Surgical-Site Infections After Coronary Artery Bypass Graft Surgery: Discriminating Site-Specific Risk Factors to Improve Prevention Efforts

Roy, Madeleine

doi:10.1017/s0195941700087294

Cited by 13 publications

(11 citation statements)

References 32 publications

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“…The sternal infection is an important complication of the CABG surgery, with a prevalence of 1% to 20% (Roy, 1998). Three different compartments may be affected: the presternal (cellulitis, sinus tracts, and abscess), sternal (osteomyelitis, and dehiscence), or retrosternal (mediastinitis, hematoma, and abscess) compartments (Li & Fishman, 2003).…”

Section: Sternal Infectionmentioning

confidence: 99%

Multidector CT Imaging of Coronary Artery Stent and Coronary Artery Bypass Graft

Song¹

2013

What Should We Know About Prevented, Diagnostic, and Interventional Therapy in Coronary Artery Disease

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Additional information is available at the end of the chapter http://dx.doi.org/10.5772/54085 . IntroductionCoronary artery stenting has become the most important nonsurgical treatment for coronary artery disease. However, in-stent restenosis occurs at a relatively high rate and this problem has led to the routine use of invasive angiography for assessing stent patency. "lthough coronary angiography is the clinical gold standard and it is a very effective diagnostic tool for detecting such in-stent restenosis, it's clearly an invasive procedure with its associated morbidity and mortality risks. Therefore, a noninvasive technique for detecting in-stent restenosis would be of great interest and use for following up patients after coronary angioplasty. Multidetector-row CT MDCT is being increasingly used for noninvasive coronary artery imaging as it has high diagnostic accuracy for detecting coronary artery stenosis in native, non-stented, coronary arteries. The recently introduced -slice CT offers more improved spatial and temporal resolution than does and -slice CT and this results in superior visualization of the stent lumen and in-stent restenosis. However, although -slice MDCT allows for improved stent visualization, a relevant part up to % of the stent lumen is still not assessable Mahnken et al., . The metal of the stents can cause blooming artifacts that prevent the accurate interpretation of a lumen's patency. To improve a stent's visualization, numerous methods have been attempted such as dedicated post-processing or the use of dual-source CT. However, because of its presently limited sensitivity and high radiation exposure, MDCT should not be used as the first-line test to screen for in-stent restenosis in asymptomatic patients. Given its high specificity and negative predictive value, MDCT might be valuable for confirming stent occlusion in symptomatic patients.Coronary artery bypass graft C""G surgery is the standard care in the treatment of advanced coronary artery disease. Notwithstanding the clear benefits of bypass grafting, recurrent chest pain after myocardial revascularization surgery is a common postoperative © 2013 Song; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.presentation and the long-term clinical outcome after myocardial revascularization surgery is largely dependent on graft patency and the progression of coronary artery disease. Therefore, assessment of the status of the grafts and graft disease after C""G surgery is an important issue in cardiology. "lthough conventional coronary angiography is still standard method for assessment of the status of naïve and recipient vessels after C""G surgery, it is an invasive and costly procedure that is not risk-free. Recently, MDCT with retrospective electrocardiographic ECG gating has gained rapid acce...

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Section: Sternal Infectionmentioning

confidence: 99%

Multidector CT Imaging of Coronary Artery Stent and Coronary Artery Bypass Graft

Song¹

2013

What Should We Know About Prevented, Diagnostic, and Interventional Therapy in Coronary Artery Disease

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“…However, the infection rate reaches three times this value among heart disease patients, since these patients face a higher number of risk factors than the population in general. In respect to deep surgical site infections (DSSI), the incidence is from 0.5% to 5% [4,5]. But the incidence of mediastinitis, following median sternotomies, ranges from 0.4% to 2%, independent of the type of surgery and this is accompanied by a high mortality rate [6].…”

Section: Introductionmentioning

confidence: 99%

<![CDATA[The impact of new preventive measures and treatment of surgical site infections after coronary artery bypass graft surgery]]>

Antoniali¹,

Costa²,

Tarelho³

et al. 2005

Braz. j. cardiovasc. surg.

