title: A rigid barrier between the heart and sternum protects the heart and lungs against rupture during negative pressure wound therapy.
abstract: OBJECTIVE
  Right ventricular heart rupture is a devastating complication associated with negative pressure wound therapy (NPWT) in cardiac surgery. The use of a rigid barrier has been suggested to offer protection against this lethal complication, by preventing the heart from being drawn up and damaged by the sharp edges of the sternum. The aim of the present study was to investigate whether a rigid barrier protects the heart and lungs against injury during NPWT.
  
  
  METHODS
  Sixteen pigs underwent median sternotomy followed by NPWT at -120 mmHg for 24 hours, in the absence (eight pigs) or presence (eight pigs) of a rigid plastic disc between the heart and the sternal edges. The macroscopic appearance of the heart and lungs was inspected after 12 and 24 hours of NPWT.
  
  
  RESULTS
  After 24 hours of NPWT at -120 mmHg the area of epicardial petechial bleeding was 11.90 ± 1.10 cm² when no protective disc was used, and 1.15 ± 0.19 cm² when using the disc (p < 0.001). Heart rupture was observed in three of the eight animals treated with NPWT without the disc. Lung rupture was observed in two of the animals, and lung contusion and emphysema were seen in all animals treated with NPWT without the rigid disc. No injury to the heart or lungs was observed in the group of animals treated with NPWT using the rigid disc.
  
  
  CONCLUSIONS
  Inserting a rigid barrier between the heart and the sternum edges offers protection against heart rupture and lung injury during NPWT.
authors: Department of Cardiothoracic Surgery, Lund University and Skåne University Hospital, Lund, Sweden. sandra.lindstedt@skane.se
authors: Sandra
authors: S
authors: Lindstedt
authors: Richard
authors: R
authors: Ingemansson
authors: Malin
authors: M
authors: Malmsjö
mesh_terms: D000818:Animals; D006348:Cardiac Surgical Procedures; D004195:Disease Models, Animal; D006335:Heart Injuries / Q000209:etiology / Q000517:prevention & control*; D006352:Heart Ventricles; D055370:Lung Injury / Q000209:etiology / Q000517:prevention & control*; D054843:Negative-Pressure Wound Therapy / Q000009:adverse effects*; D012421:Rupture / Q000209:etiology / Q000517:prevention & control; D056346:Sternotomy; D013249:Sternum; D013552:Swine