SATS 2009 Final Program - Scandinavian Association for Thoracic ...
SATS 2009 Final Program - Scandinavian Association for Thoracic ...
SATS 2009 Final Program - Scandinavian Association for Thoracic ...
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S09:5<br />
STERNAL CLOSURE WITH THERMOREACTIVE CLIPS IN 1000 HIGH RISK PATIENTS<br />
- A SINGLE CENTRE COHORT STUDY.<br />
Balasubramanian Sendhil Kumaran 1 , Dunning Joel 1 , Avlonitis Vassilios 1 , Gill Michael 1 ,<br />
Goodwin Andrew 1 , Owens Andrew 1 , Kendall Simon 1<br />
1) The James Cook University Hospital, United Kingdom<br />
Background<br />
Nitillium thermoreactive clips are a novel method of sternalclosure. These clips are highly pliable at low temperature<br />
making them easy to place round the sternum but stiffen at body temperature. They also demonstrate elasticity<br />
on coughing, returning to their original position rather than cutting through. We sought to assess the incidence of<br />
sternal wound complications using these thermo-reactive clips(flexigrips) in 1,000 high-risk patients and identify the<br />
risk factors <strong>for</strong> deep sternal wound infection (DSWI).<br />
Methods<br />
From May-2004 to August-2008, 1,000 high-risk patients, had sternal closure using flexigrips. Perioperative and<br />
demographic variables were analyzed with univariate and multivariate logistic regression analysis to identify risk<br />
factors associated with DSWI.<br />
Results<br />
Median age was 64yrs and median BMI was 32. 85% were male, 30%diabetics and 75% had hypertension. 74% had<br />
CABG, 9% had valve replacements and 12% had combined procedures.There were no sternal complications in 981<br />
patients (98%). The total incidence of DSWI was 1.9% and sternal dehiscence was 1%. Superficial wound infection<br />
was 8.6%. Overall mortality was 1.6%. Multivariate analysis identified, BMI≥35 (Odds ratio 3.21:95%CI 1.16-8.85),<br />
type-II diabetes (Odds ratio 3.9:95%CI 1.27 – 12.3) and need <strong>for</strong> emergency resternotomy (Odds ratio 7.65:95%CI<br />
2.3-25.19) were significant risk factors <strong>for</strong> DSWI.<br />
Conclusions<br />
Thermo-reactive clips can be safely used <strong>for</strong> sternal closure in these high risk patients with an incidence of sternal<br />
dehiscence of 1%. Incidence of sternal dehiscence requiring surgery is low. BMI≥35, diabetes and mediastinal reexploration<br />
were additional predictors of DSWI.<br />
S09:6<br />
CARDIAC SURGERY IN PATIENTS WITH HAEMOPHILIA<br />
Tang Mariann 1 , Wierup Per 1 , Terp Kim 1 , Ingerslev Jørgen 2 , Sørensen Benny 2<br />
1) Department of Cardiothoracic Surgery, Aarhus University Hospital, Skejby,<br />
2) Center <strong>for</strong> Haemophilia and Thrombosis, Denmark<br />
Background<br />
Today the populations of haemophilia patients have a higher life expectancy than previously known, and age-related<br />
disorders are expected to become more prevalent. Cardiac surgery constitutes a major haemostatic challenge.<br />
Hence, only limited systematic in<strong>for</strong>mation exists on efficacious and safe haemostatic substitution regimens during<br />
and after these major surgical episodes. Furthermore, postoperative thromboprophylaxis with antiplatelet drugs is<br />
questionable and seem problematic in patients with haemophilia.<br />
Aim<br />
Evaluation of our current experience and results with cardiac surgery in patients with haemophilia. Provide detailed<br />
in<strong>for</strong>mation on the haemostatic treatment regimens adopted. Forward systematic details on the organization of<br />
haemostatic treatment regimens and postoperative thromboprophylaxis.<br />
Material & Methods<br />
Six patients with haemophilia A undergoing cardiac surgery. In<strong>for</strong>mation on concomitant disorders and EuroSCORE<br />
was registrated. Outcome measures were: (i)re-operation caused by bleeding, (ii) blood transfusion requirements,<br />
(iii) peri- and postoperative blood loss, (iv) peri- and postoperative complications and (v) postoperative development<br />
of inhibitors. Data was compared with historical data from patients without congenital haemophilia (n = 5977) as<br />
extracted from the Danish Heart Database.<br />
Results<br />
None of the six patients were reoperated due to bleeding and none developed inhibitors. Peri- and postoperative<br />
blood loss ranged from 565 to 1055 ml. No incidence of myocardial infarction or thromboembolic complications was<br />
seen. Data did not deviate from results with non-haemophiliacs undergoing major cardiac surgery. All patients were<br />
substituted with a recombinant factor VIII product.<br />
Conclusion<br />
Major cardiac surgery can safely be per<strong>for</strong>med in patients with congenital haemophilia. Outcome measures were<br />
acceptable in comparison with data from non-haemophiliacs.<br />
STOCKHOLM, SWEDEN 59