1. Biomechanical Pressure Sensor Testing
Institut for Biomechanical Engineering University Vienna, Prof. Dr. Bijak
Result: Posthorax produced 8 NM counter pressure – the flexible bandage only 2 NM : -75%
2. Multicenter Prospective Randomized Clinical Trial
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)
3. Cohort Study University Heartcenter Hamburg
including all patients (2200) comparing 2011-2012
Result: Reduction of mediastinitis from 2,39 % to 0,88 % : -63%
(mediastinitis classification El Oakley and Wright)
4. Karolinska University Hospital Stockholm
Cohort study 978 patients 2011-2012
Result: Reduction mediastinitis from 2,2% to 0,6% : -72%
5. University Hospital Southampton NHS
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
6. University Heartcenter Zurich, Switzerland
Retrospective 1689 patients 2010-2012
Result: Reduction DSWI from 3,2% to 1,5% : -52%
Perioperative Management and Strategies to Decrease Sternal Wound Infection
(Presented at 27th EACTS Annual Meeting, Vienna, Austria, 5 - 9 October 2013)
- Abstract (Review) : Perioperative Management and Strategies to Decrease Sternal Wound Infection
- Presentation : Sternum Infect 1BIMA
7. Clinica Del Lavoro e Delle Riabilitazione Milano, Italy
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
8. Karolinska University Hospital Stockholm
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.
9. University Hospital of Novara 'Maggiore della Caritá'
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.
10. Cohort Study, University Hospital Mainz
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
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.
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.
11. Robert - Bosch - Hospital Stuttgart, Germany
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
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.
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.
12. Royal Sussex County Hospital, Brighton, UK
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.