{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:01:12Z","timestamp":1753876872647,"version":"3.41.2"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T00:00:00Z","timestamp":1750982400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>Mediastinitis is an infection affecting the mediastinum, often caused by cardiovascular or thoracic surgery procedures. Management entails antibiotic therapy, surgical debridement, drainage of infected sites and immediate or delayed closure. Negative pressure wound therapy is useful in cases of delayed sternal closure. Several approaches for mediastinal drainage have been proposed, but there is no consensus on the thoracic intervention approach.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>A single-centre, retrospective analysis from the UK analysed data from 19 patients who underwent surgical management for mediastinitis between September 2015 and April 2023. Our primary aim was to describe the outcomes from our series where we predominantly employed an open surgical approach.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>The mean age of our cohort was 49\u2009\u00b1\u200917.12\u2009years old; the mean performance status (PS ECOG) was 2\u2009\u00b1\u20090.77. Two people were known smokers (10.53%), while five were non-smokers (26.31%). Fifteen patients underwent an open operation (78.85%), with rest undergoing a minimally invasive approach. The majority of procedures were undertaken from the right-hand side. The overall intensive care unit admission rate was 68.42% (n\u2009=\u200913) with an in-hospital complication rate of 5.26% (n\u2009=\u20091). This was a respiratory arrest secondary to mucous plugging. There were no in-hospital deaths, and median follow-up was 41\u2009months (22\u201350). Overall survival at 3\u2009years was 85%.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Open thoracotomy remains an important surgical strategy in the management of complex mediastinitis, but further validation is required through larger, prospective studies.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/icvts\/ivaf154","type":"journal-article","created":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T09:35:32Z","timestamp":1751016932000},"source":"Crossref","is-referenced-by-count":0,"title":["Surgical management of complex mediastinitis: an 8-year single-centre experience reinforcing the role of open thoracotomy"],"prefix":"10.1093","volume":"40","author":[{"given":"Nabih","family":"Berjaoui","sequence":"first","affiliation":[{"name":"Department of Thoracic Surgery, Guy\u2019s Hospital, Guy\u2019s and St Thomas\u2019 NHS Foundation Trust , London,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felix","family":"Santos","sequence":"additional","affiliation":[{"name":"King\u2019s College Medical School , Great Maze Pond , London, SE1 1UL,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabiana","family":"Curti","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Guy\u2019s Hospital, Guy\u2019s and St Thomas\u2019 NHS Foundation Trust , London,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Puiyee Sophia","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Guy\u2019s Hospital, Guy\u2019s and St Thomas\u2019 NHS Foundation Trust , London,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Savvas","family":"Lampridis","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, 424 General Military Hospital , Thessaloniki,","place":["Greece"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9170-8618","authenticated-orcid":false,"given":"Akshay","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Guy\u2019s Hospital, Guy\u2019s and St Thomas\u2019 NHS Foundation Trust , London,","place":["UK"]},{"name":"Institute of Immunology and Immunotherapy , University of Birmingham , Birmingham, B15 2TT,","place":["England"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Bille","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Guy\u2019s Hospital, Guy\u2019s and St Thomas\u2019 NHS Foundation Trust , London,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,6,27]]},"reference":[{"key":"2025071304121036500_ivaf154-B1","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.cmi.2019.07.005","article-title":"Mediastinitis