Incidence, treatment strategies and outcome of deep sternal wound infection after orthotopic heart transplantation.

BACKGROUND

Deep sternal wound infection (DSWI) after orthotopic heart transplantation (OHT) has not been well studied and its outcome remains largely unknown. Herein we report the incidence, clinical presentation, treatment strategies and early and late outcome after this complication.

METHODS

We retrospectively analyzed 149 consecutive patients (mean age 53 +/- 16 years, 113 [76%] males) who underwent OHT between January 1998 and December 2005. Mean body mass index (BMI) was 27 +/- 6 kg/m(2) and 30 (20%) patients were diabetics. Sixty (40%) patients had prior cardiac surgery, 11 (7%) underwent previous ventricular assist device (VAD) implantation, and 10 (7%) were in a critical hemodynamic state requiring inotropic support.

RESULTS

DSWI occurred in 13 (8.7%) patients as compared with 1.7% of patients in our general cardiac surgery population (p < 0.001). Predictors of DSWI in univariate analyses were BMI >30 kg/m(2) (p = 0.02), previous heart surgery (p = 0.03), previous VAD (p = 0.006) and inotropic support (p = 0.04). Hospital mortality after DSWI was significantly increased as compared with patients without this complication (31% vs 8%, p = 0.03). One- and 5-year survival after DSWI was 100 +/- 12% and 80 +/- 18% as compared with 92 +/- 3% and 82 +/- 4% in patients without DSWI (p = 0.8).

CONCLUSIONS

DSWI after OHT is a common complication and carries high mortality and morbidity rates. We were able to identify specific risk factors for this condition, such as prior VAD insertion and pre-operative inotropic support. Long-term survival after DSWI remains similar to that of transplant patients without this complication.