Mediastinitis in heart transplantation

Karwande, Shreekanth V.; Renlund, Dale G.; Olsen, Stephanie L.; Richenbacher, Wayne E.; Hawkins, John A.; Millar, Roger C.; Marks, John D.

doi:10.1016/0003-4975(92)90067-e

Cited by 38 publications

(12 citation statements)

References 17 publications

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“…Recently, the (*) The patient was discharged from the hospital but had to be readmitted because of infection; PO-postoperative day; PVPI-povidone iodine; AVatrioventricular; ARF-acute renal failure; CPA-cardiopulmonary arrest; PTE-pulmonary thromboembolism; DVT-deep venous thrombosis; MOF-multiple organ failure. mortality rate has dropped to figures lower than 10%, even in cases of cardiac transplantation 2,8 . In our study, the incidence of mediastinitis and its mortality confirmed the severity of that entity, which was observed by other authors 3,6,8 .…”

Section: Discussionmentioning

confidence: 99%

“…mortality rate has dropped to figures lower than 10%, even in cases of cardiac transplantation 2,8 . In our study, the incidence of mediastinitis and its mortality confirmed the severity of that entity, which was observed by other authors 3,6,8 . Grossi et al 7 , in an analysis of 7,949 patients undergoing cardiac operations, observed that only 0.97% of patients developed mediastinitis.…”

Section: Discussionmentioning

confidence: 99%

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Mediastinitis after cardiac transplantation

Fiorelli

Bacal

et al. 2000

Arq. Bras. Cardiol.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Mediastinitis after cardiac transplantation

Fiorelli

Bacal

et al. 2000

Arq. Bras. Cardiol.

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“…According to the random effect model, Ridderstolpe et al 's study [31] (5.14%) had the largest effect weight and Karwande et al 's study [20] (0.42%) had the smallest effect weight. The effect weight of trials were not homogenous (Q: 89.09, df(Q): 31, p:0.00, I2:65.20%).…”

Section: Resultsmentioning

confidence: 97%

“…7/2 1890 Prospective Adult Combined Colombier et al [19] 2013 55/19 222 Retrospective Adult Combined Gualis et al [22] 2009 18/4 838 Prospective Adult Combined Ashley et al [7] 2004 84/59 223 Prospective Adult Combined Baillot et al [14] 2010 201/66 23499 Combined Adult Combined Ben-Ami et al [15] 2008 20/27 141 Retrospective Pediatric Congenital San Juan et al [28] 2007 6/11 68 Prospective Adult Combined Karwande et al [20] 1992 12/0 420 Retrospective Adult Transplantation Sa et al [36] 2011 4/7 157 Retrospective Adult CABG CABG: coronary artery bypass grafting.…”

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confidence: 99%

Does gender predict development of mediastinitis?

Öztürk

2017

EJMO

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T he rate of developing mediastinitis after cardiac surgery is approximately 0.8%-5.6%. [1,2] Although the rate of occurrence of mediastinitis is low, mediastinitis causes complications, such as the need for intra-aortic balloon pump or inotropic drug support, ventricular or supraventricular arrhythmias, stroke, and myocardial ischemia, leading to reduction in long-term survival. [3,4] Mediastinal infections can be caused by direct contamination, hematogenous spread, or through extension of infection from the neck, retroperitoneum, lung, pleura, or chest wall.[5] Mediastinal infections are defined as microbiological or clinical infection of presternal tissue. There are two types of mediastinal infections: superficial or deep wound infections (mediastinitis).[6] Superficial wound infections involve only the skin and subcutaneous tissue; however, mediastinitis is the wound infection that includes sternal osteomyelitis which spreads to retrosternal space. [6] There are many risk factors for the development of mediastinitis: diabetes mellitus, obesity, age, peripheral artery disease, smoking, previous cardiac surgery, >5-h long surgery, and length of stay in intensive care unit. [7,8] There are few clinical studies alleging that sex is a risk factor for the development of mediastinitis after cardiac surgery; [9,10] however, there is no evidence. Therefore, we aimed to analyze whether sex is a risk factor for the development of mediastinitis after cardiac surgery. Methods Search StrategyWe searched PubMed database for articles according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA) [11] to determine whether the sex of patients could predict devel- Objectives:We aimed to analyze whether sex was a risk factor for the development of mediastinitis after cardiac surgery. Methods: Literature screening was performed using PubMed database without date limitation. Trial results were evaluated with random or fixed-effect model according to the heterogeneity. Statistical evaluation was performed. Results: In total, 4044 articles were obtained after database searching. Of all these articles, 32 articles containing 1.11.303 patients, which satisfied the inclusion criteria, were included in the meta-analysis. The rate of mediastinitis was 2.19%. The effect size was observed as heterogeneous (Q: 89.09, df(Q): 31, p:0.00, I2:65.20%). Analysis results according to the random effect model were as follows: OR (odds ratio), 1.09; 95% CI, 0.90-1.32; and p=0.34 (p>0.05). Conclusion:The results of the quantitative analysis showed that a patient's sex does not predict the development of mediastinitis after cardiac surgery for children and/or adults.

