Intervention Surgery Research Articles

Analysis of Risk Factors of Postoperative Arrhythmia in Patients with Coronary Heart Disease and Establishment of Nomogram Risk Model

Background: To explore the risk factors of postoperative arrhythmia in patients with coronary heart disease (CHD) and to establish a Nomogram model for predicting the risk of postoperative arrhythmia in CHD patients. Methods: Retrospectively, the medical data of CHD patients (from January 2021 to January 2024, n = 390) were collected. According to whether arrhythmia occurred after percutaneous coronary intervention surgery, patients were divided into the arrhythmia group (n = 130) and non-arrhythmia group (n = 260). The risk factors of postoperative arrhythmia were obtained by multi-factor logistic regression analysis. A Nomogram model for predicting the risk of postoperative arrhythmia in CHD patients was established using R language and underwent verification. Results: The results of multi-factor logistic regression analysis showed that diastolic pressure, heart function grade at III–IV, creatinine, C-reactive protein (CRP), N-terminal pro-brain natriuretic peptide (NT-ProBNP) peak value, total bilirubin (TBIL) and red cell distribution width (RDW) were the risk factors inducing postoperative arrhythmia in CHD patients. Based on these risk factors, a Nomogram model was successfully established. The verification results revealed that the predicted values were basically consistent with the actual values, indicating that the Nomogram model had good prediction ability. The area under the curve (AUC) value was 0.974, suggesting the high prediction efficiency of Nomogram model. Conclusion: Diastolic pressure, heart function grade at III–IV, creatinine, CRP, NT-ProBNP peak value, TBIL and RDW are the risk factors of postoperative arrhythmia in CHD patients. Nomogram model based on these risk factors has good prediction efficiency and underlying clinical value.

An unsupervised learning-based guidewire shape registration for vascular intervention surgery robot

In a vascular interventional surgery robot(VISR), a high transparency master-slave system can aid physicians in the more precise manipulation of guidewires for navigation and operation within blood vessels. However, deformations arising from the movement of the guidewire can affect the accuracy of the registration, thus reducing the transparency of the master-slave system. In this study, the degree of the guidewire’s deformation is analyzed based on the Kirchhoff model. An unsupervised learning-based guidewire shape registration method(UL-GSR) is proposed to estimate geometric transformations by learning displacement field functions. It can effectively achieve precise registration of flexible bodies. This method not only demonstrates high registration accuracy but also performs robustly under different complexity degrees of guidewire shapes. The experiments have demonstrated that the UL-GSR method significantly improves the accuracy of shape point set registration between the master and slave sides, thus enhancing the transparency and operational reliability of the VISR system.

Pulmonary Atresia with Intact Ventricular Septum, a National Comparison Between Interventional and Surgical Approach, in Combination with a Systemic Literature Review.

This study aimed to compare long-term morbidity in patients with pulmonary atresia with intact ventricular septum (PA-IVS) treated with catheter-based intervention (group A) versus those undergoing heart surgery (group B) as initial intervention. Additionally, we conducted a systematic literature review on PA-IVS treatment. All neonates born in Sweden with PA-IVS between 2007 and 2019 were screened for inclusion. The inclusion criterion was decompression of the right ventricle for initial intervention. Medical records were reviewed, as well as the initial preoperative angiogram, and the diagnostic echocardiogram. Comparisons between groups were performed with Mann-Whitney U-test and Fisher´s exact test. A systematic literature review of original studies regarding treatment of PA-IVS (2002 and onward) was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, to assess the outcomes of patients with PA-IVS. 34 (11 females) patients were included, 18 in group A and 16 in group B. There was no mortality in either group. Follow-up time ranged from 2 to 15years (median 9). All attempted perforations in group A were successful, and 16 out of 18 patients reached biventricular circulation. In the surgical group 15 out of 16 patients reached biventricular circulation. The literature review presented heterogeneity in standards for treatment. This retrospective population-based multicenter study demonstrates that both catheter-based intervention and heart surgery are safe procedures. Our results are comparable to, or exceed, those in the systematic literature review. The systematic literature review displays a great heterogeneity in study design, with no definitive golden standard treatment.

