Introduction:Deep sternal wound infection (DSWI) remains a serious complication of coronary artery bypass grafting (CABG), particularly when bilateral internal thoracic arteries (BITA) are used. Concerns regarding DSWI often limit the adoption of multiple arterial grafting. Aim:To evaluate the effect of topical vancomycin paste on the incidence of DSWI in patients undergoing primary isolated CABG with BITA. Material and methods:This multicenter, retrospective study analyzed 1,694 patients who underwent BITA grafting between 2006 and 2024. Patients were stratified based on whether topical vancomycin paste was applied to the sternal edges (n = 455) or not (n = 1,239). Propensity score matching was used to account for baseline differences, generating 368 matched pairs. Odds ratios (ORs) were estimated using multivariable and conditional logistic regression. Results:Multivariable logistic regression demonstrated that the use of topical vancomycin paste was independently associated with a 63% reduction in DSWI (OR = 0.37; 95% CI: 0.14-0.97; p = 0.045). Other independent predictors of increased DSWI risk included age ≥ 60 years, obesity, chronic lung disease, insulin therapy, female sex, and heart failure symptoms. After propensity score matching, 368 well-balanced pairs were obtained. In this matched cohort, topical vancomycin paste was associated with a substantial reduction in DSWI (OR = 0.17; 95% CI: 0.05-0.60; p = 0.001). Conclusions:Topical application of vancomycin paste significantly reduces the risk of DSWI in patients undergoing CABG with BITA. This simple and effective prophylactic measure may help enable safer and broader adoption of multiple arterial grafting strategies.

BACKGROUND:Coronary artery revascularization is vital for managing coronary artery disease, especially in elderly patients with multiple comorbidities. AIMS:To evaluate the outcomes of coronary artery bypass surgery in patients aged ≥75 years, focusing on the survival benefits of different surgical techniques and graft types. MATERIAL AND METHODS:This retrospective cohort study analyzed data from the Polish National Registry of Cardiac Surgery Procedures (2012-2022) for patients aged ≥75 years undergoing isolated coronary artery bypass surgery. RESULTS:We analysed 18 215 patients: 12 843 patients were under 80 years old; 4689 were between 80 and 84 years old; and 683 were ≥85 years old. Key preoperative risk factors associated with increased hospital mortality included extracardiac arteriopathy, atrial fibrillation, chronic renal failure, recent myocardial infarction, and poor mobility. The median follow-up time was 4.8 years (interquartile range 2.37-7.27). On-pump coronary artery bypass grafting (ONCAB) demonstrated a significant long-term benefit in patients aged <80 years. The use of an internal mammary artery graft provided significant survival advantages for those <85 years old, but this benefit was not observed in patients aged ≥85 years (P = 0.73). Multiarterial grafting did not demonstrate a significant survival advantage across all age groups. CONCLUSIONS:In patients ≥80 years old there was no survival benefit between ONCAB and off-pump coronary bypass grafting. However, ONCAB was associated with significantly improved survival outcomes in younger patients. The internal mammary artery graft improved long-term survival in patients <85 years old, while additional arterial grafts did not confer a survival benefit in the elderly population.

BACKGROUND:This multicentre study aimed to investigate the impact of deep sternal wound infection (DSWI) on long-term survival among patients undergoing coronary artery bypass grafting (CABG) using multiple arterial grafting (MAG) or single artery with saphenous vein grafts (SAG). METHODS:Data were obtained from the Polish National Registry of Cardiac Surgery Procedures database. Between January 2012 and December 2020, 81,136 patients who underwent CABG for multivessel disease were included in the study. Patients were divided into four groups: MAG with DSWI (n=219), MAG without DSWI (n=8,611), SAG with DSWI (n=1,432), and SAG without DSWI (n=70,874). Inverse probability of treatment weighting based on the generalised propensity score was used to minimise imbalance between the groups. RESULTS:In the weighted sample, DSWI in patients who received MAG was associated with reduced long-term survival when compared with patients without DSWI and MAG (hazard ratio [HR] 1.89, 95% confidence interval [CI] 1.29-2.78; Bonferroni corrected p=0.01). Deep sternal wound infection in patients who received SAG was associated with reduced long-term survival when compared with patients without DSWI and SAG (HR 1.92, 95% CI 1.69-2.17; Bonferroni corrected p=0.01). In patients who did not develop DSWI, MAG was associated with improved long-term survival compared with SAG (HR 0.68, 95% CI 0.63-0.74; Bonferroni corrected p=0.01). However, patients who received MAG and developed DSWI had similar long-term survival when compared with patients who received SAG and did not develop DSWI (HR 1.31, 95% CI 0.90-1.92; Bonferroni corrected p=0.63). A landmark analysis excluding the first 6 months of follow-up was performed to exclude the risk of acute mortality due to DSWI. In the weighted sample, the results were consistent with the main analysis. CONCLUSION:Deep sternal wound infection is associated with worse survival in patients receiving MAG and SAG. Moreover, the superior effect of MAG over SAG diminishes once DSWI develops.

