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Delayed sternal closure after cardiac surgery.

W J Fanning, J S Vasko, J W Kilman

    The Annals of Thoracic Surgery
    |August 1, 1987
    PubMed
    Summary
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    Delayed sternal closure in cardiac surgery patients with hemorrhage or dilated hearts offers benefits. This approach, performed 2.8 days post-operation, proved acceptable for selected high-risk individuals.

    Area of Science:

    • Cardiovascular Surgery
    • Thoracic Surgery
    • Critical Care Medicine

    Background:

    • Mediastinal hemorrhage and cardiac dilatation pose significant risks during cardiac operations.
    • Delayed sternal closure (DSC) is a strategy to manage these complications.
    • Effective management is crucial for patient outcomes in high-risk cardiac surgery.

    Purpose of the Study:

    • To evaluate the efficacy and safety of delayed sternal closure in cardiac surgery patients.
    • To assess the impact of DSC on hemodynamic stability and mediastinal access.
    • To determine the morbidity and mortality associated with this surgical approach.

    Main Methods:

    • A retrospective analysis of 57 cardiac surgery patients managed with DSC.
    • DSC was employed due to ongoing mediastinal hemorrhage or extreme cardiac dilatation.

    Related Experiment Videos

  • Sternal reapproximation was performed a mean of 2.8 days post-operatively after hemodynamic and hemostatic correction.

    • Main Results:

    • Thirty-eight of 57 patients (66.7%) survived to hospital discharge.
    • DSC facilitated mediastinal access for clot evacuation and relieved cardiac compression.
    • Complications included superficial wound infection (3), sternal osteomyelitis (1), and fatal mediastinal infection (1).

    Conclusions:

    • Delayed sternal closure is a beneficial strategy for selected high-risk cardiac surgery patients.
    • The technique provides necessary access for managing mediastinal hemorrhage and cardiac tamponade.
    • Morbidity and mortality associated with DSC were acceptable in this patient cohort.