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O impacto de mudanças nas medidas de prevenção e no tratamento de infecções incisionais em cirurgia de revascularização do miocárdio The impact of new preventive measures and treatment of surgical site infections after coronary artery bypass graft surgery Abstract Objective: To assess the impact of new preventive measures of surgical site infections after coronary artery bypass graft (CABG) surgery. Method: A retrospective study of 468 patients who underwent CABG surgery with cardiopulmonary bypass was performed. These patients were distributed into two groups: Group A (n=224) and Group B (n=244), respectively before and after a new protocol. The two groups were compared by statistical analysis to determine differences in risk factors, the incidence of sternotomy surgical site infections (superficial and deep), recurrent infections and hospital readmission. Results: There was a greater use of internal thoracic artery grafts (p=0.003) and a shorter time of mechanical ventilation (p=0.001) in Group B. Surgical site infections occurred in 44 patients of Group A (19.6%); 33 superficial (14.7%) and 11 deep (4.9%) while in Group B only 13 patients had this complication (5.3%); 10 superficial (4.1%) and 3 deep (1.2%) surgical site infections. Significant improvements were seen in the total number of surgical site infections (p<0.001), of superficial infections (p<0.001) and of deep infections (p=0.037). There were 36.3% and 7.7% of recurrent infections in Groups A and B, respectively (p=0.102). Hospital readmissions due to surgical site infections were 21 in Group A and 3 in Group B (p<0.001). Conclusion: The new preventive measures and treatment for surgical site infections after CABG surgery in this series of patients significantly reduced the incidence of sternotomy surgical site infections and hospital readmissions related to this complication. Descriptors: Infection. Surgical wound infection. Infection control. Cardiac surgical procedures. Myocardial revascularization. Resumo Objetivo: Avaliar o impacto de novas medidas de prevenção e tratamento para infecções incisionais em cirurgia de revascularização do miocárdio (RM). Método: Estudo retrospectivo incluindo 468 pacientes ANTONIALI, F ET AL-The impact of new preventive measures and treatment of surgical site infections after coronary artery bypass graft surgery

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“…Approximately 2-20% of CABGs are complicated by a surgical site infection. 6 Diagnosis of sternal dehiscence is usually made clinically; imaging plays an important role to confirm diagnosis. A midline vertical lucency over the sternum of greater than 3mm is usually abnormal and should raise the suspicion for dehiscence.…”

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confidence: 99%

MSCT coronary angiography in non-invasive assessment of coronary artery bypass grafts patency

et al. 2019

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Background: Coronary artery disease (CAD) is one of the leading cause of the morbidity and mortality in India and worldwide and last decade has seen a steep rise in incidence of CAD in India and its treatment as bypass surgery. Direct visualization of the grafts and native coronary arteries by invasive catheterization is now being replaced by non-invasive CT coronary angiography with higher slice machines and newer technology as it has good temporal resolution, high scanning speed as well as low radiation dose. We share our experience of graft imaging on 128 slice CT machine.Methods: This is a retrospective, single-center, observational study. We included 500 symptomatic patients who have undergone CT study between the year 2014 to 2018 post bypass surgery.Results: Arterial grafts have a better patency rate than venous grafts. (88% vs. 64.1%). Amongst the individual arterial grafts RIMA had the best patency rate (100%) followed by LIMA (90.8%), RA (68.7%). LAD was the most commonly involved artery (91%).Conclusions: Significant absolute concordance between CT and catheter angiographic findings have been documented for all arterial and venous grafts patency in the literature. The MSCT with retrospective gating permits an accurate and non-invasive evaluation of patent and diseased arterial and vein grafts and could replace conventional angiography for the follow-up of symptomatic, stable patients. Moreover, an optimal diagnostic accuracy was also documented in the appraisal of native vessels distal to the graft anastomoses.

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Surgical-Site Infections After Coronary Artery Bypass Graft Surgery: Discriminating Site-Specific Risk Factors to Improve Prevention Efforts

Cited by 13 publications

References 32 publications

Multidector CT Imaging of Coronary Artery Stent and Coronary Artery Bypass Graft

Multidector CT Imaging of Coronary Artery Stent and Coronary Artery Bypass Graft

<![CDATA[The impact of new preventive measures and treatment of surgical site infections after coronary artery bypass graft surgery]]>

MSCT coronary angiography in non-invasive assessment of coronary artery bypass grafts patency

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