Vacuum-assisted closure in cardiac surgery - clinical outcome and vascular effects

Johan Sjögren

Vacuum-assisted closure in cardiac surgery - clinical outcome and vascular effects

Thoracic Surgery

Research output: Thesis › Doctoral Thesis (compilation)

Abstract

The aim of this research was to clinically and experimentally evaluate the use of vacuum-assisted closure in poststernotomy mediastinitis after cardiac surgery. Vacuum-assisted closure (VAC) is a new wound-healing therapy based on the application of a local negative pressure to the wound. New techniques for treating poststernotomy mediastinitis are needed since conventional techniques have an unsatisfactorily high mortality rate and are associated with high morbidity. It was concluded that VAC in poststernotomy mediastinitis results in a lower mortality rate and a lower rate of recurrent infection compared to conventional treatment. The long-term survival after VAC-treated mediastinitis following isolated coronary artery bypass grafting (CABG) was similar to the long-term survival in CABG without mediastinitis. Obesity, diabetes mellitus, low left ventricular ejection fraction, renal failure, and three-vessel disease were identified as independent risk factors for developing mediastinitis after isolated CABG. It was shown that VAC can be applied without impairment of the central hemodynamics in a sternotomy wound model. It was also shown that the application of VAC for 12 hours does not induce perforation or dissection of porcine femoral arteries. However, the endothelin-receptor-mediated vasoconstriction was enhanced, together with more efficacious endothelium-dependent vasodilatation.

In conclusion, the clinical results when using VAC in poststernotomy mediastinitis were superior to conventional treatment, both in the short and the long term. The experimental results indicate that VAC can be used safely without impairment of central hemodynamics or damage to the blood vessels.

Original language	English
Qualification	Doctor
Awarding Institution	Thoracic Surgery
Supervisors/Advisors	Ingemansson, Richard, Supervisor
Award date	2005 May 19
Publisher	Department of Cardiothoracic Surgery, Clinical Sciences, Lund University
ISBN (Print)	91-85439-35-5
Publication status	Published - 2005

Bibliographical note

Defence details

Date: 2005-05-19
Time: 13:00
Place: Segerfalkssalen, Wallenberg Neurocenter, BMC

External reviewer(s)

Name: Ivert, Torbjörn
Title: Associate Professor
Affiliation: Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden

---

<div class="article_info">J Sjögren, R Gustafsson, J Nilsson, M Malmsjö and R Ingemansson. <span class="article_issue_date">2005</span>. <span class="article_title">Clinical Outcome after Poststernotomy Mediastinitis: Vacuum-Assisted Closure Therapy versus Conventional Treatment.</span> <span class="journal_series_title">The Annals of Thoracic Surgery</span>, (inpress)</div>
<div class="article_info">J Sjögren, J Nilsson, R Gustafsson, M Malmsjö and R Ingemansson. <span class="article_issue_date">2005</span>. <span class="article_title">The Impact of Vacuum-Assisted Closure on Long-Term Survival after Poststernotomy Mediastinitis.</span> <span class="journal_series_title">The Annals of Thoracic Surgery</span>, (accepted)</div>
<div class="article_info">J Sjögren, R Gustafsson, A Wackenfors, M Malmsjö, L Algotsson and R Ingemansson. <span class="article_issue_date">2004</span>. <span class="article_title">Effects of Vacuum-Assisted Closure on Hemodynamic Parameters in a Porcine Sternotomy Wound Model.</span> <span class="journal_series_title">Interactive Cardiovascular and Thoracic Surgery</span>, <span class="journal_volume">vol 3</span> <span class="journal_pages">pp 666-71</span>.</div>
<div class="article_info">A Wackenfors, J Sjögren, L Algotsson, R Gustafsson, R Ingemansson and M Malmsjö. <span class="article_issue_date">2004</span>. <span class="article_title">The Effect of Vacuum-Assisted Closure Therapy on the Pig Femoral Artery Vasomotor Responses.</span> <span class="journal_series_title">Wound Repair and Regeneration</span>, <span class="journal_volume">vol 12</span> <span class="journal_pages">pp 244-51</span>.</div>

Subject classification (UKÄ)

Cardiac and Cardiovascular Systems
Surgery

Keywords

orthopaedics
Surgery
Kardiovaskulära systemet
Cardiovascular system
Infektioner
Infections
endothelium
vascular
central hemodynamics
risk factors
long-term survival
mortality
wound closure
cardiac surgery
vacuum-assisted closure
poststernotomy mediastinitis
traumatology
Kirurgi
ortopedi
traumatologi

