A policy of elective delayed sternal closure does not improve the outcome after arterial switch

Delayed sternal closure is regularly used in the immediate management of hemodynamic instability after neonatal cardiac procedures. The aim of this study was to assess whether the routine, elective use of delayed sternal closure would reduce morbidity in neonates undergoing arterial switch for transposition of the great arteries.

A retrospective statistical analysis was performed on 52 neonates operated on from 1991 to 1998. Until 1994, chest closure was routinely attempted in all patients after arterial switch; the policy was then changed to delayed sternal closure in all cases in the latter half of the study period.

Delayed sternal closure did not significantly alter the mean duration of ventilation (2.7 +/- 2.37 versus 2.7 +/- 1.3 days) nor intensive care stay (4.1 +/- 2.8 versus 5.7 +/- 10.0 days; p = 0.46). There was no increase in the incidence of wound sepsis (7.7% versus 3.8%; p = 0.55), and mortality was unchanged (7.7% in both groups). There was an increase in the incidence of urgent reexploration (7.7% versus 19.2%; p = 0.22), which did not reach significance.

This study does not support the hypothesis that elective delayed sternal closure reduces the morbidity after arterial switch in neonates but does, however, confirm the safety and efficacy of the procedure.