The current data strengthen the observation that preoperative smoking status is predictive of adverse outcomes of cardiac surgery in the elderly. Further study into the effect of preoperative smoking cessation in the elderly may inform cessation counselling and the timing of surgery.

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A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed whether prophylactic anti-arrhythmic drugs may prevent atrial fibrillation (AF) following lung resection. Altogether 457 papers were found using the reported search, of which 14 presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. We identified single randomized trials that have demonstrated a benefit for Diltiazem, Bupivacaine epidural and magnesium for prophylaxis against AF in patients undergoing non-cardiac thoracic surgery, with a number needed to treat of between 4 and 8 with these regimes.

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether pleurotomy during internal mammary artery (IMA) harvest increases post-operative pulmonary complications. Altogether, 154 papers were found using the reported search, of which 8 presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. We conclude that all patients undergoing cardiac surgery suffer a significant deterioration in pulmonary function and chest radiograph appearance post-operatively. Pleurotomy seems to compound this with increased rates of atelectasis and pleural effusions, although no impact on clinical outcome or length of hospital stay has been demonstrated.

A 29-year-old woman was transferred at 31 weeks gestation for management of infective endocarditis (IE). Echocardiography demonstrated vegetations on aortic valve and severe mitral regurgitation. Blood cultures were positive for Streptococcus sanguis. Due to impending hemodynamic collapse, a cesarean section was performed followed by aortic valve replacement and mitral valve repair with a patch of bovine pericardium. At 10-month review, both mother and baby are doing well.