INTRODUCTION: Mediastinitis is a rare though potentially fatal complication. The incidence is reported to be between 0.2% and 5.0% and is a major cause of postoperative morbidity. Despite early diagnosis and proper treatment, prognosis is poor because of the chance of mediastinal spread of the infection and poor physical state of these patients. OBJECTIVE: To review the casuistic of mediastinites. METHOD: The records of all 2,272 patients who underwent cardiac surgical procedures between 1991 and 2000 were reviewed. All operations were performed using longitudinal sternotomy and extracorporeal circulation in João XXIII Hospital / Institute of Cardiovascular Surgery of Paraíba in Campina Grande, Paraíba. RESULTS: The complication occurred within, on average, 10 days after operation. In total of 37 (1.6%), 8 (21.6%) deaths occurred. Mediastinitis were reported in 19 (51.4%) cases, in patients submitted to coronary artery bypass grafting, 13 (35.1%) in valve diseases, 4 (10.8%) in congenital cardiopathy corrections and 1 (2.7%) in ascending aortic aneurysm. Several risk factors mediastinitis were identified (obesity, prolonged stay in hospital, diabetes mellitus, smoking, reoperation and emergency surgery), especially the prolonged stay in intensive-care unit for more then 72 hours before cardiac operation. Bacterial cultures of exudates were positive in 35 (94.6%) of 37 patients; Staphylococcus aureus was the responsible pathogen in 17 (48.6%) patients. CONCLUSION: The incidence of mediastinitis after longitudinal sternotomy following cardiac surgery do not decreased in the last 10 years and represents a surgical challenge, in spite of the progress added to the diagnostic and therapeutic of this pathology.
Mediastinitis; Mediastinal infection; Cardiac surgery; Surgical infection