Knowledge, Perception, and Awareness of the Specialty of Oral and Maxillofacial Surgery Among the Public and Medical Field in Hail, Saudi Arabia: A Cross-Sectional Study.

Aim and background Oral and maxillofacial surgery is a crucial medical specialty focused on diagnosing, treating, and preventing diseases and injuries affecting the oral cavity, jaw, and face. There is a lack of awareness about this field in the specific study area of hail. This study aimed to assess the knowledge, awareness, and perception of maxillofacial surgery among healthcare professionals and the public. Methods The study included 225 participants, consisting of dental and medical professionals and the general public in Hail, Saudi Arabia. Convenience sampling was employed, and participants needed to be at least 20 years old and residents of Hail. A validated online questionnaire, translated into Arabic, was used for data collection. Results A proportion (78.2%) of dental professionals were aware of the specialty of oral and maxillofacial surgery. Among the general population and most medical professionals, the most commonly associated procedures with maxillofacial surgery were the treatment of injuries, bone fractures, and morphological changes in the mouth, jaw, and face, reported by 85.8% of the participants. Furthermore, 60.9% of the participants believed that maxillofacial surgery was the appropriate referral for cleft lip correction. Conclusion The study highlighted significant knowledge about the role of oral and maxillofacial surgeons among the target population. Out of the 225 participants, 137 participants (60.9%) chose thespecialty of maxillofacial surgery for surgical intervention to treat cleft lips. Moreover, 75.1% (n = 169) of the participants had previously heard about oral and maxillofacial surgery, while 24.9% (n = 56) had never heard of this specialty. The findings also showed that 189 participants were not aware that a maxillofacial surgeon is responsible for treating severe deformities that cannot be eliminated using orthodontics, such as growth disorders, hypoplasia and hypoplasia of the lower jaw, and asymmetry of the lower jaw (prognathism and retrognathism of the jaw). To bridge this knowledge gap, it is crucial to implement targeted educational initiatives and awareness campaigns among both the general population and healthcare professionals. By increasing awareness and understanding of the specialized role of oral and maxillofacial surgeons, patient care can be optimized, and appropriate referrals to these specialists can be ensured. Clinical significance This study shows the importance of increasing awareness of oral and maxillofacial surgery among health professionals and the general public. Improved understanding of this specialty can lead to better patient outcomes and early referrals.

The effectiveness of early intensified cardiac rehabilitation training in patients with acute non-ST segment elevation myocardial infarction after percutaneous coronary intervention surgery.

The effectiveness of early intensified cardiac rehabilitation training in patients with acute non-ST segment elevation myocardial infarction after percutaneous coronary intervention surgery.

Evaluating the clinical application and effect of acupuncture therapy in anal function rehabilitation after low-tension rectal cancer surgery

BACKGROUND According to the indexes of serum and anal function, acupuncture therapy was applied to patients with low rectal cancer in order to avoid the occurrence of anal incontinence and reduce complications. AIM To explore the clinical application and evaluate the effect of acupuncture therapy for anal function rehabilitation after low-tension rectal cancer surgery. METHODS From the anorectal surgery cases, we selected 120 patients who underwent colorectal cancer surgery between January 2020 and December 2022 and randomly divided them into a control group (n = 60), observation group (n = 60), and control group after surgery for lifestyle intervention (including smoking cessation and exercise), dietary factor adjustment, anal movement, and oral loperamide treatment. The serum levels of motilin, 5-hydroxytryptamine, and vasoactive intestinal peptide (VIP), Wexner score for anal incontinence, and incidence of complications were compared between groups. RESULTS After treatment, the VIP and 5-hydroxytryptamine levels in the observation group were lower than those in the control group (P < 0.05). The motilin level was higher than that in the control group (P < 0.05). Postoperative anal incontinence was better in the observation group than in the control group (P < 0.05). The incidence of complications in the observation group was 6.67%, which was significantly lower than that in the control group (21.67%; P < 0.05). CONCLUSION Acupuncture therapy has a positive effect on the rehabilitation of anal function after low-tension rectal cancer surgery; it can effectively help to improve the serum indices of patients, avoid the occurrence of anal incontinence, and reduce the incidence of complications. Popularizing and applying it will be valuable.

