The new EACTS Guidelines on perioperative medication in adult cardiac surgery address antithrombotic management, atrial fibrillation, renin–angiotensin–aldosterone system inhibitors, beta-blockers, dyslipidaemia, ulcer prevention and steroids, antibiotic prophylaxis, anaesthesia and postoperative analgesia, and blood glucose management.
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Pharmacology
July 18, 2017
In this study, the Dabigatran reversal-drug Idarucizumab was tested. 503 patients were enrolled, of whom 202 had to undergo an urgent procedure. Of the patients requiring an urgent procedure, the median time of initiation of the procedure was 1.6 hours, and at that time periprocedural hemostasis was assessed as normal in 93.4% of the patients.
December 22, 2016
This retrospective study compared Celsior (65% of pts) to all-blood continuous myocardial protection (35%) in 631 patients undergoing elective aortic valve replacement. Troponin T release was lower in Celsior patients, as was the risk of postoperative death (OR 0.33; 0.15 - 0.76). Other outcomes were similar between the groups.
August 8, 2016
This is a retrospective study comparing outcomes of conventional 1:4 cardioplegia vs 4:1 Del Nido cardioplegia on adult patients undergoing CABG. 249 consecutive patients underwent coronary artery bypass using blood cardioplegia and 159 using del Nido Cardioplegia.
July 14, 2016
In this matched cohort study the authors evaluate the age-associated risk of bleeding and thrombosis in 3313 patients ≥70 years attending a single thrombosis service and treated with vitamin K antagonist (VKA). Patients were matched 1:1:1 by decade (70-79, 80-89, 90-99 years) and duration of treatment.
July 13, 2016
The authors enrolled 149 patients on DAPT undergoing urgent cardiac surgery in a prospective study analyzing the association between platelet reactivity and postoperative bleeding. They found that decreasing platelet reactivity correlated with an increase in calculated red blood cell loss after surgery.
May 8, 2016
The entire issue is dedicated to thrombosis and makes a compulsory read for cardiovascular and thoracic hospitalists. Of patricular relevance to the thoracic surgeon are the translational articles on system analysis (page 1348) and the table on oral anticoagulants on page 1410.
May 8, 2016
A collaborative multi-funded RCT by Chinese surgeons and European epidemiologists, this article is guaranteed to elicit thunderous responses from biomedical publishing and the pharmaceutical industry.
March 27, 2016
Norepinephrine is often used to maintain the mean pressure during open heart surgery but it is said that it could constrict cerebral arteries, reducing cerebral blood flow. Is it true? The authors explored the association of Norepi doses and rSO2 measured using near-infrared spectroscopy.
February 2, 2016
This randomized trial (NEAT-HFpEF) of 110 subjects (59 placebos) disproves, by clinical and biological markers, the utility of nitrates for exercise tolerance. This is a subset of cardiac failure patients we are likely to encounter in general cardiothoracic surgical practice.