Strategies preventing deep sternal wound infection in cardiac surgery review.

Deep sternal wound infection is a feared complication of cardiac surgery due to the negative impact on mortality, morbidity and long-term survival. Its incidence has remained more or less unchanged over the last three decades despite the significant increase in patients´ morbidity and complexity of cardiac surgery. The review summaries strategies to reduce the incidence of deep sternal wound reflecting general surgical site infection prevention and specificities of surgery performed through the median sternotomy. Furthermore, contemporary evidence-based recommendations for prevention of this complication are highlighted in the review. Key words: sternal infection - prevention - cardiac surgery.

[Penetrating Injuries of the Heart and Great Vessels - Fifteen Years of Experience of the Cardiac Surgery Service as a Part of the Major Trauma Centre]. / Penetrující poranení srdce a velkých cév ­ patnáctiletá zkusenost kardiochirurgického servisu v rámci primárního traumacentra.

PURPOSE OF THE STUDY Outcome analysis of penetrating cardiac and great vessels injury within the 15-year existence of the cardiac surgery service as a part of the major trauma centre of the University Hospital Olomouc MATERIAL AND METHODS Retrospective analysis of a group of a total of 16 patients who underwent a surgery for penetrating cardiac and great vessels injury since II/2002 to XI/2016. The dominant causes of penetrating trauma were stab injuries (15 patients, 94%), in one patient only (6%) it was a gunshot injury. The mean age of the patients included in the group was 42.9 ± 16.1 years, with men significantly prevailing (13 patients, 81%). A total of 7 injured persons (44%) were haemodynamically stable when admitted, 9 injured persons (56%) were unstable or in critical condition. The average transfer distance was 48.8 ± 34.5 km; the injured were admitted on average 115.9 ± 154.8 minutes after being injured. Preoperatively, all the injured suffered from pericardial effusion (>5 mm) confirmed by TTE (81%) or CTA (19%). In 4 patients (25%) pericardial drainage for cardiac tamponade was performed before surgery. RESULTS All the penetrating cardiac and great vessels injuries were repaired by cardiac surgeon, in one case only (6%) the extracorporeal circulation support was used. The injury of coronary arteries was in one case managed by CABG and in the other case by ligation of the peripheral part of the coronary artery. In 4 patients (25%) also a penetrating injury of other organs was simultaneously managed. The mean ICU stay reached 85.8 ± 91.9 hours, on average 5.6 ± 9.3 units of red blood cells were administered during the in-hospital stay which lasted on average 7.1 ± 2.4 days. In the group a nonsignificant increase of left ventricular ejection fraction (44.1 ± 4.7 vs. 49.3 ± 3.2, p = 0.882) was reported at discharge of the injured patients. One patient died on the 78 th day of hypoxic brain damage (6% three-month mortality). The long-term survival analysis showed 94% one-year and 88% five-year cumulative survival in the group. DISCUSSION The incidence of the penetrating cardiac and great vessels injury is directly dependent on the crime level in the respective countries and regions. A cardiac arrest, severe hemodynamic instability, unconsciousness, serious concomitant injury, gunshot injury, multiple or atrial injury represent independent predictors of death in these injuries. The total three-month mortality in penetrating cardiac and great vessels injury ranges from 18 to 42%, the presence of vital signs at the time of hospital admission is associated with 78-92% probability of survival. The surviving patients show excellent long-term results with the exception of those who suffered a severe damage to valve apparatus or with significantly depressed left ventricular function. CONCLUSIONS Our experience proves a high survival rate of patients with penetrating cardiac and great vessels injury. The centralisation of the care into the major trauma centre with a cardiac surgery background, a unified treatment algorithm, and a vital interdisciplinary cooperation are the key goal of successful management of these injuries. Key words:penetrating injury, cardiac injury, great vessel injury, outcome. Práce byla podporena programem institucionální podpor.

Greenhouse gas emissions from a Cu-contaminated soil remediated by in situ stabilization and phytomanaged by a mixed stand of poplar, willows, and false indigo-bush.

