Background: In adult and pediatric cardiac surgery, median sternotomy is considered the usual access to gain variable cardiac operations. Although the rarity of this complication in pediatrics, it is serious and carry a high risk of morbidity and mortality. Vacuum assisted closure (VAC) system is increasingly used for treating deep sternal wound infection (DSWI), VAC therapy becomes a widely accepted method for treating DSWI and mediastinitis in adults. In spite of this, there is no wide experience of using the VAC system in pediatric cardiac surgery. Objective: The aim of the current work was toinvestigate the safety and efficacy of vacuum-assisted therapy in management of deep sternal wound infections in pediatric cardiac surgery. Subjects and Methods: Between May 2012 to April 2022, we treat 44 infant and child complicated with postoperative DSWI and mediastinitis. This prospective analytical study was conducted at Abo Elrish Hospitals, Cairo University. The main primary end point of our study was complete resolution of sternal wound and patient survival. Results: Since 2012 to 2022 about 44 patients treated from DSWI and/or mediastinitis post pediatric cardiac surgery using VAC system. Age of the patients ranging from 3 months to 9 years with mean 2.5 years. There was one case of mortality not related to VAC therapy in our study group due to severe chest infection in spite of dramatic improvement of the local wound condition within one week of starting treatment. No complications were encountered during the period of VAC treatment. Most importantly, there was no VAC device related complications experienced in all patients. The VAC was used as a destination therapy in 42 cases with wound closure by secondary sutures. There was only one case needed a sternal rewiring with good results. Conclusion: It could be concluded that VAC therapy is a safe and effective treatment modality for either infant and children and provide a good alternative to the conventional methods of treatment in settings of mediastinitis and deep sternal wound infections with excellent results.