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

S09:5
STERNAL CLOSURE WITH THERMOREACTIVE CLIPS IN 1000 HIGH RISK PATIENTS
- A SINGLE CENTRE COHORT STUDY.
Balasubramanian Sendhil Kumaran 1 , Dunning Joel 1 , Avlonitis Vassilios 1 , Gill Michael 1 ,
Goodwin Andrew 1 , Owens Andrew 1 , Kendall Simon 1
1) The James Cook University Hospital, United Kingdom
Background
Nitillium thermoreactive clips are a novel method of sternalclosure. These clips are highly pliable at low temperature
making them easy to place round the sternum but stiffen at body temperature. They also demonstrate elasticity
on coughing, returning to their original position rather than cutting through. We sought to assess the incidence of
sternal wound complications using these thermo-reactive clips(flexigrips) in 1,000 high-risk patients and identify the
risk factors for deep sternal wound infection (DSWI).
Methods
From May-2004 to August-2008, 1,000 high-risk patients, had sternal closure using flexigrips. Perioperative and
demographic variables were analyzed with univariate and multivariate logistic regression analysis to identify risk
factors associated with DSWI.
Results
Median age was 64yrs and median BMI was 32. 85% were male, 30%diabetics and 75% had hypertension. 74% had
CABG, 9% had valve replacements and 12% had combined procedures.There were no sternal complications in 981
patients (98%). The total incidence of DSWI was 1.9% and sternal dehiscence was 1%. Superficial wound infection
was 8.6%. Overall mortality was 1.6%. Multivariate analysis identified, BMI≥35 (Odds ratio 3.21:95%CI 1.16-8.85),
type-II diabetes (Odds ratio 3.9:95%CI 1.27 – 12.3) and need for emergency resternotomy (Odds ratio 7.65:95%CI
2.3-25.19) were significant risk factors for DSWI.
Conclusions
Thermo-reactive clips can be safely used for sternal closure in these high risk patients with an incidence of sternal
dehiscence of 1%. Incidence of sternal dehiscence requiring surgery is low. BMI≥35, diabetes and mediastinal reexploration
were additional predictors of DSWI.
S09:6
CARDIAC SURGERY IN PATIENTS WITH HAEMOPHILIA
Tang Mariann 1 , Wierup Per 1 , Terp Kim 1 , Ingerslev Jørgen 2 , Sørensen Benny 2
1) Department of Cardiothoracic Surgery, Aarhus University Hospital, Skejby,
2) Center for Haemophilia and Thrombosis, Denmark
Background
Today the populations of haemophilia patients have a higher life expectancy than previously known, and age-related
disorders are expected to become more prevalent. Cardiac surgery constitutes a major haemostatic challenge.
Hence, only limited systematic information exists on efficacious and safe haemostatic substitution regimens during
and after these major surgical episodes. Furthermore, postoperative thromboprophylaxis with antiplatelet drugs is
questionable and seem problematic in patients with haemophilia.
Aim
Evaluation of our current experience and results with cardiac surgery in patients with haemophilia. Provide detailed
information on the haemostatic treatment regimens adopted. Forward systematic details on the organization of
haemostatic treatment regimens and postoperative thromboprophylaxis.
Material & Methods
Six patients with haemophilia A undergoing cardiac surgery. Information on concomitant disorders and EuroSCORE
was registrated. Outcome measures were: (i)re-operation caused by bleeding, (ii) blood transfusion requirements,
(iii) peri- and postoperative blood loss, (iv) peri- and postoperative complications and (v) postoperative development
of inhibitors. Data was compared with historical data from patients without congenital haemophilia (n = 5977) as
extracted from the Danish Heart Database.
Results
None of the six patients were reoperated due to bleeding and none developed inhibitors. Peri- and postoperative
blood loss ranged from 565 to 1055 ml. No incidence of myocardial infarction or thromboembolic complications was
seen. Data did not deviate from results with non-haemophiliacs undergoing major cardiac surgery. All patients were
substituted with a recombinant factor VIII product.
Conclusion
Major cardiac surgery can safely be performed in patients with congenital haemophilia. Outcome measures were
acceptable in comparison with data from non-haemophiliacs.
STOCKHOLM, SWEDEN 59