Journal and News Scan

The authors investigated the efficacy of vancomycin paste applied to the sternal edges during cardiac surgery in reducing the risk of deep sternal wound infection among nearly 14,500 cardiac surgical patients.  The incidence of such infections was 09.%.  In a multivariable analysis, BMI, NYHA class, and the STS DSWI risk index were significantly associated with deep sternal wound infection.  Vancomycin paste did not reduce the incidence of infection.

Using pigs as an experimental model, the authors demonstrated incorporation of bioengineered tracheal grafts in large tracheal defects.  The grafts were constructed of acellular bovine dermis extracellular matrix and human mesenchymal stem cells incubated with chondogenic factors.  The authors demonstrated that the use of stem cells resulted in chondrogenesis, and that the grafts developed neovascularization and epithelialization, all of which are important in supporting tracheal healing and growth.

This New STS Expert Consensus Statement is now available to download.

For the first time this protocol gives units who look after patients after cardiac surgery a complete guide for the management for patients who arrest.

Most notably there is a recommendation that patients should undergo an emergency resternotomy within 5 minutes if quickly reversible factors are not found, in order to save those patients who have arrested due to tamponade, for whom external CPR is ineffective.

There are recommendations for the organisation of the team, recommendations against the use of epinephrine, recommendations on how to identify rapidly reversible causes for the arrest and importantly there is advice as to how to implement this guidance into your unit and how to get trained.

The APACVS have also set up a training arm to help with the implementation of the protocol that can be found at www.csu-als.com

This article is a propensity matched analysis comparing patients undergoing hybrid coronary revascularization (HCR) with minimally invasive left internal mammary artery to left anterior descending artery (LAD) bypass and percutaneous coronary intervention (PCI) to non-LAD arteries to patients undergoing conventional coronary artery bypass grafting (CABG) with either single (SIMA) or bilateral internal mammary arteries (BIMA).  A total of 306 patients underwent HCR from 2003 to 2013 compared with 8254 patients undergoing CABG.  In the HCR group LIMA harvest was performed endoscopically before 2009 and with robotic assistance thereafter.   In the matched study populations, cardiopulmonbary bypass was used in 0% of patients in HCR group, 21% in SIMA group and 7% in BIMA group.  Patient factors that were associated with HCR use were older age, lower body mass index, history of PCI, and 2-vessel coronary disease. In the HCR group, 84% of non-LAD lesions were treated with drug eluting stents.  At 30 days, there was no significant difference in major cerebrovascular and cardiac events between groups.  In hospital complications,  the need for blood transfusions, and hospital stay duration were lower for the HCR group.  There was no difference in survival between the matched groups at midterm followup (median follow-up 2.8 years).   The authors conclude that HCR in selected patients may be a safe and less invasive alternative to conventional CABG with similar short and midterm outcomes.