Phytomanagement of trace element-contaminated soils can reduce soil toxicity and restore soil ecological functions, including the soil gas exchange with the atmosphere. We studied the emission rate of the greenhouse gases (GHGs) CO2, CH4, and N2O; the potential CH4 oxidation; denitrification enzyme activity (DEA), and glucose mineralization of a Cu-contaminated soil amended with dolomitic limestone and compost, alone or in combination, after a 2-year phytomanagement with a mixed stand of Populus nigra, Salix viminalis, S. caprea, and Amorpha fruticosa. Soil microbial biomass and microbial community composition after analysis of the phospholipid fatty acids (PLFA) profile were determined. Phytomanagement significantly reduced Cu availability and soil toxicity, increased soil microbial biomass and glucose mineralization capacity, changed the composition of soil microbial communities, and increased the CO2 and N2O emission rates and DEA. Despite such increases, microbial communities were evolving toward less GHG emission per unit of microbial biomass than in untreated soils. Overall, the aided phytostabilization option would allow methanotrophic populations to establish in the remediated soils due to decreased soil toxicity and increased nutrient availability.

Complex gunshot injury to the heart as a consequence of suicide attempt in a schizophrenic patient.

INTRODUCTION: Self-inflicted gunshot injury to the heart is uncommon in Western Europe countries. However it is considered to have a high mortality through cardiac tamponade or exsanguination and concomitant chest or abdominal cavity injury. CASE PRESENTATION: We present a 39-year-old schizophrenic woman who attempted suicide with the aid of a 6.35mm caliber handgun, after self-discontinuing of antipsychotic treatment. Lower third of sternum, right heart atrium and ventricle and inferior caval vein were hit by the bullet which consequently got lodged in the right paravertebral muscle mass at the lower thoracic vertebral level. As she was hemodynamically unstable due to hemopericardium and a huge right hemothorax, she underwent emergent surgery. Heart and inferior vena caval injuries were repaired on extracorporeal circulation. The postoperative course was uneventful and she was transferred to a psychiatric facility on the 7th postoperative day. One year after the surgery she is well, compliant to antipsychotic medications and on periodic follow-up by psychiatrists. CONCLUSION: This case represents management of complex self-inflicted gunshot cardiac injury in a schizophrenic patient who discontinued antipsychotic medication. Liaison between themedical rescue service and high level trauma center essentially reduced injury-to-surgery time. Complex heart injury was successfully repaired on extracorporeal circulation.

[The role of surgical embolectomy and extracorporeal membrane oxygen therapy in the treatment of massive pulmonary embolism - a review]. / Role chirurgické embolektomie arteria pulmonalis a membránové mimotelní oxygenoterapie v lécbe masivní plicní embolie - prehled.

Acute massive pulmonary embolism remains potentially lethal with mortality varying between 2553%. In the thrombolytic era, surgical pulmonary embolectomy is deemed as a rescue approach for patients with absolute contraindication of thrombolysis or its failure. However, close interdisciplinary cooperation, meticulous choice of optimal reperfusion strategy, standardization of surgical approach, and mainly the inclusion of mechanical circulatory support into the treatment algorithm have led to a drop in in-hospital mortality below 10% in the last 10 years. Nevertheless, cardiac arrest and refractory cardiogenic shock still remain independent risk factors of death with mortality exceeding 70%. Extracorporeal membrane oxygen therapy provides rapid circulatory support, end-organ perfusion and oxygenation which are essential for right-sided obstruction haemodynamic. Subsequently, optimal reperfusion strategy can be chosen or patients may be transported for it. The review highlights the contemporary role of surgical pulmonary embolectomy and extracorporeal membrane oxygen therapy in the treatment algorithm for acute massive pulmonary embolism, summarising current perspectives on the indications and contraindications for these treatment strategies and their results.Key words: massive pulmonary embolism - surgical pulmonary embolectomy - extracorporeal membrane oxygen therapy.

