Abstract
ObjectivesRight ventricular heart rupture is a devastating complication associated with negative pressure wound therapy (NPWT) in cardiac surgery. The use of a rigid barrier has been suggested to offer protection against this lethal complication, by preventing the heart from being drawn up and damaged by the sharp edges of the sternum. The aim of the present study was to investigate whether a rigid barrier protects the heart and lungs against injury during NPWT.MethodsSixteen pigs underwent median sternotomy followed by NPWT at -120 mmHg for 24 hours, in the absence (eight pigs) or presence (eight pigs) of a rigid plastic disc between the heart and the sternal edges. The macroscopic appearance of the heart and lungs was inspected after 12 and 24 hours of NPWT.ResultsAfter 24 hours of NPWT at -120 mmHg the area of epicardial petechial bleeding was 11.90 ± 1.10 cm2 when no protective disc was used, and 1.15 ± 0.19 cm2 when using the disc (p < 0.001). Heart rupture was observed in three of the eight animals treated with NPWT without the disc. Lung rupture was observed in two of the animals, and lung contusion and emphysema were seen in all animals treated with NPWT without the rigid disc. No injury to the heart or lungs was observed in the group of animals treated with NPWT using the rigid disc.ConclusionInserting a rigid barrier between the heart and the sternum edges offers protection against heart rupture and lung injury during NPWT.
Highlights
Cardiac surgery is complicated by poststernotomy mediastinitis in 1 to 5% of all procedures [1], and is a lifethreatening complication [2]
In 1999, Obdeijn and colleagues described the treatment of poststernotomy mediastinitis using vacuum-assisted closure [5], called negative pressure wound therapy (NPWT)
After 12 hours of NPWT, the area of epicardial bleeding was significantly larger when NPWT had been performed without the rigid disc (10.40 ± 1.10 cm2) than with the disc (1.03 ± 0.20 cm2, p < 0.001, Figure 2)
Summary
Cardiac surgery is complicated by poststernotomy mediastinitis in 1 to 5% of all procedures [1], and is a lifethreatening complication [2]. The reported early mortality using conventional therapy is between 8 and 25% [3,4]. In 1999, Obdeijn and colleagues described the treatment of poststernotomy mediastinitis using vacuum-assisted closure [5], called negative pressure wound therapy (NPWT). The technique entails the application of negative pressure to a sealed wound. NPWT has remarkable effects on the healing of poststernotomy mediastinitis, and has reduced the rate of mortality considerably [6]. There are, increasing numbers of reports of deaths and serious complications associated with the
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