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World J Cardiol. Nov 26, 2010; 2(11): 391-398
Published online Nov 26, 2010. doi: 10.4330/wjc.v2.i11.391
Mediastinitis in pediatric cardiac surgery: Prevention, diagnosis and treatment
Yves Durandy
Yves Durandy, Perfusion and Intensive Care Unit in Pediatric Cardiac Surgery, Institut Hospitalier Jacques Cartier, Avenue du Noyer Lambert, 91300 Massy, France
Author contributions: Durandy Y solely contributed to this manuscript.
Correspondence to: Dr. Yves Durandy, Perfusion and Intensive Care Unit in Pediatric Cardiac Surgery, Institut Hospitalier Jacques Cartier, Avenue du Noyer Lambert, 91300 Massy, France. iciprea@icip.org
Telephone: +33-1-60134656 Fax: +33-1-60136267
Received: July 6, 2010
Revised: October 7, 2010
Accepted: October 14, 2010
Published online: November 26, 2010
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.

Keywords: Pediatric cardiac surgery; Mediastinal infection; Staphylococcus post cardiac surgery infection; Mediastinitis drainage; Prevention of mediastinitis; Treatment of mediastinitis