Fbtients

From January 1981 to June 1986, some 136 consecutive adult patients were admitted to the ICU of Bichat Hospital, Paris, referred from seven Parisian surgical departments because of mediastinitis following cardiac surgery. Patients were included in the study when viral cultures could be performed within ten days after surgical dёbridement. Ten patients died before the cultures could be performed, and 11 others were excluded because of toxic or contaminated cultures. The group studied was therefore 115 patients whose clinical characteristics (mean ± SD) were as follows: mean age, 57 ± 13 years; sex ratio, 16 percent female (18/115); and type of initial surgery: coronary artery bypass graft (n=34); valve replacement (n = 62); combined procedure (n = 6); or miscellaneous (n = 13) (Table 1).

Table 1—Characteristics of Patients at Entry into Study

Data

VE +

VE-

Total

No. of patients

29

86

115

Mean age, у

59 ±29

56± 14

57 ±13

First-day APACHE II score»

15 ±8

14.3 ±7

14.6 ±7.3

Culture day after surgery

22 ±12

21 ±11

21 ±11

Type of surgery

CABGt

9

25

34

Valve replacement

17

45

62

CABG and valve replacement^

1

5

6

Miscellaneous

2

11

13

Sex ratio (F/M)

9§/20

9/77

18/97

Seropositive patients (IgG

8/22

14/56

22/78

titer >1/8 within 30 days

after ECC)

Record of Illness

The following data were recorded to determine the possible influence of CMV infection on morbidity: first-day APACHE II score; maximal abnormalities during hospitalization for hemoglo­bin (lower level); WBC differential count; presence of atypical lymphocytosis; serum levels of creatinine, bilirubin, AST, ALT, and LDH; maximal abnormalities on the chest roentgenogram using a radiologic score modified from Weinberg; duration of hospitaliza­tion; and final clinical outcome.
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Viral Cultures

Samples of blood and urine were obtained within ten days (mean, 4.5 ±3 days) after diagnosis of mediastinitis. The mean interval between the initial surgical procedure and the first viral culture was 21 ±11 days, and additional cultures were performed during the course of hospitalization every three weeks, leading to a total of 228 samplings for the 115 patients. Fresh specimens of blood and urine were inoculated onto cultures of human fibroblasts (MRCS cells; Merieux Lab) and evaluated weekly for six weeks for cytopa- thologic effect typical of CMV infection.

Serology

IgG antibody titers to CMV were determined by a microtiter complement-fixation test (reference antigen: Behring Lab), with titers less than 1/8 considered negative. In 78 of the 115 patients, CMV-IgG titers could be determined within 30 days following ECC; thus, the preoperative status could be approximated.

Statistical Analysis

All comparisons were done by x* test with Yates’ correction. tadacip

Category: Diseases / Tags: Cardiac Surgery, Cytomegaloviral Infection, incidence, Morbidity

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