Background We retrospectively evaluated vascular complications and wound infections after surgical or percutaneous transfemoral removal of temporary extracorporeal life support systems (ECLSs). Methods A total of 83 patients were weaned from ECLS between August 2015 and September 2020. We analyzed for a composite endpoint of vascular complications and wound infections requiring negative-pressure wound therapy. Patients were divided into two groups: percutaneous group using the MANTA vascular occlusion system (VCD; Teleflex, Morrisville, North Carolina, United States) (n = 23) and surgical group (n = 60). Results The median age in the entire cohort was 67 years. Vascular complications were seen in 20% (n = 12) in the surgical group and in 13% (n = 3) in the percutaneous group (p = 0.72). A total of 32% (n = 19) in the surgical group and 9% (n = 2) in the percutaneous group (p = 0.031) had wound infections. A composite endpoint of vascular complications and wound infections showed significantly more complications in the surgical group (52%, n = 31) as compared with the percutaneous group (22%, n = 5) (p = 0.020). The median duration in the intensive care unit was 13 days for the surgical group and 12 days for the percutaneous group without any significant difference in both groups (p = 0.93). Conclusions Using the MANTA VCD for percutaneous removal of ECLS cannulas after weaning from ECLS is safe and reproducible. A composite endpoint of vascular complications and wound infections was significantly lower in the percutaneous removal group as compared with the surgical group. C.P., MD: Substantial contributions to the conception and design of the work, acquisition, analysis and interpretation of data for the work. Drafting the work and revising it critically for important intellectual content, and final approval of the version to be published. S.K., MD: Substantial contributions to the acquisition, analysis and interpretation of data for the work, revising the work critically for important intellectual content, and final approval of the version to be published. H.S., MD: Substantial contributions to the conception of the work and revising it critically for important intellectual content, and final approval of the version to be published. M.K., MD: Substantial contributions to the conception of the work and revising it critically for important intellectual content, and final approval of the version to be published. P.P., MD: Substantial contributions to the acquisition, analysis and interpretation of data for the work. Revising it critically for important intellectual content and final approval of the version to be published. S.K., MD: Substantial contributions to the conception of the work and revising it critically for important intellectual content. Final approval of the version to be published. T.B., MD: Substantial contributions to the conception of the work and revising it critically for important intellectual content. Final approval of the version to be published. F.B., MD: Substantial contributions to the conception of the work and revising it critically for important intellectual content. Final approval of the version to be published. M.S., MD: Substantial contributions to the conception of the work and revising it critically for important intellectual content. Final approval of the version to be published. M.C., MD: Substantial contributions to the conception and design of the work, acquisition, analysis, and interpretation of data for the work, drafting the work and revising it critically for important intellectual content, and final approval of the version to be published. All authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Received: 11 December 2020 Accepted: 05 March 2021 Publication Date: 10 August 2021 (online) © 2021. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

We retrospectively analysed perioperative and mid-term outcomes for patients undergoing mitral valve surgery with and without atrial fibrillation. Patients who underwent mitral valve surgery between January 2018 and February 2023 were included and categorized into 3 groups: ‘No AF’ (no documented atrial fibrillation), ‘AF no SA’ (atrial fibrillation without surgical ablation) and ‘AF and SA’ (atrial fibrillation with concomitant surgical ablation). Groups were compared for perioperative and mid-term outcomes, including mortality, stroke, bleeding and pacemaker implantation. A P-value <0.05 was considered statistically significant. Of the 400 patients included, preoperative atrial fibrillation was present in 43%. Mean follow-up was 1.8 (standard deviation: 1.1) years. The patients who underwent surgical ablation for atrial fibrillation exhibited similar overall outcomes compared to patients without preoperative atrial fibrillation. Patients with untreated atrial fibrillation showed higher mortality (‘No AF’: 2.2% versus ‘AF no SA’: 8.3% versus ‘AF and SA’: 3.2%; P-value 0.027) and increased postoperative pacemaker implantation rates (‘No AF’: 5.7% versus ‘AF no SA’: 15.6% versus ‘AF and SA’: 7.9%, P-value: 0.011). In a composite analysis of adverse events (Mortality, Bleeding, Stroke), the highest incidence was observed in patients with untreated atrial fibrillation, while patients with treated atrial fibrillation had similar outcomes as those without preoperative documented atrial fibrillation (‘No AF’: 9.6% versus ‘AF no SA’: 20.2% versus ‘AF and SA’ 3: 9.5%, P-value: 0.018). Concomitant surgical ablation should be considered in mitral valve surgery for atrial fibrillation, as it leads to similar mid-term outcomes compared to patients without preoperative documented atrial fibrillation.

Background and Objectives: Patients with chronic total occlusions of the coronary arteries are either treated with PCI or referred for surgical revascularization. We analyzed the patients with chronic occluded coronary arteries that were surgically treated and aimed to describe the anatomical characteristics, revascularization rates, and in-hospital outcomes achieved with coronary artery bypass grafting. Methods: Angiographic data of 2005 patients with coronary artery disease treated in our institution between January 2005 and December 2014 were retrospectively analyzed. A total of 1111 patients with at least one coronary total occlusion were identified. We reviewed the preoperative coronary angiograms and surgical protocols to determine the presence, localization, and revascularization of coronary occlusions. We also evaluated the perioperative data and in-hospital outcomes. Results: The median age of the study population was 68 years (25th–75th percentiles, 61.0–74.0). Three-vessel disease was present in 94.8% of patients and the rest (5.8%) had a two-vessel disease. The localizations of the occlusions were as follows: 68.4% in the RCA system, 26.4% in the LAD, and 28.5% in the LCX system. Multiple occlusions were present in 22.6% of the patients. Complete coronary total occlusion revascularization was achieved in 86.1% of the patients. The overall in-hospital mortality was 2.3%. The median in-hospital stay was 14.0 days. After logistic regression analysis, age (odds ratio 3.44 [95% confidence interval, 1.81–6.53], p < 0.001, for a 10-year increase) and the presence of peripheral artery disease (odds ratio 3.32 [1.39–7.93], p = 0.007) were the only statistically significant independent predictors of in-hospital mortality. Conclusions: A high revascularization rate and favorable in-hospital outcomes are achieved with coronary artery bypass surgery in patients with multi-vessel diseases and coronary total occlusions. Older age and the presence of peripheral artery disease are independent predictors of in-hospital mortality. A long-term follow-up and the type of graft (arterial vs. venous) used would bring more useful data for this type of revascularization.