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J Thorac Cardiovasc Surg 2007;133:1154-1162
© 2007 The American Association for Thoracic Surgery
Cardiopulmonary Support and Physiology |
a Department of Medicine, Lund University Hospital, Lund, Sweden
b Department of Clinical Physiology, Lund University Hospital, Lund, Sweden
c Department of Cardiothoracic Surgery, Lund University Hospital, Lund, Sweden
d German Heart Institute, Berlin, Germany.
Received for publication September 26, 2006; revisions received January 2, 2007; accepted for publication January 8, 2007. * Address for reprints: Malin Malmsjö, MD, PhD, Vascular Research, Lund University, BMC A13, SE-221 84 Lund, Sweden. (Email: malin.malmsjo{at}med.lu.se).
Objective: The hemodynamic effects of vacuum-assisted closure therapy in cardiac surgery are debated. The aim of the present study was to quantify cardiac output and left ventricular chamber volumes after vacuum-assisted closure using magnetic resonance imaging, which is known to be the most accurate method for quantifying these measures.
Methods: Six pigs had median sternotomy followed by vacuum-assisted closure treatment in the presence and absence of a paraffin gauze interface dressing. Cardiac output and stroke volume were examined using magnetic resonance imaging flow quantification (breath-hold and real-time). Chamber volumes were assessed using cine magnetic resonance imaging.
Results: Cardiac output and stroke volume decreased immediately after application of negative pressures of 75, 125, and 175 mm Hg (13% ± 1% decrease in cardiac output). Interposition of 4 layers of paraffin gauze dressing over the heart during vacuum-assisted closure therapy resulted in a smaller decrease in cardiac output (8% ± 1%).
Conclusions: Vacuum-assisted closure therapy results in an immediate decrease in cardiac output, although to a lesser extent than shown previously. Covering the heart with a wound interface dressing lessens the hemodynamic effects of vacuum-assisted closure.
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