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Rev. bras. cir. cardiovasc ; 36(1): 120-124, Jan.-Feb. 2021. graf
Article in English | LILACS | ID: biblio-1155801


Abstract Minimally invasive aortic valve replacement has gained consent due to its good results in terms of minimized surgical trauma, faster rehabilitation, pain control and patient compliance. In our experience, we have tried to replicate the conventional and gold standard approach through a smaller incision. Sparing the right internal thoracic artery, avoiding rib fractures and performing total central cannulation is important to make this procedure minimally invasive from a biological point of view too. In addition, the total central cannulation is pivotal to simplify perfusion and drainage. Moreover, a complete step-by-step procedure optimization and-when possible-the use of sutureless prosthesis help to reduce the cross-clamping and perfusion times. After more than 1000 right anterior thoracotomy (RAT) aortic valve replacements, we have found tips and tricks to make our technique more effective.

Heart Valve Prosthesis , Heart Valve Prosthesis Implantation , Aortic Valve/surgery , Thoracotomy , Treatment Outcome , Sternotomy
Rev. bras. cir. cardiovasc ; 35(6): 1017-1019, Nov.-Dec. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1144003


Abstract Case Presentation: A case of a 49-year-old patient, male, victim of stab wound, developing belatedly cardiac tamponade and hemodynamic stability was reported. The patient underwent a pericardial window with drainage of pericardial effusion of blackened aspect; however, without visualization of the cardiac lesion, enlargement of the incision by median sternotomy was opted for. A hematoma was spotted at the left ventricle with epicardial lesion and a patch of pericardium was made with 3-0 polypropylene. The patient developed acute pulmonary edema and atrial fibrillation, which improved after the intensive care unit clinical management, with hospital discharge in the 7th postoperative day.

Humans , Male , Middle Aged , Pericardial Effusion/surgery , Pericardial Effusion/etiology , Pericardial Effusion/diagnostic imaging , Cardiac Tamponade/surgery , Cardiac Tamponade/etiology , Cardiac Tamponade/diagnostic imaging , Wounds, Penetrating , Wounds, Stab/surgery , Wounds, Stab/complications , Sternotomy
Rev. bras. cir. cardiovasc ; 35(6): 927-933, Nov.-Dec. 2020. tab
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1143998


Abstract Objective: To investigate the safety and cost-effectiveness of preoperative cannulation and conventional approach techniques. Methods: Sixty-one patients who underwent redo open cardiac procedures between September 2015 and November 2018 were divided into two groups - Group A (n: 30), patients who underwent conventional cannulation after sternotomy, and Group B (n: 31), those who underwent cannulation before sternotomy. Patients were evaluated retrospectively for general complication rates and total hospital costs. Results: Mortality occurred in four patients from Group A and in one patient from Group B. Four patients required extracorporeal membrane oxygenation (ECMO) in Group A, whereas two required ECMO in Group B. Duration of total operation, cardiopulmonary bypass, and cross-clamp times were longer in the conventional surgery group than in the pre-sternotomy cannulation group (420.29±188.84 vs. 314.77±187.38, P=0.036; 171.87±85.59 vs. 141.7±82.47, P=0.089; and 102.94±70.67 vs. 60.97±52.81, P=0.009; respectively). Total blood and blood product usage were higher in Group A than in Group B. Postoperative intensive care unit stay was 62.77±145.3 hours vs. 25.13±73.11 hours, ventilation time was 5.16±5.09 hours vs. 3.03±2.78 hours, duration of ward stay was 5.23±2.52 days vs. 5.57±2.16 days, and duration of hospital stay was 9.58±5.85 days vs. 9.8±5.31 days in conventional sternotomy and pre-sternotomy cannulation groups, respectively. Total hospital costs were calculated 35863.52±20803.99 Turkish Liras (TL) in Group A and 25744.74±16472.03 TL in Group B (P=0,042). Conclusion: Venous and arterial cannulations before sternotomy decreased myocardial injury and complication rates, blood and blood product usage, hospital stay, and, consequently, hospital costs in our modest cohort.