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“…3 Aspergillus fungal mediastinitis has been reported after open-heart procedures, such as coronary artery bypass operations, but it is extremely rare after heart transplantation. 2,4 This could be because postsurgical mediastinitis usually occurs within 30 days, [4][5][6] but the significant waning of cellular immunity that makes a patient increasingly vulnerable to fungal infection occurs more than 30 days postoperatively. 7 Because the 2 events are not concordant, fungal mediastinitis is unlikely to occur.…”

Section: Discussionmentioning

confidence: 99%

Aspergillus Mediastinitis after Orthotopic Heart Transplantation: A Case Report

Ahmed¹,

Almanfi²,

Aftab³

et al. 2015

Texas Heart Institute Journal

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The U.S. Centers for Disease Control and Prevention defines Aspergillus mediastinitis as the presence of a positive culture result from a mediastinal sample, plus one of the following: 1) fever higher than 38 °C, or 2) chest pain or sternal instability with purulent effusion in the mediastinum or positive culture results from surgically obtained samples or blood.1 Of all cardiothoracic procedures, orthotopic heart transplantation (OHT) is associated with the highest risk of mediastinitis (including bacterial and fungal), with infection rates of 2.5% to 6%.3 A review of the literature reveals only 3 cases in which Aspergillus mediastinitis occurred after OHT; all 3 cases involved A. fumigatus. We describe what we believe to be the first case of Aspergillus calidoustus mediastinitis after OHT. Case ReportA 55-year-old woman was admitted for OHT. Her medical history was notable for ischemic cardiomyopathy, as well as for hypertension, dyslipidemia, coronary artery disease, myocardial infarction, ventricular tachycardia, paroxysmal atrial fibrillation, and chronic kidney disease. Her surgical history included implantation of a left ventricular assist device (LVAD), resection of a left ventricular aneurysm, and implantation of a biventricular defibrillator. She had no history of infectious sequelae with her LVAD. During the OHT procedure, the patient was coagulopathic and needed several units of different blood products. Her chest was temporarily closed at the end of the operation and was permanently closed 3 days later.Postoperatively, she had prolonged respiratory and renal failure that necessitated ventilator support, hemodialysis, and inotropic and vasopressor support. Despite the new heart, she also needed further circulatory support, including an intra-aortic balloon pump. Two weeks postoperatively, she underwent a tracheostomy. Five weeks postoperatively, she developed fever with an elevated white blood cell count. Physical examination revealed tenderness, erythema, and sternal wound drainage. A computed tomographic scan revealed a mediastinal fluid collection and thereby confirmed the diagnosis. Surgical drainage of the fluid and aggressive débridement of the infected sternum were performed. During débridement, we locally irrigated the infected tis-

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Mediastinitis in heart transplantation

Cited by 38 publications

References 17 publications

Mediastinitis after cardiac transplantation

Mediastinitis after cardiac transplantation

Does gender predict development of mediastinitis?

Aspergillus Mediastinitis after Orthotopic Heart Transplantation: A Case Report

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