Background: In cardiac surgery patients, post-sternotomy mediastinitis, also known as deep sternal wound infection (DSWI), is a major cause of postoperative morbidity and mortality. Negative pressure wound therapy (NPWT), also known as vacuum assisted closure (VAC) dressing, is one therapeutic alternative that offers the following advantages: regulation of fluid drainage, reduction of local edema, and bacterial load reduction, and early development of granulation tissue by angiogenic stimulation. By acting topically with a low complication rate, offering greater comfort to the medical team and patient, and reducing hospitalization time, antibiotic usage, and dressing changes, this therapy has become an important and efficient method for fighting infection in complex wounds. Objective: To evaluate the effectiveness and clinical outcome of vacuum-assisted closure (VAC) therapy in the treatment of post-sternotomy mediastinitis in comparison with conventional treatment. Patients and methods: This study was conducted in National Heart Institute (NHI), Egypt. Patients were hospitalized from March 2019 to March 2020. It included patients with post-sternotomy mediastinitis treated with conventional therapy and VAC divided in two groups each group contained 30 patients. Results: The duration of VAC therapy was 7.42±2.23 days. Mean hospital stay after VAC therapy was 12.18±1.92 days. Twenty-two (92%) patients were treated successfully. At the end of VAC therapy, the mean reduction in wound size was 31.7%. The mean granulation tissue formation was 59%. Conclusion: VAC is a safe, reliable, and relatively new option for the treatment of DSWI after cardiac surgery. VAC is an alternative to conventional treatment in wound healing strategy in post-sternotomy mediastinitis.
Background and aim of the study: Outcomes of emergency coronary artery bypass grafting (CABG) for acute coronary syndrome (ACS) due to left main coronary (LM) disease remain unclear. This study aims to assess the short term Outcome for patients undergoing Urgent CABG, due to LM disease; as assessed by relief of symptoms and 6 months improvement of EF.
Methods:This study included 60 patients that underwent urgent coronary artery bypass grafting. Patients were divided into three groups according to the pre operative ejection fraction (EF). The three groups were compared regarding preoperative, operative, and postoperative Echo measurement of Ejection fraction and relief of symptoms.Results: 70% of our cases were male with mean age of 52.2 yr (range, ±7.19 years), no clinical significance between preoperative comorbidities in relation between 3 groups and the postoperative outcome, the risk factors for our patients are Preoperative myocardial infarction (MI), hemodynamic (HD) instability specially in group C and in turn intraoperative risk is; prolonged Cardiopulmonary bypass time and cross clamp time, while during the intensive care unit stay; postoperative bleeding, MI, prolonged ventilation time and extended ICU stay. The total mortality rate is 8.3% form our patients. Postoperative echocardiography just before discharge and 6 months later showed significant improvement of EF especially for patient showing preoperative instability and MI.
Conclusion:The present study demonstrated that patients undergoing Urgent CABG have a significant higher preoperative risk especially with myocardial impairment, despite the higher mortality rate 12%, a favorable clinical outcome can be expected if patients survive.
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