Vacuum-Assisted Closure for Mediastinitis after Pediatric Cardiac Surgery

Hiramatsu, Takeshi; Okamura, Yoshitaka; Komori, Shigeru; Nishimura, Yoshiharu; Suzuki, Hiroyuki; Takeuchi, Takashi

doi:10.1177/021849230801600524

Cited by 13 publications

(5 citation statements)

References 5 publications

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“…Although VAC has been widely recognized as an effective treatment for mediastinitis, in the field of paediatric cardiovascular surgery, this treatment is not used much because there is an undispelled concern of adverse effects caused by the strong negative pressure on the small heart of children, specific circulation and anatomy, and the existence of anastomosis on the right ventricle, such as in cases of single ventricular physiology and Rastelli-type surgery [4]. Data on the effects of VAC on haemodynamics are conflicting.…”

Section: S Takahara Et Al / Interactive Cardiovascular and Thoracicmentioning

confidence: 99%

“…Since the introduction of the vacuum-assisted closure (VAC) experience by Argenta and Morykwas [2] in 1997, this therapy has been used to treat mediastinitis and has been reported to be an effective treatment, particularly in adults [3]. The concept of this modality is based on the uniform application of strong negative pressure to the wound, which results in arteriolar dilatation and subsequently promotes granulation tissue proliferation [4].…”

Section: Introductionmentioning

confidence: 99%

“…aortopulmonary shunt, bidirectional Glenn shunt, Fontan circulation, Rastelli-type procedure, etc.) [4]. Therefore, we evaluated paediatric patients with poststernotomy mediastinitis and congenital heart disease who were treated with VAC and assessed their outcomes and the haemodynamic effects of this treatment by measuring certain clinical indices.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and haemodynamic effects of vacuum-assisted closure for post-sternotomy mediastinitis in children

Takahara

Kagatani

et al. 2014

Interact CardioVasc Thorac Surg

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OBJECTIVES: Post-sternotomy mediastinitis is a significant morbidity with controversial management. Vacuum-assisted closure (VAC) has been used to treat mediastinitis, with many reports documenting its efficacy and feasibility, particularly in adults. However, its use is not prevalent in the paediatric population because of concerns that it may deteriorate haemodynamics. This study aimed to evaluate outcomes and effects of VAC on the haemodynamics of paediatric patients with post-sternotomy mediastinitis. METHODS:Six patients were treated with VAC between April 2005 and March 2013. We retrospectively investigated their profiles, clinical outcomes and haemodynamic changes, including mean blood pressure (MBP), mean heart rate (MHR), urinary output, amount of diuretics and vasoactive-inotropic score (VIS), before and after VAC initiation. RESULTS:The median age and body weight of patients were 6.4 months and 4.5 kg, respectively. Three patients (50%) had single ventricular physiology. The median VAC duration was 12 days. One patient died of pulmonary venous obstruction after mediastinitis was cured. The average MBPs in every 8-h period were examined, and there were no significant changes (P = 0.773); the average MHRs were examined in the same manner and they decreased significantly after initiation of VAC (P = 0.032). Only 2 patients required vasoactive agents. The VIS did not change in 1 patient and decreased in the other. The mean amount of diuretics administered and urinary output per body weight did not change significantly (P = 0.395 and 0.273, respectively). CONCLUSIONS:In conclusion, the haemodynamics of children were not significantly affected by the negative pressure of VAC, indicating that this therapy may be safe and effective for post-sternotomy mediastinitis, even in small children with complex cardiac anomalies.

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Section: S Takahara Et Al / Interactive Cardiovascular and Thoracicmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Efficacy and haemodynamic effects of vacuum-assisted closure for post-sternotomy mediastinitis in children

Takahara

Kagatani

et al. 2014

Interact CardioVasc Thorac Surg

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“…The application of negative pressure has several advantages: (1) Wound drainage is enhanced by negative pressure; (2) The negative pressure avoids any residual mediastinal cavity so that the mediastinum is fill with healthy tissue; (3) The negative pressure helps approximate the wound edges and favors stabilization of the chest; and (4) Some benefits in local microcirculation have been described. This newly emerging technique was used with success in small groups of pediatric patients [75][76][77][78] . The mechanism by which the vacuum technique improves wound healing is still unclear.…”

