DEPARTMENT OF SURGERY, SHAHEED MADANI HEART HOSPITAL, UNIVERSITY OF MEDICAL SEIENCES, TABRIZ, IRAN
Background- Purulent mediastinitis is an unusual complication of median sternotomy. This complication often occurs shortly, usually within two weeks, after surgery. This study has been planned to clarify the situation of life-threatening infectious complications after surgical operation at our center and to better the ways of prevention as much as possible.
Methods- In this study, all the patients who had undergone median sternotomy were observed over a 4-year period. The documentation of the diagnoses was completed, information about the patients including demographic characteristics, type of surgery, pre-, intra- and postoperative risk factors, clinical and laboratory findings, etiological diagnoses, responsible organisms, management methods and finally the outcome of the patients were collected and analyzed by a statistical software (SPSS- Win).
Results- This review comprised 2115 patients who had undergone median sternotomy. Thirteen of them (0.61 %) suffered from post-surgical purulent mediastinitis. The type of surgery was 38% coronary artery bypass grafts (CABGs), 23% aortic valve replacement (AVR) + CABGs, and 23% valve replacement or repair. Forty-six percent of the mediastinitis patients were obese, 46% hypertensive, 38% smokers, 38% had a history of previous MI, 15% had preoperative creatinine> 1.2, and 15% needed preoperative intra aortic balloon pump. The mortality rate was 31%.
Conclusion- This complication is distinguished by its clinical manifestations and positive culturing from the mediastinum. Microbial etiology is influenced by the source of contamination and must be recognized for any center separately. A combination of antimicrobial therapy and surgical intervention has better results. A better evaluation of the patients' preoperative conditions, promotion of surgical techniques and preventive measures, and an early diagnosis of mediastinitis will be effective in the reduction of this complication.