Journal and News Scan

The benefits of early extubation in the operating room (OR) following cardiac surgery remain unproven. In this study, the authors evaluated perioperative outcomes after extubation in the OR versus extubation in the intensive care unit (ICU) in patients who underwent nonemergency isolated coronary artery bypass grafting (CABG). A total of 1,397 patients who underwent nonemergency isolated CABG during a six-year period were analyzed. Among them, 891 (63.8 percent) patients were extubated in the ICU, and 506 (36.2 percent) were extubated in the OR. After propensity score matching, 414 patient pairs were compared. Adjusted comparison did not show differences between the two groups in the incidence of major early postoperative complications such as reintubation, re-exploration for bleeding, stroke, renal failure, or thirty-day mortality. Furthermore, patients extubated in the OR had shorter ICU (P < 0.0001) and hospital stays (P < 0.0001), were more frequently discharged directly home (P < 0.0001), and presented with a lower thirty-day readmission rate (P = 0.04). Based on these results, the authors suggest a wider adoption of routine OR extubation for nonemergency CABG.

A recently published article showed the benefit of TEER compared to mitral valve surgery in older, sicker patients with a high risk in surgery. Based on the French administrative hospital discharge database, the study collected information from all consecutive patients treated for primary or secondary mitral regurgitation with isolated TEER or isolated mitral valve surgery (repair or replacement) between 2012 and 2022. A total of 57,030 patients were found in the database, and after propensity score matching, a total of 2,160 patients were included for analysis in each arm. This study has led to controversy and a heated discussion within the cardiovascular community. In his article, Michael O'Riordan from TCTMD interviews the study's primary author and other experts in the field, providing insights into this issue and a comprehensive overview of the topic.

 In findings presented at the STS annual meeting, the ten-year data showed the survival benefit of multi- over single-arterial grafting in all but patients who are severely obese. The study used data from the STS Adult Cardiac Surgery Database to look at patients who underwent isolated CABG over a ten-year period. The long-term survival rate was significantly better for patients who received multiple arterial grafting. The authors of the study acknowledged the reasons surgeons have not taken this data into account as lack of education and suspicion around the evidence.

This study used CardioSurgery Atrial Fibrillation (CASE-AF) registry data to evaluate outcomes of surgery for long standing persistent AF at one year. No AF recurrence at one year is defined by the presence of AF, no re-ablation, no further cardioversion, and no rehospitalization due to AF after a three-month blanking period. Early mortality (30 days) was 2 percent and morbidity was low. Various ablation techniques were used. Of the 202 qualifying patients, 106 (56 percent) had no AF recurrence and 93 percent of these were asymptomatic. Multivariable analysis showed that surgical ablation was most effective when delivered concomitant with endocardial cryoablation.