Risk-stratified analysis of long-term clinical outcomes and cumulative costs in Finnish patients with recent acute coronary syndrome or coronary revascularization: a 5-year real-world study using electronic health records.

Risk assessment is essential in the prevention of cardiovascular disease. In patients with recent acute coronary syndrome (ACS) or coronary revascularization, risk prediction tools, like the European Society of Cardiology guideline recommended SMART-REACH risk score, are increasingly used to predict the risk of recurrent cardiovascular events enabling risk-based personalized prevention. However, little is known about the association between risk stratification and the social and healthcare costs at a population level. This study evaluated the associations between baseline SMART-REACH risk scores, long-term recurrent clinical events, cumulative costs, and post-index event LDL-C goal attainment in patients with recent ACS and/or revascularization. This retrospective study used electronic health records and was conducted in the North Karelia region of Finland. The study cohort included all patients aged 45-85 admitted to a hospital for ACS or who underwent percutaneous coronary intervention or coronary artery bypass surgery between 1 January 2017 and 31 December 2021. Patients were divided into quintiles based on their baseline SMART-REACH risk scores to examine the associations between predicted 5-year scores and selected clinical and economic outcomes. In addition, simple age-based stratification was conducted as a sensitivity analysis. The observed 5-year cumulative incidence of recurrent events ranged from 20% in the lowest to 41% in the highest risk quintile, whereas the corresponding predicted risks ranged from 13% to 51%, and cumulative 5-year mean total costs per patient ranged from 15 827 to 46 182€, respectively. Both monitoring and attainment of low LDL-C values were suboptimal. The use of the SMART-REACH quintiles as a population-level risk stratification tool successfully stratified patients into subgroups with different cumulative numbers of recurrent events and cumulative total costs. However, more research is needed to define clinically and economically optimal threshold values for a population-level stratification.

Through the Lens of Uniqueness: An Atypical Presentation of Myocardial Bridge in the Coronary Trifurcation

Myocardial bridges are commonly encountered findings during coronary angiography, typically occurring over the mid or distal segments of the left anterior descending artery (LAD). Coronary trifurcation represents another variant of normal coronary anatomy. However, muscle bridges rarely involve a trifurcation branch. Symptomatic patients with muscle bridges often present with angina or dyspnea and may even experience acute coronary syndromes. Management typically involves medical intervention, with percutaneous coronary intervention (PCI) or cardiac surgery reserved for severe cases. Here, we present a unique case of a young female who presented with acute coronary syndrome due to a muscle bridge occurring over a trifurcation branch.

UDBRNet: A novel uncertainty driven boundary refined network for organ at risk segmentation.

Organ segmentation has become a preliminary task for computer-aided intervention, diagnosis, radiation therapy, and critical robotic surgery. Automatic organ segmentation from medical images is a challenging task due to the inconsistent shape and size of different organs. Besides this, low contrast at the edges of organs due to similar types of tissue confuses the network's ability to segment the contour of organs properly. In this paper, we propose a novel convolution neural network based uncertainty-driven boundary-refined segmentation network (UDBRNet) that segments the organs from CT images. The CT images are segmented first and produce multiple segmentation masks from multi-line segmentation decoder. Uncertain regions are identified from multiple masks and the boundaries of the organs are refined based on uncertainty data. Our method achieves remarkable performance, boasting dice accuracies of 0.80, 0.95, 0.92, and 0.94 for Esophagus, Heart, Trachea, and Aorta respectively on the SegThor dataset, and 0.71, 0.89, 0.85, 0.97, and 0.97 for Esophagus, Spinal Cord, Heart, Left-Lung, and Right-Lung respectively on the LCTSC dataset. These results demonstrate the superiority of our uncertainty-driven boundary refinement technique over state-of-the-art segmentation networks such as UNet, Attention UNet, FC-denseNet, BASNet, UNet++, R2UNet, TransUNet, and DS-TransUNet. UDBRNet presents a promising network for more precise organ segmentation, particularly in challenging, uncertain conditions. The source code of our proposed method will be available at https://github.com/riadhassan/UDBRNet.

Comfort nursing theory on the postoperative rehabilitation quality and nursing satisfaction of patients with intracranial aneurysm.

