To compare the anatomical and physiological scoring systems and the outcomes of surgical management of penetrating cardiovascular trauma at a rural center.
Seventy-seven patients underwent emergency ...surgery at our center between January/2012 and October/2018 due to penetrating cardiovascular trauma. Injury Severity Score (ISS), Revised Trauma Score (RTS), New Injury Severity Score (NISS), and Trauma and Injury Severity Score (TRISS) were calculated. The validation of these risk scores to predict mortality was assessed by the area under the receiver operating characteristic curve analysis.
All trauma scores were correlated with mortality. As ISS, NISS, and TRISS values increased and RTS values decreased, the mortality rate increased. The area under the curve (AUC) in the receiver operating characteristic curve analysis was 0.943 for TRISS, 0.915 for RTS, 0.890 for ISS, and 0.896 for NISS (P<0.001 for each). Logistic regression analysis revealed that scores were correlated with mortality (P<0.001 for each). By investigating cardiac injuries alone, only TRISS and RTS results correlated with mortality for cardiac injuries (Mann-Whitney U test, P=0.003 and P=0.01, respectively). The AUC was only statistically significant for TRISS and RTS (AUC=0.929, P<0.05 for both). For vascular injuries, all the scores were significantly correlated with in-hospital mortality (Mann-Whitney U test, P<0.001 for each). TRISS had the highest AUC (AUC=0.946, P<0.001).
TRISS has the highest predictivity for in-hospital mortality in patients with penetrating cardiovascular trauma.
In this study, we aimed to evaluate the anatomical deformations of the major vascular structures in the retrosternal area caused by adhesions following coronary artery bypass grafting (CABG).
This ...single-center, retrospective study included a total of 40 patients with a previous CABG who were admitted to our emergency unit for any reason and underwent a contrastenhanced chest computed tomography (patient group) and 40 patients without previous cardiac surgery (control group) between January 2018 and November 2019. The retrosternal area was compared between the groups using the statistical shape analysis method. The distance between the sternum and the ascending aorta and pulmonary artery was measured and anatomical deformations of the retrosternal area were examined.
There was a statistically significant difference in the anatomical structures of the retrosternal area between the patient and control groups (P<0.001). The distance from the midsternal line to the highest point of the pulmonary artery was statistically significantly shorter in the patient group, compared to the control group (P=0.013). The distance from the sternum to the ascending aorta was also shorter in the patient group, although it did not reach statistical significance (P>0.05).
Our study results showed narrowing of the retrosternal area following CABG and a shorter distance from the sternum to the pulmonary artery than the ascending aorta. Based on these findings, surgeons should be cautious about possible injuries in patients requiring cardiac surgery with repeated median sternotomy.
Objectives: The aim of this study was to present the outcomes of negative pressure wound therapy (NPWT) for deep sternal wound infection (DSWI) after cardiac surgery. Patients and methods: ...Sixty-eight patients (35 males, 33 females; mean age: 60.1±10.1 years; range, 18 to 80 years) who underwent coronary artery bypass surgery or valvular heart surgery between January 2017 and December 2021 were retrospectively reviewed. Patients who underwent NPWT for DSWI after cardiac surgery were included in the study. Baseline and postoperative characteristics of the patients were presented. Previously claimed risk factors for mortality were investigated. Results: The time interval between cardiac surgery and diagnosis of DSWI was 35.8±30.2 days. The mean duration of NPWT was 21.1±11.8 days. In-hospital mortality was 14.7%. Coagulase-negative staphylococci were the most frequently isolated microorganism (n=26, 38.2%), followed by Klebsiella spp. (n=10, 14.7%). The only factor associated with higher mortality was the female sex in our DSWI patients. Conclusion: Negative pressure therapy is a safe and reliable treatment option in patients with DSWI with or without sternal dehiscence.
Pump thrombosis in left ventricular assist device (LVAD) patients is an important cause of mortality and morbidity. Inflow cannula migration is a predisposing factor for pump thrombosis. ...Telecardiographic measurements can be used to follow up apical cannula deviation. In this study, we aimed to evaluate the migration of the inflow cannulas in patients with LVADs using angle measurements on telecardiograms.
Twenty-three patients who were implanted left ventricular assist devices in our clinic between February 2013 and April 2016 were included in our study. During the first year of follow-up, changes in angle measurements on postoperative 1
, 3
, 6
, and 12
month telecardiograms were compared against the incidence of device thrombus and serum Lactate Dehydrogenase (LDH) levels.
Patients who were diagnosed with device thrombosis had more change in inflow cannula angles than patients without device thrombus (p<0.05 at 6
and 12
months). Patients with higher LDH values had more parallel angular changes at all intervals, and the change in angle was statistically significant at 3
, 6
and 12
months (p<0.05).
This study shows that it is possible to track the migration of inflow cannulas in patients with left ventricular heart failure using telecardiograms. The correlation between angle change and LDH levels and embolic events may suggest that telecardiographic follow up of angles may be a useful tool for ventricular assist devices teams for early detection of thrombus.
PDF
