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Prospective validation of a predictive scoring system for deep sternal wound infection after routine bilateral internal thoracic artery grafting
No full textOBJECTIVES:
The Gatti score is a weighted scoring system based on risk factors for deep sternal wound infection (DSWI) that has been specifically created to predict DSWI risk after routine bilateral internal thoracic artery (BITA) grafting. It has not undergone an external validation. The aim of the present study was to perform this validation.
METHODS:
BITA grafts were used as skeletonized conduits in 304 (90.7%) of 335 consecutive patients with multivessel coronary artery disease who underwent isolated coronary bypass surgery at the authors' institution between January 2014 and July 2015. Baseline characteristics, operative data and immediate outcomes of every patient were prospectively collected in a computerized data registry. A score was assigned to each patient preoperatively. The goodness-of-fit and the discrimination power of both models, preoperative and combined, of the Gatti score were assessed with the Hosmer-Lemeshow test and the calculation of the area under the receiver-operating characteristic curve, respectively.
RESULTS:
Eighteen (5.9%) patients suffered from DSWI. Major differences were found between the original series whence the Gatti score has been derived and the present prospective series. The Gatti score goodness-of-fit was satisfactory for both the preoperative (P = 0.61) and the combined model (P = 0.81). The area under the receiver-operating characteristic curve was 0.82 (95% confidence interval: 0.72-0.91) for the preoperative model and 0.8 (95% confidence interval: 0.71-0.9) for the combined model.
CONCLUSIONS:
On the basis of the results of the present prospective study, the Gatti score has proved to be effective in predicting DSWI following BITA grafting despite some differences between the original and the present series of patients. More studies have to be performed in order to strengthen the evidence of this first external validation
First case of rapid-deployment Edwards INTUITY® Valve System Implantation in a patient with pure aortic valve regurgitation and ascending aortic aneurysm: a new solution for the future?
No full textRapid-deployment aortic valve system was designed for the treatment of aortic stenosis to enhance minimally invasive surgical techniques and to reduce ischemic and cardiopulmonary bypass time. Up to now, there are no indications to apply this system in the setting of pure aortic valve insufficiency. We report the first case of rapid deployment Edwards INTUITY (R) Valve System implantation in a 78-year-old patient affected by pure aortic valve regurgitation, ascending aortic aneurysm and multivessel coronary artery disease
Coronary Artery Bypass Grafting Using an Arteriovenous I-Conduit: Benefits and Drawbacks
No full textN/
Asymmetric ring annuloplasty for ischemic mitral regurgitation: early and mid-term outcomes
No full textThe Carpentier-McCarthy-Adams IMR ETlogix annuloplasty ring was specifically designed to treat ischemic mitral regurgitation (IMR) associated with asymmetric mitral annular dilation and leaflet tethering. The study aim was to review, retrospectively, the results of mitral annuloplasty with this asymmetric ring in a representative number of patients
Pulmonary artery aneurysm and sarcoidosis
No full textPulmonary artery aneurysm unassociated to congenital heart disease and pulmonary hypertension is exceedingly rare. Its pathogenesis and correct management remain unknown. Sarcoidosis is a systemic disease that can exceptionally involve large vessels, leading to stenosis and dilatation. Pulmonary artery aneurysm has never been described in association with sarcoidosis. Surgical approach should prevent aneurysm rupture, but it is not known when surgery should be preferred to strict medical follow-up. In this report we present a case of large pulmonary artery aneurysm associated to systemic sarcoidosis underlining problematic management of diseases 'forgotten' by evidence based medicine
Validation of a Predictive Scoring System for Deep Sternal Wound Infection after Bilateral Internal Thoracic Artery Grafting in a Cohort of French Patients
No full textThe Gatti score is a weighted scoring system based on risk factors for deep sternal wound infection (DSWI) that was created in an Italian center to predict DSWI risk after bilateral internal thoracic artery (BITA) grafting. No external evaluation based on validation samples derived from other surgical centers has been performed. The aim of this study is to perform this validation
Urgent Coronary Revascularization with Bilateral Internal Thoracic Artery Grafting: Is the Risk Justified?
