need help with cousin's upcoming sx-Monday

  1. I am a Home Care nurse, RN and have not worked critical care since '83, so I am hoping you can give me some advice. My cousin has Marphans and had a new valve and a gortex graft to her ascending aorta about ten years ago. A few weeks ago they felt there was some possibility of the graft leaking and /or infection and she had some surgery that determined no leak. She has been on po Keflex, and there is evidence of an infection in the area. Tunneling from the new wound site. Monday two cardiac thoracic surgeons are going to open things up and determine if the infection behind her sternum involved the graft: if not they will clean things up and close, if so they will replace the graft. This is pretty scary for us all and I wondered if anyone has seen this sort of problem and how did things go? It sounds doable; she is healthy, has lots of energy, a positive attitude, and a very strong consitution, is 58 years old. Any info would be appreciated.
    Bess
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  2. 5 Comments

  3. by   l.rae
    Bess, this is not my area of expertise, just wanted to let you know l will be thinking of you and your family, keeping a positive thought and a prayer....hopefully you will get some answeres here.....the members of this website are awesome to say the least.....good luck...........LR
  4. by   DIPLOMATICRN4HIRE
    Just my opinion , and I am envolved in surgeries of this type...
    It would depend on the original site of the infection... If it is stemming from the graft itself they may replace it and just wash the area and treat it with antibodics , there is also a procedure where we debrid the sterum itself and run a gent/bleach flush thrush and the collection is taken out via chest tubes. It would all depend on what the cultures produce, and the overall health of the patient. If she has Cardiothorasic surgeons doing it then she should be fine, We often get post op infections from the sterum. I have even seen a few reactions from the gortex itself. The cases that I have worked on we replaced the gortex and sent it off to see if there was a "bug" in /on it.
    Recovery will be the same stats of a cabg. The positive attitude will be her best assest.
    Let us know the results.
    Zoe
  5. by   JohnnyGage
    I, too, have seen surgeries of this type. The biggest concern I would have would be if the infection involves the sternum itself. If this is the case, a worse case scenario would involve a partial or total sternectomy, which is quite involved and takes a lot of healing time (usually with the help of a plastic surgeon). As I said -- this is a worst case scenario. As mentioned before, if she's in the hands of cardiothoracic surgeons, she'll be OK.

    Keep us posted.
  6. by   Bess
    Thank you so much for the replies, it is so reasurring to read them. If the sternum actually has to be removed what can be done to replace it's skeletal function?
    Bess
  7. by   JohnnyGage
    Originally posted by Bess
    Thank you so much for the replies, it is so reasurring to read them. If the sternum actually has to be removed what can be done to replace it's skeletal function?
    Bess
    Sometimes a plate can be put in. Sometimes a small portion of the sternum is left in place to hold the ribs and a muscle flap is used to protect the heart. In either case, use of the upper body for strength-related activities is severely limited.

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