Surgically Managed Deep Sternal Wound Infection After Heart Transplantation

Deep sternal wound infection (DSWI) remains a serious complication after heart transplantation (HT), yet data on its microbiology and outcomes are limited. We aimed to characterize the incidence, microbiology, management, and outcomes of DSWI after HT and to identify factors associated with its occurrence.

We retrospectively analyzed 298 consecutive HT recipients at a single tertiary center from 2010 to 2023. Patients were stratified by DSWI (n = 21, 7%) versus uncomplicated sternal healing (n = 277). Univariable and parsimonious multivariable logistic regression were used to assess factors associated with DSWI. Microbiologic findings among DSWI cases were described at the case level, including bacterial, fungal, and polymicrobial infections.

DSWI cases had greater operative exposure, including longer graft ischemic time and cardiopulmonary bypass (CPB) duration. In multivariable analysis, ischemic time (adjusted OR: 1.008 min^-1; p = 0.029) and CPB time (adjusted OR: 1.011 min^-1; p = 0.023) were independently associated with DSWI. Durable ventricular assist device bridging was associated with DSWI in univariable analysis (OR: 5.265; p = 0.016). Among DSWI cases, microbiologic findings were heterogeneous and some polymicrobial infections were identified. DSWI was associated with worse long-term survival (log-rank p = 0.0035). Several cases with fungal involvement had poor outcomes, although pathogen-specific interpretation was limited by the small sample size, mixed infections, and potential confounding.

DSWI after HT was an infrequent but serious complication associated with worse long-term survival and greater operative burden. Microbiologic findings were heterogeneous, and pathogen-specific outcome patterns should be interpreted cautiously.