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J Thorac Cardiovasc Surg 2007;133:1154-1162
© 2007 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Hemodynamic effects of vacuum-assisted closure therapy in cardiac surgery: Assessment using magnetic resonance imaging

Rainer Petzina, MDa, Martin Ugander, MD, PhDb, Lotta Gustafsson, MD, PhDa, Henrik Engblom, MD, PhDb, Johan Sjögren, MD, PhDc, Roland Hetzer, MD, PhDd, Richard Ingemansson, MD, PhDc, Håkan Arheden, MD, PhDb, Malin Malmsjö, MD, PhDa,*

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.

Abbreviations and Acronyms ECG = electrocardiogram; MRI = magnetic resonance imaging; SEM = standard error of the mean; TE = echo time; TR = repetition time; VAC = vacuum-assisted closure




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