Management and prevention of cardiovascular hemorrhage associated with mediastinitis

Gregory Georgiade, Therese Anne Levan, James Anthony, Newland Oldham, Hochberg Julio, Carmello Milano, Edmond F Ritter

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objective: To elucidate the causes of cardiovascular hemorrhage associated with mediastinitis and to review recommendations for prevention and treatment. Summary Background Data: Mediastinal debridement with immediate or early coverage using healthy, vascularized tissue has lead to greatly reduced morbidity and mortality for patients with mediastinitis. Myocardial hemorrhage has been anecdotally reported. Patients and Methods: Over a 36-month period, 7 patients developed massive cardiovascular bleeding after undergoing debridement for poststernotomy mediastinitis. Causes included puncture or erosion by a sternal edge in three and tearing at the myocardial-sternal interface in four. Results: Five patients survived and remain infection-free at an average of 24 months of follow-up. In these patients, ventricular defects were closed with pledgeted sutures and muscle transposition was used concomitantly to reinforce the repair. This involved a slide of the left pectoralis major muscle and turnover of the right pectoralis in three patients, bilateral sliding in one patient, and bilateral pectoralis and an omental flap in one patient who required additional coverage of the lower mediastinum. Conclusions: When a patient who has undergone mediastinal debridement shows evidence of significant bleeding, we recommend application of pressure for control of hemorrhage, expeditious return to an operating room with available cardiopulmonary bypass, and immediate muscle coverage with healthy, well-vascularized tissue. Finally, early sternectomy might largely prevent this life-threatening complication.

Original languageEnglish (US)
Pages (from-to)145-150
Number of pages6
JournalAnnals of Surgery
Volume227
Issue number1
DOIs
StatePublished - Jan 1 1998

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Mediastinitis
Hemorrhage
Debridement
Pectoralis Muscles
Muscles
Mediastinum
Operating Rooms
Cardiopulmonary Bypass
Punctures
Sutures
Morbidity
Pressure

ASJC Scopus subject areas

  • Surgery

Cite this

Management and prevention of cardiovascular hemorrhage associated with mediastinitis. / Georgiade, Gregory; Levan, Therese Anne; Anthony, James; Oldham, Newland; Julio, Hochberg; Milano, Carmello; Ritter, Edmond F.

In: Annals of Surgery, Vol. 227, No. 1, 01.01.1998, p. 145-150.

Research output: Contribution to journalArticle

Georgiade, G, Levan, TA, Anthony, J, Oldham, N, Julio, H, Milano, C & Ritter, EF 1998, 'Management and prevention of cardiovascular hemorrhage associated with mediastinitis', Annals of Surgery, vol. 227, no. 1, pp. 145-150. https://doi.org/10.1097/00000658-199801000-00021
Georgiade G, Levan TA, Anthony J, Oldham N, Julio H, Milano C et al. Management and prevention of cardiovascular hemorrhage associated with mediastinitis. Annals of Surgery. 1998 Jan 1;227(1):145-150. https://doi.org/10.1097/00000658-199801000-00021
Georgiade, Gregory ; Levan, Therese Anne ; Anthony, James ; Oldham, Newland ; Julio, Hochberg ; Milano, Carmello ; Ritter, Edmond F. / Management and prevention of cardiovascular hemorrhage associated with mediastinitis. In: Annals of Surgery. 1998 ; Vol. 227, No. 1. pp. 145-150.
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