The fate of patients having deep sternal infection after bilateral internal thoracic artery grafting in the negative pressure wound therapy era

Preoperative risk stratification of deep sternal wound infection after coronary surgery

“…[1][2][3][4] Negative pressure wound therapy 3,5,6 and advances in reconstructive surgery of the sternum may improve the outcome of patients with postoperative DSWI, 7,8 but hospital and late mortality in these patients remains nonnegligible. [9][10][11][12][13] Furthermore, the financial burden associated with the treatment of sternal wound complications is relevant due to the direct costs incurred by the related prolonged therapies and hospital stay. 9,10,14 In this context, effective preventive strategies along with a tailored method of DSWI risk stratification are of utmost importance.…”

Risk stratification tool for all surgical site infections after coronary artery bypass grafting

“…In our opinion, the main reason for this general failure of prediction is that the occurrence of SSIs after CABG, as well as after any cardiac operation or surgical intervention (albeit to a lesser degree), is a complex event that depends on several factors that are only partially established. [1][2][3][4][5][6][7][8][9]17,21,[23][24][25][26][27] First, least 4 agents are involved in this complex process: (1) the patient, with her/his baseline characteristics, cardiac disease, and immune response; (2) the microbial pathogen(s), with any potential drug resistance; (3) the healthcare workers; and (4) the hospital environment. Second, many technical details play significant roles in preventing or favoring surgical site complications after CABG: skin preparation for surgery (hair clipping and surgical site shaving, use of antiseptic scrub the night before surgery, wrapping the surgical site with impregnated disinfectant agent dressing, intraoperative use of povidone-iodine or chlorhexidine-alcohol, use of microbial sealant that immobilizes bacteria, etc), use of ITA (1, 2, or none) and the ITA harvesting technique (pedicled, skeletonized or semi-skeletonized), use of The creatinine clearance rate, calculated according to the Cockcroft-Gault formula, was used for approximating the GFR.…”

Bilateral Internal Thoracic Artery Grafting Concomitant With Other Cardiac Operations ― Insights From a European Multicenter Retrospective Study on 1,123 Consecutive Patients ―

“…Both ITAs were dissected as skeletonized conduits, and the ITA harvesting technique did not change in the 3 centers during the study period (Supplementary Methods). 5,[7][8][9][10][11][12][13]17,26,27 All coronary anastomoses on the inferolateral cardiac wall were performed before any other surgical procedure that involved cardiac valves, the left ventricle, or thoracic aorta. Cardiac tumor removal and operations for arrhythmias were included in the study.…”

“…Details pertaining to the patients and their disease during the follow-up period were recorded in a computerized data registry. 8,13,24 Clinical follow-up was obtained by the following sequential procedure: telephone contact with the patient, or the patient's family; if they could not be contacted, telephone contact with the general practitioner, referring cardiologist or other specialists listed in the patient's medical file; finally, consultation of the national death registry or the town halls of the place of birth to obtain data regarding the vital The study was performed in accordance with the Declaration of Helsinki. Approval to conduct the study, as well as to contact the patients and their families, was given by the local ethics committee of each participating center; based on the retrospective data retrieval; the need for individual written consent was waived.…”

“…Long-term outcomes were comparable with those of other similar studies in the literature, 28-38 but, as expected, poorer than those for isolated BITA grafting. [5][6][7][8][9][10][11][12][13]15,17,27,39,40 In this series of patients with an average age of more than 70 years, approximately 50% of subjects were alive or free from MACCE at 10 years after surgery; approximately 85% of patients were free from cardiac or cerebrovascular death or from hospital readmission for CHF; approximately 97% of patients were free from PCI or cardiac reoperation; finally, approximately 95% of patients were free from cerebrovascular accident after hospital discharge. Although female sex, extracardiac arteriopathy, chronic dialysis, and poor systolic function before surgery were risk factors for both cardiac or cerebrovascular death and MACCE, active infective endocarditis and prolonged myocardial ischemia during surgery were the sole predictors of repeat operation or PCI.…”