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Commentary: Enhanced Recovery After Cardiac Surgery (ERAS): A rising tide that will lift all boats?
This study used propensity matching to compare outcomes between 76 matched pairs of ERAS cohort patients and non-contemporaneous historical controls. The authors demonstrated significantly shorter ventilation time, intensive care unit (ICU) stay, and post-operative length of stay (LOS) without significant differences in 30-day readmission rates, post-operative stroke, acute kidney injury, atrial fibrillation, reoperation rates for bleeding, or mortality at two years in the ERAS patients.
Source: Seminars in Thoracic and Cardiovascular Surgery - June 15, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Mary E. Huerter, Leora B. Balsam Tags: ADULT – Commentary Source Type: research

Commentary: Moving the dial on DOAC use early after cardiac surgery
Atrial fibrillation remains an unsolved complication after cardiac surgery with published rates in the 20-50%1,2. As outlined in a recent STS database analysis3, over 60% of US surgeons still use warfarin rather than switching to direct oral anticoagulants (DOACs) for stroke prophylaxis in this clinical scenario. This trend persists despite the limitations associated with warfarin use, including prolonged and often turbulent early titration in new patients, dietary restrictions, strict monitoring requirements and extensive medication interactions.
Source: Seminars in Thoracic and Cardiovascular Surgery - June 14, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Asishana A. Osho, Gus J. Vlahakes Tags: ADULT – 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

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

Right anterior mini thoracotomy approach for isolated aortic valve replacement: Early outcomes at a Canadian center
ConclusionThe sternum-sparing RAMT approach can be safely integrated into surgical practice as a minimally invasive alternative for isolated AVR, and can reduce postoperative bleeding and narcotic requirements.
Source: Journal of Cardiac Surgery - May 18, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Ali Fatehi Hassanabad, Nader Aboelnazar, Andrew Maitland, Daniel D Holloway, Corey Adams, William D T Kent Tags: ORIGINAL ARTICLE Source Type: research

Dexmedetomidine, Delirium, and Adverse Outcomes: Analysis of the STS Adult Cardiac Surgery Database
CONCLUSIONS: In this registry of cardiac surgical patients dexmedetomidine administration was associated with POD and adverse outcomes.PMID:33901455 | DOI:10.1016/j.athoracsur.2021.03.098
Source: The Annals of Thoracic Surgery - April 26, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Nirvik Pal James H Abernathy Mark A Taylor Bruce A Bollen Ashish S Shah Xiaoke Feng Matthew S Shotwell Miklos D Kertai Source Type: research

Commentary: Until we take it seriously, the status quo of postoperative atrial fibrillation management will prevail
New-onset postoperative atrial fibrillation (POAF) is common following cardiac surgery, developing in almost one-third of patients after coronary artery bypass grafting (CABG) and two-thirds of patients after valvular surgery.1 The long-standing characterization of atrial fibrillation (AF) as a transient and benign postoperative complication may be an underlying reason for the relatively limited progress in terms of its prophylaxis and management.2 This assumption has only recently been called into question by  new studies reporting varying degrees of association between POAF and mortality, stroke, myocardial infarction, or renal failure.
Source: The Journal of Thoracic and Cardiovascular Surgery - April 19, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Grace Lee, Derrick Y. Tam, Stephen E. Fremes Tags: Commentary Source Type: research

Atrial fibrillation after cardiac surgery: A systematic review and meta-analysis
The objective was to perform a meta-analysis of the studies reporting the association of POAF with perioperative and long-term outcomes in patients with cardiac surgery.
Source: The Journal of Thoracic and Cardiovascular Surgery - March 31, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Tulio Caldonazo, Hristo Kirov, Mohamed Rahouma, N. Bryce Robinson, Michelle Demetres, Mario Gaudino, Torsten Doenst, POAF-MA Group Tags: Adult Source Type: research

