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Published on: July 18, 2014
Mediastinitis after pediatric cardiac surgery: a 15-year experience at a single institution
Tia A Tortoriello1, Jeffrey D Friedman, E Dean McKenzie
1The Lillie Frank Abercrombie Section of Pediatric Cardiology, The Heart Center, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA.
Insights
Deep sternal wound infections, or mediastinitis, are rare but serious after cardiac surgery. Prompt treatment including debridement and flap reconstruction can reduce complications in pediatric patients.
Area of Science:
- Cardiovascular Surgery
- Infectious Diseases
- Pediatric Surgery
Background:
- Mediastinitis, a deep sternal wound infection, is a rare but significant cause of morbidity and mortality following cardiac surgery in both adult and pediatric populations.
- The incidence of mediastinitis after cardiac surgery is approximately 0.2%.
Purpose of the Study:
- To analyze the characteristics, treatment, and outcomes of pediatric patients diagnosed with mediastinitis after cardiac surgery.
- To identify factors influencing morbidity and mortality in this patient group.
Main Methods:
- A retrospective review of pediatric patients diagnosed with mediastinitis post-cardiac surgery between January 1987 and December 2002.
- Data collected included demographics, cardiac diagnosis, surgical procedures, length of hospital stay, associated medical conditions, and mediastinitis treatments.
Main Results:
- Fifteen pediatric patients (0.2% of 7,616 surgeries) were diagnosed with mediastinitis, with a median diagnosis on postoperative day 14.
- Staphylococcus species were the most common organism (n=9). Six patients had associated bacteremia.
- Median hospital stay was 42.5 days, with a 6% mortality rate (1 of 15 patients). Treatment involved antibiotics, sternal debridement, and various flap reconstructions or primary closure.
Conclusions:
- Timely diagnosis and aggressive treatment, including sternal debridement and rotational muscle flaps, are crucial for minimizing morbidity and mortality in pediatric cardiac surgery patients with mediastinitis.
- Redo-sternotomy procedures following mediastinitis treatment were not associated with significant complications.
Background:
The spectrum of sternal wound infections after cardiac surgery ranges from superficial infections to a deep sternal infection known as mediastinitis. Mediastinitis is a rare but clinically relevant source of postoperative morbidity and mortality in adult and pediatric patients after cardiac surgery.
Methods:
We retrospectively identified all patients diagnosed with mediastinitis after cardiac surgery from January 1987 to December 2002 (17 patients/7,616 surgeries = 0.2%). Demographic data, cardiac diagnosis, cardiac surgery, hospital length of stay, associated medical diagnosis, and surgical treatment for mediastinitis were collected.
Results:
Fifteen pediatric patients (age < 18 years) were diagnosed with mediastinitis (mean age at diagnosis 37.5 months, range 21 days to 17 years. The median postoperative day of diagnosis was 14 days (6 to 50 days). The most common organism was Staphylococcus species (n = 9). Six patients had an associated bacteremia. The median hospital length of stay for all patients was 42.5 days (range 16 to 163 days). The hospital mortality was 1 of 15 (6%). Each patient was treated with intravenous antibiotics; sternal debridement; and rectus abdominus flap reconstruction (n = 7), pectoralis muscle flap reconstruction (n = 3), omentum reconstruction (n = 1), or primary sternal closure (n = 4). Three patients have undergone redo-sternotomy with orthotopic heart transplantation, bidirectional cavopulmonary anastomosis, and replacement of a right ventricle to pulmonary artery homograft.
Conclusions:
Timely diagnosis, aggressive sternal debridement, and liberal use of rotational muscle flaps can potentially minimize the morbidity and mortality in pediatric postoperative cardiac patients. Subsequent redo-sternotomy has not been problematic.
