Complications in cardiac surgery: An analysis of factors contributing to sternal dehiscence in patients who underwent surgery between 2010 and 2014 and a comparison with the 1990-2009 cohort.

BACKGROUND: Sternal dehiscence is a serious postoperative complication of cardiac surgery observed in 0.2-5% of procedures performed by median sternotomy. OBJECTIVES: Assessment of factors, including the method of sternum closure, which may affect the incidence of this complication. MATERIAL AND METHODS: A total of 5,152 consecutive patients undergoing surgery with median sternotomy access in the Cardiac Surgery Department of the Pomeranian Medical University between 2010 and 2014 were included in the study. The analysis centered on cases of sternal dehiscence, which occurred in 45 patients (0.9%). RESULTS: Factors such as age (p < 0.05), body mass (p < 0.005) and coronary artery bypass surgery (CABG) (p < 0.005) were found to be significant risk factors. Diabetes and chronic obstructive pulmonary disease (COPD) also had an impact on an increased risk of sternal dehiscence (p < 0.006 and p < 0.015). However, the differences were only significant in the whole study group. Apart from CABG, the type of operation did not affect the incidence of dehiscence. Logistic regression analysis found independent risk factors for the development of sternal dehiscence: body mass index (BMI) (odds ratio (OR): 2.1; p < 0.019), diabetes (OR: 2.4; p < 0.004), COPD (OR: 2.7; p < 0.016), and redo procedure (OR: 3.0; p < 0.014). There were no significant differences in postoperative mortality between these groups - 6.7% in the group with sternal dehiscence and 3.9% in the group without dehiscence. CONCLUSIONS: Introducing a more durable sternum stabilization method with 8+ loops helped to improve conditions for bone union and reduced the risk of dehiscence. Therefore, we suggest that centers which still use 6-loop sternal closure should consider shifting to a stronger technique.

Analysis of the influence of respiratory disorders observed in preoperative spirometry on the dynamics of early inflammatory response in patients undergoing isolated coronary artery bypass grafting.

BACKGROUND: Preoperative spirometry provides measurable information about the occurrence of respiratory disorders. The aim of this study was to assess the association between preoperative spirometry abnormalities and the intensification of early inflammatory responses in patients following coronary artery bypass graft in extracorporeal circulation. MATERIAL AND METHODS: The study involved 810 patients (625 men and 185 women) aged 65.4±7.9 years who were awaiting isolated coronary artery bypass surgery. On the basis of spirometry performed on the day of admittance to the hospital, the patients were divided into three groups. Patients without respiratory problems constituted 78.8% of the entire group. Restricted breathing was revealed by spirometry in 14.9% and obstructive breathing in 6.3% of patients. RESULTS: Inter-group analysis showed statistically significant differences in C-reactive protein (CRP) between patients with restrictive spirometry abnormalities and patients without any pulmonary dysfunction. CRP concentrations differed before surgery (P=0.006) and on the second (P<0.001), fourth (P=0.005) and sixth days after surgery (P=0.029). There was a negative correlation between CRP levels and FEV1. CONCLUSION: In our study, the most common pulmonary disorders in the coronary artery bypass graft patients were restrictive. Patients with abnormal spirometry results from restrictive respiratory disorders have an elevated level of generalized inflammatory response both before and after the isolated coronary artery bypass surgery. Therefore, this group of patients should be given special postoperative monitoring and, in particular, intensive respiratory rehabilitation immediately after reconstitution.

The Use of Vacuum-Assisted Closure in Purulent Complications and Difficult-To-Heal Wounds in Cardiac Surgery.

BACKGROUND: Sternal wound infections are a serious and potentially fatal complication of cardiac surgery. OBJECTIVES: The aim of the study was to analyze the results of using the vacuum-assisted closure (VAC) system over a 4-year period. MATERIAL AND METHODS: Quantitative VAC performance data from a retrospective review of a consecutive cohort of 47 patients treated with VAC for post-cardiac surgery wound complications were collected and statistically analyzed. In the study group 35 patients developed infections of the post-operative chest wound. In 12 other patients wound dehiscence was observed, but repeated cultures did not reveal the presence of any bacteria. RESULTS: The statistical analysis identified the following as significant risk factors: age, female sex, being overweight, a high total logistic EuroScore, the use of both internal thoracic arteries for bypass grafting, and diabetes. In the wound negative culture group the total length of hospital stay was significantly shorter than in the wound positive culture group. Mortality in this group was 0.0% vs. 5.7% in the wound positive culture group. In the study material, Gram-negative bacteria were responsible for 77% of the post-operative wound infections, with only 14% Gram-positive wound cultures. No complications were related to VAC use. CONCLUSIONS: The use of negative-pressure wound therapy with other concomitant surgical procedures is a good method of treating infected wounds as well as non-contaminated dehiscence of the wound and sternum. Considering that most of the infections within the authors' department are caused by Gram-negative bacteria, it would be beneficial to consider modifying the model of preventive antibiotic treatment to cover the Gram-negative spectrum in addition to the Gram-positive bacteria currently targeted.

Response of malignant breast tumours to neoadjuvant chemotherapy evaluated with Tc-99m MIBI.

INTRODUCTION: The aim of this study was to assess the efficacy of Tc-99m sestamibi scintimammography in the prediction and evaluation of tumour response to neoadjuvant chemotherapy in patients with locally advanced breast cancer. MATERIALS AND METHODS: The subjects consisted of 14 female patients with unilateral locally advanced breast cancer eligible for anthracycline-based neoadjuvant chemotherapy followed by surgery. The patients underwent mastectomies with pathologic evaluation of the residual tumour size. The early and delayed static imaging were undertaken in all subjects at 10 and 120 minutes after intravenous injection with 720-1080 MBq of Tc-99m MIBI. Patients lay prone on the scintimammographic pad (provided by the IAEA). The acquisition included three positions: both lateral prone and anterior supine. Early, delayed tumour to background ratios (TBR) and washout rate (WOR) were calculated. Three sets of scintimammography images were obtained: baseline study (BL), the first follow-up study (FF) after two cycles of chemotherapy and the second follow-up (SF) scan on completion of chemotherapy and prior to surgery. Clinical response was evaluated following WHO criteria and classified as complete response (CR), partial response (PR), stable disease (StD) and progressive disease (PD). All patients underwent BS, seven of them FF and eight completed the study with SF. RESULTS: The only statistically significant differences in Student's t-test for matched pairs were found between mean values of TBR10 and TBR120 in BL and FF study however in the SF study it was not significant. Other differences between the mean values of TBR10, TBR120 and WOR in BL/FF, BL/SF and FF/SF studies were not statistically significant. CONCLUSION: The results obtained are encouraging, but further investigations are needed.

[Use of minimally invasive direct coronary bypass (MIDCAB) in reoperative coronary surgery]. / Wykorzystanie technik maloinwazyjnych (MIDCAB) podczas powtórnych operacji tetnic wiencowych.

The authors presented the method and early results of minimally invasive direct coronary arteries reoperation in 5 patients, approximately 7, 5 years after the first CABG operation. In all patients venous grafts were occluded. there was a different approach used in every patient: small left or right anterior thoracotomy through IV or V intercostal space, laparotomy with partial low sternotomy or simultaneous combined approach through thoracotomy and sternotomy/laparotomy. The following arteries were grafted: left anterior descending, right posterior descending, LAD with right coronary artery and LAD with marginal branch. All patients were extubated in the operating room. There were no serious perioperative complications observed. Patients were transferred to cardiology department on the 5th-7th postoperative day.