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Introduction: Postoperative atrial fibrillation (POAF) is a common phenomenon following cardiac surgery. In this study, we assessed current preventive strategies used by Dutch cardiothoracic centres, identified common views on this matter and related these to international guidelines. Methods: We developed an online questionnaire and sent it to all cardiothoracic surgery centres in the Netherlands. The questionnaire concerned the management of POAF and the use of pharmaceutical therapies (beta-blockers and calcium antagonists) and non-pharmaceutical methods (posterior left pericardiotomy, pericardial flushing and epicardial botulinum toxin type A injections). Usage of electrical cardioversions, anticoagulants and left atrial appendage closure were also enquired. Results: Of the 15 centres, 14 (93%) responded to the survey and 13 reported a POAF incidence, ranging from 20 to 30%. Of these 14 centres, 6 prescribed preoperative AF prophylaxis to their patients, of which non-sotalol beta-blockers were prescribed most commonly (57%). Postoperative medication was administered by all centres and included non-sotalol beta-blockers (38%), sotalol (24%), digoxin (14%), calcium antagonists (13%) and amiodarone (10%). Only 2 centres used posterior left pericardiotomy or pericardial flushing as surgical manoeuvres to prevent POAF. Moreover, respondents expressed the need for guidance on anticoagulant use. Conclusion: Despite the use of various preventive strategies, the reported incidence of POAF was similar in Dutch cardiothoracic centres. This study highlights limited use of prophylactic amiodarone and colchicine, despite recommendations by numerous guidelines, and restricted implementation of surgical strategies to prevent POAF.

Background This study evaluates clinical and echocardiographic outcomes in patients who underwent tricuspid valve replacement (TVR) for carcinoid heart disease (CaHD) stratified to prosthesis type (biological vs mechanical). Methods All patients undergoing TVR for CaHD between 1991 and 2017 were analyzed retrospectively in four tertiary centers. Cox-proportional hazard models were used to analyze survival data and mixed-models for repeated measurements of echo and laboratory data. Results In total, 49 patients (median age: 59 [51–66], 45% male) underwent biological (n = 20, 41%) or mechanical (n = 29, 59%) TVR. Three (6%) patients died in-hospital and 3-year actuarial survival was 73.3 ± 8.7% (biological) and 56.1 ± 10.0% (mechanical) (P = 0.69). During a median follow-up of 17 months, two patients with a biological prosthesis required reoperation for structural valve deterioration, while one patient with mechanical prostheses had a reoperation due to valve thrombosis. No significant differences in bleeding, thrombosis, thromboembolism and heart failure admissions were noted between prosthesis types. Postoperative valve regurgitation increased more in patients with a biological prosthesis (p = 0.022). Maximum tricuspid inflow gradient was higher in patients with biological prostheses (p = 0.02); however, course over time was comparable between prosthesis types (p = 0.136). Conclusion Tricuspid valve surgery for CaHD can be performed with acceptable hospital mortality risk. This data shows no apparent benefit of biological valves over mechanical prosthesis or vice versa. Valve choice should be made in a multi-disciplinary team taking into account expected lifespan, planned treatment for the carcinoid syndrome and neuroendocrine tumor and patient preferences.

Background:Traditional surgical treatment for patients with atrial fibrillation (AF) is performed via sternotomy and on cardiopulmonary bypass. It is very effective in regard to rhythm control, but remains unpopular due to its invasiveness. Truly endoscopic AF treatments have decreased the threshold for electrophysiologists (and cardiologists) to refer, and the reluctance of patients to accept a standalone surgical approach. Practice guidelines from around the world have recognized this as an acceptable therapeutic approach. Current guidelines recommend the HeartTeam approach in treating these complex AF cases. In this study we report our experience with AF HeartTeam approach for surgical stand-alone AF ablation. Methods: The AF HeartTeam Program began in 2013, patients qualified for inclusion if either of the following was present: failed catheter ablation and/or medication, not suitable for catheter ablation, contraindication to anticoagulation, or patients preferring such an approach. All patients with a complex AF history were assessed by the AF HeartTeam, from which 42 patients were deemed suitable for a totally endoscopic AF procedure (epicardial ablation and LAA closure). Endpoints were intraoperative bidirectional block of the pulmonary veins and closure of left atrial appendage confirmed by transesophageal echocardiography (TEE). Post discharge rhythm follow-up was performed after 3 and 12, 24 and 36 months. Anticoagulation was discontinued 6 weeks after the procedure in patients after documented LAA closure. Results: In total 42 patients underwent the endoscopic procedure (Median CHA2DS2-VASC=3 (1-6), HAS-BLED=2 (1-6)) for paroxysmal (15/42) and non-paroxysmal AF (27/42) respectively. Bidirectional block was obtained in all patients and complete LAA closure was obtained in all but one Patient on TEE (41/42). In one patient the LAA was not addressed due to extensive adhesions. Two patients underwent median sternotomy because of bleeding during the endoscopi

Third and second harmonic generation (THG/SHG) microscopy is a novel imaging technique that has been suggested as a promising clinical tool, mainly for cancer diagnosis. Here, we test for the first time a compact, transportable ex-vivo THG/SHG microscope (Tritos Diagnostics B.V.) for clinical use. In lung surgery, immediate feedback on the nature of the excised tissue is important. We will present the first results of an ongoing study in which we image both lung tumor tissue immediately after excision and frozen section biopsies, and compare the images to the golden standard histology. Prior to this study, we performed a set of experiments collecting 3D images of mouse lung tissue to show that the combination of THG and SHG microscopy reveals key lung morphology components.

Surgical revascularization remains the standard of care for many patients. Off-pump coronary artery bypass grafting (OPCAB) without cardiopulmonary bypass (CPB) has evolved during the past 20 years, and as such can significantly reduce the occurrence of neurological complications. While avoiding the aortic cross-clamping required in conventional on-pump techniques, OPCAB results in a lower incidence of stroke. However, clamp-related risk of stroke remains if partial or side-biting clamps are applied for proximal anastomoses. Others and we have demonstrated that no-touch 'anaortic' approaches avoiding any clamping during off-pump procedures via complete in situ grafting result in significantly reduced stroke rates when compared with partial clamping. Therefore, OPCAB in situ grafting has been proposed as the 'standard of care' to reduce neurological complications. However, this technique may not be applicable to for every patient as the use of free grafts (arterial or venous) requiring proximal anastomosis is often still necessary to achieve complete revascularization. In these situations, proximal anastomosis can be performed without a partial clamp by using the HEARTSTRING device, and over the last few years, considerable evidence has arisen supporting the impact of HEARTSTRING-enabled anastomosis to significantly minimize atheroembolism and neurological complications when compared with partial- or side-bite clamping. This paper provides a systematic overview and technical information about the combination of OPCAB and clampless strategies using the HEARTSTRING for proximal anastomosis to reduce stroke to levels reported for percutaneous coronary intervention.