Extensive suprasternal dehiscence reconstruction with NPWT and advancement flaps following cardiac surgery.

Treatment of suprasternal wound infection (SSWI) following cardiac surgery is not a clearly developed procedure. We report our female patient's secondary SSWI treatment following bypass surgery. An obese female patient with unstable angina underwent an urgent, uneventful off-pump coronary artery bypass operation. An SSWI appeared within a week. After negative pressure wound therapy (NPWT), the sternum was rewired. In the previously irradiated territory of the left breast necrosis formed, a plastic surgeon reconstructed a defect. This procedure failed NPWT was restarted again, and a secondary reconstructive plastic surgery intervention was necessary. Despite extensive tissue mobilization, the central part of the reconstructive area necrotized, and we had to cover it with a split thickness skin mash graft. The irradiation therapy increases the incidence of suprasternal and/or sternal infection. It was possible to manage large soft tissue defects with bilateral and rotational advancement flaps.

Minimalinvaziv aortabillentyu-beultetes soran nyert kezdeti tapasztalataink / Minimálinvazív aortabillentyu-beültetés során nyert kezdeti tapasztalataink

Introduction: Due to the aging population, aortic valve stenosis is the most frequently diagnosed acquired cardiac disease amongst adults. Various surgical techniques have been developed and median sternotomy has become the standard practice for exploration. Improvements in cardiological intervention techniques allow surgery to provide the same quality with less invasiveness.Objective: Our aim was to compare the results of the isolated aortic valve surgeries (AVR) performed as either full or partial sternotomy during the study period in terms of pre-, intra-, and postoperative variables.Patients and methods: We examined the results of the isolated AVR performed at Gottsegen National Cardiovascular Center between January 2019 and March 2020 (99 AVR and 151 mini-AVR). During mini-AVR we opened the sternum with J shape ministernotomy up to the 3rd or 4th intercostal space while in median sternotomy we separated the sternum in its total length.Results: Blood consumption (unit) (AVR: 2.90 [2.90]; mini-AVR: 1.85 [2.12]; p<0,05), days of hospitalization (AVR: 9.75 [2.99]; mini-AVR: 8.85 [2.85]; p<0,05) and length of surgery (minutes) (AVR:148.49 [34.4]; mini-AVR: 134.6 [34.8]; p<0,05) were significantly better in the mini-AVR group. In terms of preoperative variables, the two groups were not homogeneous therefore we corrected the strong predictive variables. As a result, levels of bio-statistical significance have disappeared but there is still a trend in favour of minimally invasive surgery.Conclusions: Mini-AVR surgery is considered a more cost-effective intervention compared to standard surgery in terms of less surgical trauma, reduced blood consumption, and shorter operative time.

Surgical repositioning of Jarvik 2000 LVAD power supply pedestal following fall trauma.

Advanced heart failure (HF) is one of the leading causes of mortality and morbidity. With an aging population, its prevalence is expected to rise further. Although orthotopic heart transplantation (HTX) remains the gold standard in therapy, there is a significant deficiency in the ratio of donor organs to recipient patients. Left ventricular assist devices (LVAD) could relieve this problem either as a bridge-to-transplant (BTT) or as a destination therapy (DT). Despite the widespread implantation of ventricular assist devices, their efficacy may be limited by some serious adverse events, while infection is a major issue. A longer period of LVAD support significantly increases the risk of driveline infections (DLI). The Jarvik 2000® ventricular assist device (Jarvik Heart, New York, NY, USA) offers prolonged infection-free survival. In our report, we present the case of a 61-year-old female patient with a driveline pedestal that has become fully detached from the skull following a fall trauma. We describe how the traumatized pedestal was surgically replaced by removing the previous, damaged unit and inserting a repositioned new one. The surgical procedure presented in our case has not been performed before and we have not found any similar one in the literature. It requires individual surgical planning and a multidisciplinary surgeon's team to ensure the procedure is safe and feasible.

