The 67th Annual Conference of the Israel Heart Society

The Modified Sternoplasty Surgery for Mediastinitis Post-Cardiac Surgery

Shachar Yehezkeel 1 Liza Grosman-Rimon 1 Mattan Arazi 1,2,3 Jacob Gohari 1,3 Jordan Rimon 1 Offer Amir 1 Amihay Shinfeld 1,2 Leonid Sternik 1,2 Ehud Raanani 1,2 Erez Kachel 1,2
1Department of Cardiology and Cardiac Surgery, Poriya Medical Center, Israel
2Department of Cardiac Surgery, Sheba Medical Centre, Tel Hashomer, Israel
3The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology,, Israel

Introduction:

Deep sternal wound infection (DSWI) is one of the most complex and devastating complications post-cardiac surgery with a prevalence of up to 8% in high risk patients, significant impact on post-operative morbidity and mortality (up to 47%). Poor long term prognosis and high hospital cost. There has been no general consensus regarding optimal surgical management. Current surgical treatments include surgical debridement, bilateral pectoralis muscle or omentum flaps or combinations of these techniques without satisfying results. We present our experience with the Modified Sternoplasty surgery, a novel surgical technique for the treatment of DSWI.

Material and Methods:

The modified sternoplasty includes dissecting the heart from the infected sternal bone, aggressive surgical sternal debridement, bilateral midclavicular line longitudinal wires, 6-8 horizontal wires anchored to the healthy ribs lateral to the longitudinal wires (Figure 1A) and cover it all with bilateral pectoralis muscles flaps (Figure 1B). Baseline, demographic, length of hospitalization and mortality data were collected and compared with published data.

Results and discussion:

63 patients From 13 different medical centers in 7 different countries were included. All patients had full blown mediastinitis with complete sternal dehiscence. Mean age was 69.7 ± 9.8 years 62% had type 2 diabetes, 83% hyperlipidemia, and 83% hypertension. Prior to the Modified Sternoplasty surgery, 56% underwent CABG, 22% valve surgery, and 19% other cardiac surgeries. Mortality rate and length of stay in our cohort were significantly lower than published data at 3.1% (2/63) vs 7-36%, and 26.5± 23 vs 51 days, respectively.

Conclusion:

The Modified Sternoplasty surgery is a more complex surgery than the conventional Sternoplasty, but was found to lower rate of mortality and morbidity as well as a lower length of stay in a large group of patients. The Modified Sternoplasty has become our center’s gold standard for treating this complex patient population.

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