Journal and News Scan

The authors of this review article provide an extensive overview of the curent state of play in the field of Aortic Stenosis. They discuss risk scores,treatment decisions, and up-to-date evidence of Transcatheter Aortic Valve Replacement.

The study provides a risk-adjusted impact of postoperative atrial fibrillation on hospital mortality, resouces utlization, and costs.  49,264 patients from the STS database who underwent cardiac surgery were extracted from 2001-2012.  AF increased operative mortality 2% vs 1%), morbidity, readmission rates, ICU stay, postoperative length of stay, and costs. 

Authors describe an LVAD implantation technique, applying the concept of less invasive cardiac surgery, consisting in the association of reduced surgical approaches, off-pump implantation and reduced administration of heparin dose, in order to achieve rapid extubation and rehabilitation of the patient, preserving low morbidity, and still meeting all the goals of the standard procedure. To reduce the invasiveness, authors combine an anterior left minithoracotomy with T-upper reversed ministernotomy.

Five years ago, the Oscar-winning actor underwent surgery at the Cleveland Clinic to replace his aortic valve, fix his mitral valve and correct an irregular heartbeat.

Depression is one side effect of cardiac surgery.

It's unknown exactly when Williams' battle with depression began, but his rep issued a statement after the star's death on Monday at 63, noting he had "been battling severe depression of late."

"Open-heart surgery has historically been known to affect a person's cognitive functioning following recovery," Dr. Jeffrey Lieberman, chief of psychiatry at New York-Presbyterian Hospital Columbia, told the Daily News.

"The valve replacement involves stopping the heart while you're replacing it, and having that kind of procedure with general anesthesia, there is an increased frequency of depression occurring in the aftermath," he said.

A number of factors could contribute to this post-operative depression, said Dr. Tara Narula, associate director of the cardiac care unit at Lenox Hill Hospital and a spokeswoman for the American Heart Association and American Stroke Association.

During open-heart surgery, emboli — little pieces of plaque in the aorta — may break off and travel up to the brain, which could result in changes to the brain's structure and abilities, Narula said. Open-heart surgery also makes use of hypothermia — lowering the body's temperature — which may affect brain chemistry, as could general anesthesia.

"It's multifactorial but certainly it is something that we know exists," Narula said of cardiac depression, adding that it affects 20-40% of heart surgery patients. She said patients and doctors need to educate themselves more about the link.

"There are so many things we can do to help people with depression, but if you don't recognize you have it, you're never going to be able to get treatment," she said.

The stress of Williams' open-heart surgery could have also led to "a reactive depression," said Dr. Alan Rozanski, chief of cardiology at Mount Sinai St. Luke’s and Mount Sinai Roosevelt. He noted that up to 10% of people can develop post-traumatic stress symptoms in the wake of a major medical procedure.

"We need to be increasingly aware of that link," he said.

another article on this issue 

http://www.huffingtonpost.com/taylor-marsh/comic-genius-robin-willia_b_5...