NPWT can be successfully utilised in congenital heart surgery patients, including young neonates, for the treatment of sternal wound infections. The trends observed in the reduction of wound therapy duration and antibiotic duration with early implementation of negative pressure therapy and multidisciplinary wound management require further investigation to verify their clinical efficacy in patient care.
Background
The purpose of this study was to investigate the incidence, predictors, and long‐term impact of gastrointestinal (GI) complications following adult cardiac surgery.
Methods
Index Society of Thoracic Surgeons (STS) adult cardiac operations performed between January 2010 and February 2018 at a single institution were included. Patients were stratified by the occurrence of postoperative GI complications. Outcomes included early and late survival as well as other associated major postoperative complications. A subanalysis of propensity score‐matched patients was also performed.
Results
A total of 10,285 patients were included, and the overall rate of GI complications was 2.4% (n = 246). Predictors of GI complications included dialysis dependency, intra‐aortic balloon pump, congestive heart failure, chronic obstructive pulmonary disease, and longer aortic cross‐clamp times. Thirty‐day (2.6% vs. 24.8%), 1‐ (6.3% vs. 41.9%), and 3‐year (11.1% vs. 48.4%) mortality were substantially higher in patients who experienced GI complications (all p < .001). GI complication was associated with a threefold increased hazard for mortality (hazard ratio = 3.1, 95% confidence interval = 2.6–3.7) after risk adjustment, and there was an association between the occurrence of GI complications and increased rates of renal failure (39.4% vs. 2.5%), new dialysis dependency (31.3% vs. 1.5%), multisystem organ failure (21.5% vs .1.0%), and deep sternal wound infections (2.6% vs. 0.2%; all p < .001). These results persisted in propensity‐matched analysis.
Conclusion
GI complications are infrequent but have a profound impact on early and late survival, and often occur in association with other major complications. Risk factor modification, heightened awareness, and early detection and management of GI complications appear warranted.
Background
This study evaluated the impact of the heart allocation policy change in 2018 on the characteristics and outcomes of multiorgan transplants involving heart allografts.
Methods
Adults undergoing multiorgan heart transplantation from 2010 to 2020 were identified from the United Network for Organ Sharing (UNOS) registry. Transplants were stratified into occurring before versus after the October 2018 heart allocation change. The primary outcome was 1‐year survival following transplantation. A Cox proportional hazards model was used to evaluate the risk‐adjusted effect of the allocation policy change on outcomes between cohorts.
Results
A total of 1832 patients underwent multiorgan heart transplantation during the study period with 245 (13.37%) undergoing heart‐lung transplantation, 244 (13.32%) undergoing heart‐liver transplantation, and 1343 (73.31%) undergoing heart‐kidney transplantation. There was a higher utilization of temporary MCSDs as well as longer ischemic times for all three types of transplantation following the policy change. Heart‐lung and heart‐liver recipients had a similar 1‐year survival before and after the policy change (each p > .05). Renal failure requiring dialysis (29.5% vs. 39.4%, p = .001) as well as 1‐year survival (88% vs. 82%; log‐rank p = .01) were worse in the heart‐kidney cohort after the organ allocation system modification.
Conclusions
This study demonstrates similar trends in multiorgan transplants as has been observed in isolated heart transplants following the allocation change, including more frequent utilization of temporary mechanical support and longer ischemic times. Although outcomes have remained comparable in the new allocation era with heart‐lung and heart‐liver transplants, heart‐kidney recipients have a worse 1‐year survival following the change.
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