Clinical outcome after poststernotomy mediastinitis: vacuum-assisted closure versus conventional treatment.
BACKGROUND
The conventional treatment for poststernotomy mediastinitis usually involves surgical revision, closed irrigation, or reconstruction with omentum or pectoral muscle flaps. Recently, vacuum-assisted closure has been successfully used in poststernotomy mediastinitis. The aim of the present study was to compare the clinical outcome and survival in 101 patients undergoing vacuum-assisted closure therapy or conventional treatment for poststernotomy mediastinitis.


METHODS
One hundred one consecutive patients underwent treatment for poststernotomy mediastinitis: vacuum-assisted closure therapy (January 1999 through December 2003, n = 61) or conventional treatment (July 1994 through December 1998, n = 40). Follow-up was made in April 2004 and was 100% complete. Actuarial statistics were used to calculate the survival rates.


RESULTS
The 90-days mortality was 0% in the vacuum-assisted closure group and 15% in the conventional treatment group (p < 0.01). The failure rate to first-line treatment with vacuum-assisted closure and conventional treatment were 0% and 37.5%, respectively (p < 0.001). There was no statistically significant difference in the recurrence of sternal fistulas after vacuum-assisted closure therapy or conventional treatment: 6.6% versus 5.0%, respectively. Overall survival in the vacuum-assisted closure group was significantly better (p < 0.05) than in the conventional treatment group: 97% versus 84% (6 months), 93% versus 82% (1 year), and 83% versus 59% (5 years).


CONCLUSIONS
Our findings support that vacuum-assisted closure therapy is a safe and reliable option in poststernotomy mediastinitis with excellent survival and a very low failure rate compared with conventional treatment.
Sjögren
Johan
J
Department of Cardiothoracic Surgery, Lund University Hospital, Lund, Sweden. johan.sjogren@thorax.lu.se
Gustafsson
Ronny
R
Nilsson
Johan
J
Malmsjö
Malin
M
Ingemansson
Richard
R
D000368:Aged; D006348:Cardiac Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008477:Mediastinal Diseases / Q000209:etiology* / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery*; D012189:Retrospective Studies; D013249:Sternum / Q000601:surgery*; D013514:Surgical Procedures, Operative / Q000379:methods* / Q000401:mortality; D016019:Survival Analysis; D016896:Treatment Outcome; D014618:Vacuum