Humans , Male , Female , Child , Adult , Catheterization , Cardiac Surgical Procedures/adverse effects , Preoperative Care , Retrospective Studies , Treatment Outcome , Cost-Benefit Analysis , Sternotomy/adverse effects
Rev. cuba. cir ; 59(3): e975, jul.-set. 2020. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1144432


RESUMEN Introducción: Los teratomas se definen como tumores de tejidos extraños al órgano o sitio anatómico en el cual se originan. Los teratomas mediastinales no son frecuentes, representan alrededor del 5 por ciento al 10 por ciento de todos los tumores mediastinales. Objetivo: Describir los resultados del tratamiento quirúrgico de pacientes con diagnóstico de teratomas mediastinales. Métodos: Se estudiaron 12 pacientes tratados entre enero de 2001 y diciembre de 2018. Las variables evaluadas fueron sexo, edad, tipo histológico: maduro o inmaduro, vía de acceso quirúrgico, accidentes quirúrgicos y evolución postoperatoria. Resultados: Correspondieron 9 al sexo femenino y 3 al masculino. El promedio de edad fue de 33,3 años (17-60 años). Hubo predominio absoluto del tipo maduro (11). La esternotomía media fue el acceso más frecuente. La toracotomía se realizó cuando el tumor, voluminoso, ocupaba la mayor parte de un hemitórax. Los accidentes quirúrgicos fueron un desgarro pulmonar y una apertura del pericardio. De dos pacientes tratados mediante cirugía torácica videoasistida, uno fue convertido por sangrado venoso molesto. Al año de seguimiento todos estaban vivos, sin evidencias de recidiva. Conclusiones: Contrariamente a lo esperado, hay predominio del sexo femenino, mientras que la edad y el tipo histológico coinciden con la literatura. La esternotomía, aún hoy, es comúnmente aceptada, a pesar del auge de la cirugía torácica videoasistida. La resección total produce resultados excelentes para los teratomas benignos(AU)

ABSTRACT Introduction: Teratomas are defined as tumors of tissues foreign to the organ or anatomical site in which they originate. Mediastinal teratomas are rare, accounting for about 5-10 percent of all mediastinal tumors. Objective: To describe the outcomes of the surgical treatment of patients diagnosed with mediastinal teratomas. Methods: Twelve patients treated between January 2001 and December 2018 were studied. The variables evaluated were sex, age, histological type (mature or immature), surgical access route, surgical accidents, and postoperative evolution. Results: Nine patients corresponded to the female sex and three, to the male. The average age was 33.3 years (17-60 years). There was an absolute predominance of the mature type (11). Median sternotomy was the most frequent access. Thoracotomy was performed when the bulky tumor occupied most of a hemithorax. The surgical accidents were lung tear and opening of the pericardium. Of two patients treated by video-assisted thoracic surgery, one was converted for bothersome venous bleeding. At one year of follow-up, all were alive, with no evidence of recurrence. Conclusions: Contrary to expectations, there is predominance of the female sex, while age and histological type coincide with the literature. Sternotomy, even today, is commonly accepted, despite the rise of video-assisted thoracic surgery. Total resection produces excellent outcomes in benign teratomas(AU)

Humans , Male , Female , Adult , Teratoma/diagnosis , Thoracotomy/methods , Thoracic Surgery, Video-Assisted/methods , Sternotomy/methods , Retrospective Studies
Rev. bras. cir. cardiovasc ; 35(3): 285-290, May-June 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1137253


Abstract Objective: To compare the results of surgical repair via median sternotomy, right submammary thoracotomy, and right vertical infra-axillary thoracotomy for atrial septal defect (ASD). Methods: This is a retrospective analysis of the relative perioperative and postoperative data of 136 patients who underwent surgical repair for ASD with the abovementioned three different treatments in our hospital from June 2014 to December 2017. Results: The results of the surgeries were all satisfactory in the three groups. No statistically significant difference was found in operative time, duration of cardiopulmonary bypass, blood transfusion amount, postoperative mechanical ventilation time, duration of intensive care unit, length of hospital stay, and hospital costs. However, the median sternotomy group had the longest incision. Meanwhile, there was no significant difference in postoperative complications. Conclusion: All three types of surgical incisions can be safely and effectively used to repair ASD. The treatments via right submammary thoracotomy and right vertical infra-axillary thoracotomy have advantages over the treatment via median sternotomy in cosmetic results and should be the recommended options.