Effect of UV-C on thylakoid arrangement, pigment content and nitrogenase activity in the cyanobacterium Microchaete sp.

The effect of UV-C radiation on thylakoid arrangement, chlorophyll-a and carotenoid content and nitrogenase activity of the cyanobacterium Microchaete sp. was studied. Chlorophyll-a and carotenoid content increased gradually up to 48 h of UV-C exposure but declined with longer exposures. Nitrogenase activity decreased moderately with 6 to 12 h exposure and decreased substantially afterwards. When cells exposed to UV-C for 12 to 24 h, grown under fluorescent light for 144 h, nitrogenase activity increased to levels greater than in the control cells. The exposure of UV-C treated cells to fluorescent light, however, did not result in recovery of pigment content. In Microchaete sp. cells treated with UV-C for 144 h, thylakoid membranes became dense, were aggregated into bundles, and were surrounded by spaces devoid of cytoplasm.

[Chest wall haemorrhage as a complication of anticoagulation treatment - a case study]. / Krvácení do hrudní steny jako komplikace antikoagulacní lécby - kazuistika.

Low-molecular-weight heparins (LMWH) are a class of medication used as an anticoagulant. They belong amongst the so called direct anticoagulants. The effect on the coagulation cascade is mediated through the inactivation of anti-factor Xa. They are used in prophylaxis of thrombosis because of their lack of fibrinolytic effect. If the dosage is adequate, the effect on the bleeding time is minimal and thus monitoring is not necessary unlike in case of direct anticoagulants. Nevertheless, the monitoring is advisable in patients with renal insufficiency in whom the renal elimination of LMWH and their metabolites is reduced, hence they can cumulate in the organism and increase the risk of various bleeding complications. We present a case study of an 83-year-old patient with a massive subcutaneous haematoma caused by the cumulation of LMWH and with the subsequent huge defect of the chest wall treated with negative wound pressure therapy (Vacuum Assisted Closure - V.A.C.).

Superiority of topical negative pressure over closed irrigation therapy of deep sternal wound infection in cardiac surgery.

AIM: We sought to compare clinical outcomes, in-hospital mortality and 1-year survival of two different treatment modalities of deep sternal wound infection, topical negative pressure and the closed irrigation therapy. METHODS: Retrospective analysis of 66 consecutive patients treated for deep sternal infection at our institution. A total of 28 patients (February 2002 through September 2004) underwent primarily closed irrigation therapy, and 34 patients (November 2004 through December 2007) had the application of topical negative pressure. Four patients (July 2004 through December 2004) who underwent a combination of both strategies were excluded from the study. Clinical and wound care outcomes were compared, focusing on therapeutic failure rate, in-hospital stay and the 1-year mortality of both treatment strategies. RESULTS: Topical negative pressure was associated with a significantly lower failure rate of the primary therapy (P<0.05), shortening of the intensive care unit stay (P<0.001), a particular decrease in the in-hospital stay (P<0.05) and the 1-year mortality (P<0.05) in comparison with closed irrigation therapy. Comparable overall length of the therapy, in-hospital stay and the risk of wire-related fistulas after chest reconstruction were found. CONCLUSION: Topical negative pressure is a superior method of treatment for deep sternal wound infection, which is based on lower therapeutic failure rate, significant decrease in-hospital stay, and the decrease of the 1-year mortality rate, compared with primarily applied closed irrigation.

The effect of a cardiopulmonary bypass system with biocompatible coating on fibrinogen levels determined by the TEG--functional fibrinogen method: preliminary results.

When cardiopulmonary bypass (CPB) is used, the blood comes into contact with foreign surfaces. To diminish this impact, various types of biocompatibly coated surfaces have been developed. The study assessed the effects of heparin-coated CPB systems on the level and function of fibrinogen as measured by thromboelastography (TEG), as compared with non-coated systems. No statistically significant differences between both groups were revealed by comparing paired data. In our study, heparin-coated CPB circuits had no significant effect on either fibrinogen level or its function.

