How I do it: repair of sternal fracture with bone graft and plating.

Described here is a technique of using bone graft and plating for fixation of traumatic sternal fractures with non-union. We recommend involvement of an orthopedic surgeon and consideration of bone graft use in sternal fractures where there is likely to be large gap between sternal edges.

Bilateral costal cartilage fractures sustained in the gym during repeated bench press exercises.

Costal cartilage fractures are common in high-energy blunt chest trauma but are frequently missed on imaging evaluation and accordingly underreported in the literature. In this report, we describe a case of a 32-year-old male who sustained bilateral costal cartilage fractures following repeated blunt trauma in the gym sustained during bench press exercises. The patient presented with a painful "clicking" of a rib in and out of place while bending or turning sideways.

Evaluation of the effects of three designs of oxygenators with integrated filters on clinical and haematological outcomes at an Australasian cardiothoracic unit.

Introduction: Cardiopulmonary bypass (CPB) machines have oxygenators with integrated filters and unique biocompatible coatings to combat systemic inflammatory response syndrome (SIRS) and mitigate coagulopathy. Contemporary oxygenators have undergone comparative studies; however, our study aimed to identify the most appropriate oxygenator for our regional Cardiothoracic unit in Australasia.

Methods: A prospective audit consecutively recruited one-hundred and fifty patients undergoing cardiac surgery at Waikato Hospital, New Zealand between the periods of 29th January 2018 and 31st July 2018.

Cardiac surgery simulation: a low-cost feasible option in an Australasian setting.

Background: Simulation training is a useful adjunct to surgical training and education (SET) in Cardiothoracic Surgery yet training opportunities outside the Royal Australasian College of Surgery or industry-sponsored workshops are rare due to high cost and limited training faculty, time, assessment tools or structured curricula. We describe our experience in establishing a low-cost cardiac simulation programme.

Methods: We created low-cost models using hospital facilities, hardware stores, abattoirs and donations from industry.

Performance of the AusSCORE II and STS Score for Coronary Artery Bypass Grafting in a New Zealand Population.

Background: The updated Australian System for Cardiac Operative Risk Evaluation (AusSCORE II) and the Society of Thoracic Surgeons (STS) Score are well-established tools in cardiac surgery for estimating operative mortality risk. No validation analysis of both risk models has been undertaken for a contemporary New Zealand population undergoing isolated coronary bypass surgery. We therefore aimed to assess the efficacy of these models in predicting mortality for New Zealand patients receiving isolated coronary artery bypass grafting (CABG).

Early Discharge From Intensive Care After Cardiac Surgery is Feasible With an Adequate Fast Track, Stepdown Unit: Waikato Experience.

Background: Enhanced recovery programs within cardiothoracic surgery are a well described benefit to patient postoperative outcomes. We describe our Australasian unit's experience of a day zero discharge enhanced recovery unit from the intensive care department.

Methods: A retrospective study was conducted on a prospectively maintained database at Waikato Cardiothoracic Unit from September 2014 till October 2017 with 1,739 patients undergoing cardiac surgery.

Assessment of the EuroSCORE II in a New Zealand Tertiary Centre.

Background: The updated European System for Cardiac Operative Risk Evaluation (EuroSCORE II) is a well-established cardiac surgery risk scoring tool for estimating operative mortality. This risk stratification system was derived from a predominantly European patient cohort. No validation analysis of this risk model has been undertaken for the New Zealand population across all major cardiac surgery procedures.

Desmoid fibromatosis of the chest wall.

We report a case of desmoid fibromatosis of the chest wall. A 70-year-old woman was referred to our hospital with right shoulder blade pain and paresthesia over the right upper breast. Chest X-ray and computed tomography demonstrated a 5 cm right apical mass in the chest.

A rare case of cholesterol granuloma in the anterior mediastinum.

Cholesterol granulomas are reactant lesions that develop in response to cholesterol crystals and foreign body giant cells. They are a commonly described benign condition affecting the middle ear and paranasal sinuses, however have been reported in various sites within the body. We describe a rare case of an incidental cholesterol granuloma in the anterior mediastinum of a cardiac surgical patient.

Tricuspid valve repair for torrential tricuspid regurgitation after permanent pacemaker lead extraction.

Tricuspid regurgitation secondary to percutaneous lead extraction is uncommon, and it rarely requires surgical intervention. Most tricuspid regurgitation occurs during the implantation of tined leads, which can be entrapped in the tricuspid valve apparatus and may require immediate withdrawal. Severe tricuspid regurgitation as a sequela of extracting chronically implanted leads has rarely been reported.

Idiopathic postpneumonectomy pulmonary edema: hyperinflation of the remaining lung is a potential etiologic factor, but the condition can be averted by balanced pleural drainage.

Objectives: Idiopathic postpneumonectomy pulmonary edema is a leading cause of mortality after pneumonectomy. Postoperative hyperinflation of the remaining lung is an etiologic factor. We have demonstrated avoidance of postpneumonectomy pulmonary edema solely by changing management of the pneumonectomy space to a balanced drainage system.

Experience with unipolar radiofrequency ablation for atrial fibrillation.

Background: The cut and sew Cox maze procedure for atrial fibrillation (AF), although effective, is not widely used because of technical complexity, prolonged duration and significant risk of postoperative bleeding. This study reviews our experience with the unipolar radiofrequency ablation (RFA) procedure, which was used to create a modified maze to treat AF.

Methods: A retrospective review of 31 patients undergoing consecutive cardiac surgery who had concomitant RFA for AF over a 16-month period was carried out.

Urgent and emergency coronary artery bypass grafting for acute coronary syndromes.

Background: Urgent and emergency coronary artery bypass grafting may be associated with significant mortality and morbidity. We report our recent experience with this group of patients.

Methods: A retrospective analysis of 441 patients undergoing urgent and emergency surgery over a 3-year period was carried out.

Coronary bypass surgery for patients with chronic poor preoperative left ventricular function (EF<30%): 5-year follow-up.

Background: Optimal therapy for patients with coronary artery disease and chronic poor left ventricular function, given the absence of randomized trials, is unclear. Although coronary surgery has been performed in such patients for 25 years, it is perceived as high risk and unproven long-term benefit, especially if thallium scanning fails to demonstrate large areas of viability. We report the results of coronary surgery in these patients.

Retroaortic course of the anomalous left main coronary artery: is it a benign anomaly? A case report and review of literature.

Background: Left coronary artery sharing a common origin with the right coronary artery and taking a retroaortic course is a rare coronary anomaly. It has been considered a benign entity.

Case Report: We report a 19-year-old man who presented with chest pain.

Follow-up of Australian aboriginal patients following open-heart surgery in Western Australia.

Background: To date there has been only one published report pertaining to the outcomes following open-heart surgery in Australian aboriginal patients.

Methods: The records of 57 consecutive aboriginal patients who underwent open-heart surgery at our institution over a 6-year period were retrospectively reviewed. Attempts were made to contact the patient by telephone, by letter, through their listed next of kin, general practitioners, community nurse or through the aboriginal liaison officer.

Atrial myxoma with coexistent coronary artery disease: a report of two cases.

The age at presentation and the symptoms of atrial myxomas and coronary artery disease can be similar. At times, the two lesions coexist. Operative strategy needs to be carefully planned when combined surgical treatment is contemplated.