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Heart Surgery Complications Significantly Lower If Procedures Are Conducted In The Afternoon

A new study has shown that patients undergoing open heart surgery suffer less complications, on average, if the procedure is conducted in the afternoon, as opposed to morning surgeries.

Conductors of the study have revealed that events including heart attacks and heart failure were less common during a valve replacement operation in the afternoon. The study was published in the Lancet journal and authored by Professor David Montaigne from the University of Lille in France.

There is an explanation to these results and it confirms strong influence of the cells’ biological or “circadian” clock on the integrity of our bodies. The heart, in particular, reacts differently to the effects of being starved of blood supply during surgery, in different times of the day.

This study will definitely help reduce risk from these operations in the future, but one has to wonder what will happen when people find out and no suddenly no one wants a procedure in the morning? How would this affect crowding and organizing these delicate procedures.

The finding appears to be linked to the ability of the heart tissue to recover after being starved of blood supply during surgery – an effect the researchers say is influenced by the cells’ biological or “circadian” clock.

While the study suggests patients might fare better if they undergo afternoon surgery,  said it also highlighted another approach to reduce complications.

“We have to find a drug that can alter the circadian clock to induce a jet lag,” he said, noting that it could also help to improve patient outcomes for heart attacks and organ transplantation.

Montaigne et al. report how they looked at the outcomes of 596 patients, half of whom had valve surgery in the morning, and half in the afternoon. The results reveal that afternoon surgery patients had lower levels of the protein after their operation, suggesting about 20% less damage to the heart than those who underwent morning surgery.

The team went a step further, and took biopsies from 14 morning surgery patients and 16 afternoon surgery patients, finding that tissue from the latter recovered better after being deprived of oxygen.

Further analysis found 287 genes within the cells that showed different levels of activity depending on whether the cells were from morning or afternoon patients – genes which have, in many cases, previously been linked to the circadian clock.

Dr John O’Neill, an expert in circadian rhythms from the MRC Laboratory of Molecular Biology, said the research backed up previous work in mice and fruitflies that had explored the genes involved in the body clock – work which scooped a trio of scientists the Nobel prize for medicine earlier this month.

“The biological clock, the circadian rhythm, is in every single cell of the body, therefore it affects the biological activity of each cell type, commensurate with the function of those cells,” he said, adding that in healthy humans the heart is known to follow a daily pattern of activity and is not at its optimum performance in the morning.

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