The first article, Changes in Mitral Regurgitation After Replacement of the Stenotic Aortic Valve (2008) stresses a relatively large patient study of those undergoing Aortic valve replacement and then possibly experiencing mitral regurgitation (MR), a common and sometimes concerning complication that as the study shows can occur without any known mitral defect. The study is significant in that it establishes the fact that MR is not as dangerous as once thought and can be resolved without further surgical intervention in many patients, where as in the past further surgical intervention was the most likely outcome. The study also indicated certain precursors or markers that allows the initial surgical screening of patients who would benefit from mitral surgery, prior to mitral failure and could therefore receive the procedure during the initial surgical intervention, rather than as a separate surgical event. It is clear that the common sense of this study is that one rather than two surgical events will elicit better patient outcomes.

The second article, Impact of Cardiac Intraoperative Precursor Events on Adverse Outcomes, demonstrates a desire to follow procedural accountability in patient outcomes. The intent of the article is to stress that not enough research has been done on process related events and the adverse outcomes to patients, though much emphasis has been given to patient related precursors to surgical outcomes. The collective assertion is that some intraoperative events are more dangerous than others and can significantly change morbidity outcomes to attempt to intervene effectively to avoid or reverse such events. This blind assessment of accountability issues regarding surgical procedure is essential to a better understanding of prevention, across the whole surgical staff as well as with regard to equipment and other aspects of care.

Finally the third research article, Surgical Management of Infective Endocarditis: Early Predictors of Short-Term Morbidity and Mortality demonstrates the need to...

Patients with endocarditis require surgical intervention 20% of the time and the collaborative team of researchers want to know the predictive quality of the endocarditis variations to more quickly intervene and potentially avoid morbidity of patients. "Preoperative ECG findings of left bundle branch block and reduced left ventricular function may allow for early risk stratification of this high risk population." Again the work stresses outcomes as the essential marker to success and/or failure in cardiac surgery but also stresses predictability for adverse effects of disease. All of which indicates to this reviewer that the work done by Agnihotri, and his colleagues is essential to understandings of surgical interventions and a high level of patient efficacy, which gives this researcher rest in the idea of sending even my dearest family member to this surgeon if it were needed.
Resources

Massachusetts General Hospital Thoracic Aortic Center Website. Retrieved August, 15, 2008

http://www.massgeneral.org/tac/about/

Arvind K. Agnihotri, M.D." Massachusetts General Hospital Thoracic Aortic Center Website Our Staff. Retrieved August, 15, 2008 http://www.massgeneral.org/tac/page.asp?id=agnihotri.

Jassal, D.S. MD, Neilan, T.G. MD, Pradhan, a.D. MD, Lynch, K.E. RN, Vlahakes, G. MD, Agnihotri, a.K. MD, Picard, M.H. MD (2006) Surgical Management of Infective Endocarditis: Early Predictors of Short-Term Morbidity and Mortality. Annals of Thoracic Surgery (82) 524-529.

Waisbren, E.C. BS, Stevens, LM, MD, SM, Edwin G. Avery, E.G. MD, Picard, M.H. MD, Vlahakes, G. J. MD, Agnihotri, a.K. MD (2008) Changes in Mitral Regurgitation After Replacement of the Stenotic Aortic Valve. Annals of Thoracic Surgery (86) 56-62.

Wong D.R., Torchiana D.F., Vander Salm T.J., Agnihotri a.K., Bohmer R.M., Ali I.S. (June 2007) Impact of Cardiac Intraoperative Precursor Events on Adverse Outcomes. Surgery. 141(6) 715-22.