MAMA)2012In: Journal of Atrial Fibrillation, ISSN 1941-6911, Vol. 5, no 2, p. 13-22Article in journal (Refereed)
    Abstract [en]

    Objective: Microwave ablation in conjunction with open heart surgery is effective in restoring sinus rhythm (SR) in patients with atrial fibrillation (AF). In patients assigned for isolated mitral valve surgery no prospective randomized trial has reported its efficacy.

    Methods: 70 patients with longlasting AF where included from 5 different centres. They were randomly assigned to mitral valve surgery and atrial microwave ablation or mitral valve surgery alone.

    Results: Out of 70 randomized, 66 and 64 patients were available for evaluation at 6 and 12 months. At 12 months SR was restored and preserved in 71.0 % in the ablation group vs 36.4 % in the control group (P=0.006), corresponding figures at 6 months was 62.5 % vs 26.5 % (P=0.003). The 30-day mortality rate was 1.4 %, with one death in the ablation group vs zero deaths in the control group. At 12 months the mortality rate was 7,1 % (Ablation n=3 vs Control n=2). No significant differences existed between the groups with regard to the overall rate of serious adverse events (SAE) during the perioperative period or at the end of the study. 16 % of patients randomized to ablation were on antiarrhytmic drugs compared to 6 % in the control group after 1 year (p=0.22).

    Conclusion: Microwave ablation of left and right atrium in conjunction with mitral valve surgery is safe and effectively restores sinus rhythm in patients with longlasting AF as compared to mitral valve surgery alone.

  • 25.
    Olsson, Christian
    et al.
    Department of Thoracic and Cardiovascular Surgery, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
    Ahlsson, Anders
    Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Fuglsang, Simon
    Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Denmark.
    Geirsson, Arnar
    Department of Cardiothoracic Surgery, Faculty of Medicine, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland.
    Gunn, Jarmo
    Department of Cardiothoracic Surgery, Turku University Hospital, Turku, Finland.
    Hansson, Emma C.
    Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Hjortdal, Vibeke
    Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Denmark.
    Jarvela, Kati
    Department of Cardiothoracic Surgery, Heart Center Tampere University Hospital, Tampere, Finland.
    Jeppsson, Anders
    Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Mennander, Ari
    Department of Cardiothoracic Surgery, Heart Center Tampere University Hospital, Tampere, Finland.
    Nozohoor, Shahab
    Department of Cardiothoracic Surgery, Skane University Hospital and Lund University, Lund, Sweden.
    Wickbom, Anders
    Department of Cardiothoracic and Vascular Surgery, Orebro University Hospital, Orebro, Sweden.
    Zindovic, Igor
    Department of Cardiothoracic Surgery, Skane University Hospital and Lund University, Lund, Sweden.
    Gudbjartsson, Tomas
    Department of Cardiothoracic Surgery, Faculty of Medicine, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland.
    Medium-term survival after surgery for acute Type A aortic dissection is improving2017In: European Journal of Cardio-Thoracic Surgery, ISSN 1010-7940, E-ISSN 1873-734X, Vol. 52, no 5, p. 852-857Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To report long-term survival and predictors of mortality in patients included in a large, contemporary, multicentre, multinational database: Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD), which consists of 8 centres in 4 Nordic countries.

    METHODS: Currently, NORCAAD includes 1159 patients operated between 2005 and 2014. In 30-day survivors (n = 955, 82%), the Kaplan-Meier and Cox proportional hazard methods were used to analyse medium-term (up to 8 years) survival and relative survival versus a matched normal population. Pre- and intraoperative predictors were expressed as hazard ratio (HR) with 95% confidence interval (95% CI).

    RESULTS: Cumulative follow-up was 3514 patient-years with a median of 3.2 years (range 0-10.2 years). Survival was 95% (95% CI 93-96) at 1 year, 86% (95% CI 83-88) at 5 years and 76% (95% CI 72-81) at 8 years. Relative survival versus a matched normal population was 95% (95% CI 94-97) at 1 year, 90% (95% CI 87-93) at 5 years and 85% (95% CI 80-90) at 8 years. In multivariable analysis, increased age (HR 1.05 per year, 95% CI 1.04-1.07), previous abdominal or thoracic aortic repair (HR 3.2, 95% CI 1.6-6.4) and chronic renal disease (HR 2.7, 95% CI 1.2-6.2) were associated with increased medium-term mortality. Open distal anastomosis (HR 0.55, 95% CI 0.35-0.87) and operation in the 2010-2014 period (HR 0.90, 95% CI 0.83-0.97) were associated with decreased medium-term mortality.

    CONCLUSIONS: Medium-term survival after acute Type A aortic dissection in the NORCAAD registry is satisfactory, close to a matched normal population and improved in the later part of the study period. The use of open distal anastomosis was associated with decreased medium-term mortality.

  • 26. Ulfendahl, H R
    et al.
    Ahlsson, Anders
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Hansell, P
    Höglund, U
    Jacobsson, E
    Lee, S L
    Sjöquist, M
    Studies on the mechanisms underlying CNS-induced natriuresis.1989In: Acta Physiologica Scandinavica Supplementum, ISSN 0302-2994, Vol. 583, p. 75-8Article in journal (Refereed)
  • 27.
    Wickbom, Anders
    et al.
    Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Cha, Soon Ok
    Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Ahlsson, Anders
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Thoracocentesis in cardiac surgery patients2015In: Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery, ISSN 1813-9175Article in journal (Refereed)
    Abstract [en]

    Pleural effusion following cardiac surgery is a common complication that sometimes requires invasive treatment. Conventional methods for evacuation include needle aspiration and chest tube insertion. We present an effective, easy and potentially time-saving method of thoracocentesis, using a single-lumen central venous catheter.

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