Postoperative sternomediastinitis

Lednev, P.V.; IuV, Belov; Stonogin, A. V.; Lysenko, A. V.; Salagaev, G. I.

doi:10.17116/hirurgia2018484-89

“…Эти дан ные подтверждаются в литературном обзоре Леднева П. В. и др. [50]. Авторы указали, что сочетание СД 2 типа с ожирением и/или бимаммаро-коронарным шунтированием является предиктором развития постстернотомных инфекционных раневых осложнений [50].…”

Section: результатыunclassified

“…Авторы указали, что сочетание СД 2 типа с ожирением и/или бимаммаро-коронарным шунтированием является предиктором развития постстернотомных инфекционных раневых осложнений [50]. Во-первых, весомый вклад в развитие этих процессов может вносить недостаточная регенерация на фоне нарушения углеводного обмена [23,[50][51][52]. Во-вторых -снижение содержания остеокальцина, С-концевого телопептида в грудине на фоне СД 2 типа [22].…”

Section: результатыunclassified

“…Во-вторых -снижение содержания остеокальцина, С-концевого телопептида в грудине на фоне СД 2 типа [22]. В-третьих, ишемия тканей области стернотомии, особенно выраженная при бимаммаро-коронарном шунтировании [50][51][52]. В конечном итоге совокупность перечисленных факторов имеет негативное влияние на динамику заживления раны и исходы остеосинтеза грудины у пациентов с СД 2 типа, что может приводить к перечисленным осложнениям [22,23,[50][51][52].…”

Section: результатыunclassified

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Long-term outcomes of combined coronary bypass surgery and carotid endarterectomy in patients with type 2 diabetes

IuV

¹

,

Ustinova

²

,

Yu

³

et al. 2022

Russ J Cardiol

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5

0

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At present, there are no studies on the analysis of the incidence of complications in patients with concomitant lesions of the coronary and internal carotid arteries (ICA) after combined operation of carotid endarterectomy (CE) and coronary artery bypass grafting (CABG) against the background of type 2 diabetes (T2D). However, there is no doubt that this condition can be a predictor of cardiovascular and wound complications during in-hospital and long-term postoperative periods.Aim. To study in-hospital and long-term outcomes of combined CABG+CE in patients with and without type 2 diabetes.Material and methods. This multicenter retrospective study for the period from January 2015 to December 2019 included 653 patients with concomitant atherosclerotic lesions of ICA and coronary arteries, who underwent combined CE+CABG. Depending on presence of type 2 diabetes, 2 groups were formed: group 1 (n=183) — patients with type 2 diabetes; group 2 (n=471) — patients without type 2 diabetes. The duration of postoperative follow-up was 37,8±14,9 months.Results. During hospitalization, significant differences in the incidence of death (group 1 =1,1%; group 2 =1,0%; p=0,97), myocardial infarction (MI) (group 1 =1,1%; group 2 =0,8%; p=0,76), bleeding events (group 1 =1,1%; group 2 =0,8%; p=0,76) were not detected. However, stroke (group 1 =3,8%; group 2 =0,4%; p=0,0008), sternal wound infection and mediastinitis (group 1 =3,3%; group 2 =0,2%; p=0,0006) were significantly more often developed in patients with type 2 diabetes.In the long-term follow-up period, death (group 1 =6,6%; group 2 =1,1%; p<0,0001), MI (group 1 =4,9%; group 2 =0,8%; p=0,0008), stroke (group 1 =7,7%; group 2 =1,5%; p<0,0001), ICA restenosis (group 1 =8,8%; group 2 =1,6%; p<0,0001), repeated emergency myocardial revascularization (group 1 =7,2%; group 2 =1,5%; p=0,0002), repeated emergency cerebral revascularization (group 1 =8,8%; group 2 =1,6%; p<0,0001) were significantly more often recorded in patients with type 2 diabetes.Kaplan-Meier curve analysis and its comparison using the log rank test revealed that the death, MI, and stroke were also significantly more often observed in patients with type 2 diabetes (p=0,0007, p=0,003, p<0,0001, respectively).Conclusion. Patients with type 2 diabetes who are referred for combined CE+CABG are at an increased risk of stroke, sternal wound infection and mediastinitis in the in-hospital postoperative period, as well as all adverse cardiovascular events in the long-term follow-up period.

