Mediastinitis in cardiac surgery: A review of the literature

Background: Postoperative mediastinitis is a serious complication in cardiac surgery that substantially increases morbidity and mortality. Aim: This study reviews the various prophylactic and therapeutic measures. Material and Method: Literature searches were done to identify relevant studies. Results: Various possible causes and risk factors were identified and prophylaxis in the form of strict sterility in the operating room, preoperative skin disinfection, nonabrasive preoperative hair removal, antibiotic prophylaxis, and non-traumatic surgical intervention with sparing use of electrocautery. These along with wide range of wound-healing strategies have been established for the treatment of post-sternotomy mediastinitis. Conventional treatment are surgical revision with open dressings or closed irrigation, or reconstruction with vascularized soft tissue flap and novel treatment such as vacuum-assisted closure and their overall effect on Morbidity, Hospital stay, Cost and Mortality. Conclusion: Despite advances, there is substantial risk of postoperative mediastinitis. Presently there is no general consensus regarding the appropriate surgical approach to mediastinitis.