Delayed sternal closure: an effective procedure for life-saving in open-heart surgery

Yasa, Haydar; Lafci, Banu; Yilik, Levent; Bademci, Mehmet Şenel; Şahin, Aykut; Kestelli, Mert; Yeşìl, Murat; Gürbüz, Ali

doi:10.5152/akd.2010.043

Cited by 18 publications

(21 citation statements)

References 19 publications

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“…A significant increase in heart size causes ventricular dysfunction and important myocardial perfusion disorders when trying to close the chest. Therefore, DSC has become a helpful technique for achieving earlier recovery and better results in pediatric patients with congenital heart disease [ 2 , 14 , 15 ]. Indications for use of DSC depend on several factors, but age is one of the most important ones.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Delayed Sternal Closure in Pediatric Heart Surgery: Single-Center Experience

Hurtado-Sierra

Calderón‐Colmenero

Curi-Curi

et al. 2018

BioMed Research International

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Background Delayed sternal closure (DSC) after cardiac surgery is a therapeutic option in the treatment of the severely impaired heart in pediatric cardiac surgery. Methods A single-center retrospective review of all bypass surgeries performed over a 10-year period (2003–2012). Results Of a total of 2325 patients registered in our database, the DSC group included 259 cases (11%), and the remaining 2066 cases (89%) constituted the control group (PSC). RACHS-1 risk was higher for the DSC group (74% had a score of 3 or 4) than for the PSC group (82% had a score of 2 or 3). The most frequent diagnosis for the DSC group was transposition of the great arteries (28%). We found out that hemodynamic instability was the main indication observed in patients aged ≤ 8 years (63%), while bleeding was the principal indication for patients aged ≥ 8 years (94%) (p ≤ 0.001). The average time between surgery and sternal closure was 2.3 ± 1.4 days. Overall mortality rates were higher for patients of the DSC group (22%) than for the PSC group (8.7%) (OR: 0.4 (95% CI: 0.4 to 0.5), p < 0.05). There were six patients with DSC who developed mediastinitis (2.3%). The risk of mediastinitis was significantly higher when DSC was performed 4 days after the primary surgery. Conclusions DSC is an important management strategy for congenital cardiac surgery in infants and children. The prolonged sternal closure time is associated with an increased rate of postoperative mediastinitis.

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Section: Discussionmentioning

confidence: 99%

Outcomes of Delayed Sternal Closure in Pediatric Heart Surgery: Single-Center Experience

Hurtado-Sierra

Calderón‐Colmenero

Curi-Curi

et al. 2018

BioMed Research International

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“…Riahi and colleagues were the first to point out the problem of postoperative cardiomediastinal disproportion in 1975 [2]. Surgical manipulation of the heart leading to swelling in the pericardium and/or the pericardiomediastinal space, bleeding at the end of CPB, significant increase in heart size with severe ventricular dysfunction, reperfusion related myocardial edema and relentless arrhythmias are all severe complications of cardiac operations that preclude the sternum to be closed [3-5]. They are often associated with a prolonged perfusion time and poor myocardial preservation [3].…”

Section: Discussionmentioning

confidence: 99%

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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“…Importantly, sternal wound infection rates are low and have remained consistent across recent studies. [11][12][13][14][15] No study has specifically examined the use of DSC in patients after implantation of a left ventricular assist device (VAD). It is unknown whether these patients are at increased risk for late infection due to the presence of graft material and internal implantable components of the VAD system.…”

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confidence: 99%

Delayed sternal closure does not increase late infection risk in patients undergoing left ventricular assist device implantation

Stulak¹,

Romans²,

Cowger³

et al. 2012

The Journal of Heart and Lung Transplantation

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Delayed sternal closure: an effective procedure for life-saving in open-heart surgery

Cited by 18 publications

References 19 publications

Outcomes of Delayed Sternal Closure in Pediatric Heart Surgery: Single-Center Experience

Outcomes of Delayed Sternal Closure in Pediatric Heart Surgery: Single-Center Experience

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

Delayed sternal closure does not increase late infection risk in patients undergoing left ventricular assist device implantation

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