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1.
Kyobu Geka ; 74(6): 465-468, 2021 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-34059594

RESUMO

We report a case of a 64-year-old man with descending necrotizing mediastinitis. He had undergone ascending aortic replacement for Stanford type A acute dissection five years before, and thoracic endovascular aortic repair from the distal arch to the descending aorta for dilation of residual dissection three years before. The patient was admitted to our hospital complaining persistent fever, rubescent neck and chest. Computed tomography( CT) revealed a deep-seated mass extending between the neck and the right upper mediastinum and another mass around the ascending aorta graft. Computed tomography-guided drainage revealed infection of both masses. Surgical debridement, graft replacement, and omental flap transposition were performed. He recovered uneventfully, and no relapse of infection was observed.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Torácica , Mediastinite , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/cirurgia , Aorta , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Humanos , Masculino , Mediastinite/diagnóstico por imagem , Mediastinite/etiologia , Mediastinite/cirurgia , Pessoa de Meia-Idade
2.
Br J Oral Maxillofac Surg ; 59(6): 683-689, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34001379

RESUMO

We performed a systematic review of the literature about descending necrotising mediastinitis (DNM) of odontogenic origin. In parallel, a retrospective review of this pathology was carried out in an Oral and Maxillofacial Surgery Service of a reference hospital for a population of 1,100,000 inhabitants. The main objectives were to determine changes in mortality and prevalence of this serious complication. The systematic review included 51 articles with 89 patients and our study comprised seven patients. The period of time with the highest number of cases was between 2000-2009 (38 patients). The percentage of mortality observed was 20.2% in diffuse DNM and 4.9% in localised DNM. Thirty-one patients with DNM in our review were admitted for more than 41 days. Despite evidence of a decrease in DNM cases, publications have increased over the years, but it does not appear to be due to an increase in those of odontogenic origin. The survival of DNM has improved since 1998 and remained stable since then. Despite the low prevalence of this disease, multicentre control studies are needed to achieve better evidence about this entity.


Assuntos
Mediastinite , Drenagem , Humanos , Mediastinite/epidemiologia , Mediastinite/etiologia , Necrose , Estudos Retrospectivos
3.
Medicine (Baltimore) ; 100(20): e25973, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34011084

RESUMO

INTRODUCTION: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is less commonly used in nonmalignant diseases. In particular, its application in mediastinal cystic lesions has been reported less frequently. EBUS-TBNA is a reassuringly safe procedure with an overall complication rate less than 2%, and serious adverse event rate of 0.14% to 0.16%. The most common complications are infections (mediastinal cyst infection most seen). PATIENT CONCERNS: A 28-year-old male presented to the hospital with mediastinal cyst that was incidentally discovered by computed tomography. There was no past history of the patient reviewed. DIAGNOSIS: The cyst was identified as a round, anechoic structure by EBUS and serous fluid was aspirated. The carcino-embryonic antigen, mycobacterium tuberculosis DNA and cultures in the fluid were negative. Cytology analysis showed lots of lymphocytes and no malignant cells. The diagnosis of lymphangioma was confirmed based on the computed tomography and EBUS presentation, the nature of the aspirated fluid and the large number of mature lymphocytes within the cystic fluid. INTERVENTIONS: Twenty-six hours after EBUS-TBNA, the patient complained of a fever with the highest temperature of 39°C, accompanied by a right-side chest pain, no other symptoms of were reported. The following examinations confirmed the diagnosis of pneumonia, pleurisy, mediastinitis and mediastinal cyst infection, while cultures from cyst and right pleural effusion were both negative. The patient was treated with Teicoplanin+Imipenem/cilastatin, and ultrasound guided transcutaneous catheterization drainage of mediastinal cyst and pleural effusion were performed. OUTCOMES: Seven days after the treatments, the patient's symptoms resolved, the complete blood count, C-reactive protein, erythrocyte sedimentation rate were lowered. The size of the cyst was slightly reduced on 17 June compared to that before EBUS-TBNA. Although the surgical resection of the cyst was recommended, the patient declined. After extracted the two drainage tubes, the patient was discharged on June 22. The patient was followed up by telephone 6 months after discharge and he remained asymptomatic. CONCLUSIONS: EBUS-TBNA is a useful diagnostic and therapeutic tool for the management of mediastinal cysts. However, considering the possibility of serious complications, the clinical procedure should be carried out scrupulously with appropriate patient selection and strict aseptic principles.


