MEDIASTINITIS

and Long-Term Survival – A new approach to risk prevention after open heart surgery.


John Braxton and his colleagues, cardiac surgeons at Maine Medical Center in Portland, evaluated the impact of postoperative mediastinitis on patient recovery time and life expectancy.

When performing a bypass operation, the surgeon has to open the thorax with a sternotomy, cutting the breastbone in half, in order to gain access to the heart. Once the bypass has been grafted, the thorax gets closed and wires are used to wrap the two bone halves together. The bone-healing process takes about 6 – 8 weeks. Mediastinitis is a deep wound infection of chest-bone tissues, a dreaded complication after open heart surgery.

Its long-term effects on patient recovery time and -mortality had not yet been researched at the end of the 20th century. In 2000 Braxton and his colleagues, cardiac surgeons at Maine Medical Center in Portland, evaluated the impact of postoperative mediastinitis on patient recovery time and life expectancy.

The study covered a period of 4 years and more than 15,000 consecutive cases of patients with mediastinitis and resulting re-operations. During the first postoperative year, the survival rate for patients with mediastinitis came to 78%, while patients without the condition showed a survival rate of 95%. Over the course of a four year follow up period the divergence tripled, leading to the conclusion that a deep sternal wound infection significantly increases patient mortality. Several years later, an innovative company from Vienna, Austria, developed the Posthorax support vest, a sternal brace achieving remarkable improvements through external support and stability for the healing chest bone.

The concept was based on a completely new approach, endorsed by very few cardiac surgeons at the time: As the patient has to breathe, cough and move, these motions create internal forces on bone and wires, causing friction between the two sternum-halves. Friction in turn causes heat and therefore promotes the formation of bacterial infections. The objective achieved with the Posthorax sternum support vest was prevention or minimisation of these internal forces for the duration of the healing process.

To prove its efficacy, the product was tested in a number of studies. More than 12,000 patients were treated with the Posthorax sternum support vest. 14 clinical trials in 6 European countries showed astonishing outcomes. Use of the patented support vest reduced sternal complications by more than 50%, in some of the trials up to 90%.

The very favourable cost-benefit ratio of 1 to 5 is a result of reduced amount of antibiotics administered, and an average of a 30-day-decrease of hospitalisation time per patient. As an infection of that calibre often requires re-operations and reconstructive plastic surgery.

Prevention thereof proved another significant cost-savings factor. Thus it can be said, the Posthorax sternum support vest greatly enhances postoperative patient recovery and successfully minimises risk of complications in a highly cost effective manner.