Background: Mediastinal infection is one of the most important complications of heart surgery performed via sternotomy. We evaluated early aggressive surgical interventions to eradicate infection and prevent bone-related recurrences in patients who developed mediastinitis following coronary artery bypass surgery.

Methods: We retrospectively evaluated 18 patients (5 women, 13 men; mean age 56±7 years; range 44 to 68 years) who developed mediastinitis following coronary artery bypass surgery. Reoperations were performed after a mean of 12 days following the initial surgery and on the same day a mediastinal infection was suspected. At surgery, all necrotic tissues together with the sternum were removed with aggressive debridement.

Results: Cultures from the mediastinal fluid and postoperative blood samples revealed methicillin-resistant Staphylococcus aureus in eight patients, Pseudomonas aeruginosa in three patients, and Serratia marcescens in two patients. In the remaining five patients, no pathogen could be isolated. Purulent drainage disappeared within a mean of four days in seven patients. Open wound care and dressings were initiated in a mean of six days in 11 patients whose drainage persisted until the 14th postoperative day. All patients were discharged after a mean of 23 days (range 11 to 33 days) from revision surgery.

Conclusion: Deep mediastinal infections occurring after sternotomy can be controlled with small but aggressive interventions performed at the earliest possible period.

Keywords : Coronary artery bypass/complications; mediastinitis/ etiology/surgery; sternum/surgery; surgical wound infection/ etiology