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. 2022 Jun 15;35(1):ivac041.
doi: 10.1093/icvts/ivac041.

Feasibility of open chest management with modified negative pressure wound therapy immediately after cardiac surgery

Hiroshi Kurazumi  1 , Ryo Suzuki  1 , Ryosuke Nawata  1 , Toshiki Yokoyama  1 , Sarii Tsubone  1 , Yutaro Matsuno  1 , Akihito Mikamo  1 , Kimikazu Hamano  1
Affiliations

Feasibility of open chest management with modified negative pressure wound therapy immediately after cardiac surgery

Hiroshi Kurazumi et al. Interact Cardiovasc Thorac Surg. .

Abstract

Objectives: To evaluate the feasibility of open chest management with our modified negative pressure wound therapy immediately after cardiac surgery as a therapy for atypical tamponade.

Methods: Open chest with modified negative pressure wound therapy was performed immediately after cardiac surgery. The surface of the heart and the vessels were covered with non-adherent siliconized gauze. The sternal halves were stented using edge-cut disposable syringes to maintain a larger mediastinal cavity. Approximately 45 mm of distance was kept between the sternal edges. A trimmed sterile polyvinyl foam sponge was inserted into the mediastinum, the entire wound was sealed and negative pressure (-50 to -75 mmHg) was applied using a suction generator. Delayed chest closure was performed in a standard manner once the haemodynamic status was stabilizsed.

Results: The mortality rate was 3/15 (20%) patients. Deep sternal wound infection occurred in 1/15 (6.7%) patients. Five patients were extubated during the open chest management. Sternal closure was delayed for median of 3 days after the initial surgery. There was no incidence of bleeding complications or need for additional haemostatic procedures.

Conclusions: Negative pressure wound therapy performed immediately after cardiac surgery was feasible in our small number of patients.

Clinical registration number: Study ID: 2020-149.

Keywords: Delayed sternal closure; Negative wound pressure therapy; Open chest management.

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Figures

Figure 1:
Figure 1:
Schematic drawings and intraoperative images of the open chest management with negative pressure wound therapy applied immediately after cardiac surgery. (A) The sternal halves were stented using modified 20-ml syringes and a sterile polyvinyl foam sponge covered the mediastinum; the corresponding intraoperative images are shown in (B). (C) Negative pressure was applied using a suction generator; the corresponding intraoperative images are shown in (D). (E) The cross-section of this therapy.
See this image and copyright information in PMC

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