DEEP WOUND INFECTIONS (MEDIASTINITIS) AFTER OPEN HEART SURGERY

Abstract

Deep wound infections are a serious complication after open heart surgery and are directly related to patient survival both in the short and long term. Despite prevention, their appearance continues to be significant - 0.5% - 6.8% and the associated in-hospital mortality ranges from 7% to 35%. Analysis of the clinical material concerning the development of mediastinitis after cardiac surgery with total median sternotomy and cardiopulmonary bypass, reporting the results from the applied surgical methods, as well as consideration of prevention options, such as biomarkers – procalcitonin (PCT) and C-Reactive protein (CRP), and early diagnosis of these potentially life-threatening complications. The report presents 7- year experience of the Cardiac surgery department with prophylaxis, diagnosis and treatment of patients who develop deep wound infections after open heart surgery covering the period of January 2011 to January 2018. For this period 4563 patient with different types of cardiac pathology we operated, 94 (2.06%) of them developed deep wound infection. Patients are divided into groups depending on the type of surgery – CABG, valve correction, aortic surgery or combined procedures. The study is retrospective, and the clinical data used is from the hospital records. Sex ratio is 1,5:1 – males/females. The mean age for both sexes is 67.5 years. In hospital mortality was evaluated - 22.34% (21 patients). In 100 of the patients PCT and CRP were tested during the first postoperative day. 15 of them PCT was more 2 ng/ml and 9 (60%) patients developed deep wound infection. In all these patients, bacterial agent was isolated from wound and vacuum-assisted therapy was used. In 2 cases we used titanium plates for sternal reconstruction along with mobilization of omentum majus. Despite the progress of surgical techniques and the minimally invasive techniques, the rate of development of deep wound infections remains relatively high. The use of vancomycin paste, gentamicin-impregnated sponges, reducing the use of sternal wax and excessive cauterization of tissues seems to be a preventive measure. Evaluation of PCT And CRP on POD-1 proves to be an effective prognostic marker for the development of infectious complications. The data presented in the report is comparable to those reported in the world literature. Open heart surgery with cardiopulmonary by-pass leads to a risk of developing mediastinitis. Improved surgical techniques and research on specific biomarkers could reduce the development of this life-threatening complications.