Objective To analyze the characteristics of sternal Mycobacterium tuberculosis (Mtb) infection after cardiac surgery. Methods An electronic search was conducted for publicly available cases of sternal Mtb infection after cardiac surgery in PubMed, Web of Science, Wanfang database, and CNKI since their inception up to 18 July 2023, and 2 researchers analyzed the characteristics of the included cases and extracted relevant data. Results A total of 26 patients were included in 15 studies, 16 males and 10 females, aged 5-80 (61.9±15.6) years. Previous surgical history included coronary artery bypass grafting in 14 cases (53.8%), valve surgery in 8 cases (30.8%), congenital heart surgery in 3 cases (11.5%), and aortic surgery in 2 cases (7.7%). The main symptoms and signs were incisional abscesses, poor healing, mostly with pain, with or without erythema, and usually without systemic symptoms such as low-grade fever, night sweats, and weight loss. 13 cases reported a postoperative time to discovery of infection with a mean of 11.8 (0.5-60) months, and 9 cases reported an interval between discovery of infection and diagnosis with a mean of 12.1 (1.5-62) months. Confirmation of the diagnosis was mainly by Mtb culture of cleared bone tissue or pus, pathology and antacid staining. One case died of cardiac arrest before diagnosis. After the diagnosis of 25 cases, 13 cases received only anti-tuberculosis treatment, of which 11 cases received surgical treatment before diagnosis; 12 cases received anti-tuberculosis and surgical treatment, and all 25 cases were successfully cured. The duration of anti-tuberculosis treatment ranged from 6 to 12 months. Conclusion Sternal Mtb infection after cardiac surgery has a long incubation period, early diagnosis is difficult, the rate of missed diagnosis and misdiagnosis is extremely high, and timely diagnosis and treatment can significantly improve the prognosis.
ObjectiveTo explore the clinical efficacy of robot-assisted coronary artery bypass grafting through a small incision in the left intercostal space in the treatment of multivessel coronary disease. MethodsA retrospective analysis was conducted on the clinical data of patients who underwent coronary artery bypass grafting through a small incision in the left intercostal space at Central China Fuwai Hospital of Zhengzhou University from January 1, 2023 to October 15, 2024. Patients were divided into a robotic group and a minimally invasive group based on whether the surgery was assisted by the Da Vinci robot. ResultsA total of 81 patients were included, with 57 in the minimally invasive group, including 41 males and 16 females, with a median age of 65.0 (57.5, 69.5) years; and 24 in the robotic group, including 17 males and 7 females, with a median age of 61.0 (56.0, 69.0) years. There was no statistically significant difference in baseline data between the two groups (P>0.05). The robotic group had less intraoperative bleeding [300 (200, 438) mL vs. 500 (375, 600) mL, P=0.006], shorter postoperative mechanical ventilation time [15.0 (13.3, 23.5) h vs. 22.0 (15.5, 39.5) h, P=0.037], and lower incidence of postoperative pain [8 (33.3%) vs. 33 (57.9%), P=0.043]. The hospitalization cost in the robotic group was higher than that in the minimally invasive group [130491 (123298, 135691) yuan vs. 123892 (115543, 133449) yuan, P=0.023]. There was no statistical difference in postoperative laboratory indicators between the two groups (P>0.05). There was also no statistical difference in the duration of surgery, postoperative 24 h drainage volume, ICU stay time, postoperative hospital stay or incidences of perioperative compications including pleural effusion, transfusion, new-onset atrial fibrillation, acute kidney injury, non-union of incision, major cardiovascular and cerebrovascular adverse events, and reoperation between the two groups (P>0.05). ConclusionCompared with the minimally invasive group, the robotic group shows satisfactory efficacy and can effectively reduce postoperative pain and intraoperative bleeding, and shorten postoperative mechanical ventilation time.