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[Delayed sternal closure following open-heart surgery in infants and children]
F Oguma1, H Miyamura, H Kanazawa
1Second Department of Surgery, Niigata University School of Medicine, Japan.
Insights
Delayed sternal closure in pediatric open-heart surgery is rare but can improve outcomes for infants with severe heart failure. This approach offers advantages in managing low cardiac output post-surgery.
Area of Science:
- Pediatric Cardiac Surgery
- Thoracic Surgery
- Critical Care Medicine
Context:
- Postoperative sternal non-approximation after open-heart surgery in infants and children presents significant management challenges.
- Indications for leaving the sternum open include enlarged heart, myocardial edema, severe myocardial contractility depression, and pulmonary edema-related reduced lung compliance.
- This retrospective study analyzes outcomes for patients requiring delayed sternal closure.
Purpose:
- To evaluate the efficacy and outcomes of delayed sternal closure in pediatric patients experiencing sternal non-approximation post-open-heart surgery.
- To identify factors associated with survival and complications in this high-risk patient group.
Summary:
- Four out of nine infants who underwent delayed sternal closure survived long-term.
- Five patients with the sternum intentionally left open died within 16 days from cardiac failure.
- Complications observed during open sternum management included myocardial bleeding (1 patient) and mediastinitis (2 patients), with one mediastinitis case successfully treated.
Impact:
- Judicious use of delayed sternal closure can be advantageous in managing low cardiac output states in infants and children immediately after open-heart surgery.
- This strategy, though rare, offers a potential benefit for critically ill pediatric cardiac surgery patients.
Abstract:
Between January, 1982, and December, 1987, 14 patients failed to approximate sternum after open-heart surgery in infants and children. The indications for keeping sternum open were enlarged heart, myocardial edema, severe depression of myocardial contractility and reduced lung compliance due to pulmonary edema. Of the 14 patients, 9 underwent delayed sternal closure between 2nd and 13th postoperative day, and 4 were long-term survivals. All the rest of five patients who were left their sternum open, died of intractable cardiac failure within 16th postoperative day. During the sternum open, three patients suffered from complications-myocardial bleeding in one, and mediastinitis in two. But none of them directly related to the death, and one patient with mediastinitis successfully healed with closed mediastinal irrigation. Although the employment of the delayed sternal closure is rare and limited to the patient with severe heart failure, its judicious use adds advantages in the management of low cardiac output state in infants and children immediately postoperative period.