in the intensive care unit patient: a narrative review","volume":"26","author":"Pastene","year":"2020","journal-title":"Clin Microbiol Infect"},{"key":"2025071304121036500_ivaf154-B2","doi-asserted-by":"crossref","first-page":"171","DOI":"10.5761\/atcs.oa.21-00147","article-title":"Acute mediastinitis\u2014outcomes and prognostic factors of surgical therapy (a single-center experience)","volume":"28","author":"Vodi\u010dka","year":"2022","journal-title":"Ann Thorac Cardiovasc Surg"},{"key":"2025071304121036500_ivaf154-B3","doi-asserted-by":"crossref","first-page":"e66\u201372","DOI":"10.1093\/ejcts\/ezs385","article-title":"Diffuse descending necrotizing mediastinitis: surgical therapy and outcome in a single-centre series","volume":"42","author":"Kocher","year":"2012","journal-title":"Eur J Cardiothorac Surg"},{"key":"2025071304121036500_ivaf154-B4","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1093\/ejcts\/ezw326","article-title":"European Association for Cardio-Thoracic Surgery expert consensus statement on the prevention and management of mediastinitis","volume":"51","author":"Abu-Omar","year":"2017","journal-title":"Eur J Cardiothorac Surg"},{"key":"2025071304121036500_ivaf154-B5","doi-asserted-by":"crossref","first-page":"E2275","DOI":"10.1002\/hed.24183","article-title":"Descending necrotizing mediastinitis: systematic review on its treatment in the last 6 years, 75 years after its description","volume":"38","author":"Prado\u2013Calleros","year":"2016","journal-title":"Head Neck"},{"key":"2025071304121036500_ivaf154-B6","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1007\/s15010-015-0838-y","article-title":"Clinical features and outcome of patients with descending necrotizing mediastinitis: prospective analysis of 34 cases","volume":"44","author":"Palma","year":"2016","journal-title":"Infection"},{"key":"2025071304121036500_ivaf154-B7","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1097\/SLA.0b013e3181c1b0d1","article-title":"Descending necrotizing mediastinitis: contemporary trends in etiology, diagnosis, management, and outcome","volume":"251","author":"Ridder","year":"2010","journal-title":"Ann Surg"},{"key":"2025071304121036500_ivaf154-B8","doi-asserted-by":"crossref","first-page":"28","DOI":"10.21037\/med-23-71","article-title":"Surgical access to the mediastinum\u2014all roads lead to Rome: a literature review","volume":"8","author":"Mayer","year":"2024","journal-title":"Mediastinum"},{"key":"2025071304121036500_ivaf154-B9","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1007\/BF03217934","article-title":"Guideline of surgical management based on diffusion of descending necrotizing mediastinitis","volume":"47","author":"Endo","year":"1999","journal-title":"Jpn J Thorac Cardiovasc Surg"},{"key":"2025071304121036500_ivaf154-B10","first-page":"545","article-title":"Descending necrotizing mediastinitis","volume":"157","author":"Estrera","year":"1983","journal-title":"Surg Gynecol Obstet"},{"key":"2025071304121036500_ivaf154-B11","first-page":"114","article-title":"A new classification of post-sternotomy dehiscence","volume":"30","author":"Anger","year":"2015","journal-title":"Rev Bras Cir Cardiovasc"},{"key":"2025071304121036500_ivaf154-B12","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1016\/j.ejcts.2005.05.018","article-title":"Early open thoracotomy and mediastinopleural irrigation for severe descending necrotizing mediastinitis","volume":"28","author":"Iwata","year":"2005","journal-title":"Eur J Cardiothorac Surg"},{"key":"2025071304121036500_ivaf154-B13","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1053\/j.jvca.2009.02.007","article-title":"Epidemiology of deep sternal wound infection in cardiac surgery","volume":"23","author":"Filsoufi","year":"2009","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"2025071304121036500_ivaf154-B14","doi-asserted-by":"crossref","first-page":"265","DOI":"10.5492\/wjccm.v4.i4.265","article-title":"Deep sternal wound infection after cardiac surgery: evidences and controversies","volume":"4","author":"Cotogni","year":"2015","journal-title":"World J Crit Care Med"},{"key":"2025071304121036500_ivaf154-B15","doi-asserted-by":"crossref","first-page":"e117\u201328","DOI":"10.1016\/j.jviscsurg.2010.08.003","article-title":"Esophageal