Predictors of Reopening the Sternum in Children After Cardiac Surgery
Ghassan A Shaath1, Abdulraouf M Z Jijeh1, Sameh R Ismail1
1Division of Pediatric Cardiac Intensive Care Unit, Department of Cardiac Sciences, King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Kingdom of Saudi Arabia.
Insights
Predictors for reopening the sternum in children after heart surgery include a temperature gap, high inotropic score, and acute kidney injury. These indicators may help identify children needing emergent sternum reopening to maintain hemodynamics.
Area of Science:
- Pediatric Cardiac Surgery
- Critical Care Medicine
- Cardiovascular Research
Background:
- Capillary leak syndrome post-open-heart surgery in children can lead to mediastinal tamponade, complicating sternum closure.
- Emergent reopening of the sternum may be necessary to preserve hemodynamic and respiratory function in pediatric cardiac intensive care unit patients.
Purpose of the Study:
- To identify predictors of emergent sternum reopening in children following open-heart surgery.
- To analyze factors associated with the need for sternum reopening to manage mediastinal tamponade and low cardiac output.
Main Methods:
- A retrospective cohort study compared pediatric patients requiring emergent sternum reopening (index cases) with matched controls.
- Data on cardiac output predictors, morbidities, and mortality were collected at specific time points before reopening.
- Thirty-three index cases were compared to 63 control cases from a single cardiac center (2009-2015).
Main Results:
- Children needing sternum reopening showed a temperature gap >3°C, inotropic score >14, and acute kidney injury 6 hours prior.
- Ventilation hours were longer in the index group, while hospital stay and infections were similar.
- Mortality was higher in the sternum reopening group, particularly when extracorporeal membrane oxygenation was required.
Conclusions:
- Low cardiac output indicators such as temperature gap, elevated inotropic score, and acute kidney injury can predict the need for sternum reopening in pediatric cardiac surgery patients.
- Extracorporeal membrane oxygenation use in conjunction with sternum reopening is associated with increased mortality risk.
Objectives:
Capillary leak syndrome can be severe in children after open-heart surgery which may hinder sternum closure and described as mediastinal tamponade. Reopening the sternum postoperatively may help maintaining hemodynamics and respiratory function. We looked for predictors that indicate the need for reopening the sternum.
Design:
A retrospective cohort study.
Setting:
A single cardiac center experience from 2009 to end of 2015.
Patients:
All children who required emergent reopening the sternum in the pediatric cardiac ICU after cardiac surgery were grouped as index cases and matched to a control group for age, body weight, cardiac diagnosis, and type of repair (single vs biventricular).
Interventions:
Emergent reopening the sternum.
Measurements And Main Results:
With a ratio of two control cases for each index case, variables related to cardiac output (predictors) were collected in a time line of 12, 6 hours, and just before reopening the sternum. Morbidities and mortality were also reviewed. Thirty-three index cases were compared with 63 control cases. Hospital stay and hospital-acquired infections were the same between the groups. Ventilation hours were longer in the index cases. Temperature gap more than 3°C, inotropic score more than 14, and acute kidney injury indicated by doubled blood urea nitrogen and creatinine were higher in the index group 6 hours before reopening the sternum. Mortality was more in the reopening sternum group with higher risk when extracorporeal membrane oxygenation was needed.
Conclusions:
Low cardiac output after cardiac surgery in children in form of temperature gap more than 3°C, inotropic score more than 14, and acute kidney injury may predict the need of reopening the sternum. Rate of mortality was higher in the reopening sternum group when extracorporeal membrane oxygenation was needed.
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