Preventing heart injury during negative pressure wound therapy in cardiac surgery: Assessment using real-time magnetic resonance imaging

被引:29
作者
Malmsjoe, Malin [1 ]
Petzina, Rainer [1 ]
Ugander, Martin [2 ]
Engblom, Henrik [1 ,2 ]
Torbrand, Christian
Mokhtari, Arash [3 ]
Hetzer, Roland [4 ]
Arheden, Hakan [2 ]
Ingemansson, Richard [3 ]
机构
[1] Univ Lund Hosp, Dept Med, S-22185 Lund, Sweden
[2] Univ Lund Hosp, Dept Clin Physiol, S-22185 Lund, Sweden
[3] Univ Lund Hosp, Dept Cardiothorac Surg, S-22185 Lund, Sweden
[4] Deutsch Herzzentrum Berlin, Berlin, Germany
基金
英国医学研究理事会;
关键词
VACUUM-ASSISTED CLOSURE; POSTSTERNOTOMY MEDIASTINITIS; EXPERIENCE; RUPTURE;
D O I
10.1016/j.jtcvs.2008.11.068
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: Heart rupture is a devastating complication to negative pressure wound therapy in cardiac surgery. Also, reduced cardiac output during negative pressure wound therapy has been reported. The present study aimed to examine the effects of negative pressure wound therapy on the position of the heart in relation to the thoracic wall using magnetic resonance imaging in a porcine sternotomy wound model. Methods: Six pigs had median sternotomy followed by negative pressure wound therapy at -75, -125, and -175 mm Hg. Real-time magnetic resonance imaging movies (10 images/s) were acquired in a midventricular transverse plane or a midsagittal plane during the application of negative pressure wound therapy. Results: Similar finding were observed at all different negative pressures studied. Negative pressure wound therapy caused the heart to be displaced toward the thoracic wall, and in some cases, the right ventricular free wall bulged into the space between the sternal edges, and the sharp edges of the sternum jutted into and deformed the anterior surface of the right ventricular free wall. These events were not affected by the interposition of 4 layers of paraffin gauze dressing but were hindered by the placement of a rigid barrier between the anterior portion of the heart and the inside of the thoracic wall. Conclusion: The results show altered position of the heart in relation to the sternum during negative pressure wound therapy. This may explain 2 potentially hazardous events associated with negative pressure wound therapy, namely, risk for heart rupture and reduced cardiac output. Inserting a rigid barrier over the heart may be a protective measure that is clinically practicable.
引用
收藏
页码:712 / 717
页数:6
相关论文
共 15 条
[1]   Right ventricular rupture during use of high-pressure suction drainage in the management of poststernotomy mediastinitis [J].
Abu-Omar, Y ;
Naik, MJ ;
Catarino, PA ;
Ratnatunga, C .
ANNALS OF THORACIC SURGERY, 2003, 76 (03) :974-974
[2]   Vacuum-assisted closure: A new method for wound control and treatment: Clinical experience [J].
Argenta, LC ;
Morykwas, MJ .
ANNALS OF PLASTIC SURGERY, 1997, 38 (06) :563-576
[3]   Vacuum-assisted closure: State of clinic art [J].
Argenta, Louis C. ;
Morykwas, Michael J. ;
Marks, Malcolm W. ;
DeFranzo, Anthony J. ;
Molnar, Joseph A. ;
David, Lisa R. .
PLASTIC AND RECONSTRUCTIVE SURGERY, 2006, 117 (07) :127S-142S
[4]  
Banwell Paul, 2006, J Tissue Viability, V16, P16
[5]   Experience with the vacuum assisted closure negative pressure technique in the treatment of non-healing diabetic and dysvascular wounds [J].
Clare, MP ;
Fitzgibbons, TC ;
McMullen, ST ;
Stice, RC ;
Hayes, DF ;
Henkel, L .
FOOT & ANKLE INTERNATIONAL, 2002, 23 (10) :896-901
[6]   Hemodynamic effects of the vacuum-assisted closure device on open mediastinal wounds [J].
Conquest, AM ;
Garofalo, JH ;
Maziarz, DM ;
Mendelson, MG ;
Sun, YS ;
Wooden, WA ;
Meadows, WM ;
Nifong, W ;
Chitwood, WR .
JOURNAL OF SURGICAL RESEARCH, 2003, 115 (02) :209-213
[7]  
Crabtree Traves D, 2004, Semin Thorac Cardiovasc Surg, V16, P53
[8]   Evaluation of vacuum-assisted closure in the treatment of poststernotomy mediastinitis [J].
Domkowski, PW ;
Smith, ML ;
Gonyon, DL ;
Drye, C ;
Wooten, MK ;
Levin, LS ;
Wolfe, WG .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2003, 126 (02) :386-390
[9]   Risk factors for sternal wound infection and mid-term survival following coronary artery bypass surgery [J].
Lu, JCY ;
Grayson, AD ;
Jha, P ;
Srinivasan, AK ;
Fabri, BM .
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2003, 23 (06) :943-949
[10]   Mechanisms governing the effects of vacuum-assisted closure in cardiac surgery [J].
Malmsjo, Malin ;
Ingemansson, Richard ;
Sjogren, Johan .
PLASTIC AND RECONSTRUCTIVE SURGERY, 2007, 120 (05) :1266-1275