Humans , Male , Female , Child, Preschool , Sternotomy , Heart Septal Defects, Atrial/surgery , Thoracotomy , Retrospective Studies , Treatment Outcome
Rev. cuba. cir ; 59(1): e829, ene.-mar. 2020. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1126400


RESUMEN Introducción: Las neoplasias mediastinales son tumores poco frecuentes, pueden aparecer a cualquier edad, por lo general entre la tercera y quinta décadas y se descubren incidentalmente en una radiografía de tórax de rutina en pacientes asintomáticos. Objetivo: Caracterizar a los pacientes operados de tumores de mediastino según variables clínicas y quirúrgicas. Métodos: Se realizó un estudio observacional, descriptivo, de tipo serie de casos con una muestra de 37 pacientes ingresados y operados en el Servicio de Cirugía General del Hospital Provincial Docente "Saturnino Lora" de Santiago de Cuba, con diagnóstico de tumor mediastinal durante los años 2010 a 2017. Resultados: La esternotomía fue la vía de acceso más utilizada y se logró efectuar exéresis completa en 31 enfermos. Primaron las variedades histológicas malignas (54,1 por ciento); solo hubo cuatro complicaciones posoperatorias de relevancia y dos fallecidos. Conclusión: Predominaron los tumores malignos en los que se identificó una amplia gama de variedades histológicas, atribuibles a las características del órgano afectado. La selección de la vía de entrada al tórax, así como el procedimiento quirúrgico estuvo condicionados por el lugar y tamaño del tumor en el mediastino. Los resultados quirúrgicos fueron favorables, avalados por el bajo número de complicaciones y nivel de mortalidad en la serie(AU)

ABSTRACT Introduction: Mediastinal neoplasms are rare tumors that may appear at any age, generally between the third and fifth decades of life, and incidentally discovered by a routine chest radiograph performed on asymptomatic patients. Objective: To characterize the patients operated on for mediastinal tumors according to selected surgical and evolutionary variables. Methods: An observational, descriptive and case series study was carried out with a sample of 37 patients hospitalized and operated on in the general surgery service at Saturnino Lora Teaching Provincial Hospital in Santiago de Cuba, with a diagnosis of mediastinal tumor, and during the years 2010 to 2017. Results: Sternotomy was the most widely used access route and complete exeresis was achieved in 31 patients. Malignant histological varieties prevailed (54.1 percent). There were only four relevant postoperative complications and two deaths. Conclusion: Malignant tumors predominated with a wide range of histological varieties identified, attributable to the characteristics of the affected organ. Selection of the access route into the thorax and the surgical procedure were conditioned by location and size of the tumor in the mediastine. The surgical outcomes were favorable, supported by the low number of complications and the level of mortality in the series(AU)

Humans , Surgical Procedures, Operative/methods , Sternotomy/adverse effects , Mediastinoscopy/methods , Epidemiology, Descriptive , Observational Studies as Topic
Rev. bras. cir. cardiovasc ; 35(1): 50-57, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1092468


Abstract Introduction: Negative pressure wound therapy (NPWT) has significantly improved outcomes in individuals with superficial and deep sternal wound dehiscence (SWD). We report our experience with NPWT to evaluate factors influencing effectiveness, duration of treatment and postoperative hospital stay. Methods: We reviewed 92 patients with postoperative SWD following a median sternotomy. Patients were divided into 2 groups: those with a superficial SWD (Group 1; 72, 78%) and those with a deep SWD (Group 2; 20, 28%). Group 1 was further divided into 3 subgroups based on NPWT duration. Results: In both groups, none of the preoperative characteristics examined showed a significant association with longer NPWT duration. In Group 2, there was a trend for postoperative bleeding and neurological complications to be associated with longer treatment duration. In the entire series, staph infection resulted a weak predictor of NPWT duration. In each Group 1 subgroup and in Group 2, treatment days were compared with duration of hospitalization until discharge. Mean post-NPWT hospital stay was 6 days in subgroup 1, 12 days in subgroup 2 and 20 days in subgroup 3 (P<0.0001). At a median 3-year follow-up, there were 4 late deaths, none related to wound complications. No cases of SWD recurrence were observed. Conclusion: Our results confirm the effectiveness of NPWT in SWD management, while excessive treatment duration might have a negative impact on the length of hospital stay. Further studies are needed to define an optimal use of NPWT protocol.

Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Negative-Pressure Wound Therapy , Staphylococcus aureus , Surgical Wound Infection , Retrospective Studies , Treatment Outcome , Sternotomy
Article in Chinese | WPRIM | ID: wpr-880779


OBJECTIVE@#To compare the mid- and long-term outcomes of patients receiving mitral valve replacement through robotically assisted and conventional median sternotomy approach.@*METHODS@#The data of 47 patients who underwent da Vinci robotic mitral valve replacement in our hospital between January, 2007 and December, 2015 were collected retrospectively (robotic group). From a total of 286 patients undergoing mitral valve replacement through the median thoracotomy approach between March, 2002 and June, 2014, 47 patients were selected as the median sternotomy group for matching with the robotic group at a 1:1 ratio. The perioperative data and follow-up data of the patients were collected, and the quality of life (QOL) of the patients at 30 days and 6 months was evaluated using the Quality of Life Short Form Survey (SF-12). The time of returning to work postoperatively and the patients' satisfaction with the surgical incision were compared between the two groups.@*RESULTS@#All the patients in both groups completed mitral valve replacement successfully, and no death occurred during the operation. In the robotic group, only one patient experienced postoperative complication (pleural effusion); in median sternotomy group, one patient received a secondary thoracotomy for management of bleeding resulting from excessive postoperative drainage, and one patient died of septic shock after the operation. The volume of postoperative drainage, postoperative monitoring time, ventilation time, and postoperative hospital stay were significantly smaller or shorter in the robotic group than in the thoracotomy group (@*CONCLUSIONS@#Robotically assisted mitral valve replacement is safe and reliable. Compared with the median sternotomy approach, the robotic approach is less invasive and promotes faster postoperative recovery of the patients, who have better satisfaction with the quality of life and wound recovery.

COVID-19/drug therapy , Humans , Mitral Valve/surgery , Quality of Life , Retrospective Studies , Robotic Surgical Procedures , Sternotomy , Thoracotomy , Treatment Outcome
Rev. cuba. cir ; 58(2): e666, mar.-jun. 2019. graf
Article in Spanish | LILACS | ID: biblio-1093167


RESUMEN Se presenta una paciente de 54 años de edad con antecedentes de hipertensión arterial, que ingresa en el servicio de Medicina Interna por dolor torácico intenso, acompañado de falta de aire de moderada intensidad, decaimiento, tos y dificultad para tragar sobre todo los alimentos sólidos. Mediante estudios complementarios se diagnostica un tumor de mediastino anterior, lo que motiva su traslado al servicio de Cirugía General. En el acto quirúrgico se constata absceso del mediastino anterior, el cual se drena mediante esternotomía media, evoluciona favorablemente y es egresada 12 días después de la intervención quirúrgica(AU)

ABSTRACT We present a 54-year-old patient with a history of high blood pressure, admitted to the internal medicine service with severe chest pain, accompanied by a lack of air of moderate intensity, decay, cough and difficulty for swallowing, especially solid foods. Through complementary studies, an anterior mediastinal tumor is diagnosed, which motivates her transfer to the general surgery service. In the surgical act, abscess of the anterior mediastinum is verified and drained by means of median sternotomy. The patient evolves favorably and is discharged 12 days after the surgical intervention(AU)

Humans , Female , Middle Aged , Chest Pain/etiology , Sternotomy/methods , Mediastinal Neoplasms/surgery , Mediastinal Neoplasms/diagnostic imaging
Rev. méd. Chile ; 147(2): 243-246, Feb. 2019. graf
Article in Spanish | LILACS | ID: biblio-1004338


Embolic stroke secondary to cardiac tumors is uncommon. However, 25-30% of cardiac tumors may cause systemic emboli. We report a 29-year-old male consulting for a sudden episode of aphasia and right hemiparesis, compatible with infarct of the left middle cerebral artery territory. Transthoracic echocardiography reported an ovoid tumor of 8 × 7 × 7 mm in relation to the sub valvular apparatus of the mitral valve. After neurologic stabilization, surgical treatment was performed. Approached by median sternotomy and in cardiopulmonary bypass, the mitral valve was explored. A macroscopic tumor consistent with a papillary fibroelastoma curled in sub valvular chordae was found. It was deployed and resected from its base, while the anterior mitral leaflet was preserved intact. Histopathological examination confirmed the intraoperative macroscopic diagnosis. The patient recovered uneventfully postoperatively and was discharged on the fifth day after surgery. He currently is in functional capacity I without cardiovascular symptoms at five years follow-up.