OBJECTIVES This study aimed to compare perioperative outcomes and long-term mortality between off-pump coronary artery bypass grafting and on-pump coronary artery bypass grafting in patients with ischaemic cardiomyopathy who had a left ventricle ejection fraction of <= 35%.METHODS A retrospective cohort analysis was conducted using data from the Polish National Registry of Cardiac Surgery Procedures database, encompassing patients who underwent isolated coronary artery bypass grafting in Poland between 2012 and 2022. Patients were divided into two groups: on-pump and off-pump. Propensity score matching was used to balance the groups. The primary outcome was long-term all-cause mortality following surgical revascularization.RESULTS A total of 9920 patients were included, with 3116 patients in each group after propensity score matching. The median follow-up period was 4 years. The off-pump group was associated with a lower 30-day mortality rate (6.4% vs 9.1%, P = 0.002) and fewer perioperative complications. However, long-term survival analysis revealed a modest but statistically significant advantage for on-pump group at the 10-year follow-up (P = 0.047).CONCLUSIONS Off-pump provides short-term benefits, including reduced early mortality and fewer complications compared to on-pump technique. However, these advantages do not translate into improved long-term survival, where on-pump demonstrates a slight benefit. The choice between off-pump and on-pump technique should be individualized based on patient-specific factors and surgical expertise. Ischaemic cardiomyopathy (ICM) manifests as reduced left ventricle ejection fraction (LVEF) due to acute or acute on chronic coronary artery disease, posing a significant global health challenge [1].

AMA Łuczak M, Greberski K, Buszkiewicz K, et al. Unraveling a diagnostic enigma: managing acute mitral valve insufficiency with non-ischemic papillary muscle rupture. A comprehensive case analysis. Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery. 2024;21(2):117-119. doi:10.5114/kitp.2024.141151. APA Łuczak, M., Greberski, K., Buszkiewicz, K., Jarząbek, R., Danielecki, C., & Czaja, P. et al. (2024). Unraveling a diagnostic enigma: managing acute mitral valve insufficiency with non-ischemic papillary muscle rupture. A comprehensive case analysis. Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery, 21(2), 117-119. https://doi.org/10.5114/kitp.2024.141151 Chicago Łuczak, Maciej, Krzysztof Greberski, Karol Buszkiewicz, Radosław Jarząbek, Cezary Danielecki, Pawel Czaja, and Paweł Bugajski. 2024. "Unraveling a diagnostic enigma: managing acute mitral valve insufficiency with non-ischemic papillary muscle rupture. A comprehensive case analysis". Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery 21 (2): 117-119. doi:10.5114/kitp.2024.141151. Harvard Łuczak, M., Greberski, K., Buszkiewicz, K., Jarząbek, R., Danielecki, C., Czaja, P., and Bugajski, P. (2024). Unraveling a diagnostic enigma: managing acute mitral valve insufficiency with non-ischemic papillary muscle rupture. A comprehensive case analysis. Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery, 21(2), pp.117-119. https://doi.org/10.5114/kitp.2024.141151 MLA Łuczak, Maciej et al. "Unraveling a diagnostic enigma: managing acute mitral valve insufficiency with non-ischemic papillary muscle rupture. A comprehensive case analysis." Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery, vol. 21, no. 2, 2024, pp. 117-119. doi:10.5114/kitp.2024.141151. Vancouver Łuczak M, Greberski K, Buszkiewicz K, Jarząbek R, Danielecki C, Czaja P et al. Unraveling a diagnostic enigma: managing acute mitral valve insufficiency with non-ischemic papillary muscle rupture. A comprehensive case analysis. Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery. 2024;21(2):117-119. doi:10.5114/kitp.2024.141151.

