XXXX in heart and lung transplantation: 15 years experience.

@entity1 @entity204 @entity1764
BACKGROUND: @entity1764 after sternotomy carries a very high mortality, especially in @entity1 receiving immunosuppressive treatment. METHODS: A retrospective analysis of the data for @entity1 who had undergone cardiopulmonary transplantation between May 1985 and December 2000 was undertaken. A total of 776 @entity1 had either a median sternotomy or a transverse sternotomy through a clam-shell incision. Transplantations were as follows: 591 heart (3 simultaneous heart and renal, and 1 heart and liver), 126 bilateral sequential lung, 57 heart-lung, 1 en bloc double-lung, and 1 heart and single-lung. RESULTS: In all, 21 (2.7%) recipients had @entity1764 . Of these, 14 had heart, 3 heart-lung, and 4 bilateral lung transplantation. There were 18 median and 3 transverse sternotomies. There were 6 deaths (28.6%). Treatment consisted of antibiotics alone in 2 @entity1 and subxiphisternal drainage in another 2 @entity1 . The sternum was reopened in 17 (80.95%) @entity1 , with debridement and primary closure alone in 5 of these 17 @entity1 and additional irrigation in the other 12. Those who had resternotomy, debridement, and substernal irrigation had a better outcome when compared with the outcomes of other modes of treatment (1 @entity204 among 12 @entity1 ) (p = 0.06). Age, cardiopulmonary bypass time, body mass index, time to diagnosis, and treatment did not differ between those who survived and those who did not. CONCLUSIONS: Early aggressive debridement with substernal irrigation is the best mode of treatment for @entity1 with posttransplantation @entity1764 .
