Skip to main content
SpringerLink
Log in

Major Complications of Cardiac Surgery

  • Chapter
  • First Online:
The High-risk Surgical Patient

  • 1472 Accesses

Abstract

Complications after cardiac surgery may vary from very minor events that can be resolved without the need for pharmacological treatment to more serious episodes which can be life-threatening, require multiple interventions, delay patient’s discharge, and may lead to multiorgan failure or even death.

The Society of Thoracic Surgery identifies five major postoperative complications: stroke, renal failure (defined as a threefold or greater rise in creatinine or new dialysis requirement), prolonged intubation (>24 h), unplanned reoperation, and deep sternal wound infection/mediastinitis.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Cameron D. Initiation of white cell activation during cardiopulmonary bypass: cytokines and receptors. J Cardiovasc Pharmacol. 1996;27(Suppl 1):S1. https://doi.org/10.1097/00005344-199600001-00004. PMID: 8938277.

  2. Gold JP, Roberts AJ, Hoover EL, et al. Effects of prolonged aortic cross-clamping with potassium cardioplegia on myocardial contractility in man. Surg Forum. 1979;30:252.

    Google Scholar 

  3. Granton J, Cheng D. Risk stratification models for cardiac surgery. Semin CardiothoracVasc Anesth. 2008;12(3):167–74. https://doi.org/10.1177/1089253208323681. PMID: 18805851.

  4. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13. https://doi.org/10.1097/01.sla.0000133083.54934.ae. PMID: 15273542; PMCID: PMC1360123.

  5. Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery. 1992;111(5):518–26.

    Google Scholar 

  6. Sokol DK, Wilson J. What is a surgical complication? World J Surg. 2008;32(6):942–4. https://doi.org/10.1007/s00268-008-9471-6. PMID: 18266027.

  7. Silber JH, Williams SV, Krakauer H, Schwartz JS. Hospital and patient characteristics associated with death after surgery. A study of adverse occurrence and failure to rescue. Med Care. 1992;30:615–29. https://doi.org/10.1097/00005650-199207000-00004. PMID: 1614231.

  8. Gonzalez AA, Dimick JB, Birkmeyer JD, Ghaferi AA. Understanding the volume-outcome effect in cardiovascular surgery: the role of failure to rescue. JAMA Surg. 2014;149:119–23. https://doi.org/10.1001/jamasurg.2013.3649. PMID: 24336902; PMCID: PMC4016988.

  9. Ghaferi AA, Birkmeyer JD, Dimick JB. Complications, failure to rescue, and mortality with major inpatient surgery in medicare patients. Ann Surg. 2009;250:1029–34. https://doi.org/10.1097/sla.0b013e3181bef697. PMID: 19953723.

  10. Crawford TC, Magruder JT, Grimm JC, et al. Complications after cardiac operations: all are not created equal. Ann Thorac Surg. 2017;103(1):32–40. https://doi.org/10.1016/j.athoracsur.2016.10.022. Epub 2016 Nov 22. PMID: 27884410.

  11. Edwards FH, Ferraris VA, Kurlansky PA, et al. Failure to rescue rates after coronary artery bypass grafting: an analysis from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Ann Thorac Surg. 2016;102:458–64. https://doi.org/10.1016/j.athoracsur.2016.04.051. Epub 2016 Jun 22. PMID: 27344280.

  12. Reddy HG, Shih T, Englesbe MJ, et al. Analyzing “failure to rescue”: is this an opportunity for outcome improvement in cardiac surgery? Ann Thorac Surg. 2013;95:1976–81; discussion 1781. https://doi.org/10.1016/j.athoracsur.2013.03.027. Epub 2013 Apr 30. PMID: 23642682; PMCID: PMC4398337.

  13. Camp SL, Stamou SC, Stiegel RM, et al. Can timing of tracheal extubation predict improved outcomes after cardiac surgery? HSR Proc Intensive Care Cardiovasc Anesth. 2009;1:39–47.