Background: The presence of locomotive disorders may negatively impact the outcome of cardiac surgeries. This retrospective study aimed to assess the effect of preoperative diagnosis of locomotive disorders requiring the continuous use of orthopedic devices on postoperative rehabilitation and stable sternum adhesion. Material and methods: The study included 122 patients who underwent cardiac surgery, with 68 patients in the study group having a musculoskeletal disorder and 54 patients in the control group without such disorders. Preoperative demographic, clinical, and laboratory data as well as postoperative rehabilitation and sternum adhesion were evaluated. Results: The results showed that patients in the study group had lower levels of calcium (p < 0.001), vitamin D (p < 0.001), and creatine kinase (p = 0.022) prior to the surgery. In the early postoperative period, 8 patients from the study group and 4 from the control group required reoperation due to sternal instability (p = ns). In the late postoperative period, sternal instability was present in 2 patients from the study group and 3 from the control group (p = ns). The survey study revealed a significantly better (p = 0.029) evaluation of postoperative rehabilitation among the study group patients. Conclusions: Overall, the results indicated that a preoperative locomotive disorder has no significant impact on sternal instability in the early or late postoperative periods. However, patients with such disorders have a better understanding of the importance, purpose, and course of rehabilitation after cardiac surgery and exhibit lower levels of calcium, vitamin D, and creatinine.

Background: Coronary heart disease is the most common cause of death worldwide. It is responsible for almost a third of deaths in patients over the age of 35. Various biomarkers are currently being studied in detail for their value in predicting postoperative mortality in patients undergoing CABG. Aim: The aim of this study is to analyze the predictive value of certain blood morphological parameters in CABG and off-pump coronary artery bypass grafting (OPCAB). Methods: A total of 520 patients who underwent surgery in two consecutive years and underwent CABG (404) or OPCAB (116) were included in this retrospective study. Gender, age, comorbidities, five-year survival rate, detailed information on hospitalization, surgery, intensive care unit parameters and preoperative blood samples from the cubital vein were recorded. Inverse propensity treatment weighting was applied to adjust for confounding factors at baseline. Results: No differences were found between OPCAB and CABG as an isolated comparison. In the standardized population, patients with abnormal lymphocyte counts had an increased risk of death at one-year and five-year follow-up. In the standardized population, abnormal red blood cell distribution width (RDW-SD), neutrocyte-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) were associated with increased mortality in each period analyzed. Conclusions: Abnormal PLR, RDW-SD and NLR are associated with increased early and late mortality in patients undergoing CABG and OPCAB. Abnormal lymphocytes are only associated with increased late mortality.

Background: The objective of this multicenter study aimed to investigate the impact of sex on long-term survival among patients with multivessel coronary artery disease undergoing coronary artery bypass grafting(CABG) using multiple arterial grafting (MAG) or a single artery with saphenous vein grafts (SAG). Materials and methods: Data were obtained from the Polish National Registry of Cardiac Surgery Procedures database. This study included 81,136 patients who underwent CABG for multivessel disease between January 2012 and December 2020 (22.9% were women and 77.1% were men). MAG was performed in 8.3% and 11.7% of female and male patients, respectively. A 1:1 propensity score (PS)-matching was performed. Long-term mortality was compared between matched groups of men and women. Subgroup analyses of patients aged <70 and ≥70 years, with an ejection fraction (EF) >40% and ≤40%, and with and without diabetes, obesity, peripheral artery disease (PAD), or chronic lung disease (CLD) were performed separately in women and men. Results: MAG was associated with lower long-term mortality than SAG in 1,528 PS-matched female pairs (hazard ratio [HR]: 0.74; 95% confidence interval [CI]: 0.59–0.92; P = 0.007) and 7,283 PS-matched male pairs (HR: 0.80; 95% CI: 0.72–0.88; P <0.001). Subgroup analyses confirmed the results among female patients aged <70 years, with diabetes and EF >40%, and without PAD or CLD, and of male patients aged <70 and ≥70 years; with EF >40%; with or without diabetes, obesity, or PAD; and without CLD. Conclusions: In patients undergoing CABG, MAG was associated with significantly improved survival in both sexes. The long-term benefits of MAG observed across subgroups of men and women support the consideration of a multi-arterial revascularization strategy for a broader spectrum of patients.

Objective: The aim of this study was to evaluate the impact of coronary bypass surgery (CABG) on long-term mortality, comparing survival rates to those of the general population in Poland. Methods: The study was based on the Polish National Register of Cardiothoracic Surgical Procedures (KROK). Between January 2009 and December 2019, 133,973 patients underwent CABG. The study included all patients who underwent primary CABG. After excluding reoperations and patients with missing key data, there were 132,760 remaining patients who participated in the study. In order to compare patients who underwent CABG with the general population, data from Polish life expectancy tables from the Central Statistical Office (CSO) were used. Results: In the general population (GP), there is a consistent decrease in survival for both women and men throughout the entire observation period. The decline in survivability is more pronounced in the male group. Unlike the CABG group, which is at risk of perioperative mortality, there is no initial drop in survivability in the GP. The early mortality rate in CABG group within 30 days was significantly higher in the group of women than in men (3.51% compared to 2.19%, p < 0.001). The annual mortality rate was higher in the group of women (6.7% vs. 5.14%), and survival time was shorter (345.5 ± 0.4 vs. 351.2 ± 0.2 days, p < 0.001). However, the total mortality over a 13-year period of observation did not differ significantly between the groups (30.17% for women vs. 29.6% for men, p = 0.996) with survival time 10.08 ± 0.02 years in men vs. 10.06 ± 0.03 in women, p = 0.996. Conclusions: CABG surgery equalizes the probability of survival between genders. In long-term observation men have a greater survival benefit than women if compared to the predicted survival of the general population. These observations may provide a new perspective on the choice of revascularization strategy in relation to gender.

Introduction: Broviac catheter is a type of central venous catheter (CVC) used for long-term parenteral nutrition in specific patients, e.g., diagnosed with intestinal failure as short bowel syndrome (SBS). The way of the catheter insertion is conceived to minimalize the risk of infections. However, CVC-related blood stream infections (CVC-BSIs), including infective endocarditis (IE), remain most important complications associated with Broviac catheter. Staphylococcus epidermidis stands out as a prevalent pathogen. The increasing number of CVCs results in an increased incidence of healthcare-associated IE. Complete parenteral treatment is an independent risk that increases the likelihood of IE. Treatment of IE is mainly based on antibiotic therapy, but in certain cases, surgical treatment is needed. Presentation of Case: A 71-year-old female with SBS who had been receiving total parenteral nutrition through the Broviac catheter for several months was admitted in a serious condition with significant weakness, increasing shortness of breath, deteriorating cough, fever, low blood pressure, and heart palpitations. Echocardiography revealed severe aortic valve IE with a large, longitudinal, highly mobile vegetation (up to 40 mm) and massive aortic regurgitation with pulmonary edema. Fast pathogen detection in the patients' blood (S. epidermidis) was obtained using PCR-based multiplex test. Due to life-threatening conditions, emergency surgery with aortic valve replacement was performed. Consistent rehabilitation resulted in good condition achievement. Follow-up echocardiography showed normal function of the aortic valve bioprosthesis. Conclusion: The use of CVC, including Broviac catheter, is associated with an increased risk of infections, including IE. Treatment-resistant severe HF complicating IE requires emergency surgery.