Humans , Male , Adult , Infarction, Middle Cerebral Artery/etiology , Fibroma/complications , Heart Neoplasms/complications , Heart Valve Diseases/complications , Papillary Muscles , Echocardiography , Sternotomy , Fibroma/surgery , Fibroma/pathology , Fibroma/diagnostic imaging , Heart Neoplasms/surgery , Heart Neoplasms/pathology , Heart Neoplasms/diagnostic imaging , Heart Valve Diseases/surgery , Heart Valve Diseases/diagnostic imaging , Mitral Valve
Rev. gaúch. enferm ; 40: e20180200, 2019. tab, graf
Article in Portuguese | LILACS, BDENF | ID: biblio-1014143


Resumo OBJETIVO Verificar o perfil clínico-cirúrgico e os resultados de pacientes acompanhados em um ambulatório de ferida operatória após cirurgia cardíaca. MÉTODOS Coorte histórica com pacientes submetidos à cirurgia cardíaca e acompanhados por um ano em um ambulatório de feridas de um hospital especializado em cardiologia. Foram analisados os micro-organismos predominantes nas infecções, os produtos utilizados nos curativos, tempo de acompanhamento e o tipo de terapêutica instituída nos curativos. RESULTADOS Entre os 150 pacientes, predominaram sexagenários (61,7 ± 11,4 anos), hipertensos (75%), diabéticos (44,7%). Evidenciou-se 12 pacientes com mediastinite (8%) e 44 com infecção de sítio cirúrgico (29,3%). Utilizou-se para realização dos curativos os ácidos graxos (80%) e alginato de cálcio (19%). O tempo de acompanhamento foi de 35 ±71 dias. CONCLUSÃO Pacientes sexagenários, hipertensos, diabéticos e revascularizados constituíram a população acompanhada no ambulatório de feridas. As taxas de ISC e mediastinite encontradas foram aceitáveis e semelhantes às da literatura.

Resumen OBJETIVO Verificar el perfil clínico-quirúrgico y los resultados de pacientes acompañados en un ambulatorio de heridas operatorias después de cirugía cardiaca. MÉTODO Cohorte histórica con pacientes sometidos a la cirugía cardiaca y acompañados por un año en el ambulatorio de heridas de un hospital especializado en cardiología. Fueron analizados los microorganismos predominantes en las infecciones, los productos utilizados en las curaciones, el tiempo de seguimiento, o el tipo de tratamiento utilizado en las curaciones. RESULTADOS Entre los 150 pacientes predominaron el sexo masculino (58%), sexagenarios (61,7 ± 11,4 años), hipertensos (75%), diabéticos (44.7%). Se evidenciaron 12 pacientes con mediastinitis (8%) y 44 con infección en el sitio quirúrgico (29.3%). Se utilizó en las curaciones fueron los ácidos grasos (80%) y el alginato de calcio (19%). El tiempo medio de seguimiento fue de 35 ± 71 días. CONCLUSIÓN Los pacientes sexagenarios, hipertensos, diabéticos y revascularizados constituyeron la población acompañada en el ambulatorio de heridas. Las tasas de ISC y mediastinitis encontradas fueron aceptables y similares a las de la literatura.

Abstract OBJECTIVE Verifying the clinical-surgical profile and the results of patients monitored in an surgical wound ambulatory after a cardiac surgeries. METHODS This is a historical cohort research with patients submitted to cardiac surgery and monitored for a year in an outpatient surgical wound clinic from a hospital specialized in cardiology. The study analyzed the prevalent microorganisms in infections, the products used in the dressings, the time of follow-up, and the type of therapy established in the dressings. RESULTS Among the 150 patients, most were sexagenarians (61.7 ± 11.4 years), hypertensive patients (75%), and diabetic (44.7%). There were 12 patients with mediastinitis (8%) and 44 with surgical site infection (29.3%). Fatty acids (80%) and calcium alginate (19%) were used for wound healing. The mean follow-up time was 35 ± 71 days. CONCLUSION Sexagenary, hypertensive, diabetic and revascularized patients constituted the population monitored in the wounds outpatient clinic. The SSI and mediastinitis rates found were acceptable and similar to those in literature.

