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Lawrenceville, NJ (Dr Simone) – Everyone has a central clock in the brain, and each organ and cell type have their own internal clocks. There is a rhythmic expression of clock genes in the heart that modify ischemia-reperfusion injury (heart attack and heart damage). Heart attacks that occur in the morning are usually worse in outcome than those that occur in the afternoon or evening. On-pump cardiac surgery causes heart ischemia-reperfusion injury. 


Montaigne and colleagues in a single center, randomized and propensity-matched cohort study found that 298 patients who had aortic valve replacement surgery in the afternoon did much better than 298 patients who had surgery in the morning. 


Morning surgery produced a significant increase in early major cardiovascular events after surgery (mainly peri-operative heart attack infarction) associated with a lower left ventricular ejection fraction at discharge and a higher incidence of acute heart failure within the first 500 days post-surgery compared with the 298 patients operated in the afternoon (hazard ratio 0·50 [95% CI 0·32–0·77]; p=0·0021) (Montaigne D, et al. The Lancet. 2018. 391:59-69). And these researchers showed in mouse studies that cardiac damage can be reduced by genetic and pharmacological modulation of clock genes.


Should all heart surgeries be done in the afternoon?


(c) 2018 Charles B. Simone, M.MS., M.D.