Sternal reconstruction after post-sternotomy dehiscence and mediastinitis
Andrea Dell'Amore1, Stefano Congiu1, Alessio Campisi1
1Department of Cardio-Thoracic Surgery, S. Orsola Malpighi University Hospital, Via Massarenti 9, Bologna, BO Italy.
Indian Journal of Thoracic and Cardiovascular Surgery
|October 16, 2020
Summary
Post-sternotomy dehiscence and mediastinitis are serious cardiothoracic surgery complications. Repeated sternal revisions significantly increase mortality, highlighting the need for optimal repair strategies in high-risk patients.
Area of Science:
- Cardiothoracic Surgery
- Surgical Complications
- Wound Healing
Background:
- Post-sternotomy dehiscence and mediastinitis represent significant challenges in cardiothoracic surgery.
- These complications can lead to prolonged hospital stays and increased morbidity.
Purpose of the Study:
- To report an 8-year experience in surgical treatment of post-sternotomy dehiscence and mediastinitis.
- To analyze risk factors associated with these complications and their management outcomes.
Main Methods:
- Retrospective collection of data from 237 patients treated for post-sternotomy dehiscence over 8 years.
- Categorization of patients based on sternal fracture patterns, failed procedures, and presence of mediastinal abscess.
- Multivariate analysis to identify risk factors for revision failure and mortality.
Main Results:
- Various surgical techniques and materials were employed for sternal repair.
- Twenty-one patients required a second reoperation due to initial revision failure.
- Multivariate analysis identified key risk factors for revision failure and in-hospital mortality, with significantly higher mortality in patients undergoing multiple revisions (19% vs 8%).
Conclusions:
- Patients with sternal dehiscence often have preoperative comorbidities, increasing postoperative morbidity and mortality risk.
- Accurate assessment of sternal dehiscence characteristics is crucial for selecting the appropriate repair strategy.
- Repeated sternal revisions are associated with increased mortality, necessitating further research into standardized procedures for high-risk patients.
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