Vacuum-assisted wound closure with instillation followed by nitinol clips application to treat deep sternal wound infections after cardiac surgery: evolution of a two-step approach.

INTRODUCTION: DSWI, or mediastinitis, is a life-threatening complication following cardiac surgery. Although infrequent, it can cause significant morbidity and mortality, often requires multiple procedures, and increases health care costs. Different treatment approaches have been used. OBJECTIVE: This article compares closed catheter irrigation with the currently used 2-stage approach using a proprietary vacuum-assisted wound closure with instillation system followed by sternal synthesis with nitinol clips. MATERIALS AND METHODS: The records of 34 patients with DSWI who underwent cardiac surgery between January 2012 and December 2020 were retrospectively analyzed. Patients received either closed catheter irrigation or vacuum-assisted wound closure with instillation for decontamination and subsequent closure with pectoralis major flaps (with or without the modified Robicsek technique), or more recently, with nitinol clips. RESULTS: Wound healing was achieved in all patients treated with vacuum-assisted wound closure with instillation. In this group, no patients died and the mean hospital stay was reduced. CONCLUSIONS: These findings suggest that use of vacuum-assisted wound closure with instillation along with nitinol clips for sternal closure decreases mortality and reduces the length of hospital stay, making it a safer, effective, and less invasive technique for the management of DSWI after cardiac surgery.

Acute thrombotic occlusion of a brachiocephalic branch graft and pseudoaneurysm formation after debranching surgery for a "non-A non-B" aortic dissection.

Non-A non-B aortic dissection is a pathology with potentially life-threatening consequences, and aortic debranching followed by thoracic endovascular aortic repair is one of the possible treatment options. Branch graft occlusion is an infrequent complication and no definite guidelines exist about postoperative antithrombotic therapy nor preoperative evaluation of individual anatomical characteristics-in particular regarding cerebral circulation-in such patients. We present the case of a 54-year-old man undergoing an aortic debranching procedure for a thoracoabdominal aortic dissection originating in the aortic arch, complicated by thrombotic occlusion of the brachiocephalic branch of the prosthesis and pseudoaneurysm of the ascending aorta, with our management and considerations.

Hybrid Single-Stage Repair of Kommerell's Diverticulum in a Right Aortic Arch in a Patient With 22q11.2 Deletion Syndrome.

Hybrid single-stage repair of Kommerell's diverticulum in a right aortic arch.Aortic arch anomalies, isolated or associated with congenital heart defects, are cardiovascular manifestations frequently associated with 22q11.2 deletion syndrome. Kommerell's diverticulum in the context of a right aortic arch is an exceedingly rare congenital anomaly, consisting in aneurysmal degeneration of the origin of an aberrant left subclavian artery. Open surgical repair has been the treatment paradigm, but in recent years, hybrid and endovascular procedures have also been proposed. In this report we present the case of a patient affected by 22q11.2 deletion syndrome successfully treated for Kommerell's diverticulum associated with a right-sided aortic arch through a single-stage hybrid procedure, consisting of bilateral carotid-subclavian bypass, exclusion of the diverticulum by an endovascular thoracic stent graft, and aberrant left subclavian artery plug occlusion. This type of hybrid technique can be an excellent alternative to extensive open surgical repairs or when total endovascular repair is deemed unachievable, also in the context of a complex genetic syndrome.