Humans , Male , Female , Aged , Surgical Wound Infection/microbiology , Surgical Wound Infection/therapy , Bandages , Cardiac Surgical Procedures/adverse effects , Saphenous Vein/surgery , Surgical Wound Infection/epidemiology , Wound Healing , Fatty Acids, Essential/therapeutic use , Cohort Studies , Follow-Up Studies , Diabetes Mellitus/epidemiology , Alginates/therapeutic use , Sternotomy/adverse effects , Ambulatory Care Facilities , Hypertension/epidemiology , Mediastinitis/epidemiology , Middle Aged
Article in English | WPRIM | ID: wpr-759972


Spinal surgery of the anterior aspect of the cervicothoracic junction is difficult and has technological challenges because of the kyphotic alignment of the upper thoracic spine. This approach requires knowledge of the cervicothoracic regional anatomy. Surgery in this region is rare because of its indications; despite this rarity, surgeons must be prepared to expose this region. In addition, surgery in this region demands extensive opening of the surgical field and results in severe postoperative pain. Therefore, a less invasive procedure must be considered. Six cases of cervicothoracic lesion operation have been reported. The patients were successfully treated using an anterior modified approach (J-type manubriotomy). Anterior reconstruction and instrumentation of the cervicothoracic junction offers a distinct advantage of a stable anterior implant bone construction while preserving the posterior osseo-ligamentous tension band. Moreover, the modified anterior approach (J-type manubriotomy) provides the same exposure of the cervicothoracic junction without a full median sternotomy and avoids injury to subclavian vessels during resection of the clavicle or sternoclavicular junction. Therefore, the anterior cervical approach combined with J-type manubriotomy allows extensive exposure of the cervicothoracic junction and causes less complications. We performed preoperative radiological evaluation to identify the cases in which J-type manubriotomy was necessary.

Anatomy, Regional , Clavicle , Humans , Pain, Postoperative , Spine , Sternotomy , Surgeons
Article in English | WPRIM | ID: wpr-786483


PURPOSE: FDG-PET/CT has the potential to play an important role in the diagnosis of sternal wound infections (SWI). The purpose of this study was to analyze the diagnostic accuracy of FDG-PET/CT for SWI in patients following sternotomy.METHODS: We performed a single-center, retrospective analysis of patients who had undergone median sternotomy and FDG-PET/CT imaging. The gold standard consisted of positive bacterial culture and/or the presence of purulent material at surgery. Qualitative patterns of sternal FDG uptake, SUV(max), and associated CT findings were determined, and an imaging scoring system was developed. The diagnostic performances were studied in both the recent (≤ 6 months between sternotomy and imaging) and remote surgery phase (> 6 months).RESULTS: A total of 40 subjects were identified with 11 confirmed SWI cases. Consensus interpretation was associated with a sensitivity of 91%and specificity of 97%. Combination of uptake patterns yielded an AUC of 0.96 while use of SUVmax yielded an AUC of 0.82.CONCLUSION: Results suggest that FDG-PET/CT may be useful for the diagnosis of SWI with optimal diagnostic accuracy achieved by identifying specific patterns of uptake. SUV(max) can be helpful in assessing subjects with remote surgery, but its use is limited in the context of recent surgery. Further studies are required to confirm these results.

Area Under Curve , Consensus , Diagnosis , Humans , Retrospective Studies , Sensitivity and Specificity , Sternotomy , Wound Infection , Wounds and Injuries
Article in English | WPRIM | ID: wpr-762851


Median sternotomy is the most popular approach in cardiac surgery. Post-sternotomy wound complications are rare, but the occurrence of a deep sternal wound infection (DSWI) is a catastrophic event associated with higher morbidity and mortality, longer hospital stays, and increased costs. A literature review was performed by searching PubMed from January 1996 to August 2017 according to the guidelines in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The following keywords were used in various combinations: DSWI, post-sternotomy complication, and sternal reconstruction. Thirty-nine papers were included in our qualitative analysis, in which each aspect of the DSWI-related care process was analyzed and compared to the actual standard of care. Plastic surgeons are often involved too late in such clinical scenarios, when previous empirical treatments have failed and a definitive reconstruction is needed. The aim of this comprehensive review was to create an up-to-date operative flowchart to prevent and properly treat sternal wound infection complications after median sternotomy.

