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Dynamic, Multiplanar Separation of the Sternum Demonstrated in Sternal Instability by Ultrasound
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Heart, Lung and Circulation 2011;20:250–284
ASCTS 2010 Abstracts
ABSTRACTS
Reduction of Surgical Site Infection Using a Microbial Sealant: A Randomised Controlled Trial Ian Gilfillan, FRACS ∗ , Anand Iyer, MCH, Sanjay Thakur, MCH Department of Cardiothoracic Surgery, Fremantle Hospital, Western Australia, Australia Background: Surgical site infection following open procedures is a major cause of mortality and morbidity. We have explored the use of a microbial sealant prior to surgical incisions to reduce surgical site infection. Methods: We conducted a prospective randomised controlled study to determine the efficacy of a cyanoacrylate sealant in patients undergoing coronary artery bypass grafting. Both left and right long saphenous veins were taken in an individual patient by open incision below the knee if three or more lengths of vein were required. The cyanoacrylate sealant (Kimberly Clark InteguSeal) was applied to one leg and the other leg was prepared in a conventional fashion. The treated leg was chosen at random. Microbiological swabs from the leg wounds were taken at five days, and wound assessment according to the Southampton score performed at 30 days by two blinded observers. Results: Since each patient acted as their own control the baseline characteristics of the treated and untreated legs were similar. The study was terminated early at 47 patients (i.e. 94 legs) following institutional ethics committee review. Patients in whom the sealant was used suffered one (2.1%) infection and there were 12 (25.5%) wound infections in the conventionally prepared leg (p = 0.001). There were 13 positive cultures from the treated leg, and 22 from the untreated site. Conclusion: We found that the use of a microbial skin sealant applied immediately prior to the incision significantly reduced the rate of surgical site infection. The incidence of skin sensitivity or other adverse reaction following application of the microbial sealant was nil. The treatment is straightforward and has been easily integrated with existing routine preoperative procedures at this surgical centre. Microbial sealant may thus be a useful addition to the multimodal approach to minimise surgical site infection. doi:10.1016/j.hlc.2010.11.040 Dynamic, Multiplanar Separation of the Sternum Demonstrated in Sternal Instability by Ultrasound D. El-Ansary a,b,∗ , G. Waddington c , R. Adams a a The
University of Sydney, Australia University of Melbourne, Australia c The University of Canberra, Australia b The
Background: Sternal instability, a complication arising for some following sternotomy for cardiac surgery, affects their later quality of life and cost of care. However, there are currently few guidelines for its diagnosis, quantification and monitoring. This study evaluated the validity and
reliability of ultrasound measures obtained in the transverse plane using ultrasound. Methods: The ultrasound measurement protocol was tested in vitro with bony sterna and in vivo, in the examination of eight patients with sternal instability. Results: Reliability estimation of the ultrasound measure on bony sterna gave ICC (2, 1) values >0.99, and reliability estimates for the sternal separation measure in the patient group were ICC (2, 1) values between 0.90 and 0.93. Discussion: Measurements of the sternal gap by ultrasound can therefore objectively reflect the extent of bony separation occurring in a group of patients with sternal instabilty. Being able to accurately measure the degree of sternal separation at rest and during movement may serve to promote better monitoring of patients and enable future research to gain information about sternal closure methods and the effects of activity and exercise on the healing sternum. This will assist in establishing clinical guidelines for the management of sternal instability. An incidental finding of this study was the dynamic, multiplanar separation of the sternum demonstrated in this patient group upon upper limb movements. Movement was recorded in two planes and it is likely that there is also movement in the sagittal plane. This study warrants more research to confirm the clinical utility of ultrasound. doi:10.1016/j.hlc.2010.11.041
BREAKFAST SESSION Bronchopulmonary Carcinoid Tumours: Long Term Outcomes Following Resection Christopher Cao a,b,∗ , Tristan D. Yan a,b , Catherine Kennedy a,b , P. Nicholas Hendel a,b , Paul G. Bannon a,b , Brian C. McCaughan a,b a The University of Sydney, Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia b The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, Australia
Introduction: Bronchopulmonary carcinoid tumours are considered as a relatively uncommon and less malignant group of lung cancers. However, patients with histologically atypical disease are known to have a worse prognosis. The present study aims to evaluate the long term outcomes following resection of bronchopulmonary carcinoid tumours according to the new TNM staging system. Methods: Patients with histologically proven bronchopulmonary carcinoid tumours who underwent surgery in our thoracic unit over the last 25 years were identified from a prospectively collected database. Results: One hundred and eighty-six patients were identified from our electronic database. Of these, 164 were known to have typical disease, whilst 22 had atypical disease. Median overall survival was 20.0 years. Univariate analysis found age over 60, atypical disease, TNM staging, N status and M status to have a statistical significance on overall survival. Multivariate analysis found age over 60, atypical histopathology and higher TNM staging to have a detrimental impact on overall survival. Patients in the
