Vacuum-assisted closure in cardiac surgery - clinical outcome and vascular effects

Sammanfattning: The aim of this research was to clinically and experimentally evaluate the use of vacuum-assisted closure in poststernotomy mediastinitis after cardiac surgery. Vacuum-assisted closure (VAC) is a new wound-healing therapy based on the application of a local negative pressure to the wound. New techniques for treating poststernotomy mediastinitis are needed since conventional techniques have an unsatisfactorily high mortality rate and are associated with high morbidity. It was concluded that VAC in poststernotomy mediastinitis results in a lower mortality rate and a lower rate of recurrent infection compared to conventional treatment. The long-term survival after VAC-treated mediastinitis following isolated coronary artery bypass grafting (CABG) was similar to the long-term survival in CABG without mediastinitis. Obesity, diabetes mellitus, low left ventricular ejection fraction, renal failure, and three-vessel disease were identified as independent risk factors for developing mediastinitis after isolated CABG. It was shown that VAC can be applied without impairment of the central hemodynamics in a sternotomy wound model. It was also shown that the application of VAC for 12 hours does not induce perforation or dissection of porcine femoral arteries. However, the endothelin-receptor-mediated vasoconstriction was enhanced, together with more efficacious endothelium-dependent vasodilatation. In conclusion, the clinical results when using VAC in poststernotomy mediastinitis were superior to conventional treatment, both in the short and the long term. The experimental results indicate that VAC can be used safely without impairment of central hemodynamics or damage to the blood vessels.