Assuntos
Broncoscopia/efeitos adversos , Cisto Mediastínico/cirurgia , Mediastinite/etiologia , Pleurisia/etiologia , Pneumonia/etiologia , Infecção da Ferida Cirúrgica/etiologia , Adulto , Antibacterianos/uso terapêutico , Broncoscopia/métodos , Terapia Combinada , Drenagem , Quimioterapia Combinada , Endossonografia , Humanos , Achados Incidentais , Masculino , Cisto Mediastínico/diagnóstico por imagem , Cisto Mediastínico/microbiologia , Mediastinite/diagnóstico , Mediastinite/terapia , Pleurisia/diagnóstico , Pleurisia/terapia , Pneumonia/diagnóstico , Pneumonia/terapia , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/terapia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
5.
J Card Surg ; 36(7): 2558-2561, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33880792

RESUMO

The 7-year long-term survival after Aspergillus fumigatus mediastinitis after heart transplantation, an uncommonly described condition, is herein reported. A 66-year-old male developed an infection with A. fumigatus covering the entire thoracic cavity with a fungal turf after orthotopic heart transplantation. Repeated surgical removal of infectious and necrotic tissue together with innovative topical treatment using voriconazole and chlorhexidine combined with systemic antifungal treatment, helped in controlling the infection. Definitive wound closure was achieved by standard sternal refixation and latissimus dorsi muscle flap plasty. Survival after A. fumigatus mediastinitis after heart transplantation was achieved with sequential debridement in combination with topical application of antifungal agents.


Assuntos
Aspergilose , Transplante de Coração , Mediastinite , Idoso , Aspergilose/tratamento farmacológico , Aspergillus , Humanos , Masculino , Mediastinite/tratamento farmacológico , Mediastinite/etiologia , Infecção da Ferida Cirúrgica/tratamento farmacológico , Resultado do Tratamento , Voriconazol
6.
Braz J Cardiovasc Surg ; 36(4): 565-570, 2021 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-33577255

RESUMO

This study presents the method used for chest reconstruction and treatment of mediastinitis following cardiac surgery at the Heart Institute of the University of São Paulo Medical School. After infection control with antibiotic therapy associated with aggressive surgical debridement and negative pressure wound therapy, chest reconstruction is performed using flaps. The advantages and disadvantages of negative pressure wound therapy are discussed, as well as options for flap-based chest reconstruction according to the characteristics of the patient and sternum. Further studies are needed to provide evidence to support the decisions when facing this great challenge.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Mediastinite , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Desbridamento , Humanos , Mediastinite/etiologia , Faculdades de Medicina , Esternotomia/efeitos adversos , Esterno/cirurgia , Infecção da Ferida Cirúrgica/etiologia , Resultado do Tratamento
7.
Khirurgiia (Mosk) ; (2): 53-57, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33570355

RESUMO

OBJECTIVE: To assess the possibilities of omentoplasty for prevention of complications after redo sternum osteosynthesis for traumatic rupture. MATERIAL AND METHODS: The study included 53 patients with recurrent sternal diastasis. Greater omentum was additionally implanted in 19 (35.8%) cases to improve healing and reduce the risk of infectious complications. In 34 patients, redo osteosynthesis was carried out using a metal wire and deployment of irrigation-aspiration system. In 19 patients, omentoplasty was additionally used to close the wound. RESULTS: Omentoplasty was characterized by less duration of lavage (7.4±1.5 vs. 4.2±3.3 days, p<0.0001) and no cases of arrosive bleeding (p=0.04). CONCLUSION: Omentoplasty reduces duration of treatment and risk of arrosive bleeding.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Fixação Interna de Fraturas/métodos , Mediastinite/cirurgia , Omento , Esterno/cirurgia , Cicatrização , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Humanos , Mediastinite/etiologia , Mediastinite/prevenção & controle , Omento/cirurgia , Omento/transplante , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/prevenção & controle , Recidiva , Irrigação Terapêutica
8.
J Med Vasc ; 46(1): 9-12, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33546823

RESUMO

Superior vena cava syndrome is the clinical expression of the obstruction of the superior vena cava reducing the blood flow. Malignant etiologies are the most common. Its management is multidisciplinary and despite the progress of endovascular procedures, conventional surgery retains its place in certain indications. Mediastinal fibrosis secondary to tuberculosis lymphadenopathy may be associated with superior vena cava syndrome. In the presence of symptomatic SVCS associated with extensive mediastinal fibrosis compressing the superior vena cava with sub occlusive thrombosis, conventional surgery remains a treatment option, with cavo-venous derivation by prosthetic bypass.


