Surgical Treatment of Mediastinitis After Cardiac Transplantation
Journal
Transplantation Proceedings
Journal Volume
40
Journal Issue
8
Pages
2629-2630
Date Issued
2008
Author(s)
Wang J.L.
Tsao C.I.
Ko W.J.
Su H.Y.
Chu S.H.
Abstract
Mediastinitis is a life-threatening complication among patients undergoing cardiac transplantation. There are conservative and aggressive surgical treatments. From October 1987 to October 2007, we reviewed the clinical records of 315 heart transplantations for those four cases with severe mediastinis needing surgical treatment for demographic data, clinical presentation, treatment, and outcome. Conservative therapy, such as sternal debridement without muscle flap closure and closed local irrigation with drainage, was performed in two cases. The other two patients needed aggressive surgical treatment with muscle flap or omental flap performed. Only one transplant recipient with severe mediastinis had undergone previous sternotomy before cardiac transplantation. The organisms were methicillin-resistant Staphylococcus aureus in three and Aspergillus fumigatus in one case. The one subject who received conservative therapy without a flap died. The other two with muscle flap and omental flap survived. Cardiac recipients survived if there was aggressive surgical treatment for severe mediastinitis. Meanwhile, we recommend prolonged aggressive antibiotic therapy and reduced immunotherapy. ? 2008 Elsevier Inc. All rights reserved.
SDGs
Other Subjects
antibiotic agent; cyclosporin A; immunosuppressive agent; tacrolimus; vancomycin; adult; antibiotic therapy; article; Aspergillus fumigatus; clinical feature; conservative treatment; controlled study; debridement; demography; disease severity; female; graft recipient; heart transplantation; human; lavage; lung aspergillosis; major clinical study; male; mediastinitis; medical record review; methicillin resistant Staphylococcus aureus; multiple organ failure; muscle flap; priority journal; septic shock; sternotomy; surgical drainage; surgical technique; survival rate; treatment outcome; wound dehiscence; Adult; Aspergillosis; Aspergillus fumigatus; Female; Heart Transplantation; Humans; Immunosuppressive Agents; Male; Mediastinitis; Methicillin Resistance; Middle Aged; Postoperative Complications; Retrospective Studies; Staphylococcal Infections
Type
journal article