Surgical management of coronary stent infections: an institutional experience with 18 patients and analysis of long-term outcomes.

Coronary stent infection (CSI) is a rare but serious complication following percutaneous coronary intervention, and is associated with significant morbidity and mortality. This report presents a 6-year institutional experience involving 18 patients who underwent surgical management for CSI. The patients, predominantly male (94.12%), ranged from 31 to 80 years old, with the majority presenting with fever, chest pain, and other symptoms, often leading to delayed diagnosis. Infections were primarily caused by Pseudomonas aeruginosa, Staphylococcus aureus, and non-tuberculous mycobacteria, with six cases yielding no pathogen on blood/tissue cultures. Surgical intervention involved stent removal, coronary artery ligation, and revascularization, when feasible. Sixteen patients underwent complete revascularization using on-pump techniques. Despite the complexity of these cases, there was no mortality during the minimum 6-month follow-up, and patients remained in New York Heart Association (NYHA) class I/II. This report underscores the critical importance of early- and late-onset recognition and multidisciplinary approach to managing CSI, emphasizing the need for high clinical suspicion in patients presenting with unexplained fever following stent placement. Strict adherence to sterilization practices in catheterization laboratories is crucial for preventing these infections. Successful outcomes can be achieved with timely surgical intervention and comprehensive perioperative care, highlighting the necessity of coordinated effort among cardiothoracic surgeons, cardiologists, infectious disease specialists, microbiologists, and radiologists.