Atrial Fibrillation after Cardiac Surgery – A Systematic Review and Meta-Analysis
The objective was to perform a meta-analysis of the studies reporting the association of POAF with peri-operative and long-term outcomes in cardiac surgery.
Source: The Journal of Thoracic and Cardiovascular Surgery - March 31, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Tulio Caldonazo, Hristo Kirov, Mohamed Rahouma, N. Bryce Robinson, Michelle Demetres, Mario Gaudino, Torsten Doenst, POAF-MA Group Source Type: research

Anticoagulation management of postoperative atrial fibrillation after cardiac surgery: A systematic review
ConclusionThere is wide practice variation in the uptake, timing of initiation, duration, and choice of OAC for POAF following cardiac surgery. The evidence is largely retrospective and insufficient to assess the efficacy of different OAC strategies. Further studies are warranted to guide clinical practice.
Source: Journal of Cardiac Surgery - March 27, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Ren Jie R. Yao, Nathaniel M. Hawkins, Yasaman Lavaie, Marc W. Deyell, Jason G. Andrade, Jamil Bashir Tags: REVIEW ARTICLE Source Type: research

New oral anticoagulants versus warfarin in atrial fibrillation after early post-operative period in patients with bioprosthetic aortic valve
CONCLUSIONS: In real-word, NOACs use overcomes the indications provided by guidelines. This study evidenced that NOACs use in patients who developed AF after bioprosthetic AVR was more effective in prevention of thromboembolism and safe in reduction of major bleeding events compared to warfarin.PMID:33744222 | DOI:10.1016/j.athoracsur.2021.03.016
Source: The Annals of Thoracic Surgery - March 21, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Vito A Mannacio Luigi Mannacio Anita Antignano Ciro Mauro Pasquale Mastroroberto Francesco Musumeci Carlo Zebele Gabriele Iannelli Source Type: research

Disappearing left atrial appendage clot —the need for a more meticulous search
AbstractLeft atrial clots are occasionally seen in patients with long-standing atrial fibrillation who come for valve surgery. Once identified on echocardiogram, intraoperative identification and retrieval of the clot are essential in order to prevent the possibly devastating complication of embolism and stroke.
Source: Indian Journal of Thoracic and Cardiovascular Surgery - March 19, 2021 Category: Cardiovascular & Thoracic Surgery Source Type: research

Improved outcomes in CABG patients with atrial fibrillation associated with surgical left atrial appendage exclusion
ConclusionsConcomitant LAA exclusion via an epicardial closure device is associated with reduced CABG mortality, thromboembolic events, and readmissions in patients with pre ‐existing atrial fibrillation.
Source: Journal of Cardiac Surgery - March 13, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Edward G. Soltesz, Krish C. Dewan, Louise H. Anderson, Michael A. Ferguson, A. M. Gillinov Tags: ORIGINAL ARTICLE Source Type: research

Impact of postoperative complications after cardiac surgery on long ‐term survival
ConclusionsPostoperative complications after cardiac surgery significantly impact outcomes that extend beyond the postoperative period. Stroke, renal failure, and pneumonia are particularly associated with poor long ‐term survival.
Source: Journal of Cardiac Surgery - March 9, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Siddharth Pahwa, Annalisa Bernabei, Hartzell Schaff, John Stulak, Kevin Greason, Alberto Pochettino, Richard Daly, Joseph Dearani, Gabor Bagameri, Katherine King, Jason Viehman, Juan Crestanello Tags: ORIGINAL ARTICLE Source Type: research

General Anesthesia Increased the Risk of Atrial Fibrillation and Acute Kidney Injury in Transcatheter Aortic Valve Replacement
CONCLUSION: GA was associated with higher rates of ICU admission, postoperative AKI, and new-onset AF. The results may provide new evidence that CS challenges universal GA.PMID:33635259 | DOI:10.1532/hsf.3361
Source: The Heart Surgery Forum - February 26, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Ying Liang Wei Wang Xu Wang Mingzheng Liu Feilong Hei Yulong Guan Source Type: research

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