Vacuum-assisted closure with Safetac technology for mediastinitis in patients with a ventricular assist device

Excerpt

Mediastinitis, a possible complication of cardiovascular surgery, is a serious and fatal pathophysiologic condition occurring in 0.4 to 5% of surgical cases. The mortality of this disease is 10 to 40% [1, 2]. In particular, it is difficult to control mediastinal infection in most of the cases in which artificial devices such as vascular prostheses are present. While favorable outcomes have increased when the Toyobo left ventricular assist device (LVAD) has been used in end-stage heart failure cases, frequently patients who are in poor general condition before surgery and patients who have undergone multiple surgeries may develop mediastinitis as a surgical complication, and these patients are very difficult to save. The Toyobo LVAD system generally has an outflow vascular prosthesis connected to the ascending aorta in the anterior mediastinum, and inflow and outflow conduits are inserted through the muscle and skin layers of the upper part of the abdomen. If mediastinitis occurs under these conditions, the outflow vascular prosthesis really exists within an abscess, and it is therefore extremely difficult to control infection. …