Clinical outcomes of open heart surgery in patients with atopic dermatitis

Abstract

Atopic dermatitis is a skin condition often complicated by colonization with Staphylococcus aureus, which increases the risk of infective endocarditis, skin cellulitis and osteomyelitis. Positive cultures for Staphylococcus aureus are obtained from 70% to 80% of wounds in patients with mediastinitis. Thus sternotomy carries increased risk of mediastinitis in patients with atopic dermatitis. We retrospectively reviewed 25 patients with atopic dermatitis who underwent cardiac surgery via a median sternotomy or thoracotomy from January 1997 to September 2010 at our institution. Postoperative mediastinitis due to methicillin-resistant Staphylococcus aureus was found in 3 patients who had a median sternotomy. They were ultimately discharged in good condition. No mediastinitis occurred in patients undergoing thoracotomy. Mediastinitis may occur due to direct exposure of the bone marrow to methicillin-resistant Staphylococcus aureus in patients with atopic dermatitis whose skin is colonized with such bacteria. Thoracotomy may be a better surgical approach in patients with atopic dermatitis who require thoracic surgery.

Pay Attention to Valvular Disease in the Presence of Atopic Dermatitis

“…7 We have introduced preoperative skin care by dermatologists for AD patients at Kobe City Medical Center General Hospital. 8 Most of the present patients had some skin trouble, although the skin appeared clear in two of them. The barrier function, however, is decreased in the skin of patients with AD, and thus, all patients must undergo skin care to prevent infection with S. aureus irrespective of requirediffer between the 2 groups.…”

“…12 We previously reported the clinical outcomes of patients with AD who underwent openheart surgery. 8 In that study, 3 patients who underwent openheart surgery via conventional median sternotomy developed postoperative mediastinitis caused by MRSA. Wound infection never occurred after thoracotomy.…”

“…Because we previously reported a higher incidence of postoperative mediastinitis in patients with AD undergoing median sternotomy than thoracotomy, 8 we selected thoracotomy whenever possible.…”

Minimally access via left anterior mini-thoracotomy for repair of adult subarterial ventricular septal defects

“…To date, intracardiac repair under direct visualization via median sternotomy is still considered the gold standard for treatment of VSDs [1]. However, the conventional surgery always accompanies by long midline or thoracotomy skin incisions, postoperative pain and poor cosmetic effects.…”

Rising Awareness of the Relationship Between Infective Endocarditis and Atopic Dermatitis

“…In terms of surgical approach, either median sternotomy or right thoracotomy was used, based on factors identified in their previous experiment, including the condition of the skin. 8 The development of IE is the net result of complex interactions between bloodstream pathogens with matrix molecules and platelets at sites of endocardial cell damage. IE is likely to result from frequent exposure to random bacteremias associated with daily activities.…”