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Prolonged open sternotomy and delayed sternal closure after cardiac operations
A P Furnary1, J A Magovern, K A Simpson
1Department of Surgery, Allegheny General Hospital, Pittsburgh, PA 15212.
The Annals of Thoracic Surgery
|August 1, 1992
Summary
Delayed sternal closure (DSC) after open sternotomy (OS) in complex cardiac surgery can be successful, with outcomes influenced by patient factors and timing. Bleeding as an indication for OS increased sternal infection risk post-DSC.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Critical Care Medicine
Background:
- Open sternotomy (OS) is sometimes maintained after complex cardiac operations for severely impaired hearts.
- Predictors for the timing, morbidity, and prognosis of delayed sternal closure (DSC) require thorough investigation.
Purpose of the Study:
- To identify predictors of timing, morbidity, and prognosis for delayed sternal closure (DSC) in adult open-heart surgery patients.
Main Methods:
- Retrospective case review of 107 adult open-heart patients with prolonged OS between 1987 and 1991.
- Analysis of indications for OS, timing of DSC, patient survival, and complications such as sternal infection.
Main Results:
- Delayed sternal closure (DSC) was performed in 75 patients, with a 67% survival rate (50/75) discharged after closure.
- Mortality occurred in 57 patients, both before and after DSC.
- DSC success in patients without ventricular assist devices was higher when performed after achieving a negative daily fluid balance (p < 0.002).
- Sternal infection occurred in 5% of DSC patients and was linked to bleeding as the initial OS indication (p < 0.02).
Conclusions:
- Delayed sternal closure (DSC) can be a viable strategy in select complex cardiac surgery patients.
- Achieving a negative fluid balance prior to DSC may improve outcomes in specific patient groups.
- Careful patient selection and monitoring are crucial, especially when bleeding necessitates initial open sternotomy (OS).