ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Human Imnunoglobulin-G Administration in Delayed Sternal Closure After Cardiac Surgery
Murat DEMİRTAŞ, Hacı AKAR, Mustafa İDİZ, Aybanu GÖKÇEN, Mehmet KAPLAN, Sabri DAĞSALI, Erdoğan DEMİRAY
Prof. Dr. Siyami Ersek Göğüs Kalp ve Damar Cerrahisi Merkezi
In our clinic, among the open heart operations performed between January 1994 and June 1994, 8 patients sternum was left open for 16,25±9,22 hours in the early postoperative period because of myocardial edema and low cardiac output state in 3 patients, surgical bleeding in 2 patients and recurrent ventricular arrhythrmias in 3 patients. Since the mediastinum was open, in order to reduce the risk of infection, we administered low dose (100 mg/kg twice between the interval of 15 days) of intravenous human immunoglobulin-G (Group 1). As a mechanical support, intraaortic balloon pump (IABP) was used in 2 patients transthoracically, and In 2 patients via femoral artery for 6±1,63 days. Antibiotic therapy have been commenced in all patients. In 2 patients Escherichia coli, in 1 patient Pseudomonas aeruginosa, and in 1 patient Streptococcus viridans was cultured from the mediastinal specimens taken. Candida albicans was cultured in 1 patient from the tracheal material. Two of these 8 patients were lost in the early postoperative period, one of them was lost due to low cardiac output, and the other from the multiorgan failure due to the sepsis. Hospitalisation period of remaining patients was 39,5±16,2 days.

These results were compared with a group of 10 patients which were chosen retrospectively, and had the same hemodynamic criterias but Ig-G had not been administered (Group 2). in this group, IABP assistance was applied transfemorally in 4 patients. Two patients who Staphylococcus aureus was cultured from the mediastinum were lost due to the sepsis. Hospitalisation period was 42,5±16,2 days for this group. There is no statistically significant difference between the two groups. Group 1 seems to have a better prognosis on the basis of infection and hospitalisation period. It will be appropriate to perform prospective randomized studies, especially with regard of cost-result relation in larger series with larger doses of immunoglobulin.

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