    Google Scholar 

  14. Moulton MJ, Creswell LL, Mackey ME, et al. Reexploration for bleeding is a risk factor for adverse outcomes after cardiac operations. J Thorac Cardiovasc Surg. 1996;111:1037–46. https://doi.org/10.1016/s0022-5223(96)70380-x. PMID: 8622301.

  15. Sellman M, Intonti MA, Ivert T. Reoperations for bleeding after coronary artery bypass procedures during 25 years. Eur J Cardiothorac Surg. 1997;11:521–7. https://doi.org/10.1016/s1010-7940(96)01111-6. PMID: 9105818.

  16. LaPar DJ, Isbell JM, Mulloy DP, et al. Planned cardiac reexploration in the intensive care unit is a safe procedure. Ann Thorac Surg. 2014;98:1645–51; discussion 51–2. https://doi.org/10.1016/j.athoracsur.2014.05.090. Epub 2014 Aug 28. PMID: 25173720; PMCID: PMC4692155.

  17. Seese L, Sultan I, Gleason TG, et al. The impact of major postoperative complications on long-term survival after cardiac surgery. Ann Thorac Surg. 2020;110(1):128–35. https://doi.org/10.1016/j.athoracsur.2019.09.100. Epub 2019 Nov 27. PMID: 31785288.

  18. Puskas JD, Winston AD, Wright CE, et al. Stroke after coronary artery operation: incidence, correlates, outcome, and cost. Ann Thorac Surg. 2000;69:1053–6. https://doi.org/10.1016/s0003-4975(99)01569-6. PMID: 10800793.

  19. Messé SR, Acker MA, Kasner SE, et al.; for the Determining Neurologic Outcomes from Valve Operations (DeNOVO) Investigators. Stroke after aortic valve surgery: results from a prospective cohort. Circulation. 2014;129:2253–2261. https://doi.org/10.1161/CIRCULATIONAHA.113.005084. Epub 2014 Apr 1. PMID: 24690611; PMCID: PMC4043861.

  20. Anyanwu AC, Filsoufi F, Salzberg SP, et al. Epidemiology of stroke after cardiac surgery in the current era. J Thorac Cardiovasc Surg. 2007;134:1121–7. https://doi.org/10.1016/j.jtcvs.2007.06.031. PMID: 17976438.

  21. Hogue CW, Murphy SF, Schechtman KB, et al. Risk factors for early or delayed stroke after cardiac surgery. Circulation. 1999;100:642–7. https://doi.org/10.1161/01.cir.100.6.642. PMID: 10441102.

  22. Stamou SC, Hill PC, Dangas G, et al. Stroke after coronary artery bypass: incidence, predictors, and clinical outcome. Stroke. 2001;32:1508–13. https://doi.org/10.1161/01.str.32.7.1508. PMID: 11441193.

  23. Gaudino M, Benesch C, Bakaeen F, et al.; American Heart Association Council on Cardiovascular Surgery and Anesthesia; Stroke Council; and Council on Cardiovascular and Stroke Nursing. Considerations for reduction of risk of perioperative stroke in adult patients undergoing cardiac and thoracic aortic operations: a scientific statement from the American Heart Association. Circulation 2020;142(14):e193-e209. https://doi.org/10.1161/CIR.0000000000000885. Epub 2020 Aug 26. PMID: 32842767.

  24. Gaudino M, Rahouma M, Di Mauro M, et al. Early versus delayed stroke after cardiac surgery: a systematic review and meta-analysis. J Am Heart Assoc. 2019;8:e012447. https://doi.org/10.1161/JAHA.119.012447. Epub 2019 Jun 19. PMID: 31215306; PMCID: PMC6662344.

  25. Bucerius J, Gummert JF, Borger MA, et al. Stroke after cardiac surgery: a risk factor analysis of 16,184 consecutive adult patients. Ann Thorac Surg. 2003;75:472–8. https://doi.org/10.1016/s0003-4975(02)04370-9. PMID: 12607656.

