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: There is a lack of published research that compare stenting versus coronary artery bypass grafting (CABG) for patients with left main coronary artery (LMCA) disease. This research compared the safety and efficacy of stents versus CABG for patients with LMCA disease in the setting of acute myocardial infarction. Materials and Methods: A retrospective chart review was conducted to retrieve the records of LMCA who underwent coronary stenting or CABG. We compared both techniques in terms of major adverse cardiovascular and cerebrovascular events (MACCE) and postoperative complications. Results: Sixty patients were included (30 patients in each group). The incidence of periprocedural mortality was equal between PCI and CABG groups (6.7% versus 10%). Likewise, the overall incidence of periprocedural complications was comparable between both groups (13.3% versus 20%). The incidence of immediate post procedural complications was 20% and 30% in PCI and CABG groups, respectively (p =0.37). Likewise, the rate of immediate post procedural mortality was 3.3% and 6.7%, respectively (p =1.0). Both groups exhibited similar rates of late post procedural complications as well (p =0.25). Conclusion: In conclusion, PCI and CABG had comparable postoperative outcomes in LMCA patients in the setting of acute myocardial infarction. Further randomized controlled trials with larger sample size and longer follow-up period are required to evaluate the safety and efficacy of both techniques in such patients.
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