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Commentary: Direct oral anticoagulants in heart surgery: A �question in need of an answer
The Invited Expert Opinion by Drs Kapadia and Svensson1 is focused on an important clinical challenge of whether direct oral anticoagulants (DOACs) can be used in patients with bioprosthetic valves who have atrial fibrillation (AF). Recommendations for anticoagulation therapy should focus on potential risks of early postoperative bleeding with DOAC treatment and not only on its long-term superiority over vitamin K antagonists (VKAs) for stroke prevention in patients with AF, with or without a bioprosthetic valve.
Source: The Journal of Thoracic and Cardiovascular Surgery - June 10, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Stephen D. Waterford, Niv Ad Tags: Commentary Source Type: research

Commentary: Direct oral anticoagulants in heart surgery: A  question in need of an answer
The Invited Expert Opinion by Drs Kapadia and Svensson1 is focused on an important clinical challenge of whether direct oral anticoagulants (DOACs) can be used in patients with bioprosthetic valves who have atrial fibrillation (AF). Recommendations for anticoagulation therapy should focus on potential risks of early postoperative bleeding with DOAC treatment and not only on its long-term superiority over vitamin K antagonists (VKAs) for stroke prevention in patients with AF, with or without a bioprosthetic valve.
Source: The Journal of Thoracic and Cardiovascular Surgery - June 10, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Stephen D. Waterford, Niv Ad Tags: Commentary Source Type: research

Biological versus Mechanical Prostheses for Aortic Valve Replacement.
The objective was to compare long-term survival and major adverse cardiac and cardiovascular events (i.e. stroke, reoperation, and major bleeding) within this population.
Source: The Journal of Thoracic and Cardiovascular Surgery - February 5, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Emiliano A. Rodr íguez-Caulo, Oscar Blanco-Herrera, Elisabet Berastegui, Javier Arias-Dachary, Souhayla Souaf, Gertrudis Parody, Gregorio Laguna, SPAVALVE study group Source Type: research

Biological versus mechanical prostheses for aortic valve replacement
The objective was to compare long-term survival and major adverse cardiac and cardiovascular events (ie, stroke, reoperation, and major bleeding) within this population.
Source: The Journal of Thoracic and Cardiovascular Surgery - February 5, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Emiliano A. Rodr íguez-Caulo, Oscar R. Blanco-Herrera, Elisabet Berastegui, Javier Arias-Dachary, Souhayla Souaf-Khalafi, Gertrudis Parody-Cuerda, Gregorio Laguna, SPAVALVE Study Group Tags: Adult Source Type: research

Commentary: The case for a comprehensive clinical, basic, and translational research strategy to understand, prevent, detect, and treat cerebrovascular injury in Fontan patients
In this issue of the Journal, the Australian and New-Zealand Fontan Registry Research group compares long-term rates of cerebrovascular injury, thrombosis, bleeding, bone mineral density, and quality of life in Fontan patients receiving warfarin and those receiving aspirin.1 Their take-home messages are (1) asymptomatic cerebrovascular injury is a frequent occurrence in Fontan patients, including stroke (39%), microhemorrhage (96%), and white matter injury (86%); (2) warfarin does not seem to protect against the risk of cerebrovascular injury when compared with aspirin; and (3) warfarin is associated with a greater risk of...
Source: The Journal of Thoracic and Cardiovascular Surgery - January 19, 2021 Category: Cardiovascular & Thoracic Surgery Authors: David Kalfa Tags: Commentary Source Type: research

Commentary: Postpericardial syndrome after cardiac surgery: Is it really benign?
Lehto and colleagues1 report on the long-term outcomes of postpericardiotomy syndrome (PPS) occurring after aortic valve replacement (AVR) surgery. The patient cohort was drawn from 2 large Finnish multi-institutional clinical trial databases, namely CAREAVR (Consortium of Studies in the Field of Atrial Fibrillation, Stroke, and Bleeding in Patients Undergoing Aortic Valve Replacement) and CAREBANK (Cardiovascular Research Consortium---A Prospective Project to Identify Biomarkers of Morbidity and Mortality in Cardiovascular Interventional Patients),1 in which a total of 671 AVR patients (bioprosthesis, n  = 361 and mecha...
Source: The Journal of Thoracic and Cardiovascular Surgery - March 11, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Suk Jung Choo Tags: Commentary Source Type: research

Commentary: Nuisance or nemesis? Postoperative atrial fibrillation increases long-term mortality regardless of sex
Postoperative atrial fibrillation (POAF) complicates approximately 30% of coronary artery bypass grafting (CABG) procedures.1 POAF has been associated with perioperative adverse outcomes including stroke, reoperation for bleeding, myocardial infarction, and pacemaker use.1,2 Patients with POAF are known to have a significantly increased risk of mortality in short-term, midterm, and long-term follow-up. POAF also lengthens hospital stay by 3 to 5  days and increases hospitalization cost from $10,000 to $20,000 per patient.
Source: The Journal of Thoracic and Cardiovascular Surgery - June 5, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Malak Elbatarny, Derrick Y. Tam, Stephen E. Fremes Tags: Commentary Source Type: research

