Krzysztof Szwed

Gentamicin-collagen sponge reduces the risk of sternal wound infections after heart surgery: Meta-analysis.

OBJECTIVES Sternal wound infections are serious postoperative complications that increase the length of hospital stay and healthcare costs. The benefit of implantable gentamicin-collagen sponges in reducing sternal wound infections has been questioned in a recent multicenter trial. We aimed to perform a comprehensive meta-analysis of studies assessing the efficacy of implantable gentamicin-collagen sponges in sternal wound infection prevention. METHODS Multiple databases were screened for studies assessing the efficacy of implantable gentamicin-collagen sponges after heart surgery. The primary end point was sternal wound infection, and secondary end points were the occurrence of deep sternal wound infection, superficial sternal wound infection, mediastinitis, and mortality. Randomized controlled trials and observational studies were analyzed separately. By means of meta-regression, we examined the correlation between sternal wound infection and extent to which the bilateral internal thoracic artery was harvested. RESULTS A total of 14 studies (N = 22,135, among them 4 randomized controlled trials [N = 4672]) were included in the analysis. Implantable gentamicin-collagen sponges significantly reduced the risk of sternal wound infection by approximately 40% when compared with control (risk ratio [RR], 0.61; 95% confidence interval [CI], 0.39-0.98; P = .04 for randomized controlled trials and RR, 0.61; 95% CI, 0.42-0.89; P = .01 for observational studies). A similar, significant benefit was demonstrated for deep sternal wound infection (RR, 0.60; 95% CI, 0.42-0.88; P = .008) and superficial sternal wound infection (RR, 0.60; 95% CI, 0.43-0.83; P = .002). The overall analysis revealed a reduced risk of mediastinitis (RR, 0.64; 95% CI, 0.45-0.91; P = .01). The risk of death was unchanged. A significant positive linear correlation (P = .05) was found between the log RR of sternal wound infection and the percentage of patients receiving bilateral internal thoracic artery grafts. CONCLUSIONS Implantable gentamicin-collagen sponges significantly reduce the risk of sternal wound infection after cardiac surgery, with evidence consistent in randomized and observational-level data. However, the extent of this benefit might be attenuated in patients receiving bilateral internal thoracic artery grafts.

Cerebrovascular Events After No-Touch Off-Pump Coronary Artery Bypass Grafting, Conventional Side-Clamp Off-Pump Coronary Artery Bypass, and Proximal Anastomotic Devices: A Meta-Analysis.

Background Off‐pump coronary artery bypass (OPCAB) has been shown to reduce the risk of neurologic complications as compared to coronary artery bypass grafting performed with cardiopulmonary bypass. Side‐clamping of the aorta while constructing proximal anastomoses, however, still carries substantial risk of cerebral embolization. We aimed to perform a comprehensive meta‐analysis of studies assessing 2 clampless techniques: aortic “no‐touch” and proximal anastomosis devices (PAD) for OPCAB. Methods and Results PubMed, CINAHL, CENTRAL, and Google Scholar databases were screened for randomized controlled trials and observational studies comparing “no‐touch” and/or PAD with side‐clamp OPCAB and reporting short‐term (≤30 days) outcomes: cerebrovascular accident and all‐cause mortality. A total of 18 studies (3 randomized controlled trials) enrolling 25 163 patients were included. Aortic “no‐touch” was associated with statistically lower risk of cerebrovascular accident as compared to side‐clamp OPCAB: risk ratio 95% CI: 0.41 (0.27–0.61); P<0.01; I2=0%. Event rates were 0.36% and 1.28% for “no‐touch” and side‐clamp OPCAB, respectively. No difference was seen between PAD and side‐clamp OPCAB: 0.71 (0.33–1.55); P=0.39; I2=39%. A trend towards increased 30‐day all‐cause mortality with PAD and no difference with “no‐touch” were observed when compared to side‐clamp OPCAB. In a subset analysis, “no‐touch” consistently reduced the risk of cerebrovascular accident regardless of patients’ baseline risk characteristics. A benefit with PAD was observed in low‐risk patients. Conclusions Aortic “no‐touch” technique was associated with nearly 60% lower risk of postoperative cerebrovascular events as compared to conventional side‐clamp OPCAB with effect consistent across patients at different risk.

Short-term outcome of attention and executive functions from aorta no-touch and traditional off-pump coronary artery bypass surgery

Abstract Objectives. Postoperative cognitive dysfunction (POCD) is an important neuropsychiatric complication of coronary artery bypass grafting (CABG). It is most likely caused by microembolic brain damage and affects domains of attention, memory, executive functions and dexterity. In order to achieve better neuroprotection, surgeons introduced some advantageous operating procedures. Noteworthy among them is a state-of-the-art off-pump CABG aorta no-touch technique (“no touch” OPCABG). The aim of this study was to investigate the short-term effect of “no touch” OPCABG on patients’ attention and executive functions. Methods. In this prospective, observational, single-surgeon trial, 74 patients scheduled for elective CABG were studied. Thirty-five patients underwent “no-touch” OPCABG and were compared to 39 patients who underwent “traditional” OPCABG. Subjects underwent neurological and neuropsychological evaluation at the time of admission (7 ± 2 days preoperatively) and discharge (7 days postoperatively). Results. Patients who underwent “traditional” OPCABG showed a significant decline in postoperative performance on 4 neuropsychological tests, while patients treated with “no touch” OPCABG showed a significant decline on 1 test. Twenty patients from “traditional” OPCABG group and ten patients from “no touch” OPCABG group were diagnosed with POCD. Conclusions. Use of “no touch” OPCABG was associated with better attention and executive functions 1 week after surgery compared with “traditional” OPCABG.

