scholarly journals Enterococcus faeciumMediastinitis Complicated by DisseminatedCandida parapsilosisInfection after Congenital Heart Surgery in a 4-Week-Old Baby

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Hanna Renk ◽  
Felix Neunhoeffer ◽  
Florian Hölzl ◽  
Michael Hofbeck ◽  
Matthias Kumpf
Keyword(s):  
Cardiac Surgery ◽  
Antibiotic Treatment ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Heart Defects ◽  
Treatment Options ◽  
Pulmonary Hemorrhage ◽  
Central Venous ◽  
Sternal Closure ◽  
Delayed Sternal Closure

Background. Cardiac surgery offers multiple treatment options for children with congenital heart defects. However, infectious complications still remain a major cause of morbidity and mortality in these patients. Mediastinitis is a detrimental complication in children undergoing cardiac surgery. The risk of mediastinitis after delayed sternal closure is up to 10%.Case Presentation. We report a case ofEnterococcus faeciummediastinitis in a 4-week-old female baby on extracorporeal membrane oxygenation after Norwood procedure. Although repeated antibiotic irrigation, debridement, and aggressive antibiotic treatment were started early, the pulmonary situation deteriorated.Candida parapsilosiswas isolated from bronchoalveolar lavage after pulmonary hemorrhage. DisseminatedC. parapsilosisinfection with pulmonary involvement was treated with liposomal amphotericin B. Subsequently, inflammatory markers increased again and eventuallyC. parapsilosiswas isolated from the central venous catheter.Conclusion. Children undergoing delayed sternal closure have a higher risk of mediastinitis. Therefore, antibiotic prophylaxis, for example, for soft tissue infection seems justified. However, long-term antibiotic treatment is a risk factor for fungal superinfection. Antifungal treatment of disseminatedC. parapsilosisinfection may fail in PICU patients with nonbiological material in place due to capacity of this species to form biofilms on medical devices. Immediate removal of central venous catheters and other nonbiological material is life-saving in these patients.

Multicenter Quality Improvement Project to Prevent Sternal Wound Infections in Pediatric Cardiac Surgery Patients

2017 ◽  
Vol 8 (4) ◽  
pp. 453-459 ◽  
Author(s):  
Cathy Woodward ◽  
Richard Taylor ◽  
Minnette Son ◽  
Roozbeh Taeed ◽  
Marshall L. Jacobs ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Quality Improvement ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
Wound Infections ◽  
Improvement Project ◽  
Sternal Closure ◽  
Increased Risk ◽  
Delayed Sternal Closure ◽  
Sternal Wound Infections

Background: Children undergoing cardiac surgery are at risk for sternal wound infections (SWIs) leading to increased morbidity and mortality. Single-center quality improvement (QI) initiatives have demonstrated decreased infection rates utilizing a bundled approach. This multicenter project was designed to assess the efficacy of a protocolized approach to decrease SWI. Methods: Pediatric cardiac programs joined a collaborative effort to prevent SWI. Programs implemented the protocol, collected compliance data, and provided data points from local clinical registries using Society of Thoracic Surgery Congenital Heart Surgery Database harvest-compliant software or from other registries. Results: Nine programs prospectively collected compliance data on 4,198 children. Days between infections were extended from 68.2 days (range: 25-82) to 130 days (range: 43-412). Protocol compliance increased from 76.7% (first quarter) to 91.3% (final quarter). Ninety (1.9%) children developed an SWI preprotocol and 64 (1.5%) postprotocol, P = .18. The 657 (15%) delayed sternal closure patients had a 5% infection rate with 18 (5.7%) in year 1 and 14 (4.3%) in year 2 P = .43. Delayed sternal closure patients demonstrated a trend toward increased risk for SWI of 1.046 for each day the sternum remained open, P = .067. Children who received appropriately timed preop antibiotics developed less infections than those who did not, 1.9% versus 4.1%, P = .007. Conclusion: A multicenter QI project to reduce pediatric SWIs demonstrated an extension of days between infections and a decrease in SWIs. Patients who received preop antibiotics on time had lower SWI rates than those who did not.

