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Delayed Sternal Closure in Congenital Heart Surgery: A Risk-Benefit Analysis
Ahmed Abdelrahman Elassal1, Osama Saber Eldib, Ahmed Mohamed Dohain
1Department of Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia. samalassal1434@gmail.com.
Insights
Delayed sternal closure is a safe technique for pediatric cardiac surgery patients. It effectively prevents cardiac compression, especially in cases of bleeding or hemodynamic instability, improving patient outcomes.
Area of Science:
- Pediatric Cardiac Surgery
- Thoracic Surgery
- Critical Care Medicine
Background:
- Delayed sternal closure is a common practice following pediatric cardiac surgery.
- This technique aims to alleviate cardiac compression and stabilize critically ill patients post-operation.
Purpose of the Study:
- To evaluate the safety and efficacy of delayed sternal closure in pediatric cardiac surgery.
- To identify indications, outcomes, and risk factors associated with delayed sternal closure.
Main Methods:
- Retrospective review of 72 patients undergoing delayed sternal closure out of 1,254 cardiac surgery patients.
- Analysis of indications, perioperative status, infection rates, and mortality.
Main Results:
- Transposition of great arteries was the most common diagnosis.
- Bleeding and hemodynamic instability were primary indications for delayed sternal closure.
- Sepsis occurred in 54.1% of patients, with ICU stay being a significant risk factor. Mortality rate was 15.2%.
Conclusions:
- Delayed sternal closure is a simple and effective method for pediatric cardiac surgery.
- It successfully prevents postoperative cardiac compression in patients with hemodynamic instability.
Background:
Delayed sternal closure commonly is used after pediatric cardiac surgery. Its benefits include relieving cardiac compression and stabilizing postoperative critically ill patients.
Methods:
We retrospectively reviewed the records of 72 patients, who had undergone delayed sternal closure, among 1,254 patients operated for congenital heart diseases. Indications of delayed sternal closure, perioperative hemodynamic and metabolic status, postoperative infection, and mortality were reported.
Results:
Transposition of great arteries was the most common preoperative cardiac pathology (26.3%). Bleeding and hemodynamic instability were the most frequent indications for delayed sternal closure, representing 38.8% and 34.7%, respectively. The mean duration of open chest was 3.45 days ± 1.46 days. The mean duration of ICU stay was 20.95 days ± 20.06 days. Two patients had deep sternal wound infection. Sepsis was found in 39 patients (54.1%), and the most common causative organism was coagulase negative (30.5%). ICU stay was a significant risk factor for sepsis (P = .003); duration of open sternum, period of mechanical ventilation (MV), and total hospital stay were not statistically significant risk factors. Sternal closure time (SCT) was affected by period of hemodynamic instability (P = .036). Bypass time, clamping time, and nonsurgical bleeding did not significantly affect SCT. The mortality rate was 15.2% (N = 11).
Conclusion:
Delayed sternal closure is a simple and effective technique that could prevent postoperative cardiac compression in hemodynamic instability states after pediatric cardiac operations.