Effect of pH on the denitrifying enzyme activity in pasture soils in relation to the intrinsic differences in denitrifier communities.

The effects of pH on denitrifying enzyme activity (DEA) and on the ratio of the denitrification products, N(2)O and N(2), were determined in three pasture soils differing in cattle impact. The linkage between intrinsic differences in the denitrifying communities and pH effects on relative N(2)O production was also assessed. Soil pH values were adjusted just before DEA determination to obtain soil slurries with a range of pH values. The intrinsic differences in the denitrifier communities were assessed by measuring the kinetic constants of NO(3)(-) and N(2)O reductions. DEA for all three soils was highest at pH 8.4, regardless of native soil pH. Because DEA has typically been measured at native soil pH, our results suggest that DEA might have been underestimated in many previous studies. Further, relative N(2)O production at different pH values did not differ among the soils, even though the denitrifier communities differed in their intrinsic capability to reduce NO(3)(-) all the way to N(2), suggesting that the ratio of denitrification products (N(2)O and N(2)) is pH-specific rather than soil-specific. This suggests that manipulations of soil pH will alter N(2)O fluxes from agricultural soils.

Biological dinitrogen fixation by selected soil cyanobacteria as affected by strain origin, morphotype, and light conditions.

The potential for N(2) fixation by heterocystous cyanobacteria isolated from soils of different geographical areas was determined as nitrogenase activity (NA) using the acetylene reduction assay. Morphology of cyanobacteria had the largest influence on NA determined under light conditions. NA was generally higher in species lacking thick slime sheaths. The highest value (1446 nmol/h C(2)H(4) per g fresh biomass) was found in the strain of branched cyanobacterium Hassalia (A Has1) from the polar region. A quadratic relationship between NA and biomass was detected in the Tolypothrix group under light conditions. The decline of NA in dark relative to light conditions ranged from 37 to 100 % and differed among strains from distinct geographical areas. Unlike the NA of temperate and tropical strains, whose decline in dark relative to light was 24 and 17 %, respectively, the NA of polar strains declined to 1 % in the dark. This difference was explained by adaptation to different light conditions in temperate, tropical, and polar habitats. NA was not related to the frequency of heterocysts in strains of the colony-forming cyanobacterium Nostoc. Colony morphology and life cycle are therefore more important for NA then heterocyst frequency. NA values probably reflect the environmental conditions where the cyanobacterium was isolated and the physiological and morphological state of the strain.

Laboratory testing of hereditary thrombophilia: previous data in the face of verification.

OBJECTIVE: Mutations in hemocoagulation factors genes are nowadays routinely examined parameters, important in hereditary trombophilia determination. We have complexly evaluated laboratory data from the 211 unselected patients with venous thrombosis, and compared with the former studies in the same Slovakian population. RESULTS: The Factor V Leiden mutation (FVL) was found in 43 of 211 patients (20.38%), with the mutant allele frequency=10.2%, while the prothrombine G20210A mutation was revealed in 11/205 individuals (5.37%), with the mutant PT 20210A allele frequency=2.68%. In both mutations, all carriers of mutant allele were heterozygotes. In 81 individuals was examined the PCAT-NR with the ProC Global assay. Of them, 24 was heterozygotes for FVL mutation with considerably lower PCAT-NR levels (median=0.67; range: 0.53-0.83) compared with homozygotes without FVL mutation (n=57; median=0.84; range: 0.54-1.67; p<0.001). The sensitivity of the assay was 0.88 (95% CI: 0.68-0.97) and the specifity =0.67 (95% CI: 0.53-0.79). CONCLUSIONS: Our examination revealed considerably lower frequency of the FVL mutation in the target population, by contrast to the neighbouring Caucasian populations. As for the PT 20210 mutation, the differences are milder. Even though the PCAT-NR was validly sensitive (sensitivity=0.88, 95% CI: 0.68-0.97) to the FVL mutation, only DNA-testing is the definitive assay for FVL-carriership (Ref. 19). Full Text (Free, PDF) www.bmj.sk.