To explore the influence of comfort nursing theory on the postoperative rehabilitation quality of patients with intracranial aneurysms. From October 2017 to December 2022, 315 patients with intracranial aneurysms underwent interventional surgery in our hospital were included in this retrospective study and divided into the routine group (n = 105) and comfort nursing group (n = 210) based on different nursing methods. The Glasgow Outcome Scale (GOS) was used to assess patient rehabilitation outcomes. Patients' anxiety, pain, quality of life, and their satisfaction with treatment were compared. Compared with the patients receiving routine nursing, the time for comfortable nursing patients to resume normal diet, get out of bed and exercise, and the total hospital stay were significantly shortened. And the GOS score of patients receiving comfort nursing was significantly higher than that of patients receiving routine nursing. After nursing, self-rating anxiety scale and visual analog scale scores of comfortable nursing patients were significantly lower than those of routine nursing, and Karnofsky performance status scores were significantly higher than those of routine nursing. This showed that receiving comfortable nursing was beneficial to improve perioperative anxiety and depression in patients with intracranial aneurysm, and significantly improve the quality of life of patients. The total satisfaction of comfortable nursing patients was 95.24%, while that of routine nursing patients was 76.19%. Complications occurred in 30 patients receiving routine nursing, while only 15 patients received comfort nursing. The immune indexes such as CD3+, CD4+, and CD23+ of comfortable nursing patients were significantly higher than the routine nursing patients within 1 and 5 days after operation, while the immune indexes of CD8+ were lower than the routine nursing patients 5 days after operation. Comfortable nursing from the perspective of quality nursing can significantly improve the physiological indicators of patients with intracranial aneurysms, accelerate the progress of postoperative rehabilitation, improve the anxiety, pain and quality of life of patients, and improve the satisfaction of patients with nursing. Comfort nursing from the perspective of quality nursing can reduce the occurrence of postoperative complications, which may be achieved by improving the patient's immune function.

Newly formed and ruptured infectious intracranial aneurysm in few days following first intracranial aneurysm embolization concurrent with middle cerebral artery occlusion: A regrettable case in a baby child

AbstractInfectious intracranial aneurysm (IIA) and embolic cerebral infarction are well‐known devastating complications of children suffering infective endocarditis. In this report, we describe a successfully embolized IIA concurrent with bilateral middle cerebral artery (MCA) occlusion. Unfortunately, a newly formed IIA located in the contralateral MCA bifurcation ruptured at the seventh day following embolization. A 6‐month‐old female child was admitted to hospital 3 days following acute right limb mobility disorder. An interventional surgery history of congenital heart disease was confirmed. She was immediately started on antibiotic therapy and the computed tomography agiography (CTA) scan showed occlusion of the upper branch of the left MCA. Unfortunately an IIA was located in the distal artery region (DAR) of the ipsilateral anterior cerebral artery. Angiography (digital subtraction angiography) was performed and the DAR IIA was embolized by OnyX‐18 with Magic 1.2 Fr. microcatheter. On the sixth day, magnetic resonance imaging during the hospital stay showed reduced infarction area with no other special sign. Desperately, a major seizure with opisthotonos attacked the baby on the seventh day after embolization. An immediate CTA scan showed massive hematoma in the right basal ganglia and a ruptured bifurcate aneurysm of the right MCA. The parents refused positive treatment and discharged in considering the critical situation. It should be noted that IIA can be fast formed anywhere in cerebral artery and dynamic angio‐image should be performed as supervision.

Repeated acute coronary syndrome caused by a mind-bending mural thrombus in ascending aorta: a case report and review of the literature

