HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): E. Dean McKenzie Charles D. Fraser Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tortoriello, T. A. Articles by Mott, A. R. Search for Related Content PubMed PubMed Citation Articles by Tortoriello, T. A. Articles by Mott, A. R. Related Collections Chest wall

Ann Thorac Surg 2003;76:1655-1660
© 2003 The Society of Thoracic Surgeons

---

Original article: general thoracic

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

^a The Lillie Frank Abercrombie Section of Pediatric Cardiology, The Heart Center, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
^b Department of Congenital Heart Surgery, The Heart Center, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
^c Department of Plastic and Reconstructive Surgery, The Heart Center, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA

Accepted for publication May 5, 2003.

^* Address reprint requests to Dr Mott, The Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, 6621 Fannin, MC-19345C, Houston, TX 77030, USA.
e-mail: amott{at}bcm.tmc.edu

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.

This article has been cited by other articles:

				K. Ashour, K. Jamieson, and K. Lakhoo A sternotomy too far Interactive CardioVascular and Thoracic Surgery, October 1, 2009; 9(4): 753 - 754. [Abstract] [Full Text] [PDF]

				C. Anslot, S. Hulin, and Y. Durandy Postoperative Mediastinitis in Children: Improvement of Simple Primary Closed Drainage Ann. Thorac. Surg., August 1, 2007; 84(2): 423 - 428. [Abstract] [Full Text] [PDF]

				S. S. Shah, J. Kagen, E. Lautenbach, W. B. Bilker, J. Matro, T. E. Dominguez, S. Tabbutt, J. W. Gaynor, and L. M. Bell Bloodstream infections after median sternotomy at a children's hospital J. Thorac. Cardiovasc. Surg., February 1, 2007; 133(2): 435 - 440. [Abstract] [Full Text] [PDF]

				T. Fleck, P. Simon, G. Burda, E. Wolner, and G. Wollenek Vacuum assisted closure therapy for the treatment of sternal wound infections in neonates and small infants Interactive CardioVascular and Thoracic Surgery, June 1, 2006; 5(3): 285 - 288. [Abstract] [Full Text] [PDF]

				A. A. Al-Sehly, J. L. Robinson, B. E. Lee, G. Taylor, D. B. Ross, M. Robertson, and I. M. Rebeyka Pediatric Poststernotomy Mediastinitis Ann. Thorac. Surg., December 1, 2005; 80(6): 2314 - 2320. [Abstract] [Full Text] [PDF]