Objective To analyze the clinical characteristics of Mycobacterium tuberculosis (Mtb) infection of the sternum after cardiac surgery. Methods A computerized search was conducted in PubMed, Web of Science, Wanfang, and CNKI databases for published case reports of post-cardiac surgery sternal Mtb infections up to July 18, 2023. Two researchers independently screened the included cases, extracted relevant data, and analyzed clinical features. Results A total of 15 articles involving 26 patients were included, comprising 16 males and 10 females, with a mean age of (61.9±15.6) years (range 5-80). Previous surgical histories included coronary artery bypass grafting (14 patients, 53.8%), valve surgery (8 patients, 30.8%), congenital heart disease surgery (3 patients, 11.5%), and aortic surgery (2 patients, 7.7%). The main symptoms and signs were wound abscesses and poor healing, often accompanied by pain, with or without redness and swelling, while systemic symptoms such as low-grade fever, night sweats, and weight loss were typically absent. The median time for infection to be discovered in 13 patients after surgery was 10.0 (3.0, 13.0) months, and the median interval between infection discovery and diagnosis in 9 patients was 3.0 (2.0, 6.0) months. The primary diagnostic methods included Mtb culture, histopathology, and acid-fast staining of debrided bone tissue or pus. One patient died of cardiac arrest before diagnosis. Among the 25 diagnosed patients, 13 received only antitubercular therapy (11 of whom had undergone surgical treatment before diagnosis), while 12 received combined antitubercular and surgical treatment. All 25 patients were successfully cured, with antitubercular therapy lasting 6-12 months. Conclusion Post-cardiac surgery sternal Mtb infection has a prolonged latency period and poses significant diagnostic challenges, leading to high rates of missed and misdiagnosed cases. Timely diagnosis and treatment can markedly improve 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.