1
|
Robu M, Rădulescu B, Margarint I, Știru O, Antoniac I, Gheorghiță D, Voica C, Nica C, Cacoveanu M, Iliuță L, Iliescu VA, Moldovan H. Surgical Strategy for Sternal Closure in Patients with Surgical Myocardial Revascularization Using Mammary Arteries. J Cardiovasc Dev Dis 2023; 10:457. [PMID: 37998515 PMCID: PMC10672728 DOI: 10.3390/jcdd10110457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/01/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Coronary artery bypass grafting has evolved from all venous grafts to bilateral mammary artery (BIMA) grafting. This was possible due to the long-term patency of the left and right internal mammary demonstrated in angiography studies compared to venous grafts. However, despite higher survival rates when using bilateral mammary arteries, multiple studies report a higher rate of surgical site infections, most notably deep sternal wound infections, a so-called "never event". METHODS We designed a prospective study between 1 January 2022 and 31 December 2022 and included all patients proposed for total arterial myocardial revascularization in order to investigate the rate of surgical site infections (SSI). Chest closure in all patients was performed using a three-step protocol. The first step refers to sternal closure. If the patient's BMI is below 35 kg/m2, sternal closure is achieved using the "butterfly" technique with standard steel wires. If the patient's BMI exceeds 35 kg/m2, we use nitinol clips or hybrid wire cable ties according to the surgeon's preference for sternal closure. The main advantages of these systems are a larger implant-to-bone contact with a reduced risk of bone fracture. The second step refers to presternal fat closure with two resorbable monofilament sutures in a way that the edges of the skin perfectly align at the end. The third step is skin closure combined with negative pressure wound therapy. RESULTS This system was applied to 217 patients. A total of 197 patients had bilateral mammary artery grafts. We report only 13 (5.9%) superficial SSI and only one (0.46%) deep SSI. The preoperative risk of major wound infection was 3.9 +/- 2.7. Bilateral mammary artery grafting was not associated with surgical site infection in a univariate analysis. CONCLUSIONS We believe this strategy of sternal wound closure can reduce the incidence of deep surgical site infection when two mammary arteries are used in coronary artery bypass surgery.
Collapse
Affiliation(s)
- Mircea Robu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.M.); (O.Ș.); (V.A.I.); (H.M.)
- Department of Cardiovascular Surgery, C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania;
| | - Bogdan Rădulescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.M.); (O.Ș.); (V.A.I.); (H.M.)
- Department of Cardiovascular Surgery, C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania;
| | - Irina Margarint
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.M.); (O.Ș.); (V.A.I.); (H.M.)
| | - Ovidiu Știru
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.M.); (O.Ș.); (V.A.I.); (H.M.)
- Department of Cardiovascular Surgery, C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania;
| | - Iulian Antoniac
- Faculty of Materials Science and Engineering, National University of Science and Technology Politehnica Bucharest, 060042 Bucharest, Romania; (I.A.); (D.G.)
- Academy of Romanian Scientists, 54, Spl. Independentei, 050711 Bucharest, Romania
| | - Daniela Gheorghiță
- Faculty of Materials Science and Engineering, National University of Science and Technology Politehnica Bucharest, 060042 Bucharest, Romania; (I.A.); (D.G.)
| | - Cristian Voica
- Department of Cardiovascular Surgery, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania; (C.V.); (C.N.); (M.C.)
| | - Claudia Nica
- Department of Cardiovascular Surgery, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania; (C.V.); (C.N.); (M.C.)
| | - Mihai Cacoveanu
- Department of Cardiovascular Surgery, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania; (C.V.); (C.N.); (M.C.)
| | - Luminița Iliuță
- Department of Cardiovascular Surgery, C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania;
| | - Vlad Anton Iliescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.M.); (O.Ș.); (V.A.I.); (H.M.)
- Department of Cardiovascular Surgery, C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania;
| | - Horațiu Moldovan
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.M.); (O.Ș.); (V.A.I.); (H.M.)
- Academy of Romanian Scientists, 54, Spl. Independentei, 050711 Bucharest, Romania
- Department of Cardiovascular Surgery, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania; (C.V.); (C.N.); (M.C.)
| |
Collapse
|
2
|
Moldovan H, Bulescu C, Cacoveanu M, Voica C, Safta S, Goicea M, Dobra I, Antoniac I, Gheorghiță D, Zaharia O. Minimally Invasive Surgical Repair of a Partial Atrioventricular Canal Defect in a 20-Year-Old Patient-A Case Report and Review of Literature. J Cardiovasc Dev Dis 2022; 9:jcdd9100352. [PMID: 36286304 PMCID: PMC9604241 DOI: 10.3390/jcdd9100352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/29/2022] [Accepted: 10/11/2022] [Indexed: 11/05/2022] Open
Abstract
The association of an ostium primum-type defect with a cleft anterior mitral valve is known in the medical literature as the partial form of an atrioventricular canal. We present a case report about a 20-year-old woman with minimal symptomatology that discovered her pathology on routine echocardiography. Today, surgical operation remains the gold standard in such pathologies, especially mandatory when there is important valvular regurgitation and left-to-right shunt. Currently living in the era of fast and good cosmetic outcomes, minimally invasive and endovascular approaches should be developed and more often practiced. This scientific presentation is the first step in showing our department steps in performing minimally invasive surgeries as a routine.
Collapse
Affiliation(s)
- Horațiu Moldovan
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania
- Academy of Romanian Scientists, 54, Spl. Independentei, 050711 Bucharest, Romania
- Correspondence: (H.M.); (D.G.)
| | - Cristian Bulescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Cardiovascular Surgery, Grigore Alexandrescu Emergency Hospital for Children, 011743 Bucharest, Romania
| | - Mihai Cacoveanu
- Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania
| | - Cristian Voica
- Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania
| | - Sabina Safta
- Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania
| | - Mihai Goicea
- Department of Cardiovascular Surgery, Grigore Alexandrescu Emergency Hospital for Children, 011743 Bucharest, Romania
| | - Irina Dobra
- Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania
| | - Iulian Antoniac
- Academy of Romanian Scientists, 54, Spl. Independentei, 050711 Bucharest, Romania
- Faculty of Materials Science and Engineering, Politehnica University of Bucharest, 060042 Bucharest, Romania
| | - Daniela Gheorghiță
- Faculty of Materials Science and Engineering, Politehnica University of Bucharest, 060042 Bucharest, Romania
- Correspondence: (H.M.); (D.G.)
| | - Ondin Zaharia
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Internal Medicine, Prof. Dr. Theodor Burghele Clinical Hospital, 050659 Bucharest, Romania
| |
Collapse
|