POI is a common condition with no established definition, aetiology or treatment. According to current literature, minimally invasive surgery, protocol-driven recovery (including early feeding and opioid avoidance strategies) and measures to avoid major inflammatory events (such as anastomotic leak) offer the best chances of reducing POI.

Coronary arteriovenous fistulae (CAVF) are a major coronary anomaly, being present in 0.002% of the general population and was first described by Krause in 1865.1,2 The majority are congenital in origin, representing 0.4% of all cardiac malformations.3 These coronary artery anomalies involve one or more coronary arteries abnormally communicating with one of the cardiac chambers (coronary cameral fistulae) or the great vessels adjacent to the heart (coronary artery or arteriovenous fistulae). 4According to the classification by Ogden in 1970, CAVF belong to coronary arteries anomalies that also include anomalous pulmonary artery origins of the coronaries, anomalous aortic origins of the coronaries, congenital atresia of the left main coronary artery, coronary artery bridging, coronary aneurysms, and coronary stenosis. Coronary anomalies may be abnormalities of origin, distribution, or termination. CAVF are considered mainly to be termination abnormalities. 5,6Nomenclature is based upon a descriptive analysis of the vessel of origin and the chamber of termination. According to Sakakibara et al, there are two types of angiographic classification: Type A-proximal type, where the proximal coronary segment is dilated to the origin of the fistula and the distal end is normal; and Type B-distal type, where the coronary artery is dilated over its entire length terminating as a fistula mainly into the right side of the heart (end-artery type) and the proximal coronary segment can or might have regular branches.6 Each one of these groups can be presented with different clinical signs and symptoms.6,7 EpidemiologyThe incidence of coronary anomalies is 0.2 to 1.2% of the population. 6CAVF are present in 0.002% of the general population and comprise 48.7% of all congenital coronary anomalies.8,9 They are the most common of hemodynamically significant coronary lesions. 8-11Among all pediatric coronary vasculature anomalies, approximately half of them are CAVF. 12,13Keywords ► arteriovenous fistula ► cardiac surgery ► coronary artery ► fistula ► symptomatic ► cardiovascular disease ► cardiac catheterization AbstractCoronary arteriovenous fistulae are a coronary anomaly, presenting in 0.002% of the general population. Their etiology can be congenital or acquired. We present a review of recent literature related to their epidemiology, etiology, pathophysiology, clinical presentation, diagnostic approach, and therapeutic management.

BackgroundThere is currently conflicting evidence surrounding the effects of obesity on postoperative outcomes. Previous studies have found obesity to be associated with adverse events, but others have found no association. The aim of this study was to determine whether increasing body mass index (BMI) is an independent risk factor for development of major postoperative complications.MethodsThis was a multicentre prospective cohort study across the UK and Republic of Ireland. Consecutive patients undergoing elective or emergency gastrointestinal surgery over a 4‐month interval (October–December 2014) were eligible for inclusion. The primary outcome was the 30‐day major complication rate (Clavien–Dindo grade III–V). BMI was grouped according to the World Health Organization classification. Multilevel logistic regression models were used to adjust for patient, operative and hospital‐level effects, creating odds ratios (ORs) and 95 per cent confidence intervals (c.i.).ResultsOf 7965 patients, 2545 (32·0 per cent) were of normal weight, 2673 (33·6 per cent) were overweight and 2747 (34·5 per cent) were obese. Overall, 4925 (61·8 per cent) underwent elective and 3038 (38·1 per cent) emergency operations. The 30‐day major complication rate was 11·4 per cent (908 of 7965). In adjusted models, a significant interaction was found between BMI and diagnosis, with an association seen between BMI and major complications for patients with malignancy (overweight: OR 1·59, 95 per cent c.i. 1·12 to 2·29, P = 0·008; obese: OR 1·91, 1·31 to 2·83, P = 0·002; compared with normal weight) but not benign disease (overweight: OR 0·89, 0·71 to 1·12, P = 0·329; obese: OR 0·84, 0·66 to 1·06, P = 0·147).ConclusionOverweight and obese patients undergoing surgery for gastrointestinal malignancy are at increased risk of major postoperative complications compared with those of normal weight.

Postoperative deep sternal wound infection (DSWI) is a serious complication in cardiac surgery (1-5% of patients) with high mortality and morbidity rates. Vacuum-assisted closure (VAC) therapy has shown promising results in terms of wound healing process, postoperative hospital length of stay and lower in-hospital costs. The aim of our retrospective study is to report the outcome of patients with DSWI treated with VAC therapy and to assess the effect of contributory risk factors. Data of 52 patients who have been treated with VAC therapy in a single institution (study period: September 2003-March 2012) were collected electronically through PAtient Tracking System PATS and statistically analysed using SPSS version 20. Of the 52 patients (35 M: 17 F), 88·5% (n = 46) were solely treated with VAC therapy and 11·5% (n = 6) had additional plastic surgical intervention. Follow-up was complete (mean 33·8 months) with an overall mortality rate of 26·9% (n = 14) of whom 50% (n = 7) died in hospital. No death was related to VAC complications. Patient outcomes were affected by pre-operative, intra-operative and postoperative risk factors. Logistic EUROscore, postoperative hospital length of stay, advanced age, chronic obstructive pulmonary disease (COPD) and long-term corticosteroid treatment appear to be significant contributing factors in the long-term survival of patients treated with VAC therapy.