ISSN: 1885-5857 Impact factor 2023 7.2
Vol. 58. Num. 4.
Pages 457 (April 2005)

Vacuum-Assisted Therapy for Mediastinitis After Heart Transplantation

Terapia de vacío en la mediastinitis postrasplante cardíaco

Evaristo CastedoaEmilio MonguióaJuan UgarteaEugenio Lalindeb

Options

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).

Are you a healthcare professional authorized to prescribe or dispense medications?