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CURRENT ISSUETHE JOURNAL OF CARDIOVASCULAR SURGERY

A Journal on Cardiac, Vascular and Thoracic Surgery

Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632

Frequency: Bi-Monthly

ISSN 0021-9509

Online ISSN 1827-191X

 

The Journal of Cardiovascular Surgery 2000 April;41(2):241-5

CARDIAC PAPERS 

    ORIGINAL ARTICLES

Primary closure of deep sternal wound infection following open heart surgery. A safe operation?

Levi N., Olsen P. S.

From the Depart­ment of Car­di­oth­o­racic Sur­gery Rig­shos­pi­talet The ­National Uni­ver­sity Hos­pital Copen­hagen, Den­mark

Back­ground. ­Deep ­median ster­notomy ­wound infec­tion is a sig­nif­i­cant ­source of mor­bidity and mor­tality ­after car­diac oper­a­tions. Man­age­ment of an ­infected ­median ster­notomy inci­sion is a sub­ject of con­tro­versy. The aim of ­this ­study was to ­assess our expe­ri­ence ­with pri­mary clo­sure ­without any irri­ga­tion ­system for ­infected ­deep ­median ster­notomy ­wound.
­Methods. ­Between Jan­uary 1994 and ­December 1997, 4227 con­sec­u­tive ­open ­heart pro­ce­dures via a ­median ster­notomy ­under car­di­o­pul­mo­nary ­bypass ­were per­formed in our depart­ment. A ­total of 27 (0.64%) con­sec­u­tive ­patients ­with ­deep ster­notomy ­wound infec­tion ­were iden­ti­fied. The ­mean age of the ­patients was 45 ­years. Six ­were ­female and 21 ­were ­male.
­Results. The inci­dence of ­deep ­sternal ­wound infec­tion was there­fore 0.64%. The ­mean dura­tion ­between the pri­mary oper­a­tion and the ­onset of ­deep ­sternal ­wound infec­tion was 2.5 ­weeks. Staph­y­lo­coccus ­aureus and Staph­y­lo­coccus epi­der­midis ­were the ­most ­common ­pathogen ­causing post­op­er­a­tive med­i­as­tinal infec­tion. Out of the 27 ­cases, 17 ­were suc­cess­fully ­treated, 8 (30%) ­died and 2 had a per­sis­tent fis­tula. The ­mean ­follow-up ­time was 18 ­months (­range 4 to 52 ­months). The mor­tality in the pedi­atric ­group was 4/8 (50%) and 4/19 (21%) in the ­adult ­group. The mor­tality for med­i­as­tin­itis pre­senting ­before one ­week or ­after 4 ­weeks ­after oper­a­tion was 63%. In con­trast, the mor­tality for med­i­as­tin­itis pre­senting ­after one ­week but ­before 4 ­weeks ­after oper­a­tion was 17%.
Con­clu­sions. Med­i­as­tin­itis ­after car­diac sur­gical pro­ce­dures ­remains a dev­as­tating com­pli­ca­tion. Pri­mary clo­sure ­without irri­ga­tion-suc­tion ­system ­should ­only be con­sid­ered in ­selected ­patients.

language: English


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