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Minimally invasive epicardial ablation of isolated atrial fibrillation yields stable, gradually improving results. Earlier surgical referral is justifiable after careful cardiologic work-up. To define the relative roles of minimally invasive ablation and transcatheter ablation, which may be considered in the future as alternative therapies, a randomized trial to compare these procedures is advisable.

In the past 20 years, numerous percutaneous vascular closure devices have been tested and compared with manual compression and to surgical cut-down. The suture-mediated closure device Perclose ProGlide™ system (Abbott Vascular, CA, USA) emerged as a safe and effective alternative for many procedures requiring either small or large bore vascular accesses. In this review, we will discuss the characteristics of this vascular closure device and the main studies that proved its potential to reduce vascular complications, time to deambulation, time to discharge and patient discomfort.

Miniaturized cardiopulmonary bypass (CPB) systems, though more biocompatible, are limited by not being adaptable to all cardiac surgical operations. We evaluate a versatile CPB system [extracorporeal vacuum-assisted device optimized (EVADO)] based on the elimination of roller pumps, separation of extracavitary suctioned blood and state-of-the-art technology for oxygenator systems and digital control. We randomized 165 patients to either EVADO or conventional CPB (cCPB). Surgery could be completed in all cases without conversion to cCPB. The use of EVADO significantly reduced the intraoperative haemolysis (lesser increase in free hemoglobin, P<0.001 vs. control, and lesser decrease in haptoglobin levels, P=0.001 vs. control). Among patients who were submitted to EVADO, postoperative bleeding (P=0.004), transfusions (P=0.046), rate of revision for bleeding (P=0.03), rate of postoperative atrial fibrillation (P=0.007), time to extubation (P=0.02) and ICU stay (P=0.04) were reduced. The clinical benefits associated with the EVADO may be due to better end-organ perfusion, lesser impairment of the coagulation and inflammatory reaction.

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