Cite this

@phdthesis{b8f278108bff427ca0680fcb72d95fca,

title = "Vacuum-assisted closure in cardiac surgery - clinical outcome and vascular effects",

abstract = "The aim of this research was to clinically and experimentally evaluate the use of vacuum-assisted closure in poststernotomy mediastinitis after cardiac surgery. Vacuum-assisted closure (VAC) is a new wound-healing therapy based on the application of a local negative pressure to the wound. New techniques for treating poststernotomy mediastinitis are needed since conventional techniques have an unsatisfactorily high mortality rate and are associated with high morbidity. It was concluded that VAC in poststernotomy mediastinitis results in a lower mortality rate and a lower rate of recurrent infection compared to conventional treatment. The long-term survival after VAC-treated mediastinitis following isolated coronary artery bypass grafting (CABG) was similar to the long-term survival in CABG without mediastinitis. Obesity, diabetes mellitus, low left ventricular ejection fraction, renal failure, and three-vessel disease were identified as independent risk factors for developing mediastinitis after isolated CABG. It was shown that VAC can be applied without impairment of the central hemodynamics in a sternotomy wound model. It was also shown that the application of VAC for 12 hours does not induce perforation or dissection of porcine femoral arteries. However, the endothelin-receptor-mediated vasoconstriction was enhanced, together with more efficacious endothelium-dependent vasodilatation. In conclusion, the clinical results when using VAC in poststernotomy mediastinitis were superior to conventional treatment, both in the short and the long term. The experimental results indicate that VAC can be used safely without impairment of central hemodynamics or damage to the blood vessels.",

keywords = "orthopaedics, Surgery, Kardiovaskul{\"a}ra systemet, Cardiovascular system, Infektioner, Infections, endothelium, vascular, central hemodynamics, risk factors, long-term survival, mortality, wound closure, cardiac surgery, vacuum-assisted closure, poststernotomy mediastinitis, traumatology, Kirurgi, ortopedi, traumatologi",

author = "Johan Sj{\"o}gren",

note = "Defence details Date: 2005-05-19 Time: 13:00 Place: Segerfalkssalen, Wallenberg Neurocenter, BMC External reviewer(s) Name: Ivert, Torbj{\"o}rn Title: Associate Professor Affiliation: Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden --- <div class={"}article_info{"}>J Sj{\"o}gren, R Gustafsson, J Nilsson, M Malmsj{\"o} and R Ingemansson. <span class={"}article_issue_date{"}>2005</span>. <span class={"}article_title{"}>Clinical Outcome after Poststernotomy Mediastinitis: Vacuum-Assisted Closure Therapy versus Conventional Treatment.</span> <span class={"}journal_series_title{"}>The Annals of Thoracic Surgery</span>, (inpress)</div> <div class={"}article_info{"}>J Sj{\"o}gren, J Nilsson, R Gustafsson, M Malmsj{\"o} and R Ingemansson. <span class={"}article_issue_date{"}>2005</span>. <span class={"}article_title{"}>The Impact of Vacuum-Assisted Closure on Long-Term Survival after Poststernotomy Mediastinitis.</span> <span class={"}journal_series_title{"}>The Annals of Thoracic Surgery</span>, (accepted)</div> <div class={"}article_info{"}>J Sj{\"o}gren, R Gustafsson, A Wackenfors, M Malmsj{\"o}, L Algotsson and R Ingemansson. <span class={"}article_issue_date{"}>2004</span>. <span class={"}article_title{"}>Effects of Vacuum-Assisted Closure on Hemodynamic Parameters in a Porcine Sternotomy Wound Model.</span> <span class={"}journal_series_title{"}>Interactive Cardiovascular and Thoracic Surgery</span>, <span class={"}journal_volume{"}>vol 3</span> <span class={"}journal_pages{"}>pp 666-71</span>.</div> <div class={"}article_info{"}>A Wackenfors, J Sj{\"o}gren, L Algotsson, R Gustafsson, R Ingemansson and M Malmsj{\"o}. <span class={"}article_issue_date{"}>2004</span>. <span class={"}article_title{"}>The Effect of Vacuum-Assisted Closure Therapy on the Pig Femoral Artery Vasomotor Responses.</span> <span class={"}journal_series_title{"}>Wound Repair and Regeneration</span>, <span class={"}journal_volume{"}>vol 12</span> <span class={"}journal_pages{"}>pp 244-51</span>.</div>",

year = "2005",

language = "English",

isbn = "91-85439-35-5",

publisher = "Department of Cardiothoracic Surgery, Clinical Sciences, Lund University",

school = "Thoracic Surgery",

}

TY - THES

T1 - Vacuum-assisted closure in cardiac surgery - clinical outcome and vascular effects

