Preliminary outcome of treatment of postoperative primarily closed sternotomy wounds treated using negative pressure wound therapy.

UNLABELLED: Hospital infections, and in particular infections of the surgical site are a common problem of the procedural departments. Due to continuous progress of surgical techniques and patient population getting older with multiple co-morbidities, multidirectional actions need to be taken to avoid these infections or, if they do occur, achieve optimal treatment outcomes. Vacuum wound therapy is one of the directions that has been developed over the recent years. The aim of the study evaluate wound healing in patients after an off-pump coronary artery bypass grafting procedure, using the internal mammary artery, treated with negative pressure wound therapy system. MATERIAL AND METHODS: This prospective, open label study evaluated healing of postoperative sternotomy wounds after their primary closure with negative pressure wound therapy, using continuous negative pressure of -80 mmHg in 40 patients and 40 patients in a control group in whom conventional dressings were applied in the postoperative period. RESULTS: The number of patients in whom primary wound healing occurred without complications was significantly higher in the negative pressure wound therapy group versus the control group (x2 test =4.50, p=0.0339) and the number of total superficial infections was significantly smaller versus the control group (x2 test =5; p=0.0254). Antibiotic therapy was also initiated significantly less often as compared to the group treated with conventional dressings (x2 test = 4.11; p=0.0425). CONCLUSIONS: Negative pressure wound therapy after primary wound closure reduces the risk of superficial infections in the population with multiple risk factors of complications in the sternotomy wound healing.

Gene therapy of coronary artery disease with phvegf165--early outcome.

BACKGROUND: Gene therapy is a new, experimental method of treatment in patients with coronary artery disease (CAD). AIM: To determine the safety and efficacy of gene encoding vascular endothelial growth factor (VEGF165) administered directly into the myocardium as the single treatment or combined with coronary artery by-pass grafting (CABG). METHODS: VEGF gene transfer was performed in 22 patients (20 male, 2 female, ages from 48 to 73 years old). A 200 micro g of the plasmid encoding VEGF165 was injected into the ischaemic myocardium which could not be surgically revascularised in patients undergoing CABG (n=14), and 400 micro g - in patients without CABG (n=8). The value of ejection fraction (EF), myocardial perfusion, angiogram, ventriculography, and nitroglycerine consumption as well as quality of life were evaluated pre- and postoperatively. RESULTS: The majority of patients had no complications and no fatal outcome was observed. Two patients developed acute myocardial infarction. Left ventricular function values improved and the majority of patients were free from angina 6 months after surgery. Patients reported improved quality of life and a reduction in nitroglycerine usage. A reduction in the ischaemic defects detected by SPECT was also observed. In some patients angiography revealed improved collateral filling. CONCLUSIONS: Direct myocardial administration of genes encoding VEGF165 can be an effective method of treatment in patients with chronic and advanced CAD either as a supplementary treatment or as a single therapy.

[Prognostic value of exercise tests performed 3 months after coronary artery grafting in evaluation cardiac events. 6 years follow-up]. / Prognostyczna wartosc próby wysilkowej wykonanej w 3 miesiace po operacji wszczepienia pomostów aortalno-wiencowych w ocenie zdarzen sercowych. Obserwacja 6-letnia.

Prognostic value of exercise test in evaluation of cardiac events were examined in 326 pts after coronary artery bypass grafting (CABG). During 6 years follow up 18 (5.5%) cardiac deaths and 23 (7.1%) myocardial infarctions were observed. Chest pains persisted in 116 pts (35.6%) and 37 (11.3%) pts needed hospital treatment. Coronary and bypass angiography were performed in 25 pts (7.7%) followed by PTCA in 8 pts (2.5%) and CABG in 5 (1.5%) pts. Exercise duration and maximal work capacity in exercise tests were significantly lower in pts with cardiac events. Reasons of exercise termination: ST segment depression, heart rate and blood pressure values were not different in pts with and without cardiac events and didn't have prognostic value. Patients with cardiac events had significantly reduced left ventricle function. The value of ejection fraction influenced significantly relative risk of cardiac death (p < 0.05).

[Angioplasty of unprotected two coronary artery ostia using cardiopulmonary bypass as a single emergency procedure - case report]. / Jednoczasowa angioplastyka niezabezpieczonych ujsc aortalnych obu tetnic wiencowych w krazeniu pozaustrojowym.

Mortality in patients with a significant left main and right coronary artery ostia stenosis is high, reaching 50% during a five-year follow-up period. To date, this type of lesion has been rarely treated with percutaneous coronary interventions (PCI). We present a case of a 50-year-old man who had had coronary artery bypass surgery because of left main stenosis in the past and was currently admitted to the hospital because of unstable angina. Coronary angiography showed tight left main and right coronary ostia stenosis and total occlusion of the left anterior descending artery. Vein grafts were occluded. The PCI procedure combined with the cardiopulmonary bypass was performed. The lesions were dilated and stents were successfully implanted. The patient tolerated the procedure well. He was discharged five days after PCI and the course of a 12-month follow-up was uneventful.