Endoscopic versus minimally invasive vein harvesting. Impact on leg-related morbidity in coronary artery bypass surgery: one-year follow-up of a prospective trial.

AIM: We sought to compare the impact of endoscopic and minimally invasive great saphenous vein harvesting on leg-related patient morbidity after coronary artery bypass grafting. METHODS: From February 2004 to July 2006, 120 patients underwent minimally invasive vein harvesting, and 180 patients underwent endoscopic vein harvesting for coronary artery bypass grafting. Patients were evaluated prospectively for wound-healing disturbances, residual leg edema, pain intensity and saphenous neuropathy at seven days, three months and one year after surgery. RESULTS: Both harvesting techniques were associated with a low incidence of wound-healing disturbances; nevertheless, endoscopic vein harvesting was associated with a significantly lower incidence of residual edema (12% vs 28%, P<0.05 seven days postoperative; 6% vs 19%, P<0.001 three months postoperative), pain (9% vs 20%, P<0.05; 6% vs 10%, P<0.05) and saphenous neuropathy (6% vs 23%, P<0.001; 3% vs 14%, P<0.05) during follow-ups. Endoscopic vein harvesting was also associated with a significantly lower incidence of neurological disturbances at one-year follow-up (2% vs 8%, P<0.05). Mean harvesting time (43.9+/-10.2 vs 40.6+/-15.5 min, P=0.09), conversion rate (2% vs 3%, P=0.71) and injury per conduit (0.3+/-0.1 vs 0.3+/-0.2, P=0.91) were comparable for both groups. CONCLUSION: EVH is superior to MIVH in terms of reduction in pain intensity, residual leg edema and saphenous neuropathy at seven days and again at three months postoperative. A significantly lower incidence of neurological disturbances is still presented one year after surgery.

Sensitivity and specificity of HIV rapid tests used for research and voluntary counselling and testing.

BACKGROUND: HIV rapid tests (RT) are a quick and non-technically demanding means to perform HIV voluntary counselling and testing (VCT) but understanding their limitations is vital to delivering quality VCT. OBJECTIVE: To determine the sensitivity and specificity of HIV rapid tests used for research and voluntary counselling and testing at four sites in East Africa. DESIGN: Cross-sectional study. SETTING: Masaka District, Uganda; a sugar plantation in Kakira, Uganda; Coastal Villages in the Kilifi District of Kenya; and the Urban slum of Kangemi located West of Nairobi, Kenya. SUBJECTS: Six thousands two hundred and fifty five consenting volunteers were enrolled into the study, and 675 prevalent HIV infections were identified. RESULTS: The RT sensitivity tended to be high for all assays at all sites (97.63-100%) with the exception of the Uni-Gold assay (90.24% in Kangemi, 96.58% in Kilifi). Twenty four RT results were recorded as 'weak positives', 22 (92%) of which were negative by ELISA. There was a high rate of RT false positives in Uganda (positive predictive values ranging from 45.70% to 86.62%). CONCLUSIONS: The sensitivity and specificity of the RT varied significantly across sites. The rate of RT misclassification in Uganda suggests that a multiple test algorithm may be preferable to a single test as screener for HIV VCT.

[Vacuum-assisted closure as a treatment modality for surgical site infection in cardiac surgery]. / Podtlaková terapie (vacuum-assisted closure) v lébe ranných infekcních komplikací po kardiochirurgických výkonech.

