Deep sternal wound infection (DSWI) is a rare but serious complication following coronary artery bypass surgery. Our study investigates the risk factors and mortality associated with DSWI with other risk models for DSWI. Data was collected prospectively on 7602 patients undergoing coronary artery bypass grafting±concomitant surgery between April 1999 and September 2009 including DSWI. All 13 Society for Thoracic Surgeons (STS) risk scoring variables were assessed using logistic regression in relation to developing DSWI. The STS risk scores were evaluated using the area under the receiver operating curve. A total of 44 (0.59%) patients developed DSWI. These patients had a higher mortality (9.1%) than patients without DSWI (2.6%) (P=0.03). The mean preoperative and combined STS scores were significantly higher in the DSWI patient group compared to the non-DSWI group (9.46±4.30 and 8.76±3.86 vs. 7.07±4.25 and 6.51±4.11, P=0.0003 and P=0.0005, respectively). Logistic regression identified age [odds ratio (OR)=1.055], body mass index (OR=1.076), diabetes (OR=2.00) and chronic lung disease (OR=2.47) as the significant independent determinants of DSWI from the variables considered. Mortality rates and mean STS scores are higher in patients requiring re-opening for DSWI. Not all the STS risk factors were predictors of DSWI in our population.

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This significant long-term survival demonstrates that CE can be an attractive adjunct to CABG in otherwise inoperable coronary artery disease.

Hypoxic pulmonary vasoconstriction is the elegant theory put forward more than six decades ago to explain regional variations in perfusion within the lung in certain animal species in response to localised restrictions in oxygenation. Although considerable progress has been made to describe the phenomenon at the macroscopic level and explain it at the microscopic level, we are far from a universal agreement about the process in humans. This review attempts to highlight some of the important evidence bases of hypoxic pulmonary vasoconstriction in humans and the significant gaps in our knowledge that would need bridging.

Extra-corporeal membrane oxygenation remains the last resort in keeping patients alive in those with profound cardiogenic shock following percutaneous interventions or open surgery on the heart. No guidelines exist on the management of patients on such a device despite a high mortality. We attempt to highlight some universal principles that would be relevant to the current practice of those exposed to this challenging field.