Filsoufi Farzan, Rahmanian Parwis B, Castillo Javier G, Pinney Sean, Broumand Stafford R, Adams David H
Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, New York 10029-1028, USA.
J Heart Lung Transplant. 2007 Nov;26(11):1084-90. doi: 10.1016/j.healun.2007.07.036. Epub 2007 Sep 27.
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.
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.
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).
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.
原位心脏移植（OHT）后深部胸骨伤口感染（DSWI）尚未得到充分研究，其预后在很大程度上仍不清楚。在此，我们报告该并发症的发生率、临床表现、治疗策略以及早期和晚期预后。
我们回顾性分析了1998年1月至2005年12月期间连续接受OHT的149例患者（平均年龄53±16岁，113例[76%]为男性）。平均体重指数（BMI）为27±6kg/m²，30例（20%）患者为糖尿病患者。60例（40%）患者曾接受过心脏手术，11例（7%）曾接受过心室辅助装置（VAD）植入，10例（7%）处于需要使用血管活性药物支持的严重血流动力学状态。
13例（8.7%）患者发生了DSWI，而我们普通心脏手术患者中的发生率为1.7%（p<0.001）。单因素分析中DSWI的预测因素为BMI>30kg/m²（p=0.02）、既往心脏手术（p=0.03）、既往VAD植入（p=0.006）和血管活性药物支持（p=0.04）。与无此并发症的患者相比，DSWI后的医院死亡率显著增加（31%对8%，p=0.03）。DSWI后的1年和5年生存率分别为100±12%和80±18%，而无DSWI的患者分别为92±3%和82±4%（p=0.8）。
OHT后DSWI是一种常见并发症，具有高死亡率和发病率。我们能够确定该疾病的特定危险因素，如既往VAD植入和术前血管活性药物支持。DSWI后的长期生存率与无此并发症的移植患者相似。
