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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jtcvs.2009.10.064 Byline: Andrew W. ElBardissi, Daniel J. DiBardino, Frederick Y. Chen, Michael H. Yamashita, Lawrence H. Cohn Abbreviations: ASA, acetylsalicylic acid; BPAV, bioprosthetic aortic valve; CVA, cerebrovascular accident; NYHA, New York Heart Association; PPM, prosthesis-patient mismatch; TE, thromboembolism; TIA, transient ischemic attack; VKA, vitamin K antagonist Abstract: Current American Heart Association/American College of Cardiology guidelines recommend anticoagulation and antiplatelet therapy during the first 90 postoperative days; however, there is wide variability in the administration of antithrombotic therapy after bioprosthetic aortic valve replacement. We sought to determine whether early antithrombotic therapy was necessary in patients undergoing isolated bioprosthetic aortic valve implantation and who were discharged in normal sinus rhythm. Author Affiliation: Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass Article History: Received 25 June 2009; Revised 7 September 2009; Accepted 1 October 2009 Article Note: (footnote) Disclosures: None.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jtcvs.2009.08.058 Byline: Daniel J. DiBardino, Andrew W. ElBardissi, R. Scott McClure, Ozwaldo A. Razo-Vasquez, Nicole E. Kelly, Lawrence H. Cohn Abbreviations: AVR, aortic valve replacement; CABG, coronary artery bypass graft; CPB, cardiopulmonary bypass; ETE, edge-to-edge; FMR, functional mitral regurgitation; IQR, interquartile range; MV, mitral valve; MVP, mitral valvuloplasty; SAM, systolic anterior motion Abstract: To determine the long-term outcomes of mitral valvuloplasty for myxomatous valve disease, rheumatic valve disease, and functional mitral regurgitation. Author Affiliation: Brigham and Women's Hospital, Harvard Medical School, Boston, Mass Article History: Received 11 May 2009; Revised 21 July 2009; Accepted 7 August 2009

Embolic events have long been thought to occur in patients with cardiac tumors secondary to embolization of tumor fragments; however, there are no large studies examining the epidemiology and occurrence of embolism in this group of patients.

Surgical flow disruptions can significantly increase the probability of surgical errors. However, little is known about the frequency and nature of surgical flow disruptions, making the development of evidence-based interventions extremely difficult. The goal of this project was to prospectively study surgical errors and their relationship to surgical flow disruptions within the context of cardiac surgery. A trained observer recorded surgical errors and flow disruptions during 31 cardiac operations over a three-week period. Flow disruptions were then reviewed and analyzed by an interdisciplinary team of surgical and human factors experts. Results revealed that flow disruptions consisted of teamwork/communication failures, equipment and technology problems, extraneous interruptions, training-related distractions, and resource accessibility issues. Errors increased significantly with increases in flow disruptions. Teamwork/communication failures were the strongest predictor of surgical errors. These findings provide preliminary data for developing evidenced-based error management and patient safety programs within cardiac surgery.

After technical errors, the most common cause of avoidable adverse events during inpatient surgical care is communication-related breakdowns. Lapses in communication have been associated with delays in care and increased patient morbidity. A previous study conducted at 4 academic medical centers examined surgical resident and attending surgeon communication practices and identified errors in communication for more than 30% of identified critical events. The data in that study also showed that residents and attending surgeons had not discussed the plan of care for 15% of randomly selected patients and that more than 20% of weekend patients had not been seen for more than 48 hours by an attending surgeon.

Errors with serious consequences continue to occur at a high rate in many surgical specialties. In this study, the Human Factors Analysis and Classification System (Wiegmann & Shappell, 2003) was used to develop a structured interviewing tool for prospectively assessing the systemic factors that may predispose operating room (OR) personnel to making errors. Approximately 50% (n = 68) of all staff involved in patient care within the cardiac surgery OR at our institution participated, with an equal proportion represented across staff specialties (Surgeons, Anesthesiologists, Nurses, Perfusionists and Technicians). Results identified a variety of potential error-producing factors present in the OR setting. While such factors were viewed by OR staff as occurring infrequently, significant relationships between the estimated frequency of systemic problems and specific error forms were identified. These findings can inform both the development of theoretical models of surgical error, as well as the practice of developing targeted intervention programs.