Single-Center Outcomes of Vacuum-Assisted Closure Therapy for Mediastinitis After Pediatric Cardiac Surgery

Objectives: Vacuum-assisted closure therapy is useful in treating mediastinitis, which is related to high mortality and morbidity rates after cardiac surgery. This study aimed to present our experience with vacuum-assisted closure therapy in mediastinitis after pediatric cardiac surgery.
Methods: This retrospective review included 10 patients who underwent vacuum-assisted closure therapy for mediastinitis in a single institution from 2020 to 2022. Patients with wound discharge or abscess, sternal dehiscence, fever, and positive wound culture were considered to have mediastinitis. The vacuum sponge was cut at the appropriate size for the mediastinal defect and the skin edges were approximated with prolene sutures. The vacuuming continuously started at −50 mm Hg.
Results: Six (60%) patients were female and the median age during therapy was 1.9 months (range: 0.1–54 months). Five (50%) patients were neonates. The median duration of vacuum-assisted closure therapy was 14.5 days (range: 4–78). The median duration to obtain negative mediastinal culture was 14.5 days (range: 6–76). The sternum could be closed without difficulty in all patients except one who died due to low cardiac output. Hospital mortality occurred in 3 (30%) patients who needed extracorporeal membrane oxygenation support postoperatively. The median duration of follow-up was 10 months (range: 2–28).
Conclusion: Mediastinitis is an important problem associated with high morbidity and mortality rates after pediatric cardiac surgery. Data suggest that vacuum-assisted closure therapy can safely treat mediastinal infections without recurrence.