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Elective delayed sternal closure portends better outcomes in congenital heart surgery: a retrospective observational
Simran Kundan1, Kamlesh Tailor2, Hari Bipin Radhakrishnan1
1Pediatric and Congenital Heart Surgery, Kokilaben Dhirubai Ambani Hospital, Mumbai, India.
Insights
Planned delayed sternal closure in pediatric cardiac surgery offers better outcomes than emergent reopening in the intensive care unit (ICU). Elective sternal closure reduces mortality compared to late interventions for hemodynamic instability.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiac Surgery
- Critical Care Medicine
Background:
- Delayed sternal closure is a common strategy in pediatric cardiac surgery for patients with hemodynamic instability or bleeding.
- The study investigates whether planned delayed closure is superior to emergent reopening in the ICU.
Purpose of the Study:
- To compare outcomes of planned delayed sternal closure versus emergent sternal reopening in the ICU for pediatric cardiac surgery patients.
- To evaluate the impact of sternal closure timing on patient mortality.
Main Methods:
- Retrospective analysis of 220/2111 (10.42%) pediatric cardiac surgery patients undergoing delayed sternal closure.
- Comparison of mortality rates between patients with elective delayed closure and those requiring emergent ICU reopening.
Main Results:
- Overall mortality for delayed sternal closure was 15% (33/220).
- Mortality was significantly higher (71.42%) for patients whose sternums were opened in the ICU (10/14) compared to those closed electively in the operating theatre (11.16%, 23/206).
Conclusions:
- Elective delayed sternal closure is associated with better outcomes in pediatric cardiac surgery patients with postoperative hemodynamic instability.
- Avoiding emergent sternal reopening in the ICU as a last resort procedure is recommended to improve survival rates.
Introduction:
Delayed sternal closure is used in paediatric cardiac surgery as a management strategy for patients with unstable hemodynamics or postoperative bleeding routinely. We hypothesise that planned postponement of sternal closure leads to better outcomes than emergent reopening in the intensive care unit (ICU) in patients exhibiting some hemodynamic indication for the same.
Methods:
We retrospectively analysed the outcomes of delayed sternal closure 220/2111 (10.42%) out of which 14 sternums were opened in the ICU after shifting the patients.
Results:
A total of 220/2111 (10.42%) sternums were left open postoperatively, out of which 14 were opened after shifting to the ICU. Total mortality of the delayed sternal closure was 33/220, i.e. 15%. The patients whose sternums were left open from the theatre had a mortality of 23/206, i.e. 11.16%, whereas those patients whose sternums were opened in the ICU had a mortality of 10/14, i.e. 71.42%.
Conclusion:
In doubtful postoperatively hemodynamic, the choice of leaving the sternum open electively has better outcomes, rather than opening the sternum as a terminal bail out procedure.
