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Delayed sternal closure is a life saving decision

Raafat I Y Shalabi1, Morsi Amin, Adel K Ayed

  • 1Department of Cardiothoracic Surgery, Chest Disease Hospital, Kuwait Univerisity.

Annals of Thoracic and Cardiovascular Surgery : Official Journal of the Association of Thoracic and Cardiovascular Surgeons of Asia
|December 11, 2002
PubMed

Insights

Delayed sternal closure in cardiac surgery is a life-saving option for patients with hemodynamic instability or uncontrollable bleeding. This approach, though carrying risks, proved effective in a Kuwaiti hospital study.

Area of Science:

  • Cardiac Surgery
  • Thoracic Surgery
  • Critical Care Medicine

Background:

  • Open heart operations carry inherent risks, including hemodynamic instability and bleeding.
  • Primary sternal closure may be contraindicated in certain high-risk surgical patients.

Purpose of the Study:

  • To evaluate the efficacy and outcomes of delayed sternal closure in cardiac surgery patients.
  • To assess the safety and survival rates associated with this critical intervention.

Main Methods:

  • Retrospective analysis of 1950 open heart operations performed between 1995 and 2000.
  • Identification of patients (40 cases, 2%) requiring delayed sternal closure due to hemodynamic instability or hemorrhage.
  • Analysis of mortality, morbidity (wound infection), and survival rates post-delayed closure.

Main Results:

  • Delayed sternal closure was performed in 40 patients (2%) due to critical conditions.
  • Mortality occurred in 4 patients (immediate) and 2 patients (late) prior to discharge.
  • Wound infections were observed in 8 patients, with 34 survivors (85%) discharged and followed up.

Conclusions:

  • Delayed sternal closure is an effective and life-saving strategy for managing patients with unstable hemodynamics and uncontrollable hemorrhage during open heart surgery.
  • Careful patient selection and management are crucial for optimizing outcomes in delayed sternal closure procedures.
  • This approach can be safely implemented in specialized cardiac surgery centers.

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