Abstract

SOTO PERNUDI, Susan et al. Infección de Esternotomía Media Después de Cirugía Cardiovascular: Experiencia en el Hospital R.A. Calderón Guardia. Rev. costarric. cardiol [online]. 2010, vol.12, n.1-2, pp.11-16. ISSN 1409-4142.

Median Sternotomy Infections After Cardiovascular Surgery. R. A. Calderón Guardia Hospital Experience. Introduction and objective. Currently, median sternotomy is the most commonly employed approach for cardiovascular surgical procedures. Infection of this incision can be superficial or deep, carrying high morbidity and mortality. Our objective was to assess the incidence, characteristics, management and results of superficial or deep median sternotomy infections of patients operated upon using this approach in our medical center.  Material and methods. The records of individuals who developed a superficial or deep median sternotomy incision infection were reviewed at the R.A. Calderon Guardia Hospital.  This included the period from the opening of the cardiovascular surgery program in march 2003 until april 2009. Results. During the 6 year study period, 525 patients underwent a median sternotomy incision for cardiovascular interventions; most of the patients were male and most of them had coronary artery disease. Eighteen (3.24%), developed a sternal wound infection which was superficial in 4 and deep in 14. There was 1 death and this occurred as a consequence of a cardiac tear during reopening of the sternum for drainage and repair. The sternal wound infections appeared as an average on the 9th postoperative day and staphylococcus sp. was the most commonly isolated microorganism. Of the 14 patients with deep wound infections, 9 patients underwent drainage and pectoral muscle flap closure and the others were managed with local treatment, vacuum assisted closure and systemic antibiotics. The major risk factors identified for a sternal wound infection were diabetes mellitus, obesity, prolonged postoperative ventilation, and pulmonary infection. Comment. Median sternotomy infections continue to be a relatively frequent problem in patients undergoing cardiovascular operations. Such infections carry serious morbidity and they impose an extra workload and anxiety for the treating team, along with a significant increase in the cost of hospitalization. Therefore, this possible complication must be kept in mind and all measures should be taken to avoid it.

Keywords : Internal mamary artery; cardiac surgery; revascularization; mediastinitis; sternal infections.

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