Surgical Vacuum-Assisted Closure Therapy for Mediastinitis Following HeartMate 3 BiVAD Implantation: A Case Report

Background: Mediastinitis following cardiac surgery in patients supported with mechanical circulatory support devices remains a serious and potentially fatal complication. Management of deep sternal wound infection in patients with a biventricular assist device (BiVAD) is surgically challenging due to the risk of device contamination and the complexity of wound reconstruction. Case presentation: A 57-year-old male with end-stage non-ischaemic cardiomyopathy underwent implantation of a HeartMate 3 BiVAD as destination therapy. Four weeks after discharge, he developed Escherichia coli mediastinitis with purulent sternal drainage and positive blood cultures. Computed tomography revealed a localised mediastinal abscess without driveline or pump involvement. The patient underwent repeated surgical debridement and prolonged vacuum- assisted closure (VAC) therapy combined with targeted antibiotic treatment. Device removal was avoided, and complete wound healing was achieved. During rehabilitation, he experienced recurrent orthostatic collapse on standing. Dynamic transoesophageal echocardiography demonstrated transient left-ventricular cavity collapse and inflow obstruction, consistent with preload insufficiency rather than device malfunction. Conclusions: This case illustrates that surgical vacuum-assisted closure (VAC) therapy can be an effective component of conservative management for mediastinitis after BiVAD implantation. A multidisciplinary approach integrating surgical, infectious, and haemodynamic assessment can allow infection resolution while preserving device function.