C. Kuehn

Vascular Complications in Patients Undergoing Femoral Cannulation for Extracorporeal Membrane Oxygenation Support

BACKGROUND Extracorporeal membrane oxygenation (ECMO) is a well-established treatment for severe cardiopulmonary failure. Patients undergoing ECMO support through femoral vessels are prone to vascular complications. The aim of this study was to evaluate such complications to outline basic technical principles for their prevention. METHODS From January 2005 to December 2009, 174 patients underwent ECMO support through cannulation of the femoral vessels. The primary outcome was any vascular complication. Secondary outcomes were 30-day mortality and 1-year survival. A logistic regression analysis including ECMO duration, peripheral arterial disease, ECMO access (percutaneous versus open), and diabetes mellitus identified predictors for vascular complications. RESULTS The venoarterial mode was used in 143 patients (82%), and venovenous in 31 patients (18%). Of the 17 (10%) observed vascular complications, 15 (88%) occurred in patients with venoarterial access, whereas 2 (12%) occurred after venovenous access (p=0.50) Two patients who had extremity ischemia required limb amputation. Thirty-day mortality and 1-year survival rates were 63% and 26%, respectively. Peripheral arterial disease was the only strong predictor of vascular complications (odds ratio, 6.95; 95% confidence interval, 1.89 to 25.59; p=0.003). Vascular complications were not associated with early or late mortality. CONCLUSIONS The incidence of vascular complications in venovenous cannulation was low, whereas in arterial cannulation, it is still considerable. Peripheral arterial disease remains a risk factor, and early involvement of vascular surgeons for open vascular exposure or alternative vascular access sites can be recommended. Vascular complications after ECMO support are not associated with higher mortality rates.

Economic aspects of deep sternal wound infections.

OBJECTIVES Surgical-site infections are a very expensive complication in cardiac surgery. Thus, the total costs for coronary artery bypass grafting (CABG) surgery may substantially increase when a deep sternal wound infection (DSWI) occurs. This may be due to an extended length of stay (LOS), the need for additional surgical procedures, vacuum-assisted wound dressing and antibiotic therapy. This study compares the LOS in the hospital and on an intensive care unit (ICU) as well as the total costs for patients undergoing CABG depending upon the occurrence of a subsequent DSWI. METHODS A case-control study was performed. Total costs of DSWI cases were analysed and compared to patients undergoing CABG without DSWI. Inclusion criterion for cases was the development of a DSWI according to the CDC criteria during hospital stay after CABG. Two control patients without any signs or symptoms of an infection during hospital stay were matched to each case by (1) type of surgery according to their diagnosis-related group (DRG), (2) age +/-5 years, (3) gender and (4) duration of preoperative hospital stay +/-2 days, but at least as long as the time at risk of cases before infection. RESULTS Between January 2006 and March 2008, 17 CABG patients with DSWI (cases) and 34 matched controls were included. The median overall costs of a CABG case were 36,261 Euro compared with 13,356 Euro per control patient without infection (p<0.0001). The median overall LOS was 34.4 days versus 16.5 days, respectively (p=0.0006). The median LOS on ICU was 6.3 days versus 5.3 days (no significant difference). CONCLUSION DSWI represents an important economic factor for the hospital as they may almost triple the costs for patients undergoing CABG. Thus, appropriate infection control measures for the prevention of DSWI should be enforced.

Thrombus formation in a HeartMate II left ventricular assist device

doi:10.1016/j.jtcvs.2007.08.048 M ajor limitations of ventricular assist devices have been the high incidence of thromboembolic events, the requirement for systemic anticoagulation, and the mechanical stability and duration of the device. The successful use of axial flow pumps for left ventricular (LV) assistance has been limited by thromboembolic events and pump thrombosis. Therefore, imaging of the devices is crucial. The HeartMate II axial flow pump (Thoratec, Pleasanton, Calif) has shown a low incidence of thromboembolic events and proper long-term mechanical function. Pump thrombosis has not been reported. We report a case of thrombus formation 4 months after HeartMate II implantation.

Surgical site infections—economic consequences for the health care system

PurposesUnfortunately, surgical site infections (SSIs) are a quite common complication and represent one of the major causes of postoperative morbidity and mortality, and may furthermore lead to enormous additional costs for hospitals and health care systems.MethodsIn order to determine the estimated costs due to SSIs, a MEDLINE search was performed to identify articles that provide data on economic aspects of SSIs and compared to findings from a matched case-control study on costs of SSIs after coronary bypass grafting (CABG) in a German tertiary care university hospital.ResultsA total of 14 studies on costs were found. The additional costs of SSI vary between

Five-year experience with intraoperative extracorporeal membrane oxygenation in lung transplantation: Indications and midterm results

3,859 (mean) and

Prevention of Early Vascular Graft Infection Using Regional Antibiotic Release

40,559 (median). Median costs of a single CABG case in the recently published study were

Veno-veno-arterial extracorporeal membrane oxygenation for respiratory failure with severe haemodynamic impairment: technique and early outcomes

49,449 (€36,261) vs.

Economic implications of infections of implantable cardiac devices in a single institution.

18,218 (€13,356) in controls lacking infection (p < 0.0001). The median reimbursement from health care insurance companies was

Graft-protective effects of the HMG-CoA reductase inhibitor pravastatin after lung transplantation--a propensity score analysis with 23 years of follow-up.

36,962 (€27,107) leading to a financial loss of

Cardiac surgery late after heart transplantation: A safe and effective treatment option

12,482 (€9,154) each.ConclusionCosts of SSIs may almost triple the individual overall health care costs and those additional charges may not be sufficiently covered. Appropriate measures to reduce SSI rates must be taken to improve the patient’s safety. This should also diminish costs for health care systems which benefits the entire community.