Emergency resternotomy after open cardiac surgery in the ICU is not a risk factor for deep wound infections

Objectives: Critical hemodynamic compromises, acute or persistent excessive bleeding after open cardiac surgery demand a rapid surgical intervention. If emergent resternotomy is required surgical procedures can easily be performed in the ICU, especially in situations without immediate access to regular operation room (OR) facilities. Because of the inferior hygienical precautions compared to the OR we analysed the rate of severe wound infections in these patients.

Methods: The charts of 6666 patients after open cardiac surgery between 2001 and 2006 were reviewed. 98 patients underwent emergent sternotomy in our ICU. The patients were devided into two groups. Group 1 (n=65) includes the patients that were discharged whithout further complications. Group 2 (n=33) includes patients that finally died in our ICU.

Results: 28 patients (29%) underwent repeat sternotomies. There was no incidence of severe infections. The healing of sternotomy wound was uneventful in 97% and secondary in 3% of the patients of group 1. The causes for sternotomy in group 1 were predominantly bleeding complications, whereas in group 2 the main causes for death were combined cardiac failure and bleeding complications due to impaired coagulation during circulatory assist.

Conclusions: In conclusion, common bleeding complications after open heart surgery can safely be treated by sternotomy in the ICU. There is no increased risk for severe infections especially not for deep wound infections. The causes of mortality were not related to resternotomy.