The HeartShield device reduces the risk for right ventricular damage in patients with deep sternal wound infection.
OBJECTIVE
Right ventricular rupture, resulting in serious bleeding, is a life-threatening complication associated with negative-pressure wound therapy (NPWT) in cardiac surgery. The use of a rigid barrier between the heart and the sharp sternal edges has been successfully tested on pigs. In the present article, we demonstrate increased safety in NPWT through the use of the HeartShield device.


METHODS
Six patients were treated with a specially designed device in combination with NPWT. The device consists of a horizontally placed disk covered in foam. The back of the T-shaped device sticks up between the sternal edges and up above skin level. This part of the device is also covered in foam. Drainage is performed through two holes at the top of the device. The device and foam are changed every second to third day, and -120 mm Hg of continuous therapy is used. Six patients were treated with traditional NPWT, serving as control group.


RESULTS
No signs of calluslike formation were seen on the right ventricle in the group treated with the HeartShield device. In the conventional NPWT control group, all six patients had calluslike formation (>1 × 2 cm2) on the anterior part of the right ventricle. All patients in the HeartShield group had grade 1 epicardial petechial bleeding (<0.5 cm2) on the right ventricle. In the control group, one patient had grade 1 (<0.5 cm2), three patients had grade 2 (0.5-2.0 cm2), and two patients had grade 3 (>2.0 cm2) epicardial petechial bleeding on the right ventricle. No major bleeding or mortality was observed in either group during the course of the study.


CONCLUSIONS
The use of the HeartShield device significantly minimizes the contact between the right ventricle and the sternal edges, thereby decreasing the risk for life-threatening complications due to bleeding.
From the Departments of *Cardiothoracic Surgery, and †Ophthalmology, Lund University Hospital, Lund, Sweden.
Richard
R
Ingemansson
Malin
M
Malmsjö
Sandra
S
Lindstedt
D000368:Aged; D000369:Aged, 80 and over; D004322:Drainage / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006335:Heart Injuries / Q000209:etiology / Q000517:prevention & control*; D006352:Heart Ventricles / Q000293:injuries*; D006801:Humans; D008297:Male; D054843:Negative-Pressure Wound Therapy / Q000009:adverse effects*; D012189:Retrospective Studies; D056346:Sternotomy / Q000009:adverse effects*; D013249:Sternum; D013530:Surgical Wound Infection / Q000628:therapy*