No full textBackground The frequent need of immediate institution of cardiopulmonary bypass because of ischemia and increased risk of bleeding and longer duration of surgery limit the use of bilateral internal thoracic artery (BITA) grafting in urgency. Patients and Methods Of 4,525 consecutive patients with multivessel coronary artery disease who underwent isolated coronary bypass surgery at the authors' institution (1999-September 2015), 121 (2.7%) patients had an operation before the beginning of the next working day after decision to operate, which is the definition for emergency according to the European System for Cardiac Operative Risk Evaluation II. BITA and single internal thoracic artery (SITA) grafting were used in 52 and 46 of these patients, respectively; venous grafts alone were used in the remaining cases. BITA and SITA patients were compared as risk profiles, operative data, and outcomes. A propensity score (PS)-matched analysis was also performed. Results Between BITA and SITA patients, there was no significant difference as hospital mortality, both in the overall (3.8 vs. 6.5%; p = 0.66) and the PS-matched series (0 vs. 4.3%; p = 1). Among the postoperative complications, only bleeding (but not blood transfusion nor mediastinal re-exploration) was increased both in the overall (p = 0.037) and the PS-matched series of BITA patients (p = 0.092); duration of surgery was increased but not quite significantly (p = 0.12). Freedom from cardiac and cerebrovascular deaths, and major adverse cardiac and cerebrovascular events were higher in PS-matched BITA patients, even though not quite significantly (p = 0.11 for both). Conclusion BITA grafting may be performed even in urgency. With respect to SITA grafting, hospital mortality and postoperative complications other than bleeding are not increased; late outcomes seem to be better
The Impact of Diabetes on Early Outcomes after Routine Bilateral Internal Thoracic Artery Grafting
No full textBACKGROUND:
Increased risk of postoperative complications limits use of bilateral internal thoracic artery (BITA) grafting in diabetic patients. The authors' experience in routine BITA grafting was reviewed to investigate the impact of diabetes on early outcomes.
METHODS:
Among the 4508 consecutive patients with multivessel coronary artery disease who underwent isolated coronary bypass surgery from January 1999 throughout August 2015, skeletonised BITA grafts were used in 3228 (71.6%) patients, 972 diabetic and 2256 non-diabetic. After one-to-one propensity score (PS)-matched analysis, 819 pairs of diabetic/non-diabetic patients were compared for postoperative outcomes. The operative risk was calculated for each patient according to the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II).
RESULTS:
Although diabetic had higher risk profiles than non-diabetic patients both in unmatched (EuroSCORE II: 5.3±7.3% vs. 3±4.2%, p<0.0001) and PS-matched series (EuroSCORE II: 5.1±7.1% vs. 3.6±4.3%, p<0.0001), there were no differences in hospital mortality (2.2% vs. 1.8%, p=0.52 and 2.1% vs. 2.3%, p=0.74, respectively). In PS-matched pairs, the use of adrenergic agonists (p=0.03), postoperative bleeding (p=0.0055) and deep incisional sternal wound infection (p=0.0018) were more frequent in diabetic patients who had a mean of longer hospital stays (p=0.023).
CONCLUSIONS:
Bilateral internal thoracic artery grafting may be routinely performed even in diabetic patients despite higher risk profiles. Increased postoperative complications prolong hospital stay but do not impact on early mortality
Aortoaxillary bypass during cardiac operation.
No full textAIMS:
The aim of the present study was to analyze our experience in the use of the aortoaxillary bypass during cardiac operation in a limited series of patients with proximal atherosclerotic lesion of the subclavian artery combined with cardiac disease amenable to surgical treatment.
METHODS:
Of 1953 consecutive patients who underwent cardiac operation at our unit between April 2009 and July 2012, nine (0.5%; four women and five men; mean age 69.0 ± 6.2 years) suffered from symptomatic occlusive disease of the subclavian artery, and underwent concomitant aortoaxillary bypass. A ring-reinforced polytetrafluoroethylene vascular graft was anastomosed to the proximal segment of the axillary artery, introduced into the pleural cavity through the first or the second intercostal space, and anastomosed to the ascending aorta. All perioperative data were collected prospectively.
RESULTS:
Seven (77.8%) left and two (22.2%) right aortoaxillary bypasses were achieved. Ten concomitant cardiac operations were performed. There were no early postoperative complications related to the subclavian artery revascularization. At a mean follow-up of 27.3 ± 15.5 months, both the symptoms of the subclavian artery disease and those of the heart disease improved. High-resolution computed tomography angiography confirmed an excellent patency of the aortoaxillary bypass in all the patients but one.
CONCLUSION:
Concomitant aortoaxillary bypass and cardiac operation may be an option to keep in mind for patients with coexisting subclavian artery occlusion and heart disease, after the evidence that the combined operation does not increase the risk. Attention should be paid to the course of the bypass graft toward the axillary artery
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