eComment: Right ventricle bleeding secondary to vacuum assisted therapy?

The authors report an interesting case of delayed bleeding after a healed deep external infection [1]. We have noticed that they used a vacuum-assisted therapy (VAC) device before the chest was closed. We have been using VAC in 32 patients over the past five years. Although this device has worked safely in most of the patients, three suffered a right ventricle free wall rupture. Elapsed time between the beginning of the therapy and the event was four days for the earliest and two weeks for the last. Two of those three patients died due to massive bleeding. In all three cases, we used paraffin gauze to protect the right ventricle, according to Gustafsson and colleagues indications [2]. Other authors have reported similar catastrophic outcomes [3]. We believe there might be some relationship between the use of VAC and delayed bleeding in the case reported by Niclauss and colleagues. This and other articles in the literature must draw our special attention to protect the right ventricle free wall during VAC therapy and be extremely careful, when the chest is closed.