Open-chest management after heart transplantation

Postcardiotomy open-chest management has been widely used in cardiac surgery. Although this strategy can be applied to heart transplantation, the use of immunosuppressants in transplant recipients raises particular concerns about sternal wound infection and impaired healing. We performed a retrospective review of 403 patients who had undergone 410 heart transplantations at our institution from 1985 through 2004. Among them, 9 patients (2.2%) had open-chest management postoperatively. There were 8 men and 1 woman, with a mean age of 58 +/- 7 years. The graft ischemic time ranged from 130 to 374 minutes (mean, 218 +/- 99 min), and the cardiopulmonary bypass time ranged from 98 to 360 minutes (mean, 210 +/- 69 min). In all cases, the reason for open-chest management was hemodynamic lability that precluded chest closure after transplantation. One patient also experienced postoperative bleeding. All patients underwent delayed sternal closure between postoperative days 1 and 11 (median, 4 days). Delayed sternal closure did not cause any significant hemodynamic changes. One patient died of stroke on postoperative day 22. No patient had sternal wound infection or impaired wound healing during the follow-up period. We conclude that, when required, open-chest management is an effective and safe measure for hemodynamically unstable heart transplant patients.