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[Delayed sternal closure after cardiac surgery].

Y Misawa1, T Hasegawa, K Fukushima

  • 1Department of Thoracic and Cardiovascular Surgery, Jichi Medical School, Tochigi, Japan.

[Zasshi] [Journal]. Nihon Kyobu Geka Gakkai
|July 1, 1992
PubMed
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Delayed sternal closure after cardiac surgery is recommended when pressures rise significantly. This approach, used in 3.5% of patients, improves outcomes for those with unstable hemodynamics, preventing mediastinal infections.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery

Context:

  • Sternum approximation after cardiac surgery can cause hemodynamic instability, including hypotension and elevated pressures.
  • Current practices for sternal closure may not adequately address patients with compromised hemodynamics.

Purpose:

  • To propose new criteria for delayed sternal closure based on hemodynamic monitoring.
  • To evaluate the safety and efficacy of delayed sternal closure in a cohort of cardiac surgery patients.

Summary:

  • A novel criterion for delayed sternal closure is introduced: a sustained increase of >2 mmHg in mean left atrial or central venous pressure during tentative closure.
  • This criterion was applied in 3.5% (7/201) of patients, all of whom survived and underwent successful delayed closure.
  • While bypass and fibrillation times were longer in the delayed closure group, ischemic times were comparable, and mediastinal cultures were negative, suggesting low infection risk.

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Impact:

  • Delayed sternal closure is a safe and effective strategy for managing patients with brittle hemodynamics post-cardiac surgery.
  • This approach can prevent serious mediastinal infections through careful post-operative management.
  • The proposed hemodynamic criteria serve as a reliable predictor for the necessity of delayed sternal closure.