Use of NPWTi-d for simultaneous pleural and mediastinal drainage in deep sternal wound infection during mechanical circulatory support

This case report describes the management of deep sternal wound infection in a female patient supported with an extracorporeal left ventricular assist device (LVAD) following the Bentall procedure for acute aortic dissection. She developed pleural effusions with pathological communications between the pleural and mediastinal cavities, necessitating continuous drainage. After radical debridement, we applied negative pressure wound therapy (NPWT) with instillation and dwell time (NPWTi-d) to simultaneously drain the pleural cavities and the infected mediastinum. 24 French silicone fluted drain tubes were inserted into both pleural cavities and the pericardial/mediastinal space, with their proximal ends connected to the NPWTi-d sponge. Such simple management allowed for progress in rehabilitation, and the patient underwent a re-Bentall procedure and omentoplasty after 3 months of NPWTi-d therapy. No recurrence of wound infection has been observed in the subsequent 6 months, and the patient remains on LVAD support while awaiting heart transplantation.