BackgroundAcute coronary syndrome due to coronary artery embolism in the setting of ascending aortic thrombus is an uncommon condition, even rarer when there is no aortic pathology such as aneurysm, severe atherosclerosis, aortic dissection, or thrombophilia (whether inherited or acquired).Case presentationWe report a case of a 58-year-old male presented with acute chest pain, electrocardiogram showing non-ST-elevation acute coronary syndrome. The computed tomography angiography of coronary artery revealed a mural thrombus in the proximal part of ascending aorta, located above the left coronary artery ostium, without any aortic pathologies. With the exception of hypertension and cigarette smoking, no other risk factors were identified in this patient that may increase the risk of thrombosis. Given the life-threatening risk of interventional therapy and surgery, the patient determinedly opted for anticoagulant and dual antiplatelet therapy. Then he experienced the reoccurrence of chest pain after 6-day treatment, progressed to anterior and inferior ST-segment elevation myocardial infarction. Coronary artery embolism originating from the ascending aortic thrombus was suspected. Considering the hemodynamic instability of the patient, the medical treatment was continued and bridged to warfarin and aspirin after discharge. Follow-up computed tomography angiography at 6 months showed no obstruction in coronary artery and complete resolution of the thrombus. No thromboembolic events occurred henceforward.ConclusionsAcute coronary syndrome could be a manifestation of secondary coronary embolism due to ascending aortic thrombus. Currently, there is no standardized guideline for the treatment of aortic mural thrombus, individualized treatment is recommended. When surgical therapy is not applicable for the patient, anticoagulation and dual antiplatelet treatment are alternative treatments that may successfully lead to the resolution of the aortic thrombus.

Clinical Utility of the Novel Oncological Criteria of Resectability for Advanced Hepatocellular Carcinoma

Introduction: Introduction of new systemic therapies for hepatocellular carcinoma (HCC) has led to the development of new oncological criteria of resectability for the resectability of HCC. This study was aimed at validating the prognosticating ability and clinical utility of the resectability classification based on the novel criteria in real-world clinical practice. Methods: This study was conducted in 1,822 patients who had undergone curative resection for HCC (population 1) and 107 patients with unresectable disease who had received lenvatinib therapy (population 2). Patients were classified into three groups according to the novel oncological criteria for resectability (R, resectable; BR1, borderline resectable 1; and BR2, borderline resectable 2), and the prognosticating ability and clinical utility of this classification based on the novel criteria were examined. Results: Multivariate analysis confirmed that classification of the patients according to the oncological resectability criteria was significantly correlated with the overall survival (OS) (BR1: hazard ratio [HR], 1.88; 95% CI, 1.38–2.55; BR2: HR, 4.12; 95% CI, 3.01–5.65) and recurrence-free survival (BR1: HR, 1.86; 95% CI, 1.44–2.41; BR2: HR, 3.62; 95% CI, 2.71–4.82) in population 1. In population 2, the resectability classification was correlated with the rates of successful additional intervention (surgery, transarterial chemoembolization, or radiotherapy) (BR1 65.7% vs. BR2 42.3%, p = 0.023) and curative-intent conversion surgery (BR1 17.1% vs. BR2 4.2%, p = 0.056) after lenvatinib therapy, and was also predictive of the OS (HR, 1.96; 95% CI, 1.13–3.38 for BR2 [vs. BR1]) and time-to-treatment failure (HR, 1.81; 95% CI, 1.04–3.17 for BR2 [vs. BR1]). Conclusion: The resectability classification based on the novel oncological criteria for resectability showed acceptable prognosticating ability in both surgically and medically treated populations with advanced HCC.

Apnoeic oxygenation with high flow nasal oxygen for interventional surgery of the larynx and pharynx

BackgroundHighflow nasal cannula oxygen (HFNO) is known to be used for noninvasive oxygenation in intensive care patients but it has rarely been used in airway management for elective surgery of the upper aerodigestive tract.ObjectivesHFNO offers opportunities of a tubeless oxygenation system which is easy to handle and not limited only on surgery of the endolarynx.MethodsWe evaluated this method for oxygenation during brief interventional procedures of the larynx and pharynx in 92 adult patients for safety and intraoperative complications. The need of secondary endotracheal intubation and limiting comorbidities as pulmonal and cardiac diseases were documented.ResultsHFNO showed a good safety profile concerning saturation and hypercapnia. Oxygen desaturation below 90% occurred only in 5 patients, mask ventilation led to quick recovery except in one patient who was secondary intubated. A significant influence of the body mass index on the minimal O2 saturation was shown (p < 0,001) so that a possible limitation of the method exists here. Comorbidities were grouped into the ASA classification. There was a significant difference between ASA I/II and ASA III patients in terms of minimum O2saturation.ConclusionWe conclude that HFNO may hold great promise for changing ventilator technique in general anesthesia, particularly in short elective laryngeal and pharyngeal surgery. Safety and feasibility were proven in this study.

