EP 298 Microcirculatory Impairment and the Development of Deep Sternal Wound Infection following Aortic Valve Replacement and Coronary Artery Bypass Graft Surgeries
Premjithlal Bhaskaran, India Premjithlal Bhaskaran, Mohammed Farid Aslam, Terence GourlayAbstract
Background
Deep sternal wound infection (DSWI) in cardiac surgery is a devastating complication following cardiac surgery, associated with prolonged hospital stay, increased healthcare costs, and significant mortality. While recognised clinical risk factors exist, the underlying pathophysiological mechanisms predisposing patients to DSWI remain incompletely understood. Impaired sternal microcirculation may play a central role in the development of these infections.
Methods
Sternal microcirculation was prospectively assessed using laser Doppler flowmetry in patients undergoing cardiac surgery via median sternotomy. Serial measurements were obtained in the early postoperative period. Patients were subsequently stratified according to the development of DSWI or uncomplicated wound healing. Early postoperative microcirculatory perfusion patterns were compared between groups.
Results
Patients who developed DSWI demonstrated significantly reduced sternal microcirculatory perfusion in the early postoperative period compared with patients who healed without complication. This impairment was evident prior to the clinical diagnosis of infection and persisted during the initial wound-healing phase. In contrast, patients without DSWI showed a gradual recovery of sternal microcirculation following the immediate postoperative decline. Early postoperative hypoperfusion was strongly associated with subsequent deep infection, independent of conventional clinical risk factors.
Conclusion
Early postoperative impairment of sternal microcirculation is associated with the development of deep sternal wound infection. These findings suggest that microcirculatory compromise is a key contributor to the pathogenesis of DSWI rather than a secondary consequence. Serial assessment of sternal microcirculation using laser Doppler flowmetry may allow early identification of patients at high risk of DSWI and facilitate targeted preventative strategies to improve postoperative outcomes.