Self-rated health is associated with the length of stay at the intensive care unit and hospital following cardiac surgery.

BACKGROUND: Recently, a considerable amount of evidence suggested that anxiety, depression and other psychosocial variables might influence the outcomes of cardiac surgery. This study investigated the relationship between length of stay at the intensive care unit (ICU) and hospital after surgery and different psychosocial variables (e.g. depression, anxiety, self rated health, happiness, satisfaction). METHODS: We enrolled prospective patients who were waiting for elective cardiac surgery (N = 267) and consented to take part in the study. We collected data of sociodemographic, medical and perioperative factors as well as psychosocial questionnaires completed 1.56 days (standard deviation [SD] = 0.7) before surgery. The primary clinical endpoint was an ICU stay of at least 3 days and the secondary was hospital stay of at least 10 days. RESULTS: Two hundred sixty-seven patients participated in this study. Four patients (1.5%) died in the hospital and 38 patients (14.5%) spent more than 3 days in the ICU and 62 patients (23.2%) spent more than 10 days in the hospital. After controlling for medical and sociodemographic factors, lower self rated health (Adjusted Odds Ratio [AOR]: 0.51, 95% confidence interval [CI]: 0.28-0.95; p = 0.03), lower rate of happiness (AOR: 0.76, 95% CI: 0.59-0.97, p = 0.03), postoperative cardiac failure (AOR: 7.09, 95% CI:1.21-41.54; p = 0.03) and postoperative complications (AOR: 9.52, 95% CI: 3.76-24.11; p < 0.001) were associated with longer ICU stay. More than 10 days of hospital stay was associated with higher occurrence of COPD (AOR 4.56, CI: 1.95-10.67, p < 0.001), NYHA stage (AOR 6.76, CI: 2.57-17.79, p < 0.001), operation time (AOR 1.45, CI: 1.19-1.76, p < 0.001), female gender (AOR 2.16, CI: 1.06-4.40, p = 0.034) and lower self-rated health (AOR 0.63, CI: 0.41-0.99, p = 0.044). CONCLUSIONS: Lower happiness and self-rated health may influence the outcome of cardiac surgery. Therefore, these variables should be assessed in patients.

The impact of preoperative anxiety and education level on long-term mortality after cardiac surgery.

BACKGROUND: Psychosocial factors have shown independent predictive value in the development of cardiovascular diseases. Although there is strong evidence to support the role of psychosocial factors in cardiovascular mortality, there is a scarcity of knowledge about how these factors are related. Therefore, we investigated the relationship between depression, anxiety, education, social isolation and mortality 7.5 years after cardiac surgery. METHODS: After informed consent, 180 patients undergoing cardiac surgery between July 2000 and May 2001 were prospectively enrolled and followed for ten years. During the follow-up period, the patients were contacted annually by mail. Anxiety (Spielberger State-Trait Anxiety Inventory, STAI-S/STAI-T), depression (Beck Depression Inventory, BDI) and the number and reason for rehospitalizations were assessed each year. Those patients who did not respond were contacted by telephone, and national registries were searched for deaths. RESULTS: During a median follow-up of 7.6 years (25th to 75th percentile, 7.4 to 8.1 years), the mortality rate was 23.6% (95% confidence interval [CI] 17.3-29.9; 42 deaths). In a Cox regression model, the risk factors associated with an increased risk of mortality were a higher EUROSCORE (points; Adjusted Hazard Ratio (AHR):1.30, 95%CI:1.07-1.58)), a higher preoperative STAI-T score (points; AHR:1.06, 95%CI 1.02-1.09), lower education level (school years; AHR:0.86, 95%CI:0.74-0.98), and the occurrence of major adverse cardiac and cerebral events during follow up (AHR:7.24, 95%CI:2.65-19.7). In the postdischarge model, the same risk factors remained. CONCLUSIONS: Our results suggest that the assessment of psychosocial factors, particularly anxiety and education may help identify patients at an increased risk for long-term mortality after cardiac surgery.