Philippe P. Caimmi . Maurizio Sabbatini . Emmanouil I. Kapetanakis . Silvia Cantone . Marcus V. Ferraz . Mario Cannas . Ugo F. Tesler
Received: November 1, 2016
© The Author(s) 2016. This article is published with open access at Springerlink.com
Interactive CardioVascular and Thoracic Surgery Advance Access published August 30, 2016
A.Modi_Royal_Sussex_County_Hospital_Brighton_UK
Michael Gorlitzer, Florian Wagner, Steffen Pfeiffer, Sandra Folkmann, Johann Meinhart, Theodor Fischlein, Hermann Reichenspurner and Martin Grabenwoeger
Corresponding author. Hietzing Hospital, Wolkersbergenstr. 1, 1130 Vienna, Austria. Tel: +43-1-80110; fax: +43-1-80110-2729; e-mail: michael.gorlitzer@wienkav.at (M. Gorlitzer). Received 17 October 2012; received in revised form 22 April 2013; accepted 29 April 2013
A prospective randomized multicenter trial shows improvement of sternum related complications in cardiac surgery with the Posthorax ® support vest Michael Gorlitzer, Florian Wagner, Steffen Pfeiffer, Sandra Folkmann, Johann Meinhart, Theodor Fischlein, Hermann Reichenspurner and Martin Grabenwöger
Interact CardioVasc Thorac Surg 2010;10:714-718; originally published online Jan 26, 2010;
European Journal of Cardio-thoracic Surgery 36 (2009) 335—339
POSTHORAX STERNUM SUPPORT
Institut for Biomechanical Engineering University Vienna, Prof. Dr. Bijak
Result: Posthorax produced 8 NM counter pressure – the flexible bandage only 2 NM : -75%
Multicenter study, prospective randomized (2600 patients) Heartcenter Hietzing/Vienna, University Hospital Hamburg - Eppendorf, Heartcenter Nürnberg
Result: Reduction mediastinitis from 2,27 % to 1,04 % : -54% (mediastinitis classification El Oakley and Wright)
DGTHG_2011_slides_E Papers: EJCTS_Paper_2009 ICVTS_paper_2010 ICVTS_paper_2013
including all patients (2200) comparing 2011-2012
Result: Reduction of mediastinitis from 2,39 % to 0,88 % : -63% (mediastinitis classification El Oakley and Wright)
Cohort study 978 patients 2011-2012
Result: Reduction mediastinitis from 2,2% to 0,6% : -72%
Karolinska Sternum Instability in Clinical practice
Risk adjusted study of 265 patients 2011-2012
Result: Reduction DSWI from 2,1 % to 1,2 % : -43% Indication prophylactic use: BMI >30, diabetes, steroids, Re-OP, reduced lung function, osteoporosis. Therapeutic use: clicky sternum, severe cough, SWI, Delirium/agitation, DSWC (on Vac pump or post rewiring)
Nomination HSJ Efficiency Awards 2013
First UK Experience Southampton General Hospital 2012
Retrospective 1689 patients 2010-2012
Result: Reduction DSWI from 3,2% to 1,5% : -52%
Papers:
Perioperative Management and Strategies to Decrease Sternal Wound Infection
(Presented at 27th EACTS Annual Meeting, Vienna, Austria, 5 - 9 October 2013)
Respiratory study, prospective randomised 80 patients. Testing of cardiopulmonary % VO2, Plethysmograph TLC%, DLCO%, KCO%, 6 min walking, EuroQoL 5D-3L.
Result: No significant differences in the groups with and without vest
Presentazione ANMCO definitiva EN (english)
Presentazione ANMCO definitiva IT (italian)
There are several mechanisms by which the vest could affect respiration. Breathing while wearing the vest may be more dependent on the diaphragm, shifting ventilation to the lower lobes.
This may prevent atelectasis of the lower lobes, where it has been shown to occur most frequently following surgery (17). Movement of the ribcage after sternotomy may be painful, as this can cause movement of the two halves of the sternum. Such pain has been well documented and may persist for years (22,30). Because the vest restricts expansion and movement of the ribcage, breathing while wearing the vest may be less painful for the wearer.
