Deep Sternal Wound Infection after Coronary Artery Bypass Surgery: Management and Risk Factor Analysis for Mortality


  • Gunduz Yumun
  • Burak Erdolu
  • Faruk Toktas
  • Cuneyt Eris
  • Derih Ay
  • Tamer Turk
  • Ahmet Kagan As



Background: Deep sternal wound infection is a life-threatening complication after cardiac surgery. The aim of this study was to investigate the factors leading to mortality, and to explore wound management techniques on deep sternal wound infection after coronary artery bypass surgery.

Methods: Between 2008 and 2013, 58 patients with deep sternal wound infection were analyzed. Risk factors for mortality and morbidity including age, gender, body mass index, smoking status, chronic renal failure, hypertension, diabetes, and treatment choice were investigated.

Results: In this study, 19 patients (32.7%) were treated by primary surgical closure (PSC), and 39 patients (67.3%) were treated by delayed surgical closure following a vacuum-assisted closure system (VAC). Preoperative patient characteristics were similar between the groups. Fourteen patients (24.1%) died in the postoperative first month. The mortality rate and mean duration of hospitalization in the PSC group was higher than in the VAC group (P = .026, P = .034). Significant risk factors for mortality were additional operation, diabetes mellitus, and a high level of EuroSCORE.

Conclusions: Delayed surgical closure following VAC therapy may be associated with shorter hospitalization and lower mortality in patients with deep sternal wound infection. Additional operation, diabetes mellitus, and a high level of EuroSCORE were associated with mortality.


Baillot R, Cloutier D, Montalin L, et al. 2010. Impact of deep sternal wound infection management with vacuum-assisted closure therapy followed by sternal osteosynthesis: a 15-year review of 23,499 sternotomies. Eur J Cardiothorac Surg 37:880-7.nBovill E, Banwell PE, Teot L, et al. 2008. Topical negative pressure wound therapy: a review of its role and guidelines for its use in the management of acute wounds. Int Wound J 5:511-29.nChoo SJ, Lee SK, Chung SW, et al. 2009. Does bilateral pedicle internal thoracic artery harvest increase the risk of mediastinitis? Yonsei Med J 50:78-82.nConquest AM, Garofalo JH, Maziarz DM, et al. 2003. Hemodynamic effects of the vacuum-assisted closure device on open mediastinal wounds. J Surg Res 115:209-13.nDe Paulis R, de Notaris S, Scaffa R, et al. 2005. The effect of bilateral internal thoracic artery harvesting on superficial and deep sternal infection: The role of skeletonization. J Thorac Cardiovasc Surg 129:536-43.nDemaria RG, Giovannini U, Téot L, Frapier JM, Albat B. 2003. A new technique for the treatment of delayed sternotomy healing: the vacuum therapy. Heart Surg Forum 6:434-7.nEl Oakley RM, Wright JE. 1996. Postoperative mediastinitis: classification and management. Ann Thorac Surg 61:1030-6.nFarinas MC, Gald Peralta F, Bernal JM, et al. 1995. Suppurative mediastinitis after open-heart surgery: a case-control study covering a seven-year period in Santander, Spain. Clin Infect Dis 20:272-9.nFleck T, Moidl R, Giovanoli P, et al. 2006. A conclusion from the first 125 patients treated with the vacuum assisted closure system for postoperative sternal wound infection. Interact Cardiovasc Thorac Surg 5:145-8.nFuchs U, Zittermann A, Stuettgen B, et al. 2005. Clinical outcome of patients with deep sternal wound infection managed by vacuum-assisted closure compared to conventional therapy with open packing: a retrospective analysis. Ann Thorac Surg 79:526-31.nGummert JF, Barten MJ, Hans C, et al. 2002. Mediastinitis and cardiac surgery—an updated risk factor analysis in 10,373 consecutive adult patients. Thorac Cardiovasc Surg 50:87-91.nOlbrecht VA, Barreiro CJ, Bonde PN, et al. 2006. Clinical outcomes of noninfectious sternal dehiscence after median sternotomy. Ann Thorac Surg 82:902-7.nRaja SG, Berg GA. 2007. Should vacuum-assisted closure therapy be routinely used for management of deep sternal wound infection after cardiac surgery? Interact Cardiovasc Thorac Surg 6:523-8.nRoques F, Nashef SA, Michel P, et al. 1999. Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19,030 patients. Eur J Cardiothorac Surg 15:816-22.nSong DH, Wu LC, Lohman RF, Gottlieb LJ, Franczyk M. 2003. Vacuum-assisted closure for the treatment of sternal wounds: the bridge between debridement and definitive closure. Plast Reconstr Surg 111:92-7.nVos RJ, Yilmaz A, Sonker U, Kelder JC, Kloppenburg GT. 2012. Vacuum-assisted closure of post-sternotomy mediastinitis as compared to open packing. Interact Cardiovasc Thorac Surg 14:17-21.n



How to Cite

Yumun, G., Erdolu, B., Toktas, F., Eris, C., Ay, D., Turk, T., & As, A. K. (2014). Deep Sternal Wound Infection after Coronary Artery Bypass Surgery: Management and Risk Factor Analysis for Mortality. The Heart Surgery Forum, 17(4), E212-E216.




Most read articles by the same author(s)

1 2 > >>