  26. McKhann GM, Grega MA, Borowicz LM Jr, et al. Stroke and encephalopathy after cardiac surgery: an update. Stroke. 2006;37:562–71. https://doi.org/10.1161/01.STR.0000199032.78782.6c. Epub 2005 Dec 22. PMID: 16373636.

  27. Glas KE, Swaminathan M, Reeves ST, et al.; Council for Intraoperative Echocardiography of the American Society of Echocardiography. Guidelines for the performance of a comprehensive intraoperative epiaortic ultrasonographic examination: recommendations of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists; endorsed by the Society of Thoracic Surgeons. Anesth Analg 2008;106:1376-1384. https://doi.org/10.1213/ane.0b013e31816a6b4c. PMID: 18420847.

  28. Head SJ, Milojevic M, Taggart DP, Puskas JD. Current practice of state-of-the-art surgical coronary revascularization. Circulation. 2017;136:1331–45. https://doi.org/10.1161/CIRCULATIONAHA.116.022572.

  29. Xu JR, Zhu JM, Jiang J, et al. Risk factors for long-term mortality and progressive chronic kidney disease associated with acute kidney injury after cardiac surgery. Medicine (Baltimore). 2015;94:e2025.

    Google Scholar 

  30. Lagny MG, Jouret F, Koch JN, et al. Incidence and outcomes of acute kidney injury after cardiac surgery using either criteria of the RIFLE classification. BMC Nephrol. 2015;16:76. https://doi.org/10.1186/s12882-015-0066-9. PMID: 26025079; PMCID: PMC4448315.

  31. Englberger L, Suri RM, Li Z, et al. Clinical accuracy of RIFLE and Acute Kidney Injury Network (AKIN) criteria for acute kidney injury in patients undergoing cardiac surgery. Crit Care. 2011;15:R16. https://doi.org/10.1186/cc9960. Epub 2011 Jan 13. PMID: 21232094; PMCID: PMC3222049.

  32. Pickering JW, James MT, Palmer SC. Acute kidney injury and prognosis after cardiopulmonary bypass: a metanalysis of cohort studies. Am J Kidney Dis. 2015;65:283–93. https://doi.org/10.1053/j.ajkd.2014.09.008. Epub 2014 Nov 5. PMID: 25445101.

  33. Chikwe J, Castillo JG, Rahmanian PB, et al. The impact of moderate-to-end-stage renal failure on outcomes after coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth. 2010;24:574–9. https://doi.org/10.1053/j.jvca.2009.10.017. Epub 2010 May 31. PMID: 20570181.

  34. Mehta RH, Grab JD, O’Brien SM, et al. Bedside tool for predicting the risk of postoperative dialysis in patients undergoing cardiac surgery. Circulation. 2006;114:2208–16. https://doi.org/10.1161/CIRCULATIONAHA.106.635573. Epub 2006 Nov 6. PMID: 17088458.

  35. Ivert T, Holzmann MJ, Sartipy U. Survival in patients with acute kidney injury requiring dialysis after coronary artery bypass grafting. Eur J Cardiothorac Surg. 2014;45:312–7. https://doi.org/10.1093/ejcts/ezt247. Epub 2013 May 8. PMID: 23657549.

  36. Rahmanian PB, Kwiecien G, Langebartels G, et al. Logistic risk model predicting postoperative renal failure requiring dialysis in cardiac surgery patients. Eur J Cardiothorac Surg. 2011;40:701–7. https://doi.org/10.1016/j.ejcts.2010.12.051. Epub 2011 Feb 21. PMID: 21334918.

  37. Wang Y, Bellomo R. Cardiac surgery-associated acute kidney injury: risk factors, pathophysiology and treatment. Nat Rev Nephrol. 2017;13(11):697–711. https://doi.org/10.1038/nrneph.2017.119. Epub 2017 Sep 4. PMID: 28869251.

  38. Luo X, Jiang L, Du B, et al.; Beijing Acute Kidney Injury Trial (BAKIT) Workgroup. A comparison of different diagnostic criteria of acute kidney injury in critically ill patients. Crit Care. 2014;18(4):R144. https://doi.org/10.1186/cc13977. PMID: 25005361; PMCID: PMC4227114.

