Sternal wound infection after heart transplantation: incidence and results with aggressive surgical treatment.
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.
Carrier
M
M
Department of Surgery and Medicine, Montreal Heart Institute and University of Montreal, Quebec, Canada. carrier@icm.umontreal.ca
Perrault
L P
LP
Pellerin
M
M
Marchand
R
R
Auger
P
P
Pelletier
G B
GB
White
M
M
Racine
N
N
Bouchard
D
D
D000208:Acute Disease; D000367:Age Factors; D003646:Debridement; D005260:Female; D006084:Graft Rejection; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008297:Male; D008480:Mediastinitis / Q000209:etiology / Q000401:mortality; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D013249:Sternum / Q000601:surgery*; D013530:Surgical Wound Infection / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate
D007166:Immunosuppressive Agents