Congenital heart disease treatment of postoperative sternomediastinitis in infants

Aim. To evaluate the results of vacuum therapy and closed irrigation drainage (CID) technique for the treatment of postoperative sternomediastinitis in infants Methods. This single-institution retrospective study included 69 patients diagnosed with sternomediastinitis from 2008 to 2018. Patients were divided into two groups: those treated using vacuum-assisted closure therapy (VAC; n = 29) and those treated using CID (n = 40). After propensity score matching, a total of 25 infants were included in each group. Results. Age, gender, weight, body surface area, Risk Adjustment for Congenital Heart Surgery score, cardiopulmonary bypass time and the frequency of open chest management were comparable between the two groups after propensity score matching. During hospital stay, no deaths were noted in the VAC group, whereas eight patients died in the CID group (32%; P = 0.004). The median durations of mechanical ventilation were 79 (28; 176) and 154 (24; 356) hours in the VAC and CID groups, respectively (P = 0.38). Moreover, eight patients in the VAC group (32%) were extubated early (P = 0.028). Re-mediastinitis occurred in 1 (4%) and 8 (32%) patients from the VAC and CID groups, respectively (P = 0.01). The multivariable regression analysis revealed that the CID technique was the only risk factor for re-mediastinitis (odds ratio, 13.9; 95% confidence interval, 1.2-152.5; P = 0.031). The median durations of hospital stay were 14 (10; 30) and 23 (18; 33) days in the VAC and CID groups, respectively (P = 0.045). Conclusion. VAC therapy in patients with mediastinitis showed better outcomes than CID technique such as lower hospital mortality and re-mediastinitis rates.