Comparison between Vacuum-Assisted Closure Technique and Conventional Approach in Patients with Mediastinitis After Isolated Coronary Artery Bypass Graft Surgery

Abstract

Introduction Median sternotomy is the most preferred approach in heart surgery. Post-sternotomy mediastinitis is a catastrophic and potentially life-threatening complication with an incidence rate of 0.15% to 5%, and its overall mortality rate reaches 47%. In this study, we aimed to compare the results of vacuum-assisted closure technique and the conventional methods on the management of mediastinitis following isolated coronary artery bypass graft surgery. Methods Between February 2001 and July 2013, 32,106 patients who underwent cardiac operations were evaluated retrospectively. One hundred and fourteen patients who developed post-sternotomy mediastinitis were included in this study. The patients were divided into two groups and compared - vacuum-assisted closure group (n=52, 45.6%) and conventional treatment group (n=62, 54.4%). Results There were no differences between the two groups according to the patients’ characteristics, surgical data, and mediastinal cultures. However, we found that total treatment duration for post-sternotomy mediastinitis, time interval from diagnosis to negative culture, hospitalization time, and in-hospital mortality were statistically significantly lower in the vacuum-assisted closure group than in the conventional treatment group (P<0.001, P<0.001, P<0.001, and P=0.03, respectively). Conclusion This study demonstrates that the vacuum-assisted closure technique improves the medical outcome of patients with post-sternotomy mediastinitis compared with the conventional treatment. The vacuum-assisted closure is a safe and more effective treatment modality for patients with post-sternotomy mediastinitis after cardiac surgery with reasonable morbidity and mortality.

The role of negative pressure wound therapy in the treatment of poststernotomy mediastinitis in Asians: A single‐center, retrospective cohort study

“…A prior systematic review also demonstrated favorable outcomes when comparing negative pressure wound care with other wound management techniques for PSM, including a shorter hospital stay, reduced reinfection rate, and decreased early mortality 29 . Akbayrak et al, 15 in a recent study, found statistically significant reductions in the total treatment duration, time from diagnosis to negative culture, hospitalization duration, and in‐hospital mortality in their NPWT group as compared with the CoT group. However, our study has presented conflicting findings, and we need a larger sample size to gain a clearer understanding of the indication of NPWT and relationship between mortality and morbidity in patients with PSM.…”

“…This approach facilitates the healing and stabilization of the sternotomy wound. Recent studies have provided evidence of the safety and effectiveness of NPWT, showcasing its ability to accelerate the formation of granulation tissue in the wound, promote enhanced wound closure, and reduce the frequency of dressing change as compared with open packing 15,16 …”