Background: Octogenarians constitute the fastest-growing segment within contemporary cardiac surgery, yet precise risk assessment in this age group remains challenging. Aims: This study aimed to evaluate EuroSCORE II reliability in octogenarians undergoing isolated coronary surgery and to create an adjustment formula if necessary. Patients and Methods: All octogenarians who had isolated coronary surgery in Poland from January 2012 to December 2023, recorded in the Polish National Registry of Cardiac Surgical Procedures (KROK registry), were retrospectively assessed. EuroSCORE II's reliability was measured using the ROC curve area and observed-to-predicted mortality ratio, differentiating on-pump and off-pump cases. A nomogram was developed to enhance predictive accuracy. Results: Among 5771 octogenarians, 2729 (47.3%) underwent on-pump and 3042 (52.7%) underwent off-pump surgery. EuroSCORE II demonstrated reliability in off-pump patients (AUC:0.72, O/E ratio:0.98) but underestimated mortality for on-pump cases (AUC:0.73, O/E ratio:1.62). The lowest predicted mortality group (0.50-1.82%) showed the greatest discrepancies. Calibration was improved by adding a coefficient and creating a nomogram. Conclusions: EuroSCORE II was dependable in predicting outcomes for Polish octogenarians undergoing isolated coronary surgery. Observed mortality following on-pump surgeries was higher than expected, which was corrected by adding a coefficient to the initial EuroSCORE II calculation.

AMA Greberski K, Danielecki C, Jarząbek R, Łuczak M, Buszkiewicz K, Bugajski P. Comprehensive cardiosurgical intervention for displaced Amplatzer Amulet device with atrial fibrillation complications. Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery. 2024;21(1):67-69. doi:10.5114/kitp.2024.138446. APA Greberski, K., Danielecki, C., Jarząbek, R., Łuczak, M., Buszkiewicz, K., & Bugajski, P. (2024). Comprehensive cardiosurgical intervention for displaced Amplatzer Amulet device with atrial fibrillation complications. Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery, 21(1), 67-69. https://doi.org/10.5114/kitp.2024.138446 Chicago Greberski, Krzysztof, Cezary Danielecki, Radosław Jarząbek, Maciej Łuczak, Karol Buszkiewicz, and Paweł Bugajski. 2024. "Comprehensive cardiosurgical intervention for displaced Amplatzer Amulet device with atrial fibrillation complications". Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery 21 (1): 67-69. doi:10.5114/kitp.2024.138446. Harvard Greberski, K., Danielecki, C., Jarząbek, R., Łuczak, M., Buszkiewicz, K., and Bugajski, P. (2024). Comprehensive cardiosurgical intervention for displaced Amplatzer Amulet device with atrial fibrillation complications. Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery, 21(1), pp.67-69. https://doi.org/10.5114/kitp.2024.138446 MLA Greberski, Krzysztof et al. "Comprehensive cardiosurgical intervention for displaced Amplatzer Amulet device with atrial fibrillation complications." Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery, vol. 21, no. 1, 2024, pp. 67-69. doi:10.5114/kitp.2024.138446. Vancouver Greberski K, Danielecki C, Jarząbek R, Łuczak M, Buszkiewicz K, Bugajski P. Comprehensive cardiosurgical intervention for displaced Amplatzer Amulet device with atrial fibrillation complications. Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery. 2024;21(1):67-69. doi:10.5114/kitp.2024.138446.

The influence of gender on both early and long-term outcomes of coronary artery bypass grafting (CABG) is not clearly defined. Objectives: This study aimed to assess the impact of gender on early and long-term mortality after CABG using data from the KROK Registry. Methods: All 133,973 adult patients who underwent CABG in Poland between 1 January 2009 and 31 December 2019 were included in the Polish National Registry of Cardiac Surgical Procedures (KROK Registry). The study enrolled 90,541 patients: 68,401 men (75.55%) and 22,140 women (24.45%) who met the inclusion criteria. Then, 30-day mortality, 1-year mortality, and long-term mortality rates were compared. Results: Advanced age, higher Canadian Cardiovascular Society (CCS) and New York Heart Association (NYHA) grade, diabetes, hypercholesterolemia, arterial hypertension, body mass index BMI > 35 kg/m2, and renal failure, before the propensity matching, were more frequently observed in women. Women more frequently underwent urgent surgery, including single and double graft surgery, and off-pump CABG (OPCAB) (p < 0.001). In propensity-matched groups, early mortality (30 days) was significantly higher in women (3.4% versus 2.8%, p < 0.001). The annual mortality remained higher in this group (6.6% versus 6.0%, p = 0.025). However, long-term mortality differed significantly between the groups and was higher in the male group (33.0% men versus 28.8% women, p < 0.001). Conclusions: There are no apparent differences in long-term mortality between the two sexes in the entire population. In propensity-matched patients, early mortality was lower for men, but the long-term survival was found to be better in women.

