The impact of surgical site occurrences and the role of closed incision negative pressure therapy.

Surgical site occurrences are observed in up to 60% of inpatient surgical procedures in industrialised countries. The most relevant postoperative complication is surgical site infection (SSI) because of its impact on patient outcomes and enormous treatment costs. Literature reviews ('SSI', 'deep sternal wound infections' (DSWI), 'closed incision negative pressure wound therapy' (ciNPT) were performed by electronically searching MEDLINE (PubMed) and subsequently using a 'snowball' method of continued searches of the references in the identified publications.

Closed incision negative pressure therapy: international multidisciplinary consensus recommendations.

Surgical site occurrences (SSOs) affect up to or over 25% of patients undergoing operative procedures, with the subset of surgical site infections (SSIs) being the most common. Commercially available closed incision negative pressure therapy (ciNPT) may offer surgeons an additional option to manage clean, closed surgical incisions. We conducted an extensive literature search for studies describing ciNPT use and assembled a diverse panel of experts to create consensus recommendations for when using ciNPT may be appropriate.

Effect of surgical incision management on wound infections in a poststernotomy patient population.

Skin breakdown and infiltration of skin flora are key causative elements in poststernotomy wound infections. We hypothesised that surgical incision management (SIM) using negative pressure wound therapy over closed surgical incisions for 6-7 days would reduce wound infections in a comprehensive poststernotomy patient population. 'All comers' undergoing median sternotomy at our institution were analysed prospectively from 1 September to 15 October 2013 (study group, n = 237) and retrospectively from January 2008 to December 2009 (historical control group, n = 3508).

Prevention of poststernotomy wound infections in obese patients by negative pressure wound therapy.

Objective: The majority of wound infections after median sternotomy in obese patients are triggered by the breakdown of skin sutures and subsequent seepage of skin flora. The purpose of this study was to evaluate negative pressure wound dressing treatment for the prevention of infection. We hypothesized that negative pressure wound dressing treatment for 6 to 7 days applied immediately after skin closure reduces the numbers of wound infections.

Simultaneous aortic valve replacement in left ventricular assist device recipients: single-center experience.

Introduction: Aortic valve regurgitation or the presence of a mechanical aortic valve prosthesis is a relative contraindication for implantation of left ventricular assist devices (LVAD). However, concomitant aortic valve replacement by a biological prosthesis is one of the options in this situation. We analyzed our recent experience with left ventricular assist device implantation and concomitant aortic valve replacement.

Cyanoacrylate-sealed Donati suture for wound closure after cardiac surgery in obese patients.

The majority of wound infections after median sternotomy in obese patients are triggered by the breakdown of skin suture and subsequent seepage of skin flora into the deeper tissue layers. In a prospective study, 90 patients (body mass index ≥30) who had cardiac surgery via median sternotomy were enrolled. In 45 patients, skin closure was performed according to the Donati technique (vertical interrupted mattress suture) and sealed with octylcyanoacrylate (group A).

Infectious erosion of aorta ascendens during vacuum-assisted therapy of mediastinitis.

Sternal wound infection is a potentially life-threatening complication after cardiac surgery. With the vacuum-assisted closure (VAC) system a relatively new treatment option is available, with encouraging results and few complications. However, fatal right ventricular rupture for mechanical reasons has been reported.

Survival of patients with idiopathic pulmonary arterial hypertension after listing for transplantation: impact of iloprost and bosentan treatment.

Background: Survival after idiopathic pulmonary arterial hypertension (IPAH) diagnosis is often shorter than the waiting time for grafts. Iloprost and bosentan improve outcome in advanced IPAH (New York Heart Association Functional Class III), but there is controversy about the limits of their efficacy in end-stage (Class IV) IPAH.

Methods: We investigated the impact of iloprost (prostacyclin analog) and bosentan (endothelin-receptor antagonist) therapy on the outcome of patients with IPAH after listing for transplantation (Tx) to answer the following questions: (1) How efficient is this treatment in reducing mortality on waiting lists? (2) Is Tx still most promising for survival once recurrent right heart failure emerges, or can this treatment improve survival to an extent that exceeds post-Tx survival? We assessed the outcome of our IPAH patients listed for Tx between September 1996 and September 2005 in relation to kind and duration of medical treatment.

Coronary atherosclerosis of the donor heart--impact on early graft failure.

Objective: Due to the shortage of donor hearts, the criteria for organ acceptability have been considerably extended and donor grafts with coronary atherosclerosis are among those offered. This study evaluated whether and to what degree pre-existing coronary atherosclerosis may be acceptable.

Methods: A total of 1253 consecutive HTx recipients were investigated retrospectively for donor-transmitted coronary atherosclerosis (DCAS).

Prevalence of graft vessel disease after paediatric heart transplantation: a single centre study of 54 patients.

The study tested the prevalence of graft vessel disease (GVD) in 54 paediatric heart transplant (HTx) patients (32 male, age 0-17 years) who underwent coronary angiographic investigations (N=117). These were evaluated according to the Stanford classification and additional criteria (peripheral obliterations, diameter fluctuations, pathologic tapering) were applied for risk assessment (no GVD/minimal lesions, GVD without Stanford lesions, accelerated GVD). In H&E stainings from right ventricular endomyocardial biopsies (EMB=169) diagnosis of acute cellular rejection (ACR, ISHLT) and microvasculopathy were performed.

Observational study with everolimus (Certican) in combination with low-dose cyclosporine in de novo heart transplant recipients.

Background/methods: This observational study reports on immunosuppression with cyclosporine (CsA) in 38 de novo heart transplant recipients receiving everolimus compared with 14 patients receiving mycophenolate mofetil (MMF).

