Produção Nacional
Revisado por pares
Mediastinitis after cardiac transplantation
2000; Sociedade Brasileira de Cardiologia (SBC); Volume: 74; Issue: 5 Linguagem: Inglês
10.1590/s0066-782x2000000500003
ISSN1678-4170
AutoresNoedir Antônio Groppo Stolf, Alfredo Inácio Fiorelli, Fernando Bacal, Luís Fernando Aranha Camargo, E A Bocchi, Andréa Cristina Oliveira Freitas, André Gustavo Bombana Nicoletti, Daniela Meira,
Tópico(s)Tracheal and airway disorders
ResumoAssessment of incidence and behavior of mediastinitis after cardiac transplantation.From 1985 to 1999, 214 cardiac transplantations were performed, 12 (5.6%) of the transplanted patients developed confirmed mediastinitis. Patient's ages ranged from 42 to 66 years (mean of 52.3 +/- 10.0 years) and 10 (83.3%) patients were males. Seven (58.3%) patients showed sternal stability on palpation, 4 (33.3%) patients had pleural empyema, and 2 (16.7%) patients did not show purulent secretion draining through the wound.Staphylococcus aureus was the infectious agent identified in the wound secretion or in the mediastinum, or both, in 8 (66.7%) patients. Staphylococcus epidermidis was identified in 2 (16.7%) patients, Enterococcus faecalis in 1 (8.3%) patient, and the cause of mediastinitis could not be determined in 1 (8.3%) patient. Surgical treatment was performed on an emergency basis, and the extension of the débridement varied with local conditions. In 2 (16.7%) patients, we chose to leave the surgical wound open and performed daily dressings with granulated sugar. Total sternal resection was performed in only 1 (8.3%) patient. Out of this series, 5 (41.7%) patients died, and the causes of death were related to the infection. Autopsy revealed persistence of mediastinitis in 1 (8.3%) patient.Promptness in diagnosing mediastinitis and precocious surgical drainage have changed the natural evolution of this disease. Nevertheless, observance of the basic precepts of prophylaxis of infection is still the best way to treat mediastinitis.
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