Postoperative Mediastinitis in Pediatric Cardiac Surgery: Clinical Characteristics, Management and Risk Factors for...

The aim is to describe the clinical features, management and outcomes of postoperative mediastinitis in children following cardiac surgery and to identify risk factors for mortality.

We retrospectively reviewed all cases of mediastinitis in children following congenital heart surgery over a 10-year period (2013-2023) at Necker Hospital, a tertiary care center.

Cumulative incidence of mediastinitis was 0.74% [95% confidence interval (CI): 0.56-0.96] with 57 cases of 7665 interventions. Median age at surgery was 12 days (6-146), with 58% of patients younger than 1 month. Thirty-four patients (60%) had delayed sternal closure. The most frequent germs were Staphylococcus spp. (45%), Gram-negative bacteria (36%) and fungi (9%). All patients had surgical debridement: 46 (81%) in the operating room and 11 (19%) in the intensive care unit (ICU). Median length of stay was 21 days (13-30) in the ICU and 35 days (28-48) until hospital discharge. The mortality rate was 27%, with 12 of 15 deaths occurring in the ICU. In univariate analysis, mortality risk factors were surgical revision in the ICU compared with the operating room [odds ratio (OR): 4.9; 95% CI: 1.3-19.9], delayed sternal closure superior to 3 days (OR: 5.0; 95% CI: 1.3-16.5) and fungal mediastinitis (OR: 14.9; 95% CI: 2.0-185.4). In the multivariate analysis, only fungal infection remained a significant risk factor for mortality (OR: 25.4; 95% CI: 2.7-608).

Mediastinitis is a rare complication of neonatal cardiac surgery, with a low incidence (0.74%) in this tertiary referral center. However, mortality from this condition remains high, with fungal infections identified as the main mortality risk factor.