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 (Adv Clin Exp Med 2015, 24, 4, 643-650).

IntroductionAbout 30% of patients undergoing cardiac surgery are diabetic, and glycated hemoglobin (HbA1c) is a reliable marker for long-term glucose control. The aim of our study was to examine whether tight glucose control before a cardiac operation results in a better outcome of the surgical treatment.Material and methodsWe performed a retrospective record review of 350 diabetic patients undergoing cardiac surgery in our institution. Preoperative glycemia control was assessed by measurement of the glycated hemoglobin level. The patient population was divided into three groups: group I – patients with HbA1c below 7% (n = 195); group II – patients with HbA1c between 7% and 8% (n = 88); and group III – patients with HbA1c above 8% (n = 67).ResultsThe demographic data and operating risk in all groups of patients were similar. There were 2 deaths (1.02%) in group I, 2 deaths (2.27%, p = 0.78) in group II and 3 deaths (4.47%, p = 0.20) in group III. Cardiac accidents occurred in 9 patients (4.60%) from group I, 7 patients (7.95%, p = 0.20) from group II, and in 6 patients (9.05%, p = 0.40) from group III. Cerebrovascular accidents (CVA) occurred in 7 (3.58%), 5 (5.68%, p = 0.67) and 5 (7.46%, p = 0.61) patients, respectively. Acute renal dysfunction requiring renal replacement therapy occurred in 4 patients from group I (2.05%), 3 patients from group II (3.40%, p = 0.78) and 4 patients from group III (5.97%, p = 0.23).ConclusionsA large percentage of diabetic patients referred for cardiac operations have poorly controlled glycemia. Optimal preoperative glycemia control results in lower postoperative mortality and morbidity. In addition, the preoperative HbA1c level is a good indicator of the risk of postoperative complications in diabetic patients undergoing cardiac operations.

Background: Elderly patients and those with multiple concomitant disorders are nowadays qualified for cardiac surgery procedures, which is related to higher incidence of the postoperative complications. Aim: The aim of this study was a retrospective analysis of the perioperative factors potentially contributing to occurrence of cardiac incidents after cardiac surgery procedures. Methods: Data of 552 patients of the cardiac surgery clinic were collected and analyzed. Data concerning medical history, previous treatment, laboratory results, additional tests results, operation and hospitalization period were examined. Results: In the study population of 552 patients, cardiac complications were observed in 49.5% of them. Among cardiac complications, the most frequent were supraventricular tachycardia (30.1%) and atrial fibrillation (27.4%). Postoperative bradycardia occurred in 5.25% patients, half of whom required temporary cardiac pacing. Conclusions: The risk of incidence of cardiac complications after cardiac surgery procedures depends mostly on patient’s age, EuroSCORE Logistic (ESL) score, left ventricular ejection fraction, myocardial hypertrophy, presence of paroxysmal AF and coincidence of nephrological complications. The necessity of performing more than one heart defibrillation after removing aortic cross-clamp favors early postoperative bradycardia. Considering the outcomes of this study, continuing reperfusion at least until 1/3 of the aortic cross-clamp time brings no additional benefits to the patients.

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Background: There is a need for early diagnostic solutions for cardiac surgery associated acute kidney injury (CSA-AKI) as serum creatinine changes do not occur dynamically enough. Moreover, new approaches are needed for kidney protective strategy in patients undergoing cardiac surgery procedures; Methods: Samples of serum and urine were taken from the selected group of patients undergoing elective cardiac surgery procedures. The aim of this study was to assess the utility of specific inflammation and kidney injury biomarkers in the early diagnostic of CSA-AKI and in the prognosis of long-term postoperative kidney function; Results: At 6 h after weaning from cardiopulmonary bypass, there were significant differences in IL-6, IL-8, TNF-α, MMP-9 and NGAL concentrations in patients with CSA-AKI, compared to the control group. Serum IL-8 and urine NGAL 6 h after weaning from CPB proved to be independent acute kidney injury predictors. The TNF-α, MMP-9, IL-18, TIMP-1 and MMP-9/TIMP-1 ratio in the early postoperative period correlated with long-term kidney function impairment; Conclusions: Novel kidney injury biomarkers are an eligible tool for early diagnosis of CSA-AKI. They are also reliable indicators of long-term postoperative kidney function impairment risk after cardiac surgery procedures.

The recommended pharmacological therapy for patients with coronary artery disease (CAD) treated by coronary artery bypass grafting (CABG) is acetylsalicylic acid (ASA). To improve the antiplatelet effect, supplementation with flavonoids is also recommended. The aim of this study was to estimate anti-aggregation properties of diosmin, in combination with ASA, pre- and postoperatively and assess the relationship of this therapy with inflammatory processes in CAD patients undergoing CABG. The study patients (n = 26) took diosmin (1000 mg/day); the control patients (n = 27) took a placebo. The therapeutic period for taking diosmin was from at least 30 days before to 30 days after CABG. All patients also took 75 mg/day ASA. Platelet aggregation and IL-6, CRP, and fibrinogen concentrations were determined before and 30 days after surgery. Results showed that diosmin did not enhance the anti-aggregation effect of ASA at any assessment time. However, there was a stronger anti-aggregation effect 30 days after surgery that was diosmin independent and was associated with acute-phase markers in the postoperative period. Increased levels of inflammatory markers in the late phase of the postoperative period may provide an unfavorable prognostic factor in long-term follow-up, which should prompt the use of stronger antiplatelet therapy in patients after CABG.

BackgroundPreoperative 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 methodsThe 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.ResultsInter-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.ConclusionIn 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.

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