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“…Авторы указали, что сочетание СД 2 типа с ожирением и/или бимаммаро-коронарным шунтированием является предиктором развития постстернотомных инфекционных раневых осложнений [50]. Во-первых, весомый вклад в развитие этих процессов может вносить недостаточная регенерация на фоне нарушения углеводного обмена [23,[50][51][52]. Во-вторых -снижение содержания остеокальцина, С-концевого телопептида в грудине на фоне СД 2 типа [22].…”

Section: результатыunclassified

“…Во-вторых -снижение содержания остеокальцина, С-концевого телопептида в грудине на фоне СД 2 типа [22]. В-третьих, ишемия тканей области стернотомии, особенно выраженная при бимаммаро-коронарном шунтировании [50][51][52]. В конечном итоге совокупность перечисленных факторов имеет негативное влияние на динамику заживления раны и исходы остеосинтеза грудины у пациентов с СД 2 типа, что может приводить к перечисленным осложнениям [22,23,[50][51][52].…”

Section: результатыunclassified

Long-term outcomes of combined coronary bypass surgery and carotid endarterectomy in patients with type 2 diabetes

IuV

¹

,

Ustinova

²

,

Yu

³

et al. 2022

Russ J Cardiol

Self Cite

5

0

View full text Add to dashboard Cite

At present, there are no studies on the analysis of the incidence of complications in patients with concomitant lesions of the coronary and internal carotid arteries (ICA) after combined operation of carotid endarterectomy (CE) and coronary artery bypass grafting (CABG) against the background of type 2 diabetes (T2D). However, there is no doubt that this condition can be a predictor of cardiovascular and wound complications during in-hospital and long-term postoperative periods.Aim. To study in-hospital and long-term outcomes of combined CABG+CE in patients with and without type 2 diabetes.Material and methods. This multicenter retrospective study for the period from January 2015 to December 2019 included 653 patients with concomitant atherosclerotic lesions of ICA and coronary arteries, who underwent combined CE+CABG. Depending on presence of type 2 diabetes, 2 groups were formed: group 1 (n=183) — patients with type 2 diabetes; group 2 (n=471) — patients without type 2 diabetes. The duration of postoperative follow-up was 37,8±14,9 months.Results. During hospitalization, significant differences in the incidence of death (group 1 =1,1%; group 2 =1,0%; p=0,97), myocardial infarction (MI) (group 1 =1,1%; group 2 =0,8%; p=0,76), bleeding events (group 1 =1,1%; group 2 =0,8%; p=0,76) were not detected. However, stroke (group 1 =3,8%; group 2 =0,4%; p=0,0008), sternal wound infection and mediastinitis (group 1 =3,3%; group 2 =0,2%; p=0,0006) were significantly more often developed in patients with type 2 diabetes.In the long-term follow-up period, death (group 1 =6,6%; group 2 =1,1%; p<0,0001), MI (group 1 =4,9%; group 2 =0,8%; p=0,0008), stroke (group 1 =7,7%; group 2 =1,5%; p<0,0001), ICA restenosis (group 1 =8,8%; group 2 =1,6%; p<0,0001), repeated emergency myocardial revascularization (group 1 =7,2%; group 2 =1,5%; p=0,0002), repeated emergency cerebral revascularization (group 1 =8,8%; group 2 =1,6%; p<0,0001) were significantly more often recorded in patients with type 2 diabetes.Kaplan-Meier curve analysis and its comparison using the log rank test revealed that the death, MI, and stroke were also significantly more often observed in patients with type 2 diabetes (p=0,0007, p=0,003, p<0,0001, respectively).Conclusion. Patients with type 2 diabetes who are referred for combined CE+CABG are at an increased risk of stroke, sternal wound infection and mediastinitis in the in-hospital postoperative period, as well as all adverse cardiovascular events in the long-term follow-up period.

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Local infectious complications in cardiac surgery: etiology and the role of antimicrobial prophylaxis

Stepin¹

2022

Khir. Z. im. N.I. Pirogova

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Postoperative sternomediastinitis

Cited by 10 publications

References 42 publications

Long-term outcomes of combined coronary bypass surgery and carotid endarterectomy in patients with type 2 diabetes

Long-term outcomes of combined coronary bypass surgery and carotid endarterectomy in patients with type 2 diabetes

Long-term outcomes of combined coronary bypass surgery and carotid endarterectomy in patients with type 2 diabetes

Local infectious complications in cardiac surgery: etiology and the role of antimicrobial prophylaxis

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