Mediastinal vacuum-assisted closure therapy following pediatric congenital cardiac surgery

Abstract

Background: In this study, we report nine pediatric cases who developed sternal wound complications following complex congenital cardiac surgery and treated with mediastinal vacuum-assisted closure technique. Methods: Between January 2014 and December 2015, a total of 473 congenital heart operations were performed in our hospital. Of these patients, nine (8 males, 1 femalesmedian age 24 daysrange 15 days to 14 months) underwent mediastinal vacuum-assisted closure therapy. The indication of vacuum-assisted closure therapy was mediastinitis in five patients and sternal wound complications in four patients. Results: Sternum was left open in four patients after the initial operation. The median time from opening sternum to vacuum-assisted closure therapy was 10 days (range, 7 to 15 days) in these patients. Indications were positive mediastinal cultures in three patients and intolerance for sternal closure due to ventricular dysfunction and cardiac edema in one patient. In the remaining five patients, sternal wound complications developed later and vacuum-assisted closure therapy was applied after a median of 19 days (range, 11 to 36 days) after the operation. Mediastinal cultures were positive in two patients. Two patients (22\%) died of sepsis and multi-organ failure. In the remaining patients, sternal wounds were closed within seven days (range, 5 to 19 days), when sternal cultures were negative or good granulation was obtained. Recurrent sternal wound complication developed in one patient (14.2\%) and vacuum-assisted closure therapy was repeated. All patients, except two, underwent vacuum-assisted closure therapy in the intensive care unit. Conclusion: Mediastinal vacuum-assisted closure therapy is a good option in children with sternal wound complications after cardiac surgery. In addition, it may accelerate the healing process and reduce medical resource use.