The psychological burden of the COVID-19 pandemic may have a lasting effect on emotional well-being of healthcare workers. Medical personnel working at the time of the pandemic may experience elevated occupational stress due to the uncontrollability of the virus, high perceived risk of infection, poor understanding of the novel virus transmission routes and unavailability of effective antiviral agents. This study used path analysis to analyze the relationship between stress and alexithymia, emotional processing and negative/positive affect in healthcare workers. The sample included 167 nurses, 65 physicians and 53 paramedics. Sixty-two (21.75 %) respondents worked in COVID-19-designated hospitals. Respondents were administered the Toronto Alexithymia Scale-20, Cohen's Perceived Stress Scale, Emotional Processing Scale, and the Positive and Negative Affect Schedule. The model showed excellent fit indices (χ2 (2)=2.642, p=0.267; CFI=0.999, RMSEA=0.034, SRMR=0.015). Multiple group path analysis demonstrated physicians differed from nurses and paramedics at the model level (X2diff (7)=14.155, p<0.05 and X2diff (7)=18.642, p<0.01, respectively). The relationship between alexithymia and emotional processing was stronger in nurses than in physicians (difference in beta=0.27; p<0.05). Individual path χ2 tests also revealed significantly different paths across these groups. The results of the study may be used to develop evidence-based intervention programs promoting healthcare workers' mental health and well-being.

Treatment of ACS: a designated COVID -19 hospital perspective 1 diagnosed with ACS between March 15 and December 5, 2020 with data from the same period in 2019.The comparison also included the number of hospitalizations and deaths.The study was of retrospective design.Information on the procedures performed, diagnoses, comorbidities, and deaths was obtained from an electronic database of the Cardiology Department created based on patients' medical histories and administered by physicians.The study did not require consent of the Bioethics Committee. Statistical analysisThe STATISTICA 10 software (Statsoft, Tulsa, Oklahoma, United States) was used for statistical analysis.Continuous variables were presented as means and categorical variables as numbers and percentages.For data with binomial distribution, the binomial proportion test was applied to compare the parameters between the 2 groups.Statistical significance was set at P below 0.05. ResultsIn the time interval covering the first and second waves of the pandemic (March 15 to December 5, 2020), a total of 390 patients were hospitalized in the Cardiology Department.During that period, 53 coronary artery angiographies were performed in the catheterization laboratory in the patients diagnosed with ACS (ST -segment elevation myocardial infarction [STEMI] and non -STEMI [NSTEMI]).The mean age of the patients was 61 years (range, 36-96).Men constituted 75% (n = 40) of the study population.Of the study participants, 74% (n = 39) had NSTEMI and 26% (n = 14) had STEMI.A total of 30 percutaneous transluminal coronary angioplasties (PTCAs) were performed.Of these, 67% (n = 20)

BACKGROUND:Ravitch technique of chest correction has been considered, although invasive, as a safe and efficacious surgical method.CASE:We describe a case of a 35-year-old woman with cardiac tamponade and in cardiogenic shock due to exceptional late complication after pectus excavatum reconstruction by means of classic Ravitch technique 19 years earlier. This very late adverse event was caused by a broken metal sternal wire that injured the wall of the ascending aorta. The patient underwent salvage repair of this segment of the aorta in cardiopulmonary bypass. Postoperative course and postdischarge 3-year follow-up have been uneventful.CONCLUSION:Therefore, life-threatening cardiovascular complications may occur even many years after reconstructive surgery for chest deformity.