Heart, Lung and Circulation 2011;20:250–284
ASCTS 2010 Abstracts
ABSTRACTS
Reduction of Surgical Site Infection Using a Microbial Sealant: A Randomised Controlled Trial Ian Gilfillan, FRACS ∗ , Anand Iyer, MCH, Sanjay Thakur, MCH Department of Cardiothoracic Surgery, Fremantle Hospital, Western Australia, Australia Background: Surgical site infection following open procedures is a major cause of mortality and morbidity. We have explored the use of a microbial sealant prior to surgical incisions to reduce surgical site infection. Methods: We conducted a prospective randomised controlled study to determine the efficacy of a cyanoacrylate sealant in patients undergoing coronary artery bypass grafting. Both left and right long saphenous veins were taken in an individual patient by open incision below the knee if three or more lengths of vein were required. The cyanoacrylate sealant (Kimberly Clark InteguSeal) was applied to one leg and the other leg was prepared in a conventional fashion. The treated leg was chosen at random. Microbiological swabs from the leg wounds were taken at five days, and wound assessment according to the Southampton score performed at 30 days by two blinded observers. Results: Since each patient acted as their own control the baseline characteristics of the treated and untreated legs were similar. The study was terminated early at 47 patients (i.e. 94 legs) following institutional ethics committee review. Patients in whom the sealant was used suffered one (2.1%) infection and there were 12 (25.5%) wound infections in the conventionally prepared leg (p = 0.001). There were 13 positive cultures from the treated leg, and 22 from the untreated site. Conclusion: We found that the use of a microbial skin sealant applied immediately prior to the incision significantly reduced the rate of surgical site infection. The incidence of skin sensitivity or other adverse reaction following application of the microbial sealant was nil. The treatment is straightforward and has been easily integrated with existing routine preoperative procedures at this surgical centre. Microbial sealant may thus be a useful addition to the multimodal approach to minimise surgical site infection. doi:10.1016/j.hlc.2010.11.040 Dynamic, Multiplanar Separation of the Sternum Demonstrated in Sternal Instability by Ultrasound D. El-Ansary a,b,∗ , G. Waddington c , R. Adams a a The
University of Sydney, Australia University of Melbourne, Australia c The University of Canberra, Australia b The
Background: Sternal instability, a complication arising for some following sternotomy for cardiac surgery, affects their later quality of life and cost of care. However, there are currently few guidelines for its diagnosis, quantification and monitoring. This study evaluated the validity and
reliability of ultrasound measures obtained in the transverse plane using ultrasound. Methods: The ultrasound measurement protocol was tested in vitro with bony sterna and in vivo, in the examination of eight patients with sternal instability. Results: Reliability estimation of the ultrasound measure on bony sterna gave ICC (2, 1) values >0.99, and reliability estimates for the sternal separation measure in the patient group were ICC (2, 1) values between 0.90 and 0.93. Discussion: Measurements of the sternal gap by ultrasound can therefore objectively reflect the extent of bony separation occurring in a group of patients with sternal instabilty. Being able to accurately measure the degree of sternal separation at rest and during movement may serve to promote better monitoring of patients and enable future research to gain information about sternal closure methods and the effects of activity and exercise on the healing sternum. This will assist in establishing clinical guidelines for the management of sternal instability. An incidental finding of this study was the dynamic, multiplanar separation of the sternum demonstrated in this patient group upon upper limb movements. Movement was recorded in two planes and it is likely that there is also movement in the sagittal plane. This study warrants more research to confirm the clinical utility of ultrasound. doi:10.1016/j.hlc.2010.11.041
BREAKFAST SESSION Bronchopulmonary Carcinoid Tumours: Long Term Outcomes Following Resection Christopher Cao a,b,∗ , Tristan D. Yan a,b , Catherine Kennedy a,b , P. Nicholas Hendel a,b , Paul G. Bannon a,b , Brian C. McCaughan a,b a The University of Sydney, Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia b The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, Australia
Introduction: Bronchopulmonary carcinoid tumours are considered as a relatively uncommon and less malignant group of lung cancers. However, patients with histologically atypical disease are known to have a worse prognosis. The present study aims to evaluate the long term outcomes following resection of bronchopulmonary carcinoid tumours according to the new TNM staging system. Methods: Patients with histologically proven bronchopulmonary carcinoid tumours who underwent surgery in our thoracic unit over the last 25 years were identified from a prospectively collected database. Results: One hundred and eighty-six patients were identified from our electronic database. Of these, 164 were known to have typical disease, whilst 22 had atypical disease. Median overall survival was 20.0 years. Univariate analysis found age over 60, atypical disease, TNM staging, N status and M status to have a statistical significance on overall survival. Multivariate analysis found age over 60, atypical histopathology and higher TNM staging to have a detrimental impact on overall survival. Patients in the