The Year in Cardiovascular Surgery

Beta blockers for the prevention of atrial fibrillation after coronary artery bypass surgery: carvedilol versus metoprolol

Although all beta blockers appear to be effective in the prevention of postoperative atrial fibrillation (AF) following coronary artery bypass surgery (CABG), carvedilol was found to be much more effective than metoprolol in this respect as the current study clearly delineated. We believe that the ongoing COMPACT trial will answer the question of whether or not carvedilol is more superior than metoprolol to prevent postoperative AF in patients undergoing CABG.

Intraoperative Crossover: The Well-Kept Surgical Secret to Apparent Surgical Success

Cardiologists and patients contemplate the risk of proposed operations. Surgeons typically report outcomes on operations performed. Emergency intraoperative crossover from off- to on-pump coronary artery bypass grafting occurs uncommonly but has substantial rates of mortality and morbidity. Much of the reported perioperative benefit of off- compared with on-pump coronary artery bypass grafting is erased if data are presented by intention to treat and not by operation performed. Cardiologists and cardiac surgeons should share the responsibility for advising a patient to consent to a cardiac operation using honestly presented evidence of potential benefits and risks substantiated with information analyzed in patient-centric and not physician-centric ways.