Mediastinitis in heart and lung transplantation: 15 years experience.
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 clam-shell 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.
Abid
Qamar
Q
Department of Cardiopulmonary Transplantation, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom. qumarabid@hotmail.com
Nkere
Udim U
UU
Hasan
Asif
A
Gould
Kate
K
Forty
Jonathan
J
Corris
Paul
P
Hilton
Colin J
CJ
Dark
John H
JH
D000293:Adolescent; D000328:Adult; D002648:Child; D003646:Debridement; D016027:Heart Transplantation; D016041:Heart-Lung Transplantation; D006801:Humans; D016867:Immunocompromised Host; D016040:Lung Transplantation; D008480:Mediastinitis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013249:Sternum / Q000601:surgery*; D007507:Therapeutic Irrigation; D016896:Treatment Outcome