Major complications following thoracic surgery fall into two categories: respiratory complications and wound infections. Especially at risk are those patients with co-morbidities (e.g. diabetes, obesity, emphysema, COPD, etc.) as well as barrel-chested men, large breasted women and patients on a ventilator for a prolonged period.

Respiratory complications are a primary concern in the recovery of the post-surgical patient. Stabilization and return to preoperative levels of respiratory function is a major determinant in the discharge of patients. The use of a Sternum Support Harness provides patients with the confidence and independence to be aggressive with respiratory therapy and coughing, keeping them on the clinical pathway. Following discharge, continuing respiratory therapy exercises are critical to full recovery.

Sternal wound infections increase length of hospitalization more consistently than any other major complication and significantly influences readmission.  Treatment of sternal wound complications requires a multidisciplinary approach for effective patient care.  Use of a Sternum Support Harness to stabilize the sternal wound reduces both respiratory and wound complications, enhancing both quality of care and cost containment.

Providing patients with Heart Hugger™ Sternum Support Harness gives them the best possible chance at a speedy, uncomplicated recovery. Heart Hugger™ is the standard of care at more than 340 hospitals worldwide.

Sternal wound complications fall into three categories: 1) Deep Subcutaneous Infection, 2) Sternal Infection, and 3) Mediastinal Infection with Sternal Dehiscence.

Mediastinitis can contribute to the development of life threatening illnesses, such as systemic sepsis, respiratory insufficiency, and renal failure.  Mediastinitis occurs as a result of sternal instability and dehiscence and is usually evident from six days to three weeks following surgery.   Most patients are usually discharged by this time. Patients at risk for mediastinitis and dehiscence include: those older than 65 years (the Medicare population), and those suffering from diabetes, osteoporosis, obesity, COPD and those subjected to prolonged postoperative ventilation.

The incidence of morbidity and death from sternal wound complications occurs in significant numbers of patients. Upwards of 2.3% of patients may suffer these complications with an associated mortality rate of 13% to 52%.  The incidence of mortality after initial discharge and up to the first postoperative year is nearly as high as hospital mortality.  Heart Hugger™ provides sternal stability and support.

Return to pre-morbid levels of respiratory function is a major determinant in the discharge of patients. Recovering open heart patients are frequently non-compliant during their respiratory therapy exercises because of pain or fear of pain. Recent federal studies have shown that inadequately managed pain can inhibit recovery, prolong hospitalization and contribute to higher-than-necessary costs. The Wound Support and Pain Management provided by Heart Hugger™ helps keep patients on the clinical pathway.

The post discharge necessity of respiratory therapy exercises cannot be overemphasized. The use of Heart Hugger™ gives patients the confidence and independence to continue these exercises in the unsupervised post discharge setting.

In addition to a high mortality rate, wound complications can be financially devastating to the hospital, particularly the Medicare and co-morbid population. The cost to hospitals for complications and the resulting increased length of stay ranges from $13,453 to $109,118 per complication. (To see how much money your hospital’s heart program can save by using Heart Hugger™ click here).

Aggressive coughing and deep breathing maneuvers, which frequently initiates coughing, are important for purging the lungs of fluid and inflating the lungs to prevent atelectasis and pneumonia. These maneuvers are initiated in the hospital and are a mandatory part of post discharge respiratory therapy.  Percussive expansion associated with coughing puts extreme stress on the sternal wound. Ambulating, getting into and out of bed or chairs or cars, bowel movements and other normal activities also place strain on the surgical wound site. While patients experience this stress on their surgical wound as pain and the feeling that they are "coming apart," the clinical result may in fact be grave: dehiscence and mediastinal infection.

Sternal stability is crucial in preventing these severe sternal wound complications. Traditionally, prophylactic methods used to achieve sternal stability following a sternotomy has been available only to the extent that folded sheets, towels, a pillow or a teddy bear could be used to "splint" the surgical wound.   These methods, while providing an inward pressure to the sternum, provides no encircling support to the rib cage and chest wall during coughing, is unavailable to the patient when ambulating, and provides no lateral support to stabilize the surgical wound.

Without support, the pain of the surgical wound is often extreme. For this reason, patients often lack the confidence to continue with respiratory therapy exercises and coughing following discharge.

There is a trend toward early discharge of open heart surgery patients.  The risk to these patients in the unsupervised, post discharge setting is two-fold: 1) the patient may be unaware or unable to diagnose a potential surgical wound complication (success in treating sternal wound complications depends upon early recognition and management);  and 2) due to pain considerations, patients often lack the confidence to continue their respiratory therapy exercises in the outpatient setting. Heart Hugger™ can help manage their pain by stabilizing and supporting their surgical wound.

Heart Hugger™ Sternum Support Harness is U.S. FDA Classified, Medicare Approved and conforms conforms to the European Medical Device Directive. It provides a clear alternative to folded sheets, towels, a pillow or teddy bear.

Heart Hugger™ is a simple harness fitting over the shoulders, a four inch wide belt around the chest, finished with handles on either end. The chest belt is adjusted to center the handles over the surgical wound, the patient's hand width apart. Squeezing the handles together with one or both hands tightens the chest belt, supporting the chest wall and stabilizing the sternal wound. Completely encircling the chest, it remains loose and passive until activated by the patient.

The Patient is introduced to Heart Hugger™ prior to surgery as a part of their preoperative education. Following surgery (optimally in the ICU/CCU immediately after extubation) patients are fitted with the device. Following discharge, patients wear the device at home over their street clothes for approximately four to six weeks. In this unsupervised setting it is essential that patients be able to stabilize their sternal wound for continuing respiratory therapy exercises and other stress resulting from the resumption of normal activities.

Used in conjunction with contemporary methods of wiring the sternum and suturing tissue layers, maximal sternal wound stability is achieved. The incidence of sternal infection is reduced and sternal dehiscence is practically eliminated. Additionally, preoperative respiratory capacity levels are achieved sooner when the device is used in conjunction with respiratory therapy exercises.

After a short training period, patients operate the Heart Hugger™ themselves when they feel the need to stabilize their wound. It is a turning point in the patient's perception of recovery. It returns control to the patient. If patients feel that they have some control over the situation that affects them they will perceive the situation to be less stressful, will be less threatened, and will cooperate and perform better. Patients experience more confidence and independence, taking control of their own recovery sooner, exemplifying the true sense of cardiac rehabilitation and keeping them on the clinical pathway.

There is a trend toward earlier discharge of thoracic surgical patients. The potential for respiratory complications, and particularly wound complications continues well into the discharge period. Heart Hugger™ enables patients to stabilize their wound, continuing aggressive coughing and deep breathing exercises while resuming normal activities: walking, climbing stairs, getting into and out of automobiles, etc.