Heart Surgery May Be Safer in Afternoon Than in Morning

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Having heart surgery later in the day may be safer than having it in the morning.

Researchers studied 596 patients, half of whom had undergone open-heart surgery for aortic valve replacement in the morning and half in the afternoon. They followed their recoveries for 17 months.

On almost every measure — heart attack during the operation, major adverse cardiac event, acute heart failure, cardiovascular death — afternoon surgery produced significantly fewer complications.

They followed this observational study with a randomized trial of 88 patients, 44 assigned to morning surgery, 44 to the afternoon. During 12 days of follow-up they found that levels of troponin, a measure of heart muscle damage, were significantly lower in the afternoon group. The study is in Lancet.

The genetic mechanisms that protect tissue under stress function differently in the morning and the afternoon — in all organs, not just the heart — and the authors believe that these circadian variations account for their findings.

Bart Staels, the senior author, a professor of pharmacology at the University of Lille, said that no one should avoid valve replacement surgery based on the time of day it will be performed, since the operation can be lifesaving.

But, he said, “We should identify patients at high risk for complications — those with diabetes or other metabolic risks, for example — and operate on those in the afternoon.”