Hemodynamic effects of chest closure in adult patients undergoing cardiac surgery

Adsumelli, Rishimani; Shapiro, Janine R.; Shah, Pranav R.; Martella, A.; Afifi, A; Risher, William B.; Hicks, George L.

doi:10.1053/jcan.2001.26537

Cited by 7 publications

(1 citation statement)

References 10 publications

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“…Cardiopulmonary bypass induces a complex sequence of events that have the potential to produce tissue edema and dysfunction including myocardial and pulmonary edema [4]. in some cases that require prolonged CPB, sternal closure causes severe hypotension and may lead to hemodynamic changes including a reduction in cardiac index and stroke volume index [13]. These changes may require inotrope agents adjustment, fluid administration, or reopening of the chest and reassessment.…”

Section: Discussionmentioning

confidence: 99%

Early and Mid-Term Outcomes of Delayed Sternum Closure Strategy in Adult Cardiac Surgery: A Single-Center Experience

Alagha

Çiçekçioğlu

Ekim

et al. 2023

HSF

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Background: Delayed sternum closure is a crucial strategy in the management of hemodynamic instability after weaning from cardiopulmonary bypass. This study aimed to evaluate our outcomes with this technique in light of the literature. Methods: We retrospectively reviewed the data of all the patients who developed postcardiotomy hemodynamic compromise and intraaotic balloon pump was inserted between November 2014 to January 2022. Patients were divided into two groups: primary sternal closure group, and delayed sternum closure group. Patients' demographic data, hemodynamic parameters, and postoperative morbidities were recorded. Results: Delayed sternum closure was performed in 16 patients with an incidence of 3.6%. The most common indication was hemodynamic instability in 14 patients (82%), followed by arrhythmia in 2 patients (12%) and diffuse bleeding in 1 patient (6%). The mean time to sternum closure was 21 (±7) hours. Three patients died (19%), p > 0.999. The median follow-up period was 25 months. Survival analysis revealed that the survival rate was 92%, p = 0.921. Deep sternal infection was observed in one patient with (6%), p > 0.999. multivariate logistic regression analysis revealed that end-diastolic diameter [odds ratio (OR) 4.5, 95% CI (1.19–17), p = 0.027], right ventricle diameter [OR 3.9, 95% CI (1.3–10.7), p = 0.012] and aortic clamp time [OR 1.16, 95% CI (1.02–1.12), p = 0.008] were independent risk factors for delayed sternum closure. Conclusions: Elective delayed sternal closure is a safe and effective method for treating postcardiotomy hemodynamic instability. It can be performed with a low incidence of mortality and sternal infections.

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Section: Discussionmentioning

confidence: 99%