Clinical Outcomes in Delayed Sternal Closure in Lung Transplantation

Lung transplantation (LTx) is a critical treatment for end-stage pulmonary diseases. Delayed sternal closure (DSC) has been noted in cardiac surgery for several decades and is a viable strategy for patients who are hemodynamically unstable, at high risk for postoperative bleeding, and/or require prolonged cardiopulmonary bypass. However, DSC use and its effects on LTx clinical outcomes are not well-defined.

A retrospective analysis was performed on patients who had undergone LTx between January 1, 2010, and October 1, 2018, at the University of Washington. Patients under the age of 18, undergoing repeat LTx, other solid organ transplantation, and/or had prior major cardiothoracic surgery were excluded. Patients were classified into 2 categories: DSC and primary sternal closure (PSC) groups. We examined hospital length of stay (LOS), intensive care unit (ICU) LOS, duration on the ventilator, and overall survival.

A total of 370 patients were identified, with 350 patients in the PSC group and 20 patients in the DSC group. The median hospital LOS, ICU LOS and duration on the ventilator in the DSC group were 23.0 ± 3.8, 16.0 ± 3.6, and 9.0 ± 3.5 compared with 15.0 ± 0.8, 5.0 ± 0.5, and 1.0 ± 0.3 in the PSC group, respectively (All P < .01). Kaplan-Meier analysis revealed that, at 1, 3, and 5 years, the DSC group had a survival of 75.0%, 60.0%, and 55.0%, and the PSC group had a survival of 91.4%, 82.6% and 75.1% respectively (P = .019).

DSC is not uncommon in LTx and patients who do require DSC had a longer duration on the ventilator, ICU LOS, and hospital LOS. Additionally, the DSC group had a worse survival compared with the PSC group. DSC is unlikely to be the sole factor influencing worse survival, but may be a marker of underlying patient factors that negatively affect survival.