ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Mediastinal vacuum-assisted closure therapy following pediatric congenital cardiac surgery
Selim Aydın1, Bahar Temur1, Dilek Suzan1, Barış Kırat2, İbrahim Halil Demir3, Metehan Özen4, Ersin Erek1
1Acıbadem Üniversitesi Atakent Hastanesi, Kalp ve Damar Cerrahisi Bölümü, İstanbul, Türkiye
2Acıbadem Üniversitesi Atakent Hastanesi, Anesteziyoloji ve Reanimasyon Bölümü, İstanbul, Türkiye
3Acıbadem Üniversitesi Atakent Hastanesi, Çocuk Kardiyolojisi Bölümü, İstanbul, Türkiye
4Acıbadem Üniversitesi Atakent Hastanesi, Çocuk Enfeksiyon Hastalıkları Bölümü, İstanbul, Türkiye
DOI : 10.5606/tgkdc.dergisi.2017.13820
Background: In this study, we report nine pediatric cases who developed sternal wound complications following complex congenital cardiac surgery and treated with mediastinal vacuumassisted 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 females; median age 24 days; range 15 days to 14 months) underwent mediastinal vacuumassisted 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 vacuumassisted 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.

Keywords : Congenital heart surgery; mediastinitis; newborn; sternum; vacuum-assisted closure
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