Comparison of Vacuum-Assisted Closure Therapy Versus Conventional Treatment for Post-sternotomy Mediastinitis: A Retrospective Study From a Tertiary Care Centre.

BACKGROUND

A median sternotomy is widely utilised as the standard approach for open cardiac surgeries to manage heart conditions like heart failure, valve disorders, irregular heart rhythms as part of arrhythmia surgery, aneurysms, and coronary artery disease, with coronary artery bypass grafting (CABG) being a common procedure. Despite the application of proper aseptic techniques, perioperative antibiotics, and meticulous wound care, surgical site infections, such as deep sternal wound infections (DSWI) or mediastinitis, can still develop.

METHODOLOGY

Between October 2016 and December 2023, 1,542 osteotomies were performed on patients undergoing cardiac surgeries in the Department of Cardiothoracic and Vascular Surgery, Jawaharlal Nehru Medical College, Aligarh. Thirty-six patients (2.34%) were diagnosed with mediastinitis post-cardiac surgery. These patients were analysed retrospectively for demographics and clinical information comprising of medical history, vital signs, findings from a comprehensive clinical examination, laboratory results, comorbidities, prior surgeries, duration of hospital stay, and the indication for the current procedure, and two groups were formed: Group 1 (n = 20), who were treated with vacuum-assisted closure (VAC) therapy, and Group 2 (n = 16), who received conventional treatment.

RESULTS

The mean age of patients in the vacuum-assisted closure group was 38.9 ± 4.5 years, while the conventional treatment group had a mean age of 43.6 ± 5.0 years; other baseline characteristics were comparable in both groups. The average length of hospital stay after VAC therapy was 13 ± 2.5 days, with 16 patients requiring intensive care unit admission for more than three days. The conventional treatment group had an average stay of 23 ± 3.2 days, with eight patients needing ICU care for over three days. The duration of treatment, calculated from the time of mediastinitis diagnosis, was 16 days in the VAC group compared to 22 days in the conventional treatment group. The mortality rate in our study was 5% in the VAC therapy group and 6.25% in the conventional treatment group. Both patients who died did so due to multiorgan failure resulting from severe sepsis.

CONCLUSION

VAC therapy can be considered a good alternative to more aggressive surgery that might not be suitable for some patients during certain times of their treatment course. It can also be used as a bridge to reconstructive surgery by improving the wound situation and the patient's general condition. This will improve the clinical outcome and patient satisfaction. VAC therapy for poststernotomy mediastinitis is an effective treatment, which speeds up wound granulation tissue formation and accelerates wound closure with decreased need for more aggressive reconstructive surgery. Moreover, accelerated wound closure may be associated with fewer complications and reduced expenses.