Fraser Douglas Rubens

Objective: To identify modifiable surgical practices associated with reduced sternal wound infection rates following isolated coronary artery bypass grafting (CABG) using positive deviancy methodology. Design: Retrospective cohort study with prospectively collected data (January 2021–June 2025). Setting: Single tertiary referral cardiac surgery center. Patients: 3,087 consecutive patients undergoing isolated CABG. Methods: Primary outcome was total sternal wound infection (deep and superficial combined) within 30 days. Risk-adjusted surgeon performance was evaluated using mixed-effects logistic regression with observed-to-expected (O/E) ratios. Positive deviants were defined as surgeons with O/E ratios P < .001), and minimal cautery usage (1.0/5 vs 3.2/5 vs 3.5/5, P < .001). Conclusions: Positive deviancy methodology successfully identified four modifiable surgical practices associated with reduced total sternal wound infections. These techniques represent immediately implementable interventions for infection prevention in cardiac surgery. Further study is needed to validate these findings across multiple institutions and evaluate implementation outcomes.

Multiple arterial grafting (MAG) has been evidenced to likely improve long-term mortality and morbidity outcomes compared with single arterial grafting during coronary artery bypass grafting (CABG), with current guidelines recommending its use. Notably, women make up less than 30% of the cohorts in the studies that inform these guidelines, and the use of MAG has not been well studied in the female population, despite the evidence that women present with more comorbidities and severe symptoms, and often perform worse after CABG compared with their male counterparts. Therefore, this comprehensive narrative review focuses on the currently available evidence examining MAG in women, and its use in on- and off-pump CABG.

Acute myocardial infarction (AMI) is the leading cause of cardiovascular mortality in developed countries. While primary percutaneous coronary intervention is the gold-standard first-line therapy for initial revascularization of a culprit vessel, coronary artery bypass grafting (CABG) surgery can allow for subsequent complete revascularization when additional high-risk coronary stenoses remain. The optimal timing of CABG after AMI remains controversial. Early surgery during the acute period can lead to a detrimental systemic inflammatory response and may be associated with a higher bleeding risk due to the use of antiplatelet and fibrinolytic agents. On the other hand, later surgery increases the risk of ischemic recurrence while waiting, with the potential for an irreversible decrease in myocardial function or death. This narrative review summarizes the evidence supporting decision-making for optimal timing of surgical revascularization in patients with AMI.