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Delayed sternal closure following cardiac operations
Insights
Delayed sternal closure (DSC) in complex open-heart surgery patients prevented complications and improved survival. This technique offers benefits in critical situations, with a low infection risk.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
Background:
- Delayed sternal closure (DSC) is a strategy employed in specific complex open-heart procedures.
- Indications include cardiac dilatation, bleeding, arrhythmias, need for mediastinal assist devices, or pulmonary edema.
Purpose of the Study:
- To evaluate the safety and efficacy of delayed sternal closure in patients undergoing open-heart surgery.
- To assess the impact of DSC on patient outcomes, including survival and complications.
Main Methods:
- Retrospective analysis of 13 patients undergoing open-heart surgery (coronary artery bypass, valve replacement, aneurysmectomy) where primary sternal closure was inadvisable.
- Skin closure was performed initially, with delayed sternal closure 36-120 hours later in 10 patients after stabilization.
Main Results:
- Nine out of 10 patients who underwent delayed sternal closure were long-term survivors.
- No patients developed mediastinitis, wound infection, osteomyelitis, or sternal instability.
- Advantages included prevention of hemodynamic deterioration, facilitated access for tamponade or arrhythmias, and easier device insertion.
Conclusions:
- Judicious use of delayed sternal closure in selected high-risk patients is safe and effective.
- DSC can prevent adverse hemodynamic events, allow rapid cardiac access, and aid in managing critical postoperative conditions.
- This approach offers significant benefits in complex cardiac surgical cases with a low risk of infection when performed carefully.
Abstract:
In 13 patients, sternal closure was delayed at the end of open heart procedures. Seven patients underwent coronary artery bypass surgery (CAB), 5 valve replacements, and one left ventricular aneurysmectomy and closure of post myocardial infarction VSD. In all, primary closure of the sternum was considered impossible or inadvisable. The major indications for delaying sternal closure were: cardiac dilatation with tamponade-like behaviour upon attempted sternal closure (8 patients); intractable bleeding (2); intractable arrhythmia (1); insertion of mediastinal assist devices (3) and intraoperative non-cardiogenic pulmonary edema (1). In all, only the skin was closed. Delayed sternal closure (DSC) was performed 36-120 hours later on 10 of the patients, when their condition had stabilized. Nine patients are long term survivors. None of these patients has developed mediastinitis, wound infection, osteomyelitis or instability of the sternum. The judicious use of DSC in selected situations has several advantages: hemodynamic deterioration from pressure upon the heart may be prevented; a quick access to the heart in case of tamponade or intractable arrhythmia is obtained; insertion of mediastinal assist devices is facilitated. With careful technique the risk of infection is low.