Impacto de la terapia de vacío en el tratamiento de las infecciones profundas y mediastinitis tras esternotomía media en los últimos 10 años

Abstract

Introduction and objectiveThe vacuum-assisted closure (VAC) therapy is a current method used for post-surgical mediastinitis treatment. The VAC system works by exerting negative pressure on the wound surface.VAC approaches the sternal borders and promotes granulation and angiogenesis, in addition to providing local infection control. Before this therapy, this complication was treated by surgical cleaning, continuous lavage, and the use of vascularised tissue, often with poor patient results.The aim of this study was to analyse the mortality in patients subjected to these treatments. MethodsA review was performed on patients that suffered mediastinitis after cardiac surgery by sternotomy in our hospital during the period between 2005 and 2015. A total of 3843 patients were reviewed. The incidence rate was1.4%, with a total of 54 patients (23 women and 31 men), of whom 31 received vacuum therapy, and 23 received conventional treatments. ResultsThe multiple Cox regression performed show longer survival in patients treated with vacuum therapy (96.8%), compared to 65.2% of the group with no VAC (HR 0.040, 95% CI: 0.002-0.462, P=.023). Secondarily to the objective of the study, statistical significance was observed in curing patients who were not diagnosed with COPD (HR 121.2, 95% CI: 1.44-10,203 P=.034). The remaining variables did not reach statistical significance. ConclusionTo sum up, VAC therapy decreases mortality in patients suffering from medium mediastinitis post-sternotomy, and therefore it can be considered as a first-line treatment.