Risk Factors for Sternal Wound Infection after Coronary Artery Bypass Grafting in Patients with and without Diabetes.

Diabetes mellitus (DM) is a well-known risk factor for sternal wound infections (SWIs). However, SWIs are also known to occur in patients without DM. This study aimed to examine the difference in risk factors for SWIs after coronary artery bypass grafting (CABG) between non-diabetic and diabetic patients.We conducted a retrospective observational study including 6,697 patients who underwent CABG at our hospital from 2015-2018. The patients were assigned to the non-diabetic (group N, n = 2,930) or diabetic (group D, n = 3,767) group. A total of 24 potential risk factors were evaluated using univariate and multivariate analyses. Differences between superficial and deep SWIs were also examined.A total of 209 (3.1%) CABG patients, comprising 47 (22.5%) and 162 (77.5%) in groups N and D, respectively, required surgical treatment for SWIs. Univariate analyses indicated that a body mass index (BMI) > 25 kg/m2 was uniquely associated with superficial SWIs in group N. Moreover, married status may have lowered the risk of deep SWIs in group D. Renal failure, intra-aortic balloon pump (IABP) use, and reopening in group N, as well as female sex, emergency admission, and reopening in group D, were independent predictors of SWI in the multivariate analysis.In this study, reopening was a common risk factor associated with SWIs in patients who underwent CABG with and without DM. Female sex and emergency admission were independent predictors of deep SWIs in patients with DM, whereas renal failure and IABP use were independent predictors of deep SWIs in patients without DM.

Ruptured sinus of Valsalva aneurysm with ventricular septal defect complicated by preoperative cardiogenic shock, cardiac arrest, and multiple organ dysfunction: a rare survivor and review of contemporary literature.

Sinus of Valsalva aneurysm (SVA) is a relatively rare cardiac condition, in which the patient is usually asymptomatic. However, once this aneurysm ruptures, patients present with acute symptoms of heart failure. Timely surgical intervention is essential. We present the case of a 27-year-old woman, who had a ruptured SVA with a ventricular septal defect (VSD). The patient collapsed before the emergency operation and needed cardiopulmonary resuscitation. The patient required preoperative high inotoropic support and postoperative management was difficult because of multiple organ dysfunction. However, the patient recovered after using inhaled nitric oxide and veno-venous hemofiltration and tracheostomy, and was discharged with no further complications. To the best of our knowledge, no such case of a ruptured SVA with VSD, complicated by preoperative cardiac arrest and multiple organ dysfunction that culminated in a successful recovery, has been reported to date.