Background: The incidence of sternal dehiscence following cardiothoracic surgery via sternotomy is rare. It causes serious patient dissatisfaction and leads to higher hospital costs. For years, each clinic has made efforts to reduce this complication. Here, we aimed to summarize our techniques to prevent dehiscence. Material: This retrospective study included two groups operated via median sternotomy from March 2009 to May 2019. The first group included 1,105 consecutive patients who only received sternum wire for sternum closure from March 2009 to October 2013. The second group included 1,559 consecutive patients operated from January 2014 to May 2019; preventive closure techniques were performed for predefined high-risk patients in this group. These closure techniques included polyglyconate (Maxon) or simple longitudinal reinforced sutures, sternal cable or sternoband, sternal plate, and Robiscek technique. Results: All patients in Group 1, and 63.8% (995/1559) patients in Group 2 received sternal wire only (P < .001). In Group 2, we applied preventive closure techniques to 564 (36.2%) patients. There was no sternal dehiscence in Group 2, whereas 29 (2.6%) patients postoperatively suffered sternal dehiscence in Group 1; this was statistically significant (P = .001, OR:85.5, 95%CI:5.22-1400.4). The overall incidence of mediastinitis was 0.94%. The incidence significantly was lower in Group 2 (P = .004, OR:3.6, 95%CI:1.52-8.82). Sternum-related mortality in Group 2 also was lower (0.54% versus 0.06%, P = .048, OR:8.5, 95% CI: 1.02-70.75). Conclusion: Sternal dehiscence can be avoided by careful perioperative risk assessment and enhanced closure techniques. The same special consideration may significantly reduce mediastinitis and sternal-related mortality.

Ana pulmoner arterden çıkan sol ana koroner arter anormalisi, çocuklarda çok nadir görülen bir doğuştan kalp hastalığıdır. Ölümcül iskemik ve aritmik komplikasyonlar genellikle pulmoner vasküler direncin düştüğü ve sol koroner arter akımının azaldığı erken bebeklik döneminde ortaya çıkar. Yaygın kollateral koroner arter dolaşım gelişirse, hastaların yaklaşık %10'u çocukluk ve yetişkinlik çağına ulaşır. Bu yazıda, 10 yaşındaki bir hastada sol internal mamaryan arterin sol ana koroner artere uygulanan uç uca anastomoz tekniğimiz sunuldu. Anah tar söz cük ler: ALCAPA; pulmoner arterden çıkan sol koroner arter anomalisi; doğuştan kalp hastalığı; koroner arter.

No abstract

Objective To compare peripheral and central cannulation techniques in cardiac reoperation. Methods This retrospective study included 258 patients undergoing cardiac reoperation between January 2013 and July 2018. Patients were divided into two groups according to the cannulation type. The first group included 145 (56.2%) patients operated with standard central cannulation through aorta and right atrium or bicaval cannulation. In this group, cardiopulmonary bypass was instituted after sternotomy. The second group consisted of 113 (43.8%) patients operated with peripheral cannulation through femoral artery, vein, and internal jugular vein. In this group, cardiopulmonary bypass was started before sternotomy and after systemic heparinisation. The two groups’ operative complications and postoperative outcomes were compared. Results Procedure-related injury was higher in the central cannulation group than in the peripheral cannulation group (8.3% vs. 1.8%, respectively, P =0.038). Cardiopulmonary bypass time was shorter in the central cannulation group ( P =0.008) and total operation time was similar between the groups ( P =0.115). Postoperative red blood cell requirement was higher with central cannulation ( P =0.004). Operative mortality (2.8% vs. 0, P =0.186), hospital mortality (4.3% vs. 2.7%, P =0.523), and one-year survival rate (90.3% vs. 94.7%, P =0.202) were similar between the groups. Conclusion Peripheral cannulation reduces cardiac injury and blood transfusion in cardiac reoperation. The cannulation type does not affect postoperative complication, mortality, and one-year survival.

No abstract