Assuntos
Mediastinite/etiologia , Esclerose/etiologia , Síndrome da Veia Cava Superior/etiologia , Tuberculose dos Linfonodos/complicações , Corticosteroides/uso terapêutico , Adulto , Antituberculosos/uso terapêutico , Implante de Prótese Vascular , Feminino , Humanos , Mediastinite/diagnóstico por imagem , Mediastinite/tratamento farmacológico , Esclerose/diagnóstico por imagem , Esclerose/tratamento farmacológico , Síndrome da Veia Cava Superior/diagnóstico por imagem , Síndrome da Veia Cava Superior/cirurgia , Resultado do Tratamento , Tuberculose dos Linfonodos/diagnóstico , Tuberculose dos Linfonodos/tratamento farmacológico
9.
Artigo em Inglês | MEDLINE | ID: mdl-33577144

RESUMO

Deep sternal wound infection is a major complication of cardiac surgery, with a low incidence but with catastrophic consequences in terms of morbidity, mortality, and health-care costs. Negative pressure wound therapy and appropriately timed sternal revision, with or without muscle flap mobilization, can improve the outcomes. This video tutorial illustrates the technical aspects of the surgical treatment of mediastinitis with the Robicsek method for sternal closure and an original wound closure technique, very effective and much simpler than the pectoral muscle flap technique.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Mediastinite/cirurgia , Infecção da Ferida Cirúrgica/cirurgia , Técnicas de Fechamento de Ferimentos , Idoso , Humanos , Masculino , Mediastinite/etiologia , Tratamento de Ferimentos com Pressão Negativa , Reoperação , Esternotomia/efeitos adversos , Esterno/cirurgia , Retalhos Cirúrgicos , Infecção da Ferida Cirúrgica/complicações , Resultado do Tratamento
10.
J Mycol Med ; 31(2): 101109, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33422936

RESUMO

We report a case of a 50-year-old shepherd hospitalized in intensive care unit for hiatal hernia complicated by an occlusive syndrome. In post-surgery, an acute respiratory distress occurs due to mediastinitis with large pleural effusion. At the laboratory, direct examination of the pleural sample revealed the presence of pseudohyphae. Kazachstania slooffiae was identified by Mass Spectrometry and confirmed by DNA sequencing. This uncommon yeast has never been previously described in human infections. Although its pathogenicity is not well known, K. slooffiae should be considered in the case of critically ill patients.


Assuntos
Micoses/diagnóstico por imagem , Derrame Pleural/microbiologia , Saccharomycetales/genética , Antifúngicos/uso terapêutico , Cuidados Críticos , Hérnia Hiatal/complicações , Hérnia Hiatal/diagnóstico por imagem , Hérnia Hiatal/cirurgia , Humanos , Masculino , Mediastinite/diagnóstico por imagem , Mediastinite/etiologia , Mediastinite/microbiologia , Pessoa de Meia-Idade , Micoses/tratamento farmacológico , Micoses/microbiologia , Saccharomycetales/efeitos dos fármacos , Saccharomycetales/isolamento & purificação , Saccharomycetales/patogenicidade , Análise de Sequência de DNA , Tomografia Computadorizada por Raios X
14.
J Thorac Cardiovasc Surg ; 162(4): 1125-1130.e1, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32386766

RESUMO

OBJECTIVES: Perioperative bacterial decolonization and prophylactic antibiotic therapy at the Veterans Affairs Health Care System have changed over the past decade. Our objectives were to identify associated changes in the microbiology of mediastinitis and to perform a contemporary survival analysis in patients with mediastinitis after isolated coronary artery bypass grafting procedure. METHODS: From January 2006 to December 2015, 45,323 consecutive patients underwent coronary artery bypass grafting at 83 medical centers. The Veterans Affairs Health Care System nationwide administrative database was queried to identify patients with postoperative mediastinitis and obtain patient-level data. Simple descriptive statistics and multivariable logistic regression were used to analyze microbiologic data and identify risk factors for infection. Poisson regression was used to determine yearly incidence estimates. Cox proportional hazard model identified predictors of long-term survival from date of operation. RESULTS: During the study period, 348 patients (0.78%) developed postoperative mediastinitis-with a stable rate of incidence (Cochrane-Armitage test, P = .69). Of patients with microbiologic data, 75.5% of infections (n = 188) were caused by gram-positive and 24.5% (n = 61) gram-negative organisms. The incidence of methicillin-resistant Staphylococcus aureus mediastinitis decreased during the study period (Cochrane-Armitage test, P = .013). Gram-negative mediastinitis occurred earlier than gram-positive mediastinitis (median, 15.0 vs 25.0 days; P < .0001). Patients with mediastinitis did not have increased 30-day mortality (2.0% vs 1.9%; P = .9), but had worse long-term survival compared with uninfected patients (P < .0001). CONCLUSIONS: The incidence of methicillin-resistant S aureus mediastinitis has decreased over the past decade. Gram-negative bacteria are responsible for 1 in 4 cases of mediastinitis and infection is diagnosed earlier in the postoperative period than gram-positive mediastinitis. These findings highlight the need for efforts to prevent gram-negative and methicillin-susceptible S aureus mediastinitis.


