Comparison between Vacuum-Assisted Closure Technique and Conventional Approach in Patients with Mediastinitis After Isolated Coronary Artery Bypass Graft Surgery

ABSTRACT Introduction: Median sternotomy is the most preferred approach in heart surgery. Post-sternotomy mediastinitis is a catastrophic and potentially life-threatening complication with an incidence rate of 0.15% to 5%, and its overall mortality rate reaches 47%. In this study, we aimed to compare the results of vacuum-assisted closure technique and the conventional methods on the management of mediastinitis following isolated coronary artery bypass graft surgery. Methods: Between February 2001 and July 2013, 32,106 patients who underwent cardiac operations were evaluated retrospectively. One hundred and fourteen patients who developed post-sternotomy mediastinitis were included in this study. The patients were divided into two groups and compared - vacuum-assisted closure group (n=52, 45.6%) and conventional treatment group (n=62, 54.4%). Results: There were no differences between the two groups according to the patients’ characteristics, surgical data, and mediastinal cultures. However, we found that total treatment duration for post-sternotomy mediastinitis, time interval from diagnosis to negative culture, hospitalization time, and in-hospital mortality were statistically significantly lower in the vacuum-assisted closure group than in the conventional treatment group (P<0.001, P<0.001, P<0.001, and P=0.03, respectively). Conclusion: This study demonstrates that the vacuum-assisted closure technique improves the medical outcome of patients with post-sternotomy mediastinitis compared with the conventional treatment. The vacuum-assisted closure is a safe and more effective treatment modality for patients with post-sternotomy mediastinitis after cardiac surgery with reasonable morbidity and mortality.

摘要
引言：正中胸骨切开术是心脏手术中最常用的手术入路。胸骨切开术后纵隔炎是一种灾难性且潜在致命的并发症，发病率为0.15%~5%，总体死亡率高达47%。本研究旨在比较负压封闭引流术（vacuum-assisted closure, VAC）与传统疗法治疗单纯冠状动脉旁路移植术后纵隔炎的临床疗效。
方法：2001年2月至2013年7月期间，本研究对32106例行心脏手术的患者进行了回顾性分析。最终纳入114例确诊胸骨切开术后纵隔炎的患者，将其分为两组进行对比：负压封闭引流组（n=52，45.6%）与传统治疗组（n=62，54.4%）。
结果：两组患者的基线特征、手术相关资料及纵隔培养结果均无统计学差异。但研究结果显示，负压封闭引流组患者的纵隔炎总治疗时长、确诊至培养转阴的时间、住院时长及院内死亡率均显著低于传统治疗组（分别为P<0.001、P<0.001、P<0.001及P=0.03）。
结论：本研究证实，与传统治疗方案相比，负压封闭引流术可改善胸骨切开术后纵隔炎患者的临床结局。对于心脏手术后并发胸骨切开术后纵隔炎的患者，负压封闭引流术是一种安全且更为有效的治疗方式，可获得可控的并发症发生率与死亡率。