A Medium-Term Venous Access Alternative for Infants Undergoing Congenital Heart Surgery

2018 ◽  
Vol 9 (1) ◽  
pp. 91-94 ◽  
Author(s):  
Muhammad Aanish Raees ◽  
Paul V. Dubar ◽  
David P. Bichell
Keyword(s):  
Congenital Heart Defects ◽  
Right Atrium ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Heart Defects ◽  
Venous Access ◽  
Congenital Heart Surgery ◽  
Medium Term ◽  
Central Venous ◽  
Single Lumen

We describe a strategy aimed at maximizing the safety and minimizing the thrombogenicity of central venous lines for neonates with congenital heart defects. Our method involves the use of a tunneled technique to place a 4.2 Fr single-lumen (Broviac) catheter in the subpericardial space, with minimal intravascular course and a tip placed in the lower right atrium. Using this technique, we potentially eliminated the requirement for percutaneous placement of central venous lines postoperatively as well as potentially decreased the risk of intrapericardial bleeding associated with transthoracic lines.

Minimization of Surgical Site Infections in Patients With Delayed Sternal Closure After Pediatric Cardiac Surgery

2019 ◽  
Vol 10 (4) ◽  
pp. 400-406 ◽  
Author(s):  
Mouhammad Yabrodi ◽  
Jeremy L. Hermann ◽  
John W. Brown ◽  
Mark D. Rodefeld ◽  
Mark W. Turrentine ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Heart Surgery ◽  
Recent Literature ◽  
Surgical Site Infections ◽  
Congenital Heart Surgery ◽  
Infectious Complications ◽  
Pediatric Cardiac Surgery ◽  
Clinical Sepsis ◽  
Sternal Closure ◽  
Delayed Sternal Closure

Background: Delayed sternal closure (DSC) following pediatric cardiac surgery is commonly implemented at many centers. Infectious complications occur in 18.7% of these patients based on recent multicenter data. We aimed to describe our experience with DSC, hypothesizing that our practices surrounding the implementation and maintenance of the open sternum during DSC minimize the risk of infectious complications. Methods: We reviewed patients less than 365 days who underwent DSC between 2012 and 2016 at our institution. Infectious complications as defined by the Society of Thoracic Surgeons Congenital Heart Surgery Database were recorded. Patients with and without infectious complications were compared using Wilcoxon rank sum tests or Fisher exact tests as appropriate. Results: We identified 165 patients less than 365 days old who underwent DSC, 135 (82%) of whom had their skin closed over their open sternum. Median duration of open sternum was 3 days (range: 1-32 days). Infectious complications occurred in 15 (9.1%) patients—13 developed clinical sepsis with positive blood cultures, one patient developed ventilator-associated pneumonia, and one patient developed wound infection (0.6%). No cases of mediastinitis occurred. No statistical differences in characteristics between patients with and without infectious complications could be identified. Conclusion: Infectious complications after DSC at our institution were notably less than reported in recent literature, primarily due to minimization of surgical site infections. Practices described in the article, including closing skin over the open sternum whenever possible, could potentially aid other institutions aiming to reduce infectious complications associated with DSC.

scholarly journals Delayed Sternal Closure after Congenital Heart Surgery in Infants: Postoperative Course

2020 ◽  
pp. 44-48
Author(s):  
E. Yakimishen ◽  
A. Petrenko ◽  
S. Boyko ◽  
M. Rudenko ◽  
L. Prokopovych
Keyword(s):  
Cardiac Output ◽  
Blood Lactate ◽  
Postoperative Period ◽  
Congenital Heart ◽  
Heart Defects ◽  
Assisted Circulation ◽  
Cardiac Complications ◽  
Sternal Closure ◽  
Young Infants ◽  
Delayed Sternal Closure

Delayed sternal closure in infants and children of the first months of life after the correction of complex congenital heart defects (CHD) can increase cardiac output. This is a forced measure due to the development of unstable hemodynamics, capillary leak syndrome and myocardial edema, as the sternotomy wound closure in the early postoperative period provides a compression effect on the function of the myocardium. The aim. To evaluate mortality and to detect predictors of adverse outcome as well as the incidence of non-cardiac complications in delayed sternal closure after surgical repair of CHD. Materials and methods. Twenty two children were studied. Six children died. Anesthetic management was provided using propofol (4–6 mg/kg/h) and fentanyl (5–10 μg/kg/h) infusions. Modified ultrafiltration was applied at the end of assisted circulation in all the cases. Sternal closure was performed on average on day 3 ± 2 after surgery. Results. Mortality odds ratio (OR) in patients with the mean arterial pressure (MAP) < 35 mmHg was 3.7; mortality OR in patients with SVO2 < 40 % was 0.94; mortality OR in patients with blood lactate > 10 mmol/L in the first three days of postoperative intensive care was 2.1. Conclusions. Delayed sternal closure is an acceptable method of maintaining cardiac output in young infants with CHD in postoperative period. High blood lactate (> 10 mmol/L) and especially its further growth, as well as MAP < 35 mmHg, can predict adverse outcomes of cardiac surgery with open sternotomy.