Assuntos
Antibioticoprofilaxia/métodos , Ponte de Artéria Coronária/efeitos adversos , Mediastinite , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Complicações Pós-Operatórias , Infecções Estafilocócicas , Infecção da Ferida Cirúrgica , Idoso , Ponte de Artéria Coronária/métodos , Feminino , Humanos , Incidência , Masculino , Mediastinite/epidemiologia , Mediastinite/etiologia , Mediastinite/microbiologia , Mediastinite/terapia , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/prevenção & controle , Modelos de Riscos Proporcionais , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/etiologia , Infecções Estafilocócicas/prevenção & controle , Infecção da Ferida Cirúrgica/microbiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Estados Unidos/epidemiologia , Saúde dos Veteranos/estatística & dados numéricos
15.
Ann Vasc Surg ; 73: 509.e21-509.e24, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33333193

RESUMO

Aortic and arterial calcification is a complication of advanced atherosclerosis and is a critical intraoperative issue that can reduce the ability to achieve safe and adequate access for stent graft introduction. Different vascular access sites are used to deliver stent grafts when a standard transfemoral or iliac access is not feasible. We report a challenging case of a direct transabdominal aortic thoracic endovascular aortic repair for a thoracic aortic aneurysm complicated with severe aortic and arterial calcification, in which the noncalcified area of the infrarenal abdominal aorta was extremely limited. This may be a reasonable access site, especially for patients with severe aortic and arterial calcification.


Assuntos
Aneurisma Infectado/cirurgia , Aorta Abdominal , Aorta Torácica/cirurgia , Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Calcificação Vascular/cirurgia , Idoso , Aneurisma Infectado/complicações , Aneurisma Infectado/diagnóstico por imagem , Aorta Abdominal/diagnóstico por imagem , Aorta Torácica/diagnóstico por imagem , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico por imagem , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Procedimentos Endovasculares/instrumentação , Humanos , Masculino , Mediastinite/etiologia , Índice de Gravidade de Doença , Resultado do Tratamento , Calcificação Vascular/complicações , Calcificação Vascular/diagnóstico por imagem
16.
Khirurgiia (Mosk) ; (12): 93-98, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33301261

RESUMO

Perforation of the esophagus is a serious and dangerous condition due to progressive development of mediastinitis and sepsis. This disease is often fatal. In the last decade, endoscopic stenting of the esophagus became more common in these patients as an alternative to traditional surgery. We report successful minimally invasive endoscopic treatment of esophageal perforation with post-burn necrosis of its wall.


Assuntos
Perfuração Esofágica , Esofagoscopia , Mediastinite , Implantação de Prótese/métodos , Drenagem , Perfuração Esofágica/diagnóstico , Perfuração Esofágica/etiologia , Perfuração Esofágica/cirurgia , Humanos , Mediastinite/diagnóstico , Mediastinite/etiologia , Mediastinite/cirurgia , Sepse/etiologia , Stents
17.
BMJ Case Rep ; 13(12)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33370968

RESUMO

A 50-year-old Caucasian man presented to the emergency department during the early stages of the COVID-19 pandemic with a rapidly progressive facial swelling, fever, malaise and myalgia. The patient had recently travelled to a COVID-19-prevalent European country and was therefore treated as COVID-19 suspect. The day before, the patient sustained a burn to his left forearm after falling unconscious next to a radiator. A CT neck and thorax showed a parapharyngeal abscess, which was surgically drained, and the patient was discharged following an intensive care admission. He then developed mediastinitis 3 weeks post-discharge which required readmission and transfer to a cardiothoracic unit for surgical drainage. This report discusses the evolution of a deep neck space infection into a mediastinitis, a rare and life-threatening complication, despite early surgical drainage. This report also highlights the difficulties faced with managing patients during the COVID-19 pandemic.


