Sternal Wound Infection Research Articles

Temperature analysis of aortic repair with hypothermic circulatory arrest to quantify the injury by cooling

We analyzed the temperature in proximal aortic repair with moderate hypothermic circulatory arrest (HCA) and evaluated the effect of the cooling status on postoperative outcomes. A total of 340 patients who underwent elective ascending aortic replacement or total arch replacement with moderate HCA from December 2006 to January 2021 were studied. The change in body temperature trends recorded during surgery was shown graphically. Several parameters, such as the nadir temperature, cooling speed and the degree of cooling (cooling area), which was the area under curve of inverted temperature trends from cooling to rewarming as calculated by the integral method, were analyzed. The relationships between these variables and a major adverse outcome (MAO) postoperatively defined as prolonged ventilation (>72 h), acute renal failure, stroke, reoperation for bleeding, deep sternal wound infection or in-hospital death were evaluated. An MAO was observed in 68 patients (20%). The cooling area was larger in the MAO group than in the non-MAO group (1668.7 vs 1383.2°C min; P < 0.0001). A multivariate logistic model showed that old myocardial infarction, peripheral vascular disease, chronic renal dysfunction, cardiopulmonary bypass time and the cooling area were independent risk factors for an MAO (odds ratio = 1.1 per 100°C min; P < 0.001). The cooling area, which indicates the degree of cooling, shows a significant relationship with an MAO after aortic repair. This finding indicates that the cooling status with HCA can affect clinical outcomes.

Management Outcome of Patients with Infected Sternotomy Wounds

Objective: to evaluate management outcomes of post-sternotomy wounds.&#x0D; Study Design: Retrospective longitudinal study.&#x0D; Place and Duration of Study: Department of Plastic Surgery, Shifa International Hospital, Islamabad Pakistan, from Jan 2020 to Dec 2021.&#x0D; Methodology: We reviewed 35 patients who had developed sternal wound infections post-cardiothoracic surgery. Outcomes of the study were measured using the SF-36 Quality of Life questionnaire.&#x0D; Results: Our patients presented with either Pairolero Type-II 11(31.4%) or Type-III 19(54.2%) sternal wound infection. Preoperatively patients scored 296.667±69.40 in physical functional, 100.00±30.51 in limitations due to physical health, 16.67±37.90 in role limitation due to emotional problems, energy/fatigue scored 43.53±23.70, emotional well-being 163.33±23.54, social functioning as 11.40±11.66, pain score 31.25±19.90 and general health 131.67±35.31. The improvement in scores was noted in all domains postoperatively. Physical functioning mean scored as 790.00±48.07, role limitations due to physical health scored as310.34±67.32, role limitations due to emotional problems scored as 266.67±47.94, energy/fatigue 284.67±18.71, emotional well being 448.67±18.71, social functioning 185.83±12.60, pain score 164.17±22.01 and general health 316.67±34.95. Thirty-four (97.1%) out of 35 patients recovered well postoperative, with a maximum follow-up of 4 years and a minimum follow-up of 1 year. One patient expired on the sixth day of muscle flap coverage of the wound due to cardiac arrest.&#x0D; Conclusion: A positive prognosis can be obtained by this treatment protocol.

Treatment algorithm for post sternotomy wound infection - our experience.