  39. Kellum JA, Lameire N, KDIGO AKI Guideline Work Group. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Crit Care. 2013;17(1):204. https://doi.org/10.1186/cc11454. PMID: 23394211; PMCID: PMC4057151.

  40. Lameire N, Kellum JA, KDIGO AKI Guideline Work Group. Contrast-induced acute kidney injury and renal support for acute kidney injury: a KDIGO summary (Part 2). Crit Care. 2013;17(1):205. https://doi.org/10.1186/cc11455. PMID: 23394215; PMCID: PMC4056805.

  41. Schiffl H. Renal recovery from acute tubular necrosis requiring renal replacement therapy: a prospective study in critically ill patients. Nephrol Dial Transplant. 2006;21:1248–52. https://doi.org/10.1093/ndt/gfk069. Epub 2006 Jan 31. PMID: 16449291.

  42. Kollef MH, Wragge T, Pasque C. Determinants of mortality and multi organ dysfunction in cardiac surgery patients requiring prolonged mechanical ventilation. Chest. 1995;107:1395–401. https://doi.org/10.1378/chest.107.5.1395. PMID: 7750337.

  43. Filsoufi F, Rahmanian PB, Castillo JG, et al. Predictors and early and late outcomes of respiratory failure in contemporary cardiac surgery. Chest. 2008;133:713–21. https://doi.org/10.1378/chest.07-1028. Epub 2008 Feb 8. PMID: 18263692.

  44. Reddy S, Grayson AD, Griffiths EM, Pullan DM, Rashid A. Logistic risk model for prolonged ventilation after adult cardiac surgery. Ann Thorac Surg. 2007;84:528–36. https://doi.org/10.1016/j.athoracsur.2007.04.002. PMID: 17643630.

  45. Richey M, Mann A, He J, et al. Implementation of an early extubation protocol in cardiac surgical patients decreased ventilator time but not intensive care unit or hospital length of stay. J Cardiothorac Vasc Anesth. 2018;32:739–44. https://doi.org/10.1053/j.jvca.2017.11.007. Epub 2017 Nov 8. PMID: 29229252.

  46. Crawford TC, Magruder JT, Grimm JC, et al. Early extubation: a proposed new metric. Semin Thorac Cardiovasc Surg. 2016;28:290–9. https://doi.org/10.1053/j.semtcvs.2016.04.009. Epub 2016 Apr 26. PMID: 28043432.

  47. Zochios V, Klein AA, Jones N, et al. Intra-operative mechanical ventilation strategies in cardiac surgical patients. J Intensive Care Soc. 2018;19:85. https://doi.org/10.1053/j.jvca.2019.10.052.

  48. Zochios V, Klein AA, Gao F. Protective invasive ventilation in cardiac surgery: a systematic review with a focus on acute lung injury in adult cardiac surgical patients. J Cardiothorac Vasc Anesth. 2018;32(4):1922–36. https://doi.org/10.1053/j.jvca.2017.10.031. Epub 2017 Dec 6. PMID: 29199052.

  49. Apostolakis E, Filos KS, Koletsis E, et al. Lung dysfunction following car diopulmonary bypass. J Card Surg. 2010;25:47–55. https://doi.org/10.1111/j.1540-8191.2009.00823.x. Epub 2009 Jun 22. PMID: 19549041.

  50. Sharma V, Rao V, Manlhiot C, et al. A derived and validated score to predict prolonged mechanical ventilation in patients undergoing cardiac surgery. J Thorac Cardiovasc Surg. 2017;153(1):108–15. https://doi.org/10.1016/j.jtcvs.2016.08.020. PMID: 27665221.

  51. Hall TS, Brevetti GR, Skoultchi AJ, Sines JC, Gregory P, Spotnitz AJ. Reexploration for hemorrhage following open heart surgery differentiation on the causes of bleeding and the impact on patient outcomes. Ann Thorac Cardiovasc Surg. 2001;7:352–7.

