Mediastinitis in pediatric cardiac surgery: Prevention, diagnosis and treatment

Abstract

In spite of advances in the management of mediastinitis following sternotomy, mediastinitis is still associated with significant morbidity. The prognosis is much better in pediatric surgery compared to adult surgery, but the prolonged hospital stays with intravenous therapy and frequent required dressing changes that occur with several therapeutic approaches are poorly tolerated. Prevention includes nasal decontamination, skin preparation, antibioprophylaxis and air filtration in the operating theater. The expertise of the surgical team is an additional factor that is difficult to assess precisely. Diagnosis is often very simple, being made on the basis of a septic state with wound modification, while retrosternal puncture and CT scan are rarely useful. Treatment of mediastinitis following sternotomy is always a combination of surgical debridement and antibiotic therapy. Continued use of numerous surgical techniques demonstrates that there is no consensus and the best treatment has yet to be determined. However, we suggest that a primary sternal closure is the best surgical option for pediatric patients. We propose a simple technique with high-vacuum Redon's catheter drainage that allows early mobilization and short term antibiotherapy, which thus decreases physiological and psychological trauma for patients and families. We have demonstrated the efficiency of this technique, which is also cost-effective by decreasing intensive care and hospital stay durations, in a large group of patients.

Ultrasound evaluation of complications after cardiovascular surgery in pediatric patients: A case series

“…The differentiation of infection and hematoma may also be difficult by using imaging modalities such as ultrasound and CT alone. Physical examination findings of fever and erythema at the incision site are important for the diagnosis of mediastinitis (case 4, 5) [8,30].…”

Vacuum‐Assisted Closure for Mediastinitis in Pediatric Cardiac Surgery: A Single‐Center Experience

“…Postcardiac surgery mediastinitis affects approximately 1% of the children and this rate appears to be higher in neonatal patients . The prognosis of mediastinitis is better in children compared to the adults, but it remains as a serious threat . Mediastinitis causes a series of problems such as prolonged hospital stays and increased healthcare costs.…”

Successful Salvage of an Extracardiac Fontan in the Setting of Purulent Mediastinitis using Antibiotic-Impregnated Beads

“…Mediastinitis in the pediatric population following cardiac surgery is relatively uncommon. [1][2][3][4][5][6] Many of the risk factors for post-cardiotomy infection in the adult population are not applicable in children. Intraoperative introduction of organisms is thought to be the primary etiologic process.…”

“…Post-cardiotomy mediastinitis is a serious complication affecting 0.2 to 2.0% of the congenital heart surgery population. [1][2][3][4][5][6] The presence of prosthetic material makes mediastinitis a particularly difficult infection to eradicate. The modified extracardiac Fontan operation is typically performed with some form of prosthetic material (GoreTex or Dacron) to create a conduit between the IVC and the pulmonary arteries.…”