Delayed sternal closure: an effective procedure for life-saving in open-heart surgery

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Critical Care Medicine

Background:

• Delayed sternal closure is a strategy employed in specific open-heart surgery cases.
• Indications include myocardial edema, non-surgical bleeding, and malignant arrhythmias.
• This retrospective study evaluates the outcomes of this approach.

Purpose of the Study:

• To determine the incidence of delayed sternal closure.
• To assess short-term survival and safety following this procedure.
• To identify postoperative complications associated with delayed sternal closure.

Main Methods:

• Retrospective review of medical records for patients undergoing open-heart surgery.
• Identification of patients with delayed sternal closure (sternum left open initially or re-opened).
• Analysis of morbidity, mortality, and postoperative complications using statistical tests (Chi-square, Mann Whitney U, ANOVA).

Main Results:

• Delayed sternal closure was performed in 1.7% (46/2698) of on-pump cardiac surgery patients.
• Primary reasons included bleeding (21), hemodynamic instability (16), arrest (5), and arrhythmia (4).
• Thirty-day mortality was 23.9%, with complications including mediastinitis, wound infection, and renal failure.

Conclusions:

• Delayed sternal closure is a safe and simple method for managing specific complications after on-pump cardiac surgery.
• The technique is effective for treating bleeding, arrhythmia, and myocardial edema.
• Increased familiarity with delayed sternal closure may lead to its wider application.