Early Repair of Sternal Instability Prevents Mediastinitis

Background: Discharge due to superficial wound infection and sternal dehiscence are the common complications of median sternotomy. This condition leads to mediastinitis. Mediastinitis is a serious condition which increases morbidity, mortality and hospital costs. The correct time for surgical treatment is contraversial in cases who have sternal dehiscence and discharge due to superficial infection. In this study, patients received sternal stabilization as soon as a diagnosis was made and monitored for the development of mediastinitis. Methods: Among the 1440 patients who had undergone elective CABG, a total of 85 patients who developed sternal dehiscence and superficial wound discharge were included in this study. These patients were re-operated on as soon as diagnosed and early sternal stabilization was provided. Results: The ratio of overall dehiscence was 5.9%. Mediastinitis developed in only 2 of the 85 patients. These patients were treated with VAC (Vacuum Assisted Closure) therapy. The ratio of overall mediastinitis was 0.13. Mediastinitis-related mortality was not detected. Conclusion: The ratio of mediastinitis decreases when patients who have discharge due to sternal dehiscence and superficial wound infection are immediately reviewed without waiting for the results of conventional methods such as antibiotic treatment and chest binder support.

High Altitude: A Possible Reason for Postoperative Bleeding after Coronary Artery Bypass Graft Operations

Background: This study evaluated the possible hypothesis that high altitude might be a reason of excessive postoperative drainage after coronary artery bypass graft operations (CABG). Methods: 212 patients were operated by the same surgical team and included to the study with retrospective data scan on postoperative bleeding after elective CABG with cardiopulmonary bypass (CPB). Study was derived from two different altitude centers: Group A patients (n = 107) from the center at an altitude of 1985 meters and Group B patients (n = 105) from the center in approximately sea level with 150 meters altitude. Multiple preoperative, intraoperative and postoperative characteristics with postoperative bleeding amounts were reviewed and calculated to determine a result through the aim of our study. Results: Preoperative, operative and intraoperative parameters for both groups were almost identical. Statistically significance occurred on intensive care unit treatment period, total hospitalization days, usage of erythrocyte suspension and fresh frozen plasma among postoperative periods on behalf of Group B. Parameters such as CABG numbers, Cross clamp and CPB time were not significant. High altitude patients were considered to be with a higher outcome in preoperative hematocrit (Htc) levels which did not occur in the study group. Htc levels presented a slight elevation for Group A as in the preoperative values but a statistically significance was not calculated. Postoperative bleeding volumes and calculated mean values were statistically significantly different among both groups in days of 1, 2 and 3. Reoperations for hemorrhage occurred in 9 cases (8.4%) in Group A and 4 cases (3.8%) in Group B. Conclusions: We want to attract attention to the relation between high altitude and postoperative bleeding after CABG surgery. But yet uncertain and unidentified physiological and biochemical conditions can be a reason as an uncontrollable perioperative factor in this patients. Operation at high altitude can be a reason for postoperative excessively bleeding.

Comparison of the Modified Eversion Carotid Endarterectomy Technique with the Conventional Carotid Endarterectomy Technique: Early Results

Objectives: In this study, we aimed to compare early results of the modified eversion carotid endarterectomy technique with the conventional carotid endarterectomy technique. The modified eversion carotid endarterectomy technique consisted of a longitudinal arteriotomy that was begun from the common carotid artery proximally to the origin of external carotid artery. We also avoided applying a carotid shunt during surgery in both techniques. Methods: Each patient was evaluated for coronary artery stenosis and valve replacement indications. Diagnosis of significant coronary artery stenosis or valve disease directed us to a combination of CEA and cardiac surgery (CABG/Valvular). We generally had a tendency to perform these two surgical procedures separately. Patients which had surgery for both at the same session were excluded in this study. As a result, our study included 120 patients and 137 carotid interventions. We performed the modified eversion carotid endarterectomy technique in 61 patients (68 carotid interventions) (Group A) and the conventional CEA technique in 59 patients (69 carotid interventions) (Group B). At follow-up, the patients were evaluated by physical examination and color Doppler USG. Results: There was no significant difference between the groups in terms of demographic data. Statistically significant difference was observed in one operative parameter between Group A and Group B;patchplasty requirements during surgery (12 carotid interventions in group B and 4 carotid interventions in group A, p = 0.036). We recorded temporary tongue deviation in five cases, facial asymmetry in eight cases, hoarseness in four cases, neurocognitive impairment in three cases and transient neurologic in two cases with no significant difference between the groups. There was in one case of permanent neurologic deficit (1 in group B). There were two postoperative deaths (1 in group A and 1 in group B). The death in group A occurred because of subarachnoid haemorrhage and the death in group B occurred because of myocardial infarction. After 6 month follow-up, no restenosis occurred in group A. Restenosis occurred in three patients of group B. Conclusion: The modified eversion technique for carotid endarterectomy decrease the incidence of patchplasty applications and postoperative restenosis by avoiding internal carotid artery manipulation and sewing. Besides, it is easy and possible to remove plaques completely from internal carotid artery via the modified arteriotomy line.