Topical versus systemic vancomycin for deep sternal wound infection caused by methicillin-resistant Staphylococcus aureus in a rodent experimental model

In 37 Wistar albino rats, we investigated the effects of topical vancomycin on deep sternal wound infection caused by methicillin-resistant Staphylococcus aureus. Partial median sternotomy was performed under sterile conditions. Group I (n=6) was the sham, and group II (n=7) was the control. Group III (n=8) received topical vancomycin, group IV (n=8) received systemic vancomycin, and group V (n=8) received topical and systemic vancomycin (combined). Rats in groups II through V were inoculated with 0.5 mL × 108 CFU/mL methicillin-resistant S. aureus in the mediastinum and sternum. No medication was given to groups I and II. Twenty-four hours after surgery, 40 mg/kg/day vancomycin was given topically in group III; systemically in group IV; and topically and systemically in group V. After 7 days, smear samples from the mediastinum and tissue cultures from the sternum were obtained. We found 5.00 ± 0 CFU/mL microorganisms in the mediastinum in group II, 1.90 ± 1.70 in group III, 3.33 ± 0.48 in group IV, and 1.70 ± 1.08 in group V. The quantity of microorganisms per gram of tissue in the sternum was 7.36 ± 0.23 in group II, 6.01 ± 0.33 in group III, 5.81 ± 0.81 in group IV, and 3.99 ± 2.47 in group V. The quantity of microorganisms was less in the 3 treatment groups than in the control group (P <0.05). We conclude that topical plus systemic vancomycin treatment might be more effective in patients with deep sternal wound infections caused by methicillin-resistant S. aureus. © 2006 by the Texas Heart® Institute

Abdominal aortic aneurysm repair in octogenarians: outcomes and predictors

OBJECTIVES: This study was undertaken to evaluate predictors and outcomes of octogenarians who underwent abdominal aortic aneurysm repair. DESIGN: A prospective observational study. MATERIALS AND METHODS: Between January 1st, 1997 and April 15th, 2005, 31 octogenarians were admitted to our Department with the diagnosis of abdominal aortic aneurysm. Mean follow-up time was 53.7+/-27.2 months. All patients were in good clinical condition and represented a selected healthy group of octogenarians. RESULTS: The overall perioperative (30-days) mortality rate was 3.1%. The total in-hospital morbidity rate was 22.6%. Overall survival estimates at 48 and 96 months were 81+/-8% and 46+/-21%, respectively. The actuarial freedom from aneurysm-related death at 48 and 96 months was 96+/-4% and 96+/-4%, respectively. The actuarial freedom from aneurysm-unrelated death at 48 and 96 months was 84+/-7% and 48+/-21%. Only coronary artery disease was a significant predictor of survival using multivariate stepwise logistic regression analysis. CONCLUSIONS: In this series, AAA surgery was carried out in selected octogenarians without affecting long-term survival

Resection and end-to-end anastomosis for ascending aortic aneurysms associated with a bicuspid valve : case reports

Ascending aortic aneurysms associated with a bicuspid valve are generally treated by replacement with a tubular graft because the aortic wall is claimed to be genetically pathological. We describe 9 cases in which patients with an ascending aortic aneurysm and an associated diseased bicuspid valve underwent aneurysmal resection and end-to-end anastomosis. This technique permitted us to remove the entire aneurysmal wall, avoiding graft interposition

Reduction ascending aortoplasty: midterm follow-up and predictors of redilatation

Background: Reduction ascending aortoplasty is an alternative procedure to the replacement of the ascending aorta in case of ascending aorta aneurysm without aortic root involvement. This study was designed to evaluate the midterm follow-up of aortoplasty and to determine predictors of redilatation. Methods: From January 1, 1998, to April 30, 2005, 68 patients with dilatation of the ascending aorta underwent unsupported reduction aortoplasty in combination with other cardiac procedures. All patients underwent associated surgical procedures. Sixty patients (88.2%) underwent associated aortic valve replacement. Cumulative follow-up time was 191.4 patient-years and was 100% complete. Median follow-up time was 2.5 years, and mean follow-up time was 2.9 (plus or minus) 1.7 years (range, 0.4 to 6.3 years). Results: The overall perioperative mortality rate was 1.5%. Overall survival estimates at 3 and 6 years were 93.3% (plus or minus) 4.5% and 89.3% (plus or minus) 5.9%, respectively. The actuarial freedom from cardiac-related death at 3 and 6 years was 100% and 95.7% (plus or minus) 4.3%, respectively. Ascending aorta redilatation occurred in 5 patients (7.5%). The actuarial freedom from redilatation at 3 and 6 years was 97.7% (plus or minus) 2.3% and 79.8% (plus or minus) 8.4%, respectively. The actuarial freedom from reoperation at 3 and 6 years was 100% and 86.3% (plus or minus) 7.5%, respectively. Only preoperative diameter was a significant predictor of redilatation using multivariate stepwise logistic regression analysis. Conclusions: Unsupported reduction aortoplasty is a safe and effective technique with low mortality, low morbidity, and rare late complications for selected chronic aneurysm of the ascending aorta with diameter less than 55 mm

Rates of cycling cells in cryopreserved valvular homograft : a preliminary study

Some investigators claim that the viability of cryopreserved human valvular homograft is necessary for the duration of implanted homograft. In this preliminary study, the percentage of cycling cells in cryopreserved valvular homografts was evaluated with the use of monoclonal Ki-67 antibody. Three human aortic valves were harvested from multiorgan donors and cryopreserved. Sections of 5 mm in thickness were stained with monoclonal Ki-67 antibody. The proportion of endothelial cells with Ki-67 positive nuclei was 1.80 0.20%. No differences in distribution were observed from basal to marginal sites. Few fibroblasts showed Ki-67-immunopositivity (0.10 0.06%) while the Ki-67 immunostaining was 0.80 +/- 0.20% in myocytes.Our preliminary study shows that cryopreserved valvular homograft cells are not only viable but they also have the potential to replicate. These data can lead to the hypothesis that valvular cells could actively replicate even after implantation, permitting cellular renewal and regeneration of extracellular matrix\u2019s components

Administration of Octreotide for Management of Postoperative High-Flow Chylothorax

Chylothorax is a rare complication of adult cardiothoracic surgery that can affect the postoperative course as it can lead to respiratory insufficiency, protein loss, fluid imbalance, and immunodeficiency. We report the case of a 51-year-old man who developed a persistent high-flow chylothorax after replacement of the descending thoracic aorta for an aneurysm. After a week of complete oral intake cessation and total parenteral nutrition, we started administration of octreotide, a somatostatin analog. It led to rapid cessation of chyle production, and the patient was discharged without further complications and chylothorax relapses