Negative pressure wound therapy in patients with diabetes undergoing left internal thoracic artery harvest: A randomized control trial.

BACKGROUND: Patients with diabetes undergoing CABG are at risk of wound infection. Incisional negative pressure wound therapy has been shown to be effective in decreasing incidence of infection in high-risk wounds. Near infrared spectroscopy (NIRS) can be used to assess wound oxygenation and low values can predict infection. OBJECTIVES: To evaluate utility of NIRS to assess wound oxygenation, to assess effect of sternotomy, left internal thoracic artery harvest, and wound dressing type on wound edge oxygenation. METHODS: In this blinded randomized control trial, patients with diabetes undergoing isolated coronary artery bypass grafting with a left internal thoracic artery were randomized to receive either incisional negative pressure wound therapy dressing or a standard dressing. NIRS measurements were made on the left upper arm (control), and left and right parasternal regions on day -1 (preoperative), day 5, and week 6 after surgery. Results were analyzed using repeated measures parametric methods. RESULTS: Eighty patients with diabetes were recruited, 40 to the incisional negative pressure wound therapy group and 40 to the standard dressing group. Adjusted NIRS readings dropped significantly in all patients by day 5 and partially recovered by week 6. In both groups, there was no difference between readings on the left and right. At all time points and on both sides, there was no difference in readings between patients in the 2 groups. CONCLUSIONS: NIRS can be used to assess oxygenation adjacent to a sternotomy wound. Adjusted tissue oxygen levels change with time after sternotomy and left internal thoracic artery harvest in patients with diabetes. Wound dressing type does not influence day 5 wound edge oxygenation.

Effective cerebral protection using near-infrared spectroscopy monitoring with antegrade cerebral perfusion during aortic surgery.

OBJECTIVE: Antegrade cerebral perfusion (ACP) under moderate hypothermia may improve cerebral protection. Intraoperative measurement of cerebral regional oxygen saturations (rSO2) using near-infrared spectroscopy (NIRS) can provide accurate monitoring of cerebral perfusion during ACP. We evaluated the role, outcomes, and advantages of using NIRS in providing effective cerebral protection with ACP. METHODS: Between May 2006 and March 2009, 27 patients (mean age 60%, 93% elective) underwent ascending aorta replacement with ACP monitored by NIRS. ACP was established through the right axillary artery (n = 26). All patients had continuous intraoperative measurement of both anterior cerebral rSO2 using NIRS (INVOS; Somanetics Corporation, Troy, MI, USA). Posterior cerebral perfusion was measured using left radial artery pressures. Quality of life (QoL) was assessed using a Short Form 36 questionnaire. RESULTS: Mean cardiopulmonary bypass and aortic cross clamp time were 169 ± 27 and 95 ± 22 minutes, respectively. Mean ACP rate of 1.27 ± 0.35 L/min provided a mean left radial artery pressure of at least 60 mmHg. All patients' cerebral rSO2 were maintained above their baseline using NIRS. Mean ACP time was 14.3 ± 2.6 minutes at a mean core temperature of 23.4 °C ± 2.0 °C. Temporary neurological deficit was observed in two patients (7.4%). No permanent neurological dysfunction was observed. Thirty-day mortality was 3.7%. At median follow-up of 18.3 (interquartile range 10.8 to 23.3) months survival was 92% and mean norm-based QoL score was above average at 52.5 ± 6.5. CONCLUSION: Cerebral rSO2 and left radial artery pressure monitoring with ACP during aortic surgery provides accurate measurement of cerebral perfusion resulting in minimal neurological and perioperative complications and good midterm QoL outcomes.

Sternotomy following minimally invasive thoracoscopic procedures: a word of caution.

An increasing number of patients with previous minimally invasive thoracic procedures for anterior mediastinal tumors are now requiring cardiac surgery. This paper highlights the potential damage that can occur when standard sternal splitting techniques are used in these patients.