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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.
Abstract:
Mediastinal infection is a rare but life-threatening complication after open cardiac surgery. Of 852 patients undergoing cardiac operations performed with a median sternotomy between January of 1981 and August of 1989, 19 patients (2.2%) developed deep sternal infections with mediastinitis, and 6 of them (31.6%) died. Tissue cultures were obtained from all but three patients, and staphylococcus aureus was the most frequent infecting organism associated with high mortality rates (3/8). 18 patients were managed with debridement and irrigation as the primary treatment, but 4 of them developed infective endocarditis during the course of irrigation treatment and then died. After 1987, 6 patients, who didn't gain wound closure with irrigation alone, were treated with reconstructive techniques, one with pectoral muscle flap closure, another with rectus myocutaneous flap mobilization, and the remainder with omental transfer respectively. All of them achieved eradication of infection as well as wound closure. Then we have advocated early debridement and mobilization of viable tissues such as omentum into the mediastinum.
Insights
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.