Bloodstream Infections Increased After Delayed Sternal Closure: Cause or Coincidence

Das, Sabyasachi; Rubio, Agustin E.; Simsic, Janet M.; Kirshbom, Paul M.; Kogon, Brian; Kanter, Kirk R.; Maher, Kevin

doi:10.1016/j.athoracsur.2010.09.055

Cited by 39 publications

(36 citation statements)

References 20 publications

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“…The overall infection rate in our cohort (27.6%) is in the higher range of what is reported after pediatric cardiac surgery, likely because of the very high proportion of complex neonatal repairs (>80%) compared to other available studies. The infection rate in this high risk population is likely high [30], but has not been well defined. Our infection rate may limit the applicability of our findings to centers with lower infection rates.…”

Section: Discussionmentioning

confidence: 99%

Hypogammaglobulinemia after cardiopulmonary bypass in infants

Rhodes

Robert

Atkinson

et al. 2014

The Journal of Thoracic and Cardiovascular Surgery

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Background Hypogammaglobulinemia has been reported after cardiac surgery and may be associated with adverse outcomes. We sought to define baseline immunoglobulin (Ig) concentration in neonates and infants with congenital heart disease, determine its course following cardiopulmonary bypass (CPB), and determine if post-CPB hypogammaglobulinemia was associated with increased morbidity. Methods Single center, retrospective analysis of infants who underwent cardiac surgery with CPB between June 2010 and December 2011. Ig concentration obtained from banked plasma of 47 patients from a prior study (pre-CPB, immediately post-CPB, and 24- and 48-hours post-CPB). Additionally, any Ig levels drawn for clinical purposes after CPB were included. Ig levels were excluded if drawn after chylothorax diagnosis or intravenous immunoglobulin G administration. Results Median age was 7 days. Preoperative Ig concentration was similar to that described in healthy children. IgG level fell to less than 50% of preoperative concentration by 24-hr post-CPB and failed to recover by 7 days. 25/47 (53%) patients had low IgG after CPB (<248 mg/dl). Despite no difference in demographics or risk factors between patients with low and normal IgG, low IgG patients had more positive fluid balance at 24-hours, increased pro-inflammatory plasma cytokine levels, duration of mechanical ventilation, and CICU length of stay. Additionally, low IgG patients had increased incidence of post-operative infections (40% vs. 14%, p=0.056). Conclusions Hypogammaglobulinemia occurs in half of infants after CPB. Its association with fluid overload and increased inflammatory cytokines suggests it may result from capillary leak. Postoperative hypogammaglobulinemia is associated with increased morbidity, including more secondary infections.

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Section: Discussionmentioning

confidence: 99%

Hypogammaglobulinemia after cardiopulmonary bypass in infants

Rhodes

Robert

Atkinson

et al. 2014

The Journal of Thoracic and Cardiovascular Surgery

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“…However, DSC is an independent predictor for deep mediastinal infection and mortality. 5,6 Our technique is simple and effective. In our experience we have always been able to close the soft tissues in the standard fashion, thus creating a biological seal, which we postulate is more effective against surgical site infections.…”

Section: Discussionmentioning

confidence: 97%

Novel technique for delayed sternal closure: Soft tissue approximation with substernal bridge

Rajakaruna

Rodriguez

Rajbanshi

et al. 2014

The Journal of Thoracic and Cardiovascular Surgery

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References1. Alsoufi B, Rao V, Borger MA, Maganti M, Armstrong S, Feindel CM, et al. Shortand long-term results of triple valve surgery in the modern era. Ann Thorac Surg. 2006;81:2172-8. 2. Cohn LH, Adams DH, Couper GS, Bichell DP, Rosborough DM, Sears SP, et al. Minimally invasive cardiac valve surgery improves patient satisfaction while reducing costs of cardiac valve replacement and repair. Ann Surg. 1997; 226:421-8. 3. Gammie JS, Zhao Y, Peterson ED, O'Brien SM, Rankin JS, Griffith BPJ.Less-invasive mitral valve operations: trends and outcomes from the Society of

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“…Not closing the sternotomy wound in the operating room at the conclusion of the surgical procedure provides for more room and less compression and restriction of the heart, lungs and major vessels within the thorax. Some authors have suggested that DSC is associated with increased length of stay and infection rates [4][5][6]. However, others have found significant benefit [7,8] and use the technique routinely.…”

Section: Discussionmentioning

confidence: 98%