Related Experiment Video

Updated: Jun 16, 2026

Donor Posterior Atrial Flap Rotation for Left Atrial Cuff Reconstruction in Lung Transplantation
07:28

Donor Posterior Atrial Flap Rotation for Left Atrial Cuff Reconstruction in Lung Transplantation

Published on: October 11, 2024

Center variation and outcomes associated with delayed sternal closure after stage 1 palliation for hypoplastic left

Jason N Johnson1, James Jaggers, Shuang Li

  • 1Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, NC 27715, USA.

The Journal of Thoracic and Cardiovascular Surgery
|February 20, 2010
PubMed

Insights

Delayed sternal closure after stage 1 palliation for hypoplastic left heart syndrome varies widely. More frequent use is linked to longer hospital stays and increased infection rates in infants.

Area of Science:

  • Pediatric Cardiac Surgery
  • Congenital Heart Disease Management
  • Surgical Outcomes Research

Background:

  • Debate exists regarding optimal sternal closure strategy after stage 1 palliation for hypoplastic left heart syndrome (HLHS).
  • Center variation in the use of delayed sternal closure (DSC) after stage 1 palliation is significant.

Purpose of the Study:

  • To examine center variation in DSC use following stage 1 palliation for HLHS.
  • To assess the association between DSC use and key postoperative outcomes, including mortality, prolonged length of stay, and infection.

Main Methods:

  • Analysis of data from the Society of Thoracic Surgeons Congenital Database (2000-2007) for patients undergoing stage 1 palliation for HLHS.
  • Comparison of outcomes (in-hospital mortality, prolonged length of stay, postoperative infection) across centers categorized by low, middle, and high DSC utilization rates.
  • Multivariable analysis adjusting for patient and center-specific factors.

Main Results:

  • A total of 1283 patients from 45 centers were included; 74% of cases utilized DSC overall, with center variation ranging from 3% to 100%.
  • Centers with high and middle DSC use showed significantly higher rates of prolonged length of stay and postoperative infection compared to low DSC use centers.
  • Multivariable analysis revealed no significant difference in in-hospital mortality, but confirmed associations between higher DSC use and increased length of stay and infection.

Conclusions:

  • The application of DSC after stage 1 palliation for HLHS exhibits considerable variability among institutions.
  • Increased utilization of DSC appears correlated with adverse outcomes, specifically longer hospitalizations and higher infection rates.
  • Further research is warranted to elucidate the precise risks and benefits of DSC in this complex pediatric population.
Abstract

More Related Videos

Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure07:41

Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure

Published on: February 8, 2022

Related Concept Videos

Mitral Stenosis I: Introduction01:22

Mitral Stenosis I: Introduction

Mitral Valve Stenosis (MVS) is a heart condition where the mitral valve narrows, impeding blood circulation from the left atrium to the left ventricle. The etiology and pathophysiology of this condition are multifaceted, leading to a cascade of cardiovascular complications.Causes of Mitral Valve StenosisRheumatic Heart Disease: It is the main cause of mitral valve stenosis, particularly in developing nations. This condition arises from rheumatic fever, an inflammatory illness resulting from...
Cardiomyopathy III: Hypertrophic Cardiomyopathy01:29

Cardiomyopathy III: Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy, or HCM, is an autosomal dominant genetic disorder characterized by asymmetric left ventricular hypertrophy without ventricular dilation. It is more common in men and is typically diagnosed in young, athletic adults.EtiologyHCM is primarily genetic and is caused by mutations in genes encoding sarcomeric proteins. Researchers have identified over 1400 mutations across at least 11 different genes. Among these, the most frequently occurring mutations are found in the...
Mitral Stenosis III: Medical Management01:26

Mitral Stenosis III: Medical Management

Mitral stenosis, a condition marked by the narrowing of the mitral valve, necessitates an integrated approach for effective management. This approach includes preventative measures, medical therapy, and surgical interventions to reduce symptoms and prevent complications.PreventionPrevention of mitral stenosis primarily focuses on reducing the incidence of bacterial infections, particularly streptococcal infections, which can lead to rheumatic fever and subsequent valvular damage. Timely...
Cardiomyopathy VII: Pre and Post Operative Nursing Management01:28

Cardiomyopathy VII: Pre and Post Operative Nursing Management

Patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction who remain symptomatic despite optimal medical therapy may undergo a septal myectomy (Morrow procedure). This procedure involves excising a portion of the hypertrophied septum below the aortic valve using a heart-lung machine to improve blood flow through the LVOT. Effective preoperative and postoperative nursing management ensures successful patient outcomes, minimizes complications, and...