Stroke after thoracic endovascular aortic repair: Can you “plug” the problem?
Perioperative stroke has become the main factor determining quality of life in patients undergoing aortic surgery. Complications traditionally associated with aortic surgery, such as myocardial failure or bleeding, now contribute less frequently to mortality in this patient population.
Source: The Journal of Thoracic and Cardiovascular Surgery - November 8, 2018 Category: Cardiovascular & Thoracic Surgery Authors: Florian S. Schoenhoff, Thierry P. Carrel Tags: Editorial Commentary Source Type: research

Commentary: Stroke after thoracic endovascular aortic repair: Can you “plug” the problem?
Perioperative stroke has become the main factor determining quality of life in patients undergoing aortic surgery. Complications traditionally associated with aortic surgery, such as myocardial failure or bleeding, now contribute less frequently to mortality in this patient population.
Source: The Journal of Thoracic and Cardiovascular Surgery - November 7, 2018 Category: Cardiovascular & Thoracic Surgery Authors: Florian S. Schoenhoff, Thierry P. Carrel Tags: Commentary Source Type: research

Mitral repair in symptom-free patients with normal ventricles: Becoming the new normal?
We have all been there. A young, vigorous woman referred to you with severe asymptomatic mitral regurgitation is in your office to discuss surgical repair. You proceed to describe the incision you are going to make somewhere on her chest; the 1% to 2% risk of bleeding, stroke, infection, heart failure, and death; the fact that she may end up with a prosthetic mitral valve requiring lifelong anticoagulation; and the fact that she is going to have to miss a month or more of her Pilates classes because the American College of Cardiology and American Heart Association Task Force on Practice Guidelines (ACC/AHA) says that it is...
Source: The Journal of Thoracic and Cardiovascular Surgery - September 5, 2018 Category: Cardiovascular & Thoracic Surgery Authors: David D. Yuh Tags: Editorial Commentary Source Type: research

Commentary: Mitral repair in symptom-free patients with normal ventricles: Becoming the new normal?
We have all been there. A young, vigorous woman referred to you with severe asymptomatic mitral regurgitation is in your office to discuss surgical repair. You proceed to describe the incision you are going to make somewhere on her chest; the 1% to 2% risk of bleeding, stroke, infection, heart failure, and death; the fact that she may end up with a prosthetic mitral valve requiring lifelong anticoagulation; and the fact that she is going to have to miss a month or more of her Pilates classes because the American College of Cardiology and American Heart Association Task Force on Practice Guidelines (ACC/AHA) says that it is...
Source: The Journal of Thoracic and Cardiovascular Surgery - September 4, 2018 Category: Cardiovascular & Thoracic Surgery Authors: David D. Yuh Tags: Commentary Source Type: research

In pursuit of the optimal hemocompatible left ventricular assist device
Left ventricular assist device (LVAD) implantation is a firmly established treatment modality for advanced heart failure; however, major complications such as nonsurgical bleeding, driveline infections, pump thrombosis, and stroke limit wider application to patients with less severe heart failure. Of note, more than 60% of patients who receive a continuous flow LVAD experience such severe adverse events within the first year.1
Source: The Journal of Thoracic and Cardiovascular Surgery - August 29, 2018 Category: Cardiovascular & Thoracic Surgery Authors: Shuab Omer Tags: Editorial Commentary Source Type: research

Early left ventricular assist device-related strokes: Turn up the flow, turn down the embolism?
Despite technical and surgical advances in continuous-flow left ventricular assist devices (LVADs), stroke remains a major complication. In the eighth annual Interagency Registry for Mechanically Assisted Circulatory Support report,1 stroke dominates as the major cause of death between 6  months and 4 years of device support. Previously identified risk factors for stroke in LVAD patients include pump thrombosis, infection, blood pressure, gastrointestinal bleeding, and excessive antithrombotic treatment.
Source: The Journal of Thoracic and Cardiovascular Surgery - August 3, 2018 Category: Cardiovascular & Thoracic Surgery Authors: Mark Helmers, Pavan Atluri Tags: Editorial Commentary Source Type: research

Comparing apples with oranges: The funfair of statistics
The CHA2DS2-VASc score estimates the risk of stroke in patients with atrial fibrillation.1,2 The CHA2DS2-VASc score accounts for congestive heart failure; hypertension; age of at least 75  years (doubled); diabetes mellitus; previous stroke, transient ischemic attack or thromboembolism (doubled); vascular disease; age 65 to 74 years; and sex category (female). Should the CHA2DS2-VASc score be considered as a categorical or a continuous factor, if the patients have an incremental in crease in risk of death, stroke, or bleeding?
Source: The Journal of Thoracic and Cardiovascular Surgery - August 3, 2018 Category: Cardiovascular & Thoracic Surgery Authors: Ari A. Mennander Tags: Editorial Commentary Source Type: research

The limitations of observational data in assessing surgical left atrial appendage ligation
We read with interest the study by Juo and colleagues, which examined outcomes in a cohort of patients with atrial fibrillation who underwent surgical left atrial appendage (LAA) ligation concomitantly with coronary artery bypass grafting. The authors evaluated the short-term efficacy and safety of LAA ligation in 20,664 patients among a sample of 234,642 patients from the Nationwide Inpatient Sample, and reported no significant differences in postoperative stroke, mortality, bleeding, and pericardial complications.
Source: The Journal of Thoracic and Cardiovascular Surgery - June 14, 2018 Category: Cardiovascular & Thoracic Surgery Authors: Saurabh Gupta, Emilie P. Belley-C ôté, Richard P. Whitlock Tags: Letter to the editor Source Type: research

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