Outcomes of delayed sternal closure after complex aortic surgery

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Surgery

Background:

• Open chest management and delayed sternal closure are sometimes necessary for complex proximal aortic surgery.
• Infectious complications like mediastinitis and graft infections are significant concerns following these procedures.

Purpose of the Study:

• To report the experience and outcomes of open chest management with delayed sternal closure after complex proximal aortic surgery.
• To evaluate the incidence of infectious complications in patients managed with delayed sternal closure.

Main Methods:

• A retrospective review of 12 patients (1.2%) who underwent open chest management and delayed sternal closure between 1991 and 2007.
• Procedures involved total cardiopulmonary bypass with profound hypothermic circulatory arrest.
• Reasons for open chest management included hemodynamic instability, edema, bleeding, and respiratory compromise.

Main Results:

• In-hospital mortality was 16.7% (2/12). Delayed sternal closure was successful in 92% of patients within a mean of 3 days.
• Mean length of stay was 51 days, with 42% requiring mediastinal explorations.
• No patients developed mediastinitis or aortic graft infection during a mean follow-up of 60 months.

Conclusions:

• Open chest management with delayed sternal closure can be performed with acceptable mortality after complex aortic repairs.
• This management strategy does not appear to elevate the risk of infectious complications, such as mediastinitis or graft infections.