Puentes U, Santibañez-Escobar F, Morales-Flores C, Ortíz-Vázquez MP

Language: Spanish
References: 18
Page: 9-12
PDF size: 147.54 Kb.

ABSTRACT

Objective. To analyse the pre and postoperative clinical data of patients with mediastinitis underwent cardiac surgery at the National Institute of Cardiology Ignacio Chávez.
Material and methods. This is a retrospective and transversal study, there were 53 patients from January 2007 to December 2009, who underwent cardiac surgery with diagnosis of mediastinitis and mediastinal exploration, were done.
Results. We studied the records of patients diagnosed with mediastinitis corresponding to a 2.6% annual mediastinitis all patients undergoing cardiac surgery. Hospital mortality was 26%. Risk variables presented more frequent were obesity 18%, diabetes 47%, age (elder than 60 year-old, 67%), prolonged ventilation 40%, and postoperative pneumonia 18%. There were 32% of coronary artery bypass surgery and 62% of valvular surgery. Surgical treatment performed were debridement, washing and sternal closure with curettage of sternal branches 65%, partial sternectomy with pectorals overlap 12%, pectoral flap rotation 8%, and application of omentum 10%, and the use of continuous aspiration system assisted (VAC) 4%.
Conclusions. In our institution, the surgical treatment mostly consists in the exploration, debridment, washing and direct closure in relationship to the surgical findings. Beyond VAC, the incidence and mortality rates are similar than those reported in the literature. We can conclude that the surgical treatment here is the appropriate.

REFERENCES

1. Cowan KN, Teague L, Sue SC, Mahoney JL. Vacuum-Assisted Wound Closure ofDeep Sternal Infections in High-Risk Patients After Cardiac Surgery. Ann ThoracSurg 2005;80:2205-12.

2. Segers P, de Jong AP, Kloek JJ, de Mol BA. Poststernotomy mediastinitis: comparisonof two treatment modalities Interact Cardiovasc Thorac Surg 2005;4:555-60.

3. Sjögren J, Malmsjö M, Gustafsson R, Ingemansson R. Poststernotomy mediastinitis:a review of conventional surgical treatments, vacuum-assisted closure therapyand presentation of the Lund University Hospital mediastinitis algorithm. Eur JCardiothorac Surg 2006;30:898-905.

4. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for Preventionof Surgical Site Infection, 1999. Centers for Disease Control and Preven-tion (CDC) Hospital Infection Control Practices Advisory Committee. Am J InfectControl 1999;27:97-132.

5. Kanafani ZA, Arduino JM, Muhlbaier LH, et al. Incidence of and preoperativerisk factors for Staphylococcus aureus bacteremia and chest wound infection aftercardiac surgery. Infect Control Hosp Epidemiol 2009;30:242-8.

6. Eklund AM, Lyytikäinen O, Klemets P, et al. Mediastinitis after more than 10,000cardiac surgical procedures. Ann Thorac Surg. 2006;82:1784-9.

7. Klesius AA, Dzemali O, Simon A, et al. Successful treatment of deep sternal infectionsfollowing open heart surgery by bilateral pectoralis major flaps. Eur JCardiothorac Surg. 2004;25:218-23.

8. Trouillet JL, Chastre J, Fagon JY, Pierre J, Domart Y, Gibert C. Use of granulatedsugar in treatment of open mediastinitis after cardiac surgery. Lancet 1985;2:180-4.

9. Durandy Y, Batisse A, Bourel P, Dibie A, Lemoine G, Lecompte Y. Mediastinalinfection after cardiac operation. A simple closed technique. J Thorac CardiovascSurg 1989;97:282-5.

10. Kirsch M, Mekontso-Dessap A, Houël R, Giroud E, Hillion ML, Loisance DY.Closed drainage using redon catheters for poststernotomy mediastinitis: resultsand risk factors for adverse outcome. Ann Thorac Surg 2001;71:1580-6.

11. Sjögren J, Nilsson J, Gustafsson R, Malmsjö M, Ingemansson R. The impact ofvacuum-assisted closure on long-term survival after post-sternotomy mediastinitis.Ann Thorac Surg 2005;80:1270-5.

12. Jurkiewicz MJ, Bostwick J 3rd, Hester TR, Bishop JB, Craver J. Infected mediansternotomy wound. Successful treatment by muscle flaps. Ann Surg 1980;191:738-44.

13. d'Udekem Y, Lengele B, Noirhomme P, et al. Radical debridement and omentaltransposition for post sternotomy mediastinitis. Cardiovasc Surg 1998;6:415-8.

14. El Oakley RM, Wright JE. Postoperative mediastinitis: classification and management.Ann Thorac Surg 1996;61:1030-6.

15. Weir RA, MacDuff R, Nkere UU, Roditi GH. Images in cardiovascular medicine.Bursting forth: late-developing acute mediastinal abscess after sternotomy demonstratedby cardiac computed tomography. Circulation 2008;118:e673-4..

16. Misawa Y. Which is better for treatment of mediastinitis following heart surgery,omental or muscle flap transfer? Eur J Cardiothorac Surg. 2004;26:232-3..

17. Argenta LC, Morykwas MJ. Vacuum-assisted closure: a new method for woundcontrol and treatment: clinical experience. Ann Plast Surg 1997;38:563-76.

18. Fleischmann W, Strecker W, Bombelli M, Kinzl L. Vacuum sealing as treatmentof soft tissue damage in open fractures. Unfallchirurg. 1993;96:488-92. [Artículoen Alemán].