The impact of COVID-19 prevention measures on surgical wound infection rates post-cardiac surgery.

The COVID-19 pandemic had a huge impact on medical services. Several measures have been implemented to reduce the risk of viral transmission. In this paper, we assessed the impact of these measures on surgical wound infection rates in patients post-cardiac surgery. Hypothesis testing was used to compare post-cardiac operation infection rates between the year prior to the COVID-19 pandemic being declared and the first 13 months of the pandemic. The infection rates in 969 patients with operations between 01/03/2019 and 29/02/2020 were compared to those of 925 patients with cardiac surgery between 01/03/2020 and 31/03/2021. Infection rates for various operative urgencies and infection types were analysed. To compare infection rates, a two-tailed pooled z-test using the difference in infection proportions was performed. A 5% significance level was used and only categories with at least 10 patients in both the pre-covid and covid populations were tested. For leg infections, only operations involving coronary artery bypass grafting were included. To ensure that any differences in outcomes were not due to differences in patient demographics resulting in unequal operative risks, Euroscore II values, a measure of cardiac operative risk, were compared between the pre-covid and post-covid cohorts. The Mann-Whitney U-test was used to determine whether the distributions of Euroscore II values were likely to be drawn from the same population. A significance level of 5% was used. A total of 1901 patients (932 during the COVID-19 pandemic) were included in this study. Significant reduction in post-operative infections for all patients undergoing cardiac surgery from 4.3% of patients before COVID to 1.5% during the pandemic. During the pandemic, fewer elective and more urgent operations were performed. This study suggests a significant role of iatrogenic causes in wound infections prior to the pandemic. The implementation of COVID-19 prevention measures in healthcare providers can reduce surgical infection rates. As COVID-19-related restrictions have been eased, we suggest maintaining them in healthcare providers to reduce the incidence of surgical wound infections.

Redo aortic valve replacement versus valve-in-valve trans-catheter aortic valve implantation: a UK propensity-matched analysis.

This study sought to compare the morbidity and mortality of redo aortic valve replacement (redo-AVR) versus valve-in-valve trans-catheter aortic valve implantation (valve-in-valve TAVI) for patients with a failing bioprosthetic valve. A multicenter UK retrospective study of redo-AVR or valve-in-valve TAVI for patients referred for redo aortic valve intervention due to a degenerated aortic bioprosthesis. Propensity score matching was performed for confounding factors. From July 2005 to April 2021, 911 patients underwent redo-AVR and 411 patients underwent valve-in-valve TAVI. There were 125 pairs for analysis after propensity score matching. The mean age was 75.2±8.5 years. In-hospital mortality was 7.2% (n=9) for redo-AVR versus 0 for valve-in-valve TAVI, p=0.002. Surgical patients suffered more post-operative complications, including intra-aortic balloon pump support (p=0.02), early re-operation (p<0.001), arrhythmias (p<0.001), respiratory and neurological complications (p=0.02 and p=0.03) and multi-organ failure (p=0.01). The valve-in-valve TAVI group had a shorter intensive care unit and hospital stay (p<0.001 for both). However, moderate aortic regurgitation at discharge and higher post-procedural gradients were more common after valve-in-valve TAVI (p<0.001 for both). Survival probabilities in patients who were successfully discharged from the hospital were similar after valve-in-valve TAVI and redo-AVR over the 6-year follow-up (log-rank p=0.26). In elderly patients with a degenerated aortic bioprosthesis, valve-in-valve TAVI provides better early outcomes as opposed to redo-AVR, although there was no difference in mid-term survival in patients successfully discharged from the hospital.

Video-assisted thoracic surgery in hemothorax evacuation after cardiac surgery or cardiac interventions.

INTRODUCTION: Cardiac surgery and cardiac interventions are associated with the risk of iatrogenic complications, including hemothorax. Minimally invasive methods of evacuating hemothorax include video-assisted thoracic surgery (VATS). AIM: This paper presents this method and provides its detailed analysis. MATERIAL AND METHODS: The VATS procedures were used to evacuate hemothorax in 8 patients (7 after cardiac surgery and 1 after a cardiac intervention). Complete three-port VATS was performed in 7 patients, while 1 patient underwent assisted VATS due to a large number of adhesions. RESULTS: On average, the repeat procedures were performed on the 20th postoperative day (10th-58th postoperative day). In 6 (75%) cases the VATS intervention was the third surgical intervention performed. One patient, operated on 12 days after the original procedure, was diagnosed with active arterial bleeding, which required conversion to a classic procedure using median sternotomy. No postoperative wound infection was noted. Complete hemothorax removal was achieved in all patients. CONCLUSIONS: Classic median sternotomy is the standard approach for hemothorax evacuation. However, it may sometimes be burdened with a high perioperative risk due to massive mediastinal adhesions in the late postoperative period. Additionally, access through the postoperative wound appears to be associated with a higher risk of local infection and sternal instability. Hemodynamically stable patients in the late postoperative period, with stable sternums and healed postoperative wounds, are good candidates for VATS aiming to evacuate hemothorax. The VATS is an effective procedure for evacuating hemothorax.