BACKGROUND: The vacuum-asssited closure has represented an encouraging treatment modality in treatment of surgical site infection in cardiac surgery, providing superior results compared with conventional treatment strategies, particularly in the treatment of deep sternal wound infection. METHODS: From November 2004 to January 2007, 40 patients, undergoing VAC therapy (VAC system, KCI, Austria, Hartmann-Rico Inc., Czech Republic) for surgical site infection following cardiac surgery, were prospectively evaluated. Four patients (10%) were treated for extensive leg-wound infection, 10 (25%) were treated for superficial sternal wound infection and 26 (65%) for deep sternal wound infection. The median age was 69.9 +/- 9.7 years and the median BMI was 33.2 +/- 5.0 kg/m2. Twenty-three patients (57%) were women and diabetes was present in 22 patients (55%). The VAC was employed after the previous failure of the conventional treatment strategy in 7 patients (18%). RESULTS: Thirty-eight patients (95%) were successfully healed. Two patients (5%) died, both of deep sternal infetion consequences. The overall length of hospitalization was 36.4 +/- 22.6 days. The median number of dressing changes was 4.6 +/- 1.8. The median VAC treatment time until surgical closure was 9.7 +/- 3.9 days. The VAC therapy was solely used as a bridge to the definite wound closure. Four patients (10%) with a chronic fistula were re-admitted with the range of 1 to 12 months after the VAC therapy. CONCLUSION: The VAC therapy is a safe and reliable option in the treatment of surgical site infection in the field of cardiac surgery. The VAC therapy can be considered as an effective adjunct to convetional treatment modalities for the therapy of extensive and life-threatening wound infection following cardiac surgery, particurlarly in the group of high-risk patients.

Postoperative and midterm outcomes of minimally invasive and endoscopic great saphenous vein harvesting for coronary artery bypass grafting - a prospective analysis.

BACKGROUND: We sought to determine whether the postoperative and midterm outcomes of minimally invasive and endoscopic great saphenous vein harvesting are comparable. METHODS: From February 2004 to September 2006, 120 patients underwent minimally invasive vein harvesting, and subsequently 150 patients had endoscopic vein harvesting for CABG. Patients were evaluated prospectively for wound-healing disturbances, residual leg oedema, pain intensity and saphenous neuropathy on the 7th postoperative day and after 3 months. RESULTS: Both harvesting techniques were associated with a low incidence of wound-healing disturbances; nevertheless, minimally invasive vein harvesting was associated with a significantly higher incidence of residual oedema (28 % vs. 13 %; P < 0.05), (19 % vs. 6 %; P < 0.001), pain (20 % vs. 9 %; P < 0.05), (10 % vs. 6 %; P < 0.05), and saphenous neuropathy (23 % vs. 7 %; P < 0.001) (14 % vs. 3 %; P < 0.001) during follow-up on the 7th postoperative day as well as 3 months after surgery, respectively. Mean harvesting time (40.6 +/- 15.5 vs. 43.9 +/- 10.2 min; P = 0.09), conversion rate (3 % vs. 2 %; P = 0.71), and injury per conduit (0.3 +/- 0.2 vs. 0.3 +/- 0.1; P = 0.91) were comparable for both groups. CONCLUSIONS: Endoscopic vein harvesting seems to be superior to minimally invasive vein harvesting in terms of a significant reduction of residual leg oedema, pain intensity and particularly saphenous neuropathy in the postoperative and midterm follow-up.

Negative pressure therapy as a treatment modality for surgical site infection in cardiac surgery.

BACKGROUND: Negative pressure therapy (NPT), primarily introduced for the treatment of pressure ulcers or chronic debilitating wounds, has recently emerged as a novel treatment strategy in the field of cardiac surgery, providing superior results to the conventional therapeutic strategies. PATIENTS AND METHODS: From November 2004 to October 2005, 25 patients underwent NPT (negative pressure therapy). Four patients (16%) were treated for extensive leg-wound infections, 10 (40%) were treated for superficial sternal wound infections and 11 (44%) for deep sternal wound infections. The median age was 67.9 years (range 48 to 79) and the median BMI was 34.2 kg/m2 (range 28 to 41). Because of wound infection complications, 11 patients (44%) were re-admitted to the department. In 13 patients (52%), NPT was employed after the failure of the conventional treatment strategy. RESULTS: All 25 patients were successfully healed. In-hospital mortality was 0% and 30-day survival was 100%. The overall length of hospitalization reached 36.4 days (range 11 to 62). The median number of dressing changes was 4.9 (range 3 to 9). The median NPT treatment time until the surgical closure was 9.7 days (range 6 to 24 days). In 17 patients (68%), the excessive residual sternal defect required a local advancement flap transfer. One patient (4%) with a chronic wire-related fistula was re-admitted 6 months after NPT therapy. CONCLUSION: NPT therapy can be considered as an effective treatment strategy associated with a low risk of procedure failure and wound infection recurrence, particularly in the management of sternal wound infection after cardiac surgery.

