Search

Objective: Aortic valve disease is a risk factor for atrial fibrillation (AF), and AF is associated with increased late mortality and morbidity after cardiac surgery. The evolution of alternative approaches to AF prophylaxis, including less invasive technologies and medical therapies, has altered the balance between risk and potential benefit for prophylactic intervention at the time of surgical aortic valve replacement (SAVR). Such interventions impose incremental risk, however, making an understanding of predictors of new onset AF that persists beyond the perioperative episode relevant. Methods: We conducted a retrospective single‐institution cohort analysis of patients undergoing SAVR with no history of preoperative AF (n = 1014). These patients were cross‐referenced against an institutional electrocardiogram (ECG) database to identify those with ECGs 3–12 months after surgery. Logistic regression was used to identify predictors of late AF. Results: Among the 401 patients (40%), who had ECGs in our institution 3–12 months after surgery, 16 (4%) had late AF. Patients with late AF were older than patients without late AF (73 vs. 65, p =.025), and underwent procedures that were more urgent/emergent (38% vs. 15%, p =.015), with higher predicted risk of mortality (2.2% vs. 1.3%, p =.012). Predictors associated with the development of late AF were advanced age, higher preoperative creatinine level and urgent/emergent surgery. Conclusions: The incidence of late AF 3–12 months after SAVR, is low. Prophylactic AF interventions at the time of SAVR may not be warranted. [ABSTRACT FROM AUTHOR]

The global pandemic of coronavirus 2019 (COVID‐19) caused by coronavirus has had a profound impact on the delivery of health care in the United States and globally. Boston was among the earliest hit cities in the United States, and within Boston, the Massachusetts General Hospital provided care for more patients with COVID‐19 than any other hospital in the region. This necessitated a massive reallocation of resources and priorities, with a near doubling of intensive care bed capacity and a halt in all deferrable surgical cases. During this crisis, the Division of Cardiac Surgery responded in a unified manner, dealing honestly with the necessity to reduce Intensive Care Unit resource utilization for the benefit of both the institution and our community by deferring nonemergent cases while also continuing to efficiently care for those patients in urgent or emergent need of surgery. Many of the interventions that we instituted have continued to support teamwork as we adapt to the remarkably fluid changes in resource availability during the recovery phase. We believe that the culture of our division and the structure of our practice facilitated our ability to contribute to the mission of our hospital to support the community in this crisis, and now to its recovery. We describe here the challenge we faced in Boston and some of the details of the structure and function of our division. [ABSTRACT FROM AUTHOR]