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Background: Due to its antioxidant properties, vitamin C might be a promising and effective strategy for preventing postoperative atrial fibrillation (POAF) after cardiac surgery. This study was aimed at evaluating whether vitamin C supplementation is effective in reducing the cost of in-hospital postoperative medication used for patients undergoing coronary artery bypass (CABG) or valve surgery (±CABG). Objective: The primary goal of this study was to evaluate the impact of perioperative vitamin C supplementation in patients undergoing cardiac surgery on in-hospital postoperative medication costs, while secondary endpoints were the effects on length of stay (LOS) in both the intensive care unit (ICU) and the hospital, and the incidence of POAF. Material and Methods: From November 2018 to January 2021, 253 patients planned for CABG or valve surgery (±CABG) in AZ Maria Middelares, Ghent, Belgium, and who met the inclusion criteria (≥18 years of age, all having cardiac sinus rhythm, and who provided written informed consent) were randomised into a placebo group or vitamin C group. The medication was administered orally (1 g twice daily), starting from 5 days preoperatively until 10 days postoperatively. The medication used, LOS in the hospital/ICU, and development of clinically relevant POAF in the ICU were registered. Results: Mean medication costs were €264.6 ± 98.1 for patients in the vitamin C group and €294.9 ± 267.3 for patients in the placebo group. When stratifying according to the type of surgery (CABG or valve surgery [±CABG]), these costs did not significantly differ. There was no significant difference in LOS or the incidence of clinically relevant POAF. Conclusion: Our data did not identify any short-term financial impact on postoperative medication costs after oral perioperative vitamin C supplementation (1 g twice daily) for patients undergoing a CABG procedure or valve surgery (±CABG). No effect was found on the LOS or the incidence of clinically relevant POAF. Potential effects in the longer term, after intravenous administration of vitamin C or in other types of (cardiac) surgery, are still to be investigated. Clinical Trials registration number: NCT03592680.

AbstractObjectiveThe Maze IV (M-IV) procedure is regarded as the golden standard in treatment for surgical ablation of atrial fibrillation (AF); however, long-term follow-up results are scarce. We present our institutional 10-year experience.MethodsWe collected data of 117 consecutive patients who have undergone a concomitant M-IV procedure between April 2006 and April 2016. Primary endpoints are freedom of atrial arrhythmias and freedom of atrial arrhythmias off antiarrhythmic drugs (AAD).ResultsForty-seven patients (40.2%) had paroxysmal AF. Two-thirds of the procedures included mitral valve surgery. The average follow-up time per patient was 3.8 years (SD 2.8). Freedom of AF at 1 year was 79%, at 5 years freedom of AF was 69% and freedom of AF off AAD was 56%. Predictors of AF recurrence in multivariate analysis were age, preoperative pacemakers, redo cardiac surgery and in-hospital AF. Preoperative PVI ablation was found to be a protective factor.ConclusionsThe long-term outcomes of the M-IV procedure are good and remain stable over the years. Results could be improved if follow-up were to be intensified and recurrences dealt with aggressively. Key question:How many patients are free from AF in a 10-year period after concomitant M-IV surgical ablation? Key findings:In the long term around 70% of patients are free of AF with an increasing need for anti-arrhythmic drugs. Take home message:Early to midterm freedom from AF after concomitant M-IV procedure is high and remains stable after 3 years.

AbstractVentricular septal rupture (VSR) occurs in approximately 1% of the patients who experience an acute myocardial infarction. The operative mortality of VSR repair decreases if surgery can be delayed until the infarct has healed and tissue strength improved. Because of heart failure or impending cardiogenic shock, surgical treatment can often not be delayed. We present a case in which a delayed repair of a VSR was possible. The patient was initially stabilized with an intra-aortic balloon pump. She was discharged and readmitted 5 weeks later for definitive repair. Repair was performed, according to the Daggett technique, using a bovine pericardial patch and a mitral annuloplasty was carried out to correct for the regurgitation. Recovery was uneventful. Cardiac ultrasound examination at discharge showed no residual defect.