Vacuum-assisted closure of post-sternotomy mediastinitis as compared to open packing

Post-sternotomy mediastinitis is a rare but serious complication of cardiac surgery leading to prolonged hospital stay and higher mortality. In the last decades several treatment modalities have been described, of which vacuum-assisted closure (VAC) shows the most promising results. The aim of this study is to describe clinical outcomes of VAC as compared to open packing and to predict risk factors for mortality. We performed a retrospective analysis of 113 patients with mediastinitis undergoing VAC (n = 89) or open packing (n = 24) between January 2000 and July 2010. Patient characteristics, risk factors and procedure-related variables were analysed. C-reactive protein and leukocyte counts were determined on admission and at regular intervals during hospital stay. We compared length of treatment, treatment failure, hospital stay and mortality. We also analysed risk factors predicting mortality. In-hospital mortality in the VAC group was 12.4% compared to 41.7% in the conventional group (P = 0.0032). Intensive care stay was 6.8 +/- 14.4 days with VAC therapy compared to 18.5 +/- 21.0 days with open packing (P = 0.0081). Significant risk factors for mortality were pre-operative renal failure and obesity. Our findings indicate that VAC therapy is superior to open packing, resulting in shorter intensive care stay and improved survival.