Publish in this journal
Journal Information
Vol. 58. Issue 4.
Pages 457 (April 2005)
Share
Share
Download PDF
More article options
Vol. 58. Issue 4.
Pages 457 (April 2005)
DOI: 10.1016/S1885-5857(06)60678-6
Full text access
Vacuum-Assisted Therapy for Mediastinitis After Heart Transplantation
Terapia de vacío en la mediastinitis postrasplante cardíaco
Visits
9750
Evaristo Castedoa, Emilio Monguióa, Juan Ugartea, Eugenio Lalindeb
a Departamento de Cirugía Cardiovascular, Clínica Puerta de Hierro, Madrid, Spain.
b Cirugía Plástica, Clínica Puerta de Hierro, Madrid, Spain.
This item has received
9750
Visits
Article information
Full Text
Download PDF
Statistics
Figures (1)
Full Text

To the Editor:

In our heart transplant patients, postoperative mediastinitis is uncommon (1.4%), but when it does occur it is associated with very high mortality (42%). Its treatment is complex: immunosuppression needs to be temporarily suspended, and the patient usually has to be reintubated due to sternal instability.

Vacuum assisted closure (VAC) was first used in 1997 in plastic surgery, and the results were spectacular. We successfully used this technique in a 52 year-old man following surgical debridement to treat post-transplant mediastinitis (Figure, A). The system used (VAC®, KCI Clinic Spain, S.L.) involves placing a polyurethane sponge in the chest wound and covering it with a plastic adhesive (Figure, B). The area is then hermetically connected to a continuous aspiration system (Figure, C). The sponge is changed every 48 h. The negative pressure developed must be between 125 and 200 mm Hg; lower pressures are inefficient while higher pressures can provoke cardiac tamponade.

Figure. A: mediastinitis: acute phase. B: the vacuum assisted closure system in place. C: continuous aspiration apparatus. D: granulation phase 5 days after vacuum assisted closure. E: definitive cure 40 days later.

The advantages of this technique, which render it the closure method of choice in transplant patients, include the rapid induction of granulation and angiogenesis, rapid control of the infection (Figure, D) (which allows immunosuppression to be quickly reestablished), and the provision of great sternal stability. The latter facilitates extubation (Figure, B) and the mobilization of the patient during treatment. In the present case the technique provided a bridge until plasty of the left major pectoral muscle (inversion), which was performed 5 days later. A definitive cure was achieved (Figure, E).

Idiomas
Revista Española de Cardiología (English Edition)

Subscribe to our newsletter

Article options
Tools
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

es en
Política de cookies Cookies policy
Utilizamos cookies propias y de terceros para mejorar nuestros servicios y mostrarle publicidad relacionada con sus preferencias mediante el análisis de sus hábitos de navegación. Si continua navegando, consideramos que acepta su uso. Puede cambiar la configuración u obtener más información aquí. To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.