Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Delayed Sternal Closure Using a Vacuum-Assisted Closure System in Adult Cardiac Surgery

  • Hyun Ah Lim (Department of Thoracic and Cardiovascular Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Jinwon Shin (Department of Thoracic and Cardiovascular Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Min Seop Jo (Department of Thoracic and Cardiovascular Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Yong Jin Chang (Department of Thoracic and Cardiovascular Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Deog Gon Cho (Department of Thoracic and Cardiovascular Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Hyung Tae Sim (Department of Thoracic and Cardiovascular Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea)
  • Received : 2022.11.03
  • Accepted : 2023.01.26
  • Published : 2023.05.05
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Abstract

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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References

  1. Riahi M, Tomatis LA, Schlosser RJ, Bertolozzi E, Johnston DW. Cardiac compression due to closure of the median sternotomy in open heart surgery. Chest 1975;67:113-4. https://doi.org/10.1378/chest.67.1.113
  2. Mestres CA, Pomar JL, Acosta M, et al. Delayed sternal closure for life-threatening complications in cardiac operations: an update. Ann Thorac Surg 1991;51:773-6. https://doi.org/10.1016/0003-4975(91)90124-9
  3. Yasa H, Lafci B, Yilik L, et al. Delayed sternal closure: an effective procedure for life-saving in open-heart surgery. Anadolu Kardiyol Derg 2010;10:163-7. https://doi.org/10.5152/akd.2010.043
  4. Hoit BD. Pathophysiology of the pericardium. Prog Cardiovasc Dis 2017;59:341-8. https://doi.org/10.1016/j.pcad.2016.11.001
  5. Tabbutt S, Duncan BW, McLaughlin D, Wessel DL, Jonas RA, Laussen PC. Delayed sternal closure after cardiac operations in a pediatric population. J Thorac Cardiovasc Surg 1997;113:886-93. https://doi.org/10.1016/S0022-5223(97)70261-7
  6. Hakimi M, Walters HL 3rd, Pinsky WW, Gallagher MJ, Lyons JM. Delayed sternal closure after neonatal cardiac operations. J Thorac Cardiovasc Surg 1994;107:925-33. https://doi.org/10.1016/s0022-5223(94)70351-5
  7. Christenson JT, Maurice J, Simonet F, Velebit V, Schmuziger M. Open chest and delayed sternal closure after cardiac surgery. Eur J Cardiothorac Surg 1996;10:305-11. https://doi.org/10.1016/s1010-7940(96)80087-x
  8. Gangahar DM, McGough EC, Synhorst D. Secondary sternal closure: a method of preventing cardiac compression. Ann Thorac Surg 1981;31:281-2. https://doi.org/10.1016/s0003-4975(10)60944-7
  9. Tanaka Y, Miyamoto T, Naito Y, Yoshitake S, Sasahara A, Miyaji K. Sternal semi-closure using a bioresorbable osteosynthesis device: a new method for delayed sternal closure. Surg Today 2018;48:748-55. https://doi.org/10.1007/s00595-018-1652-9
  10. Kurazumi H, Suzuki R, Nawata R, et al. Feasibility of open chest management with modified negative pressure wound therapy immediately after cardiac surgery. Interact Cardiovasc Thorac Surg 2022;35:ivac041. https://doi.org/10.1093/icvts/ivac041
  11. Normandin S, Safran T, Winocour S, et al. Negative pressure wound therapy: mechanism of action and clinical applications. Semin Plast Surg 2021;35:164-70. https://doi.org/10.1055/s-0041-1731792
  12. van Wingerden JJ, Segers P, Jekel L. Major bleeding during negative pressure wound/V.A.C.(R): therapy for postsurgical deep sternal wound infection: a critical appraisal. J Cardiothorac Surg 2011;6:121. https://doi.org/10.1186/1749-8090-6-121