SATS 2009 Final Program - Scandinavian Association for Thoracic ...

P01:10
CIRCULATORY ARREST AND BRAIN MONITORING
Vainikka Tiina 1 , Wennervirta Johanna 1 , Ångerman-haasmaa Susanne 1 , Mäki Kaisa 1 , Vakkuri Anne 1 ,
Sipponen Jorma 1 , Salminen Ulla-Stina 1
1) Helsinki University Hospital, Finland
Brain monitoring in patients undergoing aortic arch surgery is unreliable. During cardiopulmonary bypass, deep
hypothermia and circulatory arrest, brain damage may occur at any time point.
Prospective patient enrollment started 11/2007. Patients (30) undergoing cardiopulmonary bypass, deep hypothermia
and circulatory arrest are included. CAD patients operated on-pump (15) or off-pump (15) serve as controls. For
brain monitoring, continuous EEG recording and NIRS oximeter are used. Neuropsychological tests are done 6
months postoperatively.
So far 18 patients, F/M = 5/13, 55.6 + 13.8 years, EuroScore 19.3% + 20.0%, were enrolled. Diagnosis was
ascending aortic dissection in 12 and rupture of ascending aortic aneurysm in 1. Elective surgery was performed in
additional 5. Circulatory arrest was 36.9 + 30.1 min. Both-sided (3) or right (5) selective cerebral perfusion was used
in 8 for 38.4 + 26.6 min. 2 (6.7%) died intrahospitally, 6 (33.3%) had neurological complications; 3 severe cerebral
infarctions. Neurological complications showed NIRS and/or EEG changes. So far 11 were controlled: 1 died, 2 were
hospitalized for stroke, 8 were tested. All 6 not retired were working. 2 patients were intact, 5 showed mild cognitive
changes, 1 was depressed. 10 on-pump controls, F/M = 1/9, 62.8 + 9.3 years, recovered uneventfully, 4 attended
control: 2 were intact and 2 had mild cognitive changes. Of 3 off-pump controls, F/M=0/3, 61.3 + 15.8 years, 2
attended and were intact.
EEG and NIRS monitoring gives information of the timing and severity of intra-operative brain damage. In less
severe neurological complications 6-month results are good.
P01:11
NEGATIVE-PRESSURE WOUND THERAPY (NPWT) FOR STERNAL WOUND INFECTION
“THE FIRST CASES IN ICELAND”
Steingrímsson Steinn 1 , Gottfredsson Magnus 2 , Gudmundsdottir Ingibjorg 3 , Sjögren Johan 4 , Gudbjartsson Tomas 2
1) 2) 3) University of Iceland, Landspitali University Hospital, Faculty of Nursing, Uni. of Iceland, Iceland
4) Lund University Hospital, Sweden
NPWT has been shown to be effective for treating sternal wound infections (SWI). Rather than leaving the wound
open after debridement or use closed irrigation, a sponge is placed in the wound and negative pressure applied. This
reduces bacterial load, increases blood flow and stimulates formation of granulation tissue in the wound. The aim of
this study was to evaluate the results of NPWT for SWI in Iceland.
Consecutive case series, including all patients with SWI following cardiac surgery that required surgical revision,
diagnosed between July 2005 and Dec 2008. During this period all patients with SWI were treated with NPWT.
12 patients (age 69 yrs, 10 males, 9 following CABG) were identified (1,3% infection rate). Coagulase-negative
staphylococci (n=6) and Staphylococcus aureus (n=4) were the most common pathogens. NPWT was initiated
on the 19th day postoperatively (median, range 5-111) and the duration of treatment was 14 days (median, range
5-36). In most cases (9/12) the sternal-wires were removed and the sponges replaced 2-8 times. Primary closure
of the sternum was achieved following NPWT in 10 out of 12 cases. In one case of Pseudomonas aeruginosa
infection, NPWT treatment failed and this patient was treated successfully with vinegar soaked gauzes. No major
complications were directly related to NPWT, however one patient died of sepsis related to SWI. The other 11
patients are alive today (Jan. 2009) and without signs of infection.
This small series shows promising results for NPWT of SWI in Iceland and that major complications are rare.
STOCKHOLM, SWEDEN 71