Primary sternal closure and mediastinal decompression by inlay autologous rib grafts

Geiger, James P.; Tabak, Carol; Aronstam, Elmore M.

doi:10.1016/0003-4975(95)00773-3

Cited by 10 publications

(4 citation statements)

References 7 publications

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“…In our series DSC performed 1.0±2.6 days when the patients became hemodynamically stable and bleeding was controlled. Geigerand associates were unable to close the sternum in most of their cases before the 4th postoperative day, when cardiac indices approached preoperative values, and when only modest amounts of inotropic agents were required [15] . Anderson and coworkers performed flap closure when persistent mediastinal edema prevents sternal closure in patients who are otherwise stable.…”

Section: Discussionmentioning

confidence: 99%

Between Hope and Risks; Insight on Delayed Sternal Closure Technique Outcomes in Adult Patients underwent Cardiac Operations

2018

Zagazig University Medical Journal

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Background: the delay of sternal closure after cardiac operations may offer the chance for survival in critical conditions; mainly sever hemodynamic instability and uncontrollable bleeding. Many concerns about hope of survival and possible risks especially mediastinitis or wound infection still represent dilemma for surgeons in such situations. The aim of our study is to evaluate the outcomes of delayed sternal closure technique after cardiac operations.Methods:this prospective study included 28 adult patients. Differentpreoperative, operative patient's data were collected and postoperative outcomes were recorded.Results: survival rate was 61% of patients; average time till sternal closure was 1.0±2.6 days. Main causes of death were multi-organ failure (n=4), low cardiac output (n=4), sepsis (n=3).Superficial sternotomy wound infection occurred in 3patients (10.7%) while only one patient developed deep sternotomy wound infection.Conclusions : delayed sternal closure is a beneficial technique that may carry the hope of survival for highly critical patients , risk of mediastinitis or wound infection were low and should not make the surgeon hesitate to offer the patient this valuable chance for survival when needed.

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Section: Discussionmentioning

confidence: 99%

Between Hope and Risks; Insight on Delayed Sternal Closure Technique Outcomes in Adult Patients underwent Cardiac Operations

2018

Zagazig University Medical Journal

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“…We found most of these techniques not only inferior to weaving, but some of them also dangerous because of the possibility of the device dislodging and entering vital organs such as heart, lung, aorta [39]. There are also reports of limited individual experiences where metal plates, bone, auto- [40] and homografts [41] were used to stabilize the disrupted sternum. After sternal repair, the old broken sternal wires should be removed if feasible because they might migrate into vital structures.…”

Section: Pectoralis Muscle Advancementmentioning

confidence: 99%

Sternal Instability After Midline Sternotomy

Robicsek¹,

Fokin²,

Cook³

et al. 2000

Thorac cardiovasc Surg

152

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“…The timing of sternal closure is a critical choice that should be made with caution, as early closure might result in failure and recurrent cardiac dysfunction due to ongoing myocardial edema. While prolonged time to closure may expose the patient to increased risk of mortality [7,11] and sternal infections [9], some previous studies reported that they were unable to close the sternum before the 3rd postoperative day [7,11,21], and patients who were successfully closed were patients who required a low amount of inotropic support and in negative fluid balance [2,7]. In our study, the sternum was closed on a subsequent postoperative day in all of the patients except for one patient (mean time to closure was 21 hours ±7).…”

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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Primary sternal closure and mediastinal decompression by inlay autologous rib grafts

Cited by 10 publications

References 7 publications

Between Hope and Risks; Insight on Delayed Sternal Closure Technique Outcomes in Adult Patients underwent Cardiac Operations

Between Hope and Risks; Insight on Delayed Sternal Closure Technique Outcomes in Adult Patients underwent Cardiac Operations

Sternal Instability After Midline Sternotomy

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

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