Results: Mean (+/- SD) everolimus C0 blood levels remained stable within 5 to 7 ng/ml. Mean CsA C0 blood levels were reduced by 47%, from 240 +/- 57 ng/ml at 2 weeks post-transplant to 128 +/- 38 ng/ml at Month 6 and by 58% to 101 +/- 26 ng/ml at Month 12 in the everolimus group, compared to 18% from 246 +/- 54 ng/ml at 2 weeks post-transplant to 201 +/- 48 ng/ml at Month 6 and by 35% to 160 +/- 41 ng/ml in MMF patients.

Orthotopic heart transplantation in patients with Marfan syndrome.

Background: Due to the risk of vascular complications, the indication for heart transplantation (HTx) in patients with Marfan syndrome and end-stage heart disease remains controversial. We analyzed the results of such patients who underwent HTx at our institution.

Methods: Ten patients with Marfan syndrome (median age 36, range 19 to 56 years) underwent HTx between March 1986 and December 2005.

Surgical treatment of right-sided active infective endocarditis with or without involvement of the left heart: 20-year single center experience.

Objective: The aim of this paper is to review the 20-year experience of surgical treatment of right-sided infective endocarditis at our institution, and in particular to compare the outcome of isolated right-sided endocarditis to right-sided endocarditis with involvement of the left heart.

Methods: Between April 1986 and April 2006, 84 operations had to be performed in 79 patients (49 men, median age 43.5 years).

Does contrast medium administration in organ donors affect early kidney graft function?

Since the upper age for organ donors has been raised, a higher incidence of preexistent organ damage and functional impairment is to be expected. Coronary artery sclerosis increases with age. It can only be diagnosed with certainty by coronary angiography.

Routine screening of donor hearts by coronary angiography is feasible.

Background: Because of the shortage of donor hearts, the criteria for acceptance have been considerably extended. Meanwhile every fourth heart donor in Europe is over 50 years old. As we have previously demonstrated, transmission of preexisting coronary atherosclerosis (CAS) by means of transplantation is not rare.

Early and mid-term results of the Shelhigh stentless bioprosthesis in patients with active infective endocarditis.

Aims: This study investigated the early and mid-term results following valve replacement with the new Shelhigh stentless bioprosthesis made entirely of biological material in patients with active infective endocarditis (AIE).

Material And Methods: Between 02/2000 and 12/2004, 164 patients (n = 122 men, mean age 59, 18-85 years) received implantation of an AIE Shelhigh stentless bioprosthesis in the aortic, mitral, tricuspid or pulmonary position. A total of 119 patients (72.

Factors influencing the results of double-valve surgery in patients with fulminant endocarditis: the importance of valve selection.

Background: Extension of infection below the aortic valve is a serious complication, especially with mitral valve involvement. Mortality is substantial and reinfection can strongly influence outcome.

Patients: Of 327 surgical patients with active infective aortic valve endocarditis admitted to the Deutsches Herzzentrum Berlin for surgical treatment between December 1996 and December 2003, 108 had root abscess, and 53 (25.

Aortic root abscess and secondary infective mitral valve disease: results of surgical endocarditis treatment.

Objective: Mortality in active infective endocarditis (AIE) is substantial and reinfection can strongly influence outcome. Assessment of factors influencing mortality is important. We studied 108 (33%) patients suffering from root abscess out of a total of 327 AIE patients admitted to the Deutsches Herzzentrum Berlin for surgical treatment between 1996 and 2003.

Orthotopic heart transplantation with concurrent coronary artery bypass grafting or previous stent implantation.

We describe three cases of donor hearts with preexisting coronary artery disease already diagnosed prior to transplantation: two were treated by coronary artery bypass grafting during the transplant procedure and one by angioplasty with stenting during the donor screening angiography. All three donor organs would otherwise have been rejected, depriving potential recipients of organ transplantation. All patients had an uneventful post-operative course with follow-up completed 22, 40 and 43 months after orthotopic transplantation showing patency of the stent and bypass grafts in the early (1 and 9 months) and late (22, 24 and 37 months) coronary angiography.

Impact of donor-transmitted coronary atherosclerosis.

Because of the shortage of donor hearts, the criteria of an acceptable organ have been extended considerably over the past few years. This has increased the probability of the transmission of atherosclerotic lesions by means of transplantation. This study evaluated the extent to which pre-existing coronary atherosclerosis boosts the cumulative injury caused by brain death, ischemia, and reperfusion, and thus additionally impairs the outcome of transplantation.

Donor-transmitted coronary atherosclerosis.

Background: Autopsies show that coronary atherosclerosis is present frequently in the young and healthy. However, according to our former guideline, we performed pre-transplant evaluation without coronary angiogram in donors <60 years. The purpose of this study is to evaluate to what extent native coronary atherosclerosis is transmitted through heart transplantation.

An assessment of different filter systems for extracorporeal elimination of bivalirudin: an in vitro study.

Bivalirudin is a new, direct thrombin inhibitor. We investigated the extracorporeal elimination rate of different hemofilters and one plasmapheresis filter for bivalirudin. Our data show that bivalirudin can be effectively eliminated via hemofiltration and plasmapheresis, although there were significant differences in the elimination rates among the filter systems investigated.

Dislocated wrap after previous reduction aortoplasty causes erosion of the ascending aorta.

We report a patient with bicuspid aortic valve and dilatation of the ascending aorta who had previous aortic valve replacement and reduction aortoplasty with wrapping. After 4 years, reoperation because of coronary artery disease and paravalvular leakage revealed an erosion of the aortic wall due to dislocation of the wrap. This complication confirms the need for secure anchoring and good fitting of the Dacron wrap to avoid alterations of the underlying aortic wall.