    Google Scholar 

  52. Karthik S, Grayson AD, McCarron EE, Pullan DM, Desmond MJ. Reexploration for bleeding after coronary artery bypass surgery: risk factors, outcomes, and the effect of time delay. Ann Thorac Surg. 2004;78:527–34. discussion 534. https://doi.org/10.1016/j.athoracsur.2004.02.088. PMID: 15276512.

  53. Ranucci M, Bozzetti G, Ditta A, Cotza M, Carboni G, Ballotta A. Surgical reexploration after cardiac operations: why a worse outcome? Ann Thorac Surg. 2008;86:1557–62. https://doi.org/10.1016/j.athoracsur.2008.07.114. PMID: 19049749.

  54. Kristensen KL, Rauer LJ, Mortensen PE, Kjeldsen BJ. Reoperation for bleeding in cardiac surgery. Interact Cardiovasc Thorac Surg. 2012;14(6):709–13. https://doi.org/10.1093/icvts/ivs050.

  55. Nishida H, Grooters RH, Soltanzadeh H, Thieman KC, et al. Discriminate use of electrocautery on the median sternotomy incision. J Thorac Cardiovasc Surg. 1991;101:488–94.

    Google Scholar 

  56. Contractor T, Williamson EE, Couri DM, Martinez MW. Suction of the left internal mammary artery graft into a pleural drain visualized by computerized tomography. Circulation. 2012;126(6):786–7. https://doi.org/10.1161/CIRCULATIONAHA.112.100396. PMID: 22869860.

  57. Ruel M, Chan V, Boodhwani M, McDonald B, Ni X, Gill G, Lam K, Hendry P, Masters R, Mesana T. How detrimental is reexploration for bleeding after cardiac surgery? J Thorac Cardiovasc Surg. 2017;154(3):927–35. https://doi.org/10.1016/j.jtcvs.2016.04.097. Epub 2017 May 25. PMID: 28826154.

  58. Becker RC, Bassand JP, Budaj A, Wojdyla DM, James SK, Cornel JH, et al. Bleeding complications with the P2Y12 receptor antagonists clopidogrel and ticagrelor in the PLATelet inhibition and patient Outcomes (PLATO) trial. Eur Heart J. 2011;32:2933–44. https://doi.org/10.1093/eurheartj/ehr422. Epub 2011 Nov 16. Erratum in: Eur Heart J. 2012 Nov;33(21):2750. PMID: 22090660.

  59. Angiolillo DJ, Firstenberg MS, Price MJ, Tummala PE, Hutyra M, Welsby IJ, et al. Bridging antiplatelet therapy with cangrelor in patients undergoing cardiac surgery: a randomized controlled trial. JAMA. 2012;307:265–74. https://doi.org/10.1001/jama.2011.2002.

  60. Qamar A, Bhatt DL. Current status of data on cangrelor. Pharmacol Ther. 2016;159:102–9.

    Google Scholar 

  61. Sousa-Uva M. 2017 EACTS guidelines on perioperative medication in adult cardiac surgery. Eur J Cardiothorac Surg. 2018;53:5–33. https://doi.org/10.1093/ejcts/ezx314.

  62. Valgimigli M, Bueno H, Byrne RA, Collet J-P, Costa F, Jeppsson A, et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS. Eur J Cardiothorac Surg. 2018;39(3):213–60. https://doi.org/10.1093/ejcts/ezx334.

  63. Patrono C, Coller B, FitzGerald GA, Hirsh J, Roth G. Platelet-active drugs: the relationships among dose, effectiveness, and side effects: the seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest. 2004;126:234S–64S.

    Google Scholar 

  64. Tang AT, Ohri SK, Haw MP. Novel application of vacuum assisted closure technique to the treatment of sternotomy wound infection. Eur J Cardiothorac Surg. 2000;17:482–4.

    Google Scholar 

  65. Eklund AM, Lyytikainen O, Klemets P, et al. Mediastinitis after more than 10,000 cardiac surgical procedures. Ann Thorac Surg. 2006;82:1784–9.

