CURRENT TRENDS IN CARDIAC SURGERY: CLINICAL EXPERIENCE IN THE TREATMENT OF MEDIASTINITIS WITH STERNAL WOUND INFECTION THROUGH NEGATIVE PRESSURE THERAPY

Introduction: During the last decades, a general amelioration of clinical outcomes has been reported because of the evolution of cardiac surgery techniques. However, infective complications as mediastinitis still represent a major problem in terms of morbidity and mortality in cardiac surgery, with severe suffering of the patient. Furthermore, the incidence of this complication has remained stable over the last three decades and this condition also determines a significant prolongation of hospitalization with an increase in costs. The procedures used for the treatment of mediastinitis have undergone deep modifications over the years but, in despite of these improvements, mortality has remained high. Over the last years, the negative pressure therapy (ie the Vacuum Assisted Closure-Therapy) is taking over all the other treatments. Materials and method: From January 2010 to December 2015, at University of Bari Cardiac Surgery Center have been performed 3123 median sternotomy for cardiac surgery. Deep sternal wound infection occurred in 35 patients (1.1207%). In all of these patients was performed vacuum therapy. Results: The duration of vacuum treatment was 14.4 ± 6.7days. Inflammatory indexes showed a marked decline. At the end of vacuum therapy, in some cases, the reconstruction of the wound was carried out with plastic reconstruction by means of a pectoral flap. No deaths for mediastinitis were recorded, neither any relapse or treatment-related complication. Hospital stay was 30.4 ± 13.5 days from the beginning of treatment. Conclusion: The results obtained in our center with vacuum therapy are much more better than those obtained with classic procedures used in the past. Based on our experience and from analysis of literature, vacuum therapy should be the procedure of choice for the treatment of post-sternotomy mediastinitis. Furthermore, this approach has shown satisfactory results in terms of hospital stay time and costs.