scholarly journals Delayed Sternal Closure in Infant Heart Surgery—The Importance of Where and When: An Analysis of the STS Congenital Heart Surgery Database

2016 ◽  
Vol 102 (5) ◽  
pp. 1565-1572 ◽  
Author(s):  
Kristen Nelson-McMillan ◽  
Christoph P. Hornik ◽  
Xia He ◽  
Luca A. Vricella ◽  
Jeffrey P. Jacobs ◽  
...  
Keyword(s):  
Congenital Heart ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
Sternal Closure ◽  
Delayed Sternal Closure

scholarly journals Outcomes of Delayed Sternal Closure in Pediatric Heart Surgery: Single-Center Experience

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Daniel Hurtado-Sierra ◽  
Juan Calderón-Colmenero ◽  
Pedro Curi-Curi ◽  
Jorge Cervantes-Salazar ◽  
Juan Pablo Sandoval ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Heart Surgery ◽  
Therapeutic Option ◽  
Hemodynamic Instability ◽  
Control Group ◽  
Single Center ◽  
Sternal Closure ◽  
Pediatric Heart Surgery ◽  
Single Center Experience ◽  
Delayed Sternal Closure

Background. Delayed sternal closure (DSC) after cardiac surgery is a therapeutic option in the treatment of the severely impaired heart in pediatric cardiac surgery. Methods. A single-center retrospective review of all bypass surgeries performed over a 10-year period (2003–2012). Results. Of a total of 2325 patients registered in our database, the DSC group included 259 cases (11%), and the remaining 2066 cases (89%) constituted the control group (PSC). RACHS-1 risk was higher for the DSC group (74% had a score of 3 or 4) than for the PSC group (82% had a score of 2 or 3). The most frequent diagnosis for the DSC group was transposition of the great arteries (28%). We found out that hemodynamic instability was the main indication observed in patients aged ≤ 8 years (63%), while bleeding was the principal indication for patients aged ≥ 8 years (94%) (p≤0.001). The average time between surgery and sternal closure was 2.3±1.4 days. Overall mortality rates were higher for patients of the DSC group (22%) than for the PSC group (8.7%) (OR: 0.4 (95% CI: 0.4 to 0.5), p<0.05). There were six patients with DSC who developed mediastinitis (2.3%). The risk of mediastinitis was significantly higher when DSC was performed 4 days after the primary surgery. Conclusions. DSC is an important management strategy for congenital cardiac surgery in infants and children. The prolonged sternal closure time is associated with an increased rate of postoperative mediastinitis.

scholarly journals Down syndrome and congenital heart disease: perioperative planning and management

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Dennis R. Delany ◽  
Stephanie S. Gaydos ◽  
Deborah A. Romeo ◽  
Heather T. Henderson ◽  
Kristi L. Fogg ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Down Syndrome ◽  
Cardiac Surgery ◽  
Heart Disease ◽  
Congenital Heart ◽  
Single Ventricle ◽  
Heart Defects ◽  
Careful Consideration ◽  
Children With Down Syndrome ◽  
Perioperative Planning

AbstractApproximately 50% of newborns with Down syndrome have congenital heart disease. Non-cardiac comorbidities may also be present. Many of the principles and strategies of perioperative evaluation and management for patients with congenital heart disease apply to those with Down syndrome. Nevertheless, careful planning for cardiac surgery is required, evaluating for both cardiac and noncardiac disease, with careful consideration of the risk for pulmonary hypertension. In this manuscript, for children with Down syndrome and hemodynamically significant congenital heart disease, we will summarize the epidemiology of heart defects that warrant intervention. We will review perioperative planning for this unique population, including anesthetic considerations, common postoperative issues, nutritional strategies, and discharge planning. Special considerations for single ventricle palliation and heart transplantation evaluation will also be discussed. Overall, the risk of mortality with cardiac surgery in pediatric patients with Down syndrome is no more than the general population, except for those with functional single ventricle heart defects. Underlying comorbidities may contribute to postoperative complications and increased length of stay. A strong understanding of cardiac and non-cardiac considerations in children with Down syndrome will help clinicians optimize perioperative care and long-term outcomes.

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