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Related Concept Videos

Tracheostomy Decannulation01:21

Tracheostomy Decannulation

374
Tracheostomy decannulation is a significant milestone in the liberation of mechanically ventilated patients. Despite its importance, there is no universally accepted protocol for this procedure. This demands an evidence-based, individualized approach.
Description of the Procedure
Decannulation refers to the permanent removal of the tracheostomy tube, signaling the resolution of the condition that initially necessitated the tracheostomy. The process requires a well-coordinated interplay between...
374

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Surgical Fixation of Sternal Fractures: Preoperative Planning and a Safe Surgical Technique Using Locked Titanium Plates and Depth Limited Drilling
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Norwood Operation: Immediate vs Delayed Sternal Closure.

Ahmed Asfari1, Jeffrey P Jacobs2, Jonathan W Byrnes1

  • 1Division of Cardiology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama.

The Annals of Thoracic Surgery
|July 21, 2022
PubMed
Summary
This summary is machine-generated.

Delayed sternal closure (DSC) is common after the Norwood operation. Early sternal closure before postoperative day 3 shows no disadvantage in mortality or hospital stay compared to immediate closure.

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Area of Science:

  • Neonatal surgery
  • Pediatric cardiac critical care
  • Surgical outcomes

Background:

  • The Norwood operation is a critical neonatal surgery for complex congenital heart defects.
  • Delayed sternal closure (DSC) is a frequent complication following this procedure.
  • Data guiding optimal sternal closure timing post-Norwood operation are limited.

Purpose of the Study:

  • To investigate the association between delayed sternal closure (DSC) and patient outcomes after the Norwood operation.
  • To compare outcomes of immediate sternal closure versus delayed sternal closure (DSC).
  • To analyze the impact of sternal closure timing on mortality, ventilation duration, hospital stay, and complications.

Main Methods:

  • Retrospective analysis of neonates undergoing the Norwood operation from the Pediatric Cardiac Critical Care Consortium registry (February 2019 - April 2021).
  • Comparison of outcomes between patients with immediate sternal closure versus early (pre-postoperative day 3) and intermediate (pre-postoperative day 6) delayed sternal closure (DSC).

Main Results:

  • The incidence of delayed sternal closure (DSC) was 74%, with a median open sternum duration of 4 days.
  • No significant differences in mortality (1.1% vs 0%) or median hospital stay (30 vs 31 days) were observed between immediate and early sternal closure groups.
  • Intermediate sternal closure was associated with longer mechanical ventilation (5.9 vs 3.9 days) but fewer re-sternotomies (3% vs 7.5%) compared to immediate closure.

Conclusions:

  • For key outcomes after the Norwood operation, immediate sternal closure offers no benefit over delayed sternal closure (DSC) if the chest can be closed by postoperative day 3.
  • These findings suggest flexibility in sternal closure timing may be acceptable in select neonatal cardiac surgery patients.