Optimization of the electrolytic polishing parameters of intravascular stent based on the orthogonal test method

Cardiovascular diseases are the most important global health threat because of their prevalence. Intravascular stent interventional surgery is regarded as the primary treatment method of cardiovascular diseases, so high-performance stents are in great demand. In this study, the influence of key process parameters on the surface properties of the stent was investigated to improve the serviceability of laser cut intravascular stent. Using the test method, the influence of each process parameter on the surface integrity of the support was determined, and then the optimal combination of electrolytic polishing parameters was obtained. On this basis, the quantitative statistics of material removal and the wettability of electrolytic polishing were studied. The results show that the surface quality of the scaffold is the best when the volume ratio of concentrated sulfuric acid and glacial acetic acid electrolyte is 1:11, the polishing temperature is 34 ℃, the polishing voltage is 22 V, the polishing time is 80 s, and the electrode distance is 22 mm. The wall thickness and bridge width of the stent were reduced by 26.99 and 29.34 μm, respectively, and the mean hydrostatic contact angle was increased by 24.35°, which improved the biocompatibility of the stent.

Excimer laser coronary angioplasty combined with drug-coated balloon in the treatment of in-stent restenosis.

The aim of this study is to investigate the safety and efficacy of excimer laser coronary angioplasty (ELCA) combined with drug-coated balloons(DCBs) in the treatment of in-stent restenosis (ISR), and to explore whether the contrast injection technique would improve the neointimal tissue ablation of ELCA. We studied patients diagnosed with ISR between January 2019 and October 2022 at two medical centers. These patients underwent DCB angioplasty guided by optical coherence tomography (OCT). Based on whether ELCA was performed before DCB treatment, patients were categorized into two groups: the ELCA + DCB group and the DCB group. All patients underwent clinical follow-up 1 year after the procedure. The primary endpoint was the 1-year rate of target lesion revascularization (TLR), which was defined as any repeat percutaneous intervention or bypass surgery on the target vessel conducted to address restenosis or other complications related to the target lesion. The secondary endpoints including immediate luminal gain (ΔMLA, defined as the difference in minimum lumen area before and after the intervention). A total of 85 lesions in 75 patients were included. The mean age of the study population was 64.2 ± 12.0 years, with 81.3% male. Baseline clinical characteristics were well-balanced, and procedural success was 100% in both groups. The ELCA + DCB group (n = 24) exhibited a greater ΔMLA compared to the DCB group (n = 61) (3.57 ± 0.79 mm² vs. 2.50 ± 1.06 mm², [95% confidence interval,CI: 0.57-1.69], p < 0.001), The reduction in 1-year TLR was more frequently observed in patients from the ELCA + DCB group compared to the DCB group (hazard ratio 0.33 [95% CI: 0.11-0.99]; log-rank p = 0.048). The exploratory analysis showed that ELCA with contrast infusion is associated with greater acute lumen gain compared to ELCA with saline infusion (p < 0.001). The combination of ELCA and DCB is a safe and effective treatment strategy for in-stent stenosis. Additionally, compared with saline injection, ELCA with contrast injection is associated with greater acute lumen gain. However, the optimal contrast agent concentration and long-term outcome of the contrast injection technique need confirmation through larger sample sizes and prospective studies.

Efectos cardiometabólicos de la pérdida de peso

The prevalence of overweight and obesity, and, consequently, associated comorbidities, is increasing significantly worldwide. The guidelines recommend a percentage of weight loss> 5% to achieve beneficial effects on metabolic comorbidities associated with obesity. Furthermore, greater weight losses (> 10%) produce more significant improvements, and may even produce remission of some of these comorbidities. In this chapter, we review the evidence of the effect of weight loss through different strategies (lifestyle intervention, pharmacological treatment, or bariatric surgery) on the main cardiometabolic pathologies associated with excess adipose tissue (type 2 diabetes, high blood pressure, dyslipidemia, metabolic dysfunction-associated steatotic liver disease, inflammation, cardiovascular diseases, and mortality).

