• Vincenzo Tarzia, Massimiliano Carrozzini, Giacomo Bortolussi, Edward Buratto, Jonida Bejko, Marina Comisso, Valentina Mescola, Valentina Penzo, Mauro Guarino, Marco De Franceschi, Chiara Pagnin, Massimo Castoro, Cosimo Guglielmi, Luca Testolin, Tomaso Bottio, and Gino Gerosa.
• Department of Cardiac, Thoracic and Vascular Sciences, Cardiac Surgery Unit, University of Padova, Padova, Italy v.tarzia@gmail.com.
• Interact Cardiovasc Thorac Surg. 2014 Jul 1;19(1):70-5.

ObjectivesSternal wound dehiscence (SWD) after cardiac surgery is a rare but serious condition associated with considerable costs and morbidity. We sought to evaluate the results of the introduction of vacuum-assisted closure (VAC) therapy in the management of sternal wound dehiscence, compared with those of previous conventional treatments.MethodsWe retrospectively collected 7148 patients who underwent cardiac surgery at our institution between January 2002 and June 2012. A total of 152 (2.1%) patients had a sternal wound dehiscence: 107 were treated with conventional treatments (Group A) and 45 were managed with VAC therapy (Group B). Patients were stratified according to preoperative risk factors and type of sternal wound dehiscence (superficial or deep; infected or not) and compared by means of a propensity-matched analysis. A cost analysis was also performed.ResultsForty-five patients of each group matched for all preoperative risk factors and type of sternal wound dehiscence. SWD-related mortality rate was significantly lower in Group B (11 vs 0%; P = 0.05). Incidence of mediastinitis (P < 0.0001), sepsis (P = 0.04), delayed SWD infection (P = 0.05), other complication (P = 0.05), surgical sternal revision (P = 0.04) and surgical superficial revision (P < 0.0001) were all significantly lower in Group B. Mean patient cost was 31 106€ in Group A and 24 383€ in Group B, thus achieving a mean saving of 6723€ per patient.ConclusionsIn our experience, the use of VAC therapy for the management of SWD was considerably effective in decreasing mortality (SWD related), incidence of complications and need for surgical procedures; thus, leading to a significant reduction of costs.© The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

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