Median sternotomy is the most commonly used approach in open cardiac surgery. As in any other surgery, surgical site infections are aknown phenomenon, but morbidity depends on the depth of infection. Superficial wound infections can be managed conservatively; however, deep sternal wound infections need an aggressive approach to prevent disastrous consequence like mediastinitis. Hence, this study was conducted with the aim to classify sternotomy wound infection and to develop atreatment algorithm for superficial and deep sternotomy wound infections. Between January 2016 to August 2021, 25 patients who had sternotomy wound infections were studied. These wound infections were classified as superficial or deep sternal wound infections. Superficial wound infections underwent treatment with diluted vinegar dressings and deep infections underwent treatment with bilateral pectoralis major muscle advancement flaps. Patients were followed up till the wounds healed completely without complications. Patient characteristics, comorbidities, duration of treatment and outcomes of treatment were analyzed. Superficial sternal wound infection patients responded favorably to diluted vinegar dressings and deep sternal wound infection patients to pectoralis major muscle advancement flaps. Average time duration of healing for superficial and deep wound infections was 66.2 days and 18 days respectively. None of the patients had an increased severity of infection or re-dehiscence following treatment and during follow-up. Relatively conservative approach using diluted vinegar (1% acetic acid) dressing for superficial sternal wound infections was efficacious, whereas aggressive debridement and bilateral pectoralis major advancement muscle flaps for deep sternal wound infections are necessary for favorable outcomes. However, more studies are needed to ascertain this treatment algorithm.

Reconstruction of Infected Mediastinal Wound with an Omental Flap Harvested Laparoscopically After Cardiac Surgery: Report of Two Cases and Literature Review

Background: Deep sternal wound infection and dehiscence are two serious complications after open cardiac surgery. Omental flap harvesting is recognized as one of the management options, with traditionally non-favorable outcomes due to laparotomy stress on patients. Objective: Herein, however, we report our experience with two patients who have developed a mediastinal wound infection following coronary artery bypass grafting and were reconstructed with omental flaps harvested laparoscopically. Case Presentation: Two 74-year-old females, who were known to have multiple comorbidities, developed a sternal wound infection after coronary artery bypass graft. Several operative trials and non-operative measures have been attempted to manage the infections and/or reconstruct the wound but failed. Both patients then underwent laparoscopic omental flap harvesting for reconstruction and exhibited significant clinical improvement postoperatively. Discussion: Omental flap is considered a feasible option for reconstruction of sternal wound dehiscence developing after open cardiac surgery because it is usually well-vascularized, contains a large number of immunologically active cells and has the ability to absorb wound secretions. The traditional method of harvesting is conventional laparotomy, but it carries high rates of morbidity. Therefore, laparoscopic harvesting can be utilized as an alternative with better outcomes. Conclusion: Laparoscopic omental flap harvesting is considered a feasible and safe procedure to manage sternal wound dehiscence after open cardiac surgery, with satisfactory surgical outcomes.

Utilizing Instilling Negative Pressure Wound Therapy with Vashe Wound Solution for an Infected Sternal Dehiscence: A Case Report

Utilization of negative pressure wound therapy with instillation (NPWTi) for sternal dehiscence wounds secondary to sternal wound infection after surgery has become an accepted therapy. NPWTi accelerates wound healing through macrostrain, microstrain, and cyclic fluid instillation. Wounds benefit from additional superficial infection control with the removal of microorganisms, the release of proinflammatory mediators, stimulation of angiogenesis, as well as mechanical debridement. However, very few cases of utilizing NPWTi in the treatment of sternal wound infections have been reported in the literature. This case study describes the use of NPWTi with hypochlorous acid for the treatment of a sternal wound infection.

Sternotomy closure using negative pressure wound therapy after heart transplantation

Summary Background Deep sternal wound infection (DSWI) after orthotopic heart transplantation (OHT) is not a common but known complication and carries high mortality and morbidity rates. This report identifies a successful management strategy for recurrent DSWI, and it is a valuable addition to the medical literature supporting the management of sternal wound infections (SWI) along with negative pressure wound therapy (NPWT). Case presentation This report describes the successful management of recurrent DSWI after OHT in a 52-year-old patient. We performed secondary sternotomy closure along with NPWT for the immunosuppressed patient. Conclusion Our case demonstrates that a combination of reduced immunosuppression, adequate antimicrobial treatment, and NPWT can effectively treat complicated DSWI.

"/" wiring (Durukan weave) to prevent sternal cutting by wires: a propensity score matched comparison with Robicsek weave.