Meta-analysis to assess the effectiveness of topically used vancomycin in reducing sternal wound infections after cardiac surgery

From the Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital; Department of Hygiene, Epidemiology and Ergonomics, Division of Ergonomics and Physical Effort, and Department of Clinical Neuropsychology, CollegiumMedicum UMK, Bydgoszcz, Poland; and Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS—ISMETT (Istituto Mediterraneo per I Trapianti e Terapie ad alta specializzazione), Palermo, Italy. Disclosures: Authors have nothing to disclose with regard to commercial support. Received for publication Jan 21, 2017; revisions received May 5, 2017; accepted for publication June 4, 2017; available ahead of print July 1, 2017. Address for reprints: Mariusz Kowalewski, MD, Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital, Maria Curie Sklodowska Str 9., Bydgoszcz 85-094, Poland (E-mail: kowalewskimariusz@ gazeta.pl). J Thorac Cardiovasc Surg 2017;154:1320-3 0022-5223/

Meta-analysis of uninterrupted as compared to interrupted oral anticoagulation with or without bridging in patients undergoing coronary angiography with or without percutaneous coronary intervention

36.00 Copyright 2017 by The American Association for Thoracic Surgery http://dx.doi.org/10.1016/j.jtcvs.2017.06.004 Reduction of risk for developing sternal wound infections with topically used vancomycin.

CArbon dioxide surgical field flooding and aortic NO-touch off-pump coronary artery bypass grafting to reduce Neurological injuries after surgical coronary revascularisation (CANON): protocol for a randomised, controlled, investigator and patient blinded single-centre superiority trial with three parallel arms

OBJECTIVES To assess safety and effectiveness of different periprocedural antithrombotic strategies in patients receiving long-term oral anticoagulation and undergoing coronary angiography with or without percutaneous coronary intervention (PCI). METHODS Studies comparing uninterrupted oral anticoagulation (UAC) with vit. K antagonists vs interrupted oral anticoagulation (IAC) with or without bridging anticoagulation before coronary procedures were eligible for inclusion in the current meta-analysis. Endpoints selected were 30-day composite of major adverse cardiovascular or cerebrovascular and thromboembolic events (MACCE) and major bleeding. RESULTS Eight studies (7 observational and 1 randomized controlled trial [N=2325pts.]) were included in the analysis. There was no difference in MACCE between UAC and IAC; RR (95%CIs): 0.74 (0.34-1.64); p=0.46 but there was a statistically significant MACCE risk reduction with UAC as compared to IAC with bridging: 0.52 (0.29-0.95); p=0.03. Likewise, there were no statistically significant differences between UAC vs IAC in regard to major bleeding: 0.62 (0.16-2.43); p=0.49; but as compared to IAC with bridging, UAC was associated with statistically significant 65% lower risk of major bleeding: 0.35 (0.13-0.92); p=0.03. Additionally, meta-regression analysis revealed significant linear correlation between log RR of MACCE (β=-4.617; p<0.001) and major bleeding (β=6.665; p=0.022) and mean value of target INR suggestive of higher thrombotic and secondary haemorrhagic risk below estimated INR cut-off of 2.17-2.27 within 30days. CONCLUSIONS Uninterrupted OAC is at least as safe as interrupted OAC, and seems to be much safer than interrupted OAC with bridging anticoagulation in patients undergoing coronary angiography with or without PCI.

P03-31 - Demographic factors and neuropsychological tests solutions in schizophrenia subjects

