Mediastinitis after open heart surgery. Analysis of risk factors and management.

Mediastinitis developed following 58 of 8803 operative procedures involving median sternotomy at Türkiye Yüksek Ihtisas Hospital. There were 40 men and 18 women. Mediastinitis occurred within, on average, 10 days after the operation. No positive cultures were obtained in 37 patients; Staphylococcus aureus was the responsible pathogen in 18, Escherichia coli in 2, and Enterococcus in 1 patients. Thirty patients had a valve procedure, 24 aortocoronary bypass grafting, 1 a total correction for tetralogy of Fallot, 1 a primary closure of an atrial septal defect, and 2 had Bentall's procedure for an ascending aortic aneurysm. Fifty patients were treated by radical debridement and closed irrigation of the mediastinum with antibiotic solutions and 8 patients were treated with sternal debridement and transposition of the omentum. The mortality rate was 36% for the former, and 12.5% for the latter technique. Omentum transposition promoted rapid healing with a low mortality rate.