The use of Prevena Incision Management System on clean closed sternal midline incisions in subjects at high risk for surgical site occurrences.

*Is male or female and 18 years of age or older
*Is scheduled for elective cardiac surgery for which a median sternotomy is needed (including coronary artery bypass grafting (CABG), valvular repair or replacement with or without CABG). Elective surgery is defined as planned surgery a minimum of 24 hours before the procedure.
*A total score of at least 8 points for the following risk factors:
>MAJOR risk factors receiving 8 points
*BMI * 40 kg/m2 *
>MAJOR risk factors receiving 4 points each:
*BMI of <18 kg/m2 or BMI * 30 kg/m2 *
*Insulin dependent Diabetes Mellitus*
*Dialysis**
>INTERMEDIATE risk factors receiving 2 points each:
*Planned bilateral mammary artery
*Diabetes Mellitus (only Type I or Type II receiving oral hypoglycemic medication)*
*Chronic lung disease GOLD *2
*Active smoker
*On long-term immunosuppressive medication (including but not restricted to cyclophosphamide, methotrexate, azathioprine, cyclosporine, tacrolimus or mycophenalate mofetil; or on a stable maintenance dose of prednisolone for 4 weeks or more; or will receive chronic immunosuppressant therapy during the study period (equivalent to a daily dose of * 10 mg Prednisone)
*Chronic kidney disease (defined according to the National Kidney Foundation Kidney Disease Improving Global Outcomes (KDIGO) guidelines as a GFR <30ml/min/1.73m2 for * 3 months) but not requiring preoperative renal replacement therapy (GFR can be determined using Cockroft-Gault equation tool, which is based on gender, age, weight and serum creatinine level)**
*Previous chest wall radiotherapy
*Breast size D cup or more (adding lateral tension to the wound edges according physicians discretion)
>MINOR risk factors receiving 1 point each:
*Cardiac reoperation after history of median sternotomy
*Peripheral vascular disease
*Left ventrical ejection fraction <30%
*Female gender
*Age >75 years old
*Acute myocardial infarction within 90 days before surgery
*Hospitalized at least 7 days before surgery;* mutually exclusive, highest score should be used
** mutually exclusive, highest score should be used;* Is capable of providing informed consent, which must be obtained prior to any study-related procedures
* Are willing and able to adhere to the study visit schedule and other protocol requirements.

* Is pregnant
* The use of Prevena post surgery is contra indicated per investigator*s discretion
* Has a systemic infection at the time of surgery: systemic infection is diagnosed on the basis of clinical signs of sepsis with or without a positive culture of an organism from the bloodstream
* Has a remote body site infection at the time of surgery (including dental, urinary or skin soft tissue infections)
* Has current nasal swabs positive for methicillin-resistant staphylococcus aureus (MRSA)
* Has a known allergy or hypersensitivity to silver, or drape materials that contain acrylic adhesives
* Has a requirement for competing wound therapy and procedures:
* Any concomitant therapies (including other NPWT treatment) or procedures deviating from the clinical standard incision treatment or with investigational device at the location of the sternotomy (e.g. use of NPWT at other location of the body is allowed)
* Any other therapies or procedures that, in the opinion of the treating physician, would affect or influence postoperative wound stability or healing
* Is simultaneously participating in another interventional trial
* Requires use of liquid skin adhesives or glues during skin closure
* Is known to be serology positive for hepatitis B, hepatitis C, and HIV