Mediastinitis after pediatric cardiac surgery: a 15-year experience at a single institution

• Published in: The Annals of thoracic surgery Vol. 76; no. 5; pp. 1655 - 1660
• Main Authors: Tortoriello, Tia A, Friedman, Jeffrey D, McKenzie, E.Dean, Fraser, Charles D, Feltes, Timothy F, Randall, Jessica, Mott, Antonio R
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.11.2003; Elsevier Science
• Subjects: Adolescent; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anti-Bacterial Agents; Biological and medical sciences; Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - methods; Cardiology. Vascular system; Child; Child, Preschool; Cohort Studies; Combined Modality Therapy; Debridement - methods; Drug Therapy, Combination - administration & dosage; Female; Follow-Up Studies; Heart Defects, Congenital - diagnosis; Heart Defects, Congenital - surgery; Humans; Infant; Infant, Newborn; Male; Mediastinitis - diagnosis; Mediastinitis - etiology; Mediastinitis - therapy; Medical sciences; Pneumology; Retrospective Studies; Risk Assessment; Severity of Illness Index; Surgical Flaps; Surgical Wound Infection - diagnosis; Surgical Wound Infection - therapy; Treatment Outcome; Wound Healing - physiology; 5; Human; Heart; Pediatrics; Treatment; Mediastinum disease; Surgery; Mediastinitis; Anesthesia; Circulatory system; Institution; Cardiology; Child
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/S0003-4975(03)01025-7

The spectrum of sternal wound infections after cardiac surgery ranges from superficial infections to a deep sternal infection known as mediastinitis. Mediastinitis is a rare but clinically relevant source of postoperative morbidity and mortality in adult and pediatric patients after cardiac surgery. We retrospectively identified all patients diagnosed with mediastinitis after cardiac surgery from January 1987 to December 2002 (17 patients/7,616 surgeries = 0.2%). Demographic data, cardiac diagnosis, cardiac surgery, hospital length of stay, associated medical diagnosis, and surgical treatment for mediastinitis were collected. Fifteen pediatric patients (age < 18 years) were diagnosed with mediastinitis (mean age at diagnosis 37.5 months, range 21 days to 17 years. The median postoperative day of diagnosis was 14 days (6 to 50 days). The most common organism was Staphylococcus species (n = 9). Six patients had an associated bacteremia. The median hospital length of stay for all patients was 42.5 days (range 16 to 163 days). The hospital mortality was 1 of 15 (6%). Each patient was treated with intravenous antibiotics; sternal debridement; and rectus abdominus flap reconstruction (n = 7), pectoralis muscle flap reconstruction (n = 3), omentum reconstruction (n = 1), or primary sternal closure (n = 4). Three patients have undergone redo-sternotomy with orthotopic heart transplantation, bidirectional cavopulmonary anastomosis, and replacement of a right ventricle to pulmonary artery homograft. Timely diagnosis, aggressive sternal debridement, and liberal use of rotational muscle flaps can potentially minimize the morbidity and mortality in pediatric postoperative cardiac patients. Subsequent redo-sternotomy has not been problematic.