Sternal reconstruction after post-sternotomy dehiscence and mediastinitis.

Autor: Dell'Amore A; Department of Cardio-Thoracic Surgery, S. Orsola Malpighi University Hospital, Via Massarenti 9, Bologna, BO Italy., Congiu S; Department of Cardio-Thoracic Surgery, S. Orsola Malpighi University Hospital, Via Massarenti 9, Bologna, BO Italy., Campisi A; Department of Cardio-Thoracic Surgery, S. Orsola Malpighi University Hospital, Via Massarenti 9, Bologna, BO Italy., Mazzarra S; Department of Cardio-Thoracic Surgery, S. Orsola Malpighi University Hospital, Via Massarenti 9, Bologna, BO Italy., Zanoni S; Department of Cardio-Thoracic Surgery, S. Orsola Malpighi University Hospital, Via Massarenti 9, Bologna, BO Italy., Giunta D; Department of Cardio-Thoracic Surgery, S. Orsola Malpighi University Hospital, Via Massarenti 9, Bologna, BO Italy.
Jazyk: angličtina
Zdroj: Indian journal of thoracic and cardiovascular surgery [Indian J Thorac Cardiovasc Surg] 2020 Jul; Vol. 36 (4), pp. 388-396. Date of Electronic Publication: 2020 Jan 02.
DOI: 10.1007/s12055-019-00880-5
Abstrakt: Purpose: Post-sternotomy dehiscence and mediastinitis remains a serious complication in cardiothoracic surgery. The aim of this work is to report our experience over a period of 8 years in the surgical treatment and risk factor analyses of post-sternotomy dehiscence and mediastinitis.
Methods: All patients treated for post-sternotomy dehiscence at our Thoracic Surgery Unit in the last 8 years were retrospectively collected. We identified 237 patients with post-sternotomy dehiscence/mediastinitis. Forty-two patients had simple fractures of the metal steel wires, 61 had an asymmetric sternotomy with multiple sternal fractures, 113 had a symmetric sternotomy with multiple sternal fractures, 14 had a failed Robicsek procedure, and 7 had sternal dehiscence with mediastinal abscess.
Results: Different surgical techniques and materials were used to repair the sternum. In 21 patients, the first revision failed and a second reoperation was required. At multivariate analyses, we have identified risk factors for revision failure and in-hospital mortality. Mortality rate was significantly higher in patients who underwent more than one surgical revision (8% vs 19%, p  < 0.001).
Conclusions: Patients with sternal dehiscence are very fragile due to multiple preoperative comorbidities as reflected by postoperative morbidity and risk factors for in-hospital mortality. A correct evaluation of the characteristics of sternal dehiscence is important to guide the most appropriate repair strategy. Patients who need repeated sternal revisions had a higher mortality. Further randomized studies are needed to evaluate different techniques and medical devices to define the gold standard procedure to reduce significantly sternal wound complications in high-risk patients as defined by well-known risk factors.
Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest.
(© Indian Association of Cardiovascular-Thoracic Surgeons 2020.)
Databáze: MEDLINE
Externí odkaz: