Background: Negative pressure wound therapy (NPWT) is traditionally used to treat postoperative wound infections. However, its use in closed wound sternotomy post cardiac surgery in high-risk patients has become increasingly popular. The potential preventive benefit of reducing sternal wound infections has been recently acknowledged. Bilateral internal mammary artery (BIMA) grafts are used in coronary artery bypass grafting but have been associated with an increased risk of sternal wound infections (SWIs). Objectives: This systematic analysis examines whether NPWT can reduce the incidence of SWI following BIMA grafts, leading to more patients benefiting from the better survival outcome associated with BIMA grafting. Method: A comprehensive systematic search and meta-analysis were performed to identify studies on the use of NPWT in closed wound sternotomy. Ovid MEDLINE (in-process and other nonindexed citations and Ovid MEDLINE 1990 to present), Ovid EMBASE (1990 to present), and The Cochrane Library (Wiley), PubMed, and Google Scholar databases were searched from their inception to May 2022 using keywords and MeSH terms. Thirty-four articles from 1991 to May 2022 were selected. Result: Three studies reported on the outcome of NPWT following BIMA grafting. The pooled analysis did not show any significant difference in the incidence of sternal wound infection between NPWT and standard dressing (RR 0.48 95% CI 0.17–1.37; P = 0.17) with substantial heterogeneity (I² 65%). Another seven studies were found comparing the outcome of SWI incidence of negative pressure closed wound therapy with conventional wound therapy in patients undergoing adult cardiac surgery. The pooled analysis showed that NPWT was associated with a low risk of SWIs compared to conventional dressing (RR 0.47 95% CI 0.36–0.59; P < 0.00001), with low heterogeneity (I² 1%). Conclusion: The literature identified that NPWT significantly decreased the incidence of sternal wound complications when applied to sutured sternotomy incisions in high-risk patients, and in some cases, it eliminated the risk. However, the inadequate number of randomized controlled trials assessing the effectiveness of NPWT in BIMA grafting emphasizes the need for further, robust studies.

(1) Background: Minimal invasive cardiac surgery via right anterolateral thoracotomy for heart valve surgery and other intracardiac procedures proven to have lower postoperative complications. We aim to compare the neurological complications and post-operative outcomes in two cohort groups as well as survival rates up to 5 years postoperatively; (2) Methodology: Retrospective observational study for patients who had minimally invasive cardiac valve surgery with retrograde femoral arterial perfusion between 2007 and 2021 (n = 596) and the categorized patients into two groups based on their age (≥70 years old and below 70). Propensity match analysis was conducted. The primary endpoint consisted of major postoperative complications and the secondary endpoint was the long-term survival rate. (3) Results: There was no difference between the two groups in terms of postoperative outcomes. Patients ≥ 70 years old had no increased risk for neurological complications (p = 0.75) compared with those below 70 years old. The mortality rate was also not significant between the two groups (p = 0.37) as well as the crude survival rates. (4) Conclusions: The use of retrograde femoral arterial perfusion in elderly patients is not associated with increased risk compared to the younger patients’ group for a spectrum of primary cardiac valve procedures. Hence, minimally invasive approaches could be offered to elderly patients who might benefit from it.

The multi-disciplinary team (MDT) meeting is well utilised in many areas of medical practice and is established in thoracic oncology. The MDT with a group of relevant specialists allows for a full discussion with the aim of ensuring efficient and streamlined patient care which benefits from all relevant expertise. There is often the need for complex discussions that are needed to benefit care—often required with the more involved and complex patients. Management of thoracic trauma is frequently non-operative and presents with other non-thoracic injuries—both requiring collaborative and interdisciplinary working. Whilst team meetings and MDT are of course established in trauma generally we outline the benefits of adopting a formal thoracic trauma MDT. There is of course a very key difference in trauma as opposed to oncology—those patients present unplanned with a need for particularly expedient decision-making. We therefore propose a daily meeting to discuss how patient care can be progressed. The exact make up of such a meeting may sometimes vary but it is our view that with daily discussion with patients with chest injuries there will be significant patient benefit—allowing for progression of care, rapid treatment of other injuries and the overall co-ordination of care toward discharge and rehabilitation.

Thoracic trauma encompasses a broad spectrum of injury and is a significant cause of morbidity and mortality. When operative intervention is required, the approach must be tailored to the nature, severity, and acuity of the injury. Video-assisted thoracoscopic surgery (VATS) has become well established in this context, with usefulness demonstrated in scenarios such as the evacuation of retained haemothorax, repair of diaphragmatic injuries, and management of lung injury. Robotic-assisted thoracic surgery (RATS) has represented progression in minimally invasive thoracic surgery, combining the access advantages of VATS with three-dimensional visualisation, articulated instrumentation, and improved ergonomics. These features can arguably bring benefit in the trauma setting, where a disrupted, bloody, or anatomically distorted operative field can present unique technical demand. RATS is now established across a wide range of elective thoracic procedures including anatomical lung resection, mediastinal and diaphragmatic surgery, and its implementation continues with more complex surgery. The combination of growing experience, technical proficiency, and improving technology continues to see its successful expansion into further areas of surgical practice. In the trauma setting, a robotic approach offers a credible and potentially advantageous role in common thoracic trauma presentations. We do not argue that RATS should be used for life-threatening trauma requiring immediate thoracotomy with patient stability remaining a prerequisite. However, for selected, appropriately stabilised patients at institutions with established robotic programmes, RATS can offer a meaningful contribution to thoracic trauma management. The evidence base remains nascent and largely observational, and there is a clear need for prospective registry data. We propose that centres with existing robotic capability develop institutional protocols to incorporate RATS into their trauma pathways, with systematic outcome recording to inform future evidence generation.