Department of Surgical Sciences

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Browsing Department of Surgical Sciences by browse.metadata.advisor "Janson, Jacques Teran"

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    Penetrating traumatic cardiac injury : experience in the current era from a high-volume tertiary hospital.
    (Stellenbosch : Stellenbosch University, 2024-03) Koen, Johan Gerhard; Janson, Jacques Teran; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Cardiothoracic Surgery.
    ENGLISH ABSTRACT: Objectives Penetrating Cardiac Injury is encountered by most surgeons at some point in their career. Prehospital and emergency department risk factors for mortality have been well established. Perioperative predictive risk factors for mortality in patients undergoing operative room surgery has not been well established. The incidence of post-operative intra-cardiac defects is not known. Early and late mortality outcomes in this patient population in the recent era is not known. Methods All suspected penetrating cardiac injuries patients who were admitted to our Trauma Unit and underwent median sternotomy between January 2014 and December 2019 were reviewed. Demographics, mechanism, and mortality, presence of intra-cardiac injuries and surgical management were assessed. Stratification and inter-variable comparison were performed. Results A total of 233 patients were identified. Mean age was 30 years with a male predominance (95%). Most were acute injuries (1 injury in 18% of cases. The presence of cardiac tamponade is highly sensitive for underlying cardiac injuries. Penetrating Zone 1 neck injuries with tamponade may avoid missing potential underlying aortic injuries. Post-operative echocardiography is advised as 23% of Ventricular Septal Defects are clinically missed on admission. We provide our algorithmic approach and surgical management of penetrating cardiac trauma.
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    Surgical outcome of infective endocarditis at Tygerberg Hospital from 2010-2019 : a retrospective review
    (Stellenbosch : Stellenbosch University, 2023-12) Nel, Riaan Frederik; Janson, Jacques Teran; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Surgery.
    ENGLISH SUMMARY: Background: There is a paucity of data on the outcome of left sided cardiac valve surgery for infective endocarditis in South Africa. It is hypothesised that outcomes may be poorer compared to international standards due to differences in disease burden, timing to surgery, organism prevalence, and co-morbidities. Method: This is a retrospective study of 160 patients with left heart valve endocarditis who underwent cardiac surgery from January 2010 until December 2019. Demographic, operative, and admission-related parameters were assessed to determine their association with all-cause mortality during the early postoperative (<30 days) and late postoperative (>30 days) periods. The study aimed to measure early and long-term mortality as well as identify risk factors for morbidity and mortality. Results: Early post operative mortality (<30 days) was 8.8% and late post-operative mortality (>30 days) was 13.1%. Late survival showed 77.5% of the patients were alive with a mean follow up period of 41 months. Increased age (p=0.04), critical illness (p<0.001), and higher urgency of intervention (p<0.001) were associated with higher early post-operative mortality. EuroScore II was a predictor of early mortality (p<0.001), but less accurate after 30 days. Peri-operative organ failure, including cardiac (p=0.025), renal (p=0.016), and respiratory failure (p<0.001), contributed significantly to both early and late mortality. Pre-operative antibiotics for fewer days (p=0.024), ongoing sepsis (p=0.022), and para-valvular extension (p=0.046) were associated with higher early mortality. Culture negative endocarditis was high at 52.5%. Both left and right ventricular function were significantly impaired early post-operatively but recovered well with long-term follow-up. Conclusion: Infective endocarditis is a common indication for cardiac valve surgery in South Africa, with a high rate of culture-negative cases making antibiotic stewardship challenging. Goal-directed medical management and clinical optimization prior to surgery were crucial to achieving better outcomes. Salvage procedures and critical illness with organ failure prior to surgery were associated with poorer outcomes. Despite unique challenges, cardiac surgery for infective endocarditis at Tygerberg Hospital compares favourably to international standards.