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

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age was 68 (interquartile range 58-74) and 539 (37%) were female. We used multiple logistic regression to evaluate preoperative risk factors for mortality and neurologic deficit.Results: Immediate neurologic deficit occurred postoperatively in 37/1443 (2.5%) of patients. Significant predictors were extent II aneurysm and decreasing preoperative glomerular filtration rate (GFR). Use of cerebrospinal fluid drainage and distal aortic perfusion (adjunct) reduced neurologic morbidity by two thirds (odds ratio 0.33, pϽ0.002). For mortality, significant predictors were decreased GFR, preoperative rupture, peripheral vascular disease, coronary artery disease and extent 2 or 3 aneurysm. With normal GFR (Ͼ 90 ml/min 1.73 m 2 ), mortality was 6%.Conclusion: Use of the adjunct cerebrospinal fluid drainage and distal aortic perfusion has had a major impact on spinal cord morbidity. The greatest mortality occurs in patients with multiple preoperative risk factors, with treatment playing a secondary role. Patients with good preoperative renal function have low morbidity and mortality.Background: Acute aortic syndromes are life threatening. Time is of the essence as mortality rises with increasing time after the acute episode. The keys to successful treatment of acute aortic disease include early diagnosis, transfer to the appropriate care facility, rapid institution of therapy, availability of cardiovascular anesthesia, and dedicated cardiovascular intensive care unit care.Objective: To report the outcomes of a pathway, an Acute Aortic Treatment Center (AATC), to expedite the care of acute aortic syndromes in a major metropolitan area with the hypothesis that "door to intervention" time under 90 minutes reduces mortality and morbidity from acute aortic disease.Methods: A database of patients admitted with aortic disease during one year prior to initiation (2007) and one year after initiation of AATC in 2008 was developed. Anatomic and functional outcomes were determined and categorized by Society of Vascular Surgery reporting criteria. Multivariate analysis and Cox proportional hazard analyses were performed.Results: A Total of 621 patients reported with aortic disease to the cardiovascular services; 304 patients were admitted of which 73(25%) were considered to have acute disease. When compared to the year before the AATC there was a 10 % increase in total number of admissions and a 25 % increase in acute pathology after setting up the AATC (pϭ0.02). There was a 2 fold increase in thoracic aortic dissections admitted to the service. Initiation of AATC resulted in significant reduction in time to definitive therapy (61% decrease) (pϭ0.016). Despite the increase in acuity, mortality and morbidity rates were unchanged and there were trends to lower ICU and total hospital stay (Table).Conclusion: Institution of AATC increased awareness for correct and early diagnosis of the acute aorta, reduced time to definitive treatment, increased referrals and appeared to impact inpatient hospital stays. Widespread adoption of the AATC paradi...

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