1 AnswerCraig Smith, Cardiothoracic Surgery, answered on behalf of Columbia University Department of SurgeryBecause transcatheter aortic valve replacement (TAVR) is done with a less invasive procedure, elderly or frail people who could not tolerate open surgery may be able to have their aortic valves repaired this way instead. According to results released in the fall of 2010 and spring of 2011, transcatheter aortic valve replacement is as good as open surgery in terms of one-year survival, and compared to medical management, it improves survival by 20% at one year. In addition to living longer, people also felt much better and experienced fewer hospitalizations.
1 AnswerAn aortic dissection is a tear in the wall of the aorta that allows blood to flow within the layers of the aorta. Because death from rupture or compromise of blood flow to major organs can ensue, early diagnosis and treatment of this illness is critical for survival.
Mortality rates among patients undergoing surgical repair of acute aortic dissection in the United States appear to be strongly associated with both institution and surgeon case volume, with lower mortality rates among surgeons and institutions annually performing more of the operations, according to a study published in The Annals of Thoracic Surgery.
Aortic dissection is usually an emergency, which limits the ability of patients to choose where they want to be treated. This study's data suggests that in settings where physicians may be able to refer a patient to several surgical centers without delaying surgery, the patient's chances of surviving are greatest in the hospitals that specialize in these types of procedures.
1 AnswerThe rate of depression among patients requiring or having undergone coronary artery bypass graft (CABG) surgery can delay postoperative recovery. Even slight depression before coronary surgery can delay a patient’s mental recovery and increase the feeling of pain after surgery.
1 AnswerAntidepressant therapy that begins two to three weeks before coronary artery bypass grafting (CABG) surgery and continues until six months post-surgery may help some patients recover their mental health more quickly and reduce postoperative pain, according to a study published in The Annals of Thoracic Surgery.
Researchers found that antidepressant therapy enables patients who were at least slightly depressed before surgery for coronary artery disease to feel better more quickly after surgery, without influencing the complication rate. Even slight depression before coronary surgery can delay a patient’s mental recovery and increase the feeling of pain after surgery.
Apart from mortality and complications, a patient’s feelings of pain and general well-being are a major concern for cardiac surgeons, as they form an integral part of patient care. This study shows that feelings of pain can be reduced and general well-being improved in patients suffering from at least slight depression before surgery. Putting in place an antidepressant therapy helps those patients get on with their lives more quickly after such a serious surgical procedure.
1 AnswerAccording to a study published in The Annals of Thoracic Surgery, the strongest predictor of worse cognitive performance after coronary artery bypass grafting (CABG) surgery was the emotional state of the patient, and patients who were anxious or stressed prior to undergoing surgery generally performed worse afterward.
Patients who are worried about adverse neurological outcomes, such as cognitive decline, can be reassured that post-operative cognitive decline is significantly less common than was reported in the past. This study suggests that identifying and treating pre-operative depression may be one approach to minimizing the risk of post-operative cognitive decline.
1 AnswerThe cognitive dysfunction observed in patients who undergo coronary artery bypass grafting (CABG) surgery usually disappears within eight weeks following surgery, according to a study published in The Annals of Thoracic Surgery.
Previously published estimates of the incidence of post-operative cognitive dysfunction vary widely, with some studies reporting lasting impairment in as many as 50% of patients.
Researchers from Monash University and RMIT University, both in Victoria, Australia, periodically tested cognitive function in three sets of patients: 16 patients who underwent elective CABG surgery, 15 patients who underwent elective chest surgery for lung biopsies or lobectomies, and 15 nonsurgical patients.
The researchers found that CABG patients performed worse on every subtest prior to surgery, and these disparities continued following surgery. Anxiety, depression, and stress were associated with impaired cognitive performance in patients in the two surgical groups one week after surgery.
At one week post-operation, 44% of CABG patients and 33% of surgical control patients were significantly impaired; however, by eight weeks post-operation, nearly all patients had recovered to pre-operation levels, with 25% of CABG patients and 13% of surgical control patients improving beyond their pre-operative performance.
The researchers also found that even though the surgical groups showed impairment, when individual performance within these groups was examined, more than half of the patients were unaffected by the surgery.
1 AnswerThe potential patient population needing aortic valve replacement (AVR) for severe aortic stenosis is estimated at 350,000 and rising. There are few, if any, medical procedures that are as effective as AVR in relieving symptoms, improving quality of life, and increasing long-term survival. Currently, almost 92,000 patients annually undergo aortic valve replacements in the United States.
Data from the STS Adult Cardiac Surgery Database show that the number of AVR procedures is rising, likely due to an aging population, increasing awareness of good results for AVR, and the new option of transcatheter aortic valve replacement (TAVR).
Recovery from heart surgery is faster today than it used to be—in some cases, patients go home the same day. In this video, Dr. Samin Sharma, MD, a leading cardiologist and stent expert at The Mount Sinai Medical Center, discusses what is involved.
1 AnswerPerforming heart surgery on the same day as angiography is now confirmed as a risk factor for acute kidney injury (AKI), and hospital policy limiting the practice for elective cardiac surgery has significantly reduced the rate of AKI, according to a study published in The Annals of Thoracic Surgery.
Although previous research has shown that performing diagnostic angiography and cardiac surgery on the same day is associated with increased risk of contrast-induced kidney injury, this study is the first to confirm causation and explore results following a change in hospital policy reducing this practice.
1 AnswerGreater saphenous (leg) vein grafts are the most commonly used vessels for coronary artery bypass graft surgery. A recent study found that one way smoking increases the risk for vein graft failure is by causing dysregulation of enzymes in those veins. The exact mechanisms of this relationship are not entirely understood.
In the meantime, Shahab A. Akhter, MD, from the University of Chicago Medicine, promotes the value of not smoking. “Smoking cessation is important to maintain cardiovascular health in a preventative manner and also to maximize the results of bypass surgery in patients who will benefit from this operation,” he said.