perforations","volume":"147","author":"Chirica","year":"2010","journal-title":"J Visc Surg"},{"key":"2025071304121036500_ivaf154-B16","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/j.athoracsur.2011.03.131","article-title":"Current concepts in the management of esophageal perforations: a twenty-seven year Canadian experience","volume":"92","author":"Bhatia","year":"2011","journal-title":"Ann Thorac Surg"},{"key":"2025071304121036500_ivaf154-B17","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1016\/j.athoracsur.2012.11.045","article-title":"A comprehensive review of anastomotic technique in 432 esophagectomies","volume":"95","author":"Price","year":"2013","journal-title":"Ann Thorac Surg"},{"key":"2025071304121036500_ivaf154-B18","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1097\/SLA.0b013e3182590603","article-title":"Outcomes after minimally invasive esophagectomy","volume":"256","author":"Luketich","year":"2012","journal-title":"Ann Surg"},{"key":"2025071304121036500_ivaf154-B19","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1159\/000322014","article-title":"Cervical or thoracic anastomosis after esophagectomy for cancer: a systematic review and meta-analysis","volume":"28","author":"Biere","year":"2011","journal-title":"Dig Surg"},{"key":"2025071304121036500_ivaf154-B20","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1016\/j.athoracsur.2017.06.078","article-title":"A prospective multi-institutional cohort study of mediastinal infections after cardiac operations","volume":"105","author":"Perrault","year":"2018","journal-title":"Ann Thorac Surg"},{"key":"2025071304121036500_ivaf154-B21","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1111\/jocs.13189","article-title":"Post-sternotomy mediastinitis in the modern era","volume":"32","author":"Goh","year":"2017","journal-title":"J Card Surg"},{"key":"2025071304121036500_ivaf154-B22"},{"key":"2025071304121036500_ivaf154-B23","doi-asserted-by":"crossref","first-page":"5992","DOI":"10.21037\/jtd-23-845","article-title":"Video-assisted thoracic surgery drainage is feasible and safe for acute necrotizing mediastinitis: a retrospective cohort study","volume":"15","author":"Liang","year":"2023","journal-title":"J Thorac Dis"},{"key":"2025071304121036500_ivaf154-B24","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/j.jtcvs.2008.01.009","article-title":"Descending necrotizing mediastinitis: a 10-year surgical experience in a single institution","volume":"136","author":"Chen","year":"2008","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025071304121036500_ivaf154-B25","first-page":"ivad053","article-title":"The efficacy of thoracoscopic surgery for descending necrotizing mediastinitis","volume":"36","author":"Tanaka","year":"2023","journal-title":"Interdiscip Cardiovasc Thorac Surg"},{"key":"2025071304121036500_ivaf154-B26","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1016\/S0003-4975(99)00453-1","article-title":"Management of descending necrotizing mediastinitis: an aggressive treatment for an aggressive disease","volume":"68","author":"Marty-An\u00e9","year":"1999","journal-title":"Ann Thorac Surg"}],"container-title":["Interdisciplinary CardioVascular and Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/icvts\/advance-article-pdf\/doi\/10.1093\/icvts\/ivaf154\/63606938\/ivaf154.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/icvts\/article-pdf\/40\/7\/ivaf154\/63606938\/ivaf154.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/icvts\/article-pdf\/40\/7\/ivaf154\/63606938\/ivaf154.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,13]],"date-time":"2025-07-13T08:12:20Z","timestamp":1752394340000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/icvts\/article\/doi\/10.1093\/icvts\/ivaf154\/8176619"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,27]]},"references-count":26,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2025,7,3]]}},"URL":"https:\/\/doi.org\/10.1093\/icvts\/ivaf154","relation":{},"ISSN":["2753-670X"],"issn-type":[{"type":"electronic","value":"2753-670X"}],"subject":[],"published-other":{"date-parts":[[2025,7]]},"published":{"date-parts":[[2025,6,27]]},"article-number":"ivaf154"}}