[Endoscopic radial artery harvesting for coronary artery bypass grafting: first experience]. / Endoskopický odber arteria radialis pro revaskularizaci myokardu. Popis techniky a první zkusenost.

BACKGROUND: Radial artery is widely accepted for surgical myocardial revascularization due to reported better long-term patency than venous grafts. Endoscopic radial artery harvesting (ERAH) represents a modern method associated with reduction of post-harvesting complications in comparison with the traditional radial artery harvesting. METHODS: From October 2005 to March 2006, ERAH was performed in a group of 10 patients employing the Vasoview 6 system (Guidant, Europe S.A., Belgium). Patients were evaluated on 7th postoperative day for wound healing disturbances and neurological complications. RESULTS: The mean age was 62.7 +/- 11.3 years, male patients dominated (60%) and 5 patients (50%) suffered from diabetes. All 10 radial arteries were successfully harvested, no conduit was injured. No conversions were made from ERAH to traditional technique. The mean harvesting time was 44.9 +/- 8.2 min (range: 32-62) and the mean time of forearm ischemia was 56.7 +/- 9.3 min (range: 42-74). The mean length of the grafts was 20.3 +/- 2.2 cm. The small local haematoma was recorded in one patient (10%). Neither wound disturbances such as wound infection, wound dehiscence, skin necrosis, nor neurological complications were recorded in our group of patients. CONCLUSION: ERAH is a safe method associated with a significant reduction of particularly neurological complications associated with traditional radial artery harvest. Full-length radial artery conduits were obtained with improved cosmetic result and patient's satisfaction.

[Endoscopic saphenous vein harvesting for coronary artery bypass grafting]. / Endoskopický odber vena safena magna pro revaskularizaci myokardu.

BACKGROUND: Traditional great saphenous vein harvest for coronary artery bypass grafting is associated with a significant risk of impaired wound healing. Endoscopic saphenous vein harvesting (EVH) has been introduced in an effort to reduce the incidence of leg-wound complications, whereas the histological quality and long-term patency of harvested grafts are comparable with grafts harvested by means of traditional technique. METHODS: From July to December 2005, EVH was performed in a group of 60 patients employing the Vasoview 6 system (Guidant, Europe S.A., Belgium). Patients were evaluated on 7th postoperative day for wound healing disturbances, residual leg oedema and saphenous neuropathy. RESULTS: The mean age was 67.4 +/- 11.2 years, male patients dominated (68%). At least one independent risk factor of leg-wound disturbances such as obesity, diabetes, peripheral vascular disease and female gender, was presented in 39 patients (63%). The mean number of harvested venous grafts was 2.0 +/- 1.2 and the mean total vein harvesting time was 46.2 +/- 7.4. In one case (1.7%), EVH was converted to the traditional harvesting technique due to superficial course of the great saphenous vein. The presence of wound haematoma was noted in 31 patients (51%). No other wound disturbances such as wound infection, wound dehiscence, skin necrosis, lymphatic wound drainage, nor saphenous neuropathy were recorded in the group of patients. The leg oedema associated with EVH was presented in 7 patients (12%). CONCLUSIONS: EVH is a safe method associated with a significant reduction of leg-wound complications, residual leg oedema and saphenous neuropathy. EVH should become method of choice, particularly in the presence of independent risk factors of leg-wound disturbances. The quality and the harvesting time of harvested grafts were comparable to grafts harvested by means of the traditional harvesting technique.