M. Özkur

Cardiac surgery antibiotic prophylaxis and calculated empiric antibiotic therapy

Background Ongoing debate exists concerning the optimal choice and duration of antibiotic prophylaxis as well as the reasonable calculated empiric antibiotic therapy for hospital-acquired infections in critically ill cardiac surgery patients. Methods A nationwide questionnaire was distributed to all German heart surgery centers concerning antibiotic prophylaxis and the calculated empiric antibiotic therapy. Results The response to the questionnaire was 87.3%. All clinics that responded use antibiotic prophylaxis, 79% perform it not longer than 24 h (single-shot: 23%; 2 doses: 29%; 3 doses: 27%; 4 doses: 13%; and >5 doses: 8%). Cephalosporin was used in 89% of clinics (46% second-generation, 43% first-generation cephalosporin). If sepsis is suspected, the following diagnostics are performed routinely: wound inspection 100%; white blood cell count 100%; radiography 99%; C-reactive protein 97%; microbiological testing of urine 91%, blood 81%, and bronchial secretion 81%; procalcitonin 74%; and echocardiography 75%. The calculated empiric antibiotic therapy (depending on the suspected focus) consists of a multidrug combination with broad-spectrum agents. Conclusion This survey shows that existing national guidelines and recommendations concerning perioperative antibiotic prophylaxis and calculated empiric antibiotic therapy are well applied in almost all German heart centers.

How to Deal with a Porcelain Aorta in Combined Valve Surgery

Objectives: Cardiac surgery in patients scheduled for combined single/multiple valve and CABG surgery with undetected porcelain aorta is challenging. The aim of this retrospective study was to characterize patients who were treated with “no-touch technique” and additional replacement of the ascending aorta with hypothermic circulatory arrest addressing the porcelain aorta and identify determinants for clinical outcome. Methods: From 01/2008 to 04/2015, 29 patients (75.5 ± 8.2 years, EuroSCORE II 8.3; 95% CI: 5.5–15.8) with preoperatively undetected porcelain aorta and combined single/multiple valve and CABG surgery were observed. In all patients the ascending aorta was replaced using circulatory arrest. Factors influencing a combined endpoint (hospital mortality, stroke and prolonged ventilation) were evaluated. Results: The 30-day mortality was 6.9% (n = 2), Stroke occurred in 6.9% (n = 2), prolonged ventilation was necessary in 35% (n = 10). Summarized the combined endpoint was met by 12 individual patients. The combined endpoint was influenced by history of stroke, surgery of mitral and/or tricuspid valve surgery, BSA, creatinine clearance, LVEF, however, only BSA (p = 0.0019), creatinine clearance (p = 0.035) and LVEF (p = 0.024) reached statistical significance. Mean survival was 5.26 years (CI 95%: 4.16–6.36). One year and three year survival were 85.9 ± 6.5% and 75.6 ± 9.1%, respectively. Long-term survival was significantly influenced by the combined endpoint (p = 0.011). Conclusion: Although our data indicate that undetected porcelain aorta in complex cardiac surgery can be operated with good short and long-term results, better preoperative imaging in patients at risk for porcelain aorta could influence the treatment strategy and improve clinical outcome.