Endovascular repair of ascending aortic pathology is feasible in patients facing high risk with open surgery, with promising early results. Technical challenges remain in adapting current endovascular technology to ascending aortic pathologies, particularly type A aortic dissection.

Delayed intervention appears to lower the risk of complications of TEVAR for aortic dissection in patients who are stable enough to wait. Among patients initially managed medically, new TEVAR indications were not uncommon, and such patients must be followed closely.

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In treating DeBakey I aortic dissection with arch tear, hemiarch replacement with primary tear repair and concomitant TEVAR is a safe alternative to conventional TAR, with improved distal aortic remodelling.

Purpose The incidence and management of sternal wound complications in patients undergoing orthotopic heart transplantation (OHT) is not well studied. We report outcomes in heart transplant patients who developed sternal infections requiring reoperations. Methods From 2004 to 2013, 437 patients underwent OHT at a single institution. In a retrospective review, patients who developed sternal infections (Infection group, n = 27) were compared with those without (Control group, n = 410). Results Sternal infection rate was 6.2% (n = 27). Demographics were similar (Table 1). Infection group had higher rates of COPD 25% vs 13%, P = 0.03, and previous cardiac surgery via median sternotomy 28% vs 15%, P = 0.03. Infection group had a greater incidence of prolonged ventilation, 44% vs 31%, P = 0.2, renal failure 56% vs 24%, P = 0.001, dialysis requirement 30% vs 10%, P = 0.006, permanent stroke 11% vs 2%, P = 0.02, perioperative myocardial infarction 4% vs 0.2%, P = 0.09. The infection group had a longer ICU stay (524  + 410 vs 187  + 355 hours, P = 0.001) and hospitalization (59  + 28 vs 0.29  + 43 days, P = 0.001). In‐hospital/30‐day mortality was 30% vs 19%, P = 0.2. The mean time for sternal reoperation at 44  + 50 days. Deep wound infection (41%) and sternal dehiscence (22%) were common presentations. Causative organisms were Enterobacter (22%), Klebsiella (15%), and Pseudomonas (15%). Vancomycin (44%), 4th generation cephalosporin (37%), and fluoroquinolones (30%) were the most commonly used antibiotics. Surgical treatment included sternal debridement with pectoralis muscle flap (52%), primary closure (18%), and omental flap (11%). Conclusion Sternal wound infections impart a significant burden on patients with OHT. Causative organisms are predominantly virulent gram‐negative bacteria. Therefore, a high index of suspicion must be maintained for early detection and treatment.