    Google Scholar 

  66. Salehi Omran A, Karimi A, Ahmadi SH, et al. Superficial and deep sternal wound infection after more than 9000 coronary artery bypass graft (CABG): incidence, risk factors and mortality. BMC Infect Dis. 2007;7(1):112. https://doi.org/10.1186/1471-2334-7-112. PMID: 17888179; PMCID: PMC2075514.

  67. Filsoufi F, Castillo JG, Rahmanian PB, Broumand SR, Silvay G, Carpentier A, Adams DH. Epidemiology of deep sternal wound infection in cardiac surgery. J Cardiothorac Vasc Anesth. 2009;23:488–94.

    Google Scholar 

  68. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of healthcare-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309–32.

    Google Scholar 

  69. Gatti G, Dell’Angela L, Barbati G, et al. A predictive scoring system for deep sternal wound infection after bilateral internal thoracic artery grafting. Eur J Cardiothorac Surg. 2016;49:910–7. https://doi.org/10.1093/ejcts/ezv208. Epub 2015 Jun 9. PMID: 26059875.

  70. Abu-Omar Y, Kocher GJ, Bosco P, et al. European association for cardiothoracic surgery expert consensus statement on the prevention and management of mediastinitis. Eur J Cardiothorac Surg. 2017;51:10–29.

    Google Scholar 

  71. Lazar HL, Salm TV, Engelman R, et al. Prevention and management of sternal wound infections. J Thorac Cardiovasc Surg. 2016;152:962–72.

    Google Scholar 

  72. Engelman R, Shahian D, Shemin R, et al. The Society of Thoracic Surgeons practice guideline series: antibiotic prophylaxis in cardiac surgery, part II: antibiotic choice. Ann Thorac Surg. 2007;83:1569–76.

    Google Scholar 

  73. Munoz P, Hortal J, Giannella M, et al. Nasalcarriage of S. aureus increases the risk of surgical site infection after major heart surgery. J Hosp Infect. 2008;68:25–31.

    Google Scholar 

  74. Ammerlaan HS, Kluytmans JA, Wertheim HF, et al. Eradication of methicillin-resistant Staphylococcus aureus carriage: a systematic review. Clin Infect Dis. 2009;48:922–30.

    Google Scholar 

  75. Kamel C, McGahan L, Polisena J, et al. Preoperative skin antiseptic preparations for preventing surgical site infections: a systemic review. Infect Control Hosp Epidemiol. 2012;33:608–17.

    Google Scholar 

  76. Harbarth S, Samore MH, Lichtenberg D, et al. Prolonged antibiotic prophylaxis after cardiovascular surgery and its effect on surgical site infections and antimicrobial resistance. Circulation. 2000;101:2916–21.

    Google Scholar 

  77. Bennett-Guerrero E, Ferguson TB Jr, Lin M, et al. Effect of an implantable gentamicin-collagen sponge on sternal wound infections following cardiac surgery—a randomized trial. JAMA. 2010;304:755–62.

    Google Scholar 

  78. Dai C, Lu Z, Zhu H, et al. Bilateral internal mammary artery grafting and risk of sternal wound infection: evidence from observational studies. Ann Thorac Surg. 2013;95:1938–45. https://doi.org/10.1016/j.athoracsur.2012.12.038. Epub 2013 Feb 28. PMID: 23453745.

  79. Deo SV, Shah IK, Dunlay SM, et al. Bilateral internal thoracic artery harvest and deep sternal wound infection in diabetic patients. Ann Thorac Surg. 2013;95:862–9. https://doi.org/10.1016/j.athoracsur.2012.11.068. Epub 2013 Jan 24. PMID: 23352296.

  80. Sa MP, Ferraz PE, Escobar RR, et al. Skeletonized vs. pedicled internal thoracic artery and risk of sternal wound infection after coronary bypass surgery: meta-analysis and meta-regression of 4817 patients. Interact Cardiovasc Thorac Surg. 2013;16:849–57. https://doi.org/10.1093/icvts/ivt012. Epub 2013 Feb 27. PMID: 23446674; PMCID: PMC3653453.

