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[Mediastinal infection after open cardiac surgery]
H Okamoto1, K Yasuura, A Matsuura
1Department of Thoracic Surgery, Nagoya University School of Medicine, Japan.
[Zasshi] [Journal]. Nihon Kyobu Geka Gakkai
|October 1, 1990
Summary
Deep sternal infections with mediastinitis are a rare but serious complication following open cardiac surgery. Early debridement and tissue mobilization, such as omental transfer, are recommended for effective treatment and wound closure.
Area of Science:
- Cardiovascular Surgery
- Infectious Diseases
Background:
- Mediastinal infection is a rare, life-threatening complication post-open cardiac surgery.
- Deep sternal infections with mediastinitis occurred in 2.2% of patients undergoing median sternotomy.
- Staphylococcus aureus was a frequent pathogen, associated with high mortality.
Purpose of the Study:
- To evaluate the incidence and outcomes of mediastinal infections after open cardiac surgery.
- To assess the effectiveness of debridement, irrigation, and reconstructive techniques in managing these infections.
Main Methods:
- Retrospective analysis of 852 patients undergoing cardiac operations via median sternotomy (1981-1989).
- Review of infection management strategies, including debridement, irrigation, and reconstructive procedures.
- Analysis of causative organisms and associated mortality rates.
Main Results:
- 19 patients (2.2%) developed deep sternal infections with mediastinitis; 6 (31.6%) died.
- Staphylococcus aureus was the most common organism, with a high mortality rate.
- Reconstructive techniques (pectoral flap, rectus flap, omental transfer) achieved infection eradication and wound closure in 6 patients after 1987.
Conclusions:
- Early debridement is crucial for managing deep sternal infections.
- Mobilization of viable tissues, such as the omentum, into the mediastinum is an effective reconstructive strategy.
- Aggressive surgical management improves outcomes for mediastinitis post-cardiac surgery.