Delayed Sternal Closure Using a Vacuum-Assisted Closure System in Adult Cardiac Surgery
Background: Delayed sternal closure (DSC) is a useful option for patients with intractable bleeding and hemodynamic instability due to prolonged cardiopulmonary bypass and a preoperative bleeding tendency. Vacuum-assisted closure (VAC) has been widely used for sternal wound problems, but only rar...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Korean Society for Thoracic & Cardiovascular Surgery
2023-05-01
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| Series: | Journal of Chest Surgery |
| Subjects: |
| Summary: | Background: Delayed sternal closure (DSC) is a useful option for patients with intractable
bleeding and hemodynamic instability due to prolonged cardiopulmonary bypass
and a preoperative bleeding tendency. Vacuum-assisted closure (VAC) has been widely
used for sternal wound problems, but only rarely for DSC, and its efficacy for mediastinal
drainage immediately after cardiac surgery has not been well established. Therefore, we
evaluated the usefulness of DSC using VAC in adult cardiac surgery.
Methods: We analyzed 33 patients who underwent DSC using VAC from January 2017
to July 2022. After packing sterile gauze around the heart surface and great vessels, VAC
was applied directly without sternal self-retaining retractors and mediastinal drain tubes.
Results: Twenty-one patients (63.6%) underwent emergency surgery for conditions including
type A acute aortic dissection (n=13), and 8 patients (24.2%) received postoperative
extracorporeal membrane oxygenation support. Intractable bleeding (n=25) was the
most common reason for an open sternum. The median duration of open sternum was 2
days (interquartile range [25th–75th pertentiles], 2–3.25 days) and 9 patients underwent
VAC application more than once. The overall in-hospital mortality rate was 27.3%. Superficial
wound problems occurred in 10 patients (30.3%), and there were no deep sternal
wound infections.
Conclusion: For patients with an open sternum, VAC alone, which is effective for mediastinal
drainage and cardiac decompression, had an acceptable superficial wound infection
rate and no deep sternal wound infections. In adult cardiac surgery, DSC using VAC may be useful
in patients with intractable bleeding or unstable hemodynamics with myocardial edema. |
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| ISSN: | 2765-1606 2765-1614 |