Introduction Neurological injuries remain a major concern following coronary artery bypass grafting (CABG) that offsets survival benefit of CABG over percutaneous coronary interventions. Among numerous efforts to combat this issue is the development of off-pump CABG (OPCABG) that obviates the need for extracorporeal circulation and is associated with improved neurological outcomes. The objective of this study is to examine whether the neuroprotective effect of OPCABG can be further pronounced by the use of two state-of-the-art operating techniques. Methods and analysis In this randomised, controlled, investigator and patient blinded single-centre superiority trial with three parallel arms, a total of 360 patients will be recruited. They will be allocated in a 1:1:1 ratio to two treatment arms and one control arm. Treatment arms undergoing either aortic no-touch OPCABG or OPCABG with partial clamp applying carbon dioxide surgical field flooding will be compared against control arm undergoing OPCABG with partial clamp. The primary endpoint will be the appearance of new lesions on control brain MRI 3 days after surgery. Secondary endpoints will include the prevalence of new focal neurological deficits in the first 7 days after surgery, the occurrence of postoperative cognitive dysfunction at either 1 week or 3 months after surgery and the incidence of delirium in the first 7 days after surgery. Data will be analysed on intention-to-treat principles and a per protocol basis. Ethics and dissemination Ethical approval has been granted for this study. Results will be disseminated through peer-reviewed media. Trial registration number NCT03074604; Pre-results. Date and version identifier 10-Mar-2017 OriginalINTRODUCTION Neurological injuries remain a major concern following coronary artery bypass grafting (CABG) that offsets survival benefit of CABG over percutaneous coronary interventions. Among numerous efforts to combat this issue is the development of off-pump CABG (OPCABG) that obviates the need for extracorporeal circulation and is associated with improved neurological outcomes. The objective of this study is to examine whether the neuroprotective effect of OPCABG can be further pronounced by the use of two state-of-the-art operating techniques. METHODS AND ANALYSIS In this randomised, controlled, investigator and patient blinded single-centre superiority trial with three parallel arms, a total of 360 patients will be recruited. They will be allocated in a 1:1:1 ratio to two treatment arms and one control arm. Treatment arms undergoing either aortic no-touch OPCABG or OPCABG with partial clamp applying carbon dioxide surgical field flooding will be compared against control arm undergoing OPCABG with partial clamp. The primary endpoint will be the appearance of new lesions on control brain MRI 3 days after surgery. Secondary endpoints will include the prevalence of new focal neurological deficits in the first 7 days after surgery, the occurrence of postoperative cognitive dysfunction at either 1 week or 3 months after surgery and the incidence of delirium in the first 7 days after surgery. Data will be analysed on intention-to-treat principles and a per protocol basis. ETHICS AND DISSEMINATION Ethical approval has been granted for this study. Results will be disseminated through peer-reviewed media. TRIAL REGISTRATION NUMBER NCT03074604; Pre-results. DATE AND VERSION IDENTIFIER 10-Mar-2017 Original.

PW01-164 - Neuropsychological assessment of cardiac rehabilitation following cardiac surgery - preliminary results

Introduction Schizophrenia is very common, chronic illness affects 1% of population. Cognition dysfunctions are considered as important factors of social and general life impairment. There are many unchangeable risk factors of cognition decline in schizophrenia subjects such as age, duration of illness, and sex. Aim The aim of study were to examined correlations among age, sex, education, duration of illness and scores in neuropsychological tests. Methods In our study 220 subjects (116 male, and 104 female) in mean age 41 ± 11,3 with diagnosis of schizophrenia were examined with battery of computerized neuropsychological tests: simple reaction test (SRT), verbal memory test (VMT) and delayed verbal memory test (VMDT), visual working memory test (VWMT). Mean duration of illness was 12 years (min 1 year; max 41 years). Mean duration of education was 11,5 years (min 6 years; max 18 years) Results 1) Age was correlated with worse scores in every parameters of all tests. 2) Females got lower correct answers and longer reaction time (815 vs. 630 ms) in SRT, remember fewer words in VMT and cards (3,9 vs.4,3) in VWMT. 3) Longer duration of education was correlated with better results in every parameters of all tests except number of correct answers in SRT, 4) Longer duration of illness was correlated with worse scores in SRT, better scores in VMT, VMDT and VWMT. Conclusions Cognition decline in schizophrenia is connected not only with factors related with illness. Demographic factors, mostly unchangeable, are take important rule in cognition functioning.

Does Toxoplasma gondii infection affect cognitive function? A case control study.

Background Cognitive functioning involves all aspects of perception, thinking, reasoning, and remembering. Cardiac surgery is associated with a decline in cognitive functions. The incidence of this complication ranges from 3% to 80%. Cardiac rehabilitation is a treatment programme designed to help heart patients manage their condition, improve their health and recover their quality of life after a cardiac event. Objectives To evaluate the influence of cardiac rehabilitation on neuropsychological parameters of patients undergoing cardiac surgery. Methods Neuropsychological data were gathered from 20 patients (M=11,F= 9; mean age 66,5 ± 11,7 years) who underwent a four week cardiac rehabilitation program. To examine patients cognitive functioning following tests were utilized: Trail Making Test A and B, Stroop test A and B, FAS test and Digit Span Test (DST). Patients were qualified into two groups: Group - I after heart valve surgery. Group II - after coronary artery bypass grafting (CABG) Results In TMT A and B both groups demonstrated similar improvement, though the results were below appropriate age norms. In part A of the Stroop test both groups improved their results, yet the improvement of the I group was greater. In part B of the Stroop test and in DST the results of group I improved, while the results of group II worsened. In the FAS test both groups improved their results, yet the improvement of group II was greater. Conclusions The group of patients who underwent heart valve surgery demonstrates greater improvement in processes associated with prefrontal cortex.