  81. Zeitani J, Penta de Peppo A, Moscarelli M, et al. Influence of sternal size and inadvertent paramedian sternotomy on stability of the closure site: a clinical and mechanical study. J Thorac Cardiovasc Surg. 2006;132:38–42. https://doi.org/10.1016/j.jtcvs.2006.03.015. PMID: 16798300.

  82. Webster J, Liu Z, Norman G, et al. Negative pressure wound therapy for surgical wounds healing by primary closure. Cochrane Database Syst Rev. 2019;3(3):CD009261. https://doi.org/10.1002/14651858.CD009261.pub4.

  83. Tewarie LS, Menon AK, Hatam N, et al. Prevention of sternal dehiscence with the sternum external fixation (Stern-E-Fix) corset e randomized trial in 750 patients. J Cardiothorac Surg. 2012;7:85. https://doi.org/10.1186/1749-8090-7-85. PMID: 22958313; PMCID: PMC3579734.

  84. Gorlitzer M, Wagner F, Pfeiffer S, et al. Prevention of sternal wound complications after sternotomy: results of a large prospective randomized multicentre trial. Interact Cardiovasc Thorac Surg. 2013;17:515–22. https://doi.org/10.1093/icvts/ivt240. Epub 2013 Jun 11. PMID: 23760221; PMCID: PMC3745148.

  85. Phoon PHY, Hwang NC. Deep sternal wound infection: diagnosis, treatment and prevention. J Cardiothorac Vasc Anesth. 2020;34(6):1602–13. https://doi.org/10.1053/j.jvca.2019.09.019. Epub 2019 Sep 18. PMID: 31623967.

  86. Wu L, Chung KC, Waljee JF, et al. A national study of the impact of ini-tial debridement timing on outcomes for patients with deep sternal wound infection. Plast Reconstr Surg. 2016;137:414e–23e. https://doi.org/10.1097/01.prs.0000475785.14328.b2. PMID: 26818332; PMCID: PMC5096730.

  87. Lonie S, Hallam J, Yii M, et al. Changes in the management of deep sternal wound infections: a 12-year review. ANZ J Surg. 2015;85:878-881. https://doi.org/10.1111/ans.13279. Epub 2015 Sep 1. PMID: 26331481.

  88. Ingemansson R, Malmsjö M, Lindstedt S. The Duration of Negative Pressure Wound Therapy Can Be Reduced Using the HeartShield Device in Patients With Deep Sternal Wound Infection. Eplasty. 2014;14:e16. PMID: 24741387; PMCID:PMC3977590.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France

    Antonio Fiore M.D.

  2. Sapienza University of Rome, Roma, Italy

    Antonio Fiore M.D.

  3. Department of Cardiac Surgery, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy

    Antonino Massimiliano Grande

  4. Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Trieste University Hospital, Trieste, Italy, Trieste, Italy

    Giuseppe Gatti M.D.

Authors
  1. Antonio Fiore M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Antonino Massimiliano Grande
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Giuseppe Gatti M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Antonino Massimiliano Grande .

Editor information

Editors and Affiliations

  1. Dipartimento di Emergenza Urgenza, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Paolo Aseni

  2. Divisione di Cardiochirurgia, IRCCS Fondazione Policlinico San Matteo, Pavia, Pavia, Italy

    Antonino Massimiliano Grande

  3. Div. of Emerg. Surg., Abdominal Center, Helsinki University Hospital Meilahti, Helsinki, Finland

    Ari Leppäniemi

  4. Department of Pathophysiology and Transplantation, General Surgery and Trauma Team, University of Milano, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Osvaldo Chiara

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Fiore, A., Grande, A.M., Gatti, G. (2023). Major Complications of Cardiac Surgery. In: Aseni, P., Grande, A.M., Leppäniemi, A., Chiara, O. (eds) The High-risk Surgical Patient. Springer, Cham. https://doi.org/10.1007/978-3-031-17273-1_49

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-17273-1_49

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-17272-4

  • Online ISBN: 978-3-031-17273-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation