Sternal Wound Infection Following Open Heart Surgery: Incidence, Risk Factor, Pathogen, and Mortality

BACKGROUND

Due to its high morbidity and mortality after open-heart surgery, sternal wound infection (SWI) is one of the most important consequences to avoid and manage.

AIM

To assess the incidence, risk factor, causative organisms, and mortality of SWIs in patients who had open-heart surgery over a 9-year period at King Abdulaziz University Hospital, Jeddah, Saudi Arabia.

METHODS

A retrospective study was done on 634 patients who underwent open heart surgery. Data was collected, including patient demographics, BMI, blood group, diabetes, hyperlipidemia, COPD, previous cardiac surgery, previous myocardial infarction, duration of the operation, blood transfusion during the operation, hospital length of stay, and bypass time with each type of sternal wound infection.

RESULTS

The incidence of SSWI and DSWI was 8.6% and 4.1%, respectively. Coagulase-negative staphylococcus was the most frequently isolated organism from SSWI and DSWI patients. A concomitant diabetes mellitus that necessitates blood transfusion was identified as one of the risk variables for SSWI in a multivariate regression study. While concomitant diabetes, being a woman, and a lengthy hospital stay were independently linked with DSWI. Compared with the SSWI group, the 30-day mortality rate for DSWI patients was 3.8% as opposed to 3.7%, and the difference in survival was not statistically significant. Having an older, longer bypass time, and postoperative problems were independent risk factors for 30-day mortality.

CONCLUSION

Future studies in various healthcare settings are required in order to generalize the results because this was a single center study.

Iatrogenic Coronary Artery Compromise Post Non-Coronary Cardiac Surgery in Patients With Normal Coronaries

BACKGROUND

Unexpected events in cardiac surgery may increase morbidity and mortality. We present rare complications related to coronary arteries in non-coronary cardiac surgery in adults and pediatrics.

PATIENTS AND METHODS

We retrospectively reviewed our surgical left-sided valve procedures and aortic root reconstruction for patients with documented coronary ostial injury or left circumflex artery (LCX) between January 2012 and December 2019. Preoperative echocardiography was the standard investigation for all cases and other specific work ups were ordered, according to each case. Management by surgical or non-surgical intervention was planned, according to each complication. Postoperative hemodynamics and mortality rate were the outcomes of interest.

RESULTS

Seven patients were found to have coronary artery compromise post left-sided valve procedures and aortic root reconstruction in adults and children. The details are shown in Table 1. The complications were in 2 patients post-mitral valve (MV) repair, 3 patients post-aortic (AV) replacement, 2 pediatric patients, 1 post-aortic homograft, and the other post-repair of anomalous single coronary arising from the pulmonary artery (ASCAPA). Six patients were hemodynamically unstable. Five patients had intraoperative ischemic changes on electrocardiogram and echocardiography, while ventricular arrhythmias were documented in 3 patients. Two patients were treated with percutaneous coronary intervention to LCX and right coronary artery (RCA), while 4 patients required immediate surgery to graft the obtuse marginal branch of the LCX artery (1) and RCA (3). No revision to valvular procedure was done. With the exception of one, all patients survived.

CONCLUSION

A high index of suspicion is required to diagnose and rescue coronary complications post-valvular surgery and aortic root reconstruction.

Successful surgical repair of complete sternal cleft in an adult

We describe direct repair of congenital complete sternal cleft in a 35-year-old woman, using titanium plates fixed by pre-drilled screws to the manubrium and costal cartilages. This provided excellent protective and cosmetic results.