Sternal closure still causes morbidity/mortality following sternotomy. Robicsek weave, cable systems, rigid plates and nitinol clips are systems employed to prevent sternal dehiscence. The aim was to document the effectiveness of a novel method using standard sternal wires decreasing load on wires and spreading load on the lateral sternum to prevent sternal cutting by wires and thus sternal dehiscence. 756 patients who underwent coronary revascularization with sternotomy between July 2018 and November 2022 were retrospectively analyzed. Fifty patients with "/"wiring were compared with 50 patients with Robicsek weave by propensity score matching. "/" wiring (Durukan weave) spreads load laterally on the sternum by lateral sequential knotting of wires instead of midline knotting. Outcomes were superficial and deep sternal wound infection and non-infectious sternal dehiscence. There were 50 patients in each group. Mean age of the patients was 65.74 ±7.47 in Robicsek weave and 66.12 ±7.23 in Durukan weave. The perioperative characteristics of patients were comparable as propensity score matching was performed. None developed superficial sternal wound infection in Robicsek weave, whereas 2% (1) in "/"wiring. There was no deep sternal wound infection in each group. Non-infectious sternal dehiscence did not occur in either group. "/" wiring seems to be a safe and cost-effective method for sternal closure for preventing sternal cutting by wires, therefore preventing sternal wound related problems and dehiscence. The method is cheap, easily applicable and less time consuming than Robicsek weave, which was proven to be the safest method for sternal wire closure.

Deep Sternal Wound Infection After Beating Heart Coronary Artery Bypass Surgery with Routine Use of Skeletonized Bilateral Internal Thoracic Artery.

Despite its survival benefits, bilateral internal thoracic artery (BITA) grafting is not commonly utilized due to concerns over deep sternal wound infection (DSWI). We observed the role of routine use of BITA and off-pump coronary artery bypass grafting (OPCABG) in the incidence of DSWI and associated risk factors. Between January 2010 and December 2020, 1,207 patients were treated with isolated coronary artery bypass grafting. In all cases, OPCABG was attempted, and BITA was used whenever there was a need for a second arterial graft for the left coronary artery. DSWI was defined as a wound infection requiring surgical intervention and/or the administration of antibiotics. Multiple linear regression analysis was employed to model the risk of DSWI. The incidence of DSWI was 0.58%. Mortality rate was higher in DSWI group than in no-DSWI group (28.57% vs. 1.25%; P<0.001). No significant difference in DSWI incidence was observed when BITA (70.6%) or single internal thoracic artery (29.4%) were used (P=0.680). The prevalence of diabetes (100% vs. 40.7%; P=0.001), hyperlipidemia (100% vs. 85.9%; P=0.045), and obesity (71.4% vs. 26.8%; P-0.017) was significantly elevated in DSWI group, when compared with no-DSWI group. Diabetes (P=0.0001), unstable angina (P=0.0064), previous myocardial infarction > 30 days (P=0.0009), left ventricular ejection fraction < 50% (P=0.0074), and emergency surgery (P=0.0002) were independent risk factors. The results of routine use of skeletonized BITA after OPCABG were satisfactory regarding DSWI incidence and operative mortality in a single-center experience.

EFFECT OF LEVOSEMINDAN ON OUTCOME OF CORONARY ARTERY BYPASS GRAFTING SURGERY IN PATIENT WITH IMPAIRED LEFT VENTRICULAR SYSTOLIC FUNCTION

