Objectives: To compare outcomes after the development of early (≤30 days) versus delayed (>30 days) deep sternal wound infection (DSWI) after cardiac surgery. Methods: Between 2005 and 2016, 64 patients were treated surgically for DSWI following cardiac surgery. Thirty-three developed early DSWI, while 31 developed late DSWI. Mean follow up was 34.1 ± 32.3 months. Results: Survival for the entire cohort at 1, 3, and 5 years was 93.9, 85.1, and 80.8%, respectively. DSWI diagnosed early and attempted medical management were strongly associated with overall mortality (hazard ratio (HR), 25.0 and 9.9; 95% confidence intervals (CI), 1.18-528 and 1.28-76.5; p-value 0.04 and 0.04, respectively). Survival was 88.1, 77.0, 70.6 and 100, 94.0 and 94.0% at 1,3, and 5 years in the early and late DSWI groups, respectively (Log-rank = 0.074). Those diagnosed early were more likely to have a positive wound culture (odds ratio (OR), 0.06, 95% CI 0.01-0.69, p=0.024) and diagnosed late were more likely to be female (OR 8.75, 95% CI 2.0-38.4, p=0.004) and require an urgent DSWI procedure (OR 9.25, 95% CI 1.86-45.9, p=0.007). Both early diagnosis of DSWI and initial attempted medial management were strongly associated with mortality (hazard ratio 7.48, 95% CI 1.38-40.4, p=0.019 and hazard ratio 7.76, 95% CI 1.67-35.9, p=0.009, respectively). Conclusions: Early aggressive surgical therapy for deep sternal wound infection after cardiac surgery results in excellent outcomes. Those diagnosed with DSWI early and have failed initial medical management have increased mortality.

Background: Controversy exists regarding durability and survival after mitral valve repair between sternotomy and a small right anterior thoracotomy approaches. Methods: Between February 2004 and July 2015, 410 patients underwent mitral valve repair via either sternotomy (ST, n=135) or small right anterior thoracotomy (RAT, n=275). Mean follow up was 72.7  38.9 months. Postoperative echocardiograms were obtained in 310 patients (75.6%) at a mean of 20.3  21.4 months. Results: Overall survival at 1, 3, 5, and 10 years were 96.3, 93.0, 93.0, and 91.4% for the ST group and 99.3, 98.9, 98.4, and 97.0% for the RAT group (Log-Rank p = 0.004). There was no difference between groups in the cumulative incidence of need for mitral valve reoperation or progression of mitral regurgitation (MR) considering death as a competing outcome over time (p=0.94 and 0.53, respectively). Propensity score weighted multivariate Cox Proportional hazard modeling built on baseline differences between the RAT and ST groups, showed presence or absence of posterior or anterior leaflet pathology was not associated with mortality, need for reoperation, or progression of MR. A RAT approach was associated with a decreased mortality on adjusted analysis (hazard ratio, 0.32, 95% confidence interval, 0.13-0.82, p=0.018), however, this result was less significant when those with coronary artery disease were removed (hazard ratio, 0.34, 95% confidence interval, 0.12-0.96, p=0.041). Conclusions: Mitral valve repair via a small right anterior thoracotomy incision in select patients can be performed with surgical results and survival that are equivalent to the sternotomy approach.