Mediastinitis in heart and lung transplantation: 15 years experience.

Abstract

BACKGROUND:

Mediastinitis after sternotomy carries a very high mortality, especially in patients receiving immunosuppressive treatment.

METHODS:

A retrospective analysis of the data for patients who had undergone cardiopulmonary transplantation between May 1985 and December 2000 was undertaken. A total of 776 patients had either a median sternotomy or a transverse sternotomy through a clam-shell incision. Transplantations were as follows: 591 heart (3 simultaneous heart and renal, and 1 heart and liver), 126 bilateral sequential lung, 57 heart-lung, 1 en bloc double-lung, and 1 heart and single-lung.

RESULTS:

In all, 21 (2.7%) recipients had mediastinitis. Of these, 14 had heart, 3 heart-lung, and 4 bilateral lung transplantation. There were 18 median and 3 transverse sternotomies. There were 6 deaths (28.6%). Treatment consisted of antibiotics alone in 2 patients and subxiphisternal drainage in another 2 patients. The sternum was reopened in 17 (80.95%) patients, with debridement and primary closure alone in 5 of these 17 patients and additional irrigation in the other 12. Those who had resternotomy, debridement, and substernal irrigation had a better outcome when compared with the outcomes of other modes of treatment (1 death among 12 patients) (p = 0.06). Age, cardiopulmonary bypass time, body mass index, time to diagnosis, and treatment did not differ between those who survived and those who did not.

CONCLUSIONS:

Early aggressive debridement with substernal irrigation is the best mode of treatment for patients with posttransplantation mediastinitis.

• Authors: Qamar Abid, Udim U Nkere, Asif Hasan, Kate Gould, Jonathan Forty, Paul Corris, Colin J Hilton, John H Dark
• Journal: The Annals of thoracic surgery (Ann Thorac Surg) Vol. 75 Issue 5 Pg. 1565-71 (May 2003) ISSN: 0003-4975 [Print] Netherlands
• PMID: 12735580 (Publication Type: Journal Article)

Topics

• Adolescent
• Adult
• Child
• Debridement
• Heart Transplantation
• Heart-Lung Transplantation
• Humans
• Immunocompromised Host
• Lung Transplantation
• Mediastinitis (diagnosis, etiology, therapy)
• Middle Aged
• Postoperative Complications (diagnosis, therapy)
• Prognosis
• Retrospective Studies
• Risk Factors
• Sternum (surgery)
• Therapeutic Irrigation
• Treatment Outcome