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Ann Thorac Surg 2001;72:719-723
© 2001 The Society of Thoracic Surgeons

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Original article: cardiovascular

Sternal wound infection after heart transplantation: incidence and results with aggressive surgical treatment

^a Department of Surgery and Medicine and the Microbiology Laboratory, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada

Accepted for publication May 3, 2001.

Address reprint requests to Dr Carrier, Department of Surgery, Montreal Heart Institute, 5000 Belanger St East, Montreal, QB, H1T 1C8, Canada
e-mail: carrier{at}icm.umontreal.ca

Background. Sternal wound infection remains a significant complication. We reviewed the incidence and the treatment of sternal wound infection after heart transplantation.

Methods. Of 226 patients who had a heart transplantation, 20 (8.8%) underwent postoperative wound debridement for superficial or deep sternal wound infection. The incidence and the survival of patients with sternal wound infection were analyzed.

Results. The incidence of sternal wound infection was similar among patients treated with four protocols of immunosuppressive drugs: cyclosporine and prednisone (0 of 22; 0%); cyclosporine, prednisone, and azathioprine (2 of 24; 8.3%); cyclosporine, prednisone, azathioprine, and antithymocyte globulin (15 of 139; 10.8%); and cyclosporine, prednisone, mycophenolate mofetil, and antithymocyte globulin (3 of 41; 7.3%) (p = 0.4). Six-month and 5-year survival of patients with sternal wound infection averaged 85% ± 8% and 74% ± 10% compared with 92% ± 2% and 82% ± 3% in patients without wound infection (p = 0.15). Patients with deep sternal wound infection, debridement, and reconstruction had a 5-year survival averaging 80% ± 10%.

Conclusions. The incidence of sternal wound infection remains similar between patients treated with the triple drug therapy. Surgical debridement and reconstruction can result in long-term survival after heart transplantation.

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