title: Does technical failure of revascularization during coronary artery bypass grafting predict severity of poststernotomy mediastinitis?
abstract: OBJECTIVE
  To assess the impact of unsuccessful revascularization in relation to poststernotomy mediastinitis (PSM), which affects long-term outcome after coronary artery bypass grafting (CABG).
  
  
  METHODS
  An active approach for the follow-up of PSM involved a step by step treatment protocol of conventional surgery and plastic reconstructive surgery. 47 patients treated for PSM after CABG were identified and further evaluated. Complete revascularization was considered unsuccessful when technical hazards were reported during CABG. When PSM subsided after thorough debridement and sternal refixation without plastic reconstructive surgery, such as omentoplasty or muscle transposition, PSM was categorized as mild PSM. If treatment required plastic reconstructive surgery, PSM was categorized as severe PSM. Preoperative coronary artery angiographic status and success of revascularization were compared to postoperative outcome in relation to mild and severe PSM.
  
  
  RESULTS
  36 patients suffered from mild PSM and 11 patients from severe PSM. Preoperative clinical status did not differ among patients. Two patients (4.3 %) died during hospitalization. The need for plastic reconstructive surgery was significant (p < 0.05) among patients with unsuccessful revascularization. 35 out of 41 patients (85 %) without problems of graft anastomosis during CABG (successful revascularization) were associated with mild PSM, whereas only 6 out of 41 patients (15 %) with successful revascularization during CABG required plastic reconstructive surgery (p < 0.05). Technical failure of graft anastomosis (3 cases) or poor outflow of internal thoracic artery (2 cases) were statistically associated with severe PSM.
  
  
  CONCLUSIONS
  Technical failures of revascularization during CABG may delay recovery from PSM.
authors.affiliation: Heart Center, Tampere University Hospital, Tampere University, Tampere, Finland. ari.mennander@pshp.fi
authors.forename: A
authors.initials: A
authors.lastname: Mennander
authors.forename: P
authors.initials: P
authors.lastname: Maaranen
authors.forename: B
authors.initials: B
authors.lastname: Negre
authors.forename: M
authors.initials: M
authors.lastname: Tarkka
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000601:surgery; D003646:Debridement; D005260:Female; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000209:etiology*; D008875:Middle Aged; D009852:Omentum / Q000601:surgery; D013249:Sternum / Q000601:surgery; D013530:Surgical Wound Infection / Q000209:etiology* / Q000601:surgery; D017211:Treatment Failure