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Qamar Abid
Udim U. Nkere
Asif Hasan
Jonathan Forty
Colin J. Hilton
John H. Dark
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Ann Thorac Surg 2003;75:1565-1571
© 2003 The Society of Thoracic Surgeons

Original article: general thoracic

Mediastinitis in heart and lung transplantation: 15 years experience

Qamar Abid, FRCS, C-Tha*, Udim U. Nkere, FRCS, C-Tha, Asif Hasan, FRCS, C-Tha, Kate Gould, MRCPa, Jonathan Forty, FRCSa, Paul Corris, FRCPa, Colin J. Hilton, FRCSa, John H. Dark, FRCSa

a Department of Cardiopulmonary Transplantation, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom

Accepted for publication November 27, 2002.

* Address reprint requests to Dr Abid, Department of Cardiothoracic Surgery, Victoria Hospital Blackpool, Whinney Heys Rd, Blackpool, UK FY3 8NZ.
e-mail: qumarabid{at}hotmail.com

BACKGROUND: Mediastinitis after sternotomy carries a very high mortality, especially in patients receiving immunosuppressive treatment.

METHODS: A retrospective analysis of the data for patients who had undergone cardiopulmonary transplantation between May 1985 and December 2000 was undertaken. A total of 776 patients had either a median sternotomy or a transverse sternotomy through a clamshell incision. Transplantations were as follows: 591 heart (3 simultaneous heart and renal, and 1 heart and liver), 126 bilateral sequential lung, 57 heart–lung, 1 en bloc double-lung, and 1 heart and single-lung.

RESULTS: In all, 21 (2.7%) recipients had mediastinitis. Of these, 14 had heart, 3 heart–lung, and 4 bilateral lung transplantation. There were 18 median and 3 transverse sternotomies. There were 6 deaths (28.6%). Treatment consisted of antibiotics alone in 2 patients and subxiphisternal drainage in another 2 patients. The sternum was reopened in 17 (80.95%) patients, with debridement and primary closure alone in 5 of these 17 patients and additional irrigation in the other 12. Those who had resternotomy, debridement, and substernal irrigation had a better outcome when compared with the outcomes of other modes of treatment (1 death among 12 patients) (p = 0.06). Age, cardiopulmonary bypass time, body mass index, time to diagnosis, and treatment did not differ between those who survived and those who did not.

CONCLUSIONS: Early aggressive debridement with substernal irrigation is the best mode of treatment for patients with posttransplantation mediastinitis.




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