AU - Sjögren, Johan

N1 - Defence details Date: 2005-05-19 Time: 13:00 Place: Segerfalkssalen, Wallenberg Neurocenter, BMC External reviewer(s) Name: Ivert, Torbjörn Title: Associate Professor Affiliation: Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden --- <div class="article_info">J Sjögren, R Gustafsson, J Nilsson, M Malmsjö and R Ingemansson. <span class="article_issue_date">2005</span>. <span class="article_title">Clinical Outcome after Poststernotomy Mediastinitis: Vacuum-Assisted Closure Therapy versus Conventional Treatment.</span> <span class="journal_series_title">The Annals of Thoracic Surgery</span>, (inpress)</div> <div class="article_info">J Sjögren, J Nilsson, R Gustafsson, M Malmsjö and R Ingemansson. <span class="article_issue_date">2005</span>. <span class="article_title">The Impact of Vacuum-Assisted Closure on Long-Term Survival after Poststernotomy Mediastinitis.</span> <span class="journal_series_title">The Annals of Thoracic Surgery</span>, (accepted)</div> <div class="article_info">J Sjögren, R Gustafsson, A Wackenfors, M Malmsjö, L Algotsson and R Ingemansson. <span class="article_issue_date">2004</span>. <span class="article_title">Effects of Vacuum-Assisted Closure on Hemodynamic Parameters in a Porcine Sternotomy Wound Model.</span> <span class="journal_series_title">Interactive Cardiovascular and Thoracic Surgery</span>, <span class="journal_volume">vol 3</span> <span class="journal_pages">pp 666-71</span>.</div> <div class="article_info">A Wackenfors, J Sjögren, L Algotsson, R Gustafsson, R Ingemansson and M Malmsjö. <span class="article_issue_date">2004</span>. <span class="article_title">The Effect of Vacuum-Assisted Closure Therapy on the Pig Femoral Artery Vasomotor Responses.</span> <span class="journal_series_title">Wound Repair and Regeneration</span>, <span class="journal_volume">vol 12</span> <span class="journal_pages">pp 244-51</span>.</div>

PY - 2005

Y1 - 2005

N2 - The aim of this research was to clinically and experimentally evaluate the use of vacuum-assisted closure in poststernotomy mediastinitis after cardiac surgery. Vacuum-assisted closure (VAC) is a new wound-healing therapy based on the application of a local negative pressure to the wound. New techniques for treating poststernotomy mediastinitis are needed since conventional techniques have an unsatisfactorily high mortality rate and are associated with high morbidity. It was concluded that VAC in poststernotomy mediastinitis results in a lower mortality rate and a lower rate of recurrent infection compared to conventional treatment. The long-term survival after VAC-treated mediastinitis following isolated coronary artery bypass grafting (CABG) was similar to the long-term survival in CABG without mediastinitis. Obesity, diabetes mellitus, low left ventricular ejection fraction, renal failure, and three-vessel disease were identified as independent risk factors for developing mediastinitis after isolated CABG. It was shown that VAC can be applied without impairment of the central hemodynamics in a sternotomy wound model. It was also shown that the application of VAC for 12 hours does not induce perforation or dissection of porcine femoral arteries. However, the endothelin-receptor-mediated vasoconstriction was enhanced, together with more efficacious endothelium-dependent vasodilatation. In conclusion, the clinical results when using VAC in poststernotomy mediastinitis were superior to conventional treatment, both in the short and the long term. The experimental results indicate that VAC can be used safely without impairment of central hemodynamics or damage to the blood vessels.

AB - The aim of this research was to clinically and experimentally evaluate the use of vacuum-assisted closure in poststernotomy mediastinitis after cardiac surgery. Vacuum-assisted closure (VAC) is a new wound-healing therapy based on the application of a local negative pressure to the wound. New techniques for treating poststernotomy mediastinitis are needed since conventional techniques have an unsatisfactorily high mortality rate and are associated with high morbidity. It was concluded that VAC in poststernotomy mediastinitis results in a lower mortality rate and a lower rate of recurrent infection compared to conventional treatment. The long-term survival after VAC-treated mediastinitis following isolated coronary artery bypass grafting (CABG) was similar to the long-term survival in CABG without mediastinitis. Obesity, diabetes mellitus, low left ventricular ejection fraction, renal failure, and three-vessel disease were identified as independent risk factors for developing mediastinitis after isolated CABG. It was shown that VAC can be applied without impairment of the central hemodynamics in a sternotomy wound model. It was also shown that the application of VAC for 12 hours does not induce perforation or dissection of porcine femoral arteries. However, the endothelin-receptor-mediated vasoconstriction was enhanced, together with more efficacious endothelium-dependent vasodilatation. In conclusion, the clinical results when using VAC in poststernotomy mediastinitis were superior to conventional treatment, both in the short and the long term. The experimental results indicate that VAC can be used safely without impairment of central hemodynamics or damage to the blood vessels.

KW - orthopaedics

KW - Surgery

KW - Kardiovaskulära systemet

KW - Cardiovascular system

KW - Infektioner

KW - Infections

KW - endothelium

KW - vascular

KW - central hemodynamics

KW - risk factors

KW - long-term survival

KW - mortality

KW - wound closure

KW - cardiac surgery

KW - vacuum-assisted closure

KW - poststernotomy mediastinitis

KW - traumatology

KW - Kirurgi

KW - ortopedi

KW - traumatologi

M3 - Doctoral Thesis (compilation)

SN - 91-85439-35-5

PB - Department of Cardiothoracic Surgery, Clinical Sciences, Lund University

ER -

Vacuum-assisted closure in cardiac surgery - clinical outcome and vascular effects

Abstract

Bibliographical note

Subject classification (UKÄ)

Keywords

Fingerprint

Cite this