Atrial fibrillation incidence after coronary artery bypass graft surgery and percutaneous coronary intervention: the prospective AFAF cohort study

Objectives. Atrial fibrillation is a common arrhythmia in patients with ischemic heart disease. This study aimed to determine the cumulative incidence of new-onset atrial fibrillation after percutaneous coronary intervention or coronary artery bypass grafting surgery during 30 days of follow-up. Design. This was a prospective multi-center cohort study on atrial fibrillation incidence following percutaneous coronary intervention or coronary artery bypass grafting for stable angina or non-ST-elevation acute coronary syndrome. Heart rhythm was monitored for 30 days postoperatively by in-hospital telemetry and handheld thumb ECG recordings after discharge were performed. The primary endpoint was the cumulative incidence of atrial fibrillation 30 days after the index procedure. Results. In-hospital atrial fibrillation occurred in 60/123 (49%) coronary artery bypass graft and 0/123 percutaneous coronary intervention patients (p < .001). The cumulative incidence of atrial fibrillation after 30 days was 56% (69/123) of patients undergoing coronary artery bypass grafting and 2% (3/123) of patients undergoing percutaneous coronary intervention (p < .001). CABG was a strong predictor for atrial fibrillation compared to PCI (OR 80.2, 95% CI 18.1–354.9, p < .001). Thromboembolic stroke occurred in-hospital in one coronary artery bypass graft patient unrelated to atrial fibrillation, and at 30 days in two additional patients, one in each group. There was no mortality. Conclusion. New-onset atrial fibrillation during 30 days of follow-up was rare after percutaneous coronary intervention but common after coronary artery bypass grafting. A prolonged uninterrupted heart rhythm monitoring strategy identified additional patients in both groups with new-onset atrial fibrillation after discharge.

3D/2D Vessel Registration Based on Monte Carlo Tree Search and Manifold Regularization.

The augmented intra-operative real-time imaging in vascular interventional surgery, which is generally performed by projecting preoperative computed tomography angiography images onto intraoperative digital subtraction angiography (DSA) images, can compensate for the deficiencies of DSA-based navigation, such as lack of depth information and excessive use of toxic contrast agents. 3D/2D vessel registration is the critical step in image augmentation. A 3D/2D registration method based on vessel graph matching is proposed in this study. For rigid registration, the matching of vessel graphs can be decomposed into continuous states, thus 3D/2D vascular registration is formulated as a search tree problem. The Monte Carlo tree search method is applied to find the optimal vessel matching associated with the highest rigid registration score. For nonrigid registration, we propose a novel vessel deformation model based on manifold regularization. This model incorporates the smoothness constraint of vessel topology into the objective function. Furthermore, we derive simplified gradient formulas that enable fast registration. The proposed technique undergoes evaluation against seven rigid and three nonrigid methods using a variety of data - simulated, algorithmically generated, and manually annotated - across three vascular anatomies: the hepatic artery, coronary artery, and aorta. Our findings show the proposed method's resistance to pose variations, noise, and deformations, outperforming existing methods in terms of registration accuracy and computational efficiency. The proposed method demonstrates average registration errors of 2.14 mm and 0.34 mm for rigid and nonrigid registration, and an average computation time of 0.51 s.

Design, Modeling, and Experimental Validation of an Active Microcatheter Driven by Shape Memory Effects.

Microcatheters capable of active guidance have been proven to be effective and efficient solutions to interventional surgeries for cardiovascular and cerebrovascular diseases. Herein, a novel microcatheter made of two biocompatible materials, shape memory alloy (SMA) and polyethylene (PE), is proposed. It consists of a reconfigurable distal actuator and a separate polyethylene catheter. The distal actuator is created via embedding U-shape SMA wires into the PE base, and its reconfigurability is mainly dominated by the shape memory effect (SME) of SMA wires, as well as the effect of thermal mismatch between the SMA and PE base. A mathematical model was established to predict the distal actuator's deformation, and the analytical solutions show great agreement with the finite element results. Structural optimization of such microcatheters was carried out using the verified analytical model, followed by fabrication of some typical prototypes. Experimental testing of their mechanical behaviors demonstrates the feasibility of the structural designs, and the reliability and accuracy of the mathematical model. The active microcatheter, together with the prediction model, will lay a solid foundation for rapid development and optimization of active navigation strategies for vascular interventions.