Sternal wound infection after heart transplantation: Incidence and resultswith aggressive surgical treatment

Background. Sternal wound infection remains a significant complication. We reviewed the incidence and the treatment of sternal wound infection after h eart transplantation. Methods. Of 226 patients who had a heart transplantation, 20 (8.8%) underwe nt postoperative wound debridement for superficial or deep sternal wound in fection. The incidence and the survival of patients with sternal wound infe ction were analyzed. Results. The incidence of sternal wound infection was similar among patient s treated with four protocols of immunosuppressive drugs: cyclosporine and prednisone (0 of 22; 0%); cyclosporine, prednisone, and azathioprine (2 of 24; 8.3%); cyclosporine, prednisone, azathioprine, and antithymocyte globul in (15 of 139; 10.8%); and cyclosporine, prednisone, mycophenolate mofetil, and antithymocyte globulin (3 of 41; 7.3%) (p = 0.4). Six-month and 5-year survival of patients with sternal wound infection averaged 85% :+/- 8% and 74% +/- 10% compared with 92% +/- 2% and 82% +/- 3% in patients without wo und infection (p = 0.15). Patients with deep sternal wound infection, debri dement, and reconstruction had a 5-year survival averaging 80% +/- 10%. Conclusions. The incidence of sternal wound infection remains similar betwe en patients treated with the triple drug therapy. Surgical debridement and reconstruction can result in long-term survival after heart transplantation . (C) 2001 by The Society of Thoracic Surgeons.