[Effectiveness of Prophylactic Negative Pressure Wound Therapy after Cardiovascular Surgery through Median Sternotomy].

Negative pressure wound therapy( NPWT) is used primarily for tissue defects. In recent years, cardiovascular surgery via full sternotomy is increasingly performed through small incisions, but the rate of cardiovascular surgery through median sternotomy remains high in elderly patients, who frequently have complicated cardiovascular diseases. Mediastinitis, among other surgical site infections( SSIs), is a serious complication after cardiovascular surgery that must be resolved. Mediastinitis has a high mortality rate once it occurs, and cost of treatment and a negative impact on a patient are substantial. In some countries, NPWT is for the prophylaxis of mediastinitis, but only for cases with a significant risk of SSI. To avoid SSI, prophylactic NPWT is administered in all cardiovascular surgeries through median sternotomy at our hospital. Of 641 consecutive median sternotomy patients from March 2011 to March 2021, 601 cases were able to observe the wound for at least 30 days following the surgery. In the 601 cases, we found a statistically significant difference in the incidence of SSI. The results suggest that prophylactic NPWT significantly reduces SSI after cardiovascular surgery through median sternotomy.

[Mitral Mechanical Valve Thrombosis after Switching to Dabigatran].

The patient is a 76-year-old man who underwent aortic and mitral valve replacement 30 years ago, both with mechanical valves. He had been on anticoagulant therapy with warfarin, which was switched to dabigatran two years ago by his primary care physician. He developed shortness of breath afterward and was taken to the hospital with heart failure. Fluoroscopy of the valve revealed that one leaflet of the prosthetic mitral valve was immobile. The patient was diagnosed with a thrombosed valve and underwent an urgency repeat mitral valve replacement. He recovered uneventfully and was discharged without complication. During long years, some patients may have comorbidities and get frail. Medical principle may change, and various treatment methods with more and more complex indications may emerge. But in patients with mechanical heart valves, warfarin still remains the only choice for anticoagulation therapy.