Objective
To evaluate the risk factors for sternal wound infections after various cardiac operations.
Methods
We retrospectively analyzed the clinical data of 2 924 consecutive patients (28% female) in our hospital from 2010 to 2014 year. Their median age was 69 years (interquartile range of 60 to 76 years). Procedures included isolated coronary artery bypass grafting (CABG), isolated valve repair or replacement, and valve procedures plus CABG.
Results
Sternal wound infection was detected in 110 (3.8%) patients among the 2 924 patients: 67 of 1 671 patients (4.0%) after CABG, 17 of 719 (2.4%) after valve operations, and 26 of 534 (4.9%) after valve+CABG operation. In the CABG patients, bilateral internal thoracic artery harvest procedure, operation time>300 minutes, diabetes, obesity, chronic obstructive pulmonary disease, and female were independent risk factors for sternal wound infection. In the valve operation patients, only revision for bleeding as an independent predictor for sternal infection. For combined valve plus CABG patients, revision for bleeding and operation time>300 minutes were independent risk factors for sternal infection.
Conclusion
Risk factors for sternal wound infections after cardiac operations vary with the type of surgical procedure. In patients undergoing valve operations or combined operations, procedure-related risk factors (revision for bleeding, operation time) independently predict infection. In patients undergoing CABG, not only procedure-related risk factors but also bilateral internal thoracic artery harvest and patient characteristics (diabetes, chronic obstructive pulmonary disease, obesity, female) are predictors of sternal wound infection. Preventive interventions may be justified according to the type of operation.
Left ventricular assist device (LVAD) serves as a critical therapeutic option for patients with end-stage heart failure, significantly enhancing survival rates and quality of life. However, LVAD implantation exerts complex and profound effects on right ventricular (RV) function, with RV dysfunction emerging as a key factor influencing the prognosis of LVAD patients. This article systematically reviews the relationship between LVAD and RV function, exploring the importance of RV function in LVAD patients, assessment methods, underlying mechanisms of impact, and strategies for prevention and management. Comprehensive evidence suggests that preoperative evaluation of RV function is crucial for predicting the risk of RV dysfunction, while effective prevention and management rely on preoperative optimization, meticulous intraoperative techniques, rigorous postoperative monitoring, and multidisciplinary collaboration. Furthermore, this review discusses the potential and future directions of emerging technologies, such as improved LVAD designs, biventricular assist devices, gene therapy, and personalized medicine, in ameliorating RV dysfunction. In conclusion, RV function is one of the key determinants of successful LVAD therapy. Through comprehensive assessment, prevention, and management of RV function, coupled with the application of novel technologies, the clinical outcomes of LVAD patients can be further improved.