Length of Stay , Mortality , Plastics , Reconstructive Surgical Procedures , Software Design , Standard of Care , Sternotomy , Sternum , Surgeons , Thoracic Surgery , Wound Infection , Wounds and Injuries
Article in English | WPRIM | ID: wpr-761871


A 55-year-old man was admitted to the trauma center after a car accident. Cardiac tamponade, traumatic aortic injury, and hemoperitoneum were diagnosed by ultrasonography. The trauma surgeon, cardiac surgeon, and interventional radiologist discussed the prioritization of interventions. Multi-detector computed tomography was carried out first to determine the severity and extent of the injuries, followed by exploratory sternotomy to repair a left auricle rupture. A damage control laparotomy was then performed to control mesenteric bleeding. Lastly, a descending thoracic aorta injury was treated by endovascular stenting. These procedures were performed in the hybrid-angio room. The patient was discharged on postoperative day 135, without complications.

Aorta , Aorta, Thoracic , Cardiac Tamponade , Heart , Hemoperitoneum , Hemorrhage , Humans , Laparotomy , Middle Aged , Resuscitation , Rupture , Shock , Stents , Sternotomy , Trauma Centers , Ultrasonography
Article in English | WPRIM | ID: wpr-761838


Right heart failure is a relatively common complication after left ventricular assist device (LVAD) implantation. Severe right heart failure can be managed by temporary right ventricular assist device (RVAD) implantation. However, trans-sternal RVAD insertion requires a subsequent third sternotomy for cannula removal. Herein, we present a case of RVAD insertion via a left anterior mini-thoracotomy after LVAD implantation in a patient with alcohol-induced cardiomyopathy.

Cardiomyopathies , Catheters , Heart Failure , Heart-Assist Devices , Humans , Sternotomy , Thoracotomy
Article in English | WPRIM | ID: wpr-764959


BACKGROUND: Propofol induced a decline in the left ventricular (LV) systolic performance in non-cardiac surgery. We tested the hypothesis that propofol decreased the LV contractile function by dose dependent manner in cardiac surgery patients. METHODS: Anesthesia was maintained with target-controlled infusions of propofol and remifentanil in cardiac surgery patients. With a fixed effect-site concentration (Ce) of remifentanil (20 ng/mL) after sternotomy, the Ce of propofol was adjusted to maintain a Bispectral index of 40–60 (Ce1). Mitral annular Doppler tissue image tracings and other echocardiographic variables, including end-diastolic and end-systolic volumes, stroke volume, and mitral inflow pulse wave Doppler profile at Ce1, were recorded using transesophageal echocardiography. Echocardiographic recordings were repeated after the Ce-values of propofol were doubled and tripled at 10-minute intervals (defined as Ce2 and Ce3, respectively). Serial changes in echocardiographic variables for each Ce of propofol were assessed using generalized linear mixed effect modeling. The pharmacodynamic relationship between the Ce of propofol and peak systolic mitral annular velocity (Sm) was analyzed by logistic regression using non-linear mixed effect modeling (NONMEM). RESULTS: Means of Ce1, Ce2, and Ce3 were 0.8, 1.6, and 2.4 μg/mL, respectively, and their means of Sm (95% confidence interval) were 9.7 (9.3–10.2), 8.7 (8.2–9.1), and 7.5 cm/sec (7.0–8.0), respectively (P < 0.01). Ce values of propofol and Sm showed a significant inter-correlation and predictability (intercept, 10.8; slope–1.0 in generalized mixed linear modeling; P < 0.01). Ce values producing 10% and 20% decline of Sm with 50%-probability were 1.4 and 2.1 μg/mL, respectively. CONCLUSION: Propofol reduces LV systolic long-axis performance in a dose-dependent manner. TRIAL REGISTRATION: Identifier: NCT01826149

Anesthesia , Echocardiography , Echocardiography, Transesophageal , Humans , Linear Models , Logistic Models , Propofol , Sternotomy , Stroke Volume , Thoracic Surgery