[Incidence of surgical site infection after open heart surgery].

INTRODUCTION: Despite modem surgical techniques, preoperative preventive use of antibiotics and optimal treatment of operative site, surgical site infections (SSI) are significant medical problem in the countries worldwide. OBJECTIVE: The aim of this paper was to estimate the frequency of SSI after open heart surgery and to identify the most frequent causes of these infections. MATERIAL AND METHODS: A prospective cohort study was performed during the period from January 2008 to December 2009 at the Clinic of Cardiovascular Surgery of the Institute of Cardiovascular Diseases, Vojvodina. The surveillance was consistent throughout the study period. During hospitalization, patients were evaluated daily by the infection control nurse. Isolation, identification and sensitivity tests of causative agents to antimicrobial drugs, obtained from patients' material, were carried out by standard microbiological methods. The descriptive epidemio-logical method was used. The incidence rates of hospital infections were calculated. RESULTS: During the study period, among 23 patients, 24 SSIs were registered. The average incidence rate of patients with SSI was 0.98% and SSI rate was 1.02% (ranged from 0% to 3.7%). There was no difference in the incidence rates according to gender (p = 0.65).The mean age of patients with SSI was 64.7 years. Except one, all patients had the ASA score higher than 2. The patients with SSIs were hospitalized approximately 3.8 times longer than the patient without SSI (p = 0.03). The most common causes of SSI were: Staphylococcus aureus (30%), coagulasa-negative Staphylococcus spp, Acinetobacter spp (8%), Enterococcus spp and Klebsiella pneumoniae. CONCLUSION: Although the incidence rate of hospital infections is low, it is necessary to maintain continuous surveillance of surgical site infections and to implement the preventive measures.

Cardiac myxoma: clinical presentation, surgical treatment and outcome.

PURPOSE: To analyse the clinical characteristics and patterns of cardiac myxomas and to evaluate the clinical course and surgical treatment results. METHODS: In this retrospective study we evaluated the clinical presentation, diagnostic methods and surgical treatment outcome in all patients (n=17) with cardiac myxoma treated at the Institute of Cardiovascular Diseases of Vojvodina between the 1.1.2006-31.1.2009. RESULTS: Patients with cardiac myxoma constituted 0.52% of all patients having had heart operations for different reasons. The average patient age was 56.59 years and 12 (70.88%) patients were female and 5 (29.12%) male. Left atrial myxomas were by far more frequent (16 patients, 94.11%) than right atrial myxomas (1 patient, 5.88%). The average time of symptom presence was around 12 months while 4 patients (23.53%) were asymptomatic. The most common symptom was dyspnoea (53%) and fatigue (41%). Total extirpation of tumor mass was achieved in all cases. The tumor size ranged from 1.7x1 cm to 9.5x3.3 cm (average of 2x2.86) and histological examination confirmed the diagnosis of cardiac myxoma in every instance. The 30-day mortality after surgical extirpation of atrial myxomas was 0%. CONCLUSION: Cardiac myxoma may mimic a huge variety of other cardiac diseases. Echocardiography plays an important role in diagnosing this disease. Because of relatively low risk, surgical treatment is recommended for most patients with excellent postoperative prognosis.

Possibilities of predicting results after surgical correction of ischemic mitral regurgitation on the basis of the degree of left ventricular dysfunction.

Results of surgical treatment for ischemic mitral regurgitation were retrospectively analyzed in 209 patients. All patients underwent myocardial revascularisation as well as mitral valve surgery. Preoperative myocardial infarction was registered in 75% of cases. These patients had different degrees of left ventricular dysfunction. Postoperative 30-day mortality was 4.3% for the whole group but higher in patients with lower ejection fraction. Looking at preoperative values of ejection fraction (EF), long term follow-up of 75 months, there is a statistically significant differences in survival rate (p < 0.05), freedom from cardiac decompensation (p < 0.05), and other complications (p < 0.001), but only comparing two subgroups of patients, those with preoperatively ejection fraction lower and higher than 20%. Early postoperative, and especially long term results, are better in patients with higher ejection fraction. According to our experience, it is possible to predict the results after surgery for ischemic mitral regurgitation, depending on the degree of preoperative left ventricular dysfunction.

[Coronary occlusive disease and carotid stenosis]. / Maladie coronarienne occlusive et sténose des artères carotides.

In around 2.5% of patients with coronary artery diseases (CAOD), considerably occlusive changes in carotid arteries were also registered at the same time. In the period from March 1982 to February 15, 1993, at the University Clinic of Cardiovascular surgery in Novi Sad, a total of 5,701 patients underwent aortocoronary by-pass (ACBG). In 137 (2.4%) patients an additionally endarterectomy of carotid arteries (EAC) were also performed. Bad left ventricle function (EF < 30%) was registered in 30 pts (22%). Endarterectomy on one or more arteries had to be performed in 45% patients because diffuse and distal occlusive changes. Two stage operations were performed in 62 cases. Three stages operations (bilat. EAC) in 24 and simultaneous in 51. Operative mortality (30 days) was registered in 5 (3%) pts. Neurologic deficit (ND) happened in two (1.4%) pts, TIA in 3 pt (2.2%). Comparing our results in simultaneous and stage procedure, operative risk is higher in simultaneous operations, and only in case of unstable angina we prefer simultaneous operations.