This may increase the effectiveness of chest physiotherapy, including deep breathing exercises, and may facilitate early mobilization. This, in turn, may lead to deeper respiration when using the vest, with improved ventilation of the lungs leading to a lower occurrence of atelectasis.
Papers:
STERNUM SUPPORT MAY PREVENT MAJOR ATELECTASIS AFTER MEDIAN STERNOTOMY
Mechanical complications of median sternotomy may cause significant morbidity and mortalita in cardiac surgical patients. This study was aimed at assesing the role of Posthorax support vest in the prevention of sternal complications and the improvement of anatomical healing in patients at high risk for mechanical dehiscende after cardiac surgery by mean of median sternotomy.
OBESE CARDIAC PATIENTS: SIGNIFICANT REDUCTION OF DEEP STERNAL WOUND COMPLICATIONS BY WEARING THE POSTHORAX VEST?
Buschmann K., Bienias J., Brendel L., Halbroth I., Ghazy A., Karliova I., Emrich A.L., Vahl C.F.
Universitätsmedizin Mainz, Herz-, Thorax-, Gefäßchirurgie, Mainz, Germany
Objectives:
Sternal wound healing disturbances are still a frequently postoperative complication after median sternotomy especially in obese patients. Surgical wound revision and prolonged hospitalization increase the costs disproportionally. Thus we planned a study to evaluate if the sternal wound complication rate after cardiac surgery can be profitably reduced by wearing the PosthoraxTM vest.
Conclusion:
The rate of deep sternal wound complication in the Vest group tells its own tale. There is a reduction of half as less. As limitation we have to ask if the Vest group is compareable to the Control group because of significant shorter ICU stay and earlier mobilization, but otherwise these factors belong to postoperative course without complications. Of course the surgical technique for wound closing is also important and dependent on the surgeon. Nevertheless in our clinic we apply the Posthorax vest in every obese patient who has to underwent cardiac surgery via median sternotomy in order to reduce postoperative deep sternal wound complications and costs.
Papers:
OBESE CARDIAC PATIENTS: SIGNIFICANT REDUCTION OF DEEP STERNAL WOUND COMPLICATIONS BY WEARING THE POSTHORAX VEST?
Presentation
THE TOTAL ARTERIAL MYOCARDIAL REVASCULARIZATION USING BILATERAL IMA AND THE ROLE OF POST-OPERATIVE STERNAL STABILIZATION TO REDUCE WOUND INFECTIONS IN A LARGE COHORT STUDY.
Albert M, MD Ursulescu A, MD Franke UFW, MD Robert-Bosch-Hospital, Stuttgart, Germany
Objectives:
The total-arterial myocardial revascularization using bilateral IMA shows improved results regarding mortality, long-term survival as well as superior graft patency and thus has become the standard technique according to recent guidelines. On the other hand, those patients might suffer from an increased risk of developing sternal wound infections, especially when being obese or having a medical history of diabetes. One reason for the wound complications may be an early sternum instability, which could be avoided using a thorax support vest (e.g. Posthorax vest). This retrospective study compares the wound complications after bilateral IMA grafting according to the use of a Posthorax vest.
Conclusion:
As seen in this retrospective study, the early perioperative use of a thorax stabilization vest such as the POSTORAX vest can reduce the incidence of sternal wound complications significantly. Furthermore when a wound infection occurred and the patients returned to hospital for wound revision, the patients who had been administered the POSTORAX vest postoperatively will have a significant shorter length of stay until wound closure.
Papers:
The total arterial myocardial revascularization using bilateral IMA and the role of post-operative sternal stabilization to reduce wound nfections in a large cohort study.
Presentation
Early post-sternotomy use of the available external non-elastic sternal support devices reduces sternal wound complications and may be associated with a shorter lenght of hospital stay.
Papers:
Do external support devices reduce sternal wound complications after cardiac surgery?