Assuntos
COVID-19 , Drenagem , Mediastinite , Administração dos Cuidados ao Paciente/métodos , Complicações Pós-Operatórias , Abscesso Retrofaríngeo , Procedimentos Cirúrgicos Torácicos/métodos , COVID-19/tratamento farmacológico , COVID-19/epidemiologia , COVID-19/terapia , Doença Catastrófica/terapia , Diagnóstico Diferencial , Drenagem/efeitos adversos , Drenagem/métodos , Humanos , Controle de Infecções/métodos , Masculino , Mediastinite/diagnóstico , Mediastinite/etiologia , Mediastinite/fisiopatologia , Mediastinite/cirurgia , Pessoa de Meia-Idade , Pescoço/diagnóstico por imagem , Pescoço/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Abscesso Retrofaríngeo/diagnóstico , Abscesso Retrofaríngeo/fisiopatologia , Abscesso Retrofaríngeo/cirurgia , SARS-CoV-2 , Resultado do Tratamento
18.
J Pak Med Assoc ; 70(10): 1848-1850, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33159767

RESUMO

Reverse saphenous vein graft aneurysm (RSVGA) is a rare complication that occurs after coronary bypass grafting surgery. Mycotic aneurysm of reverse saphenous vein graft is even more rare. We describe the case of a 76-year-old man who underwent coronary artery bypass grafting 10 years back and had mediastinitis four to five months after surgery. He presented with chest pain in July 2017 and was diagnosed as NSTEMI. Angiography showed left main coronary artery disease (90%) with aneurysm of reverse saphenous vein graft to right posterior descending artery(RPDA). Emergent percutaneous coronary intervention (PCI) of the left main artery was performed as the patient suffered ventricular arrhythmia for which cardiopulmonary resuscitation (CPR) was done. After CPR, haematoma appeared on the left side of the sternum subcutaneously. CT scan of the chest was conducted which showed a pseudoaneurysm measuring 35 mm in the mid-segment of reverse saphenous vein graft (RSVG) to the right posterior descending artery (RPDA) with a surrounding mediastinal haematoma communicating with subcutaneous haematoma, so RSVGA to RPDA was coiled. As blood culture grew candida, antifungal medication was started. When the patient's condition stabilised he was discharged.


Assuntos
Falso Aneurisma , Aneurisma Infectado , Mediastinite , Intervenção Coronária Percutânea , Idoso , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Ponte de Artéria Coronária , Humanos , Masculino , Mediastinite/etiologia , Veia Safena/diagnóstico por imagem
19.
Acta Med Okayama ; 74(5): 431-433, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33106700

RESUMO

We encountered a rare case of thymic cyst accompanied by mediastinitis. A 39-year-old Japanese male presented with fever and chest pain. The chest CT revealed a mass composed of a lobular cystic lesion with inflammation, suggesting the onset of mediastinitis. A definitive histological diagnosis was not obtained, and we performed a thymectomy. Pathologically, the thymic cyst was accompanied by multiple cavities, mimicking thymic cysts, caused by the inflammatory abscess. The surrounding adipose tissue showed inflammatory cell infiltrations with chronic fibrosis. These findings indicate that clinicians should be aware that thymic cysts may cause severe mediastinitis.


Assuntos
Cisto Mediastínico/patologia , Mediastinite/diagnóstico , Adulto , Dor no Peito/etiologia , Febre/etiologia , Humanos , Masculino , Cisto Mediastínico/complicações , Cisto Mediastínico/diagnóstico por imagem , Mediastinite/etiologia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada
20.
Ann Thorac Cardiovasc Surg ; 26(5): 229-239, 2020 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-32921659

RESUMO

Bilateral internal mammary artery (BIMA) in coronary artery bypass grafting (CABG) has traditionally been limited. This review looks at the recent outcome data on BIMA in CABG focusing on the management of risk factors for mediastinitis, one of the potential barriers for more extensive BIMA utilization. A combination of pre-, intra- and postoperative strategies are essential to reduce mediastinitis. Limited data indicate that the incidence of mediastinitis can be reduced using closed incision negative-pressure wound therapy as a part of these strategies with the possibility of offering patients best treatment options by extending BIMA to those with a higher risk of mediastinitis. Recent economic data imply that the technology may challenge the current low uptake of BIMA by reducing the short-term cost differentials between single internal mammary artery and BIMA. Given that most published randomized controlled trials and meta-analyses of observational long-term outcome data favor BIMA, if short-term complications of BIMA including mediastinitis can be controlled adequately, there may be opportunities for more extensive use of BIMA leading to improved long-term outcomes. An ongoing study looking at BIMA in high-risk patients may provide evidence to support the hypothesis that mediastinitis should not be a factor in limiting the use of BIMA in CABG.


Assuntos
Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/cirurgia , Artéria Torácica Interna/cirurgia , Mediastinite/prevenção & controle , Ponte de Artéria Coronária/economia , Doença da Artéria Coronariana/economia , Redução de Custos , Análise Custo-Benefício , Custos de Cuidados de Saúde , Humanos , Mediastinite/economia , Mediastinite/etiologia , Fatores de Risco , Resultado do Tratamento
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