Section: Treatmentmentioning

confidence: 99%

Mediastinitis in pediatric cardiac surgery: Prevention, diagnosis and treatment

Durandy¹

2010

WJC

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In spite of advances in the management of mediastinitis following sternotomy, mediastinitis is still associated with significant morbidity. The prognosis is much better in pediatric surgery compared to adult surgery, but the prolonged hospital stays with intravenous therapy and frequent required dressing changes that occur with several therapeutic approaches are poorly tolerated. Prevention includes nasal decontamination, skin preparation, antibioprophylaxis and air filtration in the operating theater. The expertise of the surgical team is an additional factor that is difficult to assess precisely. Diagnosis is often very simple, being made on the basis of a septic state with wound modification, while retrosternal puncture and CT scan are rarely useful. Treatment of mediastinitis following sternotomy is always a combination of surgical debridement and antibiotic therapy. Continued use of numerous surgical techniques demonstrates that there is no consensus and the best treatment has yet to be determined. However, we suggest that a primary sternal closure is the best surgical option for pediatric patients. We propose a simple technique with high-vacuum Redon's catheter drainage that allows early mobilization and short term antibiotherapy, which thus decreases physiological and psychological trauma for patients and families. We have demonstrated the efficiency of this technique, which is also cost-effective by decreasing intensive care and hospital stay durations, in a large group of patients.

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“…Protocols should be developed to help surgeons to manage this devastating complication. 1 Surgical drainage with debridement 8 and appropriate antibiotic regimen are considered as the corner stone for mediastinitis treatment. However, the best treatment strategy to fasten the healing of the wound is still controversial.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Primary Closure Technique in Treatment of Post-Sternotomy Mediastinitis in Paediatric Group: A Randomized Controlled Trial

Fadaly¹,

Abdellatif²,

Saeed³

et al. 2022

IJGM

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Purpose To assess the efficacy of primary sternal closure technique compared to vacuum-assisted closure technique in treatment of post-cardiac surgery mediastinitis in paediatric age group. Additionally, assessed postoperative need for IV drug use, hospital stay length, wound and sternal healing and survival. Hypotheses: primary sternal closure is a reliable technique for treatment of poststernotomy mediastinitis following cardiac surgery in paediatric age group. Materials and Methods A prospective randomized controlled trial included 217 pediatric patients developed post-cardiac surgery mediastinitis from 2016 to 2022. They were randomly divided into primary sternal closure group (A) and vacuum-assisted closure group (B) and operated by two cardiothoracic surgeons. Follow-up of the patients was done for 6-months duration following treatment of mediastinitis to assess postoperative need for hospitalization, IV drug use, wound complications, sternal stability and survival. Results The final analysis included 101 patients in each group. The chance of survival over 6 months after surgery was more for primary sternal closure group (175.2) days versus (157.6) days for the vacuum-assisted closure group, with significant difference Log Rank test p-value (0.005). Duration for IV antibiotics use in the primary closure group was 8.55±3.57 and it was 32.61±8.39 showing high statistically significant difference (p<0.001). Patients in the primary closure group had earlier discharge from hospital 15.77±4.18 than vacuum assisted group 42.61±8.39, with high statistically significant difference (p<0.001). Primary closure group showed better sternal stability and sternotomy wound healing on clinical follow-up. Conclusion Primary sternal closure technique is a favorable technique over vacuum-assisted closure technique for treatment of paediatric mediastinitis following cardiac surgery. The reinforced sternal closure technique is a reliable technique with promising results regarding IV drugs need, hospitalization duration, survival and sternotomy wound healing.

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Vacuum-Assisted Closure for Mediastinitis after Pediatric Cardiac Surgery

Cited by 13 publications

References 5 publications

Efficacy and haemodynamic effects of vacuum-assisted closure for post-sternotomy mediastinitis in children

Efficacy and haemodynamic effects of vacuum-assisted closure for post-sternotomy mediastinitis in children

Mediastinitis in pediatric cardiac surgery: Prevention, diagnosis and treatment

Efficacy of Primary Closure Technique in Treatment of Post-Sternotomy Mediastinitis in Paediatric Group: A Randomized Controlled Trial

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