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

Abstract

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.

Outcomes of Delayed Sternal Closure in Paediatric Cardiac Surgical Patients–A Prospective Single Centre Study

“…Samir et al 14 in their study of 312 neonates found that preoperative inotropic support was not related with mortality as was seen in this study. Sierra et al 34 found that risk adjustment for congenital heart surgery (RACHS-1) score > 3 predicts mortality which corroborated well with our study (p < 0.001). Longer ACC time translates into a complex cardiac surgery, which has been found to be associated with mortality.…”

“…Longer ACC time translates into a complex cardiac surgery, which has been found to be associated with mortality. 17,20,34,35 Similar finding was observed in our study (p < 0.001), however, duration of CPB was not found to be related to mortality (p = 0.94). In addition, the postoperative factors such as requirement of re-explorations (p < 0.001), duration of DSC (p < 0.001), duration of postoperative MV (p < 0.001), and development of culture-proven sepsis (p = 0.002) and mediastinitis (p = 0.03) contributed significantly to mortality, as has been corroborated by other studies.…”

“…In addition, the postoperative factors such as requirement of re-explorations (p < 0.001), duration of DSC (p < 0.001), duration of postoperative MV (p < 0.001), and development of culture-proven sepsis (p = 0.002) and mediastinitis (p = 0.03) contributed significantly to mortality, as has been corroborated by other studies. 8,14,17,34 However, on multivariate analysis, the factors independently contributing to mortality were found to be the need for preoperative MV and development of postoperative sepsis.…”

Elective delayed sternal closure portends better outcomes in congenital heart surgery: a retrospective observational study

“…On the outward, it may seem that leaving the sternum open, compared to primary sternal closure, suggests a high risk for mortality [12,13] (even in our study PSC, i.e. group A vs open sternum, i.e.…”

Delayed Sternal Closure after Congenital Heart Surgery in Infants: Postoperative Course

“…лих внутрішньоаортальна балонна контрапульсація неприйнятна для немовлят. Таким чином, відстрочене зведення грудини є однією з небагатьох методик, що дає змогу збільшити серцевий викид і є доступною для рутинного застосування в дітей перших місяців життя [4].…”