Female and diabetic patients are at higher risk for sternal SSI and should be followed up carefully after cardiac surgery to prevent the development of sternal SSI. Reducing the duration of surgery could reduce the rate of postoperative sternal SSI. The operating theater environment may have an important role in the pathogenesis of sternal SSI, and appropriate ventilation of the operating theaters would be critical in the prevention of sternal SSI.

The purpose of this study was to evaluate the acute cardioprotective effect of high-dose methylprednisolone (25 mg/kg) in the controlled in vivo model of myocardial ischemia-reperfusion injury occurring during cardiopulmonary bypass. Forty nondiabetic male patients with three-vessel disease undergoing first-time bypass surgery were enrolled for this double-blind prospective study. Patients were randomized to be given 25 mg/kg methylprednisolone (Group I) and saline (Group II) 1 h before cardiopulmonary bypass. The levels of cardiac troponin-I (cTnI) were used as a marker of myocardial tissue damage in myocardial ischemia-reperfusion injury. The cTnI levels were measured before surgery, at the second hour after cardiopulmonary bypass, at the 6th and 24th hours, and 5th day postoperatively. There was no significant difference between the two groups in respect to the duration of ischemia and reperfusion. The preoperative cTnI levels were 0.22+/-0.29 ng/ml in Group I and 0.23+/-0.28 ng/ml in Group II. cTnI levels increased to 2.40+/-1.0 ng/ml in Group I and 3.19+/-0.88 ng/ml in Group II at the 2nd hour after cardiopulmonary bypass. When the differences between T1 and T0 level that showed the amount of troponin release occurring due to ischemia-repefusion injury was calculated and then compared, there was a significant difference between Groups I and II (P=0.024). The cTnI levels measured at 6 h after CPB were 1.98+/-0.63 ng/ml in Group I and 2.75+/-1.15 ng/ml in Group II (P=0.049). cTnI levels decreased to 0.22+/-0.10 ng/ml in Group I and 0.49+/-0.25 ng/ml in Group II on the postoperative day 5 (P=0.0001). Univalent regression analysis showed that preoperative high-dose corticosteroid usage decreased the troponin release in about 12% and this effect was statistically significant (R2=0.12, P<0.05). A single dose of intravenous methylpredisolone (25 mg/kg) given 1 h before ischemia reduced myocardial ischemia-reperfusion injury. These results demonstrated that the acute cardioprotective effect of corticosteroids has much potential in the future for reducing ischemia-reperfusion injury occurring during cardiopulmonary bypass when it is inevitable.

There is no reduction of AF rate in myocardial revascularization without cardiopulmonary bypass. However, prophylactic beta-blocker usage decreases the incidence of AF after both on-pump and off-pump myocardial revascularization.

Problems of wound healing are commonly observed after coronary bypass grafting (CABG) operations. Our aim is to determine the prevalence and the predictors of saphenous vein harvesting complications after coronary artery bypass surgery. One hundred twenty six patients operated in the specified period were included in this prospective study. In an early period 3 patients were excluded because of their mortality. Twenty patients were female and 103 were male. Forty three patients underwent an open procedure with one incision (35%), 61 patients also underwent an open procedure but with multiple incisions (49%), and 19 patients underwent a closed procedure with stripper (16%). Complications related with leg incisions after surgery were investigated. Multiple incision technique has the longest (49.28 ± 14.7 cm; p < 0.001) total incision length (compare to single incision and stripper technique). As incision length increases, the incidence of drainage ( p < 0.01), pain score ( p < 0.05), hematoma ( p < 0.05) and diffuse ecchymosis ( p < 0.05) were increased. Drainage was seen more frequently in female ( p < 0.001) and diabetic patients ( p < 0.05). Sex ( p < 0.001) and incision length ( p < 0.05) have been found independent risk factors for drainage complication. Superficial infection ( p < 0.05), pain ( p < 0.05) and dehiscence ( p < 0.05) were significantly higher in female patients. As the incision length of the multiple incision technique became longer, the risk of drainage, pain, hematoma and diffuse ecchymosis were increased. The significantly increased risk for wound complications were also seen in female gender, diabetic and obese patients.saphenectomy; saphenous vein harvesting; coronary artery bypass surgery; wound; complication © 2007 Tohoku University Medical PressDespite the widespread use and superior patency of the internal mammarian artery and other arterial conduits, the saphenous vein continues to be the most commonly used conduit for coronary artery bypass graft surgery due to its length and lack of invasiveness. Open and also closed surgical techniques exist for the harvesting greater saphenous vein. However, problems of

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