Vacuum‐Assisted Closure for Mediastinitis in Pediatric Cardiac Surgery: A Single‐Center Experience

Abstract

Vacuum‐assisted closure (VAC) has been widely used to treat mediastinitis after congenital cardiac surgery, which is associated with a high risk of morbidity and mortality. The aim in this study is to review our 14 cases of mediastinitis treated with VAC therapy after congenital cardiac surgery. We retrospectively reviewed the medical records of 14 congenital heart patients with mediastinitis from January 2012 to March 2017. Patients with fever, wound discharge, sternal dehiscence, a positive wound culture or abscess diagnosed with computed tomography are accepted as mediastinitis. A VAC was applied to all our patients without irrigation or dressing the wound because of sterility concerns. The vacuuming of the wound was either 50 mm Hg or 75 mm Hg according to the sternal intactness. We gradually decreased the pressures and changed the VAC systems once every three days, after wound healing was seen and a negative culture was obtained and VAC was terminated. There were 14 patients (8 male and 6 female) with mediastinitis and all of them were treated using VAC. The mean age of the patients was 6.96 months (ranging from 0.5‐26 months). The mean weight was 5.16 kg (2.8‐12 kg). Three patients needed extracorporeal membrane oxygenation after the surgery. Mean onset of mediastinitis was 25.3 days. The wound cultures showed methicillin resistant coagulase negative streptococcus and methicillin‐sensitive staphylococcus aureus in most cases. Acinetobacter, serratia, pseudomonas, and klebsiella were the other bacterial species seen in cultures. Two patients had mediastinitis symptoms, but their cultures were negative. VAC systems were changed 3.85 times on average. Mean duration of hospital stay was 49.9 days (21‐104 days). One patient needed a muscle flap to close the thoracic cavity after mediastinitis. Two patients did not survive. Mediastinitis is a serious postoperative condition in pediatric cardiac surgery patients. Classical wound dressing and irrigation methods are not suitable in mediastinitis for the pediatric age group. Therefore, VAC therapy can be an effective way to successfully treat the situation.

Is vacuum‐assisted closure therapy feasible for children with deep sternal wound infection after cardiac surgery? The pooling results from current literature

“…Five case series studies 14,17,18,20,22 reported overall mortality, and the pooled estimate of overall mortality was 5.8% (95% CI, 2.5%-9.1%, I 2 = 0%, Figure 3B). However, only two deaths resulted from severely infectious complications, one from sepsis and the other from infectious endocarditis.…”

Artificial Organs 2019: A year in review

“…Ismihan Selen Onan et al of İstanbul SBU Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Research and Training Hospital, Istanbul, Turkey reported on their experience on 14 patients with vacuum assisted closure (VAC) for mediastinitis in pediatric cardiac surgery. Classical wound dressing and irrigation methods are not suitable in mediastinitis for the pediatric age group.…”

Impact of Istanbul Symposiums and Artificial Organs on education and training of young clinicians and the outcomes of congenital heart surgery patients in Turkey

“…A handful of talented young clinicians started the congenital heart surgery program in this particular public hospital in 2010. In only a few years, this particular program significantly improved the outcomes of congenital heart surgery as well as pediatric ECLS patients in Turkey . Despite patients having very high‐risk stratification scores, overall mortality rates after congenital heart surgery at this particular public hospital were one of the lowest in Turkey in 2018 [presented at the 10th Istanbul Symposium on November 16, 2018].…”

“…In only a few years, this particular program significantly improved the outcomes of congenital heart surgery as well as pediatric ECLS patients in Turkey. [14][15][16][17][18][19] Despite patients having very high-risk stratification scores, overall mortality rates after congenital heart surgery at this particular public hospital were one of the lowest in Turkey in 2018 [presented at the 10th Istanbul Symposium on November 16, 2018]. This is partially due to their multidisciplinary weekly morbidity and mortality conference, which has allowed them to successfully analyze and improve their outcomes throughout the past several years.…”