In-hospital outcomes of delayed sternal closure after open cardiac surgery
Khosrow Hashemzadeh1, Shahryar Hashemzadeh
1Department of Cardiovascular Surgery, Tabriz University of Medical Sciences, Tabriz, Iran. khhashemzadeh41@yahoo.com
Insights
Open chest surgery with delayed sternal closure (DSC) is a viable treatment for severe cardiac complications, offering a low rate of sternal issues. However, patients with acute renal failure or requiring an intra-aortic balloon pump (IABP) face high mortality risks.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Critical Care Medicine
Background:
- Open sternotomy is a critical procedure in cardiac surgery.
- Evaluating outcomes of open sternotomy is essential for patient care improvement.
Purpose of the Study:
- To assess the incidence, survival rates, morbidity, and mortality predictors associated with open sternotomy.
- To evaluate the efficacy and safety of delayed sternal closure (DSC) in cardiac surgery patients.
Main Methods:
- A prospective study involving 2485 cardiac operations from June 2006 to January 2008.
- Prolonged open chest was utilized in 126 patients (5.0%) for indications including hemodynamic instability, bleeding, and arrhythmias.
- Delayed sternal closure (DSC) was performed in 81 patients, with a mean closure time of 2.35 days.
Main Results:
- Of 81 patients undergoing DSC, 65 (81.4%) survived.
- Mortality before DSC was 35.7% (45 patients), and 16 patients died after DSC.
- Common causes of death included low cardiac output (67.2%) and multiorgan failure (26.2%). Sternal complications were infrequent.
- New onset acute renal failure and intra-aortic balloon pump (IABP) use were significant predictors of in-hospital mortality.
Conclusions:
- Open chest with DSC is beneficial for managing postoperative cardiac dysfunction, bleeding, and arrhythmias.
- The procedure demonstrates a low incidence of sternal wound complications.
- High mortality persists for patients with acute renal failure or requiring IABP support.
Background:
The purpose of this prospective study was to evaluate the current incidence, survival, morbidity, and predictors of mortality for open sternotomy at our center.
Methods:
Prolonged open chest was used in 126 of 2485 cardiac operations (5.0%) between June 2006 and January 2008. The indications were hemodynamic instability (98), bleeding (14), arrhythmia (five), cardiac edema (three), tamponade (three), and cardiac arrest (three). Delayed sternal closure (DSC) was performed in 81 of 126 patients at a mean of 2.35+/-1.73 days (range: 0.5 to 10 days).
Results:
Sixty-five of the 81 who had DSC (81.4%) survived. Forty-five patients (35.7%) died before DSC and 16 after this method. The 65 survivors (51.6%) were discharged from the hospital at a mean of 15.6+/-8.4 days (range: 7 to 50 days). The most common causes of death included low cardiac output (67.2%) and multiorgan failure (26.2%). Superficial sternal wound infection occurred in one of 81 (1.2%) patients after DSC, mediastinitis in four (4.9%), and sternal dehiscence in two (2.4%) patients. New onset of acute renal failure and the presence of intraaortic balloon pump (IABP) were predictive of in-hospital death.
Conclusions:
This study shows that open chest with DSC is useful in the treatment of postoperatively impaired cardiac function, intractable bleeding, and persistent arrhythmias. It can be carried out with a relatively low incidence of sternal complications. Patients with new onset acute renal failure and who require IABP continue to have a high mortality rate.
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