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J Thorac Cardiovasc Surg 2004;127:622-624
© 2004 The American Association for Thoracic Surgery

Editorial

Preoperative calcium-channel blockade in cardiac surgery: the good, the bad, the issues

^a Departments of Surgery and Physiology, LSU Health Sciences Center, New Orleans, La, USA

Received for publication October 29, 2003; accepted for publication November 3, 2003.

^* Address for reprints: T. Bruce Ferguson, Jr, MD, LSU Cardiovascular Outcomes Research Group, 3535 Bienville St, Suite E-325, New Orleans, LA 70119, USA
tbruceferg732@pol.net

The first 20% of the full text of this article appears below.

See related articles on page 625 and 755.

 

For years, cardiothoracic surgeons have focused on care factors that affect outcomes. These efforts have directly resulted in documented declines in mortality and morbidity from major cardiac surgical interventions with time, despite an increase in severity of the risk profile of patients coming to surgical intervention.^1-3

Part of this focus has been to recognize pharmacologic agents that could affect outcomes, mostly in an adverse manner. At one time, preoperative aspirin, ß-blocker, and clopidogrel therapies were relative contraindications to surgical intervention. Now most patients undergoing coronary artery bypass grafting (CABG) are on aspirin therapy before the operation, there are compelling data documenting the benefits of preoperative ß-blocker therapy⁴ and perioperative aspirin therapy^5,6 in patients undergoing CABG, and many surgeons administer clopidogrel before off-pump CABG.

This reversal in our thinking about ß-blockers⁴ and to some extent aspirin⁶ therapy was inspired by large, multicenter observational studies rather than randomized clinical trials. These observational studies have provided scientific data to reevaluate previous practices in light of newer information. By using sufficiently large patient populations, controlling for such confounding factors as site and provider effects, and using statistical techniques such as propensity score analyses, important information has been obtained that has improved the quality of care. In the case of ß-blocker therapy, these findings challenged surgical providers to change not only their own practice but also the practice of their referring cardiologists.⁷

In this issue of the Journal, Wijeysundera and colleagues⁸ have done . . . [Full Text of this Article]

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