Therapeutic Outcomes of Pectoralis Major Muscle Turnover Flap in Mediastinitis

BACKGROUND: This study aimed to evaluate the therapeutic results and safety of pectoralis major muscle turnover flaps in the treatment of mediastinitis after coronary artery bypass grafting (CABG) procedures. METHODS: Data regarding 33 patients with post-CABG deep sternal wound infections (DSWIs) who underwent pectoralis major muscle turnover flap procedures in the Emam Reza and Ghaem Hospitals of Mashhad, Iran were reviewed in this study. For each patient, age, sex, hospital stay duration, remission, recurrence, and associated morbidity and mortality were evaluated. RESULTS: Of the 2,447 CABG procedures that were carried out during the time period encompassed by our study, DSWIs occurred in 61 patients (2.5%). Of these 61 patients, 33 patients (nine females [27.3%] and 24 males [72.7%]) with an average age of 63+/-4.54 years underwent pectoralis major muscle turnover flap placement. Symptoms of infection mainly occurred within the first 10 days after surgery (mean, 10.24+/-13.62 days). The most common risk factor for DSWIs was obesity (n=16, 48.4%) followed by diabetes mellitus (n=13, 39.4%). Bilateral and unilateral pectoralis major muscle turnover flaps were performed in 20 patients (60.6%) and 13 patients (39.4%), respectively. Complete remission was achieved in 25 patients (75.7%), with no recurrence in the follow-up period. Four patients (12.1%) needed reoperation. The mean hospitalization time was 11.69+/-6.516 days. Four patients (12.1%) died during the course of the study: three due to the postoperative complication of respiratory failure and one due to pulmonary thromboembolism. CONCLUSION: Pectoralis major muscle turnover flaps are an optimal technique in the treatment of post-CABG mediastinitis. In addition to leading to favorable therapeutic results, this flap is associated with minimal morbidity and mortality, as well as a short hospitalization time.

Atrial fibrillation after off-pump versus on-pump coronary artery bypass graft surgery

Atrial fibrillation [AF] is the most common postoperative arrhythmic complication after coronary artery bypass graft surgery [CABG]. The aim of the present study was to compare AF prevalence after off-pump versus on-pump CABG. In this prospective study, performed between September 2008 and September 2009, 128 consecutive patients in our local cardiovascular surgery ward were allocated into two groups of off-pump [95 patients] and on-pump CABG [33 cases]. We compared preoperative risk factors such as left ventricular ejection fraction [LVEF]<%40, hypertension [HTN], and Cr>2mg/dl, site of grafting such as the left coronary descending artery [LAD], right coronary artery [RCA], and left circumflex artery [LCX] in the two groups of surgery techniques [on-pump versus off-pump CABG] with/without postoperative AF after 24 hours of surgery in the Intensive Care Unit, Statistical power of the study was 80%, and a P-value less than 0.05 was considered significant. The prevalence of AF was 15 [15.8%] in the off-pump group versus 7 [21.2%] in the on-pump group [p=0.67] 24 hours after CABG. In the on-pump group, there was no difference between age categories [p=0.11]. In the on-pump group, as opposed to the off-pump CABG group, there was no relationship between the surgery techniques with or without AF, LVEF <%40, and HTN. There was a significant relation with Cr more than 2 mg/dl in the on-pump CABG group [p=0.001] versus the off-pump CABG group [p=0.057]. There was no statistical relation between the type of vascular graft [LAD, RCA, and LCX] between the on-pump and off-pump CABG patients attributed to with or without AF. There was no reduction in the AF rate in the off and on-pump CABG versus off-pump CABG. It seems that there was another predictive factor for AF in the off and on-pump CABG groups, so further prospective trials with larger sample sizes are recommended