Versatility of hemisternotomy for cardiac surgery.

BACKGROUND: Hemisternotomy has been suggested as a way to reduce morbidity by limiting the invasiveness of surgical interventions but it is often limited to aortic valve disease. This study reviews the experience of one center employing hemisternotomy and compares patient outcomes, both in-hospital and post-discharge, with a matched group of full sternotomy patients. METHODS: Propensity scores were used to match all hemisternotomy valve cases (Hemi) to full sternotomy valve cases (Full) (1:2). An in-hospital composite outcome (COMP) was defined as mortality, stroke, deep sternal wound infection, sepsis, or return to operating room (OR) for bleeding or valve dysfunction. Provincial administrative health databases were used to determine freedom from mortality and hospital readmission for cardiac cause. RESULTS: During the study period, 70 patients received hemisternotomy for various cardiac surgical interventions with only 38 patients undergoing isolated aortic valve replacement. Examining valve surgery exclusively, 65 Hemi were matched to 130 Full. In-hospital complications were low in both groups, with 1.0% mortality and a non-significant trend toward COMP in the Full group (Hemi=4.6%; Full=8.5%; p=0.39). Ventilation time was significantly decreased in Hemi (median four vs. six hours; p=0.002). At two years follow-up, survival was excellent for both (Hemi=95.0%; Full=93.6%) and freedom from cardiac morbidity (Hemi=76.8%, Full=73.2%) was comparable. CONCLUSION: Hemisternotomy appears to be a safe, effective, and versatile alternative for many cardiac surgical interventions. With a median follow-up of four years, this study represents the longest cardiac morbidity follow-up for hemisternotomy patients. However, we were unable to conclusively show a morbidity benefit with this incision.

Preferred bonding motif for indium aminoethanethiolate complexes: structural characterization of (Me2NCH2CH2S)2InX/SR (X = Cl, I; R = 4-MeC6H4, 4-MeOC6H4).

The metathesis reaction of InCl3 with Me2NCH2CH2SNa or the redox reaction of indium metal with elemental iodine and the disulfide (Me2NCH2CH2S)2 yield the indium bis(thiolate) complexes (Me2NCH2CH2S)2InX [X = Cl (3) and I (4)], respectively. Compounds 3 and 4 may be further reacted with the appropriate sodium thiolate salts to afford the heteroleptic tris(thiolate) complexes (Me2NCH2CH2S)2InSR [R = 4-MeC6H4 (5), 4-MeOC6H4 (6), and Pr (7)]. Reaction of 2,6-Me2C6H3SNa with 4 affords (Me2NCH2CH2S)2InS(2,6-Me2C6H3) (8), while no reaction is observed with 3, suggesting a greater reactivity for 4. All isolated compounds were characterized by elemental analysis, melting point, and Fourier transform IR and 1H and 13C{1H} NMR spectroscopies. X-ray crystallographic analyses of 3-6 show a bicyclic arrangement and a distorted trigonal-bipyramidal geometry for In in all cases. The two sulfur and one halogen (3 and 4) or three sulfur (5 and 6) atoms occupy equatorial positions, while the nitrogen atoms of the chelating (dimethylamino)ethanethiolate ligands occupy the axial positions. The metric parameters of the (Me2NCH2CH2S)2In framework were found to change minimally upon variation of the X/SR ligand, while the solubility of the corresponding compounds in organic solvents varied greatly. 1H NMR studies in D2O showed that 6 and 7 react slowly with an excess of the tripeptide l-glutathione and that the rate of reaction is affected by the pendant thiolate ligand -SR.