Mediastinitis in Cardiac Surgery

Abstract
Introduction and objective: Mediastinitis (M.)
is a rare but potentially devastating
complication to cardiac surgery. However, very
little data exists to illuminate the consequences
of M. in Denmark. The objective of this study
was to examine the clinical outcome of M.
following cardiac surgery at one Danish Dept.
of Cardiothoracic Surgery in terms of prolonged
hospitalization, morbidity (defined as chronic
sequelae) and mortality. Furthermore an
assessment of the effectiveness of VAC therapy
(Vacuum Assisted Closure) in the treatment of
M. was approached given the data available and
by referring to previous studies.
Materials and methods: A retrospective cohort
study of 63 patients with M. postoperative to
either CABG (Coronary Artery Bypass Graft),
valve procedure or CABG and valve procedure
combined. The patients underwent their primary
procedure at the Dept. of Cardiothoracic
Surgery, Copenhagen University Hospital in the
period of 2000-2009. The control group (n =
10.575) was the total number of patients who
underwent either CABG, valve procedure or
CABG and valve procedure in the same 10-year
period.
Results: After cardiac surgery 0.6% developed
M. at a median of 14 days after primary surgery.
These patients had an increased 1 year mortality
of 29.5% compared with 11% in the control
group (P < 0.001). Another 21.3% recovered
with chronic sequelae, and the remaining 49.2%
were alive after one year and without chronic
sequelae. Median hospitalization period was
prolonged from 8 days in the control group to
36 days in the cohort (P < 0.001). 11 patients
(18%) received VAC therapy. The 1 year
mortality in this group was 45.5%, but findings
were not statistically significant (P < 0.2).
Discussion: The results found in this study
regarding mortality and admission time were
largely comparable to the data found in the
literature. The result regarding chronic sequelae
following M. was a weak indicator of the actual
frequency of chronic sequelae and this subject
is poorly described in the literature. From this
study alone nothing significant can be
concluded regarding the effectiveness of VAC
therapy. However results from other studies
have shown positive results and consequently
support the implementation of VAC therapy as
standard treatment of M.
Conclusion: The results found in this study
indicates that there is room for improvement in
the treatment of M.. Further studies into
predisposing factors are suggested. Revision of
guidelines in treatment of M. is advised, and
the implementation of VAC as standard firstline
treatment should be considered.

Opgave-fil: 

Mediastinitis in Cardiac Surgery [1]