Kareem Salhiyyah

Role of topical application of gentamicin containing collagen implants in cardiac surgery

Sternal wound infections (SWI) continue to be a major cause of concern after cardiac surgery. It leads to prolonged hospital stay and increased morbidity, mortality and increased hospital costs. Prophylactic systemic antibiotics have been used to prevent surgical site infection (SSI). However, prolonged postoperative use of systemic antibiotics can lead to emergence of resistant organisms. Gentamycin Containing Collagen Implants (GCCI) when used during sternotomy closure produces high local antibiotic concentrations in the wound with a low serum concentration. There is evidence that the concentration of gentamicin in the mediastinal fluid reaches levels high enough to be effective against bacteria that are considered resistant to gentamycin and other antibiotics.However, questions have been raised about the safety and efficacy of GCCI. There were concerns whether GCCI can lead to systemic absorption with renal impairment and whether use of topical antibiotics can lead to emergence of antimicrobial resistance.We, hereby, review the literature on GCCI (Collatamp) and take the opportunity to appraise the scientific community about their role in cardiac surgery. Several recent studies have supported their clinical effectiveness. They should be used in dry condition and should not be soaked in saline even for a short period prior to use. However, for GCCI to become part of routine practice in cardiac surgery further large randomised studies are required. As the incidence of sternal wound infection is low in the specialty of cardiac surgery, for any study to be sufficiently powered to address this issue, multicenter studies might be the way forward.Based on the evidence presented in this manuscript it is recommended GCCI (Collatamp) can be a cost effective adjunct for prevention of sternal wound infection. They can also be used for treatment of Deep Sternal Wound Infection.

Mitral valve replacement in severely calcified mitral valve annulus: a 10-year experience

OBJECTIVES Severe calcification in the mitral valve annulus is a challenging problem during mitral valve surgery. We describe our experience with mitral valve replacement in severely calcified mitral valve without decalcification of the annulus. METHODS Between April 2001 and July 2011, 61 patients underwent mitral valve replacement with severe mitral annulus calcification without decalcification of the annulus. This retrospective study was performed to assess the surgical and the long‐term postoperative outcomes in this group. RESULTS The mean age of the patients was 75.2 ± 9.2 years. Twenty‐four patients (53%) were in New York Heart Association Class III/IV. Twenty‐six patients (58%) had good left ventricular function. Mean logistic EuroSCORE was 8.75. Isolated mitral valve replacement was performed in 12 patients (27%). Coronary artery bypass grafting was done in 13 patients (29%). In‐hospital mortality was 4.9% (3 patients). Postoperative morbidity included re‐exploration for bleeding in 3 patients (7%) and transient renal impairment in 10 patients (22%). Three patients required intra‐aortic balloon pump (7%) for low cardiac output syndrome. Seven patients (16%) required permanent pacemaker, and 1 patient (2%) had thromboembolic event. The 1‐year survival was 93.3%, and the 5‐year survival was 78.8%. The mean echocardiography follow‐up was 40 months. There was no paravalvular leak detected in any patient in the long‐term follow‐up. None of the patients had valve‐related reoperation. CONCLUSIONS Mitral valve replacement without annular decalcification in severely calcified mitral valve annulus is a safe and an effective approach and has good long‐term outcome.

Surgical excision of ectopic hepatic tissue in the Right Atrium

From the Wessex Cardiothoracic Centre, University Hospitals Southampton, Southampton, United Kingdom. Disclosures: Authors have nothing to disclose with regard to commercial support. Received for publication April 11, 2017; revisions received July 3, 2017; accepted for publication July 24, 2017; available ahead of print Sept 22, 2017. Address for reprints: Suresh Giritharan, MBChB, MRCS(Ed), Wessex Cardiothoracic Centre, University Hospitals Southampton, Tremona Rd, Southampton SO16 6YD, United Kingdom (E-mail: suresh.giritharan@gmail. com). J Thorac Cardiovasc Surg 2018;155:e47-8 0022-5223/

Emergency surgical extraction of rota ablator from the stent in the left anterior descending artery

36.00 Crown Copyright 2017 Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery http://dx.doi.org/10.1016/j.jtcvs.2017.07.080 MRI showing ectopic liver mass at the junction of the IVC and right atrium with connecting stalk.

Antiplatelet therapy after coronary bypass surgery: “Broken portions” and “uncertainty” in the search for “absolute truth”

Trapping of interventional devices used to treat in-stent restenosis is rarely reported in the literature. Among those is a trapped rota ablation wire causing longitudinal stent deformation, sometime requiring another stent deployment onto the collapse stent. A Rota ablator getting stuck into the stent is very rare, and a lethal complication. We report a case of 79-year-old gentleman who underwent rota ablation for in-stent restenosis. During the procedure, the rota ablator got stuck into the stent resulting in haemodynamic compromise. To our knowledge, this is the first case where a rota ablator got stuck into the stent requiring surgical intervention.

Feasibility of a novel, synthetic, self-assembling peptide for suture-line haemostasis in cardiac surgery

From the Department of Cardiothoracic Surgery, University Hospital Southampton, Southampton, United Kingdom. Disclosures: Authors have nothing to disclose with regard to commercial support. Received for publication Aug 16, 2017; accepted for publication Aug 19, 2017. Address for reprints: Clifford Barlow, DPhil(Oxon), FRCS(CTh), MBBCh(Rand), Department of Cardiothoracic Surgery, University Hospital Southampton, Tremona Rd, Southampton SO16 6YD, United Kingdom (E-mail: cliffbarlow@hotmail.com, clifford.barlow@uhs.nhs.uk). J Thorac Cardiovasc Surg 2017;-:1-2 0022-5223/

Knife in the superior mediastinum: Amazing escape

36.00 Copyright 2017 by The American Association for Thoracic Surgery http://dx.doi.org/10.1016/j.jtcvs.2017.08.049

Candidate plasma biomarkers for predicting ascending aortic aneurysm in bicuspid aortic valve disease

BackgroudTo assess the feasibility and efficacy of PuraStat®, a novel haemostatic agent, in achieving suture line haemostasis in a wide range of cardiac surgical procedures and surgery of the thoracic aorta.MethodsA prospective, non-randomised study was conducted at our institution. Operative data on fifty consecutive patients undergoing cardiac surgery where PuraStat® was utilised in cases of intraoperative suture line bleeding was prospectively collected. Questionnaires encompassing multiple aspects of the ease of use and efficacy of PuraStat® were completed by ten surgeons (five consultants and five senior registrars) and analysed to gauge the performance of the product.ResultsNo major adverse cardiac events were reported in this cohort. Complications such as atrial fibrillation, pacemaker requirement and pleural effusions were comparable to the national average. Mean blood product use of packed red cells, platelets, fresh-frozen plasma (FFP) and cryoprecipitate was below the national average. There was one incidence of re-exploration, however this was due to pericardial constriction rather than bleeding. Analysis of questionnaire responses revealed that surgeons consistently rated PuraStat® highly (between a score of 7 and 10 in the various subcategories). The transparent nature or PuraStat® allowed unobscured visualisation of suture sites and possessed excellent qualities in terms of adherence to site of application. The application of PuraStat® did not interfere with the use of other haemostatic agents or manipulation of the suture site by the surgeon.ConclusionPuraStat® is an easy-to-use and effective haemostatic agent in a wide range of cardiac and aortic surgical procedures.

Best evidence topic - Cardiac general Does cardiac resynchronisation therapy improve survival and quality of life in patients with end-stage heart failure?

This text describe through images, how a knife is retrieved from the superior mediastinum.