Cerebral and somatic oxygen saturation decrease after delayed sternal closure in children after cardiac surgery

Horvath, Robert; Shore, Shirah; Schultz, Steven; Rosenkranz, Eliot R.; Cousins, Mary; Ricci, Marco

doi:10.1016/j.jtcvs.2009.06.013

Cited by 21 publications

(16 citation statements)

References 14 publications

(28 reference statements)

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“…With respect to changes in key physiologic parameters over time, we found that although mean heart rate and left atrial pressures were unchanged, mean blood pressure increased and inotrope score decreased in 12 hours after sternal closure which was in contradiction with Tabbutt and Horvath’s studies suggesting decrease in hemodynamic performance after sternal closure [8,22]. …”

Section: Discussioncontrasting

confidence: 62%

Delayed Sternal Closure After Pediatric Cardiac Operations; Single Center Experience: a Retrospective Study

Özker

Sarıtaş

Vuran

et al. 2012

J Cardiothorac Surg

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BackgroundDelayed sternal closure (DSC) after cardiac surgery is a therapeutic option in the treatment of the severely impaired heart in pediatric cardiac surgery. The results with the technique of DSC over a 4-year period are examined with regard to mortality and morbidity.MethodsWe retrospectively reviewed records of 38 patients who had undergone DSC among 1100 congenital cardiac operations. Indication of DSC, time to sternal closure, pre and post closure cardiopulmonary and metabolic status, mortality, rate of wound and bloodstream infections were recorded.ResultsThe mean sternal closure time was 2.9 days. The mortality rate was 34.2% (n = 13). Twenty (52.6%) patients required prolonged antibiotic use due to postoperative infection. There was gram negative microorganism predominance. There were 4 (10.5%) patients with postoperative mediastinitis. Postoperative infection rate statistically increased with cardiopulmonary bypass time (CPBT), sternal closure time (SCT) and intensive care unit (ICU) stay time (p = 0.039;p = 0.01;p = 0.012). On the other hand, the mortality rate significantly increased with increased cross clamp time (CCT), SCT, and extracorporeal membrane oxygenation (ECMO) use (p = 0.017; p = 0.026; p = 0.03). Single ventricular physiology was found to be risk factor for mortality in delayed sternal closure (p < 0.007).ConclusionsElective DSC does not reduce the morbidity. The prolonged sternal closure time is associated with increased rate of postoperative infection rate; therefore early closure is strongly advocated.

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Section: Discussioncontrasting

confidence: 62%

Delayed Sternal Closure After Pediatric Cardiac Operations; Single Center Experience: a Retrospective Study

Özker

Sarıtaş

Vuran

et al. 2012

J Cardiothorac Surg

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“…Inotropic score was first described in the Boston Circulatory Arrest Study to quantify the amount of pharmacologic cardiovascular support required during the postoperative period [25]. Inotropic score has been used in other clinical studies as a measurement of illness severity [2, 3, 11, 15]. However, until recently, inotropic score has not been validated as a surrogate marker of morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Maximum Vasoactive Inotropic Score and Low Cardiac Output Syndrome As Markers of Early Postoperative Outcomes After Neonatal Cardiac Surgery

et al. 2012

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Low cardiac output syndrome (LCOS) and maximum vasoactive inotropic score (VIS) have been used as surrogate markers for early postoperative outcomes in pediatric cardiac surgery. The objective of this study was to determine the associations between LCOS and maximum VIS with clinical outcomes in neonatal cardiac surgery. This was a secondary retrospective analysis of a prospective randomized trial, and the setting was a pediatric cardiac intensive care unit in a tertiary care children's hospital. Neonates (n = 76) undergoing corrective or palliative cardiac operations requiring cardiopulmonary bypass were prospectively enrolled. LCOS was defined by a standardized clinical criteria. VIS values were calculated by a standard formula during the first 36 postoperative hours, and the maximum score was recorded. Postoperative outcomes included hospital mortality, duration of mechanical ventilation, intensive care unit (ICU) and hospital lengths of stay (LOS), as well as total hospital charges. At surgery, the median age was 7 days and weight was 3.2 kg. LCOS occurred in 32 of 76 (42%) subjects. Median maximum VIS was 15 (range 5–33). LCOS was not associated with duration of mechanical ventilation, ICU LOS, hospital LOS, and hospital charges. Greater VIS was moderately associated with a longer duration of mechanical ventilation (p = 0.001, r = 0.36), longer ICU LOS (p = 0.02, r = 0.27), and greater total hospital costs (p = 0.05, r = 0.22) but not hospital LOS (p = 0.52). LCOS was not associated with early postoperative outcomes. Maximum VIS has only modest correlation with duration of mechanical ventilation, ICU LOS, and total hospital charges.

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“…Significant changes in cardiorespiratory variables may occur during DSC . Cerebral and somatic regional oxygen saturations may decrease after DSC . With our technique, we managed pseudo‐sternal closure in stages.…”

Section: Discussionmentioning

confidence: 99%

“…1 Cerebral and somatic regional oxygen saturations may decrease after DSC. 2 With our technique, we managed pseudo-sternal closure in stages. Therefore, when we performed ''true-sternal closure,'' the sternum had already been closed under the Esmarch, and the influence of chest closure was minimized.…”

Section: Discussionmentioning

confidence: 99%

Staged Delayed Sternal Closure Using a Binder Clip After Pediatric Cardiac Surgery

Fuchigami¹,

Nishioka²,

Akashige³

et al. 2016

J Card Surg

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After pediatric cardiac surgery, patients who undergo delayed sternal closure may become hemodynamically unstable. We performed a staged sternal closure technique using a binder clip in 31 consecutive patients to minimize cardiopulmonary instability. Only one patient (3.2%) died of mediastinitis. Thus, our technique may be safe and minimize cardiopulmonary instability. doi: 10.1111/jocs.12767 (J Card Surg 2016;31:464-466).

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Cerebral and somatic oxygen saturation decrease after delayed sternal closure in children after cardiac surgery

Cited by 21 publications

References 14 publications

Delayed Sternal Closure After Pediatric Cardiac Operations; Single Center Experience: a Retrospective Study

Delayed Sternal Closure After Pediatric Cardiac Operations; Single Center Experience: a Retrospective Study

Comparison of Maximum Vasoactive Inotropic Score and Low Cardiac Output Syndrome As Markers of Early Postoperative Outcomes After Neonatal Cardiac Surgery

Staged Delayed Sternal Closure Using a Binder Clip After Pediatric Cardiac Surgery

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