Background: Coronary artery bypass grafting (CABG) is often complicated by hemodynamic instability, especially in cases with decreased left ventricular ejection fraction (LVEF). Levosimendan as inotropic agent can be used in those patients. Objective: To assess morbidity and mortality rates up to 6 months following CABG surgery in patients with LVEF equals 35%, who were given Levosimendan. Patients and methods: 40 patients with preoperative LVEF ≤ 35% underwent elective CABG were retrospectively analyzed between March 2020 and April 2022 at Al-Azhar University Hospitals. Levosemindan was used in continuously-given bolus-free infusion at a range from 0.05 to 0.2 ug/kg/min prior surgery. Hemodynamic and outcome parameters were registered and statistically analyzed. Results: A significant improvement was recorded in EF% from 32.8% to 35.9% then 39.4% after one week and 6 months respectively; it was associated with significant increase in cardiac output from 5.22 liter per minute to 6.3 L/min and 6.1 L/min after one week and 6 months respectively. MAP was also increased from 63.44 mmHg to 80.4 mmHg and 84.6 mmHg after one week and 6 months respectively. 80% of patients showed no complications; on the other hand, 5% of them had low cardiac output syndrome (LCOS), 5% needed IABP, 5% rapid AF, and 5% needed reoperation due to bleeding. On the other hand, postoperative (later) complications included the following: severe sternal wound infection in 2 cases (5%), and chronic AF in one case (2.5%); the overall mortality rate was 10%. Conclusion: levosimendan has a beneficial effect in improving hemodynamic state; in addition, it aids the reduction of hospital and ICU stays, along with the ability to reduce the incidence of LCOS and mortality rate.

Does bone wax make sense in off-pump coronary surgery? A prospective randomized study.

The effect of bone wax on sternal infection and intraoperative bleeding in off-pump coronary surgery has not been reported in current literature. To prospectively evalute this in a cohort of high risk patients undergoing off-pump coronary artery surgery at our institution. The potential impact on cell saver utilization was also studied. A prospective randomized study was performed in 58 diabetic patients operated on for two-vessel coronary artery disease by the off-pump technique. They were randomly assigned to the wax or no-wax group. There was no significant difference in intraoperative blood loss between the wax (550 ml) and no-wax group (750 ml; p = 0.0711). In multivariate analysis the absence (non-use) of bone wax (odds ratio = 3.9 (1.12-13.51), p = 0.027) and preoperative creatinin level (odds ratio = 1.1 (0.99-1.03), p = 0.03) were identified as independent predictors of blood loss ≥ 750 ml. The number of red blood cell units during hospital stay was similar in both groups (p = 0.42). Wound healing complications were not observed in either group. The use of bone wax does not lead to a higher risk of sternal wound infection. It may reduce the risk of high intraoperative blood loss, thus avoiding the need of a cell saver during off-pump coronary surgery. However, this influence remains questionable.

Up-to-Date, Skeletonized or Pedicle Bilateral Internal Mammary Artery; Does It Matter?

In this article, we reported on the up-to-date literature regarding skeletonized bilateral internal mammary artery (BIMA) flow and the effect on sternal perfusion. We also reviewed the pros and cons of the skeletonization technique versus the conventional pedicle technique for harvesting the BIMA. We performed an up-to-date review using the PubMed database, with a specific focus on the contemporary published literature. BIMA skeletonization can preserve the sternal microcirculation, minimize tissue damage, and maintain blood supply to the chest wall at the tissue level. This effect is also apparent in diabetics. Deep sternal wound infection (DSWI) rates are significantly less with skeletonization versus the conventional pedicle technique and are comparable to single internal mammary artery harvesting. Contemporary large-scale studies demonstrate that skeletonization of the BIMA increases conduit length, provides superior flow, reduces the incidence of DSWIs, and improves late survival. Hopefully, this review will increase awareness of the compelling evidence in favor of using skeletonized internal mammary arteries and stimulate increased uptake of BIMA revascularization surgery.

Early Outcome of Mitral Valve Surgery comparing Minimally Invasive Versus Standard Median Sternotomy Approach

Minimal invasive mitral valve surgery (MIMVS) aims to avoid complications of SMS like, bleeding, postoperative pain, and sternal wound infection. It provides better cosmesis and early recovery. The aim of this study is to evaluate early clinical outcome of MIMVS.

Case Report: Endotracheal tube as life-saving tool to control an aortic rupture in intensive care unit

Background: Aortic rupture and suture dehiscence can complicate a cardiac operation, especially in case of infections of the surgical site. Such a complication can be life-threatening and require immediate surgical treatment. Case: We report the case of a 13-year-old girl who suffered a sudden dehiscence of the aortic suture line in the context of deep sternal wound infection, while in the surgical intensive care unit after a double valve replacement. Control of bleeding was obtained by the insertion of an endotracheal tube into the ascending aorta and inflation of the tube cuff to plug the aortic bleeding point. The extracorporeal circulation was then established and under deep hypothermic arrest the defect was successfully repaired. The patient was discharged 14 days after surgery and reviewed at the outpatient clinic in good health. Conclusions: An endotracheal tube can be used in cases of uncontrollable aortic bleeding as a life-saving tool to bridge the patient to adequate surgical treatment.

Sex-Associated Differences in Short-Term Outcomes in Patients with Deep Sternal Wound Infection after Open-Heart Surgery.

Deep sternal wound infection (DSWI) is a feared complication after cardiac surgery. The impact of sex-related differences on wound infection prevalence is poorly understood. Our aim was to evaluate the effect of sex on short-term outcomes in patients with DSWI after open-heart surgery. The study was a retrospective cohort study. A total of 217 patients with DSWI were identified and retrospectively analyzed using our institutional database. Patients were divided into two groups: males (n = 150) and females (n = 67). This study also includes a propensity score based matching (PSM) analysis (male group (n = 62) and female group (n = 62)) to examine the unequal groups. Mean age (p = 0.088) and mean body mass index (BMI) (p = 0.905) did not significantly differ between both groups. Vacuum assisted closure (VAC) therapy was performed among most patients (82.3% (male group) vs. 83.9% (female group), p = 0.432). The most commonly isolated bacteria from the wounds were Staphylococcus epidermidis and Staphylococcus aureus in both groups. Acute renal failure was significantly higher (p = 0.010) in the male group compared to the female group. However, dialysis rate did not significantly differ (p = 0.491) between male and female groups. Further secondary outcomes showed no major differences between the groups. Likewise, in-hospital mortality rate did not differ significantly (p = 0.680) between both groups. Based on our data, sex has no impact on deep wound infection prevalence after cardiac surgery.

Multiarterial Coronary Artery Bypass Grafting Practice Patterns in the United States: Analysis of The Society of Thoracic Surgeons Adult Cardiac Surgery Database

BackgroundWe aimed to elucidate current national multiarterial coronary bypass grafting practice patterns and assess perioperative outcomes. MethodsIsolated primary nonemergent/nonsalvage coronary artery bypass grafting patients with at least 1 internal thoracic artery and 2 or more grafts in The Society of Thoracic Surgery Adult Cardiac Surgery Database (2018-2019) were divided into 3 cohorts: single-arterial, bilateral internal thoracic artery (BITA), and radial artery multiarterial grafting. Observed-to-expected ratios based on 2017 Society of Thoracic Surgery risk models were derived for 30-day perioperative mortality, composite major morbidity and mortality, and deep sternal wound infections for each grafting group overall and as a function of institutional multiarterial case volumes per study period: low (<10), intermediate (11-30), and high (>30). ResultsA total of 281,515 patients (BITA, 15,663 [5.6%]; radial, 23,905 [8.5%]) at 1013 centers showed distinct geographic grafting patterns: BITA and radial multiarterial grafting rates were lowest in the South (4% and 6%, respectively) and highest in the Northeast (9% and 11%, respectively). The median institutional number of BITA and radial cases per study period was 4 and 7, with only 14% and 21% of institutions performing >30 BITA and radial multiarterial cases per study period, respectively. The observed-to-expected mortality for single-arterial bypass grafting was similar to multiarterial: single-arterial, 1.00 (95% CI, 0.98-1.03); BITA, 0.98 (95% CI, 0.84-1.13; P = .711); and radial, 0.96 (95% CI, 0.86-1.07; P = .818). Observed-to-expected mortality and composite major morbidity and mortality were lower at high vs low multiarterial case-volume centers: 0.91 (95% CI, 0.75-1.08) vs 1.30 (95% CI, 0.89-1.79; P = .048) and 1.06 (95% CI, 0.99-1.13) vs 1.51 (95% CI, 1.32-1.71; P < .001), respectively, for BITA, and 0.82 (95% CI, 0.87-1.30) vs 1.67 (95% CI, 1.21-2.21; P < .001) and 0.91 (95% CI, 0.93-1.08) vs 1.42 (95% CI, 1.24-1.61; P < .001), respectively, for radial. ConclusionsMultiarterial bypass grafting remains underused and limited to select centers. Worse outcomes at low-volume BITA and radial institutions document a case-volume outcomes effect. Additional studies are warranted to improve multiarterial outcomes at low-volume institutions.

Management of a rare case of pediatric deep sternal wound infection with vacuum-assisted closure (VAC)

Background: Deep sternal wound infection (DSWI) or mediastinitis is a severe and life-threatening infection with high morbidity and mortality rates. Vacuum-assisted closure (VAC) provides good results and is very useful in wound closure. VAC therapy is a safe and affordable method for managing complex sternal and thoracic injuries. The use of VAC has been shown to increase parasternal blood flow by dilating arterioles, reducing bacterial load, and accelerating granulation tissue formation. It also helps with facilitating wound edge closure. Case and Operation Technique: A 6-month-old baby presented with an ulcer 2 cm deep in the thorax region. The wound had an exposed bone surrounded by slough and hyperemic edges. Bone destruction was seen to have reached the costochondral joint with a gross visible appearance of the pleura. Management of this patient included debridement, sternotomy, internal fixation of the sternum using the Robiscek technique, and application of the Water Shield Drainage (WSD) and VAC. The tobacco-sack technique was used to close the open wound. The Robiscek technique was used in this patient because of the bone destruction to the costochondral joints causing the sternum to become unstable. The VAC dressing was then connected to a suction with an intermittent negative pressure of 75mmHg. After a significant decrease in the wound surface area, a local rotational flap was used to close the wound. Conclusion: The use of modified VAC for deep sternal wound infection (DSWI) is effective, simple, and affordable with minimal complications.

Early and late effects of aortic root enlargement: Results from the Pericardial Surgical Aortic Valve Replacement Pivotal Trial: A multicenter, prospective clinical trial

ObjectiveDuring surgical aortic valve replacement, prosthesis–patient mismatch is avoided by implanting the largest possible valve, which sometimes requires annular enlargement (ARE). The effects of ARE on mortality remain controversial. We reviewed data from a multinational clinical trial evaluating a novel pericardial bioprosthesis to determine the influence of ARE 5 years postimplant. MethodsPatients with aortic valve disease requiring surgical aortic valve replacement were prospectively enrolled at 25 centers in North America and 13 centers in Europe. Standardized follow-up was prescribed, including serial echocardiography assessed by a core lab. A composite 30-day end point of major morbidity or mortality was defined as death, reoperation for any cause, stroke, deep sternal wound infection, and acute kidney injury. ResultsAmong 602 patients with detailed intraoperative data, 90 (15%) underwent ARE with similar rates in North America (17%) and Europe (12%; P = .11). Implanted valve size was similar in both groups (P = .18). The prevalence of moderate or severe prosthesis–patient mismatch at 12 months and at 5 years was comparable between groups, as was the average indexed effective orifice area (P = .3). Five-year survival (ARE, 91% vs no ARE, 89%) and freedom from 30-day major morbidity and mortality (ARE, 87% vs no ARE, 89%) were also similar. ConclusionsIn this analysis of a prospective, observational clinical trial, we observed that the performance of an aortic root enlargement procedure did not increase morbidity or mortality at 30 days. We found that survival at 5 years was similar between groups, suggesting that the performance of an ARE procedure restored survival to that observed in patients who did not require an ARE.

Efficacy of Off-Pump Coronary Artery Bypass Grafting with Concomitant Transcatheter Aortic Valve Replacement.

This study aimed to evaluate the early and intermediate-term outcomes of patients who underwent concomitant off-pump coronary artery bypass grafting (CABG) and transcatheter aortic valve replacement (TAVR). Between January 2014 and June 2021, 49 patients underwent concomitant off-pump CABG and TAVR via median sternotomy (TAVRCAB group) and 143 underwent concomitant on-pump CABG and surgical aortic replacement. Of the 143 patients who underwent on-pump surgery, 80 (SAVRCAB group) were eligible for comparison. The composite event included all-cause death, heart failure rehospitalisation, repeat revascularisation, brain infarction, and repeat aortic valve replacement. The Society of Thoracic Surgeons' predicted risk for mortality and age were higher in the TAVRCAB group than in the SAVRCAB group (7.1% vs 3.1% [p<0.001]; 81 years vs 75 years [p<0.001], respectively), while the surgical time was shorter (289 min vs 352 min; p<0.001). There was no conversion to on-pump surgery in the TAVRCAB group. The postoperative maximum creatinine kinase-MB value was lower in the TAVRCAB group. There was no deep sternal wound infection or repeat revascularisation in either group. Hospital death and brain infarction developed in one patient (1.3%) each in the SAVRCAB group, but in no patients in the TAVRCAB group. The rates of freedom from the composite event were similar between the two groups during the follow-up period. Concomitant off-pump CABG and TAVR would be a less-invasive alternative procedure for treating intermediate or high surgical risk patients with aortic stenosis and coronary artery disease unsuitable for percutaneous coronary intervention.

Risk factors for 1-year mortality after postoperative deep sternal wound infection.

A deep sternal wound infection is a life-threatening complication after cardiac surgery. This study was conducted to describe the mortality associated with postoperative deep sternal wound infections after cardiac surgery and to find risk factors linked to increased mortality in 1 year follow-up. A total of 7973 open-heart surgeries were performed at Tampere University Hospital. Deep sternal wound infection patients were identified, their 1-year mortality status was recorded, and the related risk factors were analyzed. We detected a total of 129 (1.6%) postoperative deep sternal wound infection patients. The 1-year mortality associated with a postoperative deep sternal wound infection was 20.2%. No preoperative or perioperative, statistically significant factors associated with increased 1-year mortality were found. A prolonged stay in an intensive care unit after surgery as well as stroke, delirium, wound secretion, and co-infection were associated with increased 1-year mortality. The risk factors found for increased 1-year mortality were all postoperative. The quality of surgical treatment as well as precise postoperative care and evaluation remain the most important factors to decrease later mortality due to deep sternal wound infections.

Outcomes of Cardiac Transplantation in Western Australia - A Contemporary Single Centre Experience.

Cardiac transplantation remains the gold standard therapy for select patients with end-stage heart failure and outcomes have improved significantly over the past few decades. We report the 5-year contemporary experience of cardiac transplantation in Western Australia, one of the most remote transplant centres worldwide. Patients undergoing isolated cardiac transplant at Fiona Stanley Hospital (FSH) from February 2015 until April 2021 were included. Donor details were collected using donor electronic records (Donate Life, Australia). Recipient data was collated from electronic medical records at FSH and the Australia and New Zealand Society of Cardiothoracic Surgery database. The primary outcome measure was all-cause mortality. Secondary outcome measures included postoperative intensive care and total hospital length of stay and rates of acute kidney injury, rejection, serious infections, and cardiac allograft vasculopathy. Frailty indices were also assessed. A total of 60 patients were included (mean age 53±14 yrs, 66.7% male). The commonest indication for transplant was a non-ischaemic cardiomyopathy (46.7%). Mean donor age was 35±12 years and median donor ischaemia time was 171 minutes (IQR=138-240). After median follow up of 3.7 years, there were no mortalities. Postoperative renal failure occurred in 21 (35.0%) patients, pneumonia in four (6.7%), deep sternal wound infection in three (5.1%), acute rejection in 17 (28.3%) and cardiac allograft vasculopathy (CAV) in 23 (38.3%). With recipient and donor criteria comparable to national and international standards, compounded by the challenges of